There were comparatively few cases of yellow fever during the Civil War. Peacetime brought a boom of trade as improved rail service and shipping allowed people and goods — as well as disease — to travel easily in the united nation. By 1878, conditions were ripe for a powerful epidemic of yellow fever in the Mississippi Valley.

Seeds of an Epidemic
The beginning of the year presaged trouble. In the spring, yellow fever cases were high in the Caribbean, in particular in Cuba. There, thousands of refugees fled the island after the end of a war of independence from Spain. Many came to New Orleans. On April 26, President Rutherford B. Hayes signed the Quarantine Act of 1878 into law, giving the Marine Hospital Service responsibility to stop disease from coming ashore via sailors from ships.

The Beginning
In an attempt to stop the disease from entering New Orleans, a quarantine station on the Mississippi River south of the city inspected incoming ships. The Emily B. Souderarrived there in late May. One ill sailor, diagnosed with malaria, was removed from the ship. The ship was fumigated and cleared to dock in New Orleans. The night the ship docked, a crew member fell sick and died; another died four days later. When the Souder left to return to Havana, another ship, the Charles B. Woods arrived. Within six weeks every member of the families of the Woods' captain and engineer had contracted fever. They recovered, but a 4-year-old girl living in the same neighborhood died in July — the first official fatality from yellow fever recorded that year in New Orleans.

Spread of the Disease
The news that yellow fever had again hit New Orleans drove one-fifth of the city's population to leave, leaving streets and businesses barren. "Only our mosquitoes keep up the hum of industry," reported the New Orleans Picayune. Physicians who cared for victims watched helplessly as their patients died; attempted treatments with bloodlettings, carbolic acid, and doses of quinine proved useless. The state board of health declared an epidemic on August 10, after 431 reported cases and 118 deaths. But the epidemic was not contained to New Orleans. On July 27, a towboat dropped two crew members with yellow fever in Vicksburg, Mississippi. Another infected crew member died on the boat that night. In August, 100 cases of yellow fever were reported in Grenada, Mississippi, about 100 miles south of Memphis.

Trauma in Memphis
In response to the spreading epidemic, the mayor of Memphis on July 28 imposed a quarantine, which blocked railroad lines. Local businessmen threatened a lawsuit unless the city released a train of goods from New Orleans. City leaders allowed the shipments to enter. In early August, a steamboat crew member who had avoided the quarantine died in a Memphis hospital. On August 13, a local resident who operated a food stand near the riverfront died from yellow fever. As in New Orleans, Memphis residents fled when they heard the news, an estimated 25,000 to 27,000 out of 47,000, traveling to rural areas or north and east away from the river. While some places accommodated them, others established "shotgun barricades," with armed men insuring that no one would enter their towns. The disease would travel with fleeing refugees as far away as Kentucky, Indiana, Illinois, and Ohio.

The Toll
Those who remained in Memphis relied on volunteers from religious organizations to tend to the sick. The madam of a local brothel, Annie Cook, helped out by converting her place of business to a hospital, where she nursed the stricken. She died from the disease in September. By the end of the year, more than 5,000 were confirmed dead in Memphis. The New Orleans health board listed "not less than 4,600" dead. The Mississippi Valley experienced 120,000 cases of yellow fever, with 20,000 deaths.

The Aftermath
In New Orleans, the city's Medical and Surgical Association argued for improved drainage and sanitary measures to quell future yellow fever outbreaks. Such efforts, though they were undertaken to eliminate germs, helped to remove the breeding grounds for mosquitoes, and New Orleans never again experienced the scope of the 1878 epidemic. The $15 million in losses caused by the epidemic bankrupted the city of Memphis. The federal government convened a commission to investigate the outbreak and established the National Board of Health in 1879. In a report to Congress shortly before the national agency was created, John Woodworth, the Marine Hospital Service surgeon general, emphasized the gravity of the situation: "Yellow fever should be dealt with as an enemy which imperils life and cripples commerce and industry. To no other great nation of the earth is yellow fever so calamitous as to the United States of America."