Yellow Fever

Yellow fever was one of the most dreaded diseases in South Carolina during the eighteenth and nineteenth centuries. Along with malaria, it helped establish the reputation of the South Carolina lowcountry as a dangerously unhealthy place for whites and was used to justify African slavery. Like malaria, yellow fever is transmitted by mosquitoes and strikes in warm weather. Unlike malaria, which spread over most of the state, yellow fever was largely restricted to seaports by the habits of the Aedes aegypti mosquito.Yellow fever is caused by a flavivirus. Its name derives from one of its common symptoms, a jaundice produced by the virus’s attacks on the liver. Other symptoms include high fever, vomiting, exhaustion, convulsions, delirium, severe body aches, and bleeding from the nose, mouth, stomach, rectum, and skin. Gastric acid turns the blood in the stomach black, and when vomited it resembles coffee grounds, which led the Spanish to call the disease the “black vomit.” Yellow fever generally runs its course in a week to ten days. Victims often die of kidney failure, but patients who survive are henceforth immune. As a result, in places where the disease is common most victims are newcomers or small children. Yellow fever’s predilection for these victims gave rise to yet another name for the disease, “stranger’s fever.” Yellow fever kills many of the infected, but establishing accurate case mortality rates is extremely difficult. Many cases, especially among children, present mild symptoms and may not be diagnosed as yellow fever. Moreover, dengue fever and malaria, which have much lower case mortality rates, have often been misdiagnosed as yellow fever.

Yellow fever, like falciparum malaria, was introduced into South Carolina as a result of the African slave trade. The first major epidemic struck Charleston in 1699, killing about fifteen percent of the population, including many officials. At least five and perhaps as many as eight major epidemics occurred between 1706 and 1748. The disease was probably present in several other years as well. For several decades after 1748 no large epidemics occurred, although it appeared sporadically in some years. Between the 1790s and 1850s Charleston hosted numerous epidemics. The victims were primarily white “strangers”: immigrants, travelers, upcountry folk, and children. Few “natives” of Charleston, black or white, died from the disease. Some antebellum proslavery writers misleadingly claimed that Africans were immune to yellow fever. This was not true, as modern epidemics in Africa attest, although some Africans may have inherited resistance to it. Although primarily a disease of seaport towns, yellow fever occasionally penetrated inland as far as Augusta, Georgia. Yellow fever was sporadically present in Charleston during the Civil War and killed about two hundred people there in 1871. The state’s last recorded epidemic took place in Beaufort in 1878. Concern with yellow fever remained high until the early twentieth century, when the disease retreated from the United States altogether.

Yellow fever was dreaded not only for the horrible deaths it caused, but also because it could have a devastating impact on public business and commerce. Epidemics often prevented the sitting of the colonial assembly in the eighteenth century, and they had the potential of bringing trade to a virtual standstill for months. Because of the disease’s economic impact and the need to establish an effective public policy to deal with it, theories about its origins and transmission aroused enormous controversy until 1900, when American army physicians in Cuba demonstrated the role of the mosquito as its vector. Before then, advocates of the idea that yellow fever was contagious and/or imported demanded strict quarantine regulations. Others, who argued that the disease was noncontagious and produced by heat acting upon accumulated filth, pressed for sanitary measures. Both ideas aroused opposition. Enforcing strict quarantine regulations to avoid an epidemic disrupted trade; but sanitary improvements were expensive and interfered with property rights.

Carrigan, Jo Ann. “Yellow Fever: Scourge of the South.” In Disease and Distinctiveness in the American South, edited by Todd L. Savitt and James Harvey Young. Knoxville: University of Tennessee Press, 1988.

Carter, Henry Rose. Yellow Fever: An Epidemiological and Historical Study of Its Place of Origin. Baltimore, Md.: Williams and Wilkins, 1931.

Harris, Tucker. “Facts and Observations, Chiefly Relative to the Yellow Fever, as It Has Appeared at Different Times, in Charleston, South Carolina.” Philadelphia Medical and Physical Journal 2 (1805): 21–34.

Humphreys, Margaret. “Yellow Fever: The Yellow Jack” and “Dengue Fever: Breakbone Fever.” In Plague, Pox and Pestilence: Disease in History, edited by Kenneth F. Kiple. London: Weidenfeld & Nicolson, 1997.

Kiple, Kenneth F., and Virginia H. Kiple. “Black Yellow Fever Immunities, Innate and Acquired, as Revealed in the American South.” Social Science History 1 (summer 1977): 419–36.

Waring, Joseph I. A History of Medicine in South Carolina. 3 vols. Columbia: South Carolina Medical Association, 1964–1971.