OTRAS CAUSALES DE EXTINCIÓN DE LA CONCESIÓN

Before the materia medica and therapeutics can be understood, the diseases affecting the men in camp and field need to be briefly exam- ined. Although every possible malady recorded during the war can- not be covered in detail, it will be recalled from previous discussion, that diarrhea and dysentery, various fevers, respiratory ailments, and digestive disorders were the chief maladies affecting both Union and Confederate troops. For Union forces alone, the numbers were high: 711 per 1,000 for diarrhea/dysentery; 584 per 1,000 for various camp fevers (the vast majority diagnosed as malarial, at 522 per 1,000); 261 per 1,000 suffered from respiratory ailments (mostly acute bronchi- tis); and 252 per 1,000 reported digestive complaints. Each of these will be addressed, but it is important to emphasize that disease was a serious and ever-present problem for the medical corps of both sides.1

Historian Paul Steiner has argued convincingly that disease played significant roles in major campaigns. First, General Robert E. Lee’s failure to reclaim western Virginia in 1861 was due to his troop’s de- bilitating bouts of diarrhea and dysentery, typhoid fever, and pneu- monia. Lee wrote home to his wife during this “sickly period”2_{in Au-}

gust 1861, complaining that “soldiers everywhere are sick.”3_Next

came the Union’s initial campaign in late 1861 and early 1862 along the South Carolina coast, where attempts to seize Charleston and sever the railroad between that city and Savannah were stopped by devastating epidemics, principally yellow fever.4 _{About the same}

time yet another operation, this time in eastern Kentucky, was se- verely hampered by enteric disorders, and in July and August the Un- ion was robbed of manpower by dysentery, typhoid, and malaria.5

The Peninsular Campaign was also affected by disease. Despite offi- cial claims from the inept Medical Director Charles Tripler that there were no epidemic diseases spreading through the Army of the Poto- mac, 48,912 cases of diarrhea and dysentery were hard to ignore.6

Army of the Potomac Commander George B. McClellan was not a leader of action and resolve, but Lincoln’s complaint that his general had a bad case of the “slows” was ironically true, in part, because so many of his men had worse cases of “the trots.” The first siege of Vicksburg, lasting from May through July 1862, failed largely for two reasons: first, a serious attack of malaria; second, a serious short- age of quinine.7_{Even late in the war, Union troops were decimated}

by disease in Arkansas from 1863 to 1865. Here debility stemmed again from malaria, statistics showing that 1,287 cases occurred per 1,000 men.8_{In other words, on average every Union soldier in Ar-}

kansas could expect an attack of malaria once a year, sometimes twice.9

Disease consistently ran nearly twice the mean troop strength throughout the war (see Figure 6.1). So the average soldier could ex- pect to become ill—at least ill enough to report it—about twice a year. The image of surgeons lopping off arms and legs as quickly as possible with the appendages falling into bloody heaps may have lodged itself securely within the popular imagination, but it bears lit- tle resemblance to what most Civil War surgeons faced on a daily ba- sis. These men were not cutting half as much as they were prescrib- ing. Moreover, it could be argued that the effectiveness of the U.S. Medical Department in combating disease was at least as important

as combat in the field and, in fact, more important to the Union side than the Confederate. Although disease was a great leveler to both sides, the nature of the war itself should be kept in mind. It has been pointed out by historians and military strategists that the South could win by simply doing nothing.10_{By waging a defensive war of attri-}

tion the South could gain its independence by simple passive obsti- nacy, testing the adversary’s resolve to the point of victory. The North, on the other hand, would have to fight an aggressive war, win decisively, and occupy 750,000 square miles of territory. To be sick and avoid defeat is much easier than it is to be sick and win victories; strange as it may seem, at least early in the war, disease was the South’s great ally. With the exception of Lee’s loss of West Virginia, most other major campaigns in which disease figured prominently worked to the detriment of Union actions.

All of this underscores the importance of the materia medica in the healing art of the military surgeon and compounding hospital stew- ard. Statistics may give some sense of proportions in the Civil War medical armamentarium. In the course of the war, the Medical Pur- veying Bureau issued 775,000 ounces of ipecac (an expectorant, dia- phoretic [causing sweating], and emetic thought to be beneficial in

FIGURE 6.1. Union Army mean troop strength and incidents of disease (cases reported). Figures taken fromThe Medical and Surgical History of the War of the Rebellion, Part 1, Volume 1, Medical Volume (Washington, DC: GPO, 1875),

pp. 147, 297, 453, 605. Incidents of disease were even higher among Confeder- ate troops (see Table XIV inMed. Surg. Hist., Part 3, Volume 1, Med. Vol., p. 32).

stomach ailments); more than 1 million ounces of quinine sulfate and its crude drug derivative cinchona (used for fevers); and some 2.3 million ounces of opiates (anodynes and antidiarrheals) among other items on the standard supply table. Even when physicians were doing surgery there was a pharmaceutical component, as seen in the essen- tial anesthetics distributed—almost 3 million ounces of ether and over 1.1 million ounces of chloroform.11