"We are now in pretty bad fix & the fever has become so general that it is
impossible to go to any portion of the city without finding it. In some
places where its existence is greater, barricades have been built across the
streets to prevent wagons & from passing in order not to disturb the
sick."
E.B. Jennings of New Orleans, letter to his uncle, 1878
In late May of 1853, James McGuigan, a 26-year-old Irishman, was admitted to the Charity Hospital in New Orleans after feeling unwell for four days. His rapid decline into delirium and the subsequent black vomit, a telltale sign of yellow fever, marked the beginning of the worst epidemic the city had ever faced. McGuigan had recently arrived in New Orleans with 314 other Irish immigrants. A sailor from another ship, the Augusta, also succumbed to the illness, prompting local physician Dr. Erasmus Darwin Fenner to launch a thorough investigation. Fenner's inquiry revealed that the Augusta, carrying passengers from various European countries, had traveled with a ship from yellow fever-ridden Kingston, Jamaica. The proximity of the two vessels and the subsequent mooring near McGuigan's ship raised concerns about the potential spread of the disease.
Yellow fever became a recurring threat in the South from 1796 to 1905, particularly affecting New Orleans, earning the name of the "Necropolis of the South." In the 19th century, it had profound impacts, with outbreaks occurring every second or third year, claiming up to 8 percent of the population, with particularly devastating effects in immigrant neighborhoods, where up to 20 percent of residents succumbed to the disease. The worst epidemic in New Orleans in 1853 resulted in over 12,000 deaths, equating to 10 percent of the city's population. The Irish-born population suffered a staggering one-fifth fatality rate. The 1853 epidemic's toll was exacerbated by the city's lack of recent outbreaks, leaving many of the population susceptible.
Yellow fever was highly frightening in the 19th century and earlier. It was the most terrifying disease in the Atlantic world during that period. Its severe symptoms included sudden nausea, chills, muscle pains, jaundice, and the ominous "black vomit." Despite its lethal nature, there was no cure or vaccination, contributing to the terror it instilled. This led to a consistent toll on human lives throughout the 19th century. New Orleans served as the gateway for the imported pestilence and bore the brunt of its impact, with severe epidemic years witnessing the spread of the disease through the region via waterways and later railroads.
Yellow fever was particularly terrifying because of its mysterious nature. Even seasoned doctors were confounded by it. Only towards the end of the 19th century did Cuban researchers identify the yellow fever vector as the female Aedes aegypti mosquito. Despite limited knowledge about the virus's transmission and lethality, people recognized specific patterns. Yellow fever tended to strike during the fever season, roughly from July to October. There was a misconception that the disease was miasmatic, attributed to the city's heat, meteorology, soil, and climate. This belief, rooted in the now-obsolete miasma theory, correlated with the visible phenomenon of thick, hazy steam rising from the ground in summertime.
Misconceptions about the causes of yellow fever persisted in the 19th century. Yellow fever was not just a medical threat but shaped social structures in New Orleans. Locals dubbed yellow fever a "strangers' disease," associating it with foreign-born, poor, and hard-drinking individuals. Erroneously, contemporary science propagated the idea that Black people were less affected by yellow fever, either due to hereditary immunity or extreme resistance. Slaveholders argued that the enslavement of Black people was in line with divine intentions, as the cotton economy in the American South relied on the labor of immune Black individuals. Proponents of slavery contended that this system was humanitarian, as it purportedly protected white people from the dangers of yellow fever by distancing them from labor and environments that could be lethal, while Black individuals could safely engage in such activities.
The 19th-century South embraced the concept of acclimation, where surviving an episode of yellow fever was believed to grant immunity. This led to a unique social hierarchy based on who was considered "acclimated" or "unacclimated," impacting professional, social, and marital spheres. Bosses preferred acclimated employees and social circles excluded those who were unacclimated. The distinction was vital, yet physically indiscernible, leading people to demonstrate their ties to New Orleans as a marker of acclimation. The concept of immunity played a central role in the lives of the city's populace, influencing where individuals lived, worked, and socialized. In the absence of vaccines, it was more about persuading others of one's immunity status than actual immunity to yellow fever.
With its swampy environment, New Orleans faced significant public health challenges, especially in the aftermath of the Civil War. Sanitation issues, including unpaved streets and open gutters, contributed to the spread of diseases like dysentery, cholera, typhoid, and yellow fever. The city lacked an effective board of health dedicated to tracking or defining diseases, and sanitation measures were minimal.
The city's response to yellow fever outbreaks was peculiar. Acclimated citizens approached the scourge with indifference, considering it an expected annual occurrence. While some residents seemingly felt friendly to the scourge as a check on immigration that might alter their established way of life, others, primarily concerned with immediate gains from commercial activities, downplayed the significance of the disease. The prevailing narrative in New Orleans, shaped by influential figures, sought to minimize the impact of yellow fever, attributing its effects to the impoverished immigrant and the intemperate while reinforcing the city's image as a healthy place.
Yellow fever epidemics had profound effects on commercial activity in New Orleans and surrounding areas during the late 19th century. The onset of the disease led to a significant slowdown in business, with many establishments closing down or operating for limited hours. Quarantines, a robust public health tool, were infrequently implemented in New Orleans during the antebellum period, setting the city apart from counterparts like New York and Philadelphia. These cities sought greater control over public welfare, consolidating power in health matters and attempting to depoliticize the issue. In contrast, such developments did not transpire in New Orleans.
Official or unofficial quarantines, often imposed due to the outbreaks, hindered the shipment of products to and from the port city. Concerned about the disease, country merchants and planters refused to accept goods from New Orleans during yellow fever outbreaks. This disrupted the local economy and interfered with the harvesting of crops and the shipment of produce, delaying the normal process of economic exchange. The lack of effective quarantines, coupled with disruptions in business, inflicted distress among the laboring classes, leading to increased poverty. Newspapers in New Orleans failed to deliver timely and accurate reporting on yellow fever outbreaks, often rejecting health information provided by the Boards of Health.
State and local authorities were compelled to institute quarantine and public health measures. A pivotal development occurred in 1855 with the establishment of the Louisiana State Board of Health, marking the inaugural state board of its kind in the United States. This milestone directly emerged as a response to the epidemics of 1853 and 1854. Moving into the later nineteenth century, the evolution of public health institutions and quarantine practices remained closely intertwined with the persistent threat of yellow fever.
After the Civil War, yellow fever in the United States remained low until 1878, when a devastating epidemic hit the Mississippi Valley. Originating from the Caribbean, particularly Cuba, where high yellow fever cases led thousands to seek refuge in New Orleans, the disease entered the city through the ship Emily B. Souder. The subsequent arrival of the Charles B. Woods marked the beginning of a tragic spread, with families succumbing to the fever. The news triggered a mass exodus in New Orleans, with one-fifth of the population leaving. The state health board declared an official epidemic on August 10, 1878. The contagion spread beyond New Orleans, wreaking havoc across the entire Mississippi Valley and Gulf States area.
The epidemic of 1878 prompted national attention and the establishment of the National Board of Health in 1879. The gravity of the situation was emphasized, recognizing yellow fever as a formidable enemy threatening both life and commerce in the United States. The National Board of Health was tasked with gathering information on contagious diseases, advising federal and state governments on public health matters, and devising a system for national quarantines. However, the board's powers were limited, and it faced challenges from those advocating for state-controlled quarantines. The National Board of Health ceased to exist on March 2, 1883, and control over national quarantines reverted to the Marine Hospital Service, maintaining the status quo of limited federal intervention in state and municipal quarantine regulations.
New Orleans, struggling with topography, climate, and public apathy toward sanitation, took measures to prevent future outbreaks in the aftermath of the devastating 1878 epidemic. Public and private organizations aimed to educate the public and implement changes. The Auxiliary Sanitary Association, funded by the city's elite, significantly improved drainage canals and implemented a successful gutter-flushing system. The New Orleans Medical and Surgical Association advocated for improved drainage and sanitary measures, which contributed to eliminating mosquito breeding grounds.
Throughout the 1880s, yellow fever deaths decreased, leading to failed initiatives for water infrastructure improvement. The city hosted events like the World's Cotton Centennial and Exposition in 1884, concealing controversial gutters. By the 1890s, state, municipal, and private efforts aligned with Progressive Era public health education. The 1897 yellow fever outbreak, with almost 300 deaths, spurred action. In 1899, voters approved funds for a drainage and sewerage system. The 1902 Sewerage and Water Board initiated transformative changes, replacing gutters with subsurface piping, building a water purification plant, and installing pumping stations. By 1923, 92 percent of the city had access to sewer lines. The discovery in 1900 that mosquitoes were the carriers of yellow fever guided effective measures in 1905, marking the last outbreak in North America. New Orleans transitioned from a plague-ridden city to one with an improved water management system and effective disease prevention measures.
The historical narrative of yellow fever in 19th-century New Orleans reveals complex interactions between communities and individuals and the recurring specter of the disease. The dualities of fear and acceptance, economic interests, and the impact on various population segments add depth to understanding the disease's relentless presence. Yellow fever's association with marginalized groups reflects a broader historical pattern, perpetuating stigma and discrimination. Kathryn Olivarius, a history professor at Stanford University studying the impact of yellow fever, warns that the dynamics of diseases used to justify prejudice are not confined to the past. From HIV to the COVID-19 pandemic and the opioid crisis, diseases continue to be associated with specific groups, perpetuating stereotypes and discrimination. Our recent experience with the COVID-19 pandemic also exposed the continuing struggle between commercial, individual, and governmental interests in matters regarding public health.
Further Reading:
Necropolis: Disease, Power, and Capitalism in the Cotton Kingdom: Kathryn Olivarius