Tools of the Trade: Stanger's Fever

In a rush this morning (not a Benjamin Rush, thankfully...) so here's one from the archives circa August 2011:

The yellow jack was indeed a killer: it was difficult to fix upon any satisfactory figure, though he had heard well-authenticated accounts of a mortality amounting to eighty in a hundred. ~ from The Commodore by Patrick O'Brian.

This is just a bit of the musings that go through Doctor Stephen Maturin's mind upon realizing that he has contracted yellow fever off the coast of West Africa. The disease, which we now know is transmitted like malaria by mosquitoes, was the scourge of tropical areas all over the world. To this day there are pockets of swampy land that still harbor the deadly aedes mosquito and travelers to certain parts of the globe are advised to get vaccinated before leaving home.

In the Great Age of Sail, it was people from out of town, so to say, that tended to contract yellow fever. Locals often suffered a milder form of the disease, which did not reach the so called "toxic state" in childhood, thus building up a relative immunity. This meant that sailors from Northern shores would find themselves sick after spending time in places like the Gulf of Mexico, the West Indies, the Indian Ocean or, as O'Brian notes, the African Coast. Maturin's figures are generally accurate; mortality among sufferers was about 80% over all.

Symptoms follow a fairly recognizable path, with the patient experiencing a fever as high as 103 degrees and all the accompanying miseries: head and body aches, chills and loss of appetite. The toxic phase was experienced when internal organs began to shut down. Stomach bleeding let to the tell-tale "black vomit" along with bleeding from the nose, mouth and sometimes even the eyes. The skin and eyes took on a yellow hue as the liver and kidneys ceased to function. General lividity of the skin ensued and the patient suffered temperatures as high as 106. In these cases, death was a virtual certainty.

In the 17th and most of the 18th century the disease was treated like any other fever. A sufferer was put to bed, or in the case of a sick berth aboard ship strapped into a hammock, and given clean bedclothes whenever possible. Bathing with a cloth dipped in cool water and vinegar was often recommended with the head and hair being included in the process. Sometimes the patient was wrapped in woolen blankets and put near a fire to help "sweat out" the fever. Quiet and calm around the sick person was always thought best. Unfortunately, so was bleeding.

In the late 18th century, the rise of the medical profession pushed aside the homey, comforting remedies of mothers and wives and began aggressive treatment for yellow fever. One of the most famous proponents of hitting the fever hard was Dr. Benjamin Rush, signer of the Declaration of Independence. Rush was a physician in Philadelphia when the famous epidemic of the summer and fall of 1793 hit the city. While other doctors were prescribing barley water and Peruvian bark (quinine), along with the cooling baths mentioned above, Rush was vigorously removing liters of blood. He also prescribed purges to induce vomiting and diarrhea as soon as the fever came on.

Though Rush's proactive treatment may have appealed to the idea of "doing something" that the sick and their loved ones frequently harbor, it was in fact something akin to a death sentence to his patients. The aggressive bleeding combined with regular purging took out the much needed fluids that would have helped the patient battle the disease. While Rush blamed any patient's death on his not being called soon enough, other physicians in Philadelphia grumbled that Rush was as fatal as the disease.

Well into the 19th century, people from cooler climates blamed yellow fever on the hot, humid "miasmas" common to more southern latitudes. The yellow jack, as it was frequently called in the American South and the Caribbean, became known as the Stranger's Fever in Britain and the northern U.S. While the British never seem to have developed a specific prejudice in this regard, people in the United States definitely did. By the 1820s the Stranger's Fever was considered to be just another example of how filthy and backward the South really was. Forgetting the horrors suffered in Philadelphia, the northern states imagined themselves capable of keeping their cities clean and avoiding pestilential disease.

Meanwhile, men at sea continued to experience yellow fever into the 20th century. Even after the discovery and partial eradication of the aedes mosquito which occurred in large part thanks to efforts begun during the building of the Panama Canal, some areas of the world continue to experience infection. Modern scientists worry about two possible scenarios that could bring the killer back with a vengeance: global warming and biological warfare. Perhaps it's best that none of us forget about warm bedding and barley waters quite yet. Better still: get vaccinated.

Header: Nuns nursing yellow fever patients in Philadelphia, 1793 via Dipity's timeline of the epidemic