A few days ago I was thinking of the coincidence that the American Civil War had a widely reported military death toll of 620,000 and that is about the same as the death toll from Covid-19 in this country since the pandemic began.

Then magically an article appeared in Time magazine by Rachel Lance, PhD, that summarizes the situation better than I could. I draw pertinent information from her article. (Incidentally, Rachel has written a fascinating book on the Hunley story called, “In the Waves: My Quest to Solve the Mystery of a Civil War Submarine.” I would hope Clive Cussler, who discovered the final resting place of the Hunley, approves. I certainly do. It’s a fascinating story.)

In recent years our civilization has been confronted with a dizzying array of new, or at least newly discovered, diseases Many of these are viral hemorrhagic diseases such as Hanta, Marburg and Ebola. And then there are other viruses such as SARS and its offspring, SARS-CoV-2. And along came ZIKA to join the well known influenza and diarrhea and common cold viruses. Get rid of smallpox and polio and there are always other volunteers to fill their ranks.

And unless we think we are so smart, our old bacterial friends have become antibiotic resistant to keep us humble. That old scourge, Mycobacterium tuberculosis hangs around waiting to catch the unwary. Not wanting to be ignored, fungi are represented by Candida auris along with Cocidioides and Histoplasma. And parasites like the Plasmodium family have never gone away.

So lets compare the Civil War scourges with our current crop.

Here in no particular order are some prominent Civil War diseases (The list is not exhaustive.):

• Typhoid fever
• Typhus
• Malaria
• Yellow fever
• Cholera
• Gas gangrene
• Gonorrhea
• Syphilis
• Diarrhea and Dysentery
• Measles
• Mumps
• Whooping cough (Pertussis)
• Chickenpox
• Pneumonia
• Erysipelas
• Smallpox

Giant Microbes

It’s worth noting that malnutrition exacerbated the pathogenicity of these bugs. Accounts of the diets of many Civil War soldiers makes one wonder how they were able to function at all. Salt pork? Hardtack? Ugh! And “sanitary” facilities were worse than primitive. A bench across a latrine ditch excavating in one direction with the dirt filling in behind. And handwashing facilities? Are you kidding? It’s no wonder diarrhea and dysentery were rampant. And also why an army on the march was much healthier (think Sherman’s “March to the Sea”).

In spite of vaccines for many of these diseases, especially the childhood diseases, all of these delights are still of current interest.

Here are some current goodies to brighten your day:

• C difficile (Clostridioides difficile)
• Covid-19 (SARS-CoV-2)
• MRSA (methicillin resistant Staph aureus)
• C auris (Candida auris)
• VRE (Vancomycin resistant enterococci)
• CRE (Carbapenem resistant Enterobacteriaceae)
• Zika virus
• Malaria
• Tuberculosis
• Ebola virus
• Influenza
• Diarrhea
• Pneumonia
• Venereal diseases
• Hanta virus

Standard Precaution Signs

This, of course, is just a sampling and many more could be listed. But you get the point. While it is still true that most microorganisms are harmless, or even beneficial, there are many that lurk around ready to pounce. If you’re not familiar with it already, you owe it to yourself to look up that old song, “Some little bug is going to find you someday.” (Google it.) The poem dates back to the late 1800s and a number of people have put it to music.

And with that cheery note. . . .

Gordon Short, MD
Brevis Corporation

Methicillin resistant Staphylococcus aureus may always have been with us. It appears to be a genetic variant whose origins are unknown. But ever since those intrepid Brits, Fleming and Florey, discovered that some microorganisms may produce substances that inhibit the growth of other organisms, we have become dependent on these miraculous substances to treat all our infections. So far, so good. But Penicillium notatum probably never intended to be the savior of mankind. Furthermore, P. notatum is not the best critter to produce significant quantities of the magic substance.

Contact Precautions Signs & Labels

In the Sept 2021 Scientific American there is a little item about the related P. rubens. Fleming discovered penicillin in 1928 and its usefulness was appreciated by the beginning of World War II. How to ramp up production? Here is the story as told by Jim Daley in the article on page 22:

Andrew Moyer, a microbiologist there [Peoria, Ill], took on the problem. Moyer’s fellow researcher Mary Hunt found a moldy cantaloupe at a Peoria market and brought it to the lab for analysis. . . .As was the case with many women conducting research in that era, Hunt’s contribution to the discovery and study of that mold – which turned out to be Penicillium rubens – was diminished at the time. Moyer’s 1944 publication on P. rubens mentions Hunt only in the paper’s acknowledgments, and the press referred to her as “Moldy Mary.” P, rubens could better tolerate a new fermentation process that let it quickly produce hundreds of times more penicillin than previously studied strains, which let the Allies massively scale up antibiotic production. The same strain is still used to manufacture penicillin today.

Clean Up the Staph Button

But what does this have to do with MRSA? As the susceptible strains of Staph aureus have been killed off, the resistant strains that have maybe always been lurking around in small numbers have been allowed to flourish. Hence the search for modifications of penicillin that would still be effective. Methicillin has been the last candidate in the congregation to do the job. When bugs resistant to it showed up, we were in trouble. Which we still are. Especially since MRSA has an increased incidence in hospitals. What that means is that it is especially important to practice excellent hygiene procedures such as surface disinfection and frequent, good handwashing. Guess what. Brevis can help.

Gordon Short, MD