The 1878 yellow fever epidemic in Memphis proved to be fatal, killing almost all who got infected. The disease traveled up from New Orleans infecting and killing many on its way. Memphis was going through reconstruction and was becoming the center for merchants and travelers. Furthermore, Memphis began to become overly populated only increasing the devastation that would be caused by the yellow fever. This was a confusing period were even medical professionals did not know where the disease came from or how they could to stop it. The epidemic caused panic and challenged the state government of Tennessee and made changes to it that are still in effect today.The discovery of yellow fever would have not been possible if people had not put aside their misconceptions of where diseases originated. Diseases in olden time were believed to be divine punishment to people who had committed bad deeds, and therefore not much was done to try to find cures for diseases like yellow fever. As defined by the World Health Organization, yellow fever an acute viral hemorrhagic diseases transmitted by infected mosquitoes, and a common characteristic of this disease is the development of jaundice which gave it the name “yellow” fever. The mosquito responsible for the transmission of the disease is the female Aedes aegypti mosquito. Her transmission of the disease occurs as a result of it biting an infected host and inside her body the virus multiplies, and afterwards if the mosquito bites someone that person becomes infected. It seemed as if Memphis had met all the right conditions for the outbreak of one of the most devastating epidemics in United States history in 1878. First, the lack of money and excess debt brought Memphis to the brink of bankruptcy in January of that year. Many were the causes of this including lavish spending and mismanagement of the cities funds. Secondly, the cities filth was noteworthy. The city of Memphis was overcome with a rotten smell, excrement of animals, and filth all over the streets. Sanitation conditions were horrible and this had caused previous diseases such as cholera in the years before the Civil War. Thirdly, the weather conditions of the summer of 1878 were ideal for the growth and dispersion of the mosquito that carried the virus. The temperatures during that year’s summer were in the range of 82 degrees Fahrenheit. Finally, because Memphis was an important port city for steamboats, the virus traveled easily up north from New Orleans through the Mississippi River. Although, the city of Memphis had previous experiences with yellow fever (1828, 1855, and 186) and other diseases too, the yellow fever epidemic of 1878 was like nothing else previously seen in the history of Tennessee. It was in 1900 that it was discovered that the virus had come to Memphis from and infected ship that had ported in either the Caribbean or West Africa and had later entered the United States to New Orleans and then to Memphis. Panic arrived in Memphis right after the yellow fever reports from New Orleans but by then it was too late of a warning. It was on August 23, after the reports of the New Orleans case that the Board of Health in the city of Memphis declared an epidemic. Soon after, 25 thousand Memphians fled the city in trains and steamboats in a five day period. Mrs. Kate Bionda, a shop owner in Memphis, was the first reported death by yellow fever in the city of Memphis on August 13. Stricken with panic Memphis, the cities nearby, and surrounding states set up quarantines in order to prevent further spread of the disease. Tennessee towns including Germantown, Moscow, Milan, Collierville, Paris, Brownsville, Martin, and LaGrange were some of the hardest hit by the yellow fever as a result of many Memphians fleeing to them. The panic by nearby towns such as Jackson was so great that shot-gun quarantines, group of citizens and police officers with shot-guns, began emerging along streets and rivers to prevent the people of Memphis to come to their town for refuge. More than half of the population of Memphis had left the city and of the 19 thousand left behind 17 thousand had yellow fever. The outbreak of yellow fever had frightened everyone, and those that had no means to leave the city were confined to the danger the city posed. However, not only did the yellow fever cause social unrest but also great economic losses. Fear of infection forced shops, ports, and other businesses to close down. This made the yellow fever a disease that not only attacked physical health but also all other areas of society too. Memphis during this time period became one of the most important hubs in the country, and this was because of the profitable businesses (cotton, plantations, railroad lines, and slave market) that were at work before the epidemic arrived. Furthermore, many merchants in the early periods of the epidemic strongly opposed quarantines because it would prevent others to do business with them and therefore they would lose money. Quarantines around the area proved to be of great damage to the city’s economy and its people. Also, the mass exodus did not help either because those who left where the ones that were paying taxes that kept the city running. Left behind with only working class and poor citizens the city had a hard time dealing with public safety and health. The underfunding of the Memphis Health board would prove to be a fatal mistake as the incidence of yellow fever increased dramatically. Unfortunately the entire country was unprepared to face the magnitude of the damage that the yellow fever would cause. As a result of this, the outcomes of the yellow fever helped bring a reform and expansion in the public health field at the federal level. State Boards of Health were common in most states in the country, but Tennessee was one of the few that did not have one until after 1878. Not having a state board established, the responsibility laid in the hands of a city that was slowly deteriorating to solve the problem. It also didn’t help that medical professionals did not know the origins of the virus or how it transmitted from person to person. Nevertheless, medical professionals had two theories that were widely accepted about the disease and that was that the disease spread because of unclean surroundings and that the disease came in each summer through trains and steamboats. This held some validity as it was later discovered that mosquitoes were the vectors carrying the virus and that there was a significant decrease of their presence during the cold season and therefore little to no cases of yellow fever would be reported during winter. Also, not only did the yellow fever outbreak bring about reform in the healthcare field, but it also served to unite what was a broken country at this time.After the Civil War ended in 1865 the country was still in pieces and there was no sense of unity between the north and the south. However, during the period of the yellow fever outbreak in the south, northerners sent much needed aid to the south that included money, goods, doctors, nurses, and letters. The yellow fever served as glue that would help stick a shattered country. It is estimated that that total monetary donations towards the south by the north was above 4.5 million dollars; which was a significant amount considering political parties almost never raised more than 300 thousand dollars for their campaigns. Not only was the country being united but racial relations noticeably better during this period of time as a cause of the epidemic. Many of the citizens that fled Memphis were white upperclassmen because of this the city’s population majority were now African-Americans. African-American majority in Memphis aided in the integration in several areas of the city, one of which was in the police force; never before had blacks been allowed to serve as patrolmen in Memphis, but because of the low number of whites in the city the police department allowed blacks to join. Organizations played a big role in the aid to Memphis during the yellow fever outbreak; one of the most important was the Howards Association. The Howards Association, previously founded in New Orleans, was named after the English philanthropist John Howard, aimed at bringing aid to the sick by getting medical personnel into the Memphis area. In addition to the Howards Association, the Citizens’ Relief Committee helped those that remained in the city by providing essential items such as food, soap, candles, and bedding. Many local fraternal groups in the city also helped those that remained, and religion too helped bring comfort and peace to the people that were sick or panicked. Many ministers and priest worked to help bring peace to the dying and closure to the family members of that person; knowing that they faced the imminent danger of dying these people still went along and did what they believed was right, but in the process many died including thirty nuns and thirteen priests. Memphis with its weak economy had no way of fighting the outbreak of yellow fever, but with the generous help of many people and organizations the city was kept alive and running. Had it not been for all the aid it received, Memphis might have never made it out alive from the epidemic.The yellow fever outbreak came to an end when on October 18 a strong frost came to the city and killed many of the mosquitoes that were carrying the virus, and then shortly afterwards on the twenty-ninth the Board of Health declared the epidemic over. Along with those who fled the city infected with the virus and died somewhere else, it is estimated that yellow fever killed 5,000 people in 1878. In order to recover from the vast damage caused by the yellow fever, the city of Memphis after having declared the epidemic over sent a message to all Memphians that had fled the city to come back; as a thank you to those who suffered along with the city during the outbreak a meeting was held at Greenlaw Opera house to assure its citizens that the city would do everything possible to never let something of that magnitude to happen again. After the aftermath of the yellow fever outbreak, the United States government formed a board of experts to assess the damage and provide a resolution to what was at its time the worse epidemic in American history. Once the assessment was finished debates between different agencies arose in how to reform America’s Health Boards. The South wanted a Board of Health specifically for that area of the country, but the North argued that a National Board of Health that would be over the entire country would be the best way at preventing and managing future threats from diseases. John Shaw Billings argued for the National Board of Health and won, and therefore in 1879 the National Board of Health was created. As a result of the yellow fever of Memphis in 1878 laws both in the national and state level were passed in order to prevent future breakouts. That year congress passed a national quarantine law which called for the consular officer or United States representative to give information to the supervising surgeon general about any possible infectious disease in any foreign port or country that is incoming to the United State. In the state level, the state of Tennessee on the 1st of April, 1879 redefined the powers and policies of the State Board of Health in the following way: order quarantine when there is a threat of an epidemic, charge those with a misdemeanor for not following through with state board requests, appropriation of three thousand dollars by state, and called for the governor to elect two additional members to the board under the condition that the appointees have to have some relation with the commerce and transportation departments. These laws aimed at protecting the health of the public and avoiding the disorder that had been caused as a result of the yellow fever outbreak. With clear guidelines of what the State Board of Health could do, the city of Memphis could now start working on fixing up the city.As a result of the yellow fever the city of Memphis ordered the Board of Health to carry out a city wide cleanup. Some of the cleanup included: replacing wood sidewalks with pavement, tearing down outhouses and replacing them with modern bathrooms, creating a garbage pickup service, and inspecting food and plumbing facilities more thoroughly. The main occurrence as a response to the yellow fever was the creation of a sewer system for Memphis, and it was widely believed that because of the drainage of city the threats of yellow fever were eliminated. However, the new sewer systems did more than protect the natives of Memphis from yellow fever; it helped in bettering the overall health of the people and it also prevented other diseases that were causes by contaminated water. The person in charge of building the sewer system for Memphis was an engineer from New York whose name was George Waring. Furthermore, he was the man who came up with the idea of a separate pipe system one of which would carry sewage and the other fresh water. In conclusion, the summer and fall months of 1878 brought with them dramatic changes that helped set up the foundation of what Memphis would become and now is. Memphis was challenged by the yellow fever and although it had many victories the city came out victorious with its many policies and regulations aimed at preventing and controlling future outbreaks of any disease like the yellow fever. This was a time that was rough for the country as a whole because it had just recently gone through the Civil War and was going through the process of reconstruction. However, it should be noted that one important aspect of the yellow fever epidemic in Memphis was that it brought the country together and served as a way for the north and the south to come together. This was also a challenge for the country as a whole because up to that point a breakout of that magnitude had never occurred, and many including the president in office that year had no idea how bad yellow fever was until it came to a close on December of 1878. President Hays went so far as to say the following, “I suspect the Memphis sorrow (yellow fever epidemic) is greatly exaggerated by the panic stricken people. We do all we can for their relief.” Consequently federal aid came closer to the end of the epidemic and added frustration to the city that knew quite well what was going on. Finally, the yellow fever not only caused numerous deaths but it also helped to unite the country, integrate the city of Memphis, and create a national State Board of Health.