Fighting More with Less
DISEASE IN THE CONFEDERACY
It has been explained earlier that disease rather than battlefield in- jury was the principal challenge to medical departments, North and South. Yet poorer rations and greater exposure left the Confederates more susceptible to illness than their Union rivals. Although the North clearly suffered more severely from disease in the Peninsular Campaign from April to July of 1862, mainly because it was forced to occupy unhealthier ground and was equally devastated by disease in its first siege of Vicksburg (a problem intensified by a critical short- age of quinine),1it was the South that suffered proportionately higher
incidents of disease. A comparative analysis of malaria conducted by the Union surgeon general’s office, for example, found three times the reported cases of the fever among Confederates (41,539, com- pared with 14,842 Union cases).2
Clear and reliable information on the incidents of disease among Confederate forces is not easy to find. The burning of Richmond at
the end of the war destroyed many of the Confederate Medical De- partment’s records, and nothing is comparable to the massive compi- lation The Medical and Surgical History of the War of the Rebellion, completed by the surgeon general’s office detailing disease among Federal troops. Some data worth noting does exist. Figure 9.1 illus- trates in unequivocal terms the preponderance of disease over combat injury and how most were treated in the camp and field rather than in hospitals. The chief culprits, diarrhea/dysentery and fevers, were fairly evenly divided at 313,332 and 319,233, respectively. If a sol- dier was able to avoid these two primary scourges, he might still suc- cumb to bronchitis, pneumonia, or any number of other maladies (from intestinal parasites to rheumatism).
One category of disease that was largely unreported because it was not well understood at the time was that caused by various nutritional deficiencies. Both sides recognized some correlation between diet and certain diseases—that had been demonstrated by British naval surgeon James Lind with the introduction of orange and lemon juice to prevent scurvy in 1753—but the role of vitamins would not be
FIGURE 9.1. Confederate Sick and Wounded: Reports on File in the Surgeon- General’s Office, 1861-1862 (Source: From “Grand Summary of the Sick and
Wounded of the Confederate States Army Under Treatment During the Years 1861 and 1862,”Confederate States Medical and Surgical Journal 1, No. 9 [Sep-
known until nutritionist Casimir Funk’s landmark paper on the sub- ject in 1912. Medical staffs on both sides tended to lump nutritional deficiencies as “scorbutic diathesis.” In this regard the South seemed to have a more enlightened approach. The Union commissary and medical staff sought to relieve these “scorbutics” with potatoes and desiccated vegetables (which destroyed the very vitamin C the men so desperately needed). However, leading Confederate surgeons such as J. Julian Chisolm and Medical Director William A. Carrington were recommending fresh vegetables and fruits for their men.3Dr.
Samuel H. Stout ordered his Army of the Tennessee hospital stewards to purchase “abundant supplies of vegetables, butter, eggs and other articles for the sick and convalescent.”4Nevertheless, nutritional de-
ficiencies are especially important to discuss in terms of Confederate health because there is reason to believe their more spartan diets left them more vulnerable to scurvy, rickets, and other diseases.
Late in the war the Army of Northern Virginia was beset with widespread nyctalopia (night blindness), and one observer recalled witnessing “men led by the hand all night . . . [only] to go into battle with the command in the morning.”5Likely due to a lack of vitamin
A, dietary deficiencies such as this could lead from one medical prob- lem to another. Not only would these men have suffered night blind- ness but also increased susceptibility to infectious diseases.6 Al-
though the surgeons and stewards did not recognize the specific correlation, the problem could have been quickly resolved with a reg- imen of cod liver oil (itself rich in vitamin A); but more likely than not, the men just suffered until a better diet could be obtained. It is possible, however, that some of the vision problems experienced were due to excessive dosages of quinine given to patients along with diets poor in vitamins A and B complex and ascorbic acid.7
One disease, pellagra, deserves special attention. Before Joseph Goldberger discovered in the 1920s that pellagra was the result of poor diet, the characteristic weight loss, ulceration on the arms and legs, and general debility was usually ascribed to some vaguely de- fined “infection.”8The monotonous Southern “3-M/2-H” diet—meat,
meal, and molasses or otherwise referred to as hogs and hominy— would make Confederates more prone to pellagra than their Northern counterparts. Though likely recorded by Civil War surgeons as per- haps an “eruptive fever” or some other infectious or “miasmic” disor- der, there is every reason to believe that genuine cases of pellagra
plagued Confederate camps. The disease was endemic to Kentucky, Tennessee, Alabama, Mississippi, Louisiana, Texas, Arkansas, both Carolinas, and Georgia. Efforts to understand the nature of pellagra were made by the medical community in the early twentieth century, with one researcher identifying 10,663 fatal cases of the disease in 1915.9It would strain credulity to believe that pellagra was nonexis-
tent among the often ill-fed troops of the Confederacy. Despite the in- ability of the surgeons of the day to diagnose—much less treat—pel- lagra and similar nutritional deficiency diseases, many more diseases were all too familiar to the Southern medical staff. The epidemiology of measles was well understood. Often called an “eruptive fever,” al- most every surgeon had to deal with this potentially dangerous dis- ease, especially early in the war. Medical Director Stout observed that his 3rd Regiment, almost wholly composed of rural young men never before exposed to measles, rose to about 650 cases of measels and spread “before it was possible to perfect adequate accommoda- tions for the sick in the regimental or general hospitals.”10The epi-
demic nature of measles, fevers, and dysenteries probably explains, at least in part, the preponderance of cases treated in the field as op- posed to hospital cases, since that latter would not normally have been able to accommodate such numbers anyway.
Nevertheless, the image of busy and bloody hospitals with butcher- like surgeons lopping off arms and legs as fast as their saws would sever them is just grossly inaccurate. Even the large and important Chimborazo Hospital near Richmond, Virginia, saw far more dis- eases than wounds and still managed to maintain a remarkably low overall mortality rate of 6.42 pecent (see Figure 9.2).11
These disease statistics are borne out by the men who treated them. Assistant surgeon for the 19th Virginia Infantry, William H. Taylor, for example, recalled, “The prevailing diseases were intestinal disor- ders [i.e., diarrhea and dysentery], though we had a share of almost every malady.”12Likewise, John Samuel Apperson, hospital steward
in Company D of the 1st Virginia Brigade, noted while camped near Manassas on July 28, 1861: “This morning 105 men were up to be ex- amined, prescribed for and administered to. I am very busily engaged until 10 o’clock.”13Just a few days later he wearily observed, “Sick-
ness seems to threaten a great many of our boys—many are becoming ill every day.”14By May 1862 things were not much better. Marching
writes that thirty-eight of his regiment were ordered to fall to the rear to join an ever-growing number of men suffering from rheumatism, bronchitis, diarrhea, dysentery, and just about “all other diseases.”15
The hospital steward remarked in half-pity, and half-disgust what a “dilapidated set they were.”16
One might be inclined to conclude that since both sides were suf- fering from essentially the same diseases (save for pellagra) that all these diseases canceled themselves out as an important factor in the war. However, the South’s medical staff had a more difficult task in dealing with diseases. No better example of this can be seen than in the letters of George E. Waller, hospital steward for the 24th Virginia Regiment. On June 8, 1862, Waller bemoaned the condition of his unit:
We have a good deal of sickness now in camp. A good many are taking fever now. I sent off Hainston Payne with it yesterday and Tom Stone today. Stone is very sick and I do not think he will live—good many cases of same from other companies.17
Indeed in just one year following the regiment’s formation, Waller re- counted the devastation that disease and suicidal charges had wrought upon the regiment.
FIGURE 9.2 Confederate Injury/Disease/Mortality Rates: Chimborazo Hospital November 1861 to November 1863 (Source: “Confederate States Hospital
Reports,”Confederate States Medical and Surgical Journal Vol. 1, No. 1 [Janu-
There is a great difference between this Regiment now and when I came to it. It first had upwards of eleven hundred, it now musters about two fifty. It was then a noble regiment with good officers, it is now a small regiment with no officers at all. Capt. Gardner went down today to take command but they will never fight again as they have fought.18
By March 1864 health was still an ever-present concern, but only then could Waller see the Union Navy that stood between him and much-needed supplies. Camped near Smithfield, North Carolina, he wrote to his sister, “I fear if we stay here long we will have plenty of sickness. There is small pox here now & in the fall they have yellow fever and cholera.”19 But he added ominously, “I could see the bil-
lows on the ocean rising like mountains & looking as white as cotton & away in the distance the masts of ships were visable [sic], supposed to be the [Union] blockading fleet.”20