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Article Excerpt
From December 1861 through July 1862, the Army of the Southwest boasted numerous successful campaigns in Missouri and Arkansas, including the Battle of Pea Ridge, Missouri. Union officials considered the Army of the Southwest a powerful and dynamic force able to capture and hold Arkansas for the Union cause. However, when supply considerations necessitated the army's occupation of Helena, Arkansas, in July 1862, the army became an ineffective force in fighting not only the Confederates but also the disease-ridden Helena environment. The rapid attrition by disease caused regiments to lose strength quickly. By September 1862 the army, as a fighting force, was worthless. Sickness did not abate over the three and a half years of Federal occupation as Helena became known as one of the most insalubrious locations in the Union. By January 1865 Maj. Gen. Henry W. Halleck, once commander of the Union armies, even recommended the post's abandonment because of its unhealthiness and unimportance. (1)
Though it is widely accepted that disease caused more disability and death than wounds during the Civil War, few historians have examined this aspect of military history. Paul Steiner's Disease in the Civil War (1968) analyzed the influence of infectious diseases on selected military affairs including the Department of Arkansas, yet he neglected to take into account the effects disease treatments had on the health of armies. (2) Both aspects were examined for this study of the Army of the Southwest at Helena from July 1862 to January 1863, which focuses on the four main diseases that beset the soldiers: dysentery, malaria, typhoid, and typhus, in the context of modern-day medical knowledge. Nineteenth-century and modern medical knowledge and treatments are related to the experiences of the men who served at Helena, taking each of the four diseases in turn. The soldiers became unserviceable, and many died, because of the lack of understanding by medical authorities of the etiological cause of the disease, the relationship among sanitation, the environment and health, and the types of drugs used. Disease helps explain why the Army of the Southwest achieved little toward impeding the Confederate forces in Arkansas in 1862.
Medical records from one Helena hospital register (HHR) and the Indiana Sanitary Commission hospital register (ISCHR), army returns and reports from the Official Records, and medical data from Joseph K. Barnes's Medical and Surgical History of the Civil War indicate that the Army of the Southwest at Helena was devastated by epidemics of dysentery, typhoid, and malaria between July 1862 and January 1863. The hospital records provided information on the type and distribution of diseases among the soldiers and regiments at Helena. Rosters yielded information concerning the number of deaths by disease and disability discharges of each regiment. (3) Diaries and letters from men stationed at Helena during this period provide a picture of the soldiers' and medical officers' utter hopelessness in the face of so much disease. The men blamed their officers for the unhealthiness of the camps, especially Maj. Gen. Samuel R. Curtis, who was accused of having more interest in cotton speculation than in the welfare of his troops.
Until the acceptance of germ theory as the cause of disease, the theory and practice of medicine were based on the Hippocratic tenet that the four humors of the human body dictated disease: blood, yellow bile, black bile, and phlegm. It was believed that a bodily poison caused nervous constriction of the small blood vessels, which disrupted the flow of blood and caused disease, especially fevers. Physicians attempted to maintain and regulate humoral balance and well-being through pharmaceuticals and physical manipulation of the humors through bleeding, purging, salivating, and perspiring. (4)
Civil War-era physicians believed that three things created bodily poisons: climatic extremes, diet, and living conditions. All three influences determined and modified the conditions--if not the causes--of the poison, but climate came to be accepted as the primary source of and avenue for transmission of disease. The largest category of climatic ailment was miasmatic, or sickness induced by atmospheric influences derived from vegetable decomposition or produced by the decomposition of matters (excrement or breath) from the human body as a result of overcrowding. Poisonous gases emanating from vegetable decomposition produced the various forms of malaria and dysentery, while crowd poisoning caused typhus and typhoid. (5)
The humors could be stimulated or weakened by a bodily poison; sometimes both conditions occurred during an illness, or the conditions changed as the patient's health improved or worsened. The physician determined the state of the patient's humors by the symptoms. Stimulated humors, manifested in such symptoms as fever, diarrhea, and rapid pulse, were often associated with dysentery, malaria, and diarrhea. Doctors resorted to medications that purged the poison from the body--mercury laxatives, calomel, and emetics such as ipecacuanha. Bleeding also helped draw the "excitement" from the sick patient. Illnesses associated with humoral weakness, as observed in typhoid and congestive fever, caused feebleness, constipation, weak pulse, and delirium. Patients with such symptoms needed mild laxatives and stimulants such as quinine, camphor, alcohol, turpentine, and ipecacuanha (in small doses) and astringents (silver nitrate, tannic acid, and lead acetate) to rebuild the patient's energy, arrest discharges, and restore humoral balance. Physical manipulation included cupping, which was believed to reduce congestion and restore blood flow. The various treatments, designed to alleviate the symptoms and restore humoral balance, often killed more patients than the ailments.
During the war 156,885 soldiers died from disease in Union hospitals, accounting for approximately 80 percent of the 195,627 hospital deaths. Disability discharges for disease accounted for 75 percent of the total number of disability discharges (223,535) given by the Union army. The numbers are high because Civil War physicians did not understand the sources and causes of disease. The lack of a clear theoretical basis for diagnosis and treatment led to a variety of procedures that were thought to control the humors. (6)
Relying on symptoms to make a diagnosis caused problems that resulted in mistreatment especially for dysentery, malaria, typhus, and typhoid. According to the medical history compiled by Barnes,"Analysis of medical notes from the Civil War indicate physicians were not able in all cases to determine from symptoms alone that a fever was malarial or typhoid. So in cotemporaneous [sic] epidemics of typhus and typhoid, it is not possible in all cases for the clinician to distinguish between them." Though typhoid and typhus are separate diseases caused by different agents, their medical histories were inseparable until the late 1800s, when their etiologies became known. This confusion arose from the similarity in symptoms, which include fever, body rash, muscle aches, joint pain, and mental disturbance. There is also reference to malarial fevers taking on a typhoid or typhus character and dysentery being associated with the remittent form of malaria. Simultaneous infections and the types and dosages of medicines used to treat disease often led doctors astray when making diagnoses. (7) Nineteenth-century physicians, for instance, relied on mercury and quinine to balance the humors during an illness. Mercury, a purgative to clean the system, and quinine, to treat fever, can cause malaria and typhus sufferers to have symptoms that mimic typhoid and dysentery by causing hemorrhage and ulceration of the intestinal tract. When this occurred, physicians administered other "drugs" to quell these new symptoms and restore humoral balance. In actuality, the physicians were trying to counteract the negative side effects of the drugs. This situation is best described by Surgeon S. K. Towle, from the General Hospital at Baton Rouge, Louisiana in 1863:
Indeed, the symptoms of many of the cases would indicate rather a combination of diseases than any one disease--fevers being inexplicably combined with diarrhoea or dysentery, and vice versa, so that one would hardly know under which class to make the record. And again, with the different variety of fevers, the record will often depend upon the period of observation; an intermittent [fever], with well-marked stages, will, if neglected, often in a few days become an equally well-marked remittent, or typhomalarial [fever], or a little further on will prominently exhibit advanced typhoid symptoms; or perhaps a few weeks or months later [the man will] die from chronic diarrhoea or dysentery. (8)
Evidence of this confusion abounds in the Helena hospital and Indiana Sanitary Commission registers. In numerous cases, men first diagnosed with malaria or typhoid were later classified with diarrhea or dysentery. There were also mistakes in distinguishing among malaria, measles, and typhoid. Often one, two, or all diagnoses were given to the same patient within days. The most outlandish situation at Helena involved two patients first diagnosed with malaria; within a week the diagnosis was changed to gonorrhea. There were no absolutes when it came to disease and its treatment in the Civil War. (9)
By modern standards, Civil War pharmacopoeia consisted almost entirely of deadly poisons. It is not surprising, then, that soldiers feared not only illness, but also the surgeon's medications. As a result, many soldiers preferred to stay in their tents when illness hit and to use homeopathic treatments. When one Helena soldier's homeopathic medication lost its potency, he preferred to obtain a remedy from the horse doctor than from the regimental surgeon. Some soldiers' alternative treatments proved successful, while others did not. In this case, the men succumbed to disease in their tents, with many dying without their illnesses being recorded in a medical register. Entries in the hospital registers in these cases indicate that soldiers were "brought in dead." Soldiers also feared hospitals. As one Helena soldier noted, "When a man was taken sick he was lugged off to the hospital and that was generally the last seen of him. In the hospitals at Helena men literally rotted to death" Consequently, there were usually more men sick in their quarters than in the hospitals. The medical director at Helena in November 1863 recorded 346 sick men in the general hospital, 258 in the regimental hospitals, and 907 in their quarters. (10)
Civil War campaign strategies rarely took into account how the weather, environment, and lack of potable water affected soldiers' health. The Federal army's campaign in Arkansas during mid-1862 exemplifies this lack of planning. As a result the men in the Army of the Southwest were exposed to circumstances favorable to the spread of epidemic diseases. After the Federal army's victory at Pea Ridge, Arkansas, in March 1862, Confederate forces under Maj. Gen. Earl Van Dorn transferred from Arkansas to Tennessee to participate in the siege of Corinth, Mississippi, a transfer that left Arkansas open to Federal forces. Union major general Samuel R. Curtis moved the Army of the Southwest from Elkhorn Tavern, Arkansas, eastward to protect southern Missouri, while Van Dorn's troops marched toward the Mississippi River. Once the Confederates crossed the river, Curtis moved his army toward Little Rock, the Confederate-held state capital. Near Jacksonport Curtis converged with Brig. Gen. Frederick Steele's force and began the 100-mile march to Little Rock. The Army of the Southwest reached within forty miles of the Arkansas capital when Curtis discovered he could no longer supply his troops from his St. Louis base. Curtis withdrew his army and turned back toward Batesville, a small village on the White River.
The Army of the Southwest waited for Federal supply boats to reach Batesville via the White River, but the flotilla had stopped at Clarendon because of low water. To reach those badly needed supplies, Curtis abandoned his tenuous overland supply route and in late June marched his army down the east bank of the White River. The weather was hot and dry. Ahead of the Federal army Southern partisans and Confederate soldiers stripped the land of food, contaminated the wells, and blocked the roads. Federal troops were living on half rations, and water was scarce. Those who could find water drank from muddy holes that contained water"the color of chocolate." Others thought they could find relief from swamps and bayous, but they soon discovered that "this water was perfectly hot and almost putrid[,] for the [S]ecesh would drive hogs and cattle into these places and then shoot them and leave them to season the water for us to drink[,] but it was the only chance for us and it was rendered palatable by a burning sun and dust." "I drank water" John Burke, 5th Illinois Cavalry confessed, "that before I entered the army, I would have been ashamed to offer to a hog." (11)
The Army of the Southwest reached Clarendon on July 9 only to discover that the Federal supply boats had left the day before. Without supplies, Curtis abandoned his plans to take Little Rock and turned his army toward Helena, sixty-five miles east on the Mississippi. Occupation of Helena secured a water-borne supply route for the army, created a marketplace for trading confiscated cotton, and offered a staging area for Union forces participating in operations to open the Mississippi River to New Orleans.
Curtis reached Helena on July 12, and his troops trickled in over the next week. The heat, food depravation, and poor water left many men too fatigued to keep up with the main column. Albert Marshall, 33d Illinois Infantry, noted his regiment's arrival:
On Sunday, July thirteenth, by marching, or rather crawling, twenty-five miles, we reached Helena, on the Mississippi River. Only a few were able to go in with us. Company A only had twenty-four men in line. The others still less. Some companies of our regiment did not have over half a dozen men to stack arms when our journey ended. Back for miles the sides of the road were strewn with our sick and exhausted soldiers. Full three-fourths, if not more, of the entire command were thus lying upon the roadside. The teams are bringing in the most exhausted.... It took two or three days after we arrived to bring in our worn-out and sick...
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