‘We Yet Survive’: Physician Patient Relationships and the Yellow Fever Epidemic of 1853

‘We Yet Survive’: Physician Patient Relationships and the Yellow Fever Epidemic of 1853 Summary During the summer of 1853 a devastating yellow fever epidemic swept through the Lower Mississippi River Valley. This article examines that epidemic as it was experienced in Vicksburg, Mississippi, and reveals the disjoint between patients’ expectations and physicians’ capabilities. In the months following the first case, Vicksburg physicians leveraged their role in managing the epidemic to participate in national conversations regarding communicability, treatments and sanitation. However, from their patients’ viewpoint, these conversations were useless. Instead, growing sexton reports and overcrowded cemeteries proved physicians’ inability to manage the crisis, thus reinforcing Americans’ wariness of professionalised medicine. In the end, physicians and residents held opposing experiences of the epidemic, and physicians’ inability to meet the practical needs of their patients further challenged their claims to professional legitimacy. yellow fever, epidemic, Mississippi River, medical professionalism, doctor–patient relationships Mary Jane Lanier died on 11 August 1853. She was twenty-three years old, the mother of four small children, and lived in one of Vicksburg’s most respectable neighbourhoods. She had been ill less than a week. At first, her symptoms caused no great alarm. She most likely suffered from chills and a low fever. This coupled with pain in the head and muscles were indicative of a number of common ailments familiar to nineteenth-century Americans. Mary’s sister came to visit from her country plantation, as did her mother. Together, the women would have overseen Mary’s care until her condition worsened and they sent for a doctor. Perhaps, her skin had already turned a pallid yellow, for when Doctor Thomas Harper first examined his patient he had no doubt about the diagnosis. Yellow fever. The day after Harper took charge of Lanier’s care, her final symptom appeared. She began to vomit a thick black substance—partially digested blood. Afterwards, Lanier’s mother would recall that ‘[Mary] was so verry [sic] sick that it was distressing to see her … she had expressed some fears that she never would get well and asked her Uncle Lawrence to pray for her that she might be relieved of the sickness at her stomach.’ Her prayers were not to be answered. Black vomit was the most iconic, if horrifying, of yellow fever’s symptoms, and it was always fatal. ‘You never would forget it’, her mother wrote ‘if you could have heard her cawling “ma, ma, ma” when her tongue was faltering that she could hardly speak. I believe that “ma” was the last word she spoke.’1 Despite his presence, there was nothing Harper could do.2 Yellow fever and the American South share a long and tangled history, one that has not been ignored by historians.3 Various studies skilfully highlight how health crises shaped southern social and political ideology. The devastating epidemic of 1878, for example, was not only instrumental to post-war reconciliation, but also in creating new public health care policies. According to this narrative, the reconstructed South remained both medically and economically backward until redeemed by new discoveries in scientific medicine, urban planning and city sanitation.4 There are fewer studies about yellow fever outbreaks in the antebellum era. Those that do exist examine how physicians, city officials and even the general public used yellow fever to reinforce the antebellum South’s social stratification.5 These are important observations, particularly when anticipating the sectional crises. Over the years, however, the relationship between the antebellum South and race-based medicine has obscured other questions about the connection between health, disease and southern society, namely, how diseases like yellow fever shaped the public reputation of medical professionals. Medical care in the first half of the nineteenth-century was a curious mix of traditions and systems, all striving for primacy in the eyes of the general public. The disappearance of licensing standards combined with falling standards in medical education resulted in a class of under-trained professionals. Furthermore, the harsh treatments characteristic of heroic medicine often killed patients faster than the diseases they were designed to cure.6 All of these factors earned traditionally trained physicians a reputation for talking too much and knowing too little. By the 1830s, various medical sects had sprung into being, each challenging aspects of orthodox medicine. Groups such as homeopaths rejected the use of harsh chemical-based medicines while populist sects such as Thomsonianism sought to democratise the profession altogether. As a result, orthodox physicians redoubled their efforts to gain public respect while undermining the legitimacy of sectarian dissent. These efforts culminated in 1848 with the creation of the American Medical Association (AMA). As the first national professional organisation, the AMA was intended to police the boundaries of respectable medicine and to act as a type of gatekeeper for the formal medical establishment. However, the discussions facilitated by the AMA, and similarly minded state organisations, counted little outside of the profession itself. The relationship between patients and their physicians remained reluctant at best; medical disasters continued to perpetuate that relationship.7 The yellow fever epidemic that swept through the Lower Mississippi River Valley in 1853, however, not only highlights growing tensions between members of the medical community and the general population. It also reveals the ominous nature of the region’s growing economic and social interdependence. As such, any study of the 1853 epidemic should begin in New Orleans. People living in smaller river towns such as Natchez and Vicksburg were keenly aware that participation in the economic life of the Mississippi River offered both prosperity and danger. In light of this, the failure of New Orleans City officials, press and physicians to acknowledge the potential epidemic before it spread upriver was interpreted by smaller towns as a betrayal. Tracing the epidemic’s trajectory up river further highlights the economic and environmental ties that connected residents of the Lower Mississippi River Valley and afford the opportunity to include new voices within the traditional narrative. While there are many studies about yellow fever in New Orleans, few examine how these epidemics were experienced in smaller, more rural areas of the South. Using Vicksburg as a case study reveals how physician–patient relationships reflect the broader trends previously identified by historians. Thus, if physicians in New Orleans failed the entire region by not controlling the outbreak where it originated, local physicians failed Vicksburg residents with their inability to help implement a plan to manage the epidemic and save lives. Given these problems, residents pursued other outlets to maintain their spiritual and emotional well-being. First settled in 1819, by the middle of the nineteenth century Vicksburg was a bustling commercial town.8 Contemporary sources estimated that approximately 90,000 bales of cotton were shipped from Vicksburg’s port to New Orleans annually, and the effect of the booming cotton trade was present in the town’s landscape. Vicksburg was home to four churches, six saw mills, five brickyards, a shingle factory, and six schools, all serving a population of 4,500. The Charity Hospital, located on the east side of the city, was headed by Dr G. K. Birchett.9 More importantly, however, the city served as a major crossing point for travellers and goods moving east to west across the river. Travellers headed farther east could purchase one of the many railroad packages that would take them as far away as Charleston, or, if they preferred, could book passage on a coach.10 At Vicksburg, one could also board a steamboat headed south to New Orleans or north to Memphis. Peddlers moved up and down the river, selling newly acquired goods to the area’s residents and traveling shows flooded in for their entertainment. During the spring of 1853 alone three separate shows came through the town, offering residents the opportunity to see the exotics of California or Ireland for 50 cents admission.11 It was precisely the transient nature of Vicksburg’s population, stemming from the strong regional network of trade and travel, that made epidemics possible. The epidemic brought into sharp relief the most threatening feature of Vicksburg’s locality, the Mississippi River. However, Vicksburg’s vulnerability as a port town was not a revelation in 1853. Over the years, city officials had developed an interest in the health of other river towns with which Vicksburg shared an endless stream of people and goods. Of particular concern was New Orleans, whose port served as the gateway between the insulated Mississippi River Valley and foreign ports. River towns like Vicksburg depended on New Orleans physicians to serve as the first barrier against any potential health crisis. Unfortunately, city officials were not always forthcoming with information. On 20 May, the first recorded victim of the 1853 epidemic died in New Orleans. Yet, New Orleans physicians and city officials refused to acknowledge the virus’ growing prevalence until the end of July.12 In the interim, newspapers regularly reported on the devastating yellow fever epidemics raging in Brazil and the West Indies, but remained conspicuously silent on local conditions. By late June, the New Orleans Charity Hospital was reporting sporadic cases of yellow fever among the city’s most impoverished residents.13 These reports began to fuel rumors of a potential outbreak in the city, but even these rumors were stoutly denied. In a letter to the editor published on 23 June, one unnamed New Orleans resident maintained that while yellow fever had appeared in the city to the ‘enormous extent of about four cases’, there was nothing to worry about. ‘That it exists in a form or to an extent to produce alarm, except amongst old women, is most positively denied by all the most eminent physicians in the city.’ Not content to simply put rumors to rest, the author went on the challenge the authority of the organisation that published and sanctioned the reports: the New Orleans Board of Health. At the same time, editors of the Daily Picayune labelled the anonymous ‘observer’ as ‘a person who can be relied on as good authority.’14 Without the benefit of hindsight, it was impossible for New Orleanians to distinguish between the regular occurrence of yellow fever and the threat of an epidemic. After all, there were usually a handful of yellow fever cases each summer, but there had not been a major outbreak in over six years. Nevertheless, even the rumour of a potential crisis could send residents scurrying to the countryside with devastating economic consequences for the city’s trade. For this reason, it was all the more important not to incite panic over a health threat which might not exist. To this end, local physicians were routinely discouraged from circulating information about the few cases that did appear. Those that did were accused of attempting to arouse public apprehension.15 During his investigations, E. D. Fenner, head of the AMA’s research on epidemic disease in the region, complained that newspaper editors, guided by ‘a most erroneous impression of their duty to the public’, actively attempted to ‘conceal or suppress the true state of affairs’. As a result, many individuals who would otherwise have fled the city remained and exposed themselves to ‘imminent danger for want of correct information’.16 This hesitation would prove devastating in 1853. Yellow fever slipped unnoticed into Vicksburg in late summer when three men, Thomas Jackson, William Quimby and a Mr Scannell arrived during the last week in July. Jackson and Quimby, both labourers in their early twenties with no family and presumably little money, were admitted to the Charity hospital on 23 and 30 July respectively. There, they languished several days before succumbing to the virus. They were buried in the city cemetery, virtual unknowns. The third man’s fate was a bit different. A Jewish peddler, Scannell had enough money to pay for a private practitioner. He survived his bout with yellow fever and left town on 7 August. None of the cases were reported in local newspapers and both Jackson and Quimby were misdiagnosed in the sexton’s burial report.17 By early August, Vicksburg residents seemed to think that they were still yellow fever free.18 Had it not been for the subsequent epidemic, Jackson, Quimby and Scannell’s presence in Vicksburg might have gone unnoticed. However, as the epidemic took hold of the city, worsening through August and September, physicians struggled to reconstruct its origin. Because Jackson and Quimby had been treated in the hospital, physicians focused on Scannell. For the duration of his illness, Scannell and his travelling companions had obtained housing with the Fugate family. The Fugates owned a boarding house at the corner of Grove and Monroe streets, a prominent neighbourhood in downtown Vicksburg. Scannell’s location put him in close proximity to another important case: Mary Lanier. In fact, physicians would later note that she had purchased a dress from the peddlers just two days before she fell ill. Lanier’s case was notable among Vicksburg’s medical community. Every medical report published after the epidemic mentioned her as the first Vicksburg native to contract and die from the virus. After Lanier’s death, yellow fever spread throughout the city. By 8 September, the fever was declared an epidemic and continued at that rate for over a month. The last case recorded was Colonel Levi Mitchel who fell ill on 21 November and was buried two and a half weeks later.19 By the end of the year, nearly 500 Vicksburg residents had succumbed, nearly one eighth of the town’s population.20 In the wake of the epidemic, officials from towns all along the Mississippi River criticised New Orleans physicians, press and city officials for concealing the true nature of the city’s growing health crisis. While reporting Lanier’s death on 13 August, The Vicksburg Sentinel declared that although it ‘was customary to try and keep such things concealed … we believe it to be wrong, as the fact, when known may make others more prudent’.21 Natchez officials pointed out that yellow fever only spread up the river if there were first an epidemic in New Orleans. Thus, they argued, New Orleans was not only responsible for alerting the rest of the region to a potential epidemic, but also for implementing measures that ensured the illness did not spread to other river towns. Natchez officials recommended quarantine, and they suggested that New Orleans look to the North for how to implement one.22 By emphasising the North’s success at controlling yellow fever, Natchez officials were publicly identifying an inadequacy among the southern medical community. By 1853, yellow fever was a southern pestilence. This, however, had not always been the case. When yellow fever was first transmitted to the New World in the seventeenth century, it was not a regionally specific virus. Port cities all along the eastern seaboard, from New York to Charleston, suffered sporadic outbreaks. The most famous of these epidemics occurred in Philadelphia in 1793. That epidemic was notable not just because of the high death rate, but also because it gave rise to the theory that the virus was not contagious but the result of exposure to certain ‘miasma’, or bad air. Prevention, according to this theory, should be simple. ‘Our cities might be preserved … from the yellow fever by cleanliness’, Benjamin Rush wrote in 1799, adding that ‘it would seem as if the neglect of it was necessarily connected with suffering’.23 Driven by the concern that yellow fever could threatened the economic stability of the young Republic’s growing urban centres, cities such as Philadelphia and New York heeded Rush’s advice and began large scale sanitation projects designed to prevent further epidemics.24 The projects seemed to work at least for northern port towns. The last time yellow fever appeared north of Virginia was a small outbreak in New York and Baltimore in 1822.25 For many nineteenth-century Americans, yellow fever’s continued presence in the South was not just a symbol of the region’s questionable sanitation. It was a physical manifestation of the South’s most notable sin: slavery. Today, scientists suspect that the species of mosquito that transmits the yellow fever virus, the female aedes aegypti, was not indigenous to the western hemisphere, but came from Africa. It was the slave trade that offered these mosquitoes the opportunity to relocate to the marshy, tropical climate of the Caribbean and the American South.26 While individuals living in the late eighteenth and early nineteenth centuries remained unaware of the exact vector that connected disease with trade, they still recognised a relationship.27 By the late 1840s, this association between disease and slavery had become firmly embedded in the abolitionist movement, and reformers argued that the continuation of slavery was at the root of the South’s persistent health problems: The overpowering scent of the slave-ship, and the victims of this putrefying disease and death could not be mistaken. … No one acquainted with yellow fever can, for an instant, mistake it; and everyone familiar with a slave-ship, particularly after its voyage and while discharging its slaves, and being cleansed from its human corruption, must at once perceive the identity of the disease.28 These arguments deftly blended the moral implications of southern slavery with Rush’s miasma theory to describe a society that was not only fundamentally corrupt but also unclean. As arguments over southern slavery mounted during the 1850s, southern physicians felt particularly isolated. Already concerned by the damage to their professional reputation caused by sectarianism, the southern medical community began to feel inadequate when compared to northern orthodox physicians. That yellow fever prevailed in the South and not the North was a direct commentary on their effectiveness as professionals. Fenner himself thought his colleagues listless about attaining professional prestige. He longed for ways to ‘stimulate the physicians of the South to a more zealous and energetic prosecution of the noble science to which they have devoted their lives’.29 Yellow fever, then, became a rallying point as southern physicians struggled to recast themselves, not as weak professionals who had failed to eliminate the health threat from the South, but as experts who had the privilege of studying diseases peculiar to the South’s native environment. Unfortunately even as experts southern physicians fell short. Once word spread of a potential epidemic in New Orleans, Vicksburg physicians immediately offered recommendations for local protection. Unfortunately, not all agreed on the best course of action. As during the 1793 Philadelphia epidemic, physicians in 1853 were bitterly divided over the virus’ communicability.30 The popular medical theories of the day held that yellow fever was contracted in one of two ways. The first theory followed Rush’s belief that yellow fever was caused by miasma. Miasmatists argued that quarantines were useless since yellow fever originated somewhere inside the city and was probably caused by poor sanitation. Cleaning the city would, it was hoped, rid Vicksburg of the bad miasma and eliminate the source of the fever. Unfortunately, acknowledging the validity of the miasma theory shifted the responsibility for the epidemic onto the shoulders of city officials, physicians and residents who had failed to uphold the standards of cleanliness necessary to ensure a healthy city. In light of the unsavoury reputation yellow fever bestowed upon the region, contagionism offered a more palatable explanation. The health threat was not the result of Vicksburg’s failings, but an unavoidable consequence of the city’s social and economic ties to the rest of the region. Unfortunately, the only way to prevent such an epidemic was to sever those ties by quarantine, a decision that was nearly always controversial. Merchants and city officials feared the economic consequences of shutting down the city’s port. Towns such as Vicksburg depended on the import and export of goods, but there was no way to guarantee that these goods were not infected. Both a blessing and a curse, a quarantine might ensure the city’s physical survival while potentially spelling its economic demise. Unwilling to leave anything to chance, or perhaps unsure about which theory was more accurate, Vicksburg city officials adopted both a quarantine policy and sanitation reform measures.31 Quarantine regulations were passed on 23 July, and called for a wharf boat stationed a mile south of the city to inspect all northbound traffic. The regulations also established a hospital for the sick and infected at the quarantine grounds.32 These arrangements, however, were never meant to cut off trade completely, and the unwillingness to sever all ties to commercial traffic meant that the quarantine policy was a little too lax to be completely effective. For one thing, the quarantine only affected ships and goods coming up the Mississippi River from New Orleans. River traffic descending from Memphis was still entering the city on a regular basis, and inland traffic continued as usual. As one observer noted, ‘People could land at the quarantine, and coming round through the woods, to the East, enter the town; and as boats descending the river were not subjected to quarantine, anyone coming from New Orleans could pass up and exchange boats and land in the city coming down without delay.’ Nothing would prevent the mass exodus that resulted once word of the outbreak was made public. C. K. Marshall, a local minister, estimated that nearly two-fifths of the city’s population was eventually ‘embraced by the suburbs’.33 If anything, word of the yellow fever outbreak in New Orleans increased travel around the town, and reports made to the American Medical Association indicated that Vicksburg gave up on the idea of quarantine entirely after yellow fever cases began to multiply.34 The city’s new sanitation regulations were not nearly so controversial and were potentially more comprehensive. On 23 July , an ordinance ‘for the suppression of nuisances’ mandated that all carcasses be removed from the city limits and buried ‘at least four feet below the surface of the earth’. In addition, streets would be cleaned and disinfected with lime. The ordinance provided for the disposal of human waste, stating that every privy ‘shall have a pit in the earth at least five feet deep, walled with brick or wood’. When the contents of the privy reached nearer than two feet from ‘the surface of the earth’, it was the owner’s responsibility to ensure that the privy was either filled in or cleaned out and disinfected.35 In an effort to help residents meet the new sanitation standards and ensure the continued health of the city, the Vicksburg Lime and Cement Depot offered free lime to those who could not afford to purchase the disinfectant.36 While the debates between miasmatists and contagionists had practical implications for city policy and sanitation, there was professional merit to these conversations as well. After the epidemic, local physicians compiled case histories of their patients in an attempt to untangle the potential connections between each victim. These papers were then published by the AMA and the New Orleans Sanitary Commission for national circulation. Despite their best efforts, however, these reports consistently demonstrated only one thing. There seemed to be no logical pattern behind the virus’ spread. Or, rather, there seemed to be too many logical patterns. Whether contagionist or miasmatist, physicians found evidence to support their case. For instance, many physicians theorised that yellow fever originated aboard a ship named the Niagara which had docked in New Orleans on 30 April. Shortly thereafter, a stewardess fell ill with chills and a fever. She died on 20 May after ‘throwing up a quantity of black matter’. While contagionists argued that the Niagara transported yellow fever to New Orleans after being infected on previous voyages, others were not so certain. Fenner maintained that the yellow fever originated inside the city and pointed out that the stewardess had gone into the city to visit family just before falling ill.37 Furthermore, yellow fever’s reputation as the strangers’ disease was cited by both groups.38 It was commonly accepted that newcomers to the region were more susceptible to the virus owing to their lack of exposure to the harsh southern climate. Migrants often congratulated themselves on surviving their first sickly season in the South, considering the experience essential for adaptation to their new environment. It was not surprising to physicians, then, that the first yellow fever cases were not Vicksburg natives. Although Quimby and Jackson were confined to the hospital, physicians were quick to point out that the epidemic seemed to radiate from the Fugate Boarding house where Scannell was staying. By the epidemic’s end, all the Fugates had taken ill. Moreover, shortly after Lanier’s death all of her neighbours succumbed to yellow fever as did her sister, Mrs Myers. Myers, who had stayed with the Laniers during Mary’s illness, returned to her home in the country, spreading the disease to ‘every contiguous house’ in the process.39 Not all physicians were satisfied by the social and geographic connections that presumably linked the victims. Convinced that yellow fever was domestic, physicians like Fenner and Birchett searched for environmental factors that might have contributed to the epidemic. It was often noted that yellow fever originated in the poorest, dirtiest parts of the city.40 This too, was tied directly to the presence of strangers. In December 1853, Dr. Samuel Cartwright described the housing conditions of a group of Irish and German immigrants where he believed the epidemic started: Some of [the houses] certainly contained a mould [sic] or spots of discoloration the walls, which would have doomed them to destruction. Even the old shoes and things of that kind found in confined rooms, looked as if they were covered with frost, being white or green with mould; while the summer solstice was approaching, the heat of the weather became more intense. At length, a number of emigrants, just from Ireland and Germany, fell the first victims to that artificially created disease, the yellow fever.41 Cartwright emphasised the dangers these strangers posed to the native citizenry, describing the epidemic as an invasion. ‘As soon as it passed from the emigrant army to the citizens’, he observed, ‘it rapidly spread over the whole city.’42 Yet, as much as the epidemic might be blamed on the Irish and German immigrants, Cartwright’s article identified a startling correlation between poverty, bad air and poor city sanitation. Vicksburg’s epidemic, however, did not originate among the poor. The Fugates and the Laniers were both middle class families. As a result, accusations of poor sanitation were dismissed, and miasmatists endeavoured to identify environmental conditions that were not man-made. Birchett observed that the town of Clinton, Mississippi, east of Vicksburg, remained unscathed by the epidemic despite a railroad connecting the two communities. He pointed out that Clinton, unlike Vicksburg, was ‘not situated on the river’, suggesting that the river might have somehow been responsible. Another physician was more elusive. He simply recalled the presence of a ‘peculiar smell’, and suggested a relationship between the rise in sickness and the presence of ‘northern winds’. Contagionists were not persuaded. They addressed these theories directly and dismissed each of them. Dr Alexander Magruder, proclaimed that Vicksburg had ‘never [been] … more beautiful and cleanly condition[ed]’, while others argued that Vicksburg had suffered no climactic or meteorological variations from previous years. Additionally, there was no unusual insect or mould present in the area, and while the city did use cistern water, Marshall was quick to assure the Sanitary Commission that all cisterns were subterranean.43 Despite their best efforts, the epidemic of 1853 brought physicians no closer to understanding how yellow fever was transmitted. Nevertheless, they continued their speculation. Such debates, after all, were essential to legitimising their professional expertise. Unfortunately, these debates also exposed discrepancies between physicians’ experience of the epidemic and that of their patients. All of the reports submitted to the AMA and the New Orleans Sanitary Commission carried a similar tone. They were clinical, scientific and often provided a list of facts or observations regarding individual patients. They revealed nothing about how their patients’ experienced their illness, but those experiences were nonetheless traumatising. One newspaper correspondent graphically described what it was like to have yellow fever: As he awakes in the morning, all the fires of a volcano seem concentrated in his burning brain. His face grows haggard with its intense suffering. His eyes revolved in their orbits with glaring vivacity. Yellow streaks overspread his features in a moment, as if dashed there by a coarse brush dipped in gall. Sharp pangs tremble in his marrows. His blood throbs like lightning as hot and quick in every bursting vein, and then a whirlwind of the wildest delirium wraps his soul in dreams of fire. Oh!, This is Yellow Fever!44 Yellow fever was agony, understood only by those who suffered, lived and died from it. But the suffering was not limited to the sick. When news first broke of a potential yellow fever outbreak in Vicksburg, the fear and anxiety was almost palpable. Some businesses attempted to capitalise on this unease. ‘Protection against yellow fever!’ announced one advertisement for the New York Life Insurance Company ‘is not your life as well worth insuring as your house?’45 Advertisements for patent medicines promised to cure ‘longstanding and obstinate’ fevers at one dollar a bottle.46 Despite the press’s efforts to keep everyone calm, panicked residents left the city in droves, leaving behind empty homes, barren streets and abandoned businesses. For those who stayed, the sight was disheartening. One newspaper reported that ‘where two weeks since all was business and activity, [now] silence and stillness reign supreme’.47 Yet Vicksburg was hardly unique. Flight was the only way to ensure one’s continued health and therefore a common reaction to any epidemic at the time. New Orleans and Natchez reported similar events.48 Mobile was described as the ‘city of Tombs’, ‘silent as the grave’.49 Vicksburg, however, was not silent. For as the epidemic spread, it brought with it new, unnatural sounds that permeated city life: The hearses were running all day from earliest dawn until eight or nine o’clock at night, with the dead followed by weeping relatives and friends. We watched by the sick bed of a friend on Saturday night, and ever and anon the wailing of some widowed heart would break upon the stillness of the dull atmosphere which hung like lead over the city; and again the hurrying steps of the messengers for medical aid and the hurried gallops of the physicians horses were heard, and all was still and silent again. Death seemed to throw all his weight upon the city, crushing its very life out.50 To Emma Crutcher, even nature was filled with gloom. ‘The singing of the birds seems to be a funeral Chant’, she wrote to her nephew, ‘so sad and mournful is their song’.51 Death plays a significant role in shaping social identity by dividing the population into the young and old, the living and the dying. Furthermore, the rituals inherent to the mourning process highlight the customs and values cherished most in a society. For Vicksburg residents, as with most nineteenth-century Americans, mourning began with remembering. Obituaries and funeral sermons recast the deceased in the role of teacher whose life offered lessons, both positive and negative for survivors. In a way, the dead gained immortality on their deathbeds as the story of their last hours was repeated by whoever was there to witness, if anyone was there to witness.52 But when there is extraordinary loss of life, such as in times of war or epidemic, these rituals become strained, forced to adapt under altered circumstances, or lost entirely. Death, then, becomes a marker of social instability, of the unnaturalness of the times. This is what began to happen in late summer and early autumn of 1853, when yellow fever and death became just another, albeit horrifying, part of daily life. When, instead of immortality gained through memory, death became terrifyingly anonymous. Despite the growing number of dead, there was no increase in obituaries printed in Vicksburg newspapers. Editors of the Vicksburg Whig were appalled, proclaiming that the ‘pestilence has so completely unhinged the minds of our citizens that even friends forget or fail to publish the usual obituary notices of the dead’.53 Instead, the names of victims appeared in the daily sexton’s report, becoming little more than a statistic reminding survivors of how little individual deaths counted in such circumstances. ‘The number of deaths is appalling,’ Emma Crutcher wrote to her nephew, Tom, ‘and still the Sexton’s report of today gives a list of 42 named in three days.’ With so many victims, it was difficult to keep track of who was dead and who yet survived. Crutcher admitted that while many of Tom’s friends had passed, she could not remember to name them.54 Anonymity, however, was not the final injustice heaped upon the victims. As the body count grew, the number of corpses generally outstripped the speed with which sextons could work. One New Orleans newspaper reported that corpses were dumped inside cemeteries without care of undertaker, sexton or anyone to arrange a burial. It was this sight, above all else, that demonstrated how the epidemic threatened the very foundation of enlightened society. ‘The civilized world would scarcely believe that, in the wealthy flourishing city of New Orleans, hundreds of human bodies … have been allowed to remain exposed to the broiling sun’, one reporter wrote of the Fourth District Cemetery. When the bodies were buried, they were laid in shallow trenches fourteen inches deep, leaving two inches of the coffin exposed above the surface. Then, large ‘clumps’ of dirt were heaved on top ‘leaving openings for the flies to crawl in and crawl out, and most certainly liable to be washed away by the first heavy rain.’55 The sight gave New Orleans an otherworldly feel, like the epidemics ‘which have decimated, at different epochs, certain parts of the Old World.’ The editor of DeBow’s Review feared that if New Orleans officials hesitated any longer, the ‘pestilence of Florence will have had a counterpart here in our city’.56 By late summer, the Lower Mississippi River Valley was under siege. Isolated and struggling to care for the sick and dying, residents were desperate for relief. The current epidemic was worse than anything they had ever experienced before and its growing severity suggested no end in sight. On 12 September, a woman in Natchez wrote about conditions there, 60 miles south of Vicksburg on the Mississippi River. ‘Sickness and death are everywhere around us’, she told him, ‘scarcely a family has escaped and in several instances we have had three internments a day.’ It seems that everyone knew someone ill or dying. Indeed, this mother’s own two sons were both sick, one extremely so. She declared his recovery ‘doubtful’.57 Letters crossed the country, carrying the latest news of ‘the Fever’. Since victims took ill and died within a matter of days, many families had no idea their loved ones were ill before receiving news of their death. Mere weeks after receiving word of Mary Lanier’s death, Ellen and Tom Charles received word of the deaths of Tom’s brothers, Harry and Henry. Another letter reached the Posthlewait family of Natchez, announcing the death of a family friend in Opelousas, ‘Every few days our heartache saddens by the sight of a families’ name in the funeral announcements, and so many young, with lives of so much promise before them are taken.’58 For some, the loss was unbearable. On 8 October, the Vicksburg Whig reported that a local teacher, Mr Barbour, had gone missing. Barbour, who was suffering from yellow fever, had recently lost both his wife and mother. It was assumed he had drowned himself in the river.59 In light of the severity of the situation, it is remarkable that residents rarely mentioned the presence of physicians. When doctors were mentioned directly, it was to question their abilities. ‘Our physicians appear to be perfectly at a loss of what to do’, Emma Crutcher complained. Her doubts were not unwarranted. To date, physicians seemed incapable of answering even the simplest questions. They had failed to keep yellow fever out of the city and squabbled over how the disease might be spread, all while the epidemic slowly worsened. To make matters worse, the severity of the epidemic called physicians’ initial diagnosis into question. ‘I tell you plainly’ Crutcher admitted, in September, ‘I think it something worse than Yellow Fever.’60 Such doubt was common. Physicians had always had difficulty distinguishing yellow fever from its sister diseases: malaria, west nile and dengue. Indeed, for a brief period in the late eighteenth and early nineteenth centuries it was believed that they all might be different stages of the same illness. All these fevers, after all, produced similar symptoms, including a yellowing of the skin. Physicians therefore tended to lump all the ‘yellowing fevers’ into one vague diagnosis such as ‘malignant fever’, ‘pestilential fever’ or simply ‘the plague’.61 Physicians themselves began to doubt their diagnosis. Fenner reported that ‘There were various rumors afloat that this was not genuine yellow fever.’62 And even in Vicksburg physicians began to suspect that the epidemic was actually dengue fever.63 Despite the fact that many of the symptoms, black vomit especially, pointed directly to yellow fever, the epidemic was not behaving the way physicians anticipated. By 1853, it was commonly accepted that people of African descent were immune to yellow fever. Such an argument not only reinforced southern physicians’ assertions that slaves were biologically different from their masters, it also bolstered the proslavery argument that enslaved men and women were better suited to the environmental conditions under which they laboured. Indeed, this belief prevailed so strongly that the one newspaper identified ‘black and quadroon’ women as the the best nurses for yellow fever patients.64 In reality, though the epidemic did not recognise racial differences. On 17 August, Dr William Balfour was called to the bed of a local enslaved woman named Jane. Jane was a washerwoman who took in linens from various clients including the Washington Hotel where several visitors had taken ill. She died on 20 August after suffering from black vomit. Another case involved the family of George Selser, who lived on a modest plantation about seven miles from Vicksburg. Not only did the family fall ill after receiving an infected guest, but several of Selser’s slaves took sick as well.65 Yet many professionals refused to believe that the same illness plagued both white and black residents. In late August C. K. Marshall wrote to Samuel Cartwright, one of the most renowned southern physicians at the time, to express his doubts, ‘do negroes even have genuine yellow fever? Our Drs. are divided on the question. They (negroes) are attacked with the fever here and hence when in their cases it is dengue!!!’66 As a result, some physicians began to diagnose their patients with either ‘modified typhus’ or ‘African Fever’, in order to differentiate the cases.67 If physicians could not agree on a singular diagnosis, neither could they settle on a standard treatment. Instead, each measure was carefully taken as a means to counteract specific symptoms.68 As a result, physicians had little control over their patients’ fate. At best, they claimed that if treated within the first twenty-four to thirty-six hours, the patient had a better chance for survival.69 Most everyone agreed that if black vomit were present, the illness was fatal.70 Physicians employed a number of different treatments. By 1853, new advancements in clinical and laboratory-based medications led orthodox physicians to question the effectiveness of heroic medicine. Criticism of treatments such as bleeding and purging was voiced as early as the 1830s. By the 1850s many physicians in New England and other northern states had stopped using them. Southern physicians, however, stubbornly held on, and many of these techniques were used during the 1853 epidemic. One physician, Dr E. M’Allister, working in Grand Gulf 42 miles south of Vicksburg described his treatment for yellow fever. After ensuring that the sick room was well ventilated and subjecting the patient to a cold plunge bath, he administered tea along with ‘calomel, blue mass, hymosciamus, to cleanse the bowels and then additional castor oil if not working properly’. M’Allister heartily recommended bloodletting, noting that one woman ‘seven months advanced in pregnancy’ was bled in an attempt to calm the ‘commotion of her heart’, and reported very happily that she recovered and delivered a healthy son at term.71 It is unclear if the patient actually had yellow fever. Of course at times, professional disagreements over treatment became heated. There was at least one practitioner whose treatments were unpopular among his colleagues. Generally referred to as ‘Dr. F—’ or simply the ‘quack’, he was described as a charlatan who fooled his patients into believing they were receiving proper medical treatment. More importantly he was accused of preventing the collection of scientific information that might have helped control the epidemic. At any rate ‘Dr. F.’ succumbed to the disease himself early into the epidemic. His death was celebrated as a benefit ‘for the suffering humanity’.72 Despite the unusual circumstances, it is important to note that each of these problems—questionable diagnoses, inefficient treatments, and even professional bickering—were inherent to the state of medicine during the first half of the nineteenth century. Nevertheless, the public nature of the epidemic made it more noticeable and cast further doubt on physicians’ abilities to do their jobs. In light of this, Vicksburg residents sought comfort elsewhere. In doing so, they imparted a type of social authority to organisations or traditions that sought to help them interpret the meaning of the epidemic, both physically and spiritually. Cities such as New Orleans, Vicksburg and Natchez were in dire need of money, supplies and hands to help care for the less privileged members of society. Unlike in postbellum epidemics, most benevolent contributions did not come from national organisations.73 There was, for example, the Howard Association first organised in New Orleans during an 1837 yellow fever outbreak. Their primary objective was to care for victims of the epidemic regardless of race or class. While the Association’s first duty was to the sick and ‘indigent’ of New Orleans, they also sent agents into the surrounding areas to help local communities deal with the epidemic.74 Vicksburg benefited from the Association directly, receiving money, supplies and additional nurses and physicians to help tend the sick.75 Local benevolent societies, however, were just as important. The Vicksburg Tri-Weekly Whig printed the records of the Benevolent Association of Vicksburg alongside the Sexton and Hospital Reports. These columns kept track of monetary contributions, announced specific needs, and listed association members so that people needing help would know who to contact.76 In three months, the Benevolence Association received $6,329.50 which was used for ‘the relief of the city’.77 They also continued sharing excess funds with neighbouring communities. Money sent to Natchez went to the care of children orphaned by the epidemic. In mid-October, the newspaper announced that 22 of 33 orphans had found homes in the area.78 While benevolence societies helped Vicksburg residents cope with the physical and financial demands created by the epidemic, religion met their spiritual needs. Desperately seeking meaning for so many deaths, residents wrote of their renewed faith and an increased awareness of their dependency on God. Some, such as the writer of ‘What is Life’, a poem published in the local newspaper, sadly remarked on life’s fragility. Declaring that life was ‘quickly gone in one brief sigh/full of mournful melody’, the author prayed that hope not abandon her as she struggles to cope with sorrow and pain.79 Others sought lessons from their dying loved ones. Emma Crutcher found inspiration from her nephew Henry: He thought from the first he would not recover. On Saturday he sent for Mr. Pointer was baptized and joined the Church made all his arrangements with as much composure, as though he were going from home for a short time. He begged me to write to you [Tom Charles] and tell you he had died the death of a Christian and hoped you would prepare yourself to meet him. … He was perfectly resigned and I will never forget his death bed for it has made an impression on my mind that time can never efface. I feel now how truly important a thing Religion is and hope when Death appears to me I may be as ready to meet it as Henry.80 Ministers responded to the spiritual needs of their congregation with words of comfort. Among these men was Reverend Patterson, who refused an invitation to stay with a friend for the duration for the epidemic. ‘I have no apprehension of being taken sick’ he wrote in mid-August, ‘I have always acted upon the principle that danger flies from those who firmly meet it. Besides, in meeting it, if it comes, I am but doing an imperative duty, a duty appointed by God.’81 Religious leaders became so integral to managing the crisis that they were often placed on the same level as physicians. Their loss was equally as devastating, if not more so. When Patterson died on 14 September 1853 members of the community expressed their disbelief, ‘It seems but yesterday that the sound of his voice was in our ears … the warm pressure of his hand, the kindly greetings of affection from him are still fresh in the memory; and yet he has seen the “last of the earth.”’82 To Vicksburg residents, physicians and clergymen performed similar functions. One treated the body while the other cared for the soul. By choosing to stay, they each paid the highest price by sacrificing their own safety to perform the simplest acts of their profession. Nevertheless, the best human efforts could only ease the suffering. Nature and time were the only things that could truly end the epidemic. Just as southerners had long recognised a connection between hot, wet summers and the dangerous fever seasons, they understood a similar relationship between winter’s first frost and the end of the epidemic.83 ‘It is only the 29th [of September] and we cannot expect frost for weeks yet to come’, Crutcher warned her nephew.84 She was not alone in her impatience. In mid-October, The Vicksburg Tri-Weekly Whig reprinted the dates of the first hard frost for every year since 1832. Doubtless many residents were discouraged to discover that in 1849 the first frost did not come until 29 November, considerably later than the usual date toward the end of October. Fortunately for Vicksburg residents, they did not have to wait that long. On the morning of 25 October, they were greeted with a welcomed headline declaring ‘Frost!! Frost!! … We had a fine white frost this morning and the thermometer is down to 34 degrees.’85 While yellow fever cases would continue to appear into early November, the newspaper reported that individuals need not fear it. After nearly three months of siege, the epidemic was over. The bells of Christ Episcopal Church in Vicksburg, Mississippi, rang out on 4 December 1853, calling congregants and residents alike to the church’s doors. Crossing the gently sloping track of Main Street, people filed one by one into the small sanctuary, preparing for yet another funeral sermon, this one in memory of the church’s late rector, Reverend Stephen Patterson. After choosing to stay and nurse his flock, Patterson had fallen ill and died on 14 September. By December, he had become something of a hero. Indeed, the story of Patterson’s determination to serve his congregants and his bravery in the face of death were so celebrated that his funeral sermon was delivered by none other than Reverend William Mercer Green, the presiding bishop of the Episcopal Churches in the United States. Yet Reverend Patterson was not the only person on the congregation’s mind that day. He certainly was not the only reason the ladies wore black or the men donned mourning bands. Nearly everyone in the sanctuary had lost a loved one during the city’s latest bout with the saffron scourge.86 Green began his sermon with a description of a battered Israel who, having disobeyed God’s commandments, incurred His wrath. No doubt Green’s words stuck a chord with the weary congregation as he drew a direct comparison between the Israelites and the residents of Vicksburg. The only difference, he claimed, was that ‘The Divine judgments spoken of in the text, though sure and unavoidable, had not yet fallen upon [Israel]’. For Vicksburg, however, the judgment had come and gone. ‘A few weeks since,’ proclaimed Reverend Green ‘the streets of this city … scarcely knew the foot or the voice of the living. The Spirit of Pestilence brooded over it in fearful silence. … Seldom, if ever has the hand of disease pressed more heavily upon any people.’ Yet, it was important to find God’s lesson. Green noted that the recent calamity’ made it possible to determine true friendship and courage. ‘We yet survive’, he declared, ‘why others should have been taken whilst we have been left and for what special purpose our lives have been prolonged none can tell. Nor is it right that we should seek to know.’87 Instead, he encouraged his listeners to use their experience to become wiser and better Christians. Green’s words did not just offer reassurance. His sermon also provided direction, instructing backsliding congregants on the first steps toward rebuilding their lives and their city.88 The yellow fever epidemic of 1853 has not one, but two narratives. There are two ways in which the epidemic was experienced, two ways in which its significance was interpreted. For physicians, the epidemic reinvigorated a professional debate, creating the opportunity for rural physicians to participate in a national dialogue. E. D. Fenner believed that the epidemic would forever be remembered as extraordinary, explaining that: Heretofore the ravages of this terrible pestilence have been restricted almost entirely to [New Orleans] and some of the smaller towns; but in 1853 it attacked every town along the river as high as Napoleon at the mouth of the Arkansas River, every village in Mississippi and Louisiana south of Vicksburg, and almost every plantation along the coast below Natchez.89 Thus, the virulence that made the epidemic so terrifying to the region’s population was a benefit to medicine. Within the year no less than three accounts of the epidemic were published and circulated nationwide, including the one facilitated by the American Medical Association. These publications were important to the medical community’s efforts to attain professional authority because they cast physicians as experts who had practical experience with diagnosing and treating yellow fever. Significantly, it was southern voices that did the talking. Fenner, a resident of New Orleans collected as much as he could about the epidemic and reported it with authority. Vicksburg physicians Alexander Magruder, Thomas Harper and G. K. Birchett all published their accounts, continuing in print the discussions concerning communicability, treatments, and diagnoses that they must have begun in person. In the earliest years of the sectional conflict, just as some southern physicians were beginning to feel themselves maligned by their northern colleagues, these physicians had found something unique to offer the broader professional community. Unfortunately, professional authority cannot be seized. It must be conferred, given by patients willing to entrust themselves to their physicians’ care.90 To this end, professional debates did not matter, actions did. To Vicksburg residents, physicians offered little practical aid in managing the epidemic. They failed to identify yellow fever as a potential health threat despite epidemics raging in Jamaica and Brazil. They never agreed on the virus’s communicability, thus preventing the creation of a public policy that might have limited the epidemic’s spread, and, by the epidemic’s end, they were even doubting their own diagnoses. Indeed, physicians’ incompetence seemed to extend beyond their inadequate pharmacopeia. Just as the medical community was struggling to establish a reputation as professional experts deserving respect from would-be patients, physicians’ failures during the 1853 yellow fever epidemic undermined that reputation. The epidemic was a fresh trauma, impressed upon the psyche of Vicksburg residents. In their experiences, physicians played an insignificant role. Having been lulled into a false sense of security in 1853, Vicksburg residents endeavoured to prevent further outbreaks. None of these efforts utilised physician’s expertise in their conception or implementation. Instead, they were practical changes made to the city’s infrastructure and administration. By the following year, the city had revisited plans to build a Marine Hospital that would confine sick travellers to the river’s edge. Construction bids were completed in October of 1854, and the doors opened just in time to serve as a Confederate Hospital less than ten years later.91 As the frost disappeared in the spring of 1854 and the summer months approached, the Vicksburg Board of Health began meeting at regular intervals. By September, the Board was requiring all Vicksburg physicians to make tri-weekly reports detailing any yellow fever cases in the city. Perhaps, though, there is no better testament to the way Vicksburg residents experienced the epidemic than in the ways that they chose to memorialise it. It is telling that the only public monument erected after the epidemic honoured, not the medical men of the city, but a member of the clergy who tended the spiritual as well as physical needs of his flock. Not long after the 4 December memorial service for Reverend Patterson, congregants of Christ Episcopal Church commissioned a monument to honour the late rector’s memory. The small obelisk capped with a simple cross, still stands. Weathered and covered in moss, it sits on the north side of the church, tucked into the shade of an oak tree. Lindsay Rae Privette is a doctoral candidate at the University of Alabama. She is currently writing her dissertation, ‘“Fightin’ Johnnies, Fevers, and Mosquitoes”: A Medical History of the Vicksburg Campaign’. Her dissertation examines the mutually beneficial, but sometimes contentious relationship between the United States Army Medical Corps and military policy during the American Civil War. Footnotes 1 Lucinda McRaven to Ellen Crutcher, 11 November, 1853, Charles-Crutcher-McRaven Papers, Mississippi Department of Archives and History, Jackson, Mississippi (hereafter cited as MDAH). 2 New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans on the Epidemic Yellow Fever of 1853 (New Orleans, 1854), 71–2, 83, 90–4. 3 For a brief overview of the history of yellow fever see François Delaporte, The History of Yellow Fever: An Essay on the Birth of Tropical Medicine (Cambridge, MA: MIT Press, 1991). 4 For a general overview of yellow fever and the postbellum South see Margaret Humphrey, Yellow Fever and the South (Baltimore, MD: Johns Hopkins University Press, 1992). Humphrey’s work was one of the first that attempted to examine the virus’ role in the region as a whole and argues that yellow fever, unlike any other disease, required government involvement and lead to the creation of the modern public health care system. Other, more specialised studies include John H. Ellis, Yellow Fever and Public Health in the New South (Lexington: The University Press of Kentucky, 1992); Thomas H. Baker, ‘Yellowjack: the Yellow Fever Epidemic of 1878 in Memphis Tennessee’, Bulletin of the History of Medicine, 1968, 42, 241–64; Khaled J. Bloom, The Mississippi Valley’s Great Yellow Fever Epidemic of 1878 (Baton Rouge: Louisiana State University Press, 1993); Deanne Stephens Nuewer, Plague Among the Magnolias: The 1878 Yellow Fever Epidemic in Mississippi (Tuscaloosa: University of Alabama Press, 2009); and Molly Caldwell Crosby, The American Plague: The Untold Story of Yellow Fever. The Epidemic That Shaped our History (New York: Berkley Books, 2006). Finally, Edward J. Blum’s Reforging the White Republic: Race, Religion, and American Nationalism, 1865–1898 (Baton Rouge: Louisiana State University Press, 2005) offers a chapter arguing that the 1878 epidemic was an instrumental event leading toward reconciliation after the Civil War. 5 John Duffy, Sword of Pestilence: The Now Orleans Yellow Fever Epidemic of 1853 (Baton Rouge: Louisiana State University Press, 1966); Jo Ann Carrigan, Saffron Scourge: A History of Yellow Fever in Louisiana 1796–1906 (Lafayette: University of Southwestern Louisiana, 1994); and Henry M. McKiven Jr., ‘The Political Construction of a Natural Disaster: The Yellow Fever Epidemic of 1853’, The Journal of American History, 2007, 734–42 all offer an examination of yellow fever’s presence in antebellum Louisiana while Peter McCandless, Slavery, Disease, and Suffering in the Southern Lowcountry (Cambridge: Cambridge University Press, 2011) and Jeff Strickland, ‘Nativists and Strangers: Yellow Fever and Immigrant Mortality in Antebellum Charleston, South Carolina’ in Craig Thompson Friend and Lorri Glover (eds), Death in the American South (Cambridge: Cambridge University Press, 2015), 131–52 examine Charleston. 6 Heroic medicine was the typical method of treatment made famous by Benjamin Rush in the late eighteenth-century. It concluded that the base cause for all disease was overstimulation of the nervous and vascular system. To restore proper balance, physicians should employ dramatic treatments to bleed, blister and purge their patients. 7 For more on sectarianism and professionalisation, see Joseph F. Kett’s The Formation of the American Medical Profession: The Role of Institution, 1780–1860 (New Haven, CT: Yale University Press, 1968) and John S. Haller Jr., American Medicine in Transition, 1840–1910 (Urbana: University of Illinois Press, 1981). 8 Christopher Morris, Becoming Southern: The Evolution of a Way of Life, Warren Country and Vicksburg, Mississippi, 1770–1860 (New York: Oxford University Press, 1995), 108–10. 9 The population of New Orleans was estimated at 116,375 for the same year. US Census Bureau ‘10 Largest Urban Places, 1850’, <http://www.census.gov/history/www/through_the_decades/fast_facts/1850_fast_facts.html > (accessed 4 February 2016); W. Williams, Appleton’s Southern and Western Traveller’s Guide (New York: D. Appleton, 1850), 50. 10 Vicksburg Tri-Weekly Whig, 8 February 1853. 11 Vicksburg Tri-Weekly Whig, 22 January 1853; 3 February 1853; and 7 May 1853. The third show was a performance by a travelling hypnotist named Madam Adolphe. 12 The earliest fatality resulting from yellow fever was reported on 30 May, with Vicksburg officials not aware of the circumstances until the last weeks of July. Erasmus Darwin Fenner, ‘Report on the Epidemics of Louisiana, Mississippi, Arkansas, and Texas in the Year 1853’, in Transactions of the American Medical Association, Instituted 1847, 33 vols (New York: Charles B. Norton, 1854), VII, 436; Vicksburg Tri-Weekly Whig, 23 July 1853. 13 Daily Picayune reported yellow fever in Kingston, Jamaica and Rio de Janeiro, Brazil on 17 February 1853. Additional articles followed in the 12 April, 13 May, 6 July, and 11 July editions. Daily Picayune, 5 June 1853. 14 Daily Picayune, 23 June 1853. 15 Duffy, Sword of Pestilence, 11. 16 Erasmus Darwin Fenner, History of the Epidemic Yellow Fever at New Orleans (New York: Hall, Clayton Printers, 1854), 5. 17 R. Clark, Sexton, Register of Burials from 15 March 1852 to 20 March 1860, Old Courthouse Museum, Vicksburg, Mississippi. 18 All patient cases have been reconstructed using New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans and Erasmus Darwin Fenner, ‘Report on the Epidemics of Louisiana, Mississippi, Arkansas, and Texas’, 430–1. 19 New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans, 70–3, Clark, Register of Burials, Old Courthouse Museum. 20 ‘List of Deaths’, Vicksburg Tri-Weekly Whig, 1 November 1853. 21 Natchez Mississippi Free Trader, 23 August 1853. 22 Annual Report of the Board of Visitors and the Board of Examiners of the Natchez Institute (Natchez: Daily Courier Book and Job Office, 1854), 4, 6–7. 23 Benjamin Rush, Observations upon the Origin of the Malignant Bilious, or Yellow Fever in Philadelphia and Upon the Means of Preventing it (Philadelphia, PA: Budd and Bartram, 1799), 26. 24 Martin S. Pernick, ‘Politics, Parties, and Pestilence: Epidemic Yellow Fever in Philadelphia and the Rise of the First Party System’, The William and Mary Quarterly, 1972, 29, 559–86, 562–3,569; John Duffy, From Humors to Medical Science: A History of American Medicine (Champaign: University of Illinois Press, 1993), 67; Humphreys, Yellow Fever and the South, 18. The classic study on the 1793 epidemic is J. H. Powell, Bring Out Your Dead: The Great Plague of Yellow Fever in Philadelphia in 1793 (Philadelphia: University of Pennsylvania Press, 1949). 25 David K. Patterson, ‘Yellow Fever Epidemics and Mortality in the United States 1693–1905’, Social Science and Medicine, 1992, 34, 855–65. 26 Crosby, The American Plague, 35. 27 The relationship between disease, contagion and the slave trade appeared in a number of late eighteenth-century texts including William Roscoe’s ‘The Wrongs of Africa’ and Samuel Taylor Coleridge’s ‘The Rime of the Ancient Mariner’; Debbie Lee, ‘Yellow Fever and the Slave Trade: Coleridge’s “The Rime of the Ancient Mariner”’, ELH, 1998, 64, 675–700. 28 ‘Yellow Fever and the Slave Trade’, The Friend: A Religious and Literary Journal, 1854, 27, 5. 29 John Warner, ‘A Southern Medical Reform: The Meaning of the Antebellum Argument for Southern Medical Education’, Bulletin of the History of Medicine, 1983, 57, 364–81, 370. 30 An excellent discussion over this disagreement during the 1793 epidemic can be found in Pernick, ‘Politics, Parties, and Pestilence’, 1972, 29, 559–86. In his article, Pernick not only describes the competing medical theories of the time, the same theories used sixty years later by Vicksburg physicians, he also incorporates a valuable discussion on how these theories influenced and became influenced by contemporary politics. 31 ‘Communicated’, ‘An Order for the Suppression of Nuisances’, ‘Notice’, ‘City Council’, ‘Sanitary Regulations’, Vicksburg Tri-Weekly Whig, 23 July 1853. 32 ‘Quarantine Regulations’, Vicksburg Tri-Weekly Whig, 23 July 1853. 33 Sanitary Commission of New Orleans, Report of the Sanitary Commission of New Orleans, 74, 70. 34 Fenner, ‘Reports on the Epidemics of Louisiana, Mississippi, Arkansas, and Texas’, 517. 35 ‘An Ordinance for the Suppression of Nuisances’, Vicksburg Tri-Weekly Whig, 23 July 1853. 36 ‘Advertisement for Free Lime’, Vicksburg Tri-Weekly Whig, 30 July 1853. 37 Fenner, ‘Report on the Epidemics of Louisiana, Mississippi, Arkansas, and Texas’, 430–1. 38 For more information regarding yellow fever as the stranger’s disease, see Jo Ann Carrigan, ‘Privilege, Prejudice, and the Strangers’ Disease in Nineteenth-Century New Orleans’, The Journal of Southern History, 1970, 568–78. 39 New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans, 72. 40 This line of reasoning does have value. The portions of the city with the poorest sanitation were more likely to have pools of stagnant water, a breeding ground for mosquitoes carrying the yellow fever virus. 41 Samuel Cartwright, ‘The Epidemic and its Causes’, Mississippi Free Trader, 6 December 1853. 42 Ibid. 43 Fenner, History of the Epidemic, 74; New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans, 131, 92–5, 73. 44 The Hinds County Gazette, 28 September 1853. 45 ‘Advertisement for New York Life Insurances’, Vicksburg Tri-Weekly Whig, 26 July 1853. 46 ‘Advertisement for Emanuel’s Specific for Chill and Fever’, Vicksburg Tri-Weekly Whig, 26 July 1853. 47 Daily Picayune, 24 September 1853. 48 ‘Our City’, Vicksburg Tri-Weekly Whig, 6 September 1853. 49 ‘Deserted City’, Vicksburg Tri-Weekly Whig, 10 September 1853. 50 Vicksburg Weekly Sentinel, 14 September 1853, quoted in ‘Health’, Source Material for Mississippi History Project: Warren County, Box 10835, Series 447, MDAH. 51 Emma Crutcher to Tom Charles, 20 September 1853, Charles-Crutcher-McRaven Family Papers, MDAH. 52 There is an extensive historiography on death and the art of dying well. For further reading, see James J. Farrell, Inventing the American Way of Death, 1830–1920 (Philadelphia, PA: Temple University Press, 1980); Philippe Ariès, The Hour of Our Death (New York: Vintage Books, 1981); Ralph Houlbrooke (ed.), Death, Ritual and Bereavement (London: Routledge, 1989); Pat Jalland, Death in the Victorian Family (Oxford: Oxford University Press, 1996); and Drew Gilpin Faust, This Republic of Suffering: Death and the American Civil War (New York: Vintage Books, 2008). 53 Daily Picayune, 24 September 1853. 54 Emma Crutcher to Tom Charles, 20 September 1853, Charles-Crutcher-McRaven Family Papers, MDAH. 55 ‘The Yellow Fever in New Orleans’, Montgomery, Daily Alabama Journal, 17 August 1853. 56 ‘Plague in the Southwest’, DeBow’s Review, Agricultural, Commercial, Industrial Progress and Resources, 1853, 15, 595–635. 57 P. R. Anderson to William T. Walthall, 12 September 1853, Walthall Family Papers, MDAH. 58 Unnamed to Posthlewait, 23 September 18—, Posthlewait Family Papers, MDAH. 59 New Orleans Daily Picayune, 8 October 1853. 60 Emma Crutcher to Tom Charles, 20 September 1853, Charles-Crutcher-McRaven Family Papers, MDAH. 61 McCandless, Slavery, Disease, and Suffering in the Southern Lowcountry, 62–3. 62 Fenner, ‘Report on the Epidemics of Louisiana, Mississippi, Arkansas, and Texas’, 446. 63 C. K. Marshall to Samuel A. Cartwright, 30 August 1853, Samuel A. Cartwright Family Papers, Lower Louisiana and Mississippi Valley Collection, Baton Rouge, Louisiana (hereafter cited as LLMVC). 64 New York Daily Times, 26 September 1853. 65 New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans, 72, 74. 66 Marshall to Cartwright, 30 August 1854, Cartwright Family Papers, LLMVC. 67 Fenner, ‘Report on the Epidemics of Louisiana, Mississippi, Arkansas, and Texas’, 466. 68 To date, the yellow fever virus has no cure. 69 Fenner, History of the Epidemic Yellow Fever at New Orleans in 1853, 58. 70 New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans, 91. 71 E. M’Allister, MD, ‘The Yellow Fever at Grand Gulf, Miss, in 1853’, New Orleans Medical and Surgical Journal, 1854, 675–8. 72 New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans, 70. 73 H. S. Fulkerson, Random Recollections of Early Days in Mississippi (Vicksburg, MS: Vicksburg Printing and Publishing Company, 1885). 74 By the middle of the nineteenth-century, there would be branches of the Howard Association in a number of other southern cities, particularly those which had a high prevalence for yellow fever. Elizabeth Young Newsom, ‘Unto the Least of These: The Howard Association and Yellow Fever’, Southern Medical Journal, 1992, 85, 632–7. 75 Emma Crutcher to Tom Charles, 20 September, 1853, Charles-Crutcher-McRaven Family Papers, MDAH. 76 ‘Benevolent Association of Vicksburg’, Vicksburg Tri-Weekly Whig, 1 November 1853. 77 ‘List of the Contributors’, Vicksburg Tri-Weekly Whig, 24 November,1853. 78 ‘Orphans in Natchez’, Vicksburg Tri-Weekly Whig, 15 October 1853. 79 Mabel, ‘What Is Life?’ Vicksburg Tri-Weekly Whig, 27 August 1853. 80 Emma Crutcher to Tom Charles, 20 September, 1853, Charles-Crutcher-McRaven Family Papers, MDAH. 81 Reverend Stephen Patterson to ‘Mrs. R’, 18 August 1853, reprinted in Reverend W. M. Green. Funeral Discourse on the Death of Reverend Stephen Patterson, Late Rector of Christ’s Church Vicksburg, Miss. Delivered in that Church Dec. 4, 1853 by Rt. Rev. W. M. Green, D. D. (Vicksburg: Whig Book and Job Office, 1854), 16–17. 82 ‘Obituary’, Vicksburg Tri-Weekly Whig, 20 September 1853. 83 Today, it is generally understood that the frost plays a significant role in killing mosquitoes therefore hindering the disease’s spread. 84 Emma Crutcher to Tom Charles, 20 September 1853, Charles-Crutcher-McRaven Family Papers, MDAH. 85 ‘Frost!! Frost!!’, Vicksburg Tri-Weekly Whig, 26 October 1853. 86 Prior to this post, Green had served as the first bishop of the diocese of Mississippi. Green, Funeral Sermon. 87 Green, Funeral Sermon, 5–6. 88 Indeed, belief in Divine Providence was a dominant characteristic in eighteenth- and nineteenth-century Christianity. For more information see Nathan Hatch and Mark Noll, The Bible In America: Essays in Cultural History (Oxford: Oxford University Press, 1982); David Hall, Worlds of Wonder, Days of Judgment: Popular Religious Beliefs in Early New England (Cambridge, MA: Harvard University Press, 1990); and Nicholas Guyatt, Providence and the Invention of the United States , 1607–1876 (New York: Cambridge University Press, 2007). Additionally, Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866 (Chicago: The University of Chicago Press, 1962) specifically discusses the competition between religious leaders and physicians, both of whom endeavoured to interpret the meaning of America’s cholera epidemics. 89 Fenner, ‘Report on the Epidemics of Louisiana, Mississippi, Arkansas, and Texas’, 424. 90 For more on the evolution and growth of the authority and legitimacy claimed by the American Medical Profession see Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic Books, 1982). 91 ‘Cholera by Steamboat built Marine Hospital’, Vicksburg Evening Post, 13 April 1959. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Social History of Medicine Oxford University Press

‘We Yet Survive’: Physician Patient Relationships and the Yellow Fever Epidemic of 1853

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Oxford University Press
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© The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
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0951-631X
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1477-4666
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Abstract

Summary During the summer of 1853 a devastating yellow fever epidemic swept through the Lower Mississippi River Valley. This article examines that epidemic as it was experienced in Vicksburg, Mississippi, and reveals the disjoint between patients’ expectations and physicians’ capabilities. In the months following the first case, Vicksburg physicians leveraged their role in managing the epidemic to participate in national conversations regarding communicability, treatments and sanitation. However, from their patients’ viewpoint, these conversations were useless. Instead, growing sexton reports and overcrowded cemeteries proved physicians’ inability to manage the crisis, thus reinforcing Americans’ wariness of professionalised medicine. In the end, physicians and residents held opposing experiences of the epidemic, and physicians’ inability to meet the practical needs of their patients further challenged their claims to professional legitimacy. yellow fever, epidemic, Mississippi River, medical professionalism, doctor–patient relationships Mary Jane Lanier died on 11 August 1853. She was twenty-three years old, the mother of four small children, and lived in one of Vicksburg’s most respectable neighbourhoods. She had been ill less than a week. At first, her symptoms caused no great alarm. She most likely suffered from chills and a low fever. This coupled with pain in the head and muscles were indicative of a number of common ailments familiar to nineteenth-century Americans. Mary’s sister came to visit from her country plantation, as did her mother. Together, the women would have overseen Mary’s care until her condition worsened and they sent for a doctor. Perhaps, her skin had already turned a pallid yellow, for when Doctor Thomas Harper first examined his patient he had no doubt about the diagnosis. Yellow fever. The day after Harper took charge of Lanier’s care, her final symptom appeared. She began to vomit a thick black substance—partially digested blood. Afterwards, Lanier’s mother would recall that ‘[Mary] was so verry [sic] sick that it was distressing to see her … she had expressed some fears that she never would get well and asked her Uncle Lawrence to pray for her that she might be relieved of the sickness at her stomach.’ Her prayers were not to be answered. Black vomit was the most iconic, if horrifying, of yellow fever’s symptoms, and it was always fatal. ‘You never would forget it’, her mother wrote ‘if you could have heard her cawling “ma, ma, ma” when her tongue was faltering that she could hardly speak. I believe that “ma” was the last word she spoke.’1 Despite his presence, there was nothing Harper could do.2 Yellow fever and the American South share a long and tangled history, one that has not been ignored by historians.3 Various studies skilfully highlight how health crises shaped southern social and political ideology. The devastating epidemic of 1878, for example, was not only instrumental to post-war reconciliation, but also in creating new public health care policies. According to this narrative, the reconstructed South remained both medically and economically backward until redeemed by new discoveries in scientific medicine, urban planning and city sanitation.4 There are fewer studies about yellow fever outbreaks in the antebellum era. Those that do exist examine how physicians, city officials and even the general public used yellow fever to reinforce the antebellum South’s social stratification.5 These are important observations, particularly when anticipating the sectional crises. Over the years, however, the relationship between the antebellum South and race-based medicine has obscured other questions about the connection between health, disease and southern society, namely, how diseases like yellow fever shaped the public reputation of medical professionals. Medical care in the first half of the nineteenth-century was a curious mix of traditions and systems, all striving for primacy in the eyes of the general public. The disappearance of licensing standards combined with falling standards in medical education resulted in a class of under-trained professionals. Furthermore, the harsh treatments characteristic of heroic medicine often killed patients faster than the diseases they were designed to cure.6 All of these factors earned traditionally trained physicians a reputation for talking too much and knowing too little. By the 1830s, various medical sects had sprung into being, each challenging aspects of orthodox medicine. Groups such as homeopaths rejected the use of harsh chemical-based medicines while populist sects such as Thomsonianism sought to democratise the profession altogether. As a result, orthodox physicians redoubled their efforts to gain public respect while undermining the legitimacy of sectarian dissent. These efforts culminated in 1848 with the creation of the American Medical Association (AMA). As the first national professional organisation, the AMA was intended to police the boundaries of respectable medicine and to act as a type of gatekeeper for the formal medical establishment. However, the discussions facilitated by the AMA, and similarly minded state organisations, counted little outside of the profession itself. The relationship between patients and their physicians remained reluctant at best; medical disasters continued to perpetuate that relationship.7 The yellow fever epidemic that swept through the Lower Mississippi River Valley in 1853, however, not only highlights growing tensions between members of the medical community and the general population. It also reveals the ominous nature of the region’s growing economic and social interdependence. As such, any study of the 1853 epidemic should begin in New Orleans. People living in smaller river towns such as Natchez and Vicksburg were keenly aware that participation in the economic life of the Mississippi River offered both prosperity and danger. In light of this, the failure of New Orleans City officials, press and physicians to acknowledge the potential epidemic before it spread upriver was interpreted by smaller towns as a betrayal. Tracing the epidemic’s trajectory up river further highlights the economic and environmental ties that connected residents of the Lower Mississippi River Valley and afford the opportunity to include new voices within the traditional narrative. While there are many studies about yellow fever in New Orleans, few examine how these epidemics were experienced in smaller, more rural areas of the South. Using Vicksburg as a case study reveals how physician–patient relationships reflect the broader trends previously identified by historians. Thus, if physicians in New Orleans failed the entire region by not controlling the outbreak where it originated, local physicians failed Vicksburg residents with their inability to help implement a plan to manage the epidemic and save lives. Given these problems, residents pursued other outlets to maintain their spiritual and emotional well-being. First settled in 1819, by the middle of the nineteenth century Vicksburg was a bustling commercial town.8 Contemporary sources estimated that approximately 90,000 bales of cotton were shipped from Vicksburg’s port to New Orleans annually, and the effect of the booming cotton trade was present in the town’s landscape. Vicksburg was home to four churches, six saw mills, five brickyards, a shingle factory, and six schools, all serving a population of 4,500. The Charity Hospital, located on the east side of the city, was headed by Dr G. K. Birchett.9 More importantly, however, the city served as a major crossing point for travellers and goods moving east to west across the river. Travellers headed farther east could purchase one of the many railroad packages that would take them as far away as Charleston, or, if they preferred, could book passage on a coach.10 At Vicksburg, one could also board a steamboat headed south to New Orleans or north to Memphis. Peddlers moved up and down the river, selling newly acquired goods to the area’s residents and traveling shows flooded in for their entertainment. During the spring of 1853 alone three separate shows came through the town, offering residents the opportunity to see the exotics of California or Ireland for 50 cents admission.11 It was precisely the transient nature of Vicksburg’s population, stemming from the strong regional network of trade and travel, that made epidemics possible. The epidemic brought into sharp relief the most threatening feature of Vicksburg’s locality, the Mississippi River. However, Vicksburg’s vulnerability as a port town was not a revelation in 1853. Over the years, city officials had developed an interest in the health of other river towns with which Vicksburg shared an endless stream of people and goods. Of particular concern was New Orleans, whose port served as the gateway between the insulated Mississippi River Valley and foreign ports. River towns like Vicksburg depended on New Orleans physicians to serve as the first barrier against any potential health crisis. Unfortunately, city officials were not always forthcoming with information. On 20 May, the first recorded victim of the 1853 epidemic died in New Orleans. Yet, New Orleans physicians and city officials refused to acknowledge the virus’ growing prevalence until the end of July.12 In the interim, newspapers regularly reported on the devastating yellow fever epidemics raging in Brazil and the West Indies, but remained conspicuously silent on local conditions. By late June, the New Orleans Charity Hospital was reporting sporadic cases of yellow fever among the city’s most impoverished residents.13 These reports began to fuel rumors of a potential outbreak in the city, but even these rumors were stoutly denied. In a letter to the editor published on 23 June, one unnamed New Orleans resident maintained that while yellow fever had appeared in the city to the ‘enormous extent of about four cases’, there was nothing to worry about. ‘That it exists in a form or to an extent to produce alarm, except amongst old women, is most positively denied by all the most eminent physicians in the city.’ Not content to simply put rumors to rest, the author went on the challenge the authority of the organisation that published and sanctioned the reports: the New Orleans Board of Health. At the same time, editors of the Daily Picayune labelled the anonymous ‘observer’ as ‘a person who can be relied on as good authority.’14 Without the benefit of hindsight, it was impossible for New Orleanians to distinguish between the regular occurrence of yellow fever and the threat of an epidemic. After all, there were usually a handful of yellow fever cases each summer, but there had not been a major outbreak in over six years. Nevertheless, even the rumour of a potential crisis could send residents scurrying to the countryside with devastating economic consequences for the city’s trade. For this reason, it was all the more important not to incite panic over a health threat which might not exist. To this end, local physicians were routinely discouraged from circulating information about the few cases that did appear. Those that did were accused of attempting to arouse public apprehension.15 During his investigations, E. D. Fenner, head of the AMA’s research on epidemic disease in the region, complained that newspaper editors, guided by ‘a most erroneous impression of their duty to the public’, actively attempted to ‘conceal or suppress the true state of affairs’. As a result, many individuals who would otherwise have fled the city remained and exposed themselves to ‘imminent danger for want of correct information’.16 This hesitation would prove devastating in 1853. Yellow fever slipped unnoticed into Vicksburg in late summer when three men, Thomas Jackson, William Quimby and a Mr Scannell arrived during the last week in July. Jackson and Quimby, both labourers in their early twenties with no family and presumably little money, were admitted to the Charity hospital on 23 and 30 July respectively. There, they languished several days before succumbing to the virus. They were buried in the city cemetery, virtual unknowns. The third man’s fate was a bit different. A Jewish peddler, Scannell had enough money to pay for a private practitioner. He survived his bout with yellow fever and left town on 7 August. None of the cases were reported in local newspapers and both Jackson and Quimby were misdiagnosed in the sexton’s burial report.17 By early August, Vicksburg residents seemed to think that they were still yellow fever free.18 Had it not been for the subsequent epidemic, Jackson, Quimby and Scannell’s presence in Vicksburg might have gone unnoticed. However, as the epidemic took hold of the city, worsening through August and September, physicians struggled to reconstruct its origin. Because Jackson and Quimby had been treated in the hospital, physicians focused on Scannell. For the duration of his illness, Scannell and his travelling companions had obtained housing with the Fugate family. The Fugates owned a boarding house at the corner of Grove and Monroe streets, a prominent neighbourhood in downtown Vicksburg. Scannell’s location put him in close proximity to another important case: Mary Lanier. In fact, physicians would later note that she had purchased a dress from the peddlers just two days before she fell ill. Lanier’s case was notable among Vicksburg’s medical community. Every medical report published after the epidemic mentioned her as the first Vicksburg native to contract and die from the virus. After Lanier’s death, yellow fever spread throughout the city. By 8 September, the fever was declared an epidemic and continued at that rate for over a month. The last case recorded was Colonel Levi Mitchel who fell ill on 21 November and was buried two and a half weeks later.19 By the end of the year, nearly 500 Vicksburg residents had succumbed, nearly one eighth of the town’s population.20 In the wake of the epidemic, officials from towns all along the Mississippi River criticised New Orleans physicians, press and city officials for concealing the true nature of the city’s growing health crisis. While reporting Lanier’s death on 13 August, The Vicksburg Sentinel declared that although it ‘was customary to try and keep such things concealed … we believe it to be wrong, as the fact, when known may make others more prudent’.21 Natchez officials pointed out that yellow fever only spread up the river if there were first an epidemic in New Orleans. Thus, they argued, New Orleans was not only responsible for alerting the rest of the region to a potential epidemic, but also for implementing measures that ensured the illness did not spread to other river towns. Natchez officials recommended quarantine, and they suggested that New Orleans look to the North for how to implement one.22 By emphasising the North’s success at controlling yellow fever, Natchez officials were publicly identifying an inadequacy among the southern medical community. By 1853, yellow fever was a southern pestilence. This, however, had not always been the case. When yellow fever was first transmitted to the New World in the seventeenth century, it was not a regionally specific virus. Port cities all along the eastern seaboard, from New York to Charleston, suffered sporadic outbreaks. The most famous of these epidemics occurred in Philadelphia in 1793. That epidemic was notable not just because of the high death rate, but also because it gave rise to the theory that the virus was not contagious but the result of exposure to certain ‘miasma’, or bad air. Prevention, according to this theory, should be simple. ‘Our cities might be preserved … from the yellow fever by cleanliness’, Benjamin Rush wrote in 1799, adding that ‘it would seem as if the neglect of it was necessarily connected with suffering’.23 Driven by the concern that yellow fever could threatened the economic stability of the young Republic’s growing urban centres, cities such as Philadelphia and New York heeded Rush’s advice and began large scale sanitation projects designed to prevent further epidemics.24 The projects seemed to work at least for northern port towns. The last time yellow fever appeared north of Virginia was a small outbreak in New York and Baltimore in 1822.25 For many nineteenth-century Americans, yellow fever’s continued presence in the South was not just a symbol of the region’s questionable sanitation. It was a physical manifestation of the South’s most notable sin: slavery. Today, scientists suspect that the species of mosquito that transmits the yellow fever virus, the female aedes aegypti, was not indigenous to the western hemisphere, but came from Africa. It was the slave trade that offered these mosquitoes the opportunity to relocate to the marshy, tropical climate of the Caribbean and the American South.26 While individuals living in the late eighteenth and early nineteenth centuries remained unaware of the exact vector that connected disease with trade, they still recognised a relationship.27 By the late 1840s, this association between disease and slavery had become firmly embedded in the abolitionist movement, and reformers argued that the continuation of slavery was at the root of the South’s persistent health problems: The overpowering scent of the slave-ship, and the victims of this putrefying disease and death could not be mistaken. … No one acquainted with yellow fever can, for an instant, mistake it; and everyone familiar with a slave-ship, particularly after its voyage and while discharging its slaves, and being cleansed from its human corruption, must at once perceive the identity of the disease.28 These arguments deftly blended the moral implications of southern slavery with Rush’s miasma theory to describe a society that was not only fundamentally corrupt but also unclean. As arguments over southern slavery mounted during the 1850s, southern physicians felt particularly isolated. Already concerned by the damage to their professional reputation caused by sectarianism, the southern medical community began to feel inadequate when compared to northern orthodox physicians. That yellow fever prevailed in the South and not the North was a direct commentary on their effectiveness as professionals. Fenner himself thought his colleagues listless about attaining professional prestige. He longed for ways to ‘stimulate the physicians of the South to a more zealous and energetic prosecution of the noble science to which they have devoted their lives’.29 Yellow fever, then, became a rallying point as southern physicians struggled to recast themselves, not as weak professionals who had failed to eliminate the health threat from the South, but as experts who had the privilege of studying diseases peculiar to the South’s native environment. Unfortunately even as experts southern physicians fell short. Once word spread of a potential epidemic in New Orleans, Vicksburg physicians immediately offered recommendations for local protection. Unfortunately, not all agreed on the best course of action. As during the 1793 Philadelphia epidemic, physicians in 1853 were bitterly divided over the virus’ communicability.30 The popular medical theories of the day held that yellow fever was contracted in one of two ways. The first theory followed Rush’s belief that yellow fever was caused by miasma. Miasmatists argued that quarantines were useless since yellow fever originated somewhere inside the city and was probably caused by poor sanitation. Cleaning the city would, it was hoped, rid Vicksburg of the bad miasma and eliminate the source of the fever. Unfortunately, acknowledging the validity of the miasma theory shifted the responsibility for the epidemic onto the shoulders of city officials, physicians and residents who had failed to uphold the standards of cleanliness necessary to ensure a healthy city. In light of the unsavoury reputation yellow fever bestowed upon the region, contagionism offered a more palatable explanation. The health threat was not the result of Vicksburg’s failings, but an unavoidable consequence of the city’s social and economic ties to the rest of the region. Unfortunately, the only way to prevent such an epidemic was to sever those ties by quarantine, a decision that was nearly always controversial. Merchants and city officials feared the economic consequences of shutting down the city’s port. Towns such as Vicksburg depended on the import and export of goods, but there was no way to guarantee that these goods were not infected. Both a blessing and a curse, a quarantine might ensure the city’s physical survival while potentially spelling its economic demise. Unwilling to leave anything to chance, or perhaps unsure about which theory was more accurate, Vicksburg city officials adopted both a quarantine policy and sanitation reform measures.31 Quarantine regulations were passed on 23 July, and called for a wharf boat stationed a mile south of the city to inspect all northbound traffic. The regulations also established a hospital for the sick and infected at the quarantine grounds.32 These arrangements, however, were never meant to cut off trade completely, and the unwillingness to sever all ties to commercial traffic meant that the quarantine policy was a little too lax to be completely effective. For one thing, the quarantine only affected ships and goods coming up the Mississippi River from New Orleans. River traffic descending from Memphis was still entering the city on a regular basis, and inland traffic continued as usual. As one observer noted, ‘People could land at the quarantine, and coming round through the woods, to the East, enter the town; and as boats descending the river were not subjected to quarantine, anyone coming from New Orleans could pass up and exchange boats and land in the city coming down without delay.’ Nothing would prevent the mass exodus that resulted once word of the outbreak was made public. C. K. Marshall, a local minister, estimated that nearly two-fifths of the city’s population was eventually ‘embraced by the suburbs’.33 If anything, word of the yellow fever outbreak in New Orleans increased travel around the town, and reports made to the American Medical Association indicated that Vicksburg gave up on the idea of quarantine entirely after yellow fever cases began to multiply.34 The city’s new sanitation regulations were not nearly so controversial and were potentially more comprehensive. On 23 July , an ordinance ‘for the suppression of nuisances’ mandated that all carcasses be removed from the city limits and buried ‘at least four feet below the surface of the earth’. In addition, streets would be cleaned and disinfected with lime. The ordinance provided for the disposal of human waste, stating that every privy ‘shall have a pit in the earth at least five feet deep, walled with brick or wood’. When the contents of the privy reached nearer than two feet from ‘the surface of the earth’, it was the owner’s responsibility to ensure that the privy was either filled in or cleaned out and disinfected.35 In an effort to help residents meet the new sanitation standards and ensure the continued health of the city, the Vicksburg Lime and Cement Depot offered free lime to those who could not afford to purchase the disinfectant.36 While the debates between miasmatists and contagionists had practical implications for city policy and sanitation, there was professional merit to these conversations as well. After the epidemic, local physicians compiled case histories of their patients in an attempt to untangle the potential connections between each victim. These papers were then published by the AMA and the New Orleans Sanitary Commission for national circulation. Despite their best efforts, however, these reports consistently demonstrated only one thing. There seemed to be no logical pattern behind the virus’ spread. Or, rather, there seemed to be too many logical patterns. Whether contagionist or miasmatist, physicians found evidence to support their case. For instance, many physicians theorised that yellow fever originated aboard a ship named the Niagara which had docked in New Orleans on 30 April. Shortly thereafter, a stewardess fell ill with chills and a fever. She died on 20 May after ‘throwing up a quantity of black matter’. While contagionists argued that the Niagara transported yellow fever to New Orleans after being infected on previous voyages, others were not so certain. Fenner maintained that the yellow fever originated inside the city and pointed out that the stewardess had gone into the city to visit family just before falling ill.37 Furthermore, yellow fever’s reputation as the strangers’ disease was cited by both groups.38 It was commonly accepted that newcomers to the region were more susceptible to the virus owing to their lack of exposure to the harsh southern climate. Migrants often congratulated themselves on surviving their first sickly season in the South, considering the experience essential for adaptation to their new environment. It was not surprising to physicians, then, that the first yellow fever cases were not Vicksburg natives. Although Quimby and Jackson were confined to the hospital, physicians were quick to point out that the epidemic seemed to radiate from the Fugate Boarding house where Scannell was staying. By the epidemic’s end, all the Fugates had taken ill. Moreover, shortly after Lanier’s death all of her neighbours succumbed to yellow fever as did her sister, Mrs Myers. Myers, who had stayed with the Laniers during Mary’s illness, returned to her home in the country, spreading the disease to ‘every contiguous house’ in the process.39 Not all physicians were satisfied by the social and geographic connections that presumably linked the victims. Convinced that yellow fever was domestic, physicians like Fenner and Birchett searched for environmental factors that might have contributed to the epidemic. It was often noted that yellow fever originated in the poorest, dirtiest parts of the city.40 This too, was tied directly to the presence of strangers. In December 1853, Dr. Samuel Cartwright described the housing conditions of a group of Irish and German immigrants where he believed the epidemic started: Some of [the houses] certainly contained a mould [sic] or spots of discoloration the walls, which would have doomed them to destruction. Even the old shoes and things of that kind found in confined rooms, looked as if they were covered with frost, being white or green with mould; while the summer solstice was approaching, the heat of the weather became more intense. At length, a number of emigrants, just from Ireland and Germany, fell the first victims to that artificially created disease, the yellow fever.41 Cartwright emphasised the dangers these strangers posed to the native citizenry, describing the epidemic as an invasion. ‘As soon as it passed from the emigrant army to the citizens’, he observed, ‘it rapidly spread over the whole city.’42 Yet, as much as the epidemic might be blamed on the Irish and German immigrants, Cartwright’s article identified a startling correlation between poverty, bad air and poor city sanitation. Vicksburg’s epidemic, however, did not originate among the poor. The Fugates and the Laniers were both middle class families. As a result, accusations of poor sanitation were dismissed, and miasmatists endeavoured to identify environmental conditions that were not man-made. Birchett observed that the town of Clinton, Mississippi, east of Vicksburg, remained unscathed by the epidemic despite a railroad connecting the two communities. He pointed out that Clinton, unlike Vicksburg, was ‘not situated on the river’, suggesting that the river might have somehow been responsible. Another physician was more elusive. He simply recalled the presence of a ‘peculiar smell’, and suggested a relationship between the rise in sickness and the presence of ‘northern winds’. Contagionists were not persuaded. They addressed these theories directly and dismissed each of them. Dr Alexander Magruder, proclaimed that Vicksburg had ‘never [been] … more beautiful and cleanly condition[ed]’, while others argued that Vicksburg had suffered no climactic or meteorological variations from previous years. Additionally, there was no unusual insect or mould present in the area, and while the city did use cistern water, Marshall was quick to assure the Sanitary Commission that all cisterns were subterranean.43 Despite their best efforts, the epidemic of 1853 brought physicians no closer to understanding how yellow fever was transmitted. Nevertheless, they continued their speculation. Such debates, after all, were essential to legitimising their professional expertise. Unfortunately, these debates also exposed discrepancies between physicians’ experience of the epidemic and that of their patients. All of the reports submitted to the AMA and the New Orleans Sanitary Commission carried a similar tone. They were clinical, scientific and often provided a list of facts or observations regarding individual patients. They revealed nothing about how their patients’ experienced their illness, but those experiences were nonetheless traumatising. One newspaper correspondent graphically described what it was like to have yellow fever: As he awakes in the morning, all the fires of a volcano seem concentrated in his burning brain. His face grows haggard with its intense suffering. His eyes revolved in their orbits with glaring vivacity. Yellow streaks overspread his features in a moment, as if dashed there by a coarse brush dipped in gall. Sharp pangs tremble in his marrows. His blood throbs like lightning as hot and quick in every bursting vein, and then a whirlwind of the wildest delirium wraps his soul in dreams of fire. Oh!, This is Yellow Fever!44 Yellow fever was agony, understood only by those who suffered, lived and died from it. But the suffering was not limited to the sick. When news first broke of a potential yellow fever outbreak in Vicksburg, the fear and anxiety was almost palpable. Some businesses attempted to capitalise on this unease. ‘Protection against yellow fever!’ announced one advertisement for the New York Life Insurance Company ‘is not your life as well worth insuring as your house?’45 Advertisements for patent medicines promised to cure ‘longstanding and obstinate’ fevers at one dollar a bottle.46 Despite the press’s efforts to keep everyone calm, panicked residents left the city in droves, leaving behind empty homes, barren streets and abandoned businesses. For those who stayed, the sight was disheartening. One newspaper reported that ‘where two weeks since all was business and activity, [now] silence and stillness reign supreme’.47 Yet Vicksburg was hardly unique. Flight was the only way to ensure one’s continued health and therefore a common reaction to any epidemic at the time. New Orleans and Natchez reported similar events.48 Mobile was described as the ‘city of Tombs’, ‘silent as the grave’.49 Vicksburg, however, was not silent. For as the epidemic spread, it brought with it new, unnatural sounds that permeated city life: The hearses were running all day from earliest dawn until eight or nine o’clock at night, with the dead followed by weeping relatives and friends. We watched by the sick bed of a friend on Saturday night, and ever and anon the wailing of some widowed heart would break upon the stillness of the dull atmosphere which hung like lead over the city; and again the hurrying steps of the messengers for medical aid and the hurried gallops of the physicians horses were heard, and all was still and silent again. Death seemed to throw all his weight upon the city, crushing its very life out.50 To Emma Crutcher, even nature was filled with gloom. ‘The singing of the birds seems to be a funeral Chant’, she wrote to her nephew, ‘so sad and mournful is their song’.51 Death plays a significant role in shaping social identity by dividing the population into the young and old, the living and the dying. Furthermore, the rituals inherent to the mourning process highlight the customs and values cherished most in a society. For Vicksburg residents, as with most nineteenth-century Americans, mourning began with remembering. Obituaries and funeral sermons recast the deceased in the role of teacher whose life offered lessons, both positive and negative for survivors. In a way, the dead gained immortality on their deathbeds as the story of their last hours was repeated by whoever was there to witness, if anyone was there to witness.52 But when there is extraordinary loss of life, such as in times of war or epidemic, these rituals become strained, forced to adapt under altered circumstances, or lost entirely. Death, then, becomes a marker of social instability, of the unnaturalness of the times. This is what began to happen in late summer and early autumn of 1853, when yellow fever and death became just another, albeit horrifying, part of daily life. When, instead of immortality gained through memory, death became terrifyingly anonymous. Despite the growing number of dead, there was no increase in obituaries printed in Vicksburg newspapers. Editors of the Vicksburg Whig were appalled, proclaiming that the ‘pestilence has so completely unhinged the minds of our citizens that even friends forget or fail to publish the usual obituary notices of the dead’.53 Instead, the names of victims appeared in the daily sexton’s report, becoming little more than a statistic reminding survivors of how little individual deaths counted in such circumstances. ‘The number of deaths is appalling,’ Emma Crutcher wrote to her nephew, Tom, ‘and still the Sexton’s report of today gives a list of 42 named in three days.’ With so many victims, it was difficult to keep track of who was dead and who yet survived. Crutcher admitted that while many of Tom’s friends had passed, she could not remember to name them.54 Anonymity, however, was not the final injustice heaped upon the victims. As the body count grew, the number of corpses generally outstripped the speed with which sextons could work. One New Orleans newspaper reported that corpses were dumped inside cemeteries without care of undertaker, sexton or anyone to arrange a burial. It was this sight, above all else, that demonstrated how the epidemic threatened the very foundation of enlightened society. ‘The civilized world would scarcely believe that, in the wealthy flourishing city of New Orleans, hundreds of human bodies … have been allowed to remain exposed to the broiling sun’, one reporter wrote of the Fourth District Cemetery. When the bodies were buried, they were laid in shallow trenches fourteen inches deep, leaving two inches of the coffin exposed above the surface. Then, large ‘clumps’ of dirt were heaved on top ‘leaving openings for the flies to crawl in and crawl out, and most certainly liable to be washed away by the first heavy rain.’55 The sight gave New Orleans an otherworldly feel, like the epidemics ‘which have decimated, at different epochs, certain parts of the Old World.’ The editor of DeBow’s Review feared that if New Orleans officials hesitated any longer, the ‘pestilence of Florence will have had a counterpart here in our city’.56 By late summer, the Lower Mississippi River Valley was under siege. Isolated and struggling to care for the sick and dying, residents were desperate for relief. The current epidemic was worse than anything they had ever experienced before and its growing severity suggested no end in sight. On 12 September, a woman in Natchez wrote about conditions there, 60 miles south of Vicksburg on the Mississippi River. ‘Sickness and death are everywhere around us’, she told him, ‘scarcely a family has escaped and in several instances we have had three internments a day.’ It seems that everyone knew someone ill or dying. Indeed, this mother’s own two sons were both sick, one extremely so. She declared his recovery ‘doubtful’.57 Letters crossed the country, carrying the latest news of ‘the Fever’. Since victims took ill and died within a matter of days, many families had no idea their loved ones were ill before receiving news of their death. Mere weeks after receiving word of Mary Lanier’s death, Ellen and Tom Charles received word of the deaths of Tom’s brothers, Harry and Henry. Another letter reached the Posthlewait family of Natchez, announcing the death of a family friend in Opelousas, ‘Every few days our heartache saddens by the sight of a families’ name in the funeral announcements, and so many young, with lives of so much promise before them are taken.’58 For some, the loss was unbearable. On 8 October, the Vicksburg Whig reported that a local teacher, Mr Barbour, had gone missing. Barbour, who was suffering from yellow fever, had recently lost both his wife and mother. It was assumed he had drowned himself in the river.59 In light of the severity of the situation, it is remarkable that residents rarely mentioned the presence of physicians. When doctors were mentioned directly, it was to question their abilities. ‘Our physicians appear to be perfectly at a loss of what to do’, Emma Crutcher complained. Her doubts were not unwarranted. To date, physicians seemed incapable of answering even the simplest questions. They had failed to keep yellow fever out of the city and squabbled over how the disease might be spread, all while the epidemic slowly worsened. To make matters worse, the severity of the epidemic called physicians’ initial diagnosis into question. ‘I tell you plainly’ Crutcher admitted, in September, ‘I think it something worse than Yellow Fever.’60 Such doubt was common. Physicians had always had difficulty distinguishing yellow fever from its sister diseases: malaria, west nile and dengue. Indeed, for a brief period in the late eighteenth and early nineteenth centuries it was believed that they all might be different stages of the same illness. All these fevers, after all, produced similar symptoms, including a yellowing of the skin. Physicians therefore tended to lump all the ‘yellowing fevers’ into one vague diagnosis such as ‘malignant fever’, ‘pestilential fever’ or simply ‘the plague’.61 Physicians themselves began to doubt their diagnosis. Fenner reported that ‘There were various rumors afloat that this was not genuine yellow fever.’62 And even in Vicksburg physicians began to suspect that the epidemic was actually dengue fever.63 Despite the fact that many of the symptoms, black vomit especially, pointed directly to yellow fever, the epidemic was not behaving the way physicians anticipated. By 1853, it was commonly accepted that people of African descent were immune to yellow fever. Such an argument not only reinforced southern physicians’ assertions that slaves were biologically different from their masters, it also bolstered the proslavery argument that enslaved men and women were better suited to the environmental conditions under which they laboured. Indeed, this belief prevailed so strongly that the one newspaper identified ‘black and quadroon’ women as the the best nurses for yellow fever patients.64 In reality, though the epidemic did not recognise racial differences. On 17 August, Dr William Balfour was called to the bed of a local enslaved woman named Jane. Jane was a washerwoman who took in linens from various clients including the Washington Hotel where several visitors had taken ill. She died on 20 August after suffering from black vomit. Another case involved the family of George Selser, who lived on a modest plantation about seven miles from Vicksburg. Not only did the family fall ill after receiving an infected guest, but several of Selser’s slaves took sick as well.65 Yet many professionals refused to believe that the same illness plagued both white and black residents. In late August C. K. Marshall wrote to Samuel Cartwright, one of the most renowned southern physicians at the time, to express his doubts, ‘do negroes even have genuine yellow fever? Our Drs. are divided on the question. They (negroes) are attacked with the fever here and hence when in their cases it is dengue!!!’66 As a result, some physicians began to diagnose their patients with either ‘modified typhus’ or ‘African Fever’, in order to differentiate the cases.67 If physicians could not agree on a singular diagnosis, neither could they settle on a standard treatment. Instead, each measure was carefully taken as a means to counteract specific symptoms.68 As a result, physicians had little control over their patients’ fate. At best, they claimed that if treated within the first twenty-four to thirty-six hours, the patient had a better chance for survival.69 Most everyone agreed that if black vomit were present, the illness was fatal.70 Physicians employed a number of different treatments. By 1853, new advancements in clinical and laboratory-based medications led orthodox physicians to question the effectiveness of heroic medicine. Criticism of treatments such as bleeding and purging was voiced as early as the 1830s. By the 1850s many physicians in New England and other northern states had stopped using them. Southern physicians, however, stubbornly held on, and many of these techniques were used during the 1853 epidemic. One physician, Dr E. M’Allister, working in Grand Gulf 42 miles south of Vicksburg described his treatment for yellow fever. After ensuring that the sick room was well ventilated and subjecting the patient to a cold plunge bath, he administered tea along with ‘calomel, blue mass, hymosciamus, to cleanse the bowels and then additional castor oil if not working properly’. M’Allister heartily recommended bloodletting, noting that one woman ‘seven months advanced in pregnancy’ was bled in an attempt to calm the ‘commotion of her heart’, and reported very happily that she recovered and delivered a healthy son at term.71 It is unclear if the patient actually had yellow fever. Of course at times, professional disagreements over treatment became heated. There was at least one practitioner whose treatments were unpopular among his colleagues. Generally referred to as ‘Dr. F—’ or simply the ‘quack’, he was described as a charlatan who fooled his patients into believing they were receiving proper medical treatment. More importantly he was accused of preventing the collection of scientific information that might have helped control the epidemic. At any rate ‘Dr. F.’ succumbed to the disease himself early into the epidemic. His death was celebrated as a benefit ‘for the suffering humanity’.72 Despite the unusual circumstances, it is important to note that each of these problems—questionable diagnoses, inefficient treatments, and even professional bickering—were inherent to the state of medicine during the first half of the nineteenth century. Nevertheless, the public nature of the epidemic made it more noticeable and cast further doubt on physicians’ abilities to do their jobs. In light of this, Vicksburg residents sought comfort elsewhere. In doing so, they imparted a type of social authority to organisations or traditions that sought to help them interpret the meaning of the epidemic, both physically and spiritually. Cities such as New Orleans, Vicksburg and Natchez were in dire need of money, supplies and hands to help care for the less privileged members of society. Unlike in postbellum epidemics, most benevolent contributions did not come from national organisations.73 There was, for example, the Howard Association first organised in New Orleans during an 1837 yellow fever outbreak. Their primary objective was to care for victims of the epidemic regardless of race or class. While the Association’s first duty was to the sick and ‘indigent’ of New Orleans, they also sent agents into the surrounding areas to help local communities deal with the epidemic.74 Vicksburg benefited from the Association directly, receiving money, supplies and additional nurses and physicians to help tend the sick.75 Local benevolent societies, however, were just as important. The Vicksburg Tri-Weekly Whig printed the records of the Benevolent Association of Vicksburg alongside the Sexton and Hospital Reports. These columns kept track of monetary contributions, announced specific needs, and listed association members so that people needing help would know who to contact.76 In three months, the Benevolence Association received $6,329.50 which was used for ‘the relief of the city’.77 They also continued sharing excess funds with neighbouring communities. Money sent to Natchez went to the care of children orphaned by the epidemic. In mid-October, the newspaper announced that 22 of 33 orphans had found homes in the area.78 While benevolence societies helped Vicksburg residents cope with the physical and financial demands created by the epidemic, religion met their spiritual needs. Desperately seeking meaning for so many deaths, residents wrote of their renewed faith and an increased awareness of their dependency on God. Some, such as the writer of ‘What is Life’, a poem published in the local newspaper, sadly remarked on life’s fragility. Declaring that life was ‘quickly gone in one brief sigh/full of mournful melody’, the author prayed that hope not abandon her as she struggles to cope with sorrow and pain.79 Others sought lessons from their dying loved ones. Emma Crutcher found inspiration from her nephew Henry: He thought from the first he would not recover. On Saturday he sent for Mr. Pointer was baptized and joined the Church made all his arrangements with as much composure, as though he were going from home for a short time. He begged me to write to you [Tom Charles] and tell you he had died the death of a Christian and hoped you would prepare yourself to meet him. … He was perfectly resigned and I will never forget his death bed for it has made an impression on my mind that time can never efface. I feel now how truly important a thing Religion is and hope when Death appears to me I may be as ready to meet it as Henry.80 Ministers responded to the spiritual needs of their congregation with words of comfort. Among these men was Reverend Patterson, who refused an invitation to stay with a friend for the duration for the epidemic. ‘I have no apprehension of being taken sick’ he wrote in mid-August, ‘I have always acted upon the principle that danger flies from those who firmly meet it. Besides, in meeting it, if it comes, I am but doing an imperative duty, a duty appointed by God.’81 Religious leaders became so integral to managing the crisis that they were often placed on the same level as physicians. Their loss was equally as devastating, if not more so. When Patterson died on 14 September 1853 members of the community expressed their disbelief, ‘It seems but yesterday that the sound of his voice was in our ears … the warm pressure of his hand, the kindly greetings of affection from him are still fresh in the memory; and yet he has seen the “last of the earth.”’82 To Vicksburg residents, physicians and clergymen performed similar functions. One treated the body while the other cared for the soul. By choosing to stay, they each paid the highest price by sacrificing their own safety to perform the simplest acts of their profession. Nevertheless, the best human efforts could only ease the suffering. Nature and time were the only things that could truly end the epidemic. Just as southerners had long recognised a connection between hot, wet summers and the dangerous fever seasons, they understood a similar relationship between winter’s first frost and the end of the epidemic.83 ‘It is only the 29th [of September] and we cannot expect frost for weeks yet to come’, Crutcher warned her nephew.84 She was not alone in her impatience. In mid-October, The Vicksburg Tri-Weekly Whig reprinted the dates of the first hard frost for every year since 1832. Doubtless many residents were discouraged to discover that in 1849 the first frost did not come until 29 November, considerably later than the usual date toward the end of October. Fortunately for Vicksburg residents, they did not have to wait that long. On the morning of 25 October, they were greeted with a welcomed headline declaring ‘Frost!! Frost!! … We had a fine white frost this morning and the thermometer is down to 34 degrees.’85 While yellow fever cases would continue to appear into early November, the newspaper reported that individuals need not fear it. After nearly three months of siege, the epidemic was over. The bells of Christ Episcopal Church in Vicksburg, Mississippi, rang out on 4 December 1853, calling congregants and residents alike to the church’s doors. Crossing the gently sloping track of Main Street, people filed one by one into the small sanctuary, preparing for yet another funeral sermon, this one in memory of the church’s late rector, Reverend Stephen Patterson. After choosing to stay and nurse his flock, Patterson had fallen ill and died on 14 September. By December, he had become something of a hero. Indeed, the story of Patterson’s determination to serve his congregants and his bravery in the face of death were so celebrated that his funeral sermon was delivered by none other than Reverend William Mercer Green, the presiding bishop of the Episcopal Churches in the United States. Yet Reverend Patterson was not the only person on the congregation’s mind that day. He certainly was not the only reason the ladies wore black or the men donned mourning bands. Nearly everyone in the sanctuary had lost a loved one during the city’s latest bout with the saffron scourge.86 Green began his sermon with a description of a battered Israel who, having disobeyed God’s commandments, incurred His wrath. No doubt Green’s words stuck a chord with the weary congregation as he drew a direct comparison between the Israelites and the residents of Vicksburg. The only difference, he claimed, was that ‘The Divine judgments spoken of in the text, though sure and unavoidable, had not yet fallen upon [Israel]’. For Vicksburg, however, the judgment had come and gone. ‘A few weeks since,’ proclaimed Reverend Green ‘the streets of this city … scarcely knew the foot or the voice of the living. The Spirit of Pestilence brooded over it in fearful silence. … Seldom, if ever has the hand of disease pressed more heavily upon any people.’ Yet, it was important to find God’s lesson. Green noted that the recent calamity’ made it possible to determine true friendship and courage. ‘We yet survive’, he declared, ‘why others should have been taken whilst we have been left and for what special purpose our lives have been prolonged none can tell. Nor is it right that we should seek to know.’87 Instead, he encouraged his listeners to use their experience to become wiser and better Christians. Green’s words did not just offer reassurance. His sermon also provided direction, instructing backsliding congregants on the first steps toward rebuilding their lives and their city.88 The yellow fever epidemic of 1853 has not one, but two narratives. There are two ways in which the epidemic was experienced, two ways in which its significance was interpreted. For physicians, the epidemic reinvigorated a professional debate, creating the opportunity for rural physicians to participate in a national dialogue. E. D. Fenner believed that the epidemic would forever be remembered as extraordinary, explaining that: Heretofore the ravages of this terrible pestilence have been restricted almost entirely to [New Orleans] and some of the smaller towns; but in 1853 it attacked every town along the river as high as Napoleon at the mouth of the Arkansas River, every village in Mississippi and Louisiana south of Vicksburg, and almost every plantation along the coast below Natchez.89 Thus, the virulence that made the epidemic so terrifying to the region’s population was a benefit to medicine. Within the year no less than three accounts of the epidemic were published and circulated nationwide, including the one facilitated by the American Medical Association. These publications were important to the medical community’s efforts to attain professional authority because they cast physicians as experts who had practical experience with diagnosing and treating yellow fever. Significantly, it was southern voices that did the talking. Fenner, a resident of New Orleans collected as much as he could about the epidemic and reported it with authority. Vicksburg physicians Alexander Magruder, Thomas Harper and G. K. Birchett all published their accounts, continuing in print the discussions concerning communicability, treatments, and diagnoses that they must have begun in person. In the earliest years of the sectional conflict, just as some southern physicians were beginning to feel themselves maligned by their northern colleagues, these physicians had found something unique to offer the broader professional community. Unfortunately, professional authority cannot be seized. It must be conferred, given by patients willing to entrust themselves to their physicians’ care.90 To this end, professional debates did not matter, actions did. To Vicksburg residents, physicians offered little practical aid in managing the epidemic. They failed to identify yellow fever as a potential health threat despite epidemics raging in Jamaica and Brazil. They never agreed on the virus’s communicability, thus preventing the creation of a public policy that might have limited the epidemic’s spread, and, by the epidemic’s end, they were even doubting their own diagnoses. Indeed, physicians’ incompetence seemed to extend beyond their inadequate pharmacopeia. Just as the medical community was struggling to establish a reputation as professional experts deserving respect from would-be patients, physicians’ failures during the 1853 yellow fever epidemic undermined that reputation. The epidemic was a fresh trauma, impressed upon the psyche of Vicksburg residents. In their experiences, physicians played an insignificant role. Having been lulled into a false sense of security in 1853, Vicksburg residents endeavoured to prevent further outbreaks. None of these efforts utilised physician’s expertise in their conception or implementation. Instead, they were practical changes made to the city’s infrastructure and administration. By the following year, the city had revisited plans to build a Marine Hospital that would confine sick travellers to the river’s edge. Construction bids were completed in October of 1854, and the doors opened just in time to serve as a Confederate Hospital less than ten years later.91 As the frost disappeared in the spring of 1854 and the summer months approached, the Vicksburg Board of Health began meeting at regular intervals. By September, the Board was requiring all Vicksburg physicians to make tri-weekly reports detailing any yellow fever cases in the city. Perhaps, though, there is no better testament to the way Vicksburg residents experienced the epidemic than in the ways that they chose to memorialise it. It is telling that the only public monument erected after the epidemic honoured, not the medical men of the city, but a member of the clergy who tended the spiritual as well as physical needs of his flock. Not long after the 4 December memorial service for Reverend Patterson, congregants of Christ Episcopal Church commissioned a monument to honour the late rector’s memory. The small obelisk capped with a simple cross, still stands. Weathered and covered in moss, it sits on the north side of the church, tucked into the shade of an oak tree. Lindsay Rae Privette is a doctoral candidate at the University of Alabama. She is currently writing her dissertation, ‘“Fightin’ Johnnies, Fevers, and Mosquitoes”: A Medical History of the Vicksburg Campaign’. Her dissertation examines the mutually beneficial, but sometimes contentious relationship between the United States Army Medical Corps and military policy during the American Civil War. Footnotes 1 Lucinda McRaven to Ellen Crutcher, 11 November, 1853, Charles-Crutcher-McRaven Papers, Mississippi Department of Archives and History, Jackson, Mississippi (hereafter cited as MDAH). 2 New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans on the Epidemic Yellow Fever of 1853 (New Orleans, 1854), 71–2, 83, 90–4. 3 For a brief overview of the history of yellow fever see François Delaporte, The History of Yellow Fever: An Essay on the Birth of Tropical Medicine (Cambridge, MA: MIT Press, 1991). 4 For a general overview of yellow fever and the postbellum South see Margaret Humphrey, Yellow Fever and the South (Baltimore, MD: Johns Hopkins University Press, 1992). Humphrey’s work was one of the first that attempted to examine the virus’ role in the region as a whole and argues that yellow fever, unlike any other disease, required government involvement and lead to the creation of the modern public health care system. Other, more specialised studies include John H. Ellis, Yellow Fever and Public Health in the New South (Lexington: The University Press of Kentucky, 1992); Thomas H. Baker, ‘Yellowjack: the Yellow Fever Epidemic of 1878 in Memphis Tennessee’, Bulletin of the History of Medicine, 1968, 42, 241–64; Khaled J. Bloom, The Mississippi Valley’s Great Yellow Fever Epidemic of 1878 (Baton Rouge: Louisiana State University Press, 1993); Deanne Stephens Nuewer, Plague Among the Magnolias: The 1878 Yellow Fever Epidemic in Mississippi (Tuscaloosa: University of Alabama Press, 2009); and Molly Caldwell Crosby, The American Plague: The Untold Story of Yellow Fever. The Epidemic That Shaped our History (New York: Berkley Books, 2006). Finally, Edward J. Blum’s Reforging the White Republic: Race, Religion, and American Nationalism, 1865–1898 (Baton Rouge: Louisiana State University Press, 2005) offers a chapter arguing that the 1878 epidemic was an instrumental event leading toward reconciliation after the Civil War. 5 John Duffy, Sword of Pestilence: The Now Orleans Yellow Fever Epidemic of 1853 (Baton Rouge: Louisiana State University Press, 1966); Jo Ann Carrigan, Saffron Scourge: A History of Yellow Fever in Louisiana 1796–1906 (Lafayette: University of Southwestern Louisiana, 1994); and Henry M. McKiven Jr., ‘The Political Construction of a Natural Disaster: The Yellow Fever Epidemic of 1853’, The Journal of American History, 2007, 734–42 all offer an examination of yellow fever’s presence in antebellum Louisiana while Peter McCandless, Slavery, Disease, and Suffering in the Southern Lowcountry (Cambridge: Cambridge University Press, 2011) and Jeff Strickland, ‘Nativists and Strangers: Yellow Fever and Immigrant Mortality in Antebellum Charleston, South Carolina’ in Craig Thompson Friend and Lorri Glover (eds), Death in the American South (Cambridge: Cambridge University Press, 2015), 131–52 examine Charleston. 6 Heroic medicine was the typical method of treatment made famous by Benjamin Rush in the late eighteenth-century. It concluded that the base cause for all disease was overstimulation of the nervous and vascular system. To restore proper balance, physicians should employ dramatic treatments to bleed, blister and purge their patients. 7 For more on sectarianism and professionalisation, see Joseph F. Kett’s The Formation of the American Medical Profession: The Role of Institution, 1780–1860 (New Haven, CT: Yale University Press, 1968) and John S. Haller Jr., American Medicine in Transition, 1840–1910 (Urbana: University of Illinois Press, 1981). 8 Christopher Morris, Becoming Southern: The Evolution of a Way of Life, Warren Country and Vicksburg, Mississippi, 1770–1860 (New York: Oxford University Press, 1995), 108–10. 9 The population of New Orleans was estimated at 116,375 for the same year. US Census Bureau ‘10 Largest Urban Places, 1850’, <http://www.census.gov/history/www/through_the_decades/fast_facts/1850_fast_facts.html > (accessed 4 February 2016); W. Williams, Appleton’s Southern and Western Traveller’s Guide (New York: D. Appleton, 1850), 50. 10 Vicksburg Tri-Weekly Whig, 8 February 1853. 11 Vicksburg Tri-Weekly Whig, 22 January 1853; 3 February 1853; and 7 May 1853. The third show was a performance by a travelling hypnotist named Madam Adolphe. 12 The earliest fatality resulting from yellow fever was reported on 30 May, with Vicksburg officials not aware of the circumstances until the last weeks of July. Erasmus Darwin Fenner, ‘Report on the Epidemics of Louisiana, Mississippi, Arkansas, and Texas in the Year 1853’, in Transactions of the American Medical Association, Instituted 1847, 33 vols (New York: Charles B. Norton, 1854), VII, 436; Vicksburg Tri-Weekly Whig, 23 July 1853. 13 Daily Picayune reported yellow fever in Kingston, Jamaica and Rio de Janeiro, Brazil on 17 February 1853. Additional articles followed in the 12 April, 13 May, 6 July, and 11 July editions. Daily Picayune, 5 June 1853. 14 Daily Picayune, 23 June 1853. 15 Duffy, Sword of Pestilence, 11. 16 Erasmus Darwin Fenner, History of the Epidemic Yellow Fever at New Orleans (New York: Hall, Clayton Printers, 1854), 5. 17 R. Clark, Sexton, Register of Burials from 15 March 1852 to 20 March 1860, Old Courthouse Museum, Vicksburg, Mississippi. 18 All patient cases have been reconstructed using New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans and Erasmus Darwin Fenner, ‘Report on the Epidemics of Louisiana, Mississippi, Arkansas, and Texas’, 430–1. 19 New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans, 70–3, Clark, Register of Burials, Old Courthouse Museum. 20 ‘List of Deaths’, Vicksburg Tri-Weekly Whig, 1 November 1853. 21 Natchez Mississippi Free Trader, 23 August 1853. 22 Annual Report of the Board of Visitors and the Board of Examiners of the Natchez Institute (Natchez: Daily Courier Book and Job Office, 1854), 4, 6–7. 23 Benjamin Rush, Observations upon the Origin of the Malignant Bilious, or Yellow Fever in Philadelphia and Upon the Means of Preventing it (Philadelphia, PA: Budd and Bartram, 1799), 26. 24 Martin S. Pernick, ‘Politics, Parties, and Pestilence: Epidemic Yellow Fever in Philadelphia and the Rise of the First Party System’, The William and Mary Quarterly, 1972, 29, 559–86, 562–3,569; John Duffy, From Humors to Medical Science: A History of American Medicine (Champaign: University of Illinois Press, 1993), 67; Humphreys, Yellow Fever and the South, 18. The classic study on the 1793 epidemic is J. H. Powell, Bring Out Your Dead: The Great Plague of Yellow Fever in Philadelphia in 1793 (Philadelphia: University of Pennsylvania Press, 1949). 25 David K. Patterson, ‘Yellow Fever Epidemics and Mortality in the United States 1693–1905’, Social Science and Medicine, 1992, 34, 855–65. 26 Crosby, The American Plague, 35. 27 The relationship between disease, contagion and the slave trade appeared in a number of late eighteenth-century texts including William Roscoe’s ‘The Wrongs of Africa’ and Samuel Taylor Coleridge’s ‘The Rime of the Ancient Mariner’; Debbie Lee, ‘Yellow Fever and the Slave Trade: Coleridge’s “The Rime of the Ancient Mariner”’, ELH, 1998, 64, 675–700. 28 ‘Yellow Fever and the Slave Trade’, The Friend: A Religious and Literary Journal, 1854, 27, 5. 29 John Warner, ‘A Southern Medical Reform: The Meaning of the Antebellum Argument for Southern Medical Education’, Bulletin of the History of Medicine, 1983, 57, 364–81, 370. 30 An excellent discussion over this disagreement during the 1793 epidemic can be found in Pernick, ‘Politics, Parties, and Pestilence’, 1972, 29, 559–86. In his article, Pernick not only describes the competing medical theories of the time, the same theories used sixty years later by Vicksburg physicians, he also incorporates a valuable discussion on how these theories influenced and became influenced by contemporary politics. 31 ‘Communicated’, ‘An Order for the Suppression of Nuisances’, ‘Notice’, ‘City Council’, ‘Sanitary Regulations’, Vicksburg Tri-Weekly Whig, 23 July 1853. 32 ‘Quarantine Regulations’, Vicksburg Tri-Weekly Whig, 23 July 1853. 33 Sanitary Commission of New Orleans, Report of the Sanitary Commission of New Orleans, 74, 70. 34 Fenner, ‘Reports on the Epidemics of Louisiana, Mississippi, Arkansas, and Texas’, 517. 35 ‘An Ordinance for the Suppression of Nuisances’, Vicksburg Tri-Weekly Whig, 23 July 1853. 36 ‘Advertisement for Free Lime’, Vicksburg Tri-Weekly Whig, 30 July 1853. 37 Fenner, ‘Report on the Epidemics of Louisiana, Mississippi, Arkansas, and Texas’, 430–1. 38 For more information regarding yellow fever as the stranger’s disease, see Jo Ann Carrigan, ‘Privilege, Prejudice, and the Strangers’ Disease in Nineteenth-Century New Orleans’, The Journal of Southern History, 1970, 568–78. 39 New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans, 72. 40 This line of reasoning does have value. The portions of the city with the poorest sanitation were more likely to have pools of stagnant water, a breeding ground for mosquitoes carrying the yellow fever virus. 41 Samuel Cartwright, ‘The Epidemic and its Causes’, Mississippi Free Trader, 6 December 1853. 42 Ibid. 43 Fenner, History of the Epidemic, 74; New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans, 131, 92–5, 73. 44 The Hinds County Gazette, 28 September 1853. 45 ‘Advertisement for New York Life Insurances’, Vicksburg Tri-Weekly Whig, 26 July 1853. 46 ‘Advertisement for Emanuel’s Specific for Chill and Fever’, Vicksburg Tri-Weekly Whig, 26 July 1853. 47 Daily Picayune, 24 September 1853. 48 ‘Our City’, Vicksburg Tri-Weekly Whig, 6 September 1853. 49 ‘Deserted City’, Vicksburg Tri-Weekly Whig, 10 September 1853. 50 Vicksburg Weekly Sentinel, 14 September 1853, quoted in ‘Health’, Source Material for Mississippi History Project: Warren County, Box 10835, Series 447, MDAH. 51 Emma Crutcher to Tom Charles, 20 September 1853, Charles-Crutcher-McRaven Family Papers, MDAH. 52 There is an extensive historiography on death and the art of dying well. For further reading, see James J. Farrell, Inventing the American Way of Death, 1830–1920 (Philadelphia, PA: Temple University Press, 1980); Philippe Ariès, The Hour of Our Death (New York: Vintage Books, 1981); Ralph Houlbrooke (ed.), Death, Ritual and Bereavement (London: Routledge, 1989); Pat Jalland, Death in the Victorian Family (Oxford: Oxford University Press, 1996); and Drew Gilpin Faust, This Republic of Suffering: Death and the American Civil War (New York: Vintage Books, 2008). 53 Daily Picayune, 24 September 1853. 54 Emma Crutcher to Tom Charles, 20 September 1853, Charles-Crutcher-McRaven Family Papers, MDAH. 55 ‘The Yellow Fever in New Orleans’, Montgomery, Daily Alabama Journal, 17 August 1853. 56 ‘Plague in the Southwest’, DeBow’s Review, Agricultural, Commercial, Industrial Progress and Resources, 1853, 15, 595–635. 57 P. R. Anderson to William T. Walthall, 12 September 1853, Walthall Family Papers, MDAH. 58 Unnamed to Posthlewait, 23 September 18—, Posthlewait Family Papers, MDAH. 59 New Orleans Daily Picayune, 8 October 1853. 60 Emma Crutcher to Tom Charles, 20 September 1853, Charles-Crutcher-McRaven Family Papers, MDAH. 61 McCandless, Slavery, Disease, and Suffering in the Southern Lowcountry, 62–3. 62 Fenner, ‘Report on the Epidemics of Louisiana, Mississippi, Arkansas, and Texas’, 446. 63 C. K. Marshall to Samuel A. Cartwright, 30 August 1853, Samuel A. Cartwright Family Papers, Lower Louisiana and Mississippi Valley Collection, Baton Rouge, Louisiana (hereafter cited as LLMVC). 64 New York Daily Times, 26 September 1853. 65 New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans, 72, 74. 66 Marshall to Cartwright, 30 August 1854, Cartwright Family Papers, LLMVC. 67 Fenner, ‘Report on the Epidemics of Louisiana, Mississippi, Arkansas, and Texas’, 466. 68 To date, the yellow fever virus has no cure. 69 Fenner, History of the Epidemic Yellow Fever at New Orleans in 1853, 58. 70 New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans, 91. 71 E. M’Allister, MD, ‘The Yellow Fever at Grand Gulf, Miss, in 1853’, New Orleans Medical and Surgical Journal, 1854, 675–8. 72 New Orleans Sanitary Commission, Report of the Sanitary Commission of New Orleans, 70. 73 H. S. Fulkerson, Random Recollections of Early Days in Mississippi (Vicksburg, MS: Vicksburg Printing and Publishing Company, 1885). 74 By the middle of the nineteenth-century, there would be branches of the Howard Association in a number of other southern cities, particularly those which had a high prevalence for yellow fever. Elizabeth Young Newsom, ‘Unto the Least of These: The Howard Association and Yellow Fever’, Southern Medical Journal, 1992, 85, 632–7. 75 Emma Crutcher to Tom Charles, 20 September, 1853, Charles-Crutcher-McRaven Family Papers, MDAH. 76 ‘Benevolent Association of Vicksburg’, Vicksburg Tri-Weekly Whig, 1 November 1853. 77 ‘List of the Contributors’, Vicksburg Tri-Weekly Whig, 24 November,1853. 78 ‘Orphans in Natchez’, Vicksburg Tri-Weekly Whig, 15 October 1853. 79 Mabel, ‘What Is Life?’ Vicksburg Tri-Weekly Whig, 27 August 1853. 80 Emma Crutcher to Tom Charles, 20 September, 1853, Charles-Crutcher-McRaven Family Papers, MDAH. 81 Reverend Stephen Patterson to ‘Mrs. R’, 18 August 1853, reprinted in Reverend W. M. Green. Funeral Discourse on the Death of Reverend Stephen Patterson, Late Rector of Christ’s Church Vicksburg, Miss. Delivered in that Church Dec. 4, 1853 by Rt. Rev. W. M. Green, D. D. (Vicksburg: Whig Book and Job Office, 1854), 16–17. 82 ‘Obituary’, Vicksburg Tri-Weekly Whig, 20 September 1853. 83 Today, it is generally understood that the frost plays a significant role in killing mosquitoes therefore hindering the disease’s spread. 84 Emma Crutcher to Tom Charles, 20 September 1853, Charles-Crutcher-McRaven Family Papers, MDAH. 85 ‘Frost!! Frost!!’, Vicksburg Tri-Weekly Whig, 26 October 1853. 86 Prior to this post, Green had served as the first bishop of the diocese of Mississippi. Green, Funeral Sermon. 87 Green, Funeral Sermon, 5–6. 88 Indeed, belief in Divine Providence was a dominant characteristic in eighteenth- and nineteenth-century Christianity. For more information see Nathan Hatch and Mark Noll, The Bible In America: Essays in Cultural History (Oxford: Oxford University Press, 1982); David Hall, Worlds of Wonder, Days of Judgment: Popular Religious Beliefs in Early New England (Cambridge, MA: Harvard University Press, 1990); and Nicholas Guyatt, Providence and the Invention of the United States , 1607–1876 (New York: Cambridge University Press, 2007). Additionally, Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866 (Chicago: The University of Chicago Press, 1962) specifically discusses the competition between religious leaders and physicians, both of whom endeavoured to interpret the meaning of America’s cholera epidemics. 89 Fenner, ‘Report on the Epidemics of Louisiana, Mississippi, Arkansas, and Texas’, 424. 90 For more on the evolution and growth of the authority and legitimacy claimed by the American Medical Profession see Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic Books, 1982). 91 ‘Cholera by Steamboat built Marine Hospital’, Vicksburg Evening Post, 13 April 1959. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.

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Social History of MedicineOxford University Press

Published: Oct 30, 2017

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