The first yellow fever epidemic hit Philadelphia in 1793, killing approximately 5,000 people. The pandemic that emerged so close to New York City prompted the creation of the first Board of Health Department. To prevent the spread of yellow fever in New York City, action was taken to quarantine boats coming from Philadelphia. Although early efforts helped delay the epidemic, in the summer of 1795 cases of yellow fever began to emerge in Manhattan. The yellow fever epidemic which lasted until 1803, varied in severity. It reached epidemic proportions three times: in 1795, 1799, and 1803 claiming thousands of lives over the course of its presence in New York City.
Upon infection, most victims would experience headaches, followed by severe exhaustion, high fever and slowed heart rate. This period was followed by a remission stage and then by delirium. During the delirium stage, victims acquired a characteristic yellow hue on their skin and pupils. In final stages, a vomiting of black bile occurred and was followed by death.
Despite the presence of yellow fever in New York City since 1795, many people were unwilling to admit that an epidemic was on the horizon. A reluctance to publicize the fever epidemic was probably due to fear of business losses and to prevent a mass exodus from New York City. However, many wealthy residents fled to the country side as yellow fever reached epidemic proportions. During this time, very little was known about the origins of yellow fever.
Physicians speculated that it was born out of unsanitary condition in slums, or brought to North America from the West Indies. Some even hypothesized that it was caused by rotting coffee. By the end of the 18th Century, doctors had been speculating that it might be transmitted through mosquitos, which were often found in high numbers in infected neighborhoods. However, a belief that yellow fever was not contagious, gave a false sense of security to many wealthy New Yorkers at the time. Efforts by the Board of Health were minimal and limited to the use of quarantines on infected ships; although cleanup efforts around infected neighborhoods were occasionally carried out. The first Board of Health, created specifically to combat yellow fever, would be inactive until the cholera epidemics in 1832 and onwards. However, before a well-organized and funded Board of Health could be developed, the government paid little to no attention to the City’s health, in periods were epidemics were not immediately threatening the populace.
Looking for cause of outbreak
To be sure 18th century etiology of diseases can seem bizarre to us today. Benjamin Rush, for example, published a list of over a dozen vegetables said to cause fevers when they rotted. However, by taking their suggested causes seriously, we can learn how people in the 1790s related to their environment because they saw many infectious diseases, especially seasonal fevers, as a consequence of an imbalance between people, their community and nature. By trying to see a fever epidemic through their eyes, the seemingly simple “walking city” of the late 18th century is thrown into relief, from the quays to the bedrooms. However, causes could also be far reaching. In 1799 Noah Webster, then a newspaper publisher in New York City, wrote a two volume work to prove that the recent epidemics were caused in part by a volcanic eruption of Sicily’s Mt. Etna in 1789.
At a 1986 conference on the treatment of yellow fever, not one of the doctors attending had ever seen a case. From the descriptions of the course of the disease in the 1790s, we know that the it often began with a sharp headache and a rapid decline to prostration, with, for some, the skin turning yellow, and, for about ten percent of the victims, death, always, it was often said, accompanied by black vomit. There could be many particular agonies.
Denying the yellow fever outbreak
In late July 1795 New York’s port physician, Dr. Malachi Treat, got a fever immediately after inspecting the Zephyr, a ship from the West Indies that had three crew members sick with fevers. The ship’s boy died the day Treat boarded the vessel, and Treat died a few days later. The Health Committee was prepared, opening a fever hospital in a house called Bellevue about a mile up the East River that they had purchased in the spring. But the committee denied that there was a yellow fever epidemic.
Doctors cooperated with the committee. On August 15, they met, and reported to the newspapers “that no CONTAGIOUS fever, in any particular different from what this city has been accustomed to, for some years past at this season, exists at present.” Soon after the meeting Dr. Valentine Seaman went into the infected area of the city, and reported to the health committee that he had found “the cause of the present complaint,… a fruitful matrix generating the seeds” of the fever. The city corporation had built up Water Street in that area with landfill without requiring lot holders along the street to fill their yards to a level with the street.
Panic in the City
In mid-September the situation changed. However, the city’s panic was reported in Philadelphia newspapers, not in New York. “My God! what a change…. The fever is spreading fast,” exclaimed a letter dated the September 17. “Forty three persons have died with it in 3 days; agreeably to the report of the committee, and how many more God only knows. My family are gone to Long Island. I shall remain till a stop is put to business.” In his diary Elihu Smith noted the alarm:”Wherever you go, the Fever is the invariable & unceasing topic of conversation…. People collect in groups to talk it over, & to frighten each other into fever, or flight.” Smith thought the number of people who had fled the city “cannot be less than 12 or 15,000.”
New York editors did their best to remain upbeat. Rain, winds and cooler temperature on the 21st prompted the hope that “the city will be clear of sickness in a few days…. Broad street, Broad way, all the north of the city, and many other parts, are as healthy as usual.” A doctor wrote that he had scientific proof that the epidemic would soon end. The thermometer dropped to freezing on September 21. But the health committee recorded 32, 31, and 29 deaths on the 25th, 26th and 27th. The deaths continued into October. Several prominent men got the fever, but they survived. The Health Committee reiterated that mostly emigrants and poor living in the low lands along the East River died.
The reaction to the epidemic of 1798 could have been a prologue to a major change in the American way of life. The zeal for inspecting houses and the wide spread displeasure with the manner in which certain people lived were quite bipartisan. The Republican newspaper in Philadelphia, the Aurora, was one of the leaders of the movement to inspect houses. Samuel Latham Mitchill who inveighed at the poor in New York was a prominent Jeffersonian politician.
However, while the threat of epidemics continued to terrify New York and Philadelphia, prompting widespread evacuations of the former in 1799 and 1802, the number of deaths never climbed above 500 in those years. Health authorities were pro-active. In New York, sick sailors discovered on a ship returning from Havana on June 22, 1799, were immediately taken to the Marine Hospital for quarantine on Staten Island, and the ship thoroughly cleaned with vinegar and all interior walls whitewashed. Newspapers not only reported the daily toll in New York, but Philadelphia as well. The New York Commercial Advertiser provided a rundown of the “State of Health in the United States,” reporting that “New York, sickly, but recovering,” while New Jersey was “remarkably healthy.”
The epidemics have “evaporated” over time. Exposure to the yellow fever virus gives lifetime immunity. As with many viruses, many infected by yellow fever do not exhibit any untoward symptoms. The pool of immune people grew. Some medical commentators recognized this immunity, while others, like Benjamin Rush, claimed to have seen multiple infections.
What we know today?
The disease is caused by the yellow fever virus and is spread by the bite of an infected female mosquito. It infects only humans, other primates, and several species of mosquitoes.In cities, it is spread primarily by Aedes aegypti, a type of mosquito found throughout the tropics and subtropics. The virus is an RNA virus of the genus Flavivirus. The disease may be difficult to tell apart from other illnesses, especially in the early stages. To confirm a suspected case, blood sample testing with polymerase chain reaction is required.
A safe and effective vaccine against yellow fever exists and some countries require vaccinations for travelers. Other efforts to prevent infection include reducing the population of the transmitting mosquito. In areas where yellow fever is common and vaccination is uncommon, early diagnosis of cases and immunization of large parts of the population is important to prevent outbreaks. Once infected, management is symptomatic with no specific measures effective against the virus. Death occurs in up to half of those who get severe disease.
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