Introduction
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introduction introduction In fall 1897, yellow fever swept through the towns and cities of the southern United States. The disease’s symptoms were terrifying . Though many victims experienced only fever, headaches, nausea, vomiting , and muscle aches, others found that their eyes and skin assumed a yellow hue. Abdominal pain was paired with bloody black vomit—vomito negro—and additional blood escaped through their eyes, nose, and mouth. The disease struck first in Ocean Springs, Mississippi. This Gulf Coast town was home to a cadre of Cuban refugees engaged in transporting weapons to support the ongoing rebellion against Spanish rule on the island, where yellow fever was endemic.1 It soon spread to New Orleans, where officials proved reluctant to admit its presence. When the announcement was finally made, communities throughout the region began to panic. “Within six hours after the official declaration that fever existed here,” a report from the Crescent City asserted, “every town in Louisiana, Texas, Mississippi, and Alabama was quarantined against New Orleans. Guards were placed on every road, armed with Winchesters and shotguns, and instructed to shoot down all who failed to halt properly.”2 Throughout the region, hastily convened boards of health used the threat of violence to force trains transporting people or goods to continue on without stopping. In Jackson, Mississippi, a crowd destroyed tracks used by the Alabama and Vicksburg Railroad after a train “went through at a speed not greater than four miles an hour” rather than the twenty miles per hour mandated by local officials. “Not only was this order disregarded, but the train stopped in the heart of the city. Indignation is at a fever heat, and the people say if necessary to compel observance of their reasonable quarantine regulations , they will burn every bridge between here and Vicksburg.”3 In New Orleans, the local board of health fashioned a temporary hospital within a school. Incensed, “a riotous crowd made an attempt to burn the building. Two of the annexes were reduced to ashes, but joint efforts of the police and fire departments prevented the destruction of the main building.”4 Outside of the city, a black man was lynched for allegedly evading quarantine.5 Overall, the response to the epidemic was chaotic. States and localities worked against one another. Although the disease was introduced from abroad and was clearly spreading from state to state, the federal government proved incapable of asserting any meaningful role in attempting to stop its 2 : INTRODUCTION progress or coordinate the responses of the afflicted states and localities. Indeed, it was widely understood that the Cuban refugees who introduced the disease had evaded the United States Marine Hospital Service’s (MHS) quarantine station at Ship Island, Mississippi. The disorder of 1897 was extreme, but it was far from unprecedented. In 1878, another yellow fever outbreak had ravaged the lower Mississippi Valley, killing around 20,000. In both cases, the experience of epidemic disease threw local governing institutions into an unhelpful panic. Straining local resources and illuminating a dangerous lack of coordination and communication , epidemic disease also raised major questions about the appropriate role of the federal government in ensuring the health of Americans. Public Health and Individual Medicine This book offers a reinterpretation of the making of modern American health policy. The primary question that I ask is why the federal government created a strong national system of public health, grounded in the Atlanta-based Centers for Disease Control and Prevention, while rejecting a comparable or even integrated approach in the field of individual medicine . By “public health,” I mean efforts aimed at ensuring or improving the health of populations, such as water purification, vaccination, or mosquito eradication. I use the term “individual medicine” to refer to services aimed at the health of individuals. From the early years of the American republic, the regulation and promotion of health has been understood as a police power, left to the states under the Tenth Amendment to the Constitution, which states that all powers not given to the national government are reserved to the states or to the people. Over the course of the nineteenth century, state and local governments in the United States became engaged in increasingly sophisticated efforts to promote health.6 Aimed largely at acute contagious illnesses such as yellow fever, typhoid, and cholera, these efforts were spurred on first by the example of the British sanitarian movement and then by the bacteriological revolution and gradual acceptance of the germ...