In all of ancient medical literature there is no
reference to Yellow Fever, by that or any other name. Since epidemic yellow
fever is a dramatic disease, it seems unlikely that it could have escaped the
attention of even very early medical writers. It is perhaps reasonable to
conclude that the disease did not exist
in ancient civilizations (Warren, 1951).
There
are reports of disease with clinical description similar to yellow fever in 1498 in San Domingo and 1585 in West Africa (Scott, 1939).
Carter found the earliest record in a Mayan
manuscript describing an epidemic with hematemesis (black vomit, or “xekik”) in the Yucatan in 1648, and suggested that
the virus and mosquito vector were
introduced from Africa during the slave
trade (Carter, 1931).
According
to Garrison (1929) the term yellow fever was first employed by Griffin Hughes
in his “Natural History of Barbados” (1750). The yellow in yellow fever does
not indicate the association of the disease with jaundice but is derived from
the yellow quarantine flag used by
the ships during the 17th century (Singh and Bhatia, 1993).
Yellow
Fever was responsible for several epidemics
among the settlers in tropical areas of the Americas and Africa during the
17th to the 19th centuries. In addition, epidemics were
also reported in Europe following
importation of the virus in sailing ships. However, the origin of the disease is in doubt but the susceptibility of ‘New
World Monkeys’ but not African monkeys to latent infection by yellow fever
indicates African origin of disease
(Monath, 1994).
Until
the 20th century, yellow fever was widely believed to be an airborne
“miasma” arising from filth, sewage,
and rotting organic matter. The series of developments thereafter in disease
etiology, etiological agent, epidemiology and vaccine are given below:
1848:
View,
that spread of yellow fever required the presence of an intermediate host,
appears to have first advanced by Dr.
Josiah Clark Nott of Mobile, Alabama. Nott suggested the mosquito as a possible agent for the
dissociation of both yellow fever and malaria (Warren, 1951). Dr Louis Daniel Beauperthuy in
Venezuela made a similar suggestion in 1854.
1880:
The
first attempt to dig Panama Canal in
1880-88 failed after 52000 cases of
yellow fever and malaria were reported among the 85000 workers (Bres,
1986).
1881:
The
first really serious proponent of the mosquito transmission in yellow fever was
Dr. Carlos J. Finlay of Havana, Cuba
(Warren, 1951; Burke and Monath, 2001; WHO, 1998).
1897:
Dr. Giuseppe Sanarelli, an Italian
bacteriologist working in the islands of Flores off Montevideo announced that
he had discovered the cause of yellow fever to be a bacillus present in about
50% of patients examined by him. He named it Bacillus icteroides (Sanarelli, 1897).
1900:
In
May United States Army organized a
commission to study the infectious diseases of Cuba but more specifically yellow fever. Dr. Walter Reed was appointed as president.
Dr.
Reed and colleagues from their studies concluded that “Bacillus icteroides” stand in no causative relation to yellow
fever, but when present should be considered as a secondary invader in this
disease” (Reed, Carrol et. al., 1900).
Influenced by the work of Sir Ronald Ross
and of Italian observers on the propagation of malaria by the mosquito the
commission directed their attention on the Finlay’s theory of the propagation
of yellow fever by mosquito (Warren, 1951).
The
Reed Commission recorded 3 cases of yellow fever transmission by mosquitoes that had fed previously on patients
clinically ill with yellow fever.
Subsequent work of the commission proved
conclusively that:
a)
the mosquito
was a vector of yellow fever;
b)
there was an
interval of about twelve days
between the time the mosquito took an infectious blood meal and the time it
could convey the infection to another human being;
c)
yellow fever
could be produced experimentally by subcutaneous injection of blood taken from
the general circulation of a yellow fever patient during the 1st and
2nd days his illness; and
d)
yellow fever
was not conveyed by fomites.
In
the consequence of these findings, Reed and his coworkers (Dr.James Carrol,
Dr.Jesse, W.Lazear, and Dr.Aristides Agramonte) suggested that the spread of
yellow fever could be most effectively controlled by antimosquito measures and the protection of sick from the bites of
mosquitoes (Reed, Carrol and Agramonte, 1901).
1901:
On
October 15, Reed and Carrol injected subcutaneously 3cc of diluted filtered
serum from an experimentally infected yellow fever patient into three
non-immune persons. Two of these developed clinical yellow fever (Reed and
Carrol, 1902).
Thus for
the first time a filterable virus was proved to be the cause of specific human
disease.
In
February the Chief sanitary officer in Havana, then Major William C. Gorgas
instituted measures to wipe out yellow fever which were based entirely on
conclusions of the yellow fever commission. The
results were as dramatic as the scientific findings of the commission. By
September, 1901 the disease had been completely eradicated, and it has not
reappeared. The antimosquito measures in Havana, in addition to eliminating
yellow fever, greatly reduced the incidence of malaria. Gorgas in Panama
applied similar approach. Eradication of
yellow fever from Panama led to the resumption of work of Panama Canal in 1904
and its completion in 1914 (Warren, 1951).
The Havana and
Panama campaigns now constitute an epic chapter in the history of sanitation
and preventive medicine.
1913:
The Rockefeller
Foundation was organized for “the
well-being of mankind throughout the world”.
The International
Health Commission of the Foundation was created the same year, with
Mr. Wickliffe Rose as its director.
The foundation began its work when the real danger of
spreading the disease to countries with high density of population, such as
India and Far Eastern countries became obvious as a consequence to the opening
of the Panama Canal. Dr. S. P. James of the Indian Medical Service
made a thorough investigation of the situation on behalf of the Indian
Government and reported that the menace was sufficiently great to call for a permanent
quarantine force in Panama, Hong Kong or Singapore,
to be maintained at the expense of the English colonies in the East.
Fortunate we are
that the disease has not reached India so far, although Aedes ageypti is found
in abundance in this country.
Rockefeller Institute of Medical Research
Panama Canal Route Map
