Historical Perspectives On Contemporary Issues

In describing how disease shaped Atlantic empires in the eighteenth- and nineteenth-centuries, historian J. R. McNeill wrote, it is “perhaps a rude blow to the amour proper of our species to think that lowly mosquitoes and mindless viruses can shape our international affairs. But they can.”[1] In their presentations for the recent symposium Sickness and the City, Montana State University historian Billy Smith and University of Pennsylvania epidemiologist Michael Levy suggest these words echo across the ages. Bugs have profoundly impacted, and impact still, human affairs on both personal and geopolitical scales.

 
On their face, the 1793 yellow fever epidemic in Philadelphia and modern-day Chagas disease in Peru are very different. Their sites are thousands of miles apart and these outbreaks took place in vastly different chronological, ethnic, and medical contexts. Therefore, they had/have profoundly different social meanings and impacts. Yellow fever and Chagas also have different insect vectors. But taken together, these outbreaks pose questions about urbanization, epidemiology, disease mapping, and the role of the state and science in mediating sickness.
 
As an historian of yellow fever, primarily in the nineteenth-century Greater Caribbean and New Orleans, I have long been familiar with Professor Billy Smith’s work. His 2013 tour-de-force Ship of Death: A Voyage that Changed the Atlantic World (Yale University Press) tracked the macabre journey of the Hankey, a British ship that unknowingly spreading yellow fever—perhaps the most fearsome disease in the Atlantic World at the time—from Bolama Island off West Africa to first Barbados, Grenada, and Haiti and then to Philadelphia. Within four days of the Hankey’s August 1793 arrival in Pennsylvania, the Aedes aegypti mosquitos hiding out and breeding in the ship’s freshwater caskets had fanned out from the docks, triggering multiple outbreaks of yellow fever. By November, when the first mosquito-killing frosts descended, more than 5,000 people had died, about 10 percent of Philadelphia’s population.[2] This would be akin to New York City losing about one million inhabitants today. Flight from the city exacerbated the disease’s depopulation effect: 17,000 people—including George Washington, Thomas Jefferson, and most of the political elite—evacuated. Imagine one third of New York City, or the entire population of Brooklyn and Staten Island, making a frantic, terrified exodus. Those that remained—either by choice, a sense of duty, or because they were too poor to go—faced the prospect that they would die horribly, writhing in a pool of their own bloody vomit.  
 
Professor Michael Levy described a less dramatic, though no less important, tale: the decades-long effort to control Chagas disease in contemporary Peru. Chagas disease impacts between 5 and 20 million people worldwide, who are infected after being bitten and defecated on by the Triatoma infestans. Between 20 and 30 percent of those affected will develop the determinate form of the disease, causing various health problems, particularly in the cardiac and digestive systems. A small percentage develop an acute case which can be life threatening. Through various efforts to control the vector population—chiefly spraying houses with deltamethrin—transmission has been largely controlled in Uruguay, Chile, Brazil, and most of Paraguay. The bug remains in Bolivia, Northern Argentina, parts of Paraguay, and Southern Peru, where this historically rural disease has become increasingly urban. Since 2001, the Peruvian Ministry of Health, with funding from the Canadian government, has conducted an insecticide campaign in Arequipa. They have treated about 70,000 houses, and the bug is now essentially gone. But it can reemerge. Levy’s team has followed the health ministry, mapping the patterns of transmission and infection.
 
Levy’s work in tracking Chagas disease provides various lessons for historians and scientists alike. First and foremost, epidemiology is (and always has been) incremental and frustrating. There are essentially no silver bullets, fast cures, or easy fixes. Bugs are as elusive as they are “smart” – they adapt, disappear, and reemerge – a process complicated by climate change, migration, human politics, and urbanization. But determination and the ability to map, quantify, and adjust bears fruit. Controlling Chagas disease has been one of the greatest public health triumphs of the last twenty to thirty years, just as eradicating smallpox was in an earlier generation, or creating an effective vaccine against yellow fever was at the turn of the twentieth century. These triumphs are seldom celebrated in Hollywood movies (though I would pay good money to see lingering shots of Ryan Gosling squeezing poop out of a triotomine bug), but they have radically impacted the way we live, the way we die, what we fear, how we plan for the future, how we travel, not to mention the relationship between state and citizen, and our relationships with one another. Health and sickness have always been political and personal, shaping our identities and prospects in ways we seldom pause to recognize.
 
This is true historically, too. We know a great deal more about disease now than Benjamin Rush, Absalom Jones, Richard Allen, and Anne Saville did in the 1790s. And it can be extremely frustrating—two centuries of epidemiological advancement later—to see historical actors make choices that we would now consider obviously dangerous and misguided. (How could a Philadelphia merchant in good-conscious have argued against the efficacy of quarantines in stemming yellow fever?) But the historian’s job is to reconstruct events and to understand—and not judge—historical actors operating in a world without germ theory, the concept of viruses, or a robust definition of contagion.
 
Facing an invisible, terrifying, and seemingly intractable microbial world, Philadelphia’s inhabitants—black and white, male and female, medically-trained and lay—used this occasion to express other anxieties. Yellow fever became a Susan Sontag-like metaphor for society-writ-large. In its aftermath, as Smith details, screeds about the role of physicians, politicians, and businessmen were printed. Many argued that the poor—the group always hit the hardest—had brought the disease on themselves with their filthiness and dissipation. Some questioned whether living in pestilential cities was wise; if pestilence was God’s punishment. Still others asked what was more important: individual and commercial freedom, or the states prerogative to enact quarantine.
 
Most of all, there was an outpouring of racist rhetoric—exemplified by physician Matthew Carey—during and after the epidemic. This would appear to be a strange reaction in light of events. Philadelphia’s free black population, led by Absalom Jones and Richard Allen, was at the forefront of care during the yellow fever epidemic, doing the thankless work of guarding the city against crime and looters, nursing the sick and convalescent, and carting and burying bodies. As cases started to appear in August, Benjamin Rush had implored the city’s free black population to remain because he—like almost every person in the larger American/European medical community—believed black people were naturally immune or resistant to yellow fever. Rush famously changed his mind on this topic, but it was too late – over 240 black people died from yellow fever during the epidemic.[3] Rather than being thanked, free black people were treated mostly with contempt, derided as profiteers and death-entrepreneurs. As Jones wrote the following year, “our services [were] extorted at the peril of our lives, yet you accuse us of extorting a little money from you.”[4]
 
Though I am uninterested in resurrecting the long-heated and now-settled (I believe) debate about black hereditary resistance to yellow fever, I wonder why the narrative turned into an indictment of black people rather than a celebration. Was this just classic scapegoating? To put a finer point on it: would the Matthew Careys have always found a reason to express their racial animus, but simply seized on this epidemic as the most convenient vehicle? Do these negative reactions show the stark difference between legal freedom and citizenship; of the insurmountable prejudice black people faced in a slave nation, even in free states?[5]
 
There are other political questions, too. Smith’s amazing (and darkly funny) description that which cure a person took—heroic (purging and bleeding) or passive (bedrest and fluids)—was a statement about one’s party affiliation, shows that health was political and politicized. Did such partisan medical choices trickle down into the general population? Is there a way of accessing those voices, or perhaps triangulating them?
 
Did this epidemic change Philadelphians’ ideas about the state’s responsibilities regarding health and welfare? It is perhaps easy to indict George Washington and others for fleeing the city, leaving behind (mostly) the poorest and most vulnerable residents to fend for themselves. But what other options were there in 1793? It would be another century until the mosquito vector was discovered, and the prevailing orthodoxy of the time was that escape was the surest remedy. (“Acclimation,” falling sick with and surviving yellow fever guaranteed lifetime immunity, but this was the other and far more dangerous approach).
 
This was an era, as historian William J. Novak described, where the rights and obligations of the state and citizens were being reconfigured, especially in terms of health, welfare, and education.[6] We now would impeach politicians for fleeing the city or sacrificing thousands of people’s lives to assuage the capitalist elite’s demands to do away with quarantine (or would we?). But my research has shown that this political reaction was the norm for most of the eighteenth and nineteenth centuries, and was not necessarily seen as a dereliction of duty. In New Orleans, for example, politicians did not even feign a desire to remain in the city during the 1853 epidemic that killed nearly 12,000 people (one of the worst natural disasters in American history in mortality terms). New Orleans was starkly different than Philadelphia, which by 1850 had a robust welfare state and public health infrastructure. So, was 1793 a turning point? Can we see this epidemic as both destructive and generative, instilling the population with a new sense of their place in society going forward (based on a strict racial and class-based hierarchy) but also compelling the state to reconsider its night-watchman approach to matters of health? 
 
I’ll end with a final set of questions about the future. Historians are loath to claim that anything is inevitable or overly-determined. But as Smith lays out (and as McNeill does in Mosquito Empires) yellow fever profoundly impacted eighteenth-century diplomacy, colonization schemes, and mercantile networks. (I would also add capitalism itself to that list). Yellow fever strongly steered—if not determined—the course of geopolitics and empires, playing a crucial role in Washington’s victory at Yorktown, in tipping the scales against the French army in St. Domingue, and in prompting Napoleon’s sale of Louisiana to the United States. This in turn triggered the explosion of the Cotton Kingdom, indigenous removal, and westward expansion. Has Chagas disease had a similar, tracible effect? Has it impacted the economic, social, and political trajectories of Peruvians, or of people in other affected nations in South America? Has it controlled migration patterns, what kinds of jobs people take, when/where they decide to have children, or economic markets? What will the total eradication of the Chagas vector mean for the future on both a micro and macro scale?  
 
Both Smith and Levy remind us that sickness has been—and remains still—not just a personal experience, but a matter of statecraft, policy, and international geopolitics. A strong state reaction, undergirded by data and scientific research, is crucial to stemming not just mortality but the malignant social effects wrought by disease-carrying bugs.
 
 
 

[1] J. R. McNeill, Mosquito Empires: Ecology and War in the Greater Caribbean, 1620-1914 (Cambridge, 2010), 2.

[2] Billy Smith, Ship of Death: A Voyage that Changed the Atlantic World (New Haven, 2014), 187-93.

[3] Benjamin Rush, An Account of the Bilious Remitting Yellow Fever, as it Appeared in the City of Philadelphia, in the Year 1793 (Philadelphia, 1794), 97.

[4] Absalom Jones, A Narrative of the Proceedings of the Black People, During the Late Awful Calamity in Philadelphia, in the Year 1793: and a Refutation of Some Censures (Philadelphia, 1794), 15.

[5] Pennsylvania enacted gradual emancipation in 1780.

[6] William Novak, The People’s Welfare: Law and Regulation in Nineteenth-Century America (Chapel Hill, 1996).