3. The North American Civil War (1861–5)
At the outbreak of the Civil War almost nothing was done in the two armies to prevent the outbreak and dissemination of diseases; the assembling of so many troops rendered severe pestilences inevitable. The successful activity of numerous voluntary societies did a great deal of good in the way of improved methods of sanitation; the centre from which this activity emanated was an officially recognized Sanitary Commission, founded on June 15, 1861, which made the prevention of pestilences its principal function. It was enabled to carry on its work by large voluntary contributions of money. The means which the Commission employed were: good equipment, food, and shelter for the men, isolation of men suffering from infectious diseases, burning of the clothes, beds, and tents used by these patients, erection of clean, well-ventilated barrack-lazarets, and comprehensive plans for transferring invalid soldiers from the field-hospitals.[[210]]
Since upwards of a million men, counting both sides, were gradually brought face to face with one another, the loss of human life was necessarily terrible. Regarding the losses sustained by the Northern States, we are excellently informed by an exhaustive health-report in six volumes, issued by the United States.[[211]] The report also contains some statistics regarding the prevalence of disease among the Confederates and regarding the prisoners, but no figures relating to the losses sustained by the Southern States are available.
Regarding the total loss of troops sustained by the Northern States, we find the following compilation:[[212]]
| Cause of death. | White troops. | Coloured troops. | Total. |
|---|---|---|---|
| Killed in battle | 42,724 | 1,514 | 44,238 |
| Died from wounds, &c. | 47,445 | 1,760 | 49,205 |
| Suicide, murder, execution | 469 | 57 | 526 |
| Diseases | 157,004 | 29,212 | 186,216 |
| Unknown causes | 23,347 | 837 | 24,184 |
| Total | 270,989 | 33,380 | 304,369 |
If we divide the deaths of unknown cause proportionally among the other groups, the total number of deaths among the white troops due to diseases was 171,806, and among the coloured troops 29,963.
In the statistical table in the first volume of the Medical History the figures relating to the number of deaths are not complete; the total numbers given there are:
| White troops. | Coloured troops. | |
|---|---|---|
| Wounds, &c. | 36,688 | 1,427 |
| Suicide, murder, execution | 549 | 78 |
| Diseases | 128,937 | 27,499 |
| Uncertain | 449 | ? |
| Total | 166,623 | 29,004 |
Typhoid fever demanded the largest number of victims; in the first two years of the war it appeared in the form of murderous epidemics in the Northern army, mostly in the Atlantic and central districts, and less severely in the region of the great ocean. If the common continued fevers, the typho-malarial fevers, and typhus fever, are combined with the typhoid fevers and looked upon as typhoid fever, there died from this cause in the Northern army during the entire war 32,112 white troops and 3,689 coloured troops. In considering these figures, we must remember that, as stated above, they are incomplete. On this basis, out of every 1,000 men there succumbed to typhoid fever:[[213]]
| White troops. | Coloured troops. | |
|---|---|---|
| 1861–2 | 20·75 | |
| 1862–3 | 18·24 | |
| 1863–4 | 8·52 | 28·50 |
| 1864–5 | 11·45 | 19·31 |
| 1865–6 | 8·98 | 11·60 |
| Average | 13·58 | 19·8 |
As in the case of typhoid fever, so also in the case of other diseases, the coloured troops suffered the heaviest losses, probably because the food and shelter they received were not so good, and perhaps also because they had less understanding of the sanitary measures that were ordered. Among the Confederate prisoners that were brought north, about 40,875 in number, 18·4 out of every 1,000 succumbed to typhoid fever.[[214]]
Regarding the appearance of typhus fever in the American Civil War, views diverge. Since only a relatively small number of cases of that disease are recorded, it is probable that those cases were wrongly diagnosed, since typhus fever is so highly contagious. In the health-reports of the Northern States, in which the word typhus, as in England and France, means typhus fever, we find the following figures relating to the disease:
| No. that contracted it. | No. that succumbed to it. | |
|---|---|---|
| White troops | 2,501 | 850 |
| Coloured troops | 123 | 108 |
But there are very few case-histories and absolutely no post-mortem reports available from which one can draw a positive conclusion. Laveran doubts the occurrence of typhus fever.[[215]] According to Niedner, on the other hand, typhus fever prevailed among the Northern prisoners in the terribly neglected prisons of Salisbury, North Carolina, and probably, too, in other places.[[216]] It is to be surmised that the increased number of typhus fever patients in New York and Philadelphia, &c., which Hirsch adduces in accordance with the statements of da Costa and Corse, was connected with the epidemic among the prisoners.[[217]] According to Corse, the number of deaths due to typhus fever in Philadelphia was 37 in the year 1862, 131 in 1863, and 335 in 1864.
Unusually prevalent were diarrhoea and dysentery, so that, notwithstanding their relatively mild character, they caused a large number of deaths. The cases of cholera reported were not Asiatic cholera, but a local form of the disease. In the Northern army the following figures indicate the number of deaths due to acute and chronic dysentery and diarrhoea:
| White Troops. | Coloured Troops. | |||||||
|---|---|---|---|---|---|---|---|---|
| Dysentery. | Diarrhoea. | Dysentery. | Diarrhoea. | |||||
| Acute. | Chronic. | Acute. | Chronic. | Acute. | Chronic. | Acute. | Chronic. | |
| June 1861 | 3 | 1 | ||||||
| 1861–2 | 338 | 136 | 230 | 501 | ||||
| 1862–3 | 967 | 1,090 | 941 | 7,556 | ||||
| 1863–4 | 1,242 | 931 | 620 | 7,868 | 496 | 220 | 503 | 784 |
| 1864–5 | 1,248 | 919 | 973 | 10,600 | 584 | 255 | 608 | 1,788 |
| 1865–6 | 286 | 152 | 159 | 1,033 | 412 | 151 | 257 | 706 |
| 1861–6 | 4,084 | 3,229 | 2,923 | 27,558 | 1,492 | 626 | 1,368 | 3,278 |
Out of every 1,000 men there succumbed to dysentery and diarrhoea together:[[218]]
| White troops. | Coloured troops. | |
|---|---|---|
| 1861–2 | 4·17 | |
| 1862–3 | 15·99 | |
| 1863–4 | 15·78 | 43·54 |
| 1864–5 | 21·29 | 36·29 |
| 1865–6 | 16·00 | 26·97 |
Small-pox raged very extensively during the American Civil War; the coloured troops manifested much more susceptibility to it than the white. The dissemination of the disease was helped along by the fact that vaccination, which had been neglected on account of the hasty mobilization, could not be attended to as rapidly as was desirable.
Measles also broke out in both armies in the form of widespread epidemics. All told, 67,763 white troops and 8,555 coloured troops contracted the disease, while 4,246 of the former and 931 of the latter succumbed to it. Out of every 1,000 men there succumbed:[[219]]
| Small-pox. | Measles. | |||
|---|---|---|---|---|
| White troops. | Coloured troops. | White troops. | Coloured troops. | |
| 1861–2 | 1·36 | 1·97 | ||
| 1862–3 | 1·45 | 1·99 | ||
| 1863–4 | 3·21 | 16·52 | 1·88 | 12·35 |
| 1864–5 | 1·75 | 8·69 | 1·68 | 3·75 |
| 1865–6 | 0·69 | 14·24 | 0·11 | 0·51 |
Malaria became particularly widespread; on an average no less than 52 per cent of the white troops and 83 per cent of the coloured troops contracted the disease per annum. It is absurd to say, then, that the negroes are immune to the disease; on the contrary, they contracted it much more frequently and suffered a great deal more severely from it than the whites. The troops in the military districts of Carolina and Arkansas, and also along the great rivers—the Mississippi, Ohio, and Potomac—were attacked by it with particular severity. Out of every thousand men the number that contracted the disease and the number that succumbed to it is shown by the following table:[[220]]
| White Troops. | Coloured Troops. | |||
|---|---|---|---|---|
| No. patients. | No. deaths. | No. patients. | No. deaths. | |
| 1861–2 | 404·0 | 2·77 | ||
| 1862–3 | 460·1 | 3·76 | ||
| 1863–4 | 584·1 | 3·19 | 833·7 | 15·19 |
| 1864–5 | 558·4 | 3·34 | 750·0 | 8·77 |
| 1865–6 | 853·1 | 5·42 | 947·0 | 7·81 |
The total loss sustained by the Northern army in consequence of the most important infectious diseases is indicated by the following table:[[221]]
| White Troops. | ||||||||
|---|---|---|---|---|---|---|---|---|
| No. troops. | Typhoid fever. | Typhus fever. | Dysentery, diarrhoea. | Cholera. | Small-pox. | Measles. | Malaria. | |
| 1861 May-June | 41,556 | 17 | 3 | 4 | 1 | 3 | 1 | |
| 1861–2 | 288,919 | 5,795 | 201 | 1,205 | 34 | 393 | 568 | 800 |
| 1862–3 | 659,955 | 11,658 | 378 | 10,554 | 96 | 950 | 1,314 | 2,480 |
| 1863–4 | 675,413 | 5,632 | 123 | 10,661 | 56 | 2,171 | 1,268 | 2,152 |
| 1864–5 | 645,506 | 7,266 | 124 | 13,740 | 67 | 1,131 | 1,082 | 2,155 |
| 1865–6 | 101,897 | 894 | 21 | 1,630 | 22 | 71 | 11 | 552 |
| Annual Average | 468,275 | Totals 31,262 | 850 | 37,794 | 275 | 4,717 | 4,246 | 8,140 |
| Coloured Troops. | ||||||||
| 1863–4 | 45,174 | 1,251 | 60 | 2,003 | 7 | 760 | 568 | 699 |
| 1864–5 | 89,143 | 1,680 | 41 | 3,235 | 10 | 775 | 334 | 782 |
| 1865–6 | 56,617 | 650 | 7 | 1,526 | 13 | 806 | 29 | 442 |
| Annual Average | 63,645 | Totals 3,581 | 108 | 6,764 | 30 | 2,341 | 931 | 1,923 |
In the prisons the mortality on both sides was terrible. Regarding the conditions among the Confederate prisoners that were interned in the Northern States we are informed by the following table. The average number of men in the prisons was 40,815, and of this number 19,060, all told, died; taking the entire war into account, this gives a mortality of 230.7 per 1,000 per annum.[[222]] The figures are divided among the various diseases as follows:
| Deaths (all told). | Annual rate per 1,000. | |
|---|---|---|
| Typhoid Fever, Typhus Fever | 1,109 | 13·6 |
| Malaria | 1,026 | 12·6 |
| Small-pox, Measles, Scarlet Fever, Erysipelas | 3,453 | 42·3 |
| Diarrhoea, Dysentery | 5,965 | 73·0 |
| Scurvy | 351 | 4·3 |
| Bronchitis | 133 | 1·6 |
| Inflammation of the Lungs and Pleurisy | 5,042 | 61·7 |
| Other diseases | 1,729 | 21·3 |
| Wounds and uncertain maladies | 252 | 0·3 |
| Total | 19,060 | 230·7 |
The conditions among the Northern prisoners confined in the Southern prisons were still worse. In the Andersonville prison, where in the six months between March 1 and August 31, 1864, an average of 19,453 prisoners were confined, 7,712 died; this means an annual rate of 792.8 per 1,000 men. The following table indicates the proportional mortality of the individual diseases:[[223]]
| Cause of death. | Deaths (all told). | Annual rate per 1,000. |
|---|---|---|
| Typhoid Fever, Typhus Fever | 199 | 20·5 |
| Malaria | 119 | 12·2 |
| Small-pox, Measles, Scarlet Fever, Erysipelas | 80 | 8·2 |
| Diarrhoea, Dysentery | 4,529 | 465·6 |
| Scurvy | 999 | 102·8 |
| Bronchitis | 90 | 9·2 |
| Inflammation of the Lungs and Pleurisy | 266 | 27·4 |
| Other diseases | 844 | 86·7 |
| Wounds and uncertain maladies | 586 | 60·2 |
| Total | 7,712 | 792·8 |
Since mortality statistics existed in only a few of the Northern States at that time, and the deaths for the year in question were included merely incidentally in the census taken every ten years, it is impossible to adduce any figures relating to the spreading of infectious diseases from the army to the civil population. But certain it is that this happened to a great extent in the regions where the fighting took place. In the case of two States, Massachusetts and Connecticut, mortality statistics are available; in both we find an increased death-rate during the Civil War. The figures, which do not include the still-births, are as follows:
| Year. | Connecticut. | Massachusetts. |
|---|---|---|
| 1860 | 16·3 | 18·7 |
| 1861 | 16·5 | 19·5 |
| 1862 | 18·0 | 18·5 |
| 1863 | 18·0 | 22·1 |
| 1864 | 19·0 | 22·8 |
| 1865 | 16·0 | 20·6 |
| 1866 | 15·0 | 18·1 |
| 1867 | 14·3 | 17·0 |
In the case of Massachusetts, moreover, we have statistics relating to the cause of death; these statistics show a considerable increase in deaths due to typhoid fever, small-pox, and dysentery; the mortality of scarlet fever was also very high there during the war-years, but this fact was in no way connected with the war. The number of people who contracted the above-mentioned diseases in Massachusetts was:[[224]]
| Year. | Typhoid Fever. | Small-pox. | Dysentery. |
|---|---|---|---|
| 1860 | 937 | 334 | 441 |
| 1861 | 989 | 33 | 532 |
| 1862 | 1,135 | 40 | 479 |
| 1863 | 1,442 | 42 | 1,156 |
| 1864 | 1,344 | 242 | 1,186 |
| 1865 | 1,694 | 221 | 1,548 |
| 1866 | 1,091 | 141 | 949 |
| 1867 | 965 | 196 | 658 |
4. The Italian War of 1859[[225]]
The Italian War of 1859, which the French and Piedmontese together waged against Austria in Upper Italy, was not attended by any severe pestilences, probably because it was terminated in a comparatively short time, and the number of troops engaged was not very large. To be sure, typhoid fever and dysentery carried away many men on both sides, while an unusually large number of soldiers contracted malaria. Those fevers which were called ‘Fièvres rémittentes épidémiques d’Italie’, and which, notwithstanding their frequent occurrence, caused only a few deaths, according to Niedner were for the most part malaria, and not relapsing fever. The Austrian army seems to have lost more men in consequence of pestilences than the French army. Regarding the spreading of the pestilences on a large scale from the armies to the civil population we have no information.