The Deadly Visitor: Yellow Fever

Now no longer a threat in the civilized world, yellow fever was for almost 75 years a regular and deadly visitor to Texas' Gulf Coast.

What Yellow Fever Is

The name yellow fever comes from the deep jaundice that occurs during the latter stages of the disease, causing the patient's skin to take on an intense yellow hue. Other symptoms in severe cases of the viral disease include headache and backache, high fever, dizziness, nausea and vomiting. The disease attacks the major organs of the body with a general infection, causing fatty degeneration of the liver, kidneys and heart. Hemorrhaging from the mucous membranes leads to the "black vomit" that is characteristic of the final stages of yellow fever. Death may occur four to eight days after onset. Many cases are much milder, however, and are often mistaken for other fevers. Recovered cases are immune for life.

Yellow fever was also called "yellow jack" from the quarantine flag (or jack) raised on incoming ships by port inspection officers when suspicious signs were found in passengers or crew members. The dread disease is thought to have originated in Africa and to have come to the New World as a stowaway aboard merchant vessels, starting in the 17th century. The aedes aegypti mosquito, which carries the fever, could breed happily in the open barrels of drinking water that were routinely carried on sailing ships in those days.

Outbreaks of Yellow Fever in Texas

According to Dr. Greensville Dowell's 1876 report on yellow fever and malarial diseases, the first outbreak of yellow fever in Texas occurred in 1833 in Columbia (now West Columbia) in present-day Brazoria County. From then until 1907, the unwelcome guest made almost-annual appearances in the state, mostly along the Gulf Coast, with an occasional sortie inland. Epidemics occurred in 1833, 1839, 1844, 1847, 1848, 1853, 1854, 1855, 1858, 1859, 1862, 1867, 1873, 1878, 1897, 1898, 1899, 1903 and 1907.

During the 1833 outbreak in Columbia, Dr. John Tinsley, a druggist and a German physician named Jaeger reported about 60 cases with 32 deaths. Asiatic cholera also was introduced that year, dealing coastal residents a double blow.

Details of the yellow fever epidemic of 1839 were minutely observed, recorded and published by Dr. Ashbel Smith in the first scientific paper published in Texas. Smith had been surgeon general of the Texas army and went on to serve the people of Texas as diplomat, state representative and agricultural scientist. He also was one of the major catalysts in the establishment of the University of Texas and its medical branch at Galveston.

In a letter to Dr. Casper Wistar Pennock written Oct. 21, 1839, Smith related, "About the first of this month, the Yellow Fever made its appearance on the Strand (in Galveston)." He went on to describe the Strand – Galveston's major commercial street – as being located near a swampy "morass." Since yellow fever and malaria disappeared when cold weather arrived or when marshes or other areas of stagnant water were eliminated, many people concluded that "bad air" or "marshy emanations" caused the diseases.

Common 19th-century Treatments

Smith generally agreed, but he also realized that yellow fever was not contagious and that minimal medication and maximum nursing care were better treatment than the harsher remedies employed by many other physicians of the day. He favored quinine and calomel, whereas others used – alone or in various combinations – castor oil, powdered charcoal, sulphate of zinc, oil of black pepper, chlorine water, Dover's powders, extract of dandelion, pulverized capsicum (red pepper), phosphate of lime, carbonate of lime and elixir of vitriol, not to mention bloodletting.

During the epidemic of 1847, Smith gained intimate personal knowledge of the disease, He described his case as "severe": he could not sit up in bed for 11 days, and he fully expected to die. Smith recovered, however, and went on to treat victims of many subsequent outbreaks.

There were no trained nurses prior to the Civil War. Doctors helped as many victims as they could, but doctors were no more immune to yellow fever than their patients. Usually family members and neighbors had to nurse each other. Some of those who had survived bouts of the disease and were, therefore, immune organized into so-called Howard Associations to care for the sick, particularly around Galveston and Houston.

But the epidemics were not confined to Galveston and Houston. Publications of the period reported cases also in Brazoria, Richmond, Indianola, (Port) Lavaca, Liberty, Victoria, Brownsville, Matagorda, Sabine, Corpus Christi, Liverpool, Hockley, Cypress and La Grange, as well as other locations.

Contemporary descriptions of life during an epidemic are graphic. Amelia Barr, a novelist who lived in Texas from 1856 to 1868, described one outbreak in Galveston: "It was a terrible time. Little green frogs were everywhere and their croaking was incessant. The oleanders were sickeningly sweet and a terrible depression hung over the whole city. The cracking of ice, the moaning of the sick, the weeping for the dead or dying, the haggard faces of those well enough to nurse . . ." An account in an 1840 newspaper stated, "The sight of hearses dashing along at a gallop, without a mourner following the corpse, was horrible." A description of the 1867 epidemic in La Grange mentions mass burials in trenches at the site of the town's present cemetery with no markers erected.

Local Quarantines Partially Effective

Sporadically, public officials used quarantines to attempt to control the spread of yellow fever during the 1840s, but enforcement was not effective.

On March 31, 1850, the voters of Galveston passed quarantine regulations, which were strengthened in 1853, when money was appropriated to build and staff the first quarantine station in Texas. The captain of a ship from the infected port of New Orleans circumvented this checkpoint by landing his passengers on the beach, from which they freely walked into the city. Clearly, more stringent measures were needed.

State-legislated Quarantines Help

In 1856, the Texas Legislature authorized local governments across the state to set up quarantine regulations within their jurisdictions. This is considered to be the nucleus that evolved into the Texas Department of Health.

The Legislature enacted much stronger regulations in 1870, including authorizing the governor to declare a quarantine and to assess all incoming vessels a fee of 50 cents for every person on board.

Strict, sometimes vicious, enforcement of these 1870 quarantine laws provided the first ray of hope since the scourge first appeared on the Gulf Coast: The outbreak of yellow fever that year in Galveston resulted in only 16 deaths. In 1873, only seven people died. And in 1876, when yellow fever appeared in New Orleans, Texas' strict state quarantine officer refused to let any ships from the Louisiana city dock in Texas ports. Louisiana and Texas merchants alike complained bitterly, but the officer would not relent. There was no yellow fever in Texas that year.

Ironically, the very measures that made life along the Texas coast healthier caused development to suffer. With each quarantine, commerce was hobbled. Trade slowed to a crawl. Construction was postponed. Building of the Galveston, Harrisburg and San Antonio Railway was delayed when yellow fever broke out in the construction camps west of Columbus.

As the effects of the stringent quarantine enforcement became evident, newspapers, local officials and merchants became increasingly reluctant to admit the presence of yellow fever, so that the life and commerce of their cities would not be disrupted. But courageous doctors such as Ashbel Smith and Greensville Dowell continued to publish factual accounts of each outbreak.

Carrier of Yellow Fever Identified

Although Texas scientists and physicians had observed that yellow fever occurred near marshy areas and disappeared with cold weather, none had connected it to mosquitoes. In 1848, an Alabama physician, Josiah Clark Knott, published a paper suggesting that yellow fever was of insect or animal origin. The mosquito was suggested as the culprit in Cuban physician Carlos Juan Finlay's paper that was read before the Royal Academy in Havana, Cuba, in 1881.

But the mosquito as the carrier of the dreaded yellow jack was not proven until August 31, 1900, when a member of Dr. Walter Reed's Yellow Fever Commission, Dr. James Carroll, contracted the disease after being bitten by an infected mosquito on August 27. Anti-mosquito measures caused immediate improvement in cities, and the last recorded epidemic on the Texas Gulf Coast was in 1907. Finally, a vaccine was developed, which was made available around the world between 1940 and 1947.

But the yellow jack is not dead. It lives on today in monkeys in the jungles of South America and Africa. The disease could travel from monkey to jungle mosquito to traveler back to civilization to domestic mosquito to city dweller. There still is no specific treatment for the disease; prevention by eliminating the yellow fever mosquito is the best control.

— Written by Mary G. Ramos and first published in the 1988-1989 Texas Almanac.