TWO FACES OF DR. NOTT, THE

Alabama Heritage, Summer 2006 by Davenport, Larry J

THE MALADY STRUCK without warning, marching through the city like a legion of invisible demons. The city walls, rapidly closed in quarantine, trapped the quick (and soon-to-be dead) in mortal terror. All in its path succumbed to its fever, chills, and muscle aches, their skins turning a putridly bright yellow. Tongues and lips grew dark and cracked, blood oozed from mouths and noses, and black vomit erupted with powerful force.

Caring for thousands of these afflicted souls was Josiah Clark Nott (1804-1873). Tall and imperially slim-more cadaverous, perhaps, than handsome-the South Carolina-born physician settled in Mobile in 1836, where he quickly established a booming practice that included obstetrics, gynecology, and general surgery. His unflagging ministrations alleviated much suffering during the frequent yellow fever epidemics that ravaged the port city-epidemics that killed five of his eight children.

At the time, medicine offered only palliatives, not cures; the scientific method barely existed; and the germ theory of Pasteur and Koch remained decades (and thousands of dead guinea pigs) distant. Besides that, physicians stubbornly considered all fevers-yellow, remittent, intermittent, malaria-to have the same source, namely the environment and/or cosmos. But not Nott! In a lengthy 1848 article ("Yellow Fever contrasted with Bilious Fever-Reasons for believing it a disease sui generis-Its mode of Propagation... "), Nott offered the incredible suggestion that (1) yellow fever is different (sut generis or unique,) from other tropical fevers and that (2) because its pattern mimics that of insects, an insect vector must be involved.

And he stated his case beautifully, lining out his observations and testing his hypotheses on the way to reaching scientifically sound conclusions. He examined the patterns of disease found in his own copious notes, recording the day of first occurrence and the pattern of spread for each successive year. He forcefully argued, "Fever should have its [own] genus and species, like other things in nature," rather than a general miasmic cause, and he made clever and instructive analogies: "Yellow Fever, in 1842 and '43, travelled from house to house ... as would a tax collector, and was just about as much influenced by the weather; for neither the fever nor the tax collector like to travel in rain, though they pay no regard to the direction of winds." With its documented pattern of spread, "we could no more expect it to be contagious than the bite of a serpent," and "admitting my suggestions to be true, they do not afford any ground for the vexatious and ruinous quarantine laws which have been enacted against Yellow Fever." Finally, in a perfectly Southern manner, he compared yellow fever to the cotton army worm, which sometimes causes just

a few sporadic cases.... In another year a worm comes like a great epidemic, appearing at many points in rapid succession or simultaneously, and ravaging not only a single plantation, but laying waste the cotton region for several hundred miles.

Nott's radical findings that yellow fever-caused by a distinct "germ" and spread by mosquitoes-is not contagious predated (by fifty years!) the identical conclusions of Carlos Findlay, Walter Reed, and William Gorgas in Cuba and the Canal Zone. The embracing of his ideas, rather than their universal ridicule, would have reduced the sufferings and deaths of millions of people.

(In an odd quirk of historical happenstance, Nott helped deliver baby William Crawford Gorgas into the world on October 3, 1854. Gorgas grew up to develop the "new" theories and tools used to eradicate yellow fever-and usurped Nott's place in medical history.)

But Dr. Nott could also Hyde behind science, abusing and misusing it to support a most hateful and hurtful social agenda. ("It was the best of science, it was the worst of science.") An 1843 anthropological treatise, charmingly titled "The Mulatto a Hybrid-Probable Extermination of the Two Races If the Whites and Blacks Are Allowed to Intermarry," used grossly flawed and known-to-be-biased census data to "prove" that whites and blacks are separate species. Then in 1854, he coauthored Types of Mankind, a massive and elaborately illustrated tome designed solely to justify the continuation of slavery. His "evidence," couched in the most elegant and stately scientific terms, consisted of ancient manuscripts, histories, diatribes, drawings, and inscriptions, plus the ever-popular craniometry and phrenology-a kitchen sink of nonsense, supposition, pseudoscience, and blatant racism. (Nott apparently forgot this line from his yellow fever paper: "When a writer starts in a wrong direction, the farther he goes, the farther does he wander from the path of truth.") Of course, the universal denouncing of these ideas would have reduced the sufferings and deaths of millions of people.

Nott eventually turned his attention and considerable energy to medical education in his adopted state, almost single-handedly founding the Medical College of Alabama in Mobile (1859). Chair of Surgery, he set sail for Europe to collect the necessary library, physiological equipment, and anatomical preparations needed to start such an important venture. The school closed during the Civil War, during which Nott served as a surgeon in the Confederate army. In 1866 General O. O. Howard asked that the vacant building be used as a freedman's school. Nott, unchanged to the bitter end, replied that he would rather see it burned to the ground.