The American Plague: The Untold Story of Yellow Fever, The Epidemic That Shaped Our Nation (9 page)

It was one of the few letters she wrote; Constance worked constantly. On some days she kept a diary, but on others, she worked straight through several nights in a row. One of her sisters pleaded with her to rest and eat something.

“Sister, I am hungry all the time, no matter how much I eat: I am so very well. Do not worry for me.” She sat down to a small plate of food, brushing at the flies and sweat bees hovering in the humidity. The smell of the river was heavy in the air, a mingling of putrid sweetness and lowland fertility.

She told the nun how she had found a husband and child just taken ill, with the mother dying. The nun listened as Constance told the story and watched the manner of her hands as she spoke. “I persuaded her husband to leave the sofa in her room and to go to bed in the next room,” Constance said. “While the nurse attended to him, I put the little girl to bed in her crib; she is such a cunning little thing. As I tucked her in, she put one little arm under the pillow and through the bars of the crib and said in the sweetest little voice: ‘You can’t get that arm under.’ ” The sister would remember that conversation; it was their last.

A few days later, the ward visitor at St. Mary’s pulled Constance aside, his face blanched, to tell her he would not be back the following day. “For I am down,” he said. When he reached out his hand, his skin burned her to the touch.

The Destroying Angel

Dr. William Armstrong steered his carriage toward Poplar to St. Mary’s Cathedral—he heard the echo of hooves on stamped earth, the rattle of chains and buckles, the horse’s bit the accompanying percussion.

Armstrong had been appointed by Dr. Mitchell to oversee the cathedral district near his office on Alabama Street. Though he was used to seeing patients in his office with its cloth-covered rocker and red fainting chair, he had spent very little time there in the past weeks. Healthy physicians were few and far between. Paid ten dollars a day, local doctors and those who came from elsewhere could not make it from one home to the next without being stopped by crowds in the street begging for help. The City Hospital had long since filled its 125 beds, and the doctors now reverted to the days of house calls and saddlebags. Few people would have chosen the hospital over their homes anyway. In the 1870s, hospitalswere notorious for spreading disease more often than curing it. People even opted to have surgery performed at home, rather than risk infection in an operating room. Hospitals were essentially for the indigent who could not afford private physicians.

Armstrong continued to live in his own home, but many physicians of the Howard Association stayed at the Peabody Hotel, the only hotel to keep its doors open during the epidemic. After breakfast at the hotel, usually nothing more than bacon, milk and coffee, a doctor was assigned to his particular district, where as many as twenty calls would be waiting as soon as he arrived. The physicians, wearing
Howard Association
armbands, loaded mule carts full of provisions. The doctors carried small leather cases that held knives, scalpels, a spring-loaded bleeding lancet and a pocket watch to take the patient’s pulse. With no drugstores open, they carried leaden glass bottles of quinine and arsenic tonic for the fever, as well as vials of ethanol, morphine, caffeine and iodine. They also carried extra handkerchiefs. To identify black vomit, doctors would hold a soiled linen cloth up to the sun and watch the red edge of blood seep from the center like a crimson-colored eclipse.

Physicians reported seeing as many as 100 to 150 patients daily. Their treatments ranged from the practical to the truly bizarre, though all were remarkably similar in their ineffective-ness. Castor oil was given to force the kidneys and intestines to function once again. Sponges soaked in iced whiskey and champagne were used to bring down fevers. Laudanum was prescribed for pain. Citizens also self-medicated—gin sales were higher than ever when a rumor circulated that gin could ward off yellow fever. A doctor was quoted in the
Family Physician
for his treatment of the fever: The patient should sit naked, covered in blankets, on a split-cane, open-bottomed chair above a saucer of burning rum until the vapors caused the patient to faint and fall off the seat.

Dr. Robert Mitchell, however, gave his Howard doctors a specific protocol for treatment. Calomel, an irritant drug, was given to empty the bowels, followed by a mustard footbath and perspiration for twelve to sixteen hours. A sponge bath of whiskey and water followed until the temperature dropped below 102 degrees. Two ten-grain doses of quinine were given, and the patient was to be kept completely quiet—no visitors. Once the fever subsided, a bland diet of milk, limewater or chicken broth followed. No solids for ten days, nor could the patient sit up. Bedpans would be used in the meantime. Hopefully, a healthy family member or nurse could be found to empty them.

As is often the case in
heroic
medicine, the treatment for yellow fever could be as bad as the symptoms themselves. Calomel is mercury based and could cause mercury poisoning if given in the wrong doses or not followed with a saline enema to flush the remaining mercury from the body. And quinine, a derivative of the South American cinchona tree, the
fever tree,
had long been used as a treatment. Unknown to the doctors at that time, quinine is toxic to many bacteria and plasmodium, like in the case of malaria, but has no effect on a virus like yellow fever. Instead, given in high doses, quinine could produce many of the same symptoms as yellow fever: delirium, photosensitivity and nausea.

Though Mitchell desperately needed doctors, he was finally forced to send someone to the train station to turn away volunteers from the North. They did not survive in Memphis but for a few days before becoming patients themselves. The burden was too much.

At night, the physicians gathered to compare notes from the day and perform autopsies in search of clues to the epidemic. The liver, it was recorded, might be the color of boxwood, while the spleen was enlarged and kidneys completely congested. One doctor described the bodies of the freshly dead, which might run temperatures as high as 110 degrees, as having blood that steamed and organs that felt as though dipped in boiling water.

Yellow fever, unlike any other disease, carried a mysterious horror to it. Its attack was acute and quick, its duration painful. In addition to its gruesome symptoms, the fever could cause lacerations and bruises on the skin to openly bleed. Pregnant women spontaneously miscarried. In a testament to the ignorance toward both the fever and women’s health, one man wrote that the fever caused women well past their childbearing years to suddenly begin menstruating again. In reality, the hemorrhagic fever led to uterine bleeding just as it did all other types of internal and external hemorrhaging. For the doctors and nurses, the fever’s most disturbing symptom must have been the mental decline. In mild cases, it surfaced as irritability and inability to stay still. In severe cases, it bordered on maniacal. Patients ran yellow eyed and delirious into the streets, screamed, thrashed and had to be physically restrained.

William James Armstrong, a thirty-nine-year-old physician, had moved his practice from the country to Memphis in 1873, only a few months before that yellow fever epidemic. New to Memphis, he sent his family away and chose to stay behind in the city during the 1873 epidemic hoping to earn the respect of friends and colleagues. After all, he had a wife and children who depended on his fledgling practice. As a profession in the mid-nineteenth century, medicine was not a lucrative one, nor a highly respected one. In fact, for an educated man with connections, choosing medicine was often seen as throwing away his future. No standard schooling or licensing was required. Most American doctors relied not on science, but on the ability to please patients. In order to build a practice, they established personal, long-standing relationships with families, offering personal advice and treating husbands, wives, children and babies. He might be called in during a complicated childbirth, but even that was handled primarily by midwives and women family members. Physicians in the 1870s had to find a way to remain relevant or necessary to everyday life. When yellow fever struck in 1878, Armstrong again decided to stay in Memphis, sending his wife, Lula, and their eight children to Columbia, Tennessee.

Will Armstrong had a heavy, dark beard and a tender nature. He had married his bride on her sixteenth birthday in the midst of the Civil War, he played the violin and he called his youngest daughter, only a few weeks old, his “dear little pig.” As a physician, Armstrong must have seemed gentle, even a little timid.

Though Armstrong had served in earlier epidemics, this one far exceeded the previous ones. He had already lost many friends and acquaintances and feared sending boxes of food, clothes or money from the poisoned city to his family. He wrote to his wife that “the fever is assuming a most fearful form and no signs of abatement. It is not yellow fever such as I treated in 1873. Surely the United States never witnessed such a thing before.”

Many doctors like Armstrong had served as physicians or surgeons during the Civil War, but despite the horror of that war, the yellow fever epidemic seemed much worse. The
Boston Medical and Surgical Journal,
in 1878, reported about yellow fever: “It required a much higher order of courage than to risk life on the battlefield, where patriotism, the excitement of conflict and the contagious enthusiasm of masses are a stimulus to noble deeds: these are wanting to the physician who treads wearily along the path marked out by disease and suffering . . . the moanings that ring in his ears are never drowned out by shouts of victory and triumph, and he battles with a foe insidious and unseen till the blow is struck that lays low the victim.”

As a Howard doctor, Armstrong spent all of his time on house calls. It was lonely and frightful work, for doctors never knew what they might find when they returned to a house—walls stained with black vomit, delirium, corpses, or worse, patients barely alive, alone and completely lucid. In letters to his wife, Armstrong described the despair settling on him: “I feel sometimes as if my hands were crossed and tied and that I am good for nothing, death coming in upon the sick in spite of all that I can do.

“I never was in all my life,” wrote Armstrong, “so full of sympathy and sorrow for suffering humanity . . . God grant that I may be able to administer to the sick throughout.”

In September, Armstrong went to visit a friend known as Old Sol (Dr. Soloman P. Green), who lived across the street from St. Mary’s. Green had awakened during the night feverish, alone and terrified, and no one heard his cries for help. If taken ill in the night, the doctors knew all too well that no one would find them in their homes. They knew to expect the aches of an approaching fever, the ravaging thirst, the mental decline. And the physicians knew how their bodies, like the dozens they saw each day, would be found as though poached from the inside out. The thought, alone in one’s bedroom long after midnight, would certainly terrify the most stoic doctor. As Old Sol told the story to Armstrong the next morning, he wept like a child. “I could do nothing but sympathize,” wrote Armstrong.

The sisters at St. Mary’s had already promised to find Dr. Armstrong and care for him should he fall feverish alone in the night.

As days followed nights, there was no measure of time passing, only a blurred sense of sickness and death, of too many cries for help and too few doctors and nurses. Only one change was noticeable among the doctors: the decrease in their numbers.

The cacophony of moans and cries from the ill continued in the halls of St. Mary’s. There were not enough sisters to attend, and certainly too few doctors, so only half of the cries went answered. Exhausted, the sisters promised to return to dying patients. More than once, they returned too late or the nuns themselves were found collapsed and feverish in the rooms of patients.

On the last day of August, Will Armstrong was called to St. Mary’s on an urgent request. Their dean, George Harris, was down with the fever. He had been without a physician for ten hours, so Constance called for Reverend Charles Parsons to help attend to the dean. When possible, the rules of propriety remained: Male nurses were found for male patients and females for females. Constance told Parsons what to do, how to nurse the feverish patient and together, they waited for Dr. Armstrong. Parsons would also need to take over Harris’s duties, for now the nuns would be without their priest.

It was six months since Charles Parsons had stood in full uniform on the eve of Mardi Gras and preached to his Chickasaw Guards; never could he have known he would so soon be in that valley of death he had described, and never could he have foreseen what a hellish place it would be. Parsons had spent every day, sunup to sundown, and well into the night, ministering to the fever victims. Some were parishioners, many were strangers. The service he provided most often was the reading of the last rites, wearing his deep purple stole stitched with a white lily and green leaves, a cross ascending from the center.

Dr. Armstrong fastened his carriage to the post outside St. Mary’s and hurried inside where Constance waited for him. He felt George Harris’s feverish skin and studied the languid, depressed countenance of the dean. Armstrong gave the grave news to them that Harris had the fever. He reminded them that it could be a light case, but in a letter he later wrote, “Do not expect to see Dean Harris alive. I worked with him hard last night.” Harris would, in fact, recover after a long battle with the fever.

Armstrong quickly packed up his medical case and said good-bye to Constance and Parsons, promising that he would return later. For a moment the three of them stood there together—one who nursed, one who doctored and one who delivered the souls from this purgatorial place.

Charles Parsons found a quiet room and sat down to write a letter to his bishop and friend, Charles Quintard. Sunlight washed the floors of the convent. It was the first day of September, the choking heat showed no signs of relenting, and the death toll rose higher each day. “People constantly send to us, saying, ‘Telegraph the situation.’ It is impossible. Go and turn the Destroying Angel loose upon a defenseless city; let him smite whom he will, young and old, rich and poor, the feeble and the strong, and as he will, silent, unseen, and unfelt, until his deadly blow is struck; give him for his dreadful harvest all the days and nights from the burning midsummer sun until the last heavy frosts, and then you can form some idea of what Memphis and all this Valley is . . .”