Survivors tried to regain a sense of normalcy as quickly as possible. Union supply ships soon reappeared in places such as Key West, Florida, and blockade-runners continued to steam into the few ports that remained in Confederate hands late in the war, such as Charleston, South Carolina, and Galveston, Texas. Life and the great struggle between North and South continued until the Confederacy finally collapsed in the spring of 1865. But during each of the previous four autumns, the threat of yellow fever had hung over the various southern port towns that ringed the Atlantic coast and Gulf of Mexico. While the bloodshed lasted, outbreaks surfaced in or near New Bern, Wilmington, Hilton Head, Charleston, Key West, Pensacola, New Orleans, Sabine, Galveston, Houston, Matagorda, Lavaca, and Brownsville. Residents who did not flee their homes prayed that the pestilence would pass them by or put their faith in specious reports issued by city officials claiming that the disease was fast disappearing. Accustomed to living in denial about the problems peculiar to their region, southerners were ready to believe the best about the health of their communities up until the last moment. Others, like the residents of New Orleans welcomed the arrival of the disease, hoping that it would strike down their enemies and help the Confederacy achieve victory. One man, with the tacit approval of the Richmond government, even tried to use fomite-filled trunks as bioweapons. His plan was scientifically flawed, but it reveals the lengths some southerners were willing to go to in order to win the war. It also shows the awful respect they had for a terrifying disease that had plagued their home communities for generations.
Southerners also respected the malarial fevers that became unmanageable once the Confederacy’s supplies of medicine dried up. They paid exorbitant prices on the black market for quinine or sought relief from homegrown substitutes recommended by Richmond. Their enemies, on the other hand, were awash in the antimalarial drug by the end of the war. Federal troops swallowed more than a million ounces of quinine sulfate and other cinchona derivatives while operating in mosquito-infested regions such as the Mississippi Delta and Tidewater Virginia. Two large pharmaceutical companies headquartered in Philadelphia, Rosengarten and Sons and Powers and Weightman, were able to corner the market in quinine by keeping a steady stream of it flowing into Washington. Unable to build comparable factories, Confederates were forced to rely on a quinine smuggling network which employed both men and women as traffickers. Blockade-runners eased the shortage somewhat by auctioning off crates of the medicine smuggled in from Europe via the West Indies. But in the end these methods could not keep the South supplied with adequate amounts of quinine. The resulting increase in the number of malarial cases, coupled with terrifying yellow fever outbreaks, helped make life inside the short-lived Confederacy a miserable ordeal for most southerners.18
EPILOGUE
FOR THE MAJORITY of those who lived through the Civil War, recollections of great battles such as Antietam, Gettysburg, and Shiloh overshadowed less pleasant memories of jaundiced and feverish young soldiers writhing in agony upon their hospital beds. Disease, like slavery, seemed oddly out of place in a narrative that was supposed to heal the nation’s wounds by highlighting the brave deeds of its northern and southern heroes. In reality troops on both sides endured febrile sweats, shakes, and searing abdominal pain at least as often as they saw combat. The American Civil War, like every war that preceded it and others that would follow, was a pestilential nightmare.
Mosquitoes were a major reason why. The insects compromised soldiers’ immune systems and did more to weaken northern forces sent into marginal theaters such as North Carolina and Arkansas than Rebel armies. At the same time, they established yellow fever zones along the South’s shorelines which cowed commanders on both sides. Fortunately for the Union, northern leaders such as Ulysses S. Grant and Benjamin Butler refused to be intimidated by the South’s miasmatic environment (or Rebel armies, for that matter) and embraced the best science of the day in order to minimize disease-related casualties. Their success must have surprised Confederate military planners such as Robert E. Lee and Jefferson Davis, who thought Dixie’s unhealthiest areas were safe from attack during the sickly season.1
Mosquitoes also tormented a southern public that had never prepared itself for a long war of attrition. For most Confederate civilians life’s essentials—food, clothing, and medicine—took precedence over lofty political principles and “stay-the-course” speeches delivered late in the war by unrepentant fire-eaters. Richmond’s inability to provide quinine, the miracle drug of the mid-nineteenth century, gave southerners one more reason to doubt their leaders and the wisdom of secession.
Regrettably, the defeat of the Confederacy and the disbanding of the armies that had fought so savagely on battlefields across the South did not put an end to the suffering caused by malaria and yellow fever. In fact, for many Americans these diseases became bigger problems during Reconstruction than they had been over the course of the war. The removal of the naval blockade and the resumption of regular maritime trading through southern port cities produced a spate of yellow fever epidemics that claimed the lives of thousands of people. New Orleans, for example, which had experienced only a handful of “yellow jack” fatalities during the Union occupation, once again became an epicenter of disease and death. With ships arriving daily from the West Indies and a return to less stringent sanitation and quarantine policies, conditions were ripe for yellow fever, which in 1867 alone killed more than 3,000 of the city’s residents.
Other southern towns faced similar horrors after the war. Galveston, Texas, lost 1,150 people to yellow fever the same year the disease struck New Orleans; an epidemic in Memphis, Tennessee, in 1873 sent close to 2,000 people to their graves; another thousand perished three years later in Savannah, Georgia. But the biggest epidemiological catastrophe of the period occurred in 1878 when yellow fever swept through the Mississippi River Valley like a scythe, harvesting between 16,000 and 20,000 souls. Congress responded by creating a National Board of Health the following year, but it could do little to control a disease that baffled even the best medical minds of the era. Consequently, southerners faced the grim prospect of additional outbreaks for another two decades, until army surgeon Walter Reed’s experiments in Cuba confirmed that Aedes aegypti mosquitoes transmitted the yellow fever virus. In what was arguably a fitting denouement the South’s last epidemic occurred in 1905 in New Orleans, which had witnessed more yellow fever deaths than any other city in the country.2
Malaria was also a major health issue after the war. Infected Union soldiers returning home from the battlefields of the South reintroduced the disease into northern communities, such as the Connecticut River Valley, which had not dealt with it in decades. Between 1870 and 1890 the number of new infections in New England exploded. Immigrants contributed to this epidemic by bringing new strains of malaria to the Northeast from southern and eastern Europe.3
Across the South poverty, ignorance, and the environmental and infrastructural damage wrought by the war allowed the region’s plasmodium parasites to flourish well into the twentieth century. Authorities in every southern state reported dramatic increases in the frequency and intensity of outbreaks in the years immediately following Appomattox. The disease continued to plague the region until the federal government implemented a massive mosquito control program during World War II, which included the widespread use of the insecticide DDT.4
This program’s success in controlling the mosquito population made it easy for subsequent generations of Americans to forget about the threat these insects had once posed to the health of their communities. Yellow fever and malaria became ailments associated with “developing countries” (a label that describes the antebellum South as accurately as it does any burgeoning democracy in modern-day Asia, Africa, or South America). Popular histories of the war perpetuated the public’s amnesia by failing to include detailed discussions of soldiers’ diseases. A handful of scholars and curious physicians tried to pick up the slack, but their publications gained little tract
ion outside of classrooms and academic conferences.
And yet the diseases that were still medical mysteries in the nineteenth century were inextricably linked to the successes and failures of the armies that fought the war. Epidemiological history may never receive the same popular acclaim given to biographies and crisp military narratives, but it demands the attention of those who are dedicated to understanding the messy realities of life in previous centuries. L. P. Hartley’s keen observation that “the past is a foreign country” is true from a microbiological standpoint as well as a cultural or political one.
Disease studies such as this one help us separate historical fact from the myths created by poets and filmmakers, whose success often hinges on their ability to make us nostalgic for simpler times dominated by larger-than-life heroes. Gruesome deaths caused by nasty viruses or bacterial infections are almost always missing from their Iliadic accounts of the war. Director John Huston’s big-screen adaptation of the classic novel The Red Badge of Courage, for example, shows actor Audie Murphy (Henry Fleming) enduring all of the horrors of war except for disease. Ironically, Murphy had contracted malaria during World War II when he was a real-life American soldier fighting in Italy. Another, more recent Civil War movie that has enjoyed greater commercial success, Glory portrays black members of the Fifty-fourth Massachusetts Infantry battling racism and Rebels but not rheumatism; in reality northern surgeons diagnosed twenty-five thousand cases of that ailment among actual Afro-Yankee regiments. These are just two examples of how art can sometimes distort our view of the past even as it inspires and entertains us. From Hollywood’s perspective, of course, epidemic disease is one of those inconvenient (and therefore expendable) facts of history which has the potential to spoil a good story.5
Military historians, however, ignore disease at their peril. For in truth a sick soldier is just as useless to his commander as one who has been wounded or killed by enemy fire. By tearing down the barriers that separate medical science from military studies, scholars strengthen their chances of finding new ways of explaining why certain battles and campaigns turned out the way they did. This is especially important for Civil War historians, who toil in a field of inquiry that has been plowed over many times by both professional antiquarians and members of the general public. Epidemiological history offers a seemingly limitless supply of new research possibilities. This work has focused on how mosquitoborne illness made a difference in some of the war’s biggest campaigns, but the full extent to which other maladies affected these events remains a mystery. Diarrhea and dysentery, for example, the two most frequently diagnosed “diseases” of the war (symptoms really), sickened hundreds of thousands of soldiers on both sides, leaving historians to ponder what might have happened if even half of these men had stayed healthy. The connection between epidemiology and the military history of the conflict then deserves the same level of serious academic inquiry normally reserved for more conventional topics, such as the tactical decisions made by commanders.
By unwittingly serving as soldiers, mosquitoes have done more to shape our history than most people realize. When Napoléon Bonaparte attempted to quell a slave revolt on St. Domingue and reestablish a French colonial presence in North America, Aedes aegypti mosquitoes sickened thousands of his unacclimated European soldiers, ensuring the survival of the first black republic in the Western Hemisphere and prompting the Corsican emperor to sell Louisiana to the United States. Later in the same century anopheles mosquitoes helped Seminole Indians resist the federal government long after other tribes in the East had accepted Washington’s authority. Troops sent into Florida’s swamps to subdue the recalcitrant Native American nation were decimated by malarial fevers. During the Spanish-American War far more American soldiers were prostrated by Cuba’s mosquitoes than were wounded in combat. The scientific discoveries that emerged from this conflict as a result of the army’s yellow fever experiments were applied during the building of the Panama Canal, allowing American construction teams to avoid the mosquitoborne illnesses that had caused major setbacks for their French predecessors. During World War II malaria-carrying mosquitoes sickened U.S. soldiers serving in the Philippines and other regions. In the jungles of Vietnam American GIs encountered drug-resistant strains of the disease, sparking the rapid development of new medicines at the Walter Reed Army Institute of Research in Washington, D.C. More recently, American troops serving with the International Security Assistance Force in Afghanistan have been battling plasmodial infections as well as Taliban guerrillas.
None of this would have surprised Aldo Leopold. In his landmark study A Sand County Almanac the twentieth-century environmentalist argued that history cannot be interpreted solely in terms of human agency because humanity is in a symbiotic relationship with the environment. The mosquito’s role in the events of the Civil War proves that he was right.6
APPENDIX 1
INCIDENCE OF MOSQUITOBORNE DISEASE, 1861–1865
Note: The maps of malarial incidence among Union troops are based on data from Joseph Janvier Woodward, The Medical and Surgical History of the War of the Rebellion. Part II. Volume I. Medical History (Washington, D.C.: Government Printing Office, 1870). The map of yellow fever outbreaks is based on data from various primary and secondary sources.
APPENDIX 2
COMMON DIAGNOSES AMONG UNION TROOPS, 1861–1866
APPENDIX 3
CIVIL WAR CHRONOLOGY
1861
April 12—Confederates shell Fort Sumter (S.C.)
April 19—Sixth Massachusetts Volunteer Infantry attacked by pro-secessionist mob in Baltimore, Md.
July 21—Battle of First Manassas (Va.)
August 6—Congress approves First Confiscation Act
August 10—Battle of Wilson’s Creek (Mo.)
August 28—U.S. forces capture Fort Hatteras on the Outer Banks (N.C.)
September 6—U.S. forces capture Paducah (Ky.)
September 11–16—Cheat Mountain Campaign (present-day W.Va.)
September 12–20—Siege of Lexington (Mo.)
October 21—Battle of Ball’s Bluff (Va.)
November 7—Battle of Port Royal Sound (S.C.) gives Federals control over Hilton Head and Beaufort; Battle of Belmont (Mo.)
1862
February 6—Grant captures Fort Henry (Tenn.)
February 8—Battle of Roanoke Island (N.C.)
February 16—Grant captures Fort Donelson (Tenn.)
February 25—U.S. forces occupy Nashville (Tenn.)
March 6–8—Battle of Pea Ridge (Ark.)
March 14—U.S. forces capture New Berne (N.C.) and New Madrid (Mo.)
April 5—Siege of Yorktown begins (Va.)
April 6–7—Battle of Shiloh (Tenn.); John Pope captures Island No. 10 (Mississippi River) on April 7
April 11—U.S. forces capture Fort Pulaski on the Savannah River (Ga.) and occupy Huntsville (Ala.)
April 25—U.S. forces capture New Orleans (La.) and Fort Macon (near Beaufort, N.C.)
May 5—Battle of Williamsburg (Va.)
May 8—Battle of McDowell (Va.)
May 25—Battle of Winchester (Va.)
May 30—Confederates evacuate Corinth (Miss.)
May 31–June 1—Battle of Seven Pines (Va.)
June 6—Battle of Memphis (Tenn.)
June 8—Battle of Cross Keys (Va.)
June 9—Battle of Port Republic (Va.)
June 16—Battle of Secessionville (S.C.)
June 25—Seven Days Campaign begins (part of McClellan’s Peninsular Campaign) (Va.)
June 26—Battle of Mechanicsville (Va.) (Seven Days battles / Peninsular Campaign)
June 27—Battle of Gaines’s Mill (Seven Days battles / Peninsular Campaign)
June 29—Battle of Savage Station (Va.) (Seven Days battles / Peninsular Campaign)
June 30—Battle of White Oak Swamp (Seven Days battles / Peninsular Campaign)
July 1—Battle of Malvern Hill (Seven Days battles / Peninsular Campaign)
> July 17—Lincoln approves Second Confiscation Act
July 22—Lincoln announces his plan for emancipation to his cabinet
August 3—Halleck orders McClellan to withdraw from the Peninsula (Va.)
August 5—Battle of Baton Rouge (La.)
August 9—Battle of Cedar Mountain (Va.)
August 29–30—Battle of Second Manassas (Va.)
September 14—Battle of South Mountain (Md.)
September 15—Jackson captures Harper’s Ferry (present-day W.Va.)
September 17—Battle of Antietam (Md.)
September 19—Battle of Iuka (Miss.)
September 22—Lincoln announces his plan for emancipation to the public
October 3–4—Battle of Corinth (Miss.)
October 8—Battle of Perryville (Ky.)
December 7—Battle of Prairie Grove (Ark.)
December 13—Battle of Fredericksburg (Va.)
December 20—Van Dorn captures Grant’s supplies at Holly Springs (Miss.
December 29—Battle of Chickasaw Bayou (Miss.)
December 31–January 2, 1863—Battle of Stone’s River (Tenn.)
1863
January 1—Emancipation Proclamation goes into effect
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