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Humphrey - 30 The Mist Rises Malaria in the Nineteenth...

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Unformatted text preview: 30 The Mist Rises: Malaria in the Nineteenth Century Chapter 2 As the nineteenth century opened, malignant mists were thought to cause malarial fevers; one hundred years later a complex chain of parasite and mosquito explained the disease. Over the course of the century, malaria afflicted the American frontier, helping produce the roughness and hard- ship that defined frontier life in contrast to more eastern civilization. Dur- ing at least some decades of the nineteenth century, malaria affected all regions significantly and severely damaged the health of troops in the Civil War. Toward the end of the century, however, the disease retreated, so that by 1900 it was largely a disease of the southern states. What had been a dis- ease of all parts of the United States became in the twentieth century one more indicator of the poverty, backwardness, and unhealthiness of the South. Malaria on the Frontier While malaria declined in the northeastern states, it grew briskly along the westward-moving line of the frontier. When the lands across the Appa- lachians became available for settlement, Euro-Americans flowed through gaps and down rivers that took them into Ohio, Indiana, Illinois, Ken- tucky, Tennessee, and states farther south. As families traveled for days by flatboat and set up flimsy camps near the water, their transportation connection to goods and markets, malaria blossomed. During the antebel- lum period the wave of malaria subsided in these initial encampments as sturdier houses were built farther off the water, while at the same time it moved on to even newer camps farther west and north. Malaria, most of it vivax, became a common feature of raw frontier life, defining in part what it meant to be in the woods, beyond civilization, beyond the safe life of “back home?“ Malaria had traditionally been viewed, at least in the more temperate climates of Europe, as a country disease. David Ramsay, a South Carolina physician writing in the late eighteenth century, typically noted that inter- mittent fevers first appeared after an area had been cleared to make way for settlements and farms. So there was an initial stage without disease, followed by chronic ill health from marsh fevers. But as Cities such as Charleston grew, the land became progressively better drained and the lo- cation healthier. “It has long been observed in the low countries,” Ramsay wrote, “that they who reside in towns, are more healthy than they who live dispersed in the country.”2 Given its association with swamps, malaria de- clined where people built clusters of houses. It was general knowledge that low, wet lands made bad sites for dwellings or towns; such areas were prone to both flooding and disease. So towns tended to be built on the higher elevations in a region, where the topography encouraged drainage. This tendency was countered by the need for populations to cluster near modes of transportation, and before the advent of railroads in the 18403, that meant near bodies of water. Some cities, such as Charleston, were fa- vored by sandy soil that drained easily and by surrounding salt marshes that were inhospitable to disease-carrying anophelines. Other cities, just by dint of construction, paving, and drainage, broke the malaria chain by denying anophelines the requisite swampy expanse within a mile of hu- man populations. Hence even in the relatively rural American South and early frontier, as towns became established, malaria withdrew to the coun- tryside. This was evident to medical observers in the South, who sometimes contrasted the preferences of malaria and yellow fever for different stages of settlement. Mobile physicianjosiah Clark Nott commented in 1847, for example: “When the forest is first leveled and a town commenced, inter- mittents and remittents spring up.” So malaria was tied to breaking new ground on the frontier. Yellow fever, however, came later: “As the popula- tion increases, the town spreads, and draining and paving are introduced,” he continued, “yellow fever, the mighty monarch of the South, who scoms the rude field and forest, plants his sceptre in the centre, and drives all other fevers to the outskirts.” This would become a recurring theme throughout malaria’s course in the United States. It was associated with rough, frontier conditions, not with the increasing civilization of towns and cities. Perhaps the best description of this phenomenon comes to us from the pen of Charles Dickens, who traveled the Ohio and Mississippi Rivers in the spring of 1842 and painted a memorable scene of the raw, primitive frontier lifestyle made bleak and helpless by disease. Dickens’s account was inspired by his visit to Cairo, Illinois, situated at the junction of the two rivers. “[W]e arrived at a spot so much more desolate than any we had yet beheld,” he began in American Notes. There, “on ground so flat and low and marshy, that at certain seasons of the year, it is inundated to the house-tops, lies a breeding-place of fever, ague, and death.” It was a “dis— mal swamp . . . teeming . . . with rank unwholesome vegetation, in whose baleful shade the wretched wanderers who are tempted hither, droop, and Malaria in the Nineteenth Century 31 32 die, and lay their bones.” Cairo was, in his summary, “a place without one single quality, in earth or air or water, to commend it?” Dickens incorporated this vision into his novel about the adventures of Martin Chuzzlewit.” Here the benighted countryside serves as a metaphor for a particularly American hell. Chuzzlewit has traveled to the United States to seek his fortune, accompanied by his always cheerful servant, Mark Tapley. After meeting assorted ridiculous Americans, prone to brag- gadocio and bombast, the two men are conned into buying land in the thriving community of Eden, vaguely located somewhere downriver from the community wherein they are lodging. It is touted as “an awful lovely place, sure-1y. And frightful wholesome, likewise!” (p. 348). They hear some unsettling comments, though. One man, after carrying on about the danger of snakes on the frontier, denies that mosquitoes are a significant problem, saying that “there air some catawampous chawers in the small way, too, as graze upon a human being pretty strong; but don’t mind them— they’re company” (p. Another tells Tapley, just as he is running to catch the boat, that “nobody as goes to Eden ever comes back a-live!” (p- 371)- Chuzzlevvit and Tapley find in Eden a “dismal swamp,” full of “nox- ious vapour” and “pestilential air.” Upon their arrival at the primitive river landing, a man approaches them. “As he drew nearer, they observed that he was pale and worn, and that his anxious eyes were deeply sunken in his head.” The man explains that “I’ve had the fever very bad, . . . I haven’t stood upright these many weeks.” When Chuzzlewit and Tapley inquire whether anyone could help them with their baggage, the man replies that his eldest son would help if he could, “but today he has the chill upon him, and is lying wrapped up in the blankets.” As to the rest of his family, well, “[m]y youngest died last week.” He has buried most of his family and friends, except those who have fled. “Them that we have here, don’t come out at night.” Tapley inquires of him, “The night air an’t quite wholesome, I suppose.” The settler answers, “It’s deadly poison” (pp. 375—76). Tapley, as usual, endeavors to put a positive spin on the situation. He sets up their cabin as comfortably as possible, then walks down to the riverfront to draw water. Around him, “ [a] fetid vapor; hot and sickening as the breath of an oven, rose up from the earth, and hung on everything around; and as his foot-prints sunk into the marshy ground, a black ooze started forth to blot them out” (p. 378). As Tapley makes the acquaintance of the neighborhood, he finds that all are sickly, and many have lost family members and friends. There is “an air of great despondency and little hope on everything” (p. 515). In his cheerful way, Tapley passes it off as seasoning, for “we must all be seasoned, one way or the other. That’s reli— gion, that is, you know” (p. 380). Chuzzlewit quickly falls ill. “He shook and shivered horribly; not as Malaria people do from cold, but in a frightful kind of spasm or convulsion, that racked his whole body.” Tapley goes to a neighbor for help, who “pro- nounced his disease an aggravated kind of fever, accompanied with ague; which was very commori iri those parts, and which he predicted would be worse to-morrow, and for many more to-morrows.” Opening a trunk in his own sparse cabin, the friend brings forth a medicine that has been of some help in his own fever bouts (p. 517). After several weeks Chuzzlewit recov- ers, but Tapley falls ill. In the structure of the novel, this seasoning time makes Chuzzlewit a less selfish young man and serves as a turning point for his fortunes. The two escape from the mires of Illinois and make it, happily, back to the civilized land of England. There is little subtlety in Dickens’s narrative. He damns a whole coun- try, occupied in the East by fools, in the South by evil slaveholders, and in the West by people enfeebled by the very environment that he hears so often praised. Dickens went no farther south than Richmond, so he had no direct experience of the climate there. Frederick Law Olmsted of New York did, however, and his descriptions of the desolation frequently found throughout the southern states in the 18508 echo Dickens’s image of Illi- nois. The people are boastful, lazy, and ignorant; the forms of travel are hideously uncomfortable; the food is awful. Olmsted’s sojourn followed Dickens’s by ten years, and the former had clearly perused the latter’s work, for Tapley is mentioned in his narrative. What is striking, though, in comparing the two accounts, is how similar the South and the West some- times sound—even the southern part of the East Coast, in Virginia and North Carolina. The lack of civilization as defined by both authors, the presence of squalid living conditions, and the apathetic enervation draw the two regions together. And malaria is a defining feature of both.6 Mark Twain likewise remembered a boyhood on the Mississippi River with malaria a common visitor. He wrote fondly of a swimming hole where he spent many hours cavorting, but qualified his own version of Eden: “Bear Creek . . . was a famous breeder of chills and fever in its day. I re- member one summer when everybody in town had this disease at once. Many chimneys were shaken down, and all the houses were so racked that the town had to be rebuilt.” With the hyperbole that typified his later writ- ings, Twain went on to claim that the shaking was so bad that the land- scape was altered: “The chasm or gorge between Lover’s Leap and the hill west of it is supposed by scientists to have been caused by glacial action. This is a mistake.”7 Less famous observers of the North American frontier repeatedly echoed these descriptions of widespread, debilitating malaria that dark- ened the frontier experience. One mid-nineteenth-century jingle about Michigan advertised its charms: “Don’t go to Michigan, that land of ills; The word means ague, fever and chills.” Nearby Ontario was similarly Malaria in the Nineteenth Century 33 34 plagued, from the late eighteenth century into the 18703. Malaria thrived near the rivers and lakes that formed the region’s crucial transportation routes.9 All along the Mississippi and Missouri valleys, as well as up and down the West Coast, malaria was reported as arriving shortly after the first pioneers built houses and began to clear land for farming.10 It was, as Tapley said, evidently a necessary part of the seasoning, part of the transi- tion from wild to civilized. How accurate were these portrayals of the nineteenth-century frontier? Dickens’s observations were based on a brief trip, but a physician without any inherent antipathy to the country, after a thorough investigation, ar- rived at similar conclusions for the majority of the North American inte- rior. Daniel Drake, the preeminent physician and medical educator of ante- bellum Ohio, studied the diseases of the area between the Appalachians and the Rocky Mountains in depth and published his findings in 1850.11 Drake gave prominent place to what he termed autumnal fever, a com- plaint known variously as “bilious, intermittent, remittent, congestive, mi- asmatic, malarial, marsh, malignant, chill-fever, ague, fever and ague, dumb ague, and lastly the Fever.”" From his descriptions it is clear that these terms encompassed vivax malaria, falciparum malaria, and probably ty- phoid and a host of other fevers as well. The mapping of the modern diag- nostic term malaria onto Drake’s label of autumnal fever remains inexact, but certainly there was significant overlap. Most probably falcipamm ma- laria was part of this “autumnal fever” complex, as it generally occurred in the fall; vivax would have been less prominently associated with the fall months but could also occur then as well. . Drake, like Dickens, saw in the swampy lowlands near the region’s great rivers the primary breeding grounds of autumnal fever. He blamed the frequent inundations caused by seasonal flooding for much of this problem, as well as the presence of multiple natural and artificial lakes and ponds. Drake’s book had a long section exploring the causes of his autum- nal fever, and he discussed the idea that bad air, or malaria, arising from putrefying animal or vegetable matter, as distinguished from airborne ani- malcules, spread the disease. Drake clearly defined malaria as a cause of autumnal fever, not as a synonym for it; it was “the poison that produces autumnal fever,” acting in conjunction with heat and moisture. ‘3 Not until much later in the century did the term for the cause of this fever became the name of the disease itself. Drake found his autumnal fever to be widely distributed in the Old Northwest, as well as in the more tropical regions of the South. In the more northern areas, the fever was much more likely to be a benign or simple intermittent, while farther south the mortality was higher, since the more malignant versions prevailed. Drake did not acc'ord specificity to the vari- ous forms of autumnal fever; rather he saw them merging and transform- Malaria ing according to complex local conditions. Still, his account does support the likelihood that falcipamm malaria was rare in the Ohio and upper Mississippi valleys, while vivax was common. His description of 3 to 5 percent mortality from the benign autumnal fever accords with twentieth— century observations of vivax malaria. It is here that Dickens was most off the mark, for he exaggerated the southern Illinois settlement’s mortality rate. Drake recorded other facets of frontier history that agree with modern knowledge of malaria. First, mosquitoes existed in large numbers on the frontier. One early French explorer of the lower Mississippi recorded in his journal that the “musketoes” made rest impossible and life miserable. “One is perfectly eaten and devoured. They get into the mouth, the nos- trils, and the ears; the face, the hands, the body are all covered.”14 This plague of insects extended far north, into the icy Canadian wilderness. Dickens had a similar experience: on one occasion while meeting a digni- tary in St. Louis, he commented that the fellow did not seem too im- pressed to meet the great writer, perhaps because of his casual clothing, “and my face and nose profusely ornamented with the stings of mosqui- toes and bites of bugs?” Hence the mosquitoes were there, presumably including anopheles species, although observers made no such fine dis- tinction. But the generation of “autumnal fevers” required more than mosqui- toes and people; the plasmodium had to be present as well. One would expect that initially the river settlements would be healthy, and that only over time would malaria appear. This is in fact what Drake described. The experience of a group settling near Peoria, Illinois, was typical. At first, “a number of families had settled (as is common) on the margin of a large prairie, and remained healthy in autumn.” Then more people came and increased the amount of plowing around their cabins. By the second fall they “suffered severely in autumn from fever.”“s Another frontiersman liv- ing near Springfield told Drake that he had “resided where [Drake] found him three years, before a member of his family was seized with that fever.” Drake was puzzled: “Such instances are not uncommon, though difficult to explain.”17 While contemporary opinion held that perhaps this resulted from turning up the soil and exposing poisonous sources of vapor, it is clear in retrospect that time was needed for the critical conjunction of peo- ple, parasites, and mosquitoes to converge on a given spot. Drake’s observations were echoed in the writings of frontier explorers and settlers. Historian Erwin Ackerknecht, whose study on malaria in the Old Northwest deserves its place as a classic in American medical histori- ography, provides abundant evidence of malaria and mosquitoes in the writings of settlers in such unlikely sites as Wisconsin, Minnesota, and Iowa.18 More recently, Conevery Bolton has described the pervasive effect Malaria in the Nineteenth Century 35 of malaria on life in Arkansas and Missouri in the first half of the nineteenth century.19 Again and again lands that initially seemed wholesome became laden with periodic fevers, exhausting human capital. Malaria was added to the many dangers of the frontier—Indians, starvation, lawlessness, and rattlesnakes—to build an image of wildness and peril. But as civilization moved in, with its tighter houses, better-drained towns and fields, abun- dant food, and access to quinine, malaria receded. Everywhere, that is, except in the South, which in many ways retained a primitive, frontierlike culture well into the twentieth century. Still, on the eve of the Civil War, physicians in Indiana, Ohio, and Illi- nois were just as familiar with the ravages of malarial fevers as were their colleagues in the southern and southwestern states. All were aware that quinine sulfate, first manufactured in the 1820s, was efficacious in cases of intermittent and remittent fever, although they continued to employ other remedies to “ready the system” for quinine, such as bloodletting, emetics, and purgatives.” In fact, southern physicians continued to administer the latter two treatments for malaria into the 1940s. So quinine was not seen as a specific for intermittent fevers——it was used for other fevers and as one of several remedies for intermittants—but we can at least say in retrospect that Civil War physicians had one tool in their armamentarium that did actively alleviate their patients’ suffering. The medicine that Tapley’s Eden friend pulled out of his trunk was probably quinine, in the form of a patent remedy called Sappington’s Anti-Fever Pills. john Sappington was a rural Missouri physician who had heard about the isolation of quinine from cinchona bark early in the 18205. He rode off to Philadelphia, acquired a large supply, brought it back to Missouri, and began manufacturing a legendary product that may well have facilitated the growth of the American Midwest. Sappington’s pills contained a of quinine, and he recommended 5 grains a day as a preventive and 8 to 16 grains a day for treatment. Over the next thirty years, Sappington sold nearly six million boxes containing twenty-four pills apiece. So quinine, in this and other forms, was widely available and familiar to patients and doctors alike on the eve of the Civil War.21 Other patent remedies followed quickly on Sappington’s heels, both incorporat- ing quinine and offering alternatives to it. Quinine is unpleasant to take, given its bitter taste and unpleasant side effects of tinnitus and nausea. Drugs such as Therrnaline (“A carefully prepa...
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