Original ArticlesThe 1802 Saint-Domingue Yellow Fever Epidemic and the Louisiana PurchaseMarr, John S. MD; Cathey, John T. MSAuthor Information Department of Community and Public Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia (Dr Marr); and King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia (Dr Cathey). Correspondence: John S. Marr, MD, 6315 Pig Mountain Road, Free Union, VA 22940 ([email protected]). The authors thank Alfred Crosby, Duane Gubler, Myron G. Schultz, Cabell Smith, and Jack Woodall, for their important comments and suggestions, and the reviewers, who improved the article with important suggestions. No conflicts of interests are declared. There were no sources of support. Journal of Public Health Management and Practice: January/February 2013 - Volume 19 - Issue 1 - p 77-82 doi: 10.1097/PHH.0b013e318252eea8 Buy Metrics AbstractIn Brief Epidemics have been pivotal in the history of the world as exemplified by a yellow fever epidemic in the Caribbean that clearly altered New World geopolitics. By the end of the 18th century, yellow fever—then an “emerging disease”—was widespread throughout the Caribbean and particularly lethal in Saint-Domingue (present day Haiti). From 1793 to 1798, case fatality rates among British troops in the West Indies (including Saint-Domingue) were as high as 70%. A worse fate befell newly arrived French armed forces in 1802, ostensibly sent by Napoleon to suppress a rebellion and to reestablish slavery. Historians have disagreed on why Napoleon initially dispatched nearly 30 000 soldiers and sailors to the island. Evidence suggests the troops were actually an expeditionary force with intensions to invade North America through New Orleans and to establish a major holding in the Mississippi valley. However, lacking knowledge of basic prevention and control measures, mortality from the disease left only a small and shattered fraction of his troops alive, thwarting his secret ambition to colonize and hold French-held lands, which later became better known as the Louisiana Purchase. If an event of the magnitude of France's experience were to occur in the 21st century, it might also have profound unanticipated consequences. A devastating yellow fever epidemic in 1802 on Saint-Domingue (present day Haiti) among French forces garrisoned on the island may have been the pivotal factor causing Napoleon to abandon secret plans to invade the Louisiana territories. If such an epidemic were to occur in the 21st century, it might also have unexpected economic and geopolitical consequences. © 2013 Lippincott Williams & Wilkins, Inc.