Book Review

The Saffron Scourge: A history of yellow fever in Louisiana, 1796–1905

N Engl J Med 1995; 332:615March 2, 1995

Article

The Saffron Scourge: A history of yellow fever in Louisiana, 1796–1905
By Jo Ann Carrigan. 487 pp., illustrated. Lafayette, University of Southwestern Louisiana, 1994. $27.50. ISBN: 0-940984-86-5

The history of medicine is not everyone's cup of tea, or glass of beer. Some physicians show a studied indifference to the profession's past, whether the focus is on triumphs, ineptitude, or unscientific groupings. “What do I have to learn from such bygone episodes?” one might say. “I'm too busy with my own work.” Nevertheless, for those working in public health, epidemiology, or medical ethics, an informed acquaintance with the historical record can be both revealing and consoling.

Jo Ann Carrigan's history of yellow fever in Louisiana from 1796 through 1905 is a strong example. To some the book's title and its implied narrow focus might seem off-putting. In the first few chapters, however, the author establishes her interest not only in the history of the numerous 19th-century visitations of the “saffron scourge” in New Orleans but also in the profound effects of the pestilence on all aspects of life in the city, in the state, and indeed in the American South. She tells her story clearly and eloquently.

Over more than a century, 30 major epidemics of yellow fever broke out in New Orleans. Nearly 100,000 people succumbed to the disease, which proved to be increasingly erratic, mysterious, and terrifying. In the great epidemics of 1853 through 1855, an estimated 13,570 people out of a population of 157,000 died miserable deaths from a disease whose origin was unknown and whose course was completely unpredictable.

Moreover, the disease appeared to select its victims according to a pattern that was both puzzling and dismaying. Some groups and classes appeared to have relative immunity, at least in the early years. Long-time residents, blacks, Creoles, upper-class whites, women, and children were underrepresented among the victims, and the physicians of the period conjectured correctly that “inapparent,” very mild prior infections must have provided lasting protection to those people. But newcomers, the poor, and transients of all kinds were hit hard. The peculiar selectivity of yellow fever gave rise to the epithet “stranger's disease.”

Carrigan describes a fascinating array of treatments for patients with yellow fever. Bleeding, blistering, mercurial purging, enemas, hot mustard baths, quinine, calomel, opium, and homeopathic remedies had their champions. None stopped the regular course of the disease. Creole physicians tended to favor mild, noninterventional therapies; Anglo-American practitioners, in the more aggressive tradition represented by Benjamin Rush, pursued “heroic measures.” One patient, according to Carrigan, subjected to a radical and painful treatment by bleeding and cupping, “jumped out of bed, pulled the cup from his neck and broke it, shouting and cursing as he did so.” The truth was that no particular therapy had any consistent effect on the progress of the disease. Even today, medical textbooks prescribe only symptomatic treatment for patients with yellow fever, with emphasis on bed rest and nursing care.

The author also tells the intriguing story of the differing views about what caused yellow fever. For most of the 19th century, the cause of the disease was hotly debated. In the 1790s, Benjamin Rush and Noah Webster proposed that the pestilence was a product of a local miasma generated by decaying animal and vegetable matter. Later on, others theorized that local contagion spread the disease and only quarantine would control epidemics. Still later, bacteria were deemed to be the cause. Near the end of the century, the mystery remained unexplained.

Meanwhile, in the early 1880s, an extraordinary series of experiments was being carried out by an obscure Spanish-speaking physician in Cuba. In 1881, Dr. Carlos Finlay set forth the hypothesis that the culex or Aedes aegypti mosquito was the agent of transmission of the yellow fever virus. The results of his investigation were published in the American Journal of the Medical Sciences in 1886. Curiously, few scientists took his work seriously; some even called him a crank. Yet Carrigan shows that Finlay had found the correct solution, by means of intense observation, experimentation on himself and others, and inspired intuition. Only in 1901, backed by the considerable power and resources of the U.S. Army in Cuba, did Dr. Walter Reed and his research team finally obtain the experimental results that confirmed Finlay's theory.

A great deal more in this book deserves mention. There are accounts of heroic doctors, nurses, and members of the clergy who offered help to the sick and dying. There are sad stories of the city's power structure — politicians, business leaders, and newspaper editors — all joining the chorus of denial about the true extent of the ravages of the disease. For their own commercial interests, they wished to keep alive “the myth of New Orleans' salubrity.” With great skill the author offers a vivid and frightening account of the great epidemics of the 1850s, when the city's hospitals and morgues and cemeteries overflowed with unburied dead.

At the end of the book Carrigan traces the city's unfulfilled promise to the incursions of yellow fever. Long before, Thomas Jefferson had noted the wonderful location of New Orleans at the mouth of the Mississippi and predicted that it would become “the greatest city the world has ever seen.” In 1840 New Orleans was still the nation's third-largest city. By 1860 it had declined to 6th place, and by 1900 it had fallen to 12th. Clearly the threat of yellow fever and the city's growing reputation as “the great Southern graveyard” correlated with its declining fortunes.

Physicians around the world today are confronting the challenges of new diseases and mysteriously rampant infections: AIDS, drug-resistant tuberculosis, mutations that cause cholera to defy conventional treatment, exotic viruses, and untreatable bacteria. It should be an educational experience and also some consolation for doctors to recall the time in medical history when epidemics of yellow fever were finally brought to an end.

Richard M. Hunt, Ph.D.
Harvard University, Cambridge, MA 02138