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Yellow Fever Throughout History

Yellow Fever Throughout History:

The role of science and epidemiology

Caroline Buxenstein

History of Infectious Disease

CCBC
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Yellow Fever Throughout History

A significant part of human history has been the role infectious diseases have played in

shaping the path of history. Studies of human remains, and ancient writings have depicted the

impact of infectious diseases for centuries. One disease that has impacted history is known

commonly as yellow fever. Yellow fever is defined by the World Health Organization as being

“an acute viral hemorrhagic disease transmitted by infected mosquitoes.” (WHO,2018) The

major symptoms of yellow fever include fever, jaundice, muscle pain, nausea, vomiting, fatigue

and headaches. The severity of the symptoms of yellow fever vary between people. Of the

people with Yellow fever who experience severe symptoms, about half of them will die from

yellow fever. Research has revealed that yellow fever evolved approximately 3000 years ago in

Africa. (Centers for Disease Control an Prevention, 2018)Advancements of transportation and

colonization have led to the spread of yellow fever around the world. With the development of

the slave trade the first well known and documented cases of yellow fever emerged. In the 1600s

yellow fever’s strengthening impact on civilization can be seen in documentation. Through the

spread of ships from Africa yellow fever was able to travel to virgin populations. In 1648 the

first concrete example of yellow fever in the Americas was documented by the Mayan people.

From this documented outbreak yellow fever was then documented in 1668-1699 on the east

coast of the United States. (Centers for Disease Control an Prevention, 2018) The desire to

understand yellow fever grew as the number of people infected increased. Although the desire to

understand Yellow Fever strengthened it would not be until the early 1900s that the scientific

understanding behind yellow fever would be developed. The desire to understand the growing

impact of yellow fever did not match with the science and epidemiological knowledge of the
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Yellow Fever Throughout History
time. Therefore, the spread of yellow fever throughout history was influenced by the lack of

knowledge about epidemiology, and the science of infectious diseases.

The study of epidemiology encompasses a portion of medicine that is concerned with

distribution and control of diseases. The modern study of epidemiology allows for prevention

and limitation of the spread of infectious diseases. Documentation from outbreaks of yellow

fever in history shows early attempts to establish observation methods similar to modern

epidemiology. One document from the yellow fever outbreak in Philadelphia describes the

different observations and knowledge of yellow fever during that time. Outbreaks of yellow

fever spread throughout the 1600s and on like waves. Washington Watts discusses his

observations about yellow fever and attempts to discuss topics such as the cause of yellow fever

in the late 1700s. Watts discusses yellow fever by saying “For the production of these fevers, or

rather fever, there appears to be wanting the concurrence of three circumstances (in all countries)

viz, heat, moisture, and decaying vegetable or animal substance” (Watts, 1799) Watts goes on to

discuss each of these factors in depth. Watts observes that heat alone is not enough to produce

diseases. He also discusses moisture and dead animals impact on the prevalence of yellow fever.

Although Watts makes observations and hypothesizes these factors are a cause of yellow fever

his understanding of the spread of disease is limited. After applying all his observations Watts

goes on to discuss what he believes the cause of yellow fever is. Watts says “The miasmata

emitted from animal and vegetable substances during their putrefactive process, form the remote

cause of yellow fever, will appear probable.” (Watts,1799) Although Watts and other people

during yellow fever outbreaks attempted to observe the factors for yellow fever they were unable

to do so successfully.
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Yellow Fever Throughout History
Without the advancements of modern epidemiology yellow fever continued to spread. In

Memphis in 1878 yellow fever became a major concern. After discussions the health department

decided to use quarantine techniques to try and stop the introduction of yellow fever into the city.

The theory during 1878 in Memphis was that yellow fever was spread through filth and

uncleanliness. In The American Plague it addresses the understanding of yellow fever and

quarantine by saying “If yellow fever was a sanitary matter why would quarantines be

necessary?” (Coldwell-Crosby, 2006) In August of 1878 the health department declared a

yellow fever epidemic in Memphis. Although the health department attempted to prevent a

yellow fever epidemic without modern understanding of epidemiology and science it was

ineffectual. In response to the epidemic people fled the city in attempts to avoid yellow fever.

The changes in population in Memphis is described as “The city boasted a population of 47,000.

By September, 19,000 remained and 17,000 of them had yellow fever.” (Coldwell-Crosby, 2006)

Without proper understanding of how yellow fever spread the people were left defenseless and

were infected at high rates. The lack of advancements in epidemiology worsened the spread of

yellow fever.

Without the science to back their observations people were not able to determine if

something was a contributing factor or caused by the disease. One example of this failed

understanding of the spread of yellow fever was in Cuba. After the Spanish-American war

yellow fever became endemic in Cuba. To limit the spread of yellow fever sanitation measures

were taken. The actions taken are described as “Sanitation measures in Havana (i.e., eliminating

the “miasmas” with sewage disposal, clean water and overall cleanliness) failed to curb the rising

incidence.” (Frierson, 2010) As people began to observe the potential causes of yellow fever they

attempted to find solutions. Without having the modern applications and understandings of
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Yellow Fever Throughout History
epidemiology these attempts were frequently ineffectual. Using sanitation methods could be

effective for another infectious disease, but not for yellow fever. Epidemiology goes together

with scientific understanding. Without the scientific understanding of yellow fever, the attempts

to prevent the spread of yellow fever was unproductive.

When yellow fever outbreaks occurred starting in the 1600s and continued the desire to

scientifically understand the disease also grew. Throughout history understanding of medicine

and science has constantly changed. Understanding of infectious diseases throughout history has

included the four humors, belief in miasma and germ theory. With each of these theories there

has been treatment for the infectious disease that corresponds. For example, if there was a

imbalance of the four humors practices such as blood letting could be used. During the outbreaks

of yellow fever, the miasma theory of infectious diseases was still supported, but the beliefs were

shifting to germ theory. During the 1800s into the 1900s the debate on yellow fever was between

a theory of bacterial transmission or a theory of fomites. At this time Carlos Finlay developed a

new theory for yellow fever. Carlos Finlay “believed mosquitos spread the disease. He put this

idea forward as early as 1881 but was not taken seriously.” (American Association for the

Advancement of Science, 2006) Since the theory of mosquitoes as vectors was a new idea it was

not accepted by others in the field of science. This meant that yellow fever continued infecting

people through mosquitoes until science eventually accepted the idea after further research. The

theory of miasma was supported for years regarding yellow fever because of the elements that

existed at the same time as the outbreaks. Dead animal carcasses, stagnant water and hot

temperatures were all elements that contributed to the gross and smelly belief behind miasma.

After the bacteria theory was introduced and proven people shifted away from the theory of

miasma and towards the spread of disease as bacteria. The advancements of science were
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Yellow Fever Throughout History
described as “The close of the 19th century also witnessed dramatic discoveries in the new

science of bacteriology that would transform medicine forever.” (Frierson, 2010) Through the

development of the scientific study of bacteria understanding of the spread of certain diseases

emerged. Through scientific development the number of people infected by yellow fever could

controlled and limited. The new technology would prevent future suffering that occurred

previously without the scientific knowledge.

As yellow fever raged through Cuba an American task force was developed to undertake

the objective of finding the cause of yellow fever. This task force included people like Walter

Reed. Originally scientists believed they had found the bacteria that caused yellow fever. With

this information they attempted to develop a vaccine that was not effective. After research into

the bacteria that caused yellow fever failed the team shifted gears focusing on Carlos Finlay’s

research on mosquitos as vectors. The group attempted to purposefully expose soldiers to yellow

fever by mosquito bites. After many failed attempts the group was discouraged until one of the

scientists chose to expose himself to the bite of a lethargic mosquito. The scientist became sick

with what was later discovered to be yellow fever. After further tests it was discovered that

yellow fever was spread through mosquitos. Walter Reed presented his discoveries before his

death and propelled the future prevention and vaccination for yellow fever forward. (Coldwell-

Crosby, 2006) With the understanding of mosquitos as the vector for yellow fever science was

able to progress towards a vaccine and proper applications of epidemiology could occur. In 1927

further advancements were made to understand yellow fever in the discovery of the virus. The

advancements in yellow fever were described as “Efforts to develop yellow fever vaccines began

soon after the isolation of the virus in 1927.” (Barnett, 2007) Before Walter Reed and his fellow

scientists were able to isolate the mode of transmission of yellow fever people were infected at
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Yellow Fever Throughout History
high rates. Over a few centuries the science and understanding of epidemiology was able to rise

to a level that matched the need against yellow fever.

Today a vaccine exists to protect against yellow fever. Although there is a vaccine,

availability in certain countries is limited. There has also been a variety of different

complications with vaccination against yellow fever. The battle against yellow fever is described

as “The earlier dream of eliminating yellow fever from the earth by mosquito control died with

the discovery of the jungle cycle. Vaccination still provides an essential, though often

underutilized, mode of protection.” (Frierson, 2010) Although the vaccination is not one hundred

percent effective it has decreased the number of people infected with yellow fever worldwide.

Outbreaks of yellow fever still occur in tropical and undeveloped countries around the world.

Based upon the current scientific and epidemiological advancements travelers are able to receive

the vaccination preemptively. As the scientific advancements emerged the world was finally able

to respond to the increasing number of people infected by yellow fever. Sadly, the centuries it

took to develop this information and understanding left many people defenseless against yellow

fever. Therefore, many people lost their lives or were impacted significantly from yell ow fever

until epidemiology and science advanced accordingly.

Works Cited
American Association for the Advancement of Science. (2006). AAAS resolution: Death of Dr
James Carroll from Yellow Fever Experimentation. Medicine, Health, and Bioethics:
Essential Primary sources, 270-272.
Barnett, E. (2007). Yellow Fever: Epidemiology and Prevention. Emerging Infections , 850-856.
Centers for Disease Control an Prevention. (2018, April 8). History Timeline Transcript. Retrieved
from Centers for Disease Control and Prevention: https://www.cdc.gov/travel-
training/local/HistoryEpidemiologyandVaccination/HistoryTimelineTranscript.pdf
Coldwell-Crosby, M. (2006). The American Plague. New York: The Berkley Publishing Group.
Frierson, G. (2010). The Yellow Fever Vaccine: A History. Yale Journal of Biology and Medicine,
77-85.
Schlanger, N., & Josh, L. (2010). Advances in Identifying the Causes of Major Infectious Diseases.
Sciences and Its Times.
Watts, W. (1799). Yellow Fever. Philadelphia: John Ormrod.