'Mr. Mabry lost two of his children with Typhoid fever'
Disease in the 19th century
This is not for the faint-hearted; ill-health and disease took a terrible toll before our era of modern medicine.[1] Physicians are now sounding an alarm over a return to a 'pre-antibiotic era' in the 21st Century, as disease-causing bacteria increasingly evolve resistance to antibiotic drugs, including drugs of last resort.[2] Nate and Loulie, their babies, their family and friends lived in a pre-antibiotic, and mainly pre-vaccination [3], world. In their letters the lovers worry constantly about health and illness, a typical concern for families at that time. In the 1860's causes of sickness were imperfectly understood. Louis Pasteur only began considering germs as a source of disease in 1865 when he looked into a malady affecting silkworms [4]. The first antibiotic, penicillin, was not discovered until 1928.[5] Adding to this, during the Civil War hygiene was poor in army camps. No wonder that "On the Union side alone there were 360,000 deaths and 3 out of every 5 of those were from disease. There were 260,000 on the Confederate side and 2 out of every 3 deaths were from disease!"[6] It is hard for us today to imagine the dread that infectious diseases inspired, and the impact on human lives these diseases had, during the 1800's.
Of course, some complaints mentioned in the letters are still with us: fever, sore throat, cough, and chest congestion due to colds and flu. "Mr. James Taylor's family have been and are now down with fever from colds, so says Mrs. Mozo" (# 11 Loulie Oct. 19 1961). " I took a very sore throat on the cars the other night coming down here it has troubled me a great deal but I am in hopes it will soon be better" (# 22 Nate, Jan 12 1862). Sometimes chest colds led to death, likely due to pneumonia [6]: "One of Capt. Dent's men died last night with congestive chills" (# 22 Nate, Jan 12 1862).
Some types of fever are harder to diagnose. When he wrote his last letter, Nate was a patient in a Macon hospital with what the doctors told him was 'bilious fever' (# 58 Oct. 1 1864). According to Wikipedia [7], this was a medical term often applied to a fever accompanied by nausea and diarrhea: "'Bilious' means the condition was thought to arise from disorders of bile, the two types of which were two of the Four Humours of traditional Galenic medicine in 200 A.D. The term is obsolete and no longer used, but was used by medical practitioners in the 18th and 19th centuries, often cited as a cause on death certificates. President Lincoln's son Willie was said to have died from bilious fever. Modern diagnoses for the same symptoms would include a wide range of conditions and infections
Dysentery is another current ailment, still afflicting babies and incautious travelers. An inflammation of the bowels that results in abdominal pain and fluid loss from diarrhea, dysentery was a surprisingly effective killer in unsanitary army camps.[8] Nate and Loulie mention it: "The dear little darling is not at all well to day, has dysentery, but not badly. She is better than she has been, and the little angel laughs although she feels badly. I hope the medicine we are giving her will cure her before night" (# 35 Loulie June, 1862). "I have not heard of but one case of sickness down here in a month, and that was a case of inflammation of the bowels caused from cold" (# 42 Nate Sept. 15, 1862). Dysentery can result from infection by bacteria, viruses, or parasites; it is usually a food- or water-borne illness.[9] While healthy people typically recover from a bout of 'touristas', soldiers weakened by cold, other diseases, and slim rations were often not so fortunate.[8]
Diseases caused by specific germs were the source of major epidemics in crowded cities during the 19th century; these also rampaged in Confederate and Union army camps. Typhoid fever in particular was lethal for civilians and soldiers. In the army, the disease was called 'camp fever.'[8] In Nate and Loulie's personal experience, typhoid killed slaves and the children of friends: "She says Henry Copeland and myself have lost eight negroes in the last six weeks with typhoid fever, but did not say how many of ours had died or what ones" (# 42 Nate Sept. 15, 1862). "Mr. Mabry lost two of his children with Typhoid fever Miss Chazz and one of his little boys" (# 51 Nate Sept. 20, 1864). Typhoid fever is an infection caused by a germ closely related to the bacterial culprit of Salmonella food poisoning. As with Salmonella, people contract the disease through contaminated food and water, although lice can also be a vector.[8] High fever, headaches, body rash and delirium precede death. A vaccine against typhoid was not available until 1896, but since then vaccines have eliminated the disease from developed countries.[10]
Measles and whooping cough, today mainly diseases of unvaccinated children, were also killers. Measles, an airborne viral disease, is highly contagious, spread by coughing or sneezing.[11] Children and adults in good health usually have a mild case, as did Loulie's brother: "Witter has had the measles but is quite over them; he had them very light they did not hurt him at all so if you see any of the home folks you can tell them, he has gotten entirely over them." (# 24 Nate Jan. 28 1862). However, measles did infect the troops, and about 1 in 20 succumbed to the disease.[8] Whooping cough, or pertussis, also highly contagious and air-borne, is caused by a bacterial germ rather than a virus.[12] Nate worried about his infant daughter being exposed to measles or whooping cough: "Darling do you know that the measles and whooping cough are both in our neighborhood? If Eula gets them, I am afraid they will kill her. So you had better be very careful how you let strange children see her. Mr. John Hull's children and Mr. David Scarlett's have the whooping cough, and they will be moving up your way before long." (# 28 Nate Mar. 26 1862 ) Even though vaccines have drastically cut the incidence of these diseases, outbreaks still regularly occur. [11,12]
Several other communicable diseases plagued the 19th century, although these were not mentioned in Nate and Loulie's letters. One of Nate's grandsons died of scarlet fever, according to family notes approved by Loulie.(Addendum 1) This infection, due to the strep throat bacterium, causes a high fever, sore throat and reddened skin, and primarily affects young children; it is treated nowadays with antibiotics.[13] In the well-loved 19th century novel Little Women, one sister, Beth, dies after her health is weakened by scarlet fever, a tragedy experienced in real life by the author Louisa May Alcott when her sister Lizzie died of the disease.[14] My family notes also say that Nate died of smallpox in 1866, after returning home to White Oak. It is improbable that Nate contracted smallpox from a visiting soldier and then died three days later, as stated in the Introduction to the letters, since after a person is exposed it usually takes 7-11 days for the illness to be serious enough to cause death. A rare form of the disease, hemorrhagic smallpox, can cause sudden death in five to seven days.[15] Perhaps Nate encountered his infected comrade earlier than the family notes suggest.
Yellow fever, a viral disease that sparked fearful epidemics in the 18th century, was famously shown to be spread by mosquitoes by U.S. army doctor Walter Reed around 1900.[15] The flooded rice plantations that lined the South Carolina and Georgia low country were ideal for breeding the Aedes aegypti mosquitos that carry the virus. This hemorrhagic malady begins with fever and liver damage leading to yellowing of the skin (jaundice). In its final stage, infected patients may vomit black fluid from blood leaking out of the gut. Ironically, yellow fever originated in Africa, and was likely brought to Caribbean islands in the 1600's and 1700's with the slave trade.[17] Savannah, a major port city of the Southeast, had an outbreak of yellow fever in 1820, and serious epidemics in 1850 and 1876. In 1876, more than 1000 died of the fever; their graves dot historic Savannah cemeteries.[16] During the Civil War there were no major yellow fever outbreaks in Georgia. Brunswick did experience an epidemic in 1893. A quarantine hospital was set up in 1880 on Blackbeard Island, just north of Sapelo Island on the Georgia coast, to inspect and disinfect ships arriving from tropical ports as a check on yellow fever.[18] Modern vaccines have eliminated this threat in developed countries.
One of the most deadly diseases in the 1800's was cholera, a bacterial infection of the intestine that causes rapid fluid loss due to vomiting and diarrhea. Cholera can lead to death due to dehydration and electrolyte imbalance in a matter of hours.[19] Bacteria-laden effluents from the infected contaminate local water supplies. The 11th president of the U.S, James Polk, died of cholera contracted during a visit to New Orleans shortly after his term ended in1849.[20] Fortunately, cholera was not a major killer during the Civil War, compared to all the other diseases going around at the time. Cholera was, however, the top cause of illness and death among emigrants traveling to Oregon and California during the mid-19th century, since water sources on the trail often contained cholera bacteria.[21]
Finally, tuberculosis, or consumption as it was known in the 19th century, was a constant threat in crowded cities.[22] Loulie's letter of Aug. 6 1861 "Clarke's wife continues quite sick, spits blood so Mrs. Jocolin says.' [#6] may refer to a tuberculosis infection, as coughing up blood is a symptom. The TB bacterium is insidious, since it can hang out in a body without causing symptoms, and become active if the immune system is compromised. It is not as infectious as other diseases, but does cause long-term illness and sometimes death.
Treatment of these various diseases, considering the virtual total lack of knowledge about their causes, was not very effective, mainly a combination of folk remedies, patent medicines containing various herbs, alcohol, and opium, and doctors with little formal training. That is another story.
Grave marker of Eula Brown Dunwody, Nate and Loulie's first daughter, who died as a young woman, age 28, likely from an infection or disease common in the 19th century. Brunswick Cemetery.
Sources and Notes:
[2] Spelling et al. and the Infectious Diseases Society of America. The Epidemic of Antibiotic-Resistant Infections: A Call to Action for the Medical Community from the Infectious Diseases Society of America. Clin Infect Dis. (2008) 46 (2): 155-164. doi: 10.1086/524891
[3] There did exist an inoculation against smallpox. A process known as 'variolation' involving injecting a small amount of material from a smallpox pustule of an infected person into a person without the disease, was used to confer immunity in the 18th century. George Washington required his troops to be varioulated in 1777 after a smallpox epidemic decimated his army. A vaccine for smallpox, using cowpox virus from an infected person, had been shown to be effective by Edward Jenner in 1796. The term 'vaccine' came from the scientific name of the cowpox vector, Variolae vaccinae, used in the 18th century (vaccinae is Latin for 'from cows). Jenner's inoculation method spread world-wide in the 19th century, including in the United States, and some states made vaccination against smallpox compulsory. The cowpox virus was unstable, particularly in hot weather, and vaccination coverage was limited until improvements in vaccine production and storage were made in the 20th century. This deadly scourge was only completely eradicated from the world in 1977.
Riedel, Stephan. 2005. Edward Jenner and the history of smallpox and vaccination BUMC PROCEEDINGS 2005;18:21–25
http://science.nationalgeographic.com/science/health-and-human-body/human-diseases/smallpox-article/
Staples JE, Monath TP (Aug 27, 2008). "Yellow fever: 100 years of discovery". JAMA: The Journal of the American Medical Association. 300 (8): 960–2. doi:10.1001/jama.300.8.960. PMID 18728272.