Yellow fever is an infectious disease transmitted to humans from monkeys through the bite of infected Aedesaegypti mosquitoes. This disease cannot be transmitted from person to person.  Once a person contracts this virus, they have 5-25% chance of becoming ill, depending on the strength of each individual’s immune system.  Yellow fever was known as yellow jack, saffron scourge, sylvatic yellow fever, urban yellow fever, vómito negro (black vomit- vómito prieto), totaling more than 150 names.

Figure 1.1. Yellow Fever Patient’s Clinical Chart

This clinical chart tracks Charles Raymond, yellow fever patient’s health progress, his pulse and temperature were recorded over a period of several days until he was discharged. He was treated by Dr. Paul Osterhaut in Bocas del Toro, Panama

Yellow fever presents itself through a variety of symptoms including chills, fever, weakness, nausea, decreased urination, delirium, muscle and lower back aches, irritability, and restlessness, seizures, vomiting, and can lead to a coma. Symptoms usually occur 3-6 days after infection; the fever lasts between 3-4 days and is followed by remission and a second febrile phase, which is the most dangerous, affecting internal organs such as liver and kidneys, causing jaundice and hemorrhages in the digestive tract.  This in turn causes the yellow coloration of the skin and white of the eyes and of vomiting a black substance.

Figure 1.2. The Symptoms of a Yellow Fever Patient

This chart tracks Vaughan Philpott’s health progress from the first to the sixth day of his treatment for yellow fever starting on February 15, 1906 in Bocas del Toro, Panama. The patient was pronounced dead on the sixth day by Dr. Paul Osterhaut.

During the 19th century, it was a common belief that the firing of a cannon disrupted air particles, creating large amounts of air turbulence that could destroy the unknown agent that caused yellow fever. Along with this procedure, a common treatment for yellow fever was fumigation and burning sulfur in the patients’ room. This treatment actually caused patients to cough consistently and even choke because of the sulfuric fumes. Following the smoking of sulfur, the physician continued treatment by using a lancet to bleed the patient so rapidly they usually fainted. This treatment was known as “syncopal bleeding”. Afterward, the patient was encouraged to take large doses of calomel, which is toxic and causes people to salivate continuously and suffer from uncontrollable diarrhea. Alongside the toxic calomel, the patients were given cinchona bark, an anti-malarial agent, which actually caused intense stomach irritation and bouts of vomiting. To reduce this harsh effect, doctors applied poultices to the skin on the abdominal area which oftentimes caused blistering of the skin (VanItallie 329). Following this harsh treatment, patients’ temperature oftentimes returned to normal for a few days during remission and later rose again during the third phase. The patients soon began suffering from jaundice and vomited a black substance resembling ground coffee. They also bled from the mouth, nose, and eyes, due to the inflammation of the liver. After this level of illness, the patient usually fell into a coma, often resulting in death. The harsh treatments were replaced with more soothing procedures towards the end of the 19th century. New remedies consisted of hot mustard foot baths, bed rest, crushed ice and lemonade, cool sponging, and gentle nursing care (VanItallie 332).

Figure 1.3. Isolated Patient

This image shows a doctor treating a yellow fever patient, the uncertainty is present in the spectators’ faces.

Quarantines were very common during this time, which along with improved sewage and drainage facilities, helped keep the disease controlled.  A simple rumor of the presence of the disease caused massive blockades against the infected city.  Quarantine laws were also passed to prevent ships carrying infected persons or people coming from cities which had an outbreak from landing in ports that were not infected.  Congress created the National Board of Health in 1879 to establish a national quarantine system.

Figure 1.4. Isolated Patient

A patient is isolated in a specially made quarantine room.

There have been several major pandemics and epidemic of yellow fever throughout the world.  Historical records indicate that yellow fever affected Europe after the Roman Empire collapsed.  In the 1760s a pandemic outbreak in Cuba killed thousands of English and American troops.  At that same time in Philadelphia, the largest outbreak in the United States was taking place, killing ten percent of the total population of Philadelphia.  Napoleon also lost half of his 40,000-troop army to the disease in 1802 in Haiti.  This disease took the lives of many early American settlers and also deterred the French from constructing the Panama Canal when this area suffered from an epidemic in 1904.  The last epidemic of yellow fever in North America occurred in New Orleans in 1905 but this disease continues to kill an estimated 30,000 people annually in Africa and South America. 

The disease was especially prominent in port cities starting as early as the 1690s.  It struck at ports from Boston all the way to New Orleans and the Gulf of Mexico.  Philadelphia, New York, Galveston, and Brownsville were some of the cities that were often times affected due to the appearance of mosquitoes in those areas.  The disease usually destroyed between 5 to 10 percent of the population of cities which suffered from outbreaks, but this statistic increased to up to 20% mortality rate during major outbreaks.

Figure 1.5. Letter to Surgeon-General in Washington, D.C.

This excerpt is from a letter from Dr. Osterhout to the Surgeon-General, in Washington D.C., regarding the second Yellow Fever victim case in Bocas del Toro, Panama. August 23, 1905.

During the 1850s, a series of epidemics struck every city along the cost from Norfolk, Virginia all the way down to Brownsville, Texas. New Orleans, St. Augustine, and Jacksonville were some of the North American cities that were affected by yellow fever epidemics.  During the 1853 New Orleans epidemic, more than 3,000 cases occurred.  It lasted four months and resulted in about 1800 deaths. During this decade, New Orleans lost almost 20,000 people due to four difference epidemic outbreaks.  Following that time period, the incidences decreased until the reappearance of one final outbreak in 1905 in New Orleans.  This was the last major outbreak, which was successfully terminated with the help of effective mosquito control (Duffy 688).

Figure 1.6. Major Outbreaks in the U.S.

This map pinpoints some of the major yellow fever epidemics in different cities in the United States

For access to more documents on yellow fever, search ‘Our Americas’ Archive Partnership (a digital collaboration on the Americas) or click on the supplemental links in the upper right hand corner of this module for Kezia Payne DePelchin, Paul Osterhout, or the different variations of yellow fever (such as vómito) mentioned earlier.

Duffy, John.  “Yellow Fever in the Continental United States during the Nineteenth Century.” Bulletin of the New York Academy of Medicine (1968) 44.6: 687-701.  Print. 11 Mar. 2010.

VanItallie, Theodore B. “Yellow Fever, the Doctors, and their Victims in the 19^th Century South.” Florida Historical Quaterly (1995) 74: 329-33. Web. 11 Mar. 2010.