CHAPTER VIII. History of Yellow Fever

HISTORY OF YELLOW FEVER

From the dawn of history man has made some attempt to prevent disease. He saw on all sides evidences of the fact that he had suffered from disease through no fault of his own; that occasionally disease would occur with unusual violence and exterminate whole communities.

The cause of such mortality not being evident to his senses was attributed by him to spirits, or to powerful gods. These spirits being superior to himself in power, he attempted to propitiate them by presents and prayers. These were his first efforts at preventive medicine and sanitation. He would try to drive off the evil spirits of disease with loud and disagreeable noises made by tom-toms and similar instruments. He attempted to prevent the ingress of these same spirits by signs and incantations. The gods were looked upon as beings influenced by the same love and passions as himself, and he appealed to them with supplications or bribes, as seemed likely to be most effective. In his reasoning during this barbarous age concerning the cause of disease, he was really nearer the truth than subsequently during a much more refined age, or even up to the middle of the nineteenth century. We now know that spirits and gods do not directly cause disease in man, but we have found out that living beings, germs, are the direct cause of all infectious diseases.

A great many of our sanitary measures, if now witnessed by our ancestors of three thousand years ago, would probably seem perfectly natural and proper. The fumigation of ships and buildings would seem a very proper mode of burning incense to the hostile god who was causing yellow fever. The modern man, his descendant, is burning the pyrethrum to kill the living spirit, the mosquito, which he has found by experiment really causes the disease. Our ancestor would accept as a perfectly natural explanation the use of oil on the stagnant waters if he were told that this was a libation to propitiate the angry god who was inflicting on man malarial fevers. His descendant is using the oil really to kill the living beings, mosquito larvæ, which cause malaria.

As man advanced in intelligence and civilization he threw aside his belief in spirits and numberless higher beings as causes of disease among his fellowmen. He now began to attribute disease to abnormal conditions in the blood and tissues of the body, caused by unfavorable environment, such as filth, food, clothing, climatic conditions, etc. His efforts for the prevention of disease during all this period had little or no effect. It is probable that through long ages the human race remained stationary in numbers or increased very slowly, due principally to the fact that men were unable to affect favorably their sanitary condition, or to ward off in any way the fearful epidemic scourges that every now and then swept through the ranks of mankind.

Up to the time of the discovery of America, Europeans had been making no attempt whatever to prevent disease and with our present knowledge and point of view, we can see that any sanitary attempt on their part would necessarily have failed. They had an entirely wrong conception of disease and an erroneous theory of its cause. The mortality rates in most parts of Europe at this time were as high as its birth rates. In England, the population had not increased for several centuries, or if it had increased, the increment was so slight that it could not easily be measured. Every now and then virulent epidemics would sweep through Europe and carry off a large portion of the population. The figures as given in some of these epidemics are almost inconceivable.

For instance, it is stated by Hecker that the epidemic of plague in the fourteenth century carried off from Europe some twenty-five millions of the population, and from China alone, thirteen millions. That again, in the fourteenth and fifteenth centuries, millions of the population of Germany and other countries were carried off by the “sweating sickness.”

Such instances of mortality could be adduced ad infinitum. Leprosy in the fourteenth century was more common in England than it is now in Palestine, so common that every county had a lazaretto where lepers were strictly confined, and laws are still on the statute books prescribing the method of their confinement, and the disposition of their property.

The inhabitants of Europe at this time were subject to all the contagious and infectious diseases to which, with one or two exceptions, they are now subject, but most of these diseases, for some reason, were vastly more virulent than they are at the present time.

In the fifteenth century when America was discovered by the Europeans, the Indians undoubtedly suffered from disease. They probably had some diseases from which Europeans, up to that time, had not suffered, and the Europeans, no doubt, brought with them some diseases from which the Indians had not suffered. Yellow fever is a good example of the first, and syphilis of the second. And this must necessarily have been the case if we give a little thought to the matter.

According to generally accepted scientific belief, the buffalo developed from the first created cell from which we have all descended. If his ancestry could be traced, the line would run straight back to this first cell. But he developed into the present buffalo in a limited area in North America. The ox, at some period in the distant past, branched off from the same line of descent from which the buffalo came, yet he developed into the present ox within a very limited area in Central Asia. These animals were originally native to a very small area of country, and this seems to have been the case in the development of all animal life.

The yellow-fever germ is primarily an animal very much like the buffalo or ox, and must have come from the first created cell just as did all life, and must have developed as did other animals in a very limited area or territory. Exactly the same could be said of the tuberculosis germ. It is, therefore, just as natural that the western hemisphere should have had its peculiar diseases as that it should have had its peculiar animals.

Everywhere that the European attempted to colonize he suffered from disease, and this always occurred within the first two or three years. In Columbus’ settlement on Santo Domingo, he lost within the first three years a very large number of the colonists settled there. When the English colonized Virginia at Jamestown, they lost from disease about one-half of the total number of colonists, and the same is true of the settlers at Plymouth. Everywhere that settlements were attempted, the settlers were so nearly destroyed by disease that, in many instances, the few survivors could not be persuaded to remain.

Yellow fever is an acute specific, very fatal, febrile disease, lasting about a week, and characterized by fever, vomiting, muscular pains and albuminuria, and in the graver cases by black vomit and hematogenous jaundice. It is transmitted from person to person by the female stegomyia mosquito. The sick person does not infect the biting mosquito after the third day of the disease. One attack gives immunity against a second attack.

Like all other diseases, its origin is enveloped in a cloud of obscurity. The yellow-fever organism, like the horse or the dog, developed in some particular locality. The horse had his whole lifetime in which to wander from place to place, and so spread very rapidly and widely as compared with the yellow-fever organism. The yellow-fever organism was dependent upon the mosquito and man for his locomotion. On the average, he had not more than a week in which to travel. I presume that a week would be long for the average life of a stegomyia mosquito, and the traveling ability of the organism would be limited by the life of the mosquito. For while the female stegomyia mosquito has to live two weeks after she has bitten the yellow-fever patient before she can convey the disease to another non-immune human being, still the average length of life in the mosquito cannot be as great as this. The various conditions of unfavorable environment, the natural enemies of all kinds, wind, etc., must kill a large proportion of mosquitoes within the first week. If we consider the total number of stegomyia mosquitoes in an infected locality, we must see that only an infinitesimal proportion succeed in biting a yellow-fever patient within the first three days. This small proportion, however, has the best protection and is more likely to have a long life than the average of the female stegomyia, for they necessarily bite inside of the houses, and in such places have the best protection from the wind and sun, their greatest enemies.

In this other host, man, the parasite had only three days to travel. During these three days the man would be sick and not likely to move about much. During man’s savage state he traveled very little more than did the mosquito. We would expect, therefore, the yellow-fever organism’s rate of spread to be very much less rapid than the spread of the horse.

When America was discovered, the horse had not yet reached that continent. The evidence with regard to the yellow-fever organism seems to me to indicate that, at this same time, it had not spread further than a limited area about Vera Cruz. It is probably the latest disease to which man has been subject.

There are very many beliefs as to the locality at which yellow fever developed; that it originated among the earliest nations of the world inhabiting Asia Minor; that it originated in Africa in connection with the slave trade; that it originated in America, and was not known to Europeans until the discoveries of Columbus.

A recent writer on yellow fever, Augustin, suggests that its origin can be traced back to the siege of Troy, and that the Greeks and Trojans suffered severely from this disease during the prosecution of the war. Mr. Augustin argues quite forcibly in favor of the idea that many of the great epidemics of Europe and Asia, before and since the Christian era, were yellow fever. He thinks that the population became immune from the fact that all at some time suffered from the disease, and thus, in the course of time, it died out from want of material on which to feed. I consider Mr. Augustin one of the most competent authorities that we have on the history of yellow fever, and anyone writing on that disease in any of its phases would do well to consult his monumental work.

It seems to me, however, that the evidence is against yellow fever having occurred in Europe before the fifteenth century. If it had been general in southern Europe, semi-tropical Asia Minor and semi-tropical Africa, it would be there now, just as it is in similar localities in tropical and semi-tropical America. If the Phœnicians had suffered from yellow fever during the time of Abraham, and the great epidemics of Smyrna, Thebes, Athens, Rome and Carthage had been yellow fever, this disease would be in those countries now. History does not show that yellow fever can immunize a whole country, but merely the locality in which it prevails endemically. While the old inhabitant of Havana was immune to yellow fever, the man from the interior of Cuba where yellow fever had not been endemic knew that he was just as liable to contract yellow fever when he visited Havana as was the man who came from the United States, and he feared the disease just as much.

The native of the city of Panama was immune to yellow fever, but the soldier coming from the mountains of the interior knew that he would catch the disease, and this actually occurred many times whenever a fresh regiment was brought to Panama. At present, Guayaquil in Ecuador is the seaport of Quito, the capital of the country. Quito is situated some three hundred miles up in the mountains, and is connected by rail with Guayaquil. Yellow fever is at present endemic in Guayaquil and has been so for many years. The old resident of Guayaquil is immune to yellow fever, but the natives of Quito dread Quayaquil as they do death. They never go there when they can avoid it, and when they have to visit the outside world, they remain in Quayaquil just as few hours as will enable them to catch their ship. And the fear is well founded. Very many Ecuadorians of high position have lost their lives from yellow fever contracted in passing through Quayaquil. But all these years of endemicity of yellow fever in these cities, the inhabitants of the respective countries in which they are situated have never become immune.

The same is true of Europe, Asia and Africa. If Memphis, in Egypt, had been an endemic center of yellow fever in the dim dawn of man’s civilization, the disease would be endemic there at present. While the native of Memphis who labored on the pyramids of Cheops would have been immune to yellow fever, enough fresh material from up the Nile would have continued coming into Memphis to have kept the disease going. And the hundred thousand men whom old Cheops kept at work on his pyramids for twenty years would have died in such numbers that he would either have had to give up this work, or would have exhausted the population of his kingdom; but the interior of Egypt would never have become immune any more than has the interior of Cuba, or Panama, or Brazil in our own time.

Had Athens been subject to yellow fever in the time of Alcibiades, yellow fever would certainly be there to-day. All the citizens of the city of Athens would have become immune, but a sufficient number of Greeks would have been constantly coming into the city from the interior to have kept the disease endemic, exactly as has occurred in our own time at Havana. I think, then, that we can throw aside Europe and Asia as the original source of yellow fever.

Another theory of the origin of yellow fever is that it originated in Africa and was carried to America in connection with the slave trade. Next to that of the origin in America, this is the most generally accepted explanation. But the arguments against this belief are unanswerable.

According to Lind, the first yellow fever that appeared in Africa was in Senegal, in 1759. If yellow fever had existed along the coast, it would certainly have spread in the two hundred and fifty years during which this coast had been occupied by Europeans since its settlement by the Portuguese in the year 1415. As a matter of fact, it was recognized many times in America before it appeared in Africa. The American origin of yellow fever impresses me as being the most reasonable and the one most in accord with the recorded facts. But it seems to me that the bulk of evidence points toward its having originated in America at some period prior to its discovery by Columbus.

Dr. Carlos Finlay, in a paper published in The Climatologist, of Philadelphia, in July, 1892, gives very clear proof that the disease existed in America before the discovery by Columbus. It seems to have been endemic in the neighborhood of Vera Cruz, Mexico, and to have been very well known to the Aztec authorities. The Government, before the arrival of the Spaniards, had many times caused a forced emigration from the interior to the neighborhood of Vera Cruz, to repopulate a country that had been depopulated by an epidemic disease known to the Aztecs as “cocolitzle.” To induce them to stay, these people were given many privileges, such as exemption from taxation, etc. This cocolitzle was known among the Mayos of Yucatan as “black vomit.” The Spanish historian, Father Lapey, gives a very clear account of cocolitzle as it occurred in Yucatan in 1648. It is such a clear description of yellow fever that I think it instructive to quote from his report as given in Dr. Finlay’s paper:

With such violence and rapidity were the people attacked, big and small, rich and poor, that in less than eight days the whole population of the city (Campeche) were sick at the same time, and many citizens of the highest rank and authority died. In most of the cases the patients were taken with a most severe and intense headache, and pains in all the bones of their bodies, so violent that their limbs felt as if torn asunder, or squeezed in a press. A few moments after the pains, there came on a very intense fever, which in most instances produced delirium, though not in all. This was followed by vomiting of blood, as if putrified, and of such cases very few survived—and many suffered the fever and pain in the bones without any other symptoms. In the majority the fever seemed to remit completely on the third day; they would say that they felt no pains whatever, the delirium would cease, the patients conversing in their full senses, but they were unable to eat or drink anything; they would continue thus for several days, and while still talking and saying that they were quite well, they expired. A great number did not pass the third day, the majority died on the fifth, and very few reached the seventh. The most healthy and robust of the young men were most violently attacked and died soonest. When the laity began to improve, the disease broke out among the priests. Of the eight members of the Jesuit College, six died; of our own order (Franciscan) twenty died in the city. Almost all the heads of institutions and persons of highest rank, both ecclesiastics and seculars, were carried away by the epidemic. The disease continued over the whole country during the space of two years. Few that then lived in this land, or visited it, in the course of those two years, escaped being sick, and it rarely happened that anyone died of a second attack after having recovered from the first. I then reflected that of the young children who were attacked by the peste in Yucatan, only few had died, as compared with the adults.