For the last several months we have all been living in the shadow of the COVID-19 virus. For those of us with the Norfolk Towne Assembly it has caused the cancellation of historic dance classes, our annual late 18th – early 19th century Ball, and many living history events that our members would have taken part in. For many of us it has brought our lives to a standstill by closing businesses and venues throughout the United States.
With that in mind, I began to wonder about the epidemics that our ancestors faced here in North America during the 18th and early 19th centuries and so I began to research a piece on epidemics. Any of us who have done even a little early American history research are familiar with smallpox, and to a lesser extent measles, and the effect they had on Native Americans, and on the readiness of armed forces during the French and Indian War and the American Revolution. What really surprised me was that there was another disease, recurring in the colonies and the early United States throughout the 17th through the 19th centuries with great regularity, that wherever it struck shut down the economy and sent people fleeing the area. One that, while recurring regularly from the 1600s onward, denied physicians an understanding of its transmission method until the 1880s. Although there were several more or less effective attempts at a vaccine during the 19th and early 20th century, no safe and effective vaccine was developed until 1938. Ladies and gentlemen, may I present Yellow Fever.
What Is Yellow Fever?
The term Yellow Fever began to be used in the 1740s. Previously, doctors had referred to the disease, and others that were like it, by a variety of names, such as pestilential fever, malignant fever, putrid bilious fever, Barbados fever and the like. The new term would be used along with some of the older names for many years.
Yellow Fever is a hemorrhagic viral disease of typically short duration. In most cases, symptoms include fever, chills, loss of appetite, nausea, muscle pains - particularly in the back, and headaches. Symptoms typically improve within five days. In about 15% of those infected, the fever returns within a day of improving. In this toxic “relapse”, abdominal pain occurs, and liver damage begins causing yellow skin. If this occurs, the risk of bleeding and kidney problems increases. There is no specific treatment for those infected with Yellow Fever other than general “supportive” actions such as fluids, etc. 20% - 50% of those who enter this “toxic” phase die. The disease is not communicable directly, human to human, but transmitted by mosquitoes biting an infected human.
History
Yellow Fever did not originate in Europe. Hippocrates does not mention it nor is there any description of a disease resembling Yellow Fever by any European writer of the Pre-Columbian period. While there is some evidence that there may have been forms of Yellow Fever indigenous to South America before the arrival of the Spanish and Portuguese, the most accepted theory on the evolutionary origins of Yellow Fever holds that it most likely originated in Africa, with transmission of the disease from nonhuman primates to humans. Epidemiologists believe the virus originated in East or Central Africa and spread from there to West Africa. Because it was endemic in Africa, local populations developed some immunity to it. As a result, when an outbreak of Yellow Fever would occur in an African community where European colonists lived, most died, while the indigenous Africans usually developed nonlethal symptoms resembling influenza.
The virus, as well as the vector Aedes aegypti, a mosquito species, were probably brought to the western hemisphere and the Americas by slave trade ships from Africa shortly after the first European exploration in 1492. The first definitively recorded outbreak of Yellow Fever in the Americas happened in Barbados in 1647. An outbreak on the Yucatán Peninsula recorded by the Spanish in 1648 followed. In response to the outbreaks of Yellow Fever in Barbados, Cuba, and the Yucatan, in 1648, a strict quarantine for all ships arriving from the West Indies was established in Boston, Massachusetts, because of “ye plague or like in[fectious] disease.” The first outbreak of Yellow Fever in what would become the United States occurred in New York City in1668, followed by Philadelphia and the French colonies in the Mississippi River Valley in 1669
On June 11, 1693, Yellow Fever broke out in Boston following the arrival of the British Fleet under Sir Francis Wheeler, which had visited Martinique. By the time they arrived, Wheeler had already lost over half his command to the disease. To keep the infection from spreading among the inhabitants, Governor William Phips ordered accommodations for the forces on Long Island and the next day forbade all communication with the fleet without his permission. Not everyone obeyed and the order proved insufficient to keep the disease from the town. On June 25 Timothy Wadsworth’s man died “of the Fever of the Fleet, as is supposed, he having been on board and in the Hold of some ship. Town is much startled at it”. During July, several deaths occurred “with very direful Symptoms, of turning Yellow, vomiting and bleeding every way and so Dying”. Wheeler sailed for England, and in the fall the epidemic disappeared having killed approximately 3100 British sailors and soldiers and an estimated 10 residents of Boston.
Six years later, Yellow Fever broke out in Charleston SC and Philadelphia, PA. This outbreak killed 160 to 180 in Charleston with another 10-11 in the countryside. Among the victims in Charleston were the “chief justice, receiver-general, provost marshal, and almost half of the assembly”. Government and business activity came to a near standstill until November, when the epidemic finally ended and many of the survivors seriously thought of abandoning a country on which they thought the judgments of heaven seemed to fall so heavily.
Meanwhile, in Philadelphia, Yellow Fever was taking its toll, killing 220 (out of 4400 residents). A Quaker, living in Philadelphia at the time wrote in his diary:
"In this distemper had died six, seven, and sometimes eight in a day, for several weeks, there being few houses, if any, free of the sickness. Great was the fear that fell on all flesh! [He] saw no lofty or airy countenances nor heard any vain jesting to move men to laughter….But every face gathered paleness, and many hearts were humbled, and countenances fallen and sunk, as such that waited every moment to be summoned to the bar and numbered to the grave."
18th and Early 19th Century America
In 1728 and 1732, Yellow Fever epidemics again struck Charleston, bringing the city to a standstill on both occasions. The 1732 outbreak began in May and ran into the fall. During its height in July, the city prohibited the usual ringing of funeral bells because there were so many funerals each day. Many of the wealthier residents fled to plantations in the countryside, hoping to escape the disease. The English colonial governor, Nathaniel Johnson, refused to abandon the city and his obstinacy caused him to lose his wife, a son, and three servants. This outbreak killed 130 whites and many black slaves. Epidemics returned to Charleston in 1739, 1745, and 1748.
An outbreak hit New York the same year. The outbreak in New York was on a much smaller scale than that in Charleston. Webster called it a ‘malignant infectious fever’ and estimated that about seventy persons died. Since the city’s population was between 8,500 and 9,000, these seventy deaths are less than one per cent — a minor loss in those days.
In 1747, quick action by the city of Philadelphia avoided what might have been another outbreak. With Philadelphians aware that Yellow Fever had been traced to the West Indies, city officials closely examined a vessel arriving in the city from Barbados. After the captain reported the death of a sailor as well as a second case of Yellow Fever, the ship was quarantined and held at anchor more than a mile from the city and prevented from unloading cargo or passengers. Later, reports arrived in the city saying that Barbados was suffering from a serious outbreak of the disease at the time.
After 31 years of absence, Yellow Fever returned to Philadelphia in 1793, killing thousands of city residents over a span of several months. As the then-capital and largest city of the United States, Philadelphia was home to both state and federal governments, most of whose members (including President George Washington) fled to escape the disease. The total number of estimated cases amounted to 11,000; with a final mortality rate for the city of 10%.
Like many others, Philadelphia physician Dr. Benjamin Rush (1745-1813) studied the symptoms and spread of the disease closely, hoping to uncover some definite cause and means of prevention. Rush kept meticulous notes about his individual patients as well as about conditions in the city for many years. His notes ranged from the observation that “A meteor was seen at two o’clock in the morning, on or about the twelfth of September” to several remarks that, curiously, “Moschetoes” were “uncommonly numerous”.
Rush, however, did not seem to draw any conclusions about the presence of the mosquitoes in relation to Yellow Fever. He favored the “miasma” theory of the disease—literally “pollution”—that was widely accepted in Philadelphia at the time. Miasmatic theory argued that diseases like Yellow Fever were the result of bad air. In 1793, its proponents blamed the Yellow Fever epidemic on the miasma from a shipment of rotting coffee dumped at the docks.
Among the other comments Rush made in 1793 was one about refugees from the French West Indies escaping infection from Yellow Fever as it struck the city. Though Rush did not know it at the time, this was no doubt because the men and women who had come from the West Indies had been exposed to Yellow Fever before and were thus immune to it.
Unfortunately, Rush took a misstep in his assessment of another group as being immune to the disease:
“From the accounts of the Yellow Fever which had been published by many writers, I was led to believe that the negroes in our city would escape it. In consequence of this belief, I published the following extract in the American Daily Advertiser, from Dr. Lining’s history of the Yellow Fever, as it had four times appeared in Charleston, in South Carolina.
There is something very singular (says the doctor) in the constitution of the negroes, which renders them not liable to this fever; for though many of them were as much exposed as the nurses to the infection, yet I never knew of one instance of this fever among them, though they are equally subject with the white people to the bilious fever.”
Shortly after the passage was published, Rush notes, Matthew Clarkson, the mayor of Philadelphia, wrote a response to the printer of the paper:
September 6th, 1793
“Sir,
It is with peculiar satisfaction that I communicate to the public, through your paper, that the African Society, touched with the distresses which arise from the present dangerous disorder, have voluntarily undertaken to furnish nurses to attend the afflicted; and that, by applying to Absalom Jones and William Gray, both members of that society, they may be supplied.
MATTH. CLARKSON, Mayor”.
Tragically, as Rush noted, he was mistaken in his belief that African Americans would be immune to the disease:
"It was not long after these worthy Africans undertook the execution of their humane offer of services to the sick before I was convinced I had been mistaken. They took the disease in common with the white people, and many of them died with it."
Matthew Clarkson eventually fell victim to the disease as well: his gravestone notes that he “died of the fever in 1800”.
When Yellow Fever broke out in New York in 1794, Dr. Valentine Seaman and many other physicians in New York City disputed Rush’s claims that this disease was of foreign origins. Rush had concluded that Yellow Fever spread by contagion, from one person to the next by way of some direct or indirect contact. This was not at all the case, and the New York physicians noted the evidence for this from the way their Quarantine managed those who had this disease. Physicians caring for those with Yellow Fever were free to wander in and around the hospital setting, even encountering other patients, physicians, or family, without spreading this disease.
As mentioned earlier, the common belief as to a cause for Yellow Fever usually related it to local harbors and ports due to their filth and stench. These harbors bore the most disgusting forms of human waste, the rubbish thrown out by local restaurants and slaughterhouses, animal hide waste from tanneries and leather manufacturers, and the old ballast of ships originating from across the world. Because of this belief, neither Seaman, Rush, or any of their comrades in the large cities were ever able to define the original source and cause for this disease-causing contagion. Of course, today we know the mosquito was the cause, but it would take until 1881 for scientists to theorize this vector.
Mid-Atlantic Region
The year 1793, when the great epidemic was raging in Philadelphia, marks the beginning of a series of increasingly frequent and severe outbreaks of Yellow Fever in the seaport towns of all the colonies. Virginia, trying to contain it, resorted to strict quarantine laws to safeguard herself against the spread of the contagion. On September 17, 1793 the Governor issued a proclamation requiring all ships coming from Philadelphia, the Grenades and the Island of Tobago to anchor off Craney Island near the mouth of the Elizabeth River and forbidding the landing of passengers or cargo for twenty days.” Superintendents of quarantine were appointed, including William Nelson for the port of York and Dr. Elisha Cullen Dick for Alexandria. Dr. Dick, writing the Governor for instructions, reported:
“For my own part, notwithstanding the confidence reposed in me compelled me to act in conformity to a different opinion, yet it has always been my belief that the malignance of the Philadelphia disease was entirely local and not transportable. I have not only heard of the disorders existing under a milder form in many parts of this country, but have seen it epidemical in this Town. That it has been productive of so much mortality in Philad'a, I have ascribed to the cooperation of local circumstances”.
A contrary opinion was expressed by an anonymous “Friend to Richmond,” who wrote the Governor on October 13, 1793, asking that steps be taken to prevent the introduction of the “Malignant disorder which has proved so fatal to our fellow men in Philadelphia.” Several people, he reported, had recently come to Richmond from Philadelphia, and one girl "who has come to this town not more than one week ago from Philadelphia . . . departed this life the last night, and was buried privately.” He referred the Governor to Doctors Leiper and Prentis, who had attended the dead girl. This quarantine was revoked November 25, “the malignant fever which unhappily prevailed in the city of Philadelphia" having subsided”.
Two years later a serious epidemic broke out in Norfolk and raged there throughout August and September, accounting for 220 deaths in six weeks. It was about this epidemic that Rochefoucauld wrote in 1796:
“. . . diseases are habitual at Norfolk in summer and autumn, and . . . malignant epidemics are there frequent. Last year the Yellow Fever is said to have carried off there five hundred persons from a population of four thousand. Three hundred died at the time the distemper prevailed; the others fell victims to its consequences . . .”
The panic in Virginia at this time must have been great. In Richmond, the City Council asked the Governor for militia to keep people from Norfolk from entering the town.
In 1797, Yellow Fever was again epidemic in Norfolk. On September 19, 1797 Dr. James McClurg sent to the Governor resolutions adopted by the Richmond Common Hall, asking for executive aid in preventing the spread to Richmond of the "dangerous and contagious fever" raging in Norfolk. On September 25 James Allen, quarantine officer at Fredericksburg, asked the Governor for authority to compel ships from Philadelphia, Baltimore, and Norfolk to perform quarantine, because of the “Yellow Fever now raging" in those towns.
The year 1798 saw a still more serious outbreak, especially in Portsmouth and Petersburg. As early as August 2 Thomas Newton in Norfolk warned the Governor that according to reports, Yellow Fever was raging in Jamaica. He asked permission to have the doctor of the port examine incoming vessels. On August 17 two vessels reached Richmond from Philadelphia. On the voyage several of the seamen had died of a malignant fever. A month later Dr. Andrew Leiper reported on his examination of two sloops from City Point:
“The man who died last night must have been carried off by the Yellow Fever. The corpse very yellow, with large purple marks. The sloop . . . has now a sick man on board, is getting yellow eyes and neck, has puked up in my presence matter resembling the grounds of coffee. A distressing hiccough; will probably die”.
The Richmond papers reported that “one-sixth part of the usual number of the inhabitants residing at City-point, near Petersburgh, have been swept off in the course of about 20 days”
The Mayor of Alexandria asked the Governor's permission to move the quarantine station farther from the city on account of the danger from Yellow Fever and suggested that Maryland and Virginia might jointly use Craney Island, in the Elizabeth River, for this purpose. Throughout the late 1790s, Yellow Fever continued to be a matter of great and almost annual concern to Virginia cities.
The Nineteenth Century began with the familiar accompaniment of quarantine reports. On August 13, 1800, the Superintendent of Quarantine at Fredericksburg wrote, “I am informed, the Yellow Fever or some contagious disease is now raging in Norfolk, and numbers are dying with it daily”. The Richmond Common Hall again took steps to prevent the spread to that city, and the inhabitants of City Point asked for the appointment of a quarantine officer. Two men died at Fredericksburg on a boat thirteen days from Norfolk and several cases occurred at Alexandria. Meanwhile Thomas Newton was declaring that accounts of the sickness at Norfolk were exaggerated; however, his report showed fifty new cases and ten deaths between August 29 and September 2. Before the outbreak ended that fall it resulted in 250 deaths in the town. The disease returned to Norfolk annually through 1805 taking a particularly large toll on Norfolk in 1803 (200 dead). Similar outbreaks occurred in port cities throughout the mid-Atlantic, including Baltimore, Alexandria, and Wilmington, NC. Although Baltimore and other mid-Atlantic ports continued to have small outbreaks from time to time, Norfolk was spared any more outbreaks from 1806 through 1820.
Why this occurred is impossible to say definitively. However, the US economy was in depression from 1807-1810 and again from 1815-1821. Add to this the naval conflicts between the British, French, and Americans that occurred during the Napoleonic era and the War of 1812, and you have a combination that would have had the effect of suppressing trade with Central, America and the Caribbean. With that trade suppressed, there would have been fewer ships moving between those areas and Norfolk and thus less chance of importing the virus.
Finally, Norfolk’s luck ran out. On the 20th of July 1821, a vessel from Point Peter, Guadeloupe arrived in Norfolk and discharged her cargo of rum, sugar, and molasses. After this, she pumped out her bilges on the dock between Southgate’s and Warrin’s wharves. The two warehouses were about equidistant from the ship.
On the 1st of August, Mr. Price, clerk in one of the warehouses, took sick with fever, and died shortly afterwards. On the same day, a black woman, cook to the family occupying the other house (it was common for caretakers to live in the warehouses), sickened and died on August 9. On the 4th, the fever struck two ladies of that family, the elder of whom died on the 10th. At about the same time, a 16-year-old boy and an infant in the same family contracted the fever but both recovered. On the 10th of August cases appeared in those living in Woodside’s Lane. The fever spread gradually to Water Street and in a short time incorporated a whole section of town; bounded by market square on the east, Main Street on the north, and the river on the west and south.
New cases of Yellow Fever continued to appear with regularity until the 3rd of September when a Category 5 hurricane passed over Hampton Roads. The tide rose to the point that it covered all wharves and lower streets, particularly in the infected sections of town. Afterwards, citizens took care to carefully remove water from cellars and other low places and scatter lime profusely over the area. This caused a decline in the disease progression. However, toward the end of the month the numbers of cases once again began to climb. The epidemic finally subsided in late October/early November having claimed at least 160 lives.
For reasons unknown, this was the last outbreak of Yellow Fever in Virginia until the 1855 epidemic in Norfolk that killed 3000+ individuals. Elsewhere in the region, Baltimore, which had also suffered from a small outbreak in 1821 did not see another Yellow Fever outbreak until 1849, while North Carolina remained clear of the disease until 1862. Charleston, SC, on the other hand continued to have regular outbreaks (1830, 1834, 1840, 1841, 1854, 1857, etc.)
Well, there you have it, the story of the epidemic disease that wracked North America for over 200 years. I must confess that this post, originally planned to examine all the epidemic diseases of early America took on a life of its own. The research took much longer than I planned and thus caused me to miss one of our “every 2 weeks” publication dates. As I began researching, I quickly found myself led “down the rabbit hole” by the history of Yellow Fever and how it affected the United States. I found it paralleled today’s experience in many ways. A poor understanding of exactly how it was spread and how it could be contained, a lack of any specific treatments for those suffering from the extreme effects of the disease other than palliative care, the disruption of the economy because of the effects of the disease, social distancing (fleeing the area where the Yellow Fever outbreak occurred), and the use of “contact tracing (where was a ship coming from) as well as quarantine.
I hope you found this post on the history of Yellow Fever both informative and thought provoking. If you did, please take a moment to join our blog community (Look for the button in the upper right-hand corner of this post) and let us know your thoughts by posting a comment. We also invite you to return to our blog home page and sample some of our earlier posts.
REFERENCES
Archer, R. D. (1822). History of the Yellow Fever as it appeared in Norfolk during the summer and autumn of 1821. (J. Eberle, Ed.) The American Medical Recorder Vol. 5, pp. 60-73.
Blake, J. B. (1959). Public Health in the Town of Boston, 1630-1822. Boston: Harvard University Press.
Blanton, W. B. (1931). Medicine in Virginia in the 18th Century. Richmond: Garrett & Massie, Inc.
Davis, A. R. (2016). Distempers and Physic, Virginia's Health in the Eighteenth Century. Northern Neck of Virginia Historical Society, Vol LXVI.
Duffy, J. (1953). Epidemics in Colonial America. Baton Rouge: Louisiana State University Press.
Duffy, J. (1968). Yellow Fever in the Continental United States During the Nineteenth Century. Bulletin of the New York Academy of Medicine, Vol. 44 Nr. 6, 687 - 701.
Keating, J. M. (1879). A History of the Yellow Fever Epidemic of 1878 in Memphis, Tenn. Memphis, TN: Howard Association.
Kohn, G. C. (2001). Charleston Yellow Fever Epidemic of 1699. Encyclopedia of Plague and Pestilence from Ancient Times to the Present (Revised Edition) (p.61). New York: Checkmark Books.
La Rochefoucauld, F. A. Duc de, (1799). Travels through the United States. London
Nogueira, P. (1955). The Early History of Yellow Fever. Yellow fever, a symposium in commemoration of Carlos Juan Finlay (p. Paper 10). Philadelphia: Thomas Jefferson University.
Rush, B. (1794). An Account of the Bilious Remitting Yellow Fever, as it Appeared in Philadelphia, in the Year 1793. Philadelphia: Thomas Dobson.
South Carolina Department of Health and Environmental Control. (2008, October 9). A Chronology of the History of Public Health in South Carolina. Retrieved from Public Health History: http://www.scdhec.net/administration/history/timeline.htm
Sternberg, G. M. (1908). Yellow Fever: History and Geographic Distribution. Reference Handbook of the Medical Sciences., 715-722.
The College of Physicians of Philadelphia. (2020). 1793 Yellow Fever Decimates Philadelphia. Retrieved from History of Vaccines: https://www.historyofvaccines.org/timeline#EVT_100404
Webster, D. (1799). A brief history of epidemic and pestilential diseases Vol. I. Hartford: Hudson & Goodwin.