Yellow Fever

The New World was not immune to epidemics. North American port cities were subject to occasional but nevertheless disastrous onslaughts of yellow fever, a viral infection now known to be transmitted by mosquitoes. Cholera spread fear and death through several waves of infection, particularly during the nineteenth century. Cholera was later discovered to be caused by a bacterium and spread through food and water contaminated by human waste. For many years, though, both diseases confounded physicians and citizens alike. Observers divided roughly into two camps, contagionists and anticontagionists, which had considerable bearing on the issue of quarantine. Although writers on epidemic disease during the eighteenth and nineteenth centuries did not always maintain a pure belief in one or the other alternative, the differences can be simply stated. Contagionists took what appears to have been the commonsense position of most people through the ages, that a disease

was transmitted from one person to another. Anticontagionists, on the other hand, believed that both yellow fever and cholera were caused by many individuals coming into contact with the products of putrefaction as a result of hot weather or the inadequate cleansing of streets, homes, and businesses.^[5]

These two views postulated strikingly dissimilar conclusions not only for the origin of epidemic diseases but also for their control. When yellow fever struck Philadelphia—then capital of the United States—in 1793, government officials fled, many people died, and an acrimonious controversy ensued over the origin of the ailment. Contagionists, who were in the majority at the College of Physicians, argued that the disease had been brought into the city by a ship from the West Indies. Under this line of reasoning, quarantine of suspect ships was a wise precaution. Dr. Benjamin Rush professed the opposing view. He argued that the epidemic was caused by summer weather and the spoilage of a shipment of coffee near the wharf. He went on to assert that yellow fever was only the intensification of fever which normally "prevails every year in our city, from vegetable putrefaction."^[6] This latter view was quite in keeping with Rush's assertion that all diseases were essentially the same disruption of the body's function. From the point of view of Philadelphians, however, Rush's position was a condemnation of the city itself, while the contagionists' explanation merely called for greater vigilance, with the help of quarantine, against danger from the outside such as ships from the West Indies and visitors to the city of Philadelphia.

From the perspective of the twentieth century, the contagionist-anticontagionist controversy seems paradoxical. The contagionists correctly assumed that a specific infectious agent had to be transmitted to a person in order to elicit a specific disease. But it was the anticontagionists who, although etiologically incorrect, championed sanitary measures such as clean streets and efficient elimination of human waste which we now consider essential to a healthy community. Only later in the nineteenth century would the roles of inadequate waste disposal and mosquitoes breeding in stagnant pools be seen to be links in the epidemic chain. Rush denounced the contagionists for advocating quarantines, whose "faith in their efficacy . . . has led to the neglect of domestic cleanliness." Further, he claimed, "From this influence, the commerce, agriculture, and manufacturing of our country have suffered for many years."^[7]

The social effects of quarantine were equally deplorable:

A belief in the contagious nature of yellow fever, which is so solemnly enforced by the execution of quarantine laws, has demoralized our citizens. It has, in many instances, extinguished friendship, annihilated religion, and violated the sacraments of nature, by resisting even the loud and vehement cries of filial and parental blood.

Rush maintained that yellow fever "is propagated by means of an impure atmosphere, at all times, and in all places." Do not quarantine, he admonished, but drain the marshes and clean the streets instead. His plea to reject the contagionists' solution might have been written today about conditions found with AIDS patients: "A red or a yellow eye shall no longer be the signal to desert a friend or a brother to perish alone in a garret or a barn, nor to expel the stranger from our houses, to seek asylum in a public hospital, to avoid dying in the street."^[8] Benjamin Rush responded to the fear that created the imposition of quarantine, as well as to the cruelty that sometimes accompanied it. Such consequences are all the more regrettable now that we know that isolating yellow fever patients has no public health value whatsoever. The history of medicine, however, is filled with useless and even harmful remedies confidently applied to the trusting patient. Rush was one of many anticontagionists who not only believed that quarantines were useless, but also that those who advocated them were themselves obstacles to clean, airy, and sanitary cities.