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Although he remained literate, his decision-making abilities were compromised and Bowie had been described as confused or disoriented, which are symptoms that present in end-stage yellow fever.<ref>CDC, ''Yellow Fever.''</ref>Conversely, Bowie remained physically active and there are no records of him showing overt signs of physical illness at this time. By most accounts, Bowie arrived inside the Alamo compound without illness. Signs and symptoms; however, may not present until the disease is well advanced.

[[File:battlealamo.jpg|thumbnail|300px|left|Battle of the Alamo as depicted in the Saturday Evening Post, 1836.]]

Doctor Amos Pollard, who was present at the hospital in Bejar, wrote to Governor Smith that he was “nearly destitute of medicine” and continued to say he could be “of very little use to the sick” were an attack to occur.<ref>Amos Pollard to Henry Smith, Bejar, February 13, 1836, in ''Official Correspondence of the Texan Revolution, 1835-1836,'' ed. William C. Binkley (New York: D. Appleton-Century, 1936), 1:423.</ref> Lack of medicine combined with the lack of nutritious food and [[How did Public Sanitation Develop?|poor sanitary conditions]] created an ideal environment for disease to thrive. A water-well in the center of the Alamo courtyard did provide fresh water but was also a breeding ground for mosquitoes. It is possible that Bowie contracted yellow fever for a second time if he did not fully recover from his first bout with the disease.