Science in the Triangle

Nowhere are the medical advances of the past 150 years more obvious than during war. A U.S. soldier who is injured today on the battlefield in Iraq has about a 95 percent chance of survival. In World War II, the chance was 50 percent and during the Civil War it was 19 percent.

But the benefits of modern medicine go well beyond combat surgery.

Dr. Margaret Humphreys

Dr. Margaret Humphreys, a Duke University professor in the history of medicine and a fellow at the National Humanities Center in Research Triangle Park, issued a reminder Tuesday during a lecture at the N.C. Museum of History in Raleigh that germs bag a bigger punch than bullets.

“It wasn’t until World War I that more soldiers died from wounds than from disease,” Humphreys said during her lecture on the role malaria and yellow fever played during the Civil War.

Before the onset of modern medicine, infectious diseases had much influence on daily life, even during peaceful times. But it was during war, when food was scarce, sanitation was non-existent and many soldiers lived in close quarters away from home, that diseases brought on by viruses and parasites flourished.

The Bubonic plague ravaged parts of Europe during the Thirty Years War. Smallpox was a problem during the American Revolution. Typhus fever crippled Napoleon’s army. Yellow fever and malaria contributed to twice as many soldiers dying from disease than from wounds during the Civil War, Humphreys said, but malaria was of particular importance to the outcome of the war.

For much of the 1800s, Americans suspected bad smells had something to do with disease. They knew disinfectants made the odors go away and people who were exposed to them and didn’t die could become less vulnerable. But not until the 1880s did Louis Pasteur, a French chemist, raise the idea that microorganisms, or germs, existed and spread disease. It would take another two decades before mosquitos were identified as carriers of yellow fever and malaria.

Until then, “they don’t know about the mosquito,” said Humphreys. “Think poisonous air and bad smells” - and lots of them.

The first yellow fever epidemic broke out in Philadelphia in 1793 and several more followed in ports along the East and Gulf coasts during the next century. In 1862, an outbreak in Wilmington sickened about one-third of the town and killed 446 of the town’s 5,000 residents.

Yellow fever was feared, Humphreys said. About half of the severe cases ended in quick deaths from liver and kidney failure.

In 1864, Luke Blackburn, a physician and supporter of the Confederacy who would later become governor of Kentucky, tried to use dirty shirts and sheets from yellow fever patients in Bermuda in one of the earliest known cases of biological warfare. He packed the sheets and shirts in trunks with the intent to have them delivered to Northern cities, including one bound for President Lincoln’s White House.

There’s no record the trunks reached their destinations and it wouldn’t have mattered if they had. Even though Blackburn had much experience treating yellow fever in the American South, he had no idea the virus didn’t spread through personal contact.

Yellow fever traveled on ships and mostly affected U.S. ports. Malaria came aboard European immigrants and African slaves and was widespread. A mild version, called vivax malaria, came from Europe and affected even areas with temperate climate. The more severe and deadly version, called falciparum malaria, came from Africa and required the warm and humid climate of the American South.

During the Civil War, malaria raged in coastal North Carolina, the South Carolina Sea Islands, the Mississippi delta and on the James River peninsula in Virginia.

The combination of yellow fever outbreaks and falciparum malaria made the southern lowlands so dangerous, Confederates considered the diseases their secret weapons, Humphreys said. Southerners believed that “when the Yankees come down here, our very land will throw them out.”

But Union troops had two advantages that made a difference, particularly in battling malaria: Up to 10 percent were African-American and had at least partial immunity and the North had unrestricted access to quinine, a medicine that was regularly dispensed.

The blockade of Confederate sea ports limited the South’s access to quinine, especially after 1864, Humphreys said. Southern women smuggled the medicine in their hoop skirts and the South developed an alternative made from willow, poplar and dogwood bark and whiskey. But the “Southern quinine” didn’t work.

Also, the North brought along its own diseases, such as smallpox and measles, she said. And in the end, the Union suffered fewer deaths from disease than the Confederacy.