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.
[Illustration: Concreted Ditch. Gatun.]
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.