Lessons from America's Tropical Epidemic In 1878, an outbreak of yellow fever crippled Memphis, Tenn., fueled by unusually warm temperatures. America's yellow fever epidemic has again become relevant, as a case study of how warm temperatures shift disease trends.

Lessons from America's Tropical Epidemic

Lessons from America's Tropical Epidemic

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Memphis in 1870 was a bustling port town on the Mississippi. Albert Ruger/Corbis hide caption

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Albert Ruger/Corbis

Memphis in 1870 was a bustling port town on the Mississippi.

Albert Ruger/Corbis

Molly Caldwell Crosby, author of a history of yellow fever, stands on a bluff of the Mississippi River outside Memphis. Joseph Shapiro, NPR hide caption

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Joseph Shapiro, NPR

Many of the epidemic's victims were hurriedly buried in Elmwood Cemetery. Courtesy of Elmwood Cemetery hide caption

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Courtesy of Elmwood Cemetery

An 1879 newspaper illustration of a nun visiting a Memphis household quarantined for yellow fever. Memphis/Shelby County History Room, Memphis Library/Berkley Books hide caption

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Memphis/Shelby County History Room, Memphis Library/Berkley Books

A modest stone marks the graves of the four nuns of St. Mary's who died caring for victims of yellow fever. Courtesy of Elmwood Cemetery hide caption

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Courtesy of Elmwood Cemetery

Some scientists warn that global warming could lead to a spread of disease, as the range of where mosquitoes, ticks, mice and other carriers of disease can live expands.

In the United States, people are protected by good sanitation, medicine and wealth. But it's worth remembering that Americans were once terrorized by diseases associated with hot weather. In the 18th and 19th centuries, yellow fever killed more than 100,000 Americans.

The sweltering port cities of Philadelphia, New York and New Orleans all experienced major outbreaks. But the worst swept through Memphis, Tenn., like a biblical plague.

In 1878, people in Memphis began reporting strange weather. It was hot that year, and it got hot early.

"There were newspaper articles and personal accounts that the flowers had bloomed in January and February. They, by March, were already having 80-degree temperatures," says Molly Caldwell Crosby, author of The American Plague, a history of yellow fever.

"It's a very ugly disease — things like eyes bleeding, nose, ears, some pretty gruesome symptoms," Crosby says. "But then it also causes internal bleeding. And one of the telltale signs of yellow fever is what they call 'black vomit.' It's from digesting internal bleeding."

Victims' skin and the whites of their eyes turned yellow. "One New Orleans doctor performing an autopsy that summer described it as bright canary yellow," according to Crosby.

There had been yellow fever epidemics in Memphis before, but never anything like the outbreak in 1878.

Back then, Memphis was a busy trade route for the steamboats that went up and down the Mississippi River.

Visiting a neighborhood of old brick buildings close to the water, Crosby explains, "This would have been ground zero for the outbreak of yellow fever. It was right along the shore of the Mississippi River. There was a lot of poverty. They did have sanitation problems."

The Memphis board of health officially reported the first case on Aug. 14, 1878: a woman who ran a snack shop. News of her death set off mass panic.

"Within hours, the woman's body was burned (and) her building was closed off," Crosby says. During the next three days, between 20,000 and 25,000 people left the city.

More than half of the city's population eventually fled. People left front doors wide open and their silverware set on dining room tables.

Those who stayed behind were largely poor. Many were immigrants; many were black. Of 19,000 people who stayed, 17,000 got sick. More than 5,000 died.

Martyred Caregivers

One who stayed behind was Sister Constance at St. Mary's Episcopal Cathedral. She went from house to house to care for the sick. Sometimes she found abandoned children amid the rotting corpses of their parents.

People thought the disease was spread by bad air. So, even though temperatures were close to 100 degrees that summer, they boarded up their windows and kept fires burning to ward off the outside air.

When people died, their clothing and even their beds were dragged into the streets and burned — because it was thought that would keep the disease from spreading.

After just a few weeks, Sister Constance started to shake and her own skin turned hot to the touch. She knew what that meant. Crosby writes that when the other sisters made up their best mattresses with fresh linens, Sister Constance said no — and took a cot instead.

"She was sick for several days. The night before she died, she said to her nurse, 'I shall never get up from my bed,' Crosby says. "Her last words were: 'Alleluia, Hosannah.' Praise be to God."

Today, those words are engraved in the altar at St. Mary's. Also engraved are the names of the six nuns and priests who died caring for the sick. They're now celebrated as martyred saints by the Episcopal Church.

Elizabeth Wirls works at St. Mary's. "You really do feel their presence," she says of the saints. "It's like they're calling to you. You can do more. It's about ... being called to do for others, not picking and choosing who you do it for."

The nuns and priests are buried at Elmwood Cemetery. Every time a yellow fever victim was buried, the cemetery-keeper's young daughter, Grace, would ring the cemetery's heavy bell — until she came down with the fever, too.

Praying for Respite

The worst of the epidemic lasted for six weeks. Crosby writes that often the only people who dared go out on the streets were the collectors of the dead. With horse and wagon, they shouted "Bring out your dead!" They took the bodies to this cemetery for a hasty burial.

"We are standing over 1,400 bodies, right here," Crosby says, standing in Elmwood Cemetery. "This was a large, mass grave. The grave diggers were burying over 50 people a day, and sometimes only six inches beneath the soil. They didn't have time to dig a full 6 feet. They believed at that time that the corpses could also be spreading disease, so they were trying to get them under the ground as quickly as possible."

The names of the dead were written in ink in leather-bound ledgers. People waited anxiously for fall and the first frost. From experience, they knew that the deaths would stop then, but in 1878, they had no idea why.

It would be another two decades before it was widely understood that yellow fever is spread through the bite of a mosquito, and that the infected insects were stowed away on shipments from Africa that went through the Caribbean and then onto boats to New Orleans and up the Mississippi.

Mosquitoes' Modern Threat

Today, Memphis is still a transit hub — for airplanes, trains and — just like in the 1800s — boats.

On a bluff above the wide Mississippi River, Crosby says, "We're looking over toward President's Island. That's where a lot of the ships came through. The John D. Porter, the Golden Crown — a number of the boats that came through that landed feverish people in Memphis."

Because of the warm weather in 1878, this city had two or three times as many mosquitoes as usual.

They bit someone who was already infected, then bit somebody else — and the disease kept spreading.

Today, yellow fever is no longer much of a threat in this country. There's a vaccine, modern sewer systems and ways to control mosquitoes.

But 25 years ago, a scientist working at another Memphis cemetery, just down the street from the one with all the graves of yellow fever victims, checked a trap and discovered the first Asian tiger mosquito found in the United States. That mosquito spreads another illness: West Nile virus.

Some scientists blame global warming for the tiger mosquito's spread to 26 states and as far north as Illinois. But those first mosquitoes got to the United States the same way as the ones that brought yellow fever — by breeding in pools of water, on boats that made their way across the oceans.

Excerpt: 'The American Plague'

The American Plague book cover

Chapter 4: A City of Corpses

Even the lime could not cover the smell of death as Constance stepped off the train platform on August 20, 1878. The wind car­ried the odor for three miles outside of the city. Sister Constance and Sister Thecla returned from a vacation on the Hudson as soon as they heard the news of the fever; the sisters were the only ones traveling into Memphis.

As they made their way through the town, signs of plague were everywhere. Across the street from the marble fountain of Court Square stood a white, clapboard building flanked by two staircases. It was the headquarters for the Memphis Board of Health. In front of it, wagons filled with disinfectant held shovels protruding out of the flatbed like broken limbs. On a trip through the city the shovels would empty the chalky chemical as downy as falling snow; on the return trip, the shovels picked up badly de­composed bodies.

The carriage pulled away from the downtown train station, up Poplar Street past the empty courthouse on Main. It moved slowly through the streets, navigating the huge sinkholes and cor­roded paving. The smell of the Gayoso Bayou and all its decay was heavy in the air. A hot breeze lifted the treetops and, already, the leaves began to burn at the edges. In spite of temperatures that hovered around 100 degrees, residents had been advised to keep fires burning within their homes to cleanse the air, and windows were boarded shut against the pestilence.

As the sisters entered the infected district, yellow pieces of cardboard marked the doorways of the ill. On many porch fronts, black replaced the yellow cardboard with white chalk scrawled across it — Coffin Needed — and the dimensions for a man, woman or child.

It was a pitiful parting in a time of extravagant mourning. Un­der normal circumstances, the dying family member would have had the opportunity to say good-bye to all loved ones as they gath­ered bedside to hear the last words. The family would then have drawn the blinds, covered mirrors in black crepe and stopped all of the clocks. Strands of the deceased's hair might be cut and wo­ven into shapes like a cross to display in a glass case in the parlor. Even the children and babies would take part in the mourning, wearing a touch of black. The body would be packed in ice if it was summer and laid out in the parlor — a tradition that with time would dwindle, and the term parlor would be replaced by the living room. Finally, the women would stay behind in the home, while pallbearers in black gloves carried the coffin to its place of burial, where it would be draped with fresh flowers. Formal announcements of death would be mailed. And the widow would forgo any gold or silver jewelry wearing a dark veil during the following year and black garments for the next two and a half years.

During the epidemic, however, families prepared their own for burial, cleaning the bodies when there was time, placing the corpse in a pine box with a mixture of tar and acid before bolting the lid closed. They would listen. At some point during the day, in the suffocating silence, a team of six horses pulling a wagon would come up the block and announce, "Bring out your dead!"


A man met Constance in the street with a telegram. It was sur­prising to receive such an official note. Only days before, the newspaper had published a notice from the telegraph company re­questing people to pick up their own messages; all of the messen­gers had left the service of the agency.

The messenger handed Constance the telegram. Father and mother are lying dead in the house, brother is dying, send me some help, no money, signed Sallie U.

"Will you go to that poor girl?" he asked.

A number of nurses, doctors, ministers or nuns later wrote of the fear that accompanied them the first time they entered an in­fected home. They had nursed hundreds from the halls of sick wards, but it was something else all together to climb the steps of a porch and open a door with a yellow card swinging from a nail. The first thing to strike was the smell. It floated into the streets, a scent like rotting hay. The smell grew stronger and overpowering once the front door opened, where it mingled with soiled sheets, sweat and vomit. Inside, one never knew what to expect. Moans, cries, delirious screams, or worse, no sound at all. There was dark­ness, as windows were boarded shut, and there was the stagnant heat of imprisoned air. Then, as their eyes focused, they saw the bodies. At first it was hard to tell which ones were living and which were not. If deceased, one could never know how long they had been that way or in what condition they would be.

Constance arrived at a small but neat home. Serpentine wa­termelon vines grew wildly around the homes in the neighbor­hood, and abandoned cats and dogs howled for lost owners. A pretty young girl in mourning led her into the house. Dust floated, effulgent, in the shafts of afternoon light, and the air was heavy as steam. One corpse lay on the sofa, another one on the bed, their skin yellow and tongues black. A tall young man, nearly naked, was also in the bed, delirious, rocking back and forth. His eyes sank deep into his cheekbones ringed by bruised half moons. Outside the window, Constance heard a crowd gathering, presumably to loot the house once all were dead. Constance ran into the yard and shouted at them to leave, warned them of the plague. They scat­tered like insects in the sunlight.

The healthy were not permitted to touch the dead for fear of spreading the disease further, so Constance sent for an under­taker. But, it could take as long as two days to have the bodies re­moved. Mr. Walsh, the county undertaker, refused to pay extra wages to the colored men loading and unloading the bodies. Finally, he was arrested. From then on, the men were promised five dol­lars for an adult corpse, three dollars for a child. In the meantime, the Citizen's Relief Committee arranged burial patrols to locate bodies by report, smell or even the low flight of buzzards. At the hospitals, patients died so quickly that thirty new corpses might be piled in the dead house before the undertaker returned from the cemetery.

The grounds of Elmwood Cemetery were bloated with shal­low graves, some only sixteen inches beneath the surface. Deep, muddy scars cut into the grounds where coffins had been laid side by side in long rows in the earth. And on more than one occasion, a knock was heard before the lid was screwed tight or the coffin lowered into the ground, and a patient, thought to be dead, would call out from inside.

Elmwood was two and a half miles outside of the city between a railway line and North Walker Avenue. A streetcar ran from the city to the cemetery every ten minutes where visitors with admis­sion tickets could visit family plots. Weeping willows, seashell roads and flowers made the cemetery a peaceful place of recre­ation. Families purchased plots at Elmwood — an adult, white, first-class plot cost about fifteen dollars, while an adult, black, second-class plot cost around twelve dollars. Headstones could cost anywhere from two and a half to seventy dollars. Cemeteries had long ago moved away from church graveyards to larger land holdings outside of cities to prevent the spread of disease. Still, Elmwood strictly enforced its rule about internments — a body could only be moved during the months of December through March, considered the non-epidemic months, unless the body had been dead five years.

A young girl named Grace lived with her father, the superin­tendent, in a cottage at Elmwood. She tolled the bell each time a body was buried and kept the names in a large, red leather log­book. During the month of September, there was page after page of yellow fever victims. It was said that the bell at Elmwood tolled constantly that month.

Excerpted from The American Plague by Molly Caldwell Crosby Copyright © 2006 by Molly Caldwell Crosby. Excerpted by permission of Berkley Publishing Group, a division of Penguin Group USA, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.