Molly Caldwell Crosby on Untold Story of Yellow Fever

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November 5, 2006 Contagion By MARY ROACH

THE AMERICAN PLAGUE: The Untold Story of Yellow Fever, the Epidemic That Shaped

Our History By Molly Caldwell Crosby.

Illustrated. 308 pp. Berkley Books. $24.95.

When an illness is called a " fever, " it's bound to be underestimated. For years,

I've been getting yellow fever shots when I travel overseas, thinking, big deal,

you run a temperature for a few days and then you're fine. I never gave much

thought to the primary color attached to the front end of it. If anything, it

gave the disease a sort of sunny-side-up, school buses-and-daffodils sound. I

was unaware that the color refers to your liver and to your skin, which turns,

to use Molly Caldwell Crosby's effective description, " the color of unpolished

brass. "

Compared with other colors going on in your body, yellow is the least of your

worries. Red is oozing from your gums and other places there's no need to

mention here. Your tongue may turn black, matching the " black coffee ground

fluid " that is accumulating in your stomach and is, like the gums business, made

up of your own hemorrhaged blood. Yellow fever, the protagonist of Crosby's

frequently engrossing first book, " American Plague, " is almost as deadly a virus

as ebola.

Few Americans realize that yellow fever was not always a disease of the faraway

tropics. In 1878, an outbreak of yellow fever — the virus carried to the United

States in mosquitoes from Africa — killed 20,000 people in the Mississippi

Valley. Crosby, a journalist, profiles the outbreak as it rips through Memphis,

the city hardest hit. She vividly evokes the Faulkner-meets- " Dawn of the Dead "

horrors of that summer, as in this passage that follows a nun named Constance:

" 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. "

Many of the elements of this tale are depressingly familiar. Though the death

toll in Memphis alone surpassed that of the Chicago fire, the San Francisco

earthquake and the stown flood combined, President Rutherford B. was

dismissive, calling pleas for help " greatly exaggerated. " Tell me if this rings

a bell: " Federal response had been slow. In the South, the dead were still

rotting unburied in cities and farmlands. Thousands of people had been displaced

and collected in camps, waiting for food and supplies. "

The arrogance and ignorance of those in power is a recurring theme in " American

Plague. " Decades before Walter managed to convince the medical

establishment that mosquitoes were the vector for yellow fever, a Cuban

physician named Finlay had all but proved it. Lacking connections in the

United States and cursed by a debilitating stutter, Finlay was waved away as a

" crank " by everyone but and the other members of the Yellow Fever

Commission. When pushed for funding to follow up on Finlay's mosquito

theory, Surgeon General Sternberg initially rebuffed him, calling it " a

useless investigation. " Incredibly, years later, Sternberg would try to take the

credit for Finlay and 's discovery. Talk about unpolished brass.

" American Plague " is not as swift or dramatic as the outbreaks it profiles. The

story line through the first half of the book is patchy, jumping from Memphis to

Cuba to the Spanish-American War, pausing often to provide the background of one

or another minor character. The names come at you like mosquitoes in a sultry

Tennessee dusk: an irritating swarm, too many to keep track of. There's no one

to hook arms with and march through the chapters. Though to be fair, Crosby's in

a narrative pickle: What's a writer to do when her characters keep dropping dead

48 hours after she introduces them? The mosquitoes in this book have longer life

spans.

The pace picks up considerably in the second half, when the story shifts to the

Army's Camp Columbia, in Cuba, where finally gets a shot at nailing the

mosquitoes and setting the stage for yellow fever's eradication. Now we're

caught up in a first-rate medical detective drama. 's team must find a way

to prove beyond question that it is mosquitoes, and not bacteria or filth or

contact with an infected person, that spread yellow fever. The filth theory was

so rooted in the popular psyche that during the Civil War, a physician who

became known as " Dr. Black Vomit " practiced a bizarre early draft of germ

warfare, shipping boxes of clothes worn by yellow fever patients to cities in

the North and, at one point, to President Lincoln himself.

and his team cooked up a foolproof, utterly surreal experiment. They

erected two structures on an isolated two-acre patch of land they named Camp

Lazear. In the first, the Infected Clothing Building, three men would be sealed

for 20 days with clothes and soiled sheets " covered in vomit, sweat and feces

from the yellow fever ward. They dressed in the filthy clothing that had been

worn by dying patients, they covered their cots in sheets stained with black

vomit. " Yet this was the building to be in. The volunteer in the Infected

Mosquito Building who shared his accommodations with a swarm of mosquitoes heavy

with yellow fever blood fell ill.

Which leads to one of the most gripping issues in Crosby's book: the ethics of

human experimentation. To Walter 's credit, he did not, unlike some of his

fellow virus hunters, expose people without their knowledge. ( Jenner, in

his efforts to build a smallpox vaccine, injected his 10-month-old son with

swinepox; the child remained sickly throughout his short life.) 's subjects

were, incredibly, volunteers. (One of 's claims to fame was the invention of

the medical-consent form.) Many of the volunteers were immigrants to Cuba from

Spain. As new arrivals with no tropical disease immunity, they were likely to

come down with yellow fever anyway. Why not get paid for it, was the rationale.

Since the work was done at an Army camp, soldiers were also among the

volunteers. That is, after all, what soldiers do. They serve the cause. Crosby

makes the point that before World War II and the discovery of penicillin, vastly

more soldiers died of infectious diseases than of combat wounds. " A soldier's

duty is to defense, " she writes, " and many men felt that the greatest threat to

the American people lay not in enemy warships or troops, but in disease. "

Nothing yellow about those guys.

I closed this book feeling oddly buoyant. It is good to be reminded of the

occasional nobility of the human spirit.

Roach, a frequent contributor to the Book Review, is the author of " Spook:

Science Tackles the Afterlife " and " Stiff: The Curious Lives of Human Cadavers. "

http://www.nytimes.com/2006/11/05/books/review/Roach.t.html?_r=1