Terrible Virus, Fascinating History In "Rabid: A Cultural History of the World's Most Diabolical Virus" by Bill Wasik and Monica Murphy

By NPR Staff, 7-19-12

Here's your vocabulary word for the week: zoonosis. It describes an infection that is transmitted between species. For example, the disease that the husband and wife team of Bill Wasik and Monica Murphy have written about in their new book, "Rabid: A Cultural History of the World's Most Diabolical Virus".

Wasik is a journalist; his wife is a veterinarian, so the rabies virus seems like a natural topic for conversation. "Veterinarians spend a lot of time thinking about rabies, even though in this country, we hardly ever see it," Murphy tells NPR's Robert Siegel. "So I've been bringing home stories about rabies from my education and from my reading for a long long time."

Murphy's stories about rabies intrigued her husband. "I started to think about all the cultural resonances of that and even just of the word 'rabid,' " Wasik says. "So we realized that it would be fun for us to work on a book together about it."

Rabies is a terrible virus, causing immense suffering before it kills. "It's a really awful way to go," Wasik says, "but if you take a step back, you sort of have to admire it because it is one of those pathogens that actually compels the host to spread it."

The virus attacks the limbic system, which Murphy describes as the seat of anger, fear and desire. "The rabies virus creates a pretty effective rabies-spreading machine," she says, as maddened, infected animals bite and spread the disease through their saliva.

That idea of the infected bite that spreads madness and death is at the heart of many great modern horror narratives: Wasik says tales of vampires, werewolves and even zombies have some rabies in their DNA.

Rabies also, chillingly, blurs the line between human and animal. "I feel like that is the reason why we've always feared rabies more than is necessarily warranted by the number of people that it kills," he says. "The very disease itself is like a transfer of an animal essence to a human being ... the fear and the biting ... it is an animal aggression, transferred to us."

But rabies is rarely seen in this country; Murphy didn't see a rabid dog in person until she traveled to Indonesia during an outbreak. There were limited measures in place to control the spread of rabies; mostly, people shot the sick dogs. "Despite the large-scale culling efforts, the virus continued to spread around the island and many people died, so it's good that eventually the government came around to vaccination," she says.

That vaccine was originally developed by the French scientist Louis Pasteur in the 19th century; in fact, it was the first modern vaccine developed in the laboratory. Pasteur's work becomes even more remarkable when you consider the fact that he didn't really know what was causing rabies; he called the infectious agent a virus, but at the time, no one had ever seen a virus.

"I think that was Pasteur's great achievement," Murphy says, "that he adhered so fervently to the belief that for any infectious disease, there will be an infectious organism behind it ... that even when he couldn't see it under the microscope, he still went after it."

From: npr.org

Read More

Rabies History

By Yolanda Smith, BPharm

Rabies has long been recognized throughout history, which is most likely due to the particularly stark symptoms associated with the disease. It appears to have been ever present in dog species, as well as occurring intermittently in other animal species such as bats.

Early History
It was quickly understood even in ancient history that the rabies virus could be passed on via an animal bite. Rabies is mentioned in several ancient literature works, such as the paper by Aristotle (300BC) that notes rabies as one of the diseases that affects dogs and any animal that the dog bites.

Also in early historical times, the owner of a dog displaying symptoms of rabies such as excessive salivation was required to take precautions to prevent their dog from biting someone.

Epidemiology
The prevalence of rabies in different areas of the world varied throughout history. Some regions were thought to be free of rabies in particular time periods, although this changed with time as the disease crept back in depending on the animal population and prevalence of the disease.

At the turn of the 20th century, rabies was greatly reduced from many developed regions that were previously affected such as Central Europe. This is thought to be largely due to the introduction of rabies vaccination, although other factors may also have had an impact. Other parts of the world, however, continue to experience effects as a result of the rabies virus even today.

Prevention of Rabies Transmission
In the 18th century, legislation was passed in countries like Germany, France and Spain for the destruction of stray dogs, in attempt to reduce the risk that a rabid dog may come into contact and bite a human in the region. However, this was not held well by the public and was not enforced in most areas throughout the world.

Other preventative methods were introduced in the 19th century, such as quarantine and other health initiatives, due to a better understanding of dogs and the transmission of rabies to urban populations. Likely as a result of these measures, the number humans affected by rabies were greatly reduced and by the 20th century, many areas were considered to be free from the virus.

Rabies Vaccination
Pasteur first demonstrated the possibility of vaccinating dogs to prevent rabies infection and possible transmission to humans in 1885. However, this was not routinely practiced until the 1920s, when domestic animal vaccination was developed and became widely used.

This practice helped to reduce the prevalence of rabies in animals dramatically. Provided that the majority of domestic animals (70%) were vaccinated, the effect of rabies could essentially be eliminated from the region.

Current Management of Rabies
Even today, once symptoms develop there is no known treatment for rabies. Instead, the current management for someone exposed to rabies is post exposure prophylaxis (PEP). This involves administration of rabies immunoglobulin and vaccine soon after exposure to the virus, followed by a series of injections over 30 days.

To date, PEP has a success rate nearing 100% when administered correctly shortly after exposure to the rabies virus. As a result, there are now comparatively few cases of rabies when people have access to adequate medical treatment. 95% of the 55,000 cases of rabies each year occur in Asia and Africa where medical attention after exposure to the virus is often lacking.

From: news-medical.net

Read More

In 19th Century,Rabies Was Menacing

By Bill Kemp, Archivist/librarian; McLean County Museum of History 12-5-10

BLOOMINGTON — “Kill your dogs!” declared a panicky Bloomington newspaper in November 1860. “Better every one of them should die than that one human being should suffer.” At issue was an outbreak of hydrophobia (known today as rabies) among the canine and feline populations of the city.

The appearance of rabies often sparked such overreaction in the 19th century. A virus usually transmitted via saliva from the bites of infected animals (including people), rabies attacks the central nervous system, and once symptoms appear it’s almost always fatal. The late stages of the disease beggar all description: hydrophobia (fear of water), hallucinations, hypersalivation, difficulty swallowing, extreme agitation, uncontrollable violent acts and paralysis.

Until Louis Pasteur and Emile Roux developed a vaccine in the mid-1880s, bite marks from rabid or suspected rabid animals often were treated by cutting away the flesh in and around the infected area and then cauterizing the wound with “lunar caustic” (fused silver nitrate).

In May 1852, The Bloomington Intelligencer, a predecessor to The Pantagraph, reported a dog belonging to Kersey H. Fell (brother of town of Normal founder Jesse Fell) was killed “having previously exhibited the most indubitable indications of hydrophobia.” The Intelligencer called for a city ordinance “against the running at large of the canine race,” hoping further that such action would “lead to the extermination of a few hundred of the curs with which our town is infested.”

That August, the city did pass an ordinance for registering dogs and prohibiting them from running at large. Residents were required to register their animals with the city marshal and pay an annual tax of $1.25 for each male and $3 for each female. Registered dogs wore a metal collar supplied by the city marshal. There was a steep fine for keeping unregistered pets, and during a rabies scare the city marshal and his deputies were given the power to shoot all free-ranging canines, be they registered or not.

Misinformation was a frequent bedfellow of hydrophobia. Perhaps the oddest belief surrounding rabies was that of the supposed curative powers of madstones, which were not stones at all but rather hard, roundish, porous-like concretions found in the stomachs of deer.

Well-accepted folk medicine tradition held that a madstone placed on the suppurating bite wound would soak up blood and “poisons.” When “full,” the stone would drop off, and after being cleaned in water and dried, the process would be repeated until it would no longer “adhere” to the wound.

In late 1900, The Pantagraph detailed the story of a madstone in the possession of Mrs. D.T. Crocker of South Lee Street in Bloomington. According to the article, the madstone had been in the family for more than 200 years, arriving in the U.S. with an ancestor from Wales. In the mid-19th century, the stone was split in two, with Crocker’s mother, Scynthia A. Ewing, getting one of the pieces. Ewing was said to have treated some 120 cases “with great success,” and the daughter continued the family tradition. Crocker, for instance, had seen a girl from LeRoy, and the madstone “adhered to the wound 18 times,” reported The Pantagraph.

Rabid dogs running wild remained a serious concern well into the 20th century. In December 1936, to cite one example, a “stray brindle mongrel” bit at least five city residents before the animal was “dispatched by means of a police bullet.” The state health department delivered five packages of free anti-rabies vaccine to Dr. Benjamin Markowitz, Bloomington’s public health director, and those bitten received the appropriate ministrations.

In January 1943, a rabid dog ran wild in Mt. Hope and Funk’s Grove townships in southwestern McLean County until it was shot dead by farmer Marvin Haughey. It had bitten and infected dairy cows, hogs and other dogs. “Farmers in the vicinity have been advised to kill less valuable animals, and to have the more valuable treated,” noted The Pantagraph.

Farmhand George Boeker, working on the Haughey place, was attacked by a rabid hog. “He managed to beat off the hog with his heavy boots and finally killed it,” read the news account. “The second hog went mad the same day in the lot with a drove of others. It was killed, but it is believed to have done much damage among the other hogs.”

Though rabies is no longer the scourge it once was, it is still with us. Just this summer, the McLean County Health Department reported the highest number of rabies-positive bats in 20 years.

From: pantagraph.com

Read More

Dead Cattle and Greek Fire

By Jeffrey B. Roth, 3-25-14

The American Civil War was a conflict that sat astride two phases in military history: It began with generals on both sides employing timeworn Napoleonic-era strategies and ended with horrific trench warfare and violence against civilian populations that foreshadowed World War I. It was also a crucible in which new combat technologies were tested, among them ironclads, machine guns and submarines. And while scientists had not yet fully grasped the germ theory of disease, it was also one of the first conflicts to see chemical and biological agents tested, and even used, as weapons.

Disease was everywhere during the Civil War. By far, the biggest killer during the conflict were communicable illnesses caused by unsanitary conditions at camp and in the field. As Andrew M. Bell of the University of Virginia has documented, early in the fighting military leaders on both sides of the war began to grasp the concept of disease vectors, as weapons.

Union planners knew that among other things, the blockade against Southern ports would exacerbate the spread of disease in the South by restricting access to food, clothing and medical supplies. Malaria was still rampant across the Deep South, and quinine was in high demand before the war. “Some parts of the South experienced shortages of quinine as early as the first summer of the war, and prices climbed each year thereafter,” Bell said. “Southern civilians suffered most of all from the quinine shortage because the Confederate government requisitioned whatever little bit made it through the blockade.”

Others sought to turn disease into an offensive weapon. One Southern planner proposed shipping clothing worn by yellow fever patients to Union military units, hoping to cause an epidemic. In 1862, R.R. Barrow, a Southern farmer, suggested taking bodies of yellow fever victims, along with contaminated clothing, to New Orleans, which was occupied by Union forces. There is no evidence that either plan was put in action.

In 1863, Dr. Luke Blackburn, a Southern sympathizer and later governor of Kentucky, plotted to infect clothing with the smallpox virus and sell it to Union troops in Washington. There may have been one Union victim of the scheme, a lieutenant in the 17th Vermont named Charles W. Randall, who believed he became ill after purchasing some undergarments from a store. Later, the store was identified as a possible recipient of an infected clothing consignment.

Another approach to biological warfare was the contamination of drinking water by retreating soldiers. Maj. Gen. William T. Sherman reported that Confederate troops retreating from Vicksburg, Va., had driven animals into ponds and then shot them. In response, the Union War Department issued General Orders No. 100, on April 24, 1863, stating: “The use of poison in any manner, be it to poison wells, or food, or arms, is wholly excluded from modern warfare.”

The Civil War also saw significant use of chemical weapons, at least in an incipient form. Union forces used variants of Greek fire, essentially incendiary mixtures that were hard to extinguish and could, in some cases, float on water. “I classify Greek fire as a chemical weapon because the formulations, when ignited, released large volumes of noxious fumes, and this was considered a useful collateral effect,” said Guy R. Hasegawa, a Civil War researcher. Greek fire was used most notably during the sieges of Vicksburg, Miss., and Charleston, S.C.

Long-range artillery shells were used as the delivery system for the incendiary compounds. There were technical problems, such as the projectiles exploding too early or not at all, doing little damage. The South also developed Greek fire weapons, but how extensively they were used in the field is unclear.

Confederates had their own ideas about chemical warfare, though none were actually employed. In one case, a commando team was given chloroform for a planned raid on the Monitor ironclad, which they would use to overwhelm sleeping sailors, but the raid never took place. The South tested a shell laden with a chemical agent that would release intense noxious gases, to be fired into Union positions. The Confederates also developed another fume-producing device to be fired into tunnels. A June 4, 1861, article in The Richmond Daily Dispatch noted: “It is well known that there are some chemicals so poisonous that an atmosphere impregnated with them, makes it impossible to remain where they are by filling larges shells of extraordinary capacity with poisonous gases and throwing them very rapidly into” an enemy position (in this case Fort Pickens, a holdout Union post along the Gulf Coast).

But the most rapid innovation took place in the North. President Lincoln exhibited great interest in the development of new weapons technology. During the war, the president would often visit the Navy Yard and consult with John A. Dahlgren, head of the ordnance department of the Navy.

Yet because there was no coordinated, systematic effort to take advantage of such innovations, many ideas remained undeveloped. Nowhere was this more true than in the realm of chemical and biological weapons, where thinking got far ahead of actual doing, and the horrific implementation of things like germ warfare and chemical agents had to wait for a later, even more barbaric conflict.

Sources: Guy R. Hasegawa, “Proposals for Chemical Weapons During the American Civil War”; Jeffrey K. Smart, “Chemical and Biological Warfare Research and Development During the Civil War”; James M. Schmidt: “The Arts of Death,” The Civil War News, November 2010.

Jeffrey B. Roth is a freelance writer.

From: opinionator.blog.nytimes.com

Read More

Gangrene

From: humanillnesses.com

Gangrene (gang-GREEN) is a condition that leads to the death of living tissue. It is caused by blocked blood flow or by bacterial infection.

KEYWORDS
for searching the Internet and other reference sources

Arteriosclerosis

Bacterial infections

Debridement

Frostbite

Hyperbaric chamber

What Is Gangrene?
Gangrene is a condition in which living tissue (skin, muscle, or bone) dies and decays. Gangrene most often affects the legs, feet, arms, and fingers, but it also can affect internal organs such as the intestine or gallbladder. Gangrene can occur when blood flow to an area of the body is blocked or when certain types of bacteria * invade a wound.

* bacteria are round, spiral, or rod-shaped single-celled microorganisms without a distinct nucleus that commonly multiply by cell division. Some types may cause disease in humans, animals, or plants.

Dry gangrene
Dry gangrene can occur when blood flow to a part of the body is blocked. When tissues in the body are deprived of the nutrients and oxygen carried by blood, they begin to die. Dry gangrene

Military Medicine
U.S. Civil War (1861-1865)
The biggest killer in the U.S. Civil War was not instant death by bullet or by cannonball: it was disease resulting from wounds. An estimated 388,500 men died from wounds and other illnesses, including gangrene. Doctors with dirty hands unknowingly infected wounds with gangrene-causing bacteria while trying to treat the injured soldiers.

During this war, doctors noticed that the wounds of some of the soldiers were infested with maggots, which are the larvae of houseflies or blowflies. Those maggot-infested wounds tended to heal faster than those without maggots, because the maggots were eating the dead or decaying tissue that resulted from gangrene infection. Thus, the maggots were cleaning out the dead and decaying tissue, allowing the remaining tissue to heal. They were doing the work that surgeons do today to treat gangrene through debridement of wounds.

World War I (1914-1918)
During World War I, 15,000 miles of trenches stretched along the western front in Europe. Troops who spent many weeks in these cold, wet trenches often developed swollen limbs, damaged sensory nerves, and inflammation, a condition that they called "trench foot."

Trench foot often resulted in gangrene, loss of tissue, and sometimes in loss of limbs to amputations. Physicians and military officers responded to the problem by instituting strict standards of hygiene that became part of the military's ongoing preventive health regimen.

can result from injury or frostbite * , but it most commonly is a complication of diabetes. Diabetes can lead to hardening of the arteries (arteriosclerosis), which restricts blood flow. This is especially common in the legs and feet.

Dry gangrene usually starts in the toes. A person might first feel numbness or tingling in the feet. As gangrene progresses and tissue starts to die, the person will experience severe pain in the affected area. Eventually, the tissue turns black, marking where tissue has died. This type of gangrene needs to be treated promptly, but it is usually not life threatening.

Wet gangrene
Wet gangrene occurs when certain types of bacteria invade an injured area of the body. It occurs most often after an injury in which a body part was crushed or when blood flow was obstructed by a blood clot or a tight bandage. The lack of blood flow causes some cells to die and leak fluid, which moistens the surrounding tissue. The moist environment allows bacteria, such as Streptococci (strepto-KOK-sy) and Staphylococci (staf-i-lo-KOK-sy), to invade the wound and multiply. Wet gangrene causes swollen and blistered skin, and it has a foul odor. Once wet gangrene sets in, it spreads quickly to surrounding tissue. If left untreated, it can kill a person in a few days.

Gas gangrene
Gas gangrene is a type of wet gangrene that usually is caused by the bacterium called Clostridium (klo-STRID-e-um). This type of bacteria requires very little oxygen to live, and it releases gases and toxins as waste products. Gas gangrene causes a high fever, brown pus * , and gas bubbles on the skin.

How Is Gangrene Treated?
When a person has diabetes, frostbite, or an injury, preventing gangrene is a high priority. Taking medications, maintaining good blood circulation, avoiding foot injuries, and not smoking are essential for preventing dry gangrene in people with diabetes. Prompt cleaning of wounds to avoid bacterial infection can prevent wet gangrene.

* frostbite is damage to tissues as the result of exposure to low environmental temperatures. It is also called congelation (kon-je-LAY-shun).

* pus is a thick, creamy fluid, usually yellow or greenish in color, that forms at the site of an infection.

* amputation (am-pu-TAY-shun) is the removal of a limb or other appendage or outgrowth of the body.

* antibiotics (an-ti-bi-OT-iks) are drugs that kill or slow the growth of bacteria.

See also
Bacterial Infections
Cold-related Injuries
Diabetes

If a person develops gangrene, dead tissue needs to be surgically removed before healing can begin (a process called debridement). Doctors try to improve circulation to the affected part of the body and surgeons remove dead tissue. Because bacterial forms of gangrene can spread quickly, part or all of the affected limb might require amputation. * People with wet gangrene also are treated with antibiotics. * Sometimes, people with gangrene are treated in a hyperbaric chamber. This procedure exposes the body to oxygen at high pressure, which promotes healing of the gangrenous tissue.

Image: Amputation saws for treating gangrene infections were part of the military doctor's field equipment.

Read More

Chief Camp Diseases of the Civil War

By Jocelyn Green, 4-3-13

My novel "Wedded to War" explores the medical care of the Union army during that first chaotic year of the Civil War. During this time, disease was more of a killer than injury, especially in the Army of the Potomac during their ill-fated Peninsula Campaign in the marshes and swamps south of Richmond, Virginia.
Below are a few of the most prominent diseases that affected troops even before they could shoulder their rifles in battle. This information can be found in many sources, including the National Museum of Civil War Medicine (www.civilwarmed.org (link is external)) in Frederick, Maryland, which I visited as part of my research for this novel. The statistics for the Confederate side were not tracked as well. (Other sources will be listed at the end of this post.) Diarrhea and Dysentery The terms diarrhea and dysentery were often used interchangeably, but both were widespread and seriously debilitating. (Some sources say General Robert E. Lee was suffering with it during the Battle of Gettysburg in 1863, and that it affected his decision-making ability.) On the Union side, there were at least 1.6 million cases with more than 27,000 deaths during the course of the war. Causes ranged from poor diet and cooking practices (called at the time “death by frying pan”) to infection with microscopic organisms. For unknown reasons, chronic diarrhea and dysentery sometimes persisted for the remainder of a soldier’s life. Treatment included a good diet of fresh fruits and vegetables, opiates in alcohol and sometimes oil of turpentine and glycerin. Malaria Malaria is a fever-inducing disease caused by microscopic parasites transmitted to humans by the bite of the Anopheles mosquito—but no one knew this during the Civil War. The cause was thought to be “swamp miasma,” an invisible agent which floated through the air. Nearly a million cases of malaria were reported in Union records, with approximately 4,800 deaths. The disease was most common among soldiers of both sides serving in the deep South. Quinine, as the powdered bark of the cinchona tree or as quinine sulfate derived from the bark, served as an effective preventative and cure. Nutritional Diseases The major nutritional diseases seen during the war were scurvy (vitamin C deficiency), night blindness (vitamin A deficiency) and malnutrition. With diets often devoid of fresh fruits or vegetables, the vitamin deficiencies were often seen together. In addition to the individual disease symptoms (i.e. tender or bleeding gums), the poor diet led to compromised immune systems which hampered recovery from wounds and other diseases. Decent diet was known to cure and prevent the problems, but field logistics made this nearly impossible. There were 46,000 cases of scurvy in Union records, with 771 deaths. STDs “Camp-followers” and city brothels offered ample encounters with prostitutes. Sexually transmitted diseases, primarily syphilis and gonorrhea, were common in the armies of both North and South. Among white Union troops, there were 182,800 cases of both diseases combined. There were no effective treatments, and there would be none until long after the war. Among the techniques they tried were rest, diet, injection of various metals in to the urethra, internal use of mercury compounds and even the application of mercury vapor on the surface of the body. Reports that nearly one-third of post-war deaths in veterans’ homes were due to late-stage venereal disease show the futility of these treatments. Typhoid Fever Typhoid fever, an intestinal infection caused by the bacterium Salmonella typhi, is generally contracted from contaminated food or water. Symptoms include delirium, fever, exhaustion, and red skin lesions. Associated diarrhea can lead to puncturing of the intestines and death. Survival of the infection was known to confer immunity from further infection. Union records show 75148 cases among white troops with 27,058 deaths, a 36 percent mortality rate. Similar rates were found in Black Union troops and Confederate troops. Treatments, generally ineffective, included opiates for pain, quinine for fever, various diets and calomel (a mercury medicine). Recommended Sources: This is just a general overview of a few of the diseases that afflicted Civil War troops. For more in-depth study, I recommend: Adams, George Worthington. Doctors in Blue: The Medical History of the Union Army in the Civil War. Baton Rouge: Louisiana State University Press, 1952. [For the South, see Doctors in Gray by H.H. Cunningham.] Freemon, Frank R. Gangrene and Glory: Medical Care during the American Civil War. Chicago: University of Illinois Press, 1998. Letterman, Jonathan. Medical Recollections of the Army of the Potomac. New York: D. Appleton and Company, 1866. Available at Google Books here: http://bit.ly/OnmGGw (link is external) Wilbur, C. Keith. Civil War Medicine. Guilford, Connecticut: The Globe Pequot Press, 1998. Woodward, Joseph Janvier. Outlines of the Chief Camp Diseases of the United States Armies. Philadelphia: Lippincott, 1863.

Image: Union Nurse Annie Bell in Nashville

Read More

Beware Gangrene! Treating This Deadly Disease

By Jake Hanson, 3-28-14

During the American Civil War, two-thirds of the 700,000 soldiers died, not from battlefield trauma, but from infections as a result of battlefield wounds. This means that though a man only took a bullet to his extremities—a hand or a foot—he had the potential to die from complications. The most dreaded of the diseases that could be caught was gangrene.

Confusion abounded about what it is and how to treat it. Indeed, in both the Union and Confederacy armies the mortality rate of soldiers who contracted gangrene was a dismal 45%. That is, if you got gangrene, you might as well flip a coin concerning your chances of survival.

We know today that gangrene is the result of microorganisms that dine on unhealthy flesh, and spread rapidly down the extremities and release poisonous gases as they go. They spread rapidly from person to person, and even from room to room.

Based on thousand year old treatment techniques for the condition from Classical times, Civil War medics treated infected soldiers by calming them with whiskey, giving them a balanced diet, debridement of dead flesh, and some form of topical treatments that had limited effectiveness and was often more harmful than helpful as in the case of the caustic nitric acid. And after treatment, medics would watch for ‘laudable pus’ which was erroneously believed to be a ‘sign of healing.’

In all, these treatments were ineffective and methods often unwittingly spread the disease throughout a hospital.

Dr. Middleton Goldsmith based in Louisville, Kentucky was Surgeon-in-Chief of all military hospitals in Kentucky as well as the Army of the Ohio. He was dissatisfied with conventional treatment and began to experiment with new ways to treat the condition. While he did not understand germ theory, which was currently being studied by Louis Pasteur, he understood the necessity of cleanliness in treatment which went a long way to the prevention of its spread.

The breakthrough for Goldsmith came when he began experimenting with bromine, a chemical element which he used aggressively to treat gangrene, first injecting it deep into infected tissue, then working his way out to a topical application. The result of his treatment was a drastic drop in the mortality rate from 45% to 2.6%. Goldsmith had found that the right medicine injected aggressively and rightly was the best way to treat this deadly disease.

The Apostle Paul writes in his second letter to his disciple Timothy that false teaching about Jesus spreads like gangrene—that is, it spreads aggressively. And without proper and aggressive treatment mortality rates increase. Just like Dr. Middleton Goldsmith found an effective way of treating gangrene, so also Dr. Paul gives us the way forward in treating the infectious disease of false teaching.

“Remind them of these things” writes Paul (2 Timothy 2:14). This is the medicine. What are ‘these things’? Paul just finished telling us the Gospel of Jesus Christ beginning in verse 8 that we are to remember Jesus Christ—Jesus Christ, the Son of God, who as John makes clear, “was God”(1:1) and this God “became flesh and dwelt among us” (1:14). Remember, Paul commands, Jesus who died for our sins, and rose up from the dead, and remember that He is the coming son of David whose reign will never end. And Paul continues to remind us that our salvation and life comes when we, by faith, die with Him, and we enter into eternal glory where we will reign with Him (can you imagine?) forever. This is all ours if we receive Him.

But, for those who reject Him (not those of us who have lapses in their faith), He also will reject us. An eternal and real rejection in hell.

Today, this teaching is being rejected, just as it was rejected in Paul’s day, and has been rejected ever since. We see it in the teaching that Jesus was just a good man, but not divine. We see it with those who reject the substitutionary atonement. We see it in those who teach that Jesus was not really resurrected from the dead. We see it in those who teach that we need not receive Jesus to be accepted by God. We see it when we hear that Jesus is but ONE way to God rather than THE way.

It does not take long to find these teachings. Open up a magazine article on Jesus this Easter season, watch a television show on the Bible, or enter into one of many churches around the country, and indeed the world, and you will find the epidemic of which Paul speaks—false teaching spreads like gangrene!

We tend to treat this disease in one of two ways. First, like the Civil War doctors treating gangrenous soldiers, some waited for “laudable pus.” “It’ll work itself out,” we say to ourselves. After all, false teaching has existed since the fall, but the Church still stands. But this lack of treatment fails to obey the commands of God: “Remind them of these things!”

The second way we tend to treat this condition is to, like some Civil War medics, throw caustic and abrasive acids on the wound, sometimes killing the gangrene, but taking out healthy flesh as well, bringing great pain and discomfort to those being treated. Often in our ‘prophetic’ voices we also pour acid on those infected by the gangrene of false teaching. Paul warns against this as well. “[Correct] those who are in opposition with gentleness” that “perhaps God may grant them repentance leading to the knowledge of the truth” (2 Timothy 2:24), knowing that those infected are not the real enemy, but the devil who holds them captive (vs 25).

But aren’t I being a bit drastic here? Insisting that Jesus is the ONLY way, that Jesus really was and is God who took on flesh, died for our sins and really rose from the grave and that only if we believe in Him can we be saved? Isn’t this the caustic acid of which I warn?

Dr. Middleton Goldsmith faced similar questions. Wasn’t pure bromine too strong? Here are his own words:

"Many of the surgeons had no experience in the use of the remedy [of using bromine]. They were imbued with the idea, prevalent in the profession, that this agent is a highly corrosive and irritating one; and hence, they almost uniformly used it, in the beginning, largely diluted with alcohol, water, or ether [. . .] As the surgeons gained experience with the remedy, they gained confidence in its efficacy, and learned that it was not the corrosive and irritating agent which they had supposed it to be.

"Isn’t that what the Gospel is? Good News, the remedy of our sin-sick condition, and also the remedy of false teaching? But we often want to water it down because we hear that it is highly corrosive and irritating, when in reality, it is the false medicine that is caustic.

"The use of this medicine does not guarantee, however, approval. Paul himself was imprisoned for this Gospel. And he promises us that we too may be rejected for giving the life-saving medicine."

Though a hero, Dr. Middleton Goldsmith was not treated as one after the war. Residents of Louisville, sympathetic toward the Confederacy, turned against him, and so he moved to Vermont where he consulted for difficult medical cases and lectured but never served in active medical practice again.

But his task was complete. He had found an effective treatment regimen for gangrene and it would never be treated the same way again. To do so would be folly.

So use the medicine. Remind them of these things, and nip gangrene in the bud!

Sources: Since I know next to nothing about gangrene, here are some sources I used concerning Middleton Goldsmith:

“Gangrene Therapy and Antisepsis Before Lister: The Civil War Contributions of Middleton Goldsmith of Louisville”

“Hospital Gangrene During The Civil War - Civil War Medicine by Dr. Scott Watson”

From: thedecidedlife.com

Read More

Rickets:1800’s Old-School Disease Making A Comeback

From: thecivilwarparlor.tumblr.com

Remember When Kids Used To Play Outside?

Rickets was most common in industrialized cities during the 1800s. Children who worked in factories had poor diets and got little sunlight, resulting in a Vitamin D deficiency. This can lead to bone problems, bowed legs, and stunted growth. Since it is such an easy disease to avoid simply by spending a few minutes in the sun each day, as child labor laws limited kids’ time trapped inside, rickets all but disappeared.

Since rickets had been perceived as a disease that was “taken care of” for almost a century, doctors in the US and Europe were astonished when it suddenly started showing up in increasing numbers of children in the last decade, with several hundred cases in England alone in 2009. Part of the problem is that many children are back to having poor diets and spending very little time outside.
But the problems also present themselves in infants, ironically because new mothers are trying to do everything right. Breast milk does not contain Vitamin D and as more women breastfeed their children exclusively, and for longer time periods, as well as protecting their children’s sensitive skin from the sun when they go out, Vitamin D deficiencies are becoming more common in infants. Doctors urge women to keep breastfeeding, but to give babies vitamin supplements as well.

Read more about diseases of the Civil War era at www.CivilWarRx.com

Read More

Middleton Goldsmith and the Use of Bromine to Treat Gangrene

From: library.uthscsa.edu

The P. I. Nixon Medical Historical Library owns a report to the Surgeon General of the United States by Civil War surgeon Middleton Goldsmith on the use of bromine to treat hospital gangrene in wounded soldiers. Published in 1863, the report is entitled A Report on Hospital Gangrene, Erysipelas and Pyaemia as Observed in the Departments of the Ohio and the Cumberland, with Cases Appended. It contains detailed case reports, a foldout table containing all of Goldsmith’s research data, and his correspondence with other surgeons on the treatment of gangrene. The overall mortality of hospital gangrene cases from the Civil War has been reported as 45.6% (The Medical and Surgical History of the Civil War, Washington, U.S. Government Printing Office, 1875-1888). However, only 8 of Goldsmith’s 304 patients receiving bromine-based therapy for gangrene died, a mortality rate of only 2.6 per cent.

Goldsmith’s work predated Joseph Lister’s 1867 paper linking microbes and surgical infections and Louis Pasteur’s groundbreaking work on microbes, also published after the Civil War. Goldsmith did not know what agent caused the gangrene, erysipelas and pyaemia he observed in the wards of his hospitals, but he theorized that they were related to each other and sought a curative agent to cure the infections and prevent the spread between patients.  Goldsmith’s data was so meticulously documented that it was easy to prove his bromine treatment had cured his gangrene patients. By the conclusion of the Civil War, surgeons throughout the country applied variations of Goldsmith’s bromine therapy regimen in the treatment and prevention of gangrene.

Read More

Hospital Gangrene During The Civil War

By Dr. Scott Watson

Laudable Pus and Hospital Gangrene: This is a term first introduced to me by Dr Paul Stanton MD (then chairman of Surgery at East TN State Univ) during my surgery residency.It's an antiquated medical term that refers to a time in medicine when puralent suppuration(wound infection, pus) was considered a normal part of wound healing and a stage in healing most patients must pass thru to final healing of a wound or amputation incision. We now know and recognize four general stages of wound healing and puralent drainage/infection is definitely not one of them. Claudius Galen(circa A.D. 130-200) believed the formation of pus was a critical and essential part of wound healing. His fame as a prolific writer on the science of medicine and the proliferation of medical texts originating from the Golden Age of Greece would provide guidelines for medical practice for 2000 years.

That surgeons welcomed the sight of a purulent wound may be explained by the environment in which they were forced to practice. Wounds could be classified into two different categories: those with suppuration and those without. Wounds productive of a creamy, yellow ooze tended to run a chronic course, taking months to heal, but the patients were generally free of systemic symptoms. It was noted by Steven Smith as late as 1887 that "amputation wounds rarely, if ever, recovered at Bellevue, except after long-continued suppuration." Conversely, a thin, watery discharge was associated with a fatal outcome, with the patient dying of sepsis within days. With an infection rate of almost 100%, a purulent wound represented the lesser of the two evils. Therefore, it is of little wonder that even the most conscientious surgeons preferred and even encouraged the formation of pus.[1]

Laudable pus referred to a thick yellow creamy wound discharge and was a localized infection(probably staphlococcus). It was treated with local wound care and various antiseptics. If the infection didn't spread, the wound slowly healed and the infection would ultimately resolve. Hospital Gangrene was an entirely different matter. It is caused by anaerobic bacteria (which thrive in low oxygen levels) classically Clostridium bacteria. The infection typically begins in open wounds which may have a component of dead tissue present. Poor sanitation can allow inoculation as the bacteria are common flora to our GI tract. The organisms produce gas as a byproduct hence the telltale findings of rapidly advancing erythema, watery thin wound discharge, crepitance to the tissues(gas under the skin can be felt and heard on palpation of the wound), fever, rapid pulse, rapid respiration, low blood pressure. The infection can spread with amazing speed. Modern treatment includes high dose penicillin, surgical debridement of all dead infected tissue(amputation if needed), and hyperbaric oxygen therapy.

Despite these measures, mortality is still high. My first exposure to gas gangrene came as an intern in the emergency room where a middle aged women presented with acute onset of severe back pain. With no history of trauma I first suspected kidney stones. After sending her for CT scan it was hard for me to believe the results. A large mass(colon cancer) had perforated allowing for direct sending of Clostridum bacteria from the colon into the muscles of her back and from there widespread infection throughout her body. Gas was seen in deep tissues of the upper and lower abdomen and back. Air was even seen in the spinal canal and around the brain. Antibiotics etc were given. The infection was too widespread for any surgical debridement and the patient passed away in a few hours. This condition was intensively studied and it's distinction from laudable pus was well recognized by civil war surgeons.

Dr Middleton Goldsmith was a surgeon in the Union army stationed at Jeffersonville army hospital who focused on the treatment of gas gangrene. He wrote a classic book titled: A Report on Hospital Gangrene 1863 Bradley and Gilbert Louisville. He believed it was caused by miasm or poisonous substances that occurred on putrefied flesh.In a later passage he did note there could be passage from one patient to another after an experience where a patient was admitted to the ward with hospital gangrene. Although he died quickly, in short order all four other patients on the same ward contracted gangrene and died. Patients on a different ward in adjacent building did not become infected. He attributed it to airborne transmission of poisons.

He studied many cases of Gangrene both his own and several case reports from other military surgeons. He was convinced that topical and locally injected bromine solutions on infected wounds would improved survival.He also recommends wound debridement and cleaning with the bromine applications. See below.

Copies of this book were issued to Union Surgeons encouraging the use of bromine on these wounds.

Louis Pasteur (1822-1895) vanquished the long-held myth of spontaneous generation and attributed fermentation and meat putrefaction to living microscopic organisms. It was the simplicity and rationality of his experiments that persuaded many of his contemporaries to adopt germ theory.[1]

Joseph Lister (1827-1912; Fig. 1), a professor of surgery at Glasgow, was the first to see the connection between Pasteur's discovery of the fermentation process and the suppuration of wounds. In April 1867 he published his ground-breaking paper on antisepsis, stating that "all the local inflammatory mischief and general febrile disturbance which follow severe injuries are due to the irritating and poisoning influence of decomposing blood or sloughs." Lister began applying carbolic acid to compound fracture wounds. The wound healed without suppuration, amputation was averted, and the mortality rate from amputation plummeted from 45 to 15%.[1]

(1)Miller, Jason T et al; History of Infection Control and its Contributions to the Development and Success of Brain Tumor Operations.Neurosurgical Focus 5/95

From: civilwarmedicalbooks.com

Read More

Cholera Epidemics

From: ohiohistorycentral.org

Beginning in the early 1830s, cholera epidemics killed thousands of United States citizens, including many Ohioans. Cholera first appeared in the United States in 1832, apparently arriving with European immigrants.

Cholera is a disease that is spread by drinking water or eating food that is contaminated with human feces. People who contract cholera generally suffer from severe diarrhea, vomiting, and cramps. People with this illness can die from dehydration within a few hours or days after the symptoms first appear.

Cleveland residents were the first people in Ohio to contract the illness. Migrants or businessmen who traveled across Lake Erie probably brought the disease. Cholera tended to be most virulent in cities because of their poor sanitation systems. By the autumn of 1832, the illness had reached Cincinnati, probably brought by people traveling along the Ohio River. The Ohio and Mississippi Rivers allowed the disease to spread quickly across the United States in all directions.

Cholera also reached Ohio's interior. Canals provided a relatively stagnant source of water that allowed cholera to fester. As a result of drinking this stagnant water, canal workers commonly died from this illness. While canals, railroads, and steamboats benefited Ohioans economically, these modes of transportation also brought disease. The worst cholera epidemic to affect Ohio occurred in 1849. Eight thousand people in Cincinnati died in this epidemic, including Harriet Beecher Stowe's infant son. Many Cincinnati residents fled the city and ended up in Mt. Pleasant, a community that escaped the illness. The town residents soon changed its name to Mt. Healthy in honor of its good fortune. In Columbus, 116 inmates at the Ohio Penitentiary succumbed to the illness. Former President James Polk, a resident of Tennessee, was the most famous person to die of cholera in 1849. Cholera resulted in the postponement of the first Ohio State Fair and the Ohio Constitutional Convention of 1850-1851.

Cholera most commonly struck during spring, summer, and fall. Cold winters, at least in Ohio, routinely killed the cholera germ. Unfortunately for people stricken with cholera, the treatment, at least before the American Civil War, was almost as bad as the illness. Doctors routinely prescribed calomel for cholera victims. Calomel contained mercury, and numerous people died from mercury poisoning or suffered other ill effects from this drug.

Cholera epidemics continued in the United States until the early 1900s. As sanitation improved within the United States, including chlorination of water, the illness became less common. In modern nations, cholera cases are very rare. In developing countries, cholera remains a not-uncommon disease. The standard treatment for cholera today is to keep the ill person hydrated with germ-free water or other fluids.

Image: The oldest Jewish cemetery west of the Allegheny Mountains. It has eighty five graves and was used from 1821 to 1849, when the cholera epidemic filled the cemetery.

Read More

The Pest House Completed

From: connecticuthistory.org

On December 4, 1760, the town of Durham announced the completion of their hospital house.  An outbreak of disease the year prior had prompted its construction.  In November of 1759, John Jones, a Durham resident, contracted smallpox a disease for which was there was no known cure. At the time, isolation from other community members was seen as the only recourse to prevent the rapid spread of the contagion and the entire Jones family was removed to an old barn on the southern edge of town.

Before the discovery of the smallpox vaccination in 1798, entire communities could be quickly decimated. The disease spread by physical contact with the infected’s open sores or contaminated clothing and bedding. The disease’s wheezing cough made airborne transmission possible, too.  So, infected persons were seen as an immediate threat to the community.

Jones, his wife and daughter all died and were buried a month after being infected, and their house on the Town Green was torn down the following spring. On April 14, 1760, the town voted to build a hospital to provide a place of quarantine against future outbreaks. Located northwest of Pisgah Mountain near Cream Pot Road, a simple clapboard structure was constructed measuring 20-feet wide and 30-feet long with a fireplace and well. The Pest House served the town until the 1790s, and records indicate that during its operation 31 people with the disease were buried in the area, away from official town cemeteries.  Currently, only one gravestone remains to mark the history of smallpox in Durham: that of Timothy Hall who died in July 29, 1775.

Image: Mr. Timothy Hall who died with the small pox July 29th, 1775
– American Antiquarian Society, Farber Gravestone Collection

Read More

What Can Two 19th Century Cartoons Reveal About Disease and Hysteria?

By Medicine and Science Intern Kayla Reddecliff , 12-16-14

Every few years, we read the headlines about a new, or resurgent, disease that threatens global health. Fears of transfer erupt and hysteria sets in, at least in the initial months. If someone coughs in public, I'll recoil in concern; who knows if they have this year’s contagious disease? Every stranger becomes suspect. Of course, a more rational version of myself would realize that a cough could be caused by anything.

When it comes to disease, fear of air quality and of strangers has historical roots. One of the first epidemic diseases to excite worldwide hysteria was cholera. According to Dr. Margaret Linley, cholera became "a media disease," through the explosion of widely disseminated writings and images that intensified fear of the disease. Likewise, the historian Christopher Hamlin, explains, "it was the magnitude of the reaction to it that cholera stands out as the signal disease of the 19th century." Despite its extensive media coverage, cholera was far from the greatest killer of the 19th century (compared to malaria and tuberculosis) and rarely visited western nations.

We now know that the Vibrio comma is a marine organism that spreads through infectious vomit and fecal matter (that can contaminate food, water supplies, and even linen), but cholera remained a mysterious disease throughout much of the 19th century. When it first reached Europe and North America in 1832, cholera came as a shock to 19th century sensibilities as fluids streamed uncontrollably from both ends. Dehydration turned skin a deathly blue, made eyes appear sunken, and thickened the blood. Its onset was sudden and it could kill within hours. This initial visit would kill thousands and "King Cholera" returned to western nations four more times during the century.

While researching cholera for my advisor at the museum, I found two seemingly humorous cartoons dating to the 1830s in the museum's Medicine and Science collection. These images were first loaned to the museum—when it was still the National Museum of History and Technology—in 1945 as part of a collection of European pharmaceutical artifacts from the 15th to 19th century. Both titled "Cholera Prevention Man," they depict a man covered from head to toe in protective layers in an attempt to safeguard himself from the oncoming cholera epidemic. Germ theory had not been developed, nor was the cause of cholera understood, but bodies were still in danger. Medical writings and images were internationally exchanged, as Western nations tried to find cures and explain the horrifying disease.

The first image illustrates many 19th century remedies and preventatives for cholera. Wrapped around his waist is a grey "cholera belt" (a thermal remedy primarily used by British soldiers in order to keep the body warm), while a mask and container of camphor or vinegar vapors envelope his face in an effort to neutralize any cholera miasmas that tainted the atmosphere. He stands in a doorway made of boxed medicinals (such as calomel, cayenne pepper, and laudanum) as well as other treatments for cholera: a clyster and hot water bottle (to administer enemas) and a commode. The words roughly translate to "a well stocked home to prevent cholera." However, the ghostly apparition of cholera still lurks behind the man. Desperate people stocked their “medicine cabinets” with numerous treatments and remedies from both medical men and quacks alike that ranged from sadly ineffective to wildly dangerous.

The second cartoon (published both in German and English) is a satirical comment on the effectiveness of the overabundance of protective items that were sought out as fear of the approaching cholera pandemic grew. In the English version of this cartoon, the caption warns: "By exactly following these instructions you may be certain that the cholera… will attack you first." Early theory established that cholera was not contagious because filth and overall poor sanitation that produced miasmas in the air were attributed to its cause.

Both cartoons express this miasma theory through their concern with purification and sanitation (the man has both a juniper bush and vapor mask to purify the air). Yet, in mocking the effectiveness of the protective items, the cartoon expresses a widespread uncertainty regarding cholera's contagiousness since it was known to travel along trade routes over land and sea. This uncertainty of the disease's contagiousness is reflected in the ex-mayor of New York's, Philip Hone's, personal writings on September 20, 1832, "It is stated that forty-nine thousand five hundred and sixty-nine emigrants have arrived at Quebec… a large proportion find their way into the United States destitute and friendless. They have brought the cholera this year, and they always bring wretchedness and want."

Cholera became intertwined with the anxieties over the health of the social body. Not surprisingly, poverty and immigrants seemed to attract the disease. Cholera did strike its victims disproportionally from the poor; however, in the 19th century a life of filth and ruined morality was largely seen as a personal choice, instead of a result of poverty, poor infrastructure, and a lack of resources. Both cholera and immigration influenced newly forming cities. While Western nations became increasingly involved in the global world in the 19th century, there were increased global movements of people, especially from non-Protestant and non-white backgrounds. In America, the threat of cholera was one of the biggest concerns proposed by those who supported restricted immigration. Two of the earliest International Sanitary Conferences (the predecessor to the World Health Organization) grappled with the issue of cholera's contagiousness as well as with the attempt to coordinate measures to prevent cholera's spread from India (as it was regarded to be the home of cholera) into Europe.

In Western nations, huge capital investments in water sanitation created cholera-free cities while other measures within cities began under public health movements in order to track the disease and prevent its spread. However, the stigma of filth as a cultural choice is still prevalent as countries in Africa, South Asia, and South America deal with the seventh pandemic that has been raging since the 1960s as a result of a lack of infrastructure and resources.

Kayla Reddecliff is an intern in the Medicine and Science department. One of her favorite areas of study is the history of fashion, so disease prevention costumes were a perfect fit.

Image 1: The Cholera Prevention Man. Moritz Gottlieb Saphir, Germany and England, ca., 1832. Thousands of copies of this image were produced and disseminated. Image from the museum's Medicine and Science collection.

Image 2: The Cholera Prevention Man. Wundet, Germany and England, ca., 1830s

From: americanhistory.si.edu

Read More

Disease in Arkansas during the Civil War

By David Sesser, Henderson State University, 4-5-16

Disease was a major problem among the armies serving in Arkansas during the Civil War. Large numbers of men living in close confines made the spread of illness likely. As many as 700,000 members of the military across the country lost their lives during the war, and approximately two-thirds of them died from disease.

Outbreaks of disease were common in the state even before the beginning of the war. In 1855, a yellow fever epidemic struck Helena (Phillips County), and minor outbreaks of other diseases such as cholera and typhoid were common. The lack of major centers of population and difficulty of travel, however, prevented many large-scale epidemics before the Civil War. The state had a number of doctors in the antebellum period, but, while they did undergo some training, these men were not required to obtain any formal certification or standardized education.

With the outbreak of war in 1861, thousands of men began to gather in towns across the state to create military units. The close proximity of these men made the spread of disease much easier, as many were from rural areas and had never been exposed to common illnesses such as measles. Both a lack of trained medical professionals and little understanding of how cleanliness impacted health led to large-scale outbreaks of disease during the war. Camp Nelson near Cabot (Lonoke County) housed thousands of Confederate troops from Arkansas and Texas in 1862 before being struck by a number of epidemics. Measles, mumps, typhoid, and other diseases ran through the camp, leading to the deaths of around 1,500 men, including Brigadier General Allison Nelson. The camp was soon abandoned.

Federal units were also susceptible to outbreaks of disease. After the Battle of Pea Ridge, the Army of the Southwest marched across southern Missouri and northern Arkansas in an effort to take Little Rock (Pulaski County). Unable to do so, the army instead captured Helena, which had a strategically important location along the Mississippi River. As the Federal army crowded into the town, it was joined by hundreds of newly freed slaves. The close proximity of thousands of people in the riverside location quickly led to outbreaks of disease. Many waterborne illnesses that were spread through mosquitoes swept through the army due to a lack of sanitation in the camps. Hospitals were established in the city but could not treat the growing number of sick men. Federal military surgeons were trained to handle battlefield casualties but were ill-prepared to handle the large numbers of soldiers suffering from diseases.

The large number of sick troops hampered Union operations in eastern Arkansas for the remainder of the war. In the summer of 1863, a force under the command of Major General Frederick Steele moved from Helena in an effort to capture Little Rock. In the short march from Helena to Clarendon (Monroe County) on the White River, thousands of troops fell ill from various maladies. Steele was forced to transport his sick troops to DeValls Bluff (Prairie County), where a new hospital was established. As the expedition continued, hundreds more troops became ill crossing the Grand Prairie. After Little Rock fell to the Union army, men who had fallen ill were housed at St. Johns’ College. Confederate forces left about 1,400 sick men in the city when they retreated.

As Federal forces moved across the state and created outposts at strategic locations, they were joined by countless slaves who fled their masters. By the end of the war, Pine Bluff (Jefferson County), Helena, and Little Rock all had large populations of former slaves. Union authorities struggled to provide basic services for these freedmen but were unsuccessful in preventing numerous outbreaks of disease that quickly spread through the encampments. The former slaves commonly suffered from smallpox, as well as diarrhea caused by any number of illnesses. Some estimates put the number of deaths suffered by freedmen at twenty-five percent in their first weeks in the camps. In March 1864, Quakers in Indiana sent two missionaries to Helena to establish an orphan asylum to provide for the children who had lost their parents to disease in the city. With such large numbers of sick former slaves, white troops continued to fall ill even in the face of better healthcare. Eventually, Union authorities responded to this medical crisis by establishing military farm colonies for former slaves in the Arkansas Delta. This allowed the freedmen to become self-sufficient and lowered the population inside Helena and other towns.

Men who were former slaves also enlisted into the Federal army. Stationed at Helena and other Union strongholds, these men continued to suffer from high rates of disease. This was in part due to both continued poor sanitation, as the United States Colored Troops (USCT) units often received the worst camping locations within the city, as well as resulting from a continued shortage of qualified medical professionals willing to serve in African-American units. A single general hospital operated in Helena, while the nearest medical facility for USCT soldiers was located in DeValls Bluff. Little Rock and Memphis, Tennessee, also had hospitals open to soldiers in Helena.

The large numbers of sick troops affected Union military operations and prevented commanders from continually launching large-scale operations. In Arkansas, more than 182,500 white Federal troops became infirm during the war. Only about 4,450 were directly related to wounds, accidents, and other injuries, and the remaining was from some type of illness. Some 2,348 Union men suffering from illness died in the state during the war. The number of USCT troops that became ill in the state cannot be precisely determined, but the national mortality rate for USCT troops due to disease was 148 per 1,000, compared with 88 per 1,000 for white troops.

Confederate troops continued to suffer from disease during the war, although seemingly not in as large numbers as did their Union counterparts. After the Battle of Shiloh in April 1862, the Confederate government organized a medical department in Little Rock. This organization used a medical board of local physicians to examine applicants for commissions as surgeons and assistant surgeons. This system effectively weeded out inferior doctors. A facility for the manufacture of medicines was established in Arkadelphia (Clark County).

Outbreaks of disease continued throughout the war in southwestern Arkansas after the fall of Little Rock to Union forces in 1863. Treatment of these men was often exacerbated by dwindling supplies of medical supplies. Reliable numbers on the number of Confederates who suffered from disease in the state are not available.

The end of war saw the rate of disease in the state slowly lowering. With a major reduction of troops in the state, coupled with freedmen no longer being forced to live in confined quarters, outbreaks of disease in Arkansas dropped to prewar levels.

For additional information:
Adams, George W. Doctors in Blue: The Medical History of the Union Army in the Civil War. New York: Collier Books, 1961.

Bell, Andrew. Mosquito Soldiers: Malaria, Yellow Fever, and the Course of the American Civil War. Baton Rouge: Louisiana State University Press, 2010.

Finley, Randy. “In War’s Wake: Health Care and the Arkansas Freedman, 1863–1868.” Arkansas Historical Quarterly 51 (Summer 1992): 135–163.

Foster, Gaines M. “The Limitations of Federal Health Care of Freedmen, 1862–1868.” Journal of Southern History 48 (August 1982): 349–372.

Freemon, Frank R. Gangrene and Glory: Medical Care during the American Civil War. Madison, NJ: Fairleigh Dickinson University Press, 1998.

Hacker, J. David. “A Census-Based Count of the Civil War Dead.” Civil War History 57 (December 2011): 307–348.

Kellum, Rachel M. “Surgeons of the Severed Limb: Confederate Military Medicine in Arkansas, 1863–1865.” MA thesis, Jackson College of Graduate Studies, 2014.

Pitcock, Cynthia DeHaven, and Bill J. Gurley. I Acted from Principle: The Civil War Diary of Dr. William M. McPheeters, Confederate Surgeon in the Trans-Mississippi. Fayetteville: University of Arkansas Press, 2002.

Steiner, Paul E. Disease in the Civil War: Natural Biological Warfare in 1861–1865. Springfield, IL: Charles C. Thomas, 1968.

United States Department of the Army, Office of the Surgeon General. The Medical and Surgical History of the Civil War. 12 vols. Washington DC: Government Printing Office, 1870.

From: encyclopediaofarkansas.net

Read More

Diagnosing the Civil War

By Margaret Humphreys, 11-11-13

Germs, not guns, were the Civil War's deadliest killer. Far from the drama on the battlefield, hundreds of thousands of young men died from infectious diseases.

Margaret Humphreys, Trent Professor of the History of Medicine, discusses the challenges of fighting infectious disease on the battlefield in her latest book "Marrow of Tragedy: The Health Crisis of the American Civil War."

Humphreys, who has also written about yellow fever and malaria outbreaks in the American South, will discuss her research at noon Tuesday, Nov. 19, in 2002 Duke Hospital.

Humphreys spoke with Ezgi Ustundag of Duke Today to discuss her research on disease and the Civil War.

Q: How did you come to take an interest in the history of infectious disease in the U.S., particularly in the South?

HUMPHREYS: It all began with picking up one book, Charles Rosenberg's monograph on cholera in the 19th Century United States.  Then it was amplified by courses on the history of medicine at my undergrad school, Notre Dame, and in graduate school.

Q: How did you research the history of infectious disease in the American Civil War for your latest book?

HUMPHREYS: My interest in the Civil War goes back to childhood, as I grew up near Fort Donelson in Tennessee and Civil War historical markers were all around me. By the time I began this book I had completed two projects on the history of disease (on yellow fever and malaria) and it was natural to put my fascination with the Civil War together with my enthusiasm for disease and its historical impact. I began the research for Marrow of Tragedy in the late 1990s, and dove into the vast literature on the Civil War by reading the papers of the United States Sanitary Commission (USSC), which are available on microfilm.

The USSC was a Red Cross-like humanitarian NGO in the North that particularly focused on the health and disease of soldiers. Other sources, aside from published books and articles, were the wonderful manuscript collections at Duke, UNC, the South Carolina State Archives, the Massachusetts Historical Society and the Museum of the Confederacy. Manuscript collections preserve letters, one-of-a-kind sources that reveal much about health and disease.

Q: What are some common misconceptions related to infectious diseases that people hold about the Civil War? How does your book address those misconceptions?

HUMPHREYS: The most common misconception about Civil War medicine in general is that they had to "bite the bullet." Wrong! Anesthesia with ether and chloroform had been introduced by 1860 and was available for operations throughout the war. They also had opium compounds.

Also common, in regard to infectious disease, is the assumption that antibiotics (20th century drugs) are necessary for survival, so that health care made no difference in the Civil War. But I found that there were degrees of good and bad health care, and understanding that led me to emphasize the factors that increase or decrease immune function in the absence of antibiotics. These factors seem mundane, but were crucial--abundant, nutritious food; cleanliness of person and environment; opportunities for sufficient rest and warmth; and hydration. You can see the difference in comparing Northern and Southern disease outcomes, as food and care were ample in the North and sorely lacking in the South.

Q: Why is the story of infectious disease in the Civil War one that the general public -- not just individuals interested in disease pathology -- should be aware of?

HUMPHREYS: I hope my readers will reconsider what matters in the sick room and the key aspects of healing. Many medical lessons were learned and applied in the Civil War that are not irrelevant to the modern day. If interested in the Civil War, I hope they can also learn to see the war as not just a glorious account of battles and victory/defeat, but as a health crisis that killed more than a million Americans and was a great tragedy for the nation.

Image: The United States Sanitary Commission helped track health and disease during the Civil War.

Read More

Cholera

By Edmond Davis, 8-26-11

Cholera, a deadly, infectious gastrointestinal disease that usually spreads through contaminated water, is an acute infection of the small intestine caused by the toxin released by the Vibrio cholerae bacteria, leading to severe diarrhea and dehydration. Left untreated, cholera can be fatal in a matter of hours. The first cholera pandemic of 1817–1823 spread from India to Southeast Asia, Central Asia, the Middle East, Russia, and Europe, especially England. Cholera was prevalent in the 1800s in America beginning in New York City. Due to increased traveling, the use of steamboats, and more navigable waterways, cholera made its way to the Mississippi Delta region.

In October 1832, cholera reached Arkansas. An infected passenger boarded the steamboat Volant, captained by Charles Kelley. The Volant traveled from New Orleans, Louisiana, up the Mississippi River and into Arkansas via the White River. At the time, no deaths were reported on the Volant, but more steamboats traveled up and down the Mississippi River, where the disease preyed on travelers. That same year, the steamboat Reindeer had several infected passengers and crew members. The ship’s captain, David Miller, died near Montgomery Point, located along the river in present-day Desha County, which was a transfer point for passengers and freight that was used by bigger boats of the Mississippi River and the smaller ones running on the Arkansas and White rivers. On June 23, 1833, when the Reindeer stopped in Little Rock (Pulaski County), it had an infected crew and had already lost six people to cholera, also including the pilot and chief engineer.

In 1831, Dr. Matthew Cunningham, a physician, became the first mayor of Little Rock. He was directly involved in the formation of a board of health created by the new town council in response to a cholera epidemic brought by migrating Native Americans. In the 1830s, tens of thousands of Native Americans passed through Arkansas as part of Indian Removal, and many traveled on steamboats such as the Smelter, Volant, Thomas Yeatman, Reindeer, Little Rock, Tecumseh, and Cavalier, or on the keelboats often towed by these vessels. Arkansas became a highway not just for people and animals, but also for diseases. During the relocation of Native Americans called the “Trail of Tears,” many died from the scourge of cholera in Arkansas. Cholera prevailed amongst the Cherokee camped at the mouth of Cadron Creek.

Cholera became a problem all over the state but was more prevalent in communities near water. The growth of the major industrial cities also caused water pollution. Rivers that passed through urban areas became receptacles for human waste products, both domestic and industrial. Sewage was washed out into the streets, where it found its way to the rivers. Cholera was hardest felt in heavily populated areas, and it visited populations that had the highest poverty rates. During the Civil War, cholera hit large encampments of soldiers, such as those at Helena (Phillips County), due to poor sanitary practices, although dysentery, typhoid, and malaria claimed more lives than cholera.

Cholera struck Little Rock in 1873. According to the State Board of Health, on July 5, the first recorded case of cholera in Little Rock had sickened a woman in the Capitol Hill area. The section was often described as the most “salubrious and elevated” portion of the city. A day later in a different part of Little Rock, a man who had been in a damp and unsanitary environment was stricken. Both cases were fatal. Also, an African-American man traveling from Memphis, Tennessee, was treated for cholera and sent to the “County Poor-House,” where he died a few hours later. This facility was described as a “miserable establishment” full of undesirable inmates. The sanitation and food were unhealthy by any measure. Several more cases were registered as being cholera related.

In 1852, England passed the Metropolitan Water Act, which required water companies to filter and chlorinate the water. This sanitation effort helped to set a global trend, and it slowed cholera epidemics in London. In America, legislative interest in water pollution began in 1887, when the Connecticut General Assembly authorized the formation of a sewer study commission to “investigate the subject of sewage disposal.” In the twentieth century, many great strides were made to minimize the chances of a cholera outbreak. The last major epidemic in the United States came in 1910–1911. In the twenty-first century, cholera has all but vanished from the United States, though it remains a concern in other parts of the world, as exemplified by the outbreaks of cholera following a major earthquake in Haiti in 2010.

Several types of cholera associated with domesticated animals, such as birds and pigs, have occasionally been reported in Arkansas. In 1885, a New York Times story titled “Hog Cholera in Arkansas” reported that cholera was killing hogs in Van Buren, Stone, and adjoining counties by the hundreds. According to the U.S. National Wildlife Health Center’s quarterly wildlife mortality report, avian cholera (a.k.a. “fowl cholera”) was recorded in Arkansas and Baxter counties in January and March 2001. The species affected were American coot, an unidentified grebe, ring-necked duck, gadwall, and common grackle. This outbreak killed 226. In 2006, avian cholera was reported by U.S. Fish and Wildlife Service biologists to have killed between 1,300 and 1,500 snow geese at Bald Knob National Wildlife Refuge.

For additional information:
Dungan, D. H. “Summary of Evidence and Local Reports upon Cholera, as It Has Prevailed in the Mississippi Valley and Elsewhere in America during the Year 1873: Cholera in Little Rock, Arkansas.” Public Health Papers and Reports 1873: 257–260.

“Hog Cholera in Arkansas.” New York Times, October 7, 1885, p. 2.

Huddleston, Duane. “The Volant and Reindeer: Early Arkansas Steamboats.” Pulaski County Historical Review 24 (Summer 1976): 21–33.

Kohl, Rhonda M.“This Godforsaken Town”: Death and Disease at Helena, Arkansas, 1862–63.” Civil War History 50 (June 2004): 109–144.

McClintock, Charles T., Charles H. Boxmeyer, and J. J. Siffer. “Studies on Hog Cholera.” Journal of Infectious Diseases 2 (1905): 351–374.

Scholle, Sarah Hudson. A History of Public Health in Arkansas: The Pain in Prevention. Little Rock: Arkansas Department of Health, 1980.

From: encyclopediaofarkansas.net

Image: The Cholera Prevention Man. Moritz Gottlieb Saphir, Germany and England, ca., 1832.

Read More

Cholera: Sickness and Death in the Old South

From: tngenweb.org

Epidemic Cholera = Asiatic Cholera = Vibrio cholerae

Cholera is an acute, infectious disease characterized by extreme diarrhea, vomiting, and cramps. Cholera is primarily spread by feces-contaminated water and food; or as some say, it is a deadly water borne disease usually resulting from poor hygiene and untreated water. The cholera bacteria produce a toxin which keeps the human body from absorbing liquids. It is one of the most rapidly fatal illnesses known. Untreated individuals may die from severe dehydration within two to three hours. This disease has been the killer of millions worldwide. It is endemic in both Bangladesh and Peru. In 1991, a cholera epidemic swept down the west coast of South America. Africa suffered a similar cholera surge in 1991.

It seems that the bacteria prefers brackish coastal waters (moderately salty waters, i.e., coastal estuaries). Traditionally, this link to the seacoast areas has been credited with the transmission of the disease to other areas via ships.

The bacteria is controlled by chlorination of water and by waste water management. Of course, the less developed nations with their less developed water and waste systems are more at risk of outbreaks than the more developed nations. Natural disasters can greatly heighten the cholera risk by damaging the water and waste water systems.

Today . . . “Cholera can be simply and successfully treated by immediate replacement of the fluid and salts lost through diarrhea. Patients can be treated with oral rehydration solution, a prepackaged mixture of sugar and salts to be mixed with water and drunk in large amounts. This solution is used throughout the world to treat diarrhea. Severe cases also require intravenous fluid replacement. With prompt rehydration, fewer than 1% of cholera patients die.” U.S. Centers for Disease Control (CDC)

Cholera is still with us, lurking . . .

History

Asiatic Cholera appears to have started on the Indian subcontinent, ca. 1826. In India it became endemic. By 1831, it had spread to Russia. Eastern and Central Europe have suffered outbreaks and epidemics through World War I. The disease came the United States via English immigrants, ca. 1832.

Unfortunately, when the first epidemic hit our shores, there was no preventive, no good treatment, and no cure for the disease. The cause of the disease was not known, but we do see that early on, poor sanitation was suspected. During the years that King Cholera reigned in the United States (1832-1873), our cities were filthy, especially the ghetto areas. Waste management in those years was poor at best, but usually nonexistent. Waste would run down the middle of the streets, exposed. The streets were “ripe” with odors. Once cholera was introduced into the waste system, it was easy for the drinking water systems (poor as they were) to become cross contaminated; and once the water system was comprised, neither poor nor rich were spared. King Cholera was and is an “equal opportunity” killer. In London England, 1854, Dr. John Snow was able to stop a major cholera epidemic by closing the Broad Street pump, and thus he showed that cholera is a water borne disease. This was not previously known. According to Snow, prior to his finding it was believed that cholera “was communicated by effluvia given off from the patient into the surrounding air, and inhaled by others into the lungs ...”   Yes, London was filthy too!

One of the most common treatments for cholera in the United States up through the Civil War was the medicine calomel (Mercurous Chloride; Calogreen; Mercury Monochloride; Mercury Chloride). It was commonly used as a purgative (laxative) for the treatments of bowel illnesses ranging from diarrhea to cholera; unfortunately calomel’s effects were seriously harmful. It may have cleansed the bowels, but at the same time it caused teeth to loosen, hair to fall out and could destroy the patient’s gums and intestines. In other words, it could cause acute mercury poisoning. By 1870, we see remedies for diarrhea, brought on by long-continued use of calomel. We would need to ask -- if a person who had contracted cholera and taken calomel as treatment, could have survived to suffer calomel’s side effects?   There are a number of diseases which cause extreme diarrhea other than cholera.

Whenever there were major epidemics in the United States, it was common in the urban areas to send wagons to collect the dead. As the wagons passed the homes, the drivers would cry out, “Bring out your dead.” The deaths and burials often went without being recorded. Some families were so devastated that no one remained to put up headstones in the cemeteries -- assuming that a private burial was even possible.

The Cholera Epidemic Years in the United States

Major epidemics struck the United States in the years 1832, 1849, and 1866. There were smaller epidemics between the major ones.

1832:
   Major Epidemic
   New York City: over 3,000 people killed.
   New Orleans: 4,340 people killed.

1833:
   Columbus, Ohio.

1834:
   New York City.

1848:
   New York City: more than 5,000 killed.

1848-9:
   Major nationwide epidemic.
   See: 1849 Cholera Letter, Memphis Tennessee

1849:
   New York

1851:
   Coles Co., Illinois, The Great Plains, and Missouri

1865-73:
   Major nationwide epidemics.
   Baltimore, Memphis, Washington DC - Cholera.
   Baltimore, Memphis, New York City, Philadelphia, and Washington DC: recurring epidemics of cholera, scarlet fever, smallpox, typhus, typhoid, and yellow fever.

Learn more about cholera and other diseases of the Civil War era at www.CivilWarRx.com

Read More

Malaria: An Epic Tide of Sick and Wounded Flows into Civil War Hampton

By Mark St. John Erickson

One of the most epic sights recorded in a place that has seen many was the immense tide of sick and wounded Union soldiers that washed up on the east bank of the Hampton River in August of 1862.

Ferried by the thousands from the giant Army of the Potomac camp at Harrison's Landing in Charles City County, the stream of casualties filled ship after ship in a makeshift hospital fleet -- then made those vessels repeat the long trip up and down the James River over and over again for nearly a week.

By the time the massive evacuation was completed, some 20,000 soldiers recovering from wounds or laid low by typhoid, dysentery, malaria or Chickahominy Fever had been rescued from the endless expanse of tents that had served as the Union field hospital during the Peninsular Campaign near Richmond.

Nearly a quarter of them -- mostly those too ill or hurt to endure the longer trip north -- ended up in the sprawling complex of newly built wards and hastlily erected tents that would soon transform Hampton into the second largest facility in the Federal hospital system.

"Near the end, the Hampton hospital was like the drain for the whole campaign," says Terry Reimer, director of research for the National Museum of Civil War Medicine in Maryland.

"The Union was evacuating the sick and wounded as fast as it could. It was just insane."

Just how overwhelming this stream of soldiers became can be seen in a Harper's Weekly story that reported on the scene from nearby Fort Monroe.

""For several days ... the hospital steamers, with their little crimson flags flying from the masts, were at the upper dock,"  the correspondent noted.

"A large number (of the patients) were convalescing, so that they walked to the hospitals ... It was a touching and sympathetic sight, with forms and faces indicative of disease, some with fans, and most with staffs in their hands, they slowly walked along, like pilgrims to the promised land."

Hampton Military Hospital became a dreaded dateline in the New York Times, which published the lists of the dead on a regular basis. Amputees abounded, resulting in the construction of an isolated Gangrene Camp where many died and many others lingered.

By the time the war ended, the constant flow of sick and wounded from the Siege of Petersburg had resulted in a vast building complex that stretched from near the mouth of the Hampton River to just short of today's Booker T. Washington Bridge. So far did it extend that administrators built a special rail line from Fort Monroe and then through the camp just to keep their patients moving.

Today the only evidence that remains is Hampton National Cemetery, where many patients of the Civil War hospitals are buried, and the Veterans Administration Hospital, which is the successor to the Soldiers Home that was formed from the hospital's buildings after the war ended.

Image: Taken shortly after the Civil War, this close-up view shows the 4-story Chesapeake Female Seminary building commandeered by Union doctors for use as officers' wards. (Courtesy of the Library of Congress)

From: dailypress.com

Read More