By Margaret Humphreys
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Environment was central to the understanding of disease causation in the American Civil War. Physicians of that war, north and south, viewed the environment as the key factor in health and disease, and one that could often be manipulated. Pre-war discussions of urban epidemics had focused on meteorology and environmental filth. The increased prevalence of malaria and yellow fever in the more Southern states, for example, was explained by variations in temperature and humidity. The built environment of hospitals and prison camps, designed with an eye to ventilation, hygiene, and crowding, was similarly seen as crucial to health, either in causing disease or creating a setting conducive to recovery. The agency of place in generating disease contributed to wartime rhetoric about the ways in which geography would support one side over the other, or how the manipulation of the built environment had been done deliberately to engender disease.
This article will first sketch the pre-war understanding of environmental factors in disease etiology, including the expected improvement to health that a cleansed environment should bring. It will likewise present ideas of seasoning as an experience of the Southerner who had gained protection from the tropical influences of his home country, protection the Yankee invader would lack. My attention then turns to the Civil War camp as a de novo urban [End Page 12] space which required hygienic discipline to decrease crowd diseases. The application of this knowledge applied equally to camp, hospital, and prison, albeit with varying success in the multiple loci of Civil War occupation. The Southern belief in the power of its indigenous diseases—yellow fever and malaria—to defend their turf will be explored, and the ultimate failure of this plan explicated. Finally, the claims that prison camps spread disease and death by design, and particular suspicions about smallpox as a deliberate weapon, will be explored against the larger backdrop of ethical and humanitarian challenges of the prison camp narrative.
The Environmental Understanding of Disease Causation
The mid-nineteenth century found medical thinkers in Europe and America engrossed in arguments about contagion, disease causation, and disease prevention. The clarity offered by the germ theory—that microbe A causes disease A, and travels from person to person through air, water or insect vector—would not emerge until the late nineteenth century. Instead, observers struggled to explain the relationship of disease outbreaks to climate, contact with diseased sites via travel, and local causes within the urban or rural environment (Steiner).
One disease set the model for the concept of contagion—smallpox. While uncertain about what actually passed from person to person, physicians had clear evidence that smallpox resulted from contact with an infected case, or with that person’s clothing or blankets. Furthermore, the cause of smallpox could be scraped from one arm, dried, stored in an envelope, carried to a distant place, and inoculated into the arm of a new patient, who would then come down with the disease. This practice, dubbed inoculation, produced a genuine case of smallpox, albeit one with attenuated virulence and lowered mortality risk compared to naturally acquired disease. It was applied during the Boston smallpox outbreak of 1721. In the 1790s English physician Edward Jenner discovered that lesions of cowpox could likewise cause a smallpox-like disease, but with even lower risk of a bad outcome. From this recognition the practice of vaccination became common, and by the mid-nineteenth century vaccination was frequent in American cities. Other diseases such as measles and chickenpox also appeared to follow this contagious pattern, although vaccines against them would not be developed until the twentieth century. Here is the model of contagion, then: a susceptible person enters a room with a sick patient, breathes the air around her, and becomes sick (Fenn, Pox Americana; Willrich; Grob).
The other major epidemic diseases of the day, cholera and yellow fever, did not follow this pattern. Modern biomedicine knows that cholera is caused [End Page 13] by an intestinal pathogen that is spread through fecally-contaminated water (and sometimes food). Yellow fever is the result of a virus transmitted by mosquitoes. One could...
From: The Southern Quarterly, Volume 53, Numbers 3/4, Spring/Summer 2016