Handbook of Texas Online: EPIDEMIC DISEASES

EPIDEMIC DISEASES. Epidemic diseases may afflict large numbers of persons living in a particular geographical area. Symptoms of an epidemic disease also spread rather rapidly among many, but not all, persons in the same community. Epidemic diseases are frightening because of the number afflicted and because of the rapid spread of the disease. Some diseases, such as dengue fever and measles, disable victims for some days, but usually do not cause death. Others, such as cholera and yellow fever, cause a varying number of deaths. When particular groups have not been exposed to a disease vector, the outcome may be devastating, as appears to have been the case among the Plains Indians of Texas when they were exposed to the communicable diseases carried by the white settlers.

Texans experienced numerous epidemics during the nineteenth century. Cholera, yellow fever, smallpox, dengue fever, measles, influenza, diphtheria, and whooping cough afflicted Texans in different locales at different times. Though cholera appeared in 1833 and caused some deaths, it was far more destructive during an epidemic in 1849. Approximately 500 deaths from cholera had occurred in San Antonio by May of that year. During the early months of 1866 measles appeared "in nearly every house" in Galveston. In 1883 many residents of Galveston suffered with aches and pains of dengue fever. Galveston's doctors established a quarantine camp in 1899 to house some of the thirty-seven residents afflicted with smallpox.

Galvestonians experienced at least nine yellow fever epidemics between 1839 and 1867. The events of a yellow fever epidemic terrified everyone. A twenty-five-year-old man would be healthy one day and dead three days later, changing relentlessly from a state of debility, fever, and pains in the extremities and loins, to a stage of vomiting blood clots (called the black vomit), to jaundice and death. Doctors then did not understand the role of the mosquito in transmitting the yellow fever virus. Some thought that garbage heaps and stagnant ponds produced particles in the air (called miasmata) that caused the disease. To prevent their occurrence, doctors and town leaders advocated sanitary cleanups when epidemics appeared or threatened. Others believed that sick people transmitted the disease directly to others. During an epidemic in Galveston in 1839, Ashbel Smith^qv tasted the "black vomit" of patients and did not become sick. He believed that yellow fever was not contagious and that Galvestonians should not quarantine incoming ships. Many disagreed with Smith and urged quarantines as ways to prevent the spread of this communicable disease.

Texans, like others, were confused because improved sanitation and enforced quarantine did not prevent epidemics from occurring or continuing. During a yellow fever epidemic in Galveston in 1853, approximately 60 percent of the 5,000 residents became sick and 523 persons died. There were 175 deaths from yellow fever in Houston during 1858. During Galveston's last yellow fever epidemic in 1867, thousands were afflicted and approximately 725 residents had died by early September. Improved sanitation and quarantines appeared ineffectual, though some argued that these reduced mortality and morbidity.

With dramatic improvements in sanitation and better control of the mosquitos that carry the yellow fever and dengue fever viruses, cholera, yellow fever, and dengue fever receded in importance. A few localized outbreaks of yellow fever occurred in Calvert, Brownsville, Laredo, and San Antonio between 1867 and 1903, and significant epidemics of dengue fever appeared in South Texas in 1907 and 1918.

Epidemics of other infectious diseases occurred during the twentieth century. The most prominent included influenza, polio, St. Louis encephalitis, and AIDS. During the fall of 1918 and the winter of 1919, an epidemic of Spanish influenza affected much of the civilized world. An estimated twenty-five million Americans experienced the disease; an estimated 550,000 died from the disease. During the fall months of 1918, many schools and businesses closed, and churches did not meet. In late October the Galveston schools closed for two weeks. By that time 5,000 cases had been reported in El Paso and 400 deaths had occurred. Since that time, various strains of influenza virus have afflicted Texans periodically. During the first week in January of 1944, for example, physicians reported 126,000 cases of influenza in the United States and 24,000 cases in Texas.

During the summer of 1943, 1,274 cases of poliomyelitis (infantile paralysis) were reported, the largest number ever recorded in the state. There were 168 deaths in this group. The total number of cases in 1943 more than doubled the cases reported in 1937. The epidemic in 1943 was most intense in the Panhandle.^qv There were 996 cases confirmed for the entire state during 1945, and sixty-six counties reported 292 cases during the first six months of 1946. In Houston during 1948, 313 new cases were documented. Not yet fully understanding the etiology and transmission of the disease, physicians struggled desperately to avert the sad results of infantile paralysis. Polio receded with the advent and use of vaccines during the mid-1950s.

More than once, St. Louis encephalitis frightened Texans. An epidemic involving 114 persons occurred in Cameron County in 1957. The first epidemic of this arborvirus disease in Houston occurred during the summer of 1964. Of 149 adults admitted to Ben Taub Hospital with signs of brain infection, 119 had positive serological tests for antibodies to the arborvirus causing this disease. Among the fifty children admitted to Ben Taub with signs of meningoencephalitis, twenty-six tested positive for these antibodies. Severe brain damage occurred in some of these patients. During the summer and fall of 1966 this disease afflicted 172 residents of Dallas, with twenty deaths. The most likely vector for these epidemics were the Culex mosquitos that flourished after summer rains.

During recent years the most frightening epidemic involves those infected with the AIDS virus. By early 1992 officials at the Texas Department of Health knew of 14,782 Texans with full-blown AIDS but had no reliable data on the incidence of those testing HIV-positive. Six of 197 students at Rivercrest High School in Johntown reportedly tested HIV-positive. Between 1987 and early 1992, 357 Texas teenagers tested HIV-positive. This reality led some doctors and public health officials to believe that the AIDS epidemic might become one of the most devastating epidemics in human history.

BIBLIOGRAPHY: John P. Carrier, "Medicine in Texas: The Struggle with Yellow Fever, 1839-1903," Texas Medicine 82 (November 1986). Alfred W. Crosby, Epidemic and Peace, 1918 (Westport, Connecticut: Greenwood Press, 1976). N. Joel Ehrenkrantz et al., "Pandemic Dengue in Caribbean Countries and the Southern United States: Past, Present and Potential Problems," New England Journal of Medicine 285 (December 23, 1971). John C. Ewers, "The Influence of Epidemics on the Indian Populations and Cultures of Texas," Plains Anthropologist 18 (May 1973). J. Villasana Haggard, "Epidemic Cholera in Texas, 1833-1834," Southwestern Historical Quarterly 40 (January 1937). Bradford Luckingham, Epidemic in the Southwest, 1918-1919 (Southwestern Studies Monograph No. 72, El Paso: Texas Western Press, 1984). Ashbel Smith, An Account of the Yellow Fever Which Appeared in the City of Galveston, Republic of Texas, in the Autumn of 1839, with Cases and Dissections (Galveston: Hamilton Stuart; Houston: Cruger and Moore; Austin: J. W. Cruger, 1839; rpt., as Yellow Fever in Galveston, Republic of Texas, 1839: An Account of the Great Epidemic, Together with a Biographical Sketch by Chauncey D. Leake, and Stories of the Men Who Conquered Yellow Fever, Austin: University of Texas Press, 1951). Larry J. Wygant, "The Galveston Quarantine Stations, 1853-1950," Texas Medicine 82 (June 1986).

Chester R. Burns

The following, adapted from the Chicago Manual of Style, 15th edition, is the preferred citation for this article.: Handbook of Texas Online, s.v. "EPIDEMIC DISEASES," (accessed October 11, 2005).

(NOTE: "s.v." stands for sub verbo, "under the word.")

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