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 C H A P T E R T H R E E  Infectious Disease in the Civil War One of the most remarkable changes in medical thought in the nineteenth century was in the understanding of infectious diseases. At the start of the century, most physicians in Europe and America would have agreed that the fevers (a nebulous category marked by the symptom of high temperature) were caused by inhaling the foul odors that arose from various forms of filth. A few diseases were in a special category of contagious—smallpox, plague, and syphilis most prominently—while others became the subject of heated debates because they appeared to move across the globe by ship and train, yet were not obviously transferred person to person. By 1900 American and European physicians had largely abandoned the foul odor as an icon of danger and now adhered to the idea that tiny life-forms specific to each disease were the causative agents in infections. Most of the dramatic work in this transformation was done in Europe, where Louis Pasteur and Robert Koch argued from the 1870s that microorganisms caused disease. Koch invented a method to establish the connection between specific organism and specific disease. Pasteur promoted his own research methods, including techniques for creating vaccines. And Joseph Lister, an English surgeon, began the conversation that eventually led to sterile operating theaters and the modern surgical encounter. In America, the Civil War ignited new debates about contagion and brought disinfectants into the forefront of discussions about controlling the spread of disease. When historians claim that the Civil War came at the end of the Middle Ages as far as medicine was concerned, it is lack of knowledge of the germ theory of disease that is often mentioned. Yet 1861 was not 1800, much less 1348, when bubonic plague ravaged the European population . For decades American physicians had been actively debating whether certain diseases were contagious, and they continued that debate with the Infectious Disease in the Civil War 77 new experiences offered in hospitals and barracks during the war. Increasingly they considered contagion as a serious possibility. Conditions during the war were optimal for the amplification of contagious diseases. Civil War camps were instant slums, bringing thousands of men into close proximity with one another and with various insect vectors of disease.1 The omnipresence of smallpox on both sides during the war prompted both awareness that the cause of disease could be carried in an envelope (the dried vaccine scab) and knowledge that contact brought new infections. Physicians who had not seen much smallpox before, physicians from rural areas of the North and the South where it was rare, saw it now. Measles was even more of a problem early in the war. It was obviously a disease that swept through the troops, and its cause was suddenly the subject of much interest. The research on measles may not have led to a new discovery by modern standards, but it put the animalcular theory of disease, the idea that tiny living things cause infection, into the medical press and into doctors’ minds. Other diseases, such as meningitis , pneumonia, dysentery, and wound infections, spread through wards and camps and prompted questions about causation and spread. Physicians left the Civil War more familiar with concepts of contagion and the possible role of microorganisms in causing it than they were on entering the conflict. Historian Charles Rosenberg has identified the use of disinfectants in the 1866 cholera epidemic in New York City as a turning point in American public health.2 Here a newly created board of health stopped a cholera epidemic , the first time such a major epidemic outbreak had been contained by scientific methods. But where did this idea of disinfectants come from? Were New York City physicians familiar with the work of English physicians such as John Snow and William Budd, who had targeted the water supply as the source of poison? There is little evidence of such a connection. Rather, I would argue, it was the Civil War experience with disinfectants that led to the 1866 cholera triumph. It led also to an emphasis on disinfectants in the 1870s war against yellow fever. Paradoxically, the use of disinfectants at midcentury was almost entirely unrelated to the idea that microorganisms cause disease. But their use did pave the way for accepting bacteria as causative agents in later decades. The Civil War familiarized America’s doctors with the power of disinfectants, which readied their...

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