There is a saying that dates back
to approximately the Civil War era: that a night with Venus leads to a lifetime
with Mercury. This was a pithy warning
for a serious set of infections. At that
time, germ theory had yet to be fully developed, sexually transmitted
infections (STIs) were not yet well understood (gonorrhea and syphilis were
believed to be manifestations of the same illness), and there no effective cures
available. This was the background that
the Civil War surgeons had to work against while treating soldiers for
STIs.
Although more soldiers were wounded
and infected with other disease, there were a high number of cases of
STIs. Unfortunately, no records exist
for the number of Confederate soldiers that were infected with STIs during the
war. For white Union soldiers, 73,382 were diagnosed with syphilis, usually based on the presence of a chancre. 109,397 soldiers were diagnosed with gonorrhea
based on presence of pus coming from their urethras. Gonorrhea diagnoses probably included cases
of chlamydia and other STIs that were not yet known to be separate
infections. The diagnosed cases averaged
out over the war to be approximately 82 cases/1000 men/year. The highest rates
of STI infection were at the beginning and the end of the war.
Comparable to white soldiers, there
were 6,207 syphilis cases and 8,050 gonorrhea cases in black Union soldiers
that averaged 78 cases/1000 men/year.
There were 426 hospitalizations of white soldiers, and 136 deaths (32
fatalities reported for black soldiers).
Depending on location, age, and army, STI infection rates could be much
higher-the Department of the Pacific at one point reported rates of 461
cases/1000 men/year. Soldiers who were
not actively fighting, young, and stationed near cities were the must likely to
become infected and the soldiers of the Department of the Pacific often matched
those descriptors.
Most men contracted STIs from
contact with prostitutes also known at the time as “public women”, and surgeons
of the day knew this, although some may have also been infected during small
pox vaccinations by sharing blood of an infected individual. As STIs were a widespread problem in the
Union army, many commanders looked for various ways to stem the issue as STIs
were bad for morale, and were considered detrimental to their army’s
performance. Famously, Union General
Joseph Hooker forced all of the prostitutes in Washington, D.C. to be relocated
into a single area that was then nicknamed “Hooker’s Division.” Although this may have cleaned up the city,
it is unlikely that this was an effective measure to curb soldier’s visiting
the prostitutes’. In an interesting set
of cases, unparalleled in American history, in Nashville, prostitution became
so widespread in the city that while under Union army control in 1863, Provost
Marshall Lt. Colonel Spalding was given orders to take his men and the local
police around the city to capture all the prostitutes, put them on the merchant
ship Idahoe, and exile them. After the ship visited Louisville, Covington,
and Newport KY as well as Cincinnati, OH without being able to successfully
drop off the prostitutes, the boat was forced to return to Nashville.
Upon their return, Provost Marshall
Spalding designed a system of legalized prostitution, with the aim to reduce
new STI cases. First, all prostitutes
were required to have a license to practice.
Second, each week, a prostitute had to have an appointment with a physician
to be given a certificate of health. If
a woman was found to have contracted an STI during that examination, she was
sent to a special hospital (or ward) for treatment until she was declared
healthy. Finally, each week, each
prostitute would pay 50¢ towards the hospital for its support. This system was
deemed so successful at reducing troops contracting new cases of STIs in
Nashville, that Memphis also adopted it.
Although these treatments, as
discussed above, were not cures, it appears that by quarantining these women when
they were likely the most contagious, such as when the syphilis chancre is
present during the early stages, was at least somewhat effective in reducing
new infections. This solution accepted
that human behavior would continue, while reigning in some of the unwanted
effects to improve soldier’s performance in the battlefield.
Today, soldiers deployed to
Afghanistan and Iraq face much lower rates of STI infections, although there
does seem to be an upward trend in cases.
Between 2004-2009 case rates of gonorrhea ranged from 5/100,000 to
17.6/100,000 (not separated by gender or race) and chlamydia rates for men were
approximately steady at 192.6/100,000 (although it did increase over
time). Rates for syphilis diagnosis were
not available. The current rates are
much lower, presumably because of the ability to cure STIs using antibiotics
rather than Civil War-era treatments such as mercury, sarsaparilla, and diet
alterations as well as more widespread use of condoms than in the civil war
era. However, both the rates during the
Civil War and the current wars in Iraq and Afghanistan are probably lower than
reality, as STIs are commonly not reported by individuals either due to
embarrassment or not being aware of their infection status. Treatments and
rates of STIs have improved since the Civil War; however, most likely now just
as back then, STI rates are under-represented due to unknown cases.
Finally, what cannot be quantified,
is the lasting impact of these STIs. The
soldiers themselves would have continued to suffer from both diseases, with
severe morbidity. Gonorrhea in some
cases can continue to cause pain while urinating. Persistent syphilis can go on
to its tertiary stages (neurosyphilis/cardiovascular syphilis), which attacks the central nervous system or heart and can be fatal. Some historians
estimate that up to one third of the men in veteran’s homes and hospitals that
were caring for the soldiers from the Civil War were suffering from STIs at the
end of their lives. Undoubtedly, men
went home and infected their wives, who then could also suffer from both
neurosyphilis, but also pelvic inflammatory disease (PID) caused by gonorrhea. Although this was unknown at the time, we now
know that PID could have lead to problems with fertility, salpingitis, and
tubal pregnancies. Women could have also
passed on the diseases to children in childbirth. In children, gonorrhea can cause blindness
and syphilis is linked to stunted growth.
Unfortunately, despite good treatments and screening programs, many
individuals still do not know today whether or not they are infected with an
STI, and many of the same results can occur. Although the pathology, knowledge,
and treatments of STIs have significantly improved since the Civil War, culture
today still suffers many of the same problems from untested STIs.
Additional sources reviewed:
http://suite101.com/article/prostitution-and-venereal-disease-in-the-civil-war-a228450
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