Disease and Death go hand and hand, and the American Civil War was a breeding ground for both of these vectors. Death was the primary focus in Dr. Faust’s book The Republic of Suffering, and as such, she goes into great detail on how Death effected the American psyche, civilian, soldier and family alike. Death from battle wounds was high, not because of lack of medical knowledge, but because of Disease caused by a wide variety of factors. These factors included: “ignorance, climate, poor sanitation, lack of medicine, bad nutrition, movement of soldiers from north to south, density of warm bodies, and decisions made by military commanders…”  and “polluted water ways, unburied bodies of animals and soldiers, overcrowded populations, dislocation, and the medical profession’s uncertainty about how to respond to the many outbreaks of disease,”  especially when it came to free Black persons and runaway slaves. The Diseases that ravaged the American countryside, military camps, hospitals, and cities during the Civil War included: malaria, yellow fever, plague, cholera, typhus, typhoid fever, smallpox, dysentery, and pneumonia, all of which had devastating effects on the human populations of the north and south.
Despite the widespread outbreaks of Disease during the Civil War, Republic of Suffering only sporadically covers these outbreaks and their consequences. However, Dr.’s Mathiasen and Downs in their respected articles, Bugs and Battles during the American Civil War and Emancipation, sickness, and death in the American Civil War, concentrate their focus on Disease, its causes and its results. Dr.’s Mathiasen and Downs see Disease as the primary cause of Death in the Civil War, not battle. Dr. Mathiasen eloquently sums up Disease’s place in history by quoting Hans Zinsser, MD., in his 1935 book, Rats, Lice, and History, “soldiers have rarely won wars … typhus, with its brothers and sisters – plague, cholera, typhoid, dysentery – has decided more campaigns than Caesar, Hannibal, Napoleon, and all the inspector generals in history.”  That is quite a statement, yet, the statistics showing Disease as a cause of Death during the Civil War proves Dr. Zinsser’s statement and Dr. Mathiasen’s use of it. She states later in her article that, “By the time of the Battle of Vicksburg, July 1863, 25% of Grant’s forces were sick and incapacitated, whereas 50% of Pemberton’s soldiers had malaria.”  Dr. Downs states in his article, “Although the war certainly succeeded in dismantling plantation slavery, more than a million former slaves became sick and tens of thousands died…”  Disease is only the unified name for agents or non-human vectors of Death.
We have all heard of these agents: malaria, yellow fever, plague, cholera, typhus, typhoid fever, smallpox, dysentery, and pneumonia. Each one caused countless deaths during the Civil War, and in some cases continue to do so. Dr. Mathiasen cites from Andrew McIlwaine Bell’s book, Mosquito Soldiers: Malaria, Yellow Fever, and the course of The American Civil War, that “disease, not war produced the majority of deaths.”  Although all of these agents were devastating on their own, smallpox, yellow fever, malaria, typhoid fever, and scarlet fever were the most common agents of Death to White soldiers and civilians, while pneumonia was the agent to the Black population: soldier, slave, free man/woman, and runaway. Dr. Faust states in Republic of Suffering that generals, North and South, felt the effects of these diseases. Union general William Tecumseh Sherman saw the effects of typhoid fever when his “nine-year-old son died of typhoid fever contracted on a visit to his father in camp; Confederate general James Longstreet lost both his children when they moved to Richmond to join him and came down with scarlet fever soon after they arrived in the crowded wartime capital.”  In addition, President Lincoln’s son Willie “died in 1862 from typhoid fever,” most likely due to the Union army stationed around Washington, D.C. contaminating the water supply.  Hospitals too were highly susceptible to Diseases.
Hospitals, no matter if at the front or in a city were prime environments for the spread of disease. “nurses, matrons, and other medical workers often contracted illnesses from the patients they attended or from the polluted water supply they all shared.”  Nurses of the North and South “regularly fell victim to typhoid, smallpox, and even heart failure brought on by the conditions and demands of their employment.”  Volunteers who wanted to help the wounded, dying, and sick often fell ill themselves. “Union general Francis Barlow’s wife, Arabella, died of typhus as a result of her service in the hospitals of the [Union Army.]”  Unfortunately, many of these Diseases were spread by unseen agents, namely ticks, fleas and mosquitoes. Lice also played a role but, they were more of a pest and annoyance that an agent of Disease.
Ticks were a common occurrence of troops marching North and South, especially through long or tall weeds, grass and shrubs. Fleas, like their tick cousins, were also a normal occurrence; yet, as we know from the Black Death or plague, they could be the undoing of an entire army if proper hygiene was not properly maintained and controlled. One area where fleas were agents of Death was in the military prisons established during the war, most notably, Andersonville and Libby Prisons. Andersonville was one of the worst Confederate prisons. It held 45,000 Union prisoners with nearly 13,000 dying of scurvy, diarrhea and dysentery. Libby Prison, a Confederate prison for Union officers was quickly overcrowded, with many of the prisoners dying of malnutrition and disease. The prison was supposed to hold 300 prisoners in three rooms, but by 1863 that number increase exponentially to over 2,000. Deaths due to ticks and fleas, however, were merely a drop in the bucket compared to the Deaths caused by the favorite spreader of Disease, the mosquito. Dr. Mathiasen wrote, “the Civil War was an environmental catastrophe causing immeasurable suffering for soldiers and civilians.”  In her article, she focused on two Diseases, malaria and yellow fever, both spread by mosquitos, and both of which killed thousands during the war.
She said, “Of the 4 varieties of malaria, deadly Plasmodium falciparum was common in the United States in the 19th century.”  It was the Anopheles mosquito, which breeds in warm, stagnate water that was the main victor and spreader of malaria during the Civil War.  Once bitten, the effects the host felt included: high fevers, shaking chills, and flu-like symptoms. Although preventable today in the United States, 19th century America was stumped medically as to the cause of the symptoms and how to cure it. Another mosquito, the Aedes aegypti which lived and bred in cites was the transmitter of yellow fever. Once bitten, the host would experience bleeding from the nose and mouth, headaches, fever, jaundice and intestinal hemorrhaging.  It was this mosquito, with its yellow fever carrying pincher, that killed thousands in Texas, New Orleans, Savannah, and Charleston. “Northern prisoners in Confederate camps also fell victim to yellow fever. Dehydrated soldiers, surrounded by vomit and excrement, died in just hours.”  As mentioned, malaria and yellow fever, although extremely deadly, were not the only contagions that caused Death through Disease; other agents included: plague, cholera, typhus, typhoid fever, smallpox, dysentery, and pneumonia. The American Civil War was thus as much a biological war as World War I was. Mathiasen, Helle, PhD. “Bugs and Battles during the American Civil War.” The American Journal of Medicine 125, no. 1 (2012): 111.  Downs, Jim, PhD. “Emancipation, sickness, and death in the American Civil War.” The Lancet 380, no. 9854 (2012): 1640.  Mathiasen, Bugs and Battles during the American Civil War, 111.  Ibid.  Downs, Emancipation, sickness, and death in the American Civil War, 1640.  Ibid.  Faust, Drew Gilpin. This Republic of Suffering: Death and the American Civil War (New York: Vintage Books, 2008), 139-140.  Ibid., 140.  Ibid.  Ibid.  Ibid.  Mathiasen, Bugs and Battles during the American Civil War, 111.  Ibid.  Ibid.  Ibid.