American Civil War Medicine – Part 5 – The Scourge of “Yellow Jack”

Medicines of The American Civil War. Exhibition by So.Sk.An.

‘The Federal army may soon have to contend with a more deadly foe than the Southerners.  The yellow fever season is fast approaching, and, if the Vomito stalk through its ranks, he will slay more than the sword has done; and it is possible that the Confederacy have calculated on the reinforcement.’

(New York State, 14th July 1862)

The yellow fever is raging with unabating fury at Wilmington, N.C.  Letters from the  scourged city are many, calling for help from abroad.  Its rapid spread and malignity arises from utter ignorance of the physicians and others in their treatment of the disease.’

(The Sheffield & Rotherham Independent, 18th October 1862)

I recently came across the above in contemporary British and American newspapers.  There are many other examples of media reports on the devastation caused by the scourge of yellow fever or “Yellow Jack” as it was referred to in everyday parlance.  The disease was a particular problem in the South, killing over 10,000 people and, like malaria, epidemics occurred mainly during the summer and autumn months.  Outbreaks were reported in Charleston, Galveston, Mobile, New Orleans, Norfolk, Savannah and many more cities besides.  Wilmington’s epidemic, which killed 15% of its population, was traced to the arrival of the blockade runner Kate.   If you did manage to survive yellow fever, which was rare as mortality rates were over 50%, then you would acquire lifelong immunity.  

Yellow fever is transmitted from person-to-person by the Aedes aegypti mosquito.  This type of mosquito lived in the Southern States and laid its eggs in hollow logs and other receptacles that contained fresh water.  Horse troughs, clogged gutters and rubbish lining the streets, that had been filled with rainwater, were popular incubators for the Aedes aegypti’s eggs.  During the winter, the heavy frosts helped to curb the mosquito population.   The mid 19th century American physician was ignorant to the causes of this disease.  It was the popular held belief that yellow fever was a mysterious filth that lived in certain types of clothing and travelled aboard ships.  

Drugs and therapies for its treatment were based upon antebellum practices of inducing vomiting, sweating and purging of the bowels or bladder to release toxins from the body.  Once the toxins had been expelled, then the diseased body could be brought back into balance.  The most popular medication administered by the Army Surgeon was calomel, containing a mix of alcohol, opium, honey, chalk and mercury.   A typical treatment regime for a Civil War soldier suffering from yellow fever would have been:

  • mix of spirits of ether and whiskey;
  • calomel and 15 grains of rhubarb;
  • acid drinks;
  • liquid potasse citrate;
  • 1 ounce of castor oil;
  • 30 drops of laudanum;
  • 6 drops of oil of turpentine.

In the advanced stages of the disease you bleed from the nose and mouth, suffer crippling headaches, fever, jaundice and vomit a substance that resembles coffee grounds.  This blackened, grainy substance is in fact half-digested blood, caused by internal hemorrhaging.  Army Surgeons in the Civil War were accused of prescribing calomel too readily to their patients.   In the Spring of 1863 an ambitious young Surgeon General, Dr William A. Hammond (1828-1900), ruffled more than a few feathers amongst his colleagues.   Hammond believed calomel was indeed being overused and he decided to do something about it.  He issued the infamous, Circular No. 6, insisting that the medication be removed from all the Union Army Surgeons’ supply tables.  Hammond believed that its overuse was the cause of a range of nasty side effects amongst the soldiers.  Examples of the side effects that Hammond cited include:  melancholy, hypersalivation and gangrene of the mouth.  His colleagues were angry at this dictate and at what they thought to be interference in matters that were not of his concern.  The situation escalated resulting in Hammond’s eventual court-martial.  It wasn’t until 1878 that he was finally exonerated of the charges brought against him.

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