Wednesday, November 12, 2014

A Night with Venus, a Lifetime with Mercury

By Julia Carlson

There is a saying that dates back to approximately the Civil War era: that a night with Venus leads to a lifetime with Mercury.  This was a pithy warning for a serious set of infections.  At that time, germ theory had yet to be fully developed, sexually transmitted infections (STIs) were not yet well understood (gonorrhea and syphilis were believed to be manifestations of the same illness), and there no effective cures available.  This was the background that the Civil War surgeons had to work against while treating soldiers for STIs.

Although more soldiers were wounded and infected with other disease, there were a high number of cases of STIs.  Unfortunately, no records exist for the number of Confederate soldiers that were infected with STIs during the war.  For white Union soldiers, 73,382 were diagnosed with syphilis, usually based on the presence of a chancre.  109,397 soldiers were diagnosed with gonorrhea based on presence of pus coming from their urethras.  Gonorrhea diagnoses probably included cases of chlamydia and other STIs that were not yet known to be separate infections.  The diagnosed cases averaged out over the war to be approximately 82 cases/1000 men/year. The highest rates of STI infection were at the beginning and the end of the war.

Comparable to white soldiers, there were 6,207 syphilis cases and 8,050 gonorrhea cases in black Union soldiers that averaged 78 cases/1000 men/year.  There were 426 hospitalizations of white soldiers, and 136 deaths (32 fatalities reported for black soldiers).  Depending on location, age, and army, STI infection rates could be much higher-the Department of the Pacific at one point reported rates of 461 cases/1000 men/year.  Soldiers who were not actively fighting, young, and stationed near cities were the must likely to become infected and the soldiers of the Department of the Pacific often matched those descriptors.

Most men contracted STIs from contact with prostitutes also known at the time as “public women”, and surgeons of the day knew this, although some may have also been infected during small pox vaccinations by sharing blood of an infected individual.  As STIs were a widespread problem in the Union army, many commanders looked for various ways to stem the issue as STIs were bad for morale, and were considered detrimental to their army’s performance.  Famously, Union General Joseph Hooker forced all of the prostitutes in Washington, D.C. to be relocated into a single area that was then nicknamed “Hooker’s Division.”  Although this may have cleaned up the city, it is unlikely that this was an effective measure to curb soldier’s visiting the prostitutes’.  In an interesting set of cases, unparalleled in American history, in Nashville, prostitution became so widespread in the city that while under Union army control in 1863, Provost Marshall Lt. Colonel Spalding was given orders to take his men and the local police around the city to capture all the prostitutes, put them on the merchant ship Idahoe, and exile them.  After the ship visited Louisville, Covington, and Newport KY as well as Cincinnati, OH without being able to successfully drop off the prostitutes, the boat was forced to return to Nashville.

Upon their return, Provost Marshall Spalding designed a system of legalized prostitution, with the aim to reduce new STI cases.  First, all prostitutes were required to have a license to practice.  Second, each week, a prostitute had to have an appointment with a physician to be given a certificate of health.  If a woman was found to have contracted an STI during that examination, she was sent to a special hospital (or ward) for treatment until she was declared healthy.  Finally, each week, each prostitute would pay 50¢ towards the hospital for its support. This system was deemed so successful at reducing troops contracting new cases of STIs in Nashville, that Memphis also adopted it.

Although these treatments, as discussed above, were not cures, it appears that by quarantining these women when they were likely the most contagious, such as when the syphilis chancre is present during the early stages, was at least somewhat effective in reducing new infections.  This solution accepted that human behavior would continue, while reigning in some of the unwanted effects to improve soldier’s performance in the battlefield.

Today, soldiers deployed to Afghanistan and Iraq face much lower rates of STI infections, although there does seem to be an upward trend in cases.  Between 2004-2009 case rates of gonorrhea ranged from 5/100,000 to 17.6/100,000 (not separated by gender or race) and chlamydia rates for men were approximately steady at 192.6/100,000 (although it did increase over time).  Rates for syphilis diagnosis were not available.  The current rates are much lower, presumably because of the ability to cure STIs using antibiotics rather than Civil War-era treatments such as mercury, sarsaparilla, and diet alterations as well as more widespread use of condoms than in the civil war era.  However, both the rates during the Civil War and the current wars in Iraq and Afghanistan are probably lower than reality, as STIs are commonly not reported by individuals either due to embarrassment or not being aware of their infection status. Treatments and rates of STIs have improved since the Civil War; however, most likely now just as back then, STI rates are under-represented due to unknown cases.

Finally, what cannot be quantified, is the lasting impact of these STIs.  The soldiers themselves would have continued to suffer from both diseases, with severe morbidity.  Gonorrhea in some cases can continue to cause pain while urinating.  Persistent syphilis can go on to its tertiary stages (neurosyphilis/cardiovascular syphilis), which attacks the central nervous system or heart and can be fatal.  Some historians estimate that up to one third of the men in veteran’s homes and hospitals that were caring for the soldiers from the Civil War were suffering from STIs at the end of their lives.  Undoubtedly, men went home and infected their wives, who then could also suffer from both neurosyphilis, but also pelvic inflammatory disease (PID) caused by gonorrhea.  Although this was unknown at the time, we now know that PID could have lead to problems with fertility, salpingitis, and tubal pregnancies.  Women could have also passed on the diseases to children in childbirth.  In children, gonorrhea can cause blindness and syphilis is linked to stunted growth.  Unfortunately, despite good treatments and screening programs, many individuals still do not know today whether or not they are infected with an STI, and many of the same results can occur. Although the pathology, knowledge, and treatments of STIs have significantly improved since the Civil War, culture today still suffers many of the same problems from untested STIs.



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