Kevin Bair

For decades, historians have written about the American Civil War’s (1861-1865) medical systems, doctors, diseases and mortality. Overall, the literature centers around how various diseases played an ominous part in the way the war was conducted. Each historian reviewed had their own independent lens of the war, yet, woven within their individual thoughts is a common theme of devastating illnesses and maladies which were experienced by many soldiers throughout the war. Of the varied diseases, malaria, dysentery, and typhoid, were especially disastrous, not only for the men who contracted them, but also for the success or failure of military campaigns, such as the ill-fated 1862 Peninsula Campaign of Union General George B McClellan (1826-1885).

It was projected out of the 3.5 million soldiers who served during the war,^[1] approximately 620,000 soldiers died,^[2] roughly 413,000 succumbed to disease, and there was around 6,000,000 cases of sickness.^[3] Moreover, as the pathology of germs would not arrive for another decade via discoveries by Louis Pasteur’s (1822-1895) germ theory and Joseph Lister’s (1827-1912) experiments with carbolic acid antisepsis, army doctors had to poke, prod, purge, and invade every sickly soldier hoping to restore their health while seeking causations to many unanswered medical questions.^[4] Consequently, out of the war’s death and destruction, there was a rapid movement in medical innovation, mostly out of necessity, along with new and rigorous research into disease causation. Thus, this paper will explore the variety of ways some historians viewed the medical world of the American Civil War.

Professor George Worthington Adams (1905-1981), in his book Doctors in Blue: The Medical History of the Union Army in the Civil War (1952), explored the complex medical story of an early 1861 ill-equipped and unprepared Union army medical system. Adams noted, in that year, medical theory did not understand how disease and bacteria worked together, yet there was a belief that bad smells “mephitic effluvia” of unburied garbage, privies, crowded tents, as well as “malarial miasms [sic]”, that of stagnant and bad smelling water, was the cause of fevers and chills.^[5] Moreover, he pointed out before the war, the bulk of the soldiers had never learned good hygiene, therefore as men gathered in groups there was a high rate of disease, especially in the spring campaigns of 1862.^[6] Additionally he noted, Southerners would call their summer season “General Summer” on account of the start of the summer diseases, dysentery, malaria and typhoid; which acted like its own morbid army.^[7] Furthermore, the war’s morbidity rate was 2,435 per thousand [sic] while mortality was around 53.4 per thousand.^[8]

Adams, in looking at camp hygiene, quoted a medical director who suggested when garbage lies everywhere in camps and streets, there is a “noisome odor…in and out of camp tents”, and “the men are dirty, ragged and sickly…they are insubordinate…and without discipline.”^[9] He also explained, due to an array of “bewildering confusion of theories”, any preemptive treatment of malaria was delayed or non-existent.^[10] Union medical doctors of the day were “average in their education and experience” and lacked surgical capability, which they gained through on the job training.^[11]

While Adams focused on the Union’s medical conditions, Horace Herndon Cunningham (1913-1969) looked at the Confederate’s medical conditions in his book, Doctors in Gray: The Confederate Medical Service (1958). Cunningham suggested the massive amount of reported sickness and diseases in 1861 stemmed from the lack of proper military regulations and thorough screenings of new recruits. He also mentioned how many of these soldiers were sickly before enlistment, thus unfit for military service and the rigors of camp life.^[12] Furthermore, in a subchapter titled, Neglect of Camp Hygiene, like Adams, Cunningham discussed how in the early days of the war there was a very poor sanitary environment, with a neglect of camp and personal cleanliness, especially in regards to the placement of latrines. He related, in 1861, after a major rainstorm washed through General Robert Edward Lee’s (1807-1870) camp of 17,000, many of the men became ill, with forthcoming medical reports indicating some 4000 cases of diseases developing such as dysentery, typhoid fever, and pneumonia. He also reported these diseases and illnesses had a particularly high mortality rate. Additionally, Cunningham stated it was later discovered rainwater washed the waste from the latrines into the troop’s supply of drinking water. ^[13]

Furthermore, he reported the Confederate doctors, like their Union counterparts, also associated malaria and other diseases with bad smells, i.e., miasmas, and he stated one of the treatments thought to prevent malaria was the burning of tar, and it was assumed if you marched upwind of stagnant water there would be no danger of contracting malaria. He went on to explain from January 1862 to July 1863, South Carolina, Georgia, and Florida Confederate troops reported 41,539 malaria cases, with 227 deaths, along with 13,668 cases in and around Mobile Alabama.^[14] Both authors agreed the standard treatment of malaria at the time for the Union and the Confederacy was Quinine.

Moreover, Cunningham suggested towards the end of the war the Confederate armies began assorted retreats, and as they withdrew, they had little choice but to abandon good hospitals and stable care for their soldiers; thus, a problem erupted in how to take care of the existing sick and the wounded. He quoted Confederate Medical Director A. J. Foard of the Army of Tennessee in regards to relocating, doctors, patients and hospitals, “The poor sick and wounded are calling on the doctors for help when there is no help— for they are rendered powerless.”^[15]

Jeffrey S. Sartin, in his article, Infectious Diseases during the Civil War: The Triumph of the “Third Army” (1993), suggested during the war the real combatants wore neither the Blue or the Gray uniform, but was an invisible army, the “Third Army” of disease. Moreover, he suggested the stealthy effectiveness of the “Third Army” caused many battles to be delayed along with the total cancellation of several major campaigns. Moreover, he proposed due to disease and illness, the war was prolonged by at least two years. Like Adams and Cunningham, Sartin pointed out these epidemic infections spread from the lack of performing tasks such as basic camp, tent and hospital cleaning, and quarantine. As for treatment of malaria, he conveyed there had not been an established set of guidelines for the recommended dose and timing, thus many treatments were ineffective.^[16]

Moreover, Sartin added statistics on mortality from infections and diseases. For the Union army, it was around 275,000 deaths out of approximately 2.2 million who were ill. While in the Confederate army, it was estimated out of 750,000 soldiers there was roughly 164,000 deaths. He continued, Union forces had about 6.4 million separate medical diagnoses-mostly infections and about 220,000 men were discharged with some type of chronic disability. Additionally, some surgeons believed the welfare of the army was excellent; even though around 20% of its soldiers were unusable.^[17]

Furthermore, Sartin described the problem with measles, mumps, pertussis, and varicella. He suggested, as many of these men had never been gathered into large groups, as the bulk came from a rural setting, they had never been subjected to those childhood diseases: measles, mumps, pertussis, and varicella. These diseases, he indicated, slowly “took their toll” on many of the men, and if they survived exposure to them, there was still the greater “camp disease” such as smallpox, pneumonia and erysipelas waiting for them.^[18] He quoted Robert E. Lee on troop hygiene, “They are worse than children [at keeping clean], for the latter can be forced.”^[19]

In his section titled, The Assault of the Third, Sartin recounted how there was 45,000 deaths and 1.765 million episodes of pneumonia, which included bronchitis and influenza. Furthermore, he stated typhoid claimed the lives of 35,000 soldiers and incapacitated 149,000 others. As for diarrhea and dysentery, there was 360,000 cases and the death of at least 21,000 men. Malaria killed 10,000 Union soldiers and affected around 1.316 million. He concluded the incidences and death rates of the Confederates were most likely comparable to the Union, but stated they cannot be verified, as most of the Confederate records were burned by the advancing armies.^[20]

Additionally, Sartin detailed how this “Third Army”, comprised of malaria, typhoid, and dysentery, attacked McClellan’s troops and foiled his 1862 Peninsula Campaign (March 1862–August 2) to capture Richmond. The campaign had McClellan’s troops camped for an extended period along the Chickahominy and St Johns rivers. During that time, Sartin explained there was an unusual amount of slow-moving rain and thunderstorms which undulated the area. He stated long exposure to the ongoing wet environment slowly sickened McClellan’s men to the point that he did not have enough men to overtake Richmond. Thus, according to Sartin, this invisible army reduced McClellan’s workable men by one-third. In fact, he stated the data collected indicates over a nine-month period each of McClellan’s soldiers experienced three different bouts with disease.^[21]

Using personal notes and diaries, Robert E Denney in his book, Civil War Medicine: Care and Comfort of the Wounded (1994), explored how various wartime medical staff dealt with the war. He conveyed how several medical facilities were overburdened and had witnessed a constant disruption to their supplies, such as anesthesia and other basic provisions, which in turn, caused many additional lives to be lost. Moreover, he demonstrated the supply shortage by quoting a correspondence dated May 30,1862, from H. E. Brown, Surg., USA, Hooker’s Div., Battle of Seven Pines (Fair Oaks), Va., “The supplies for the wounded were abundant… The only articles deficient were chloroform and ether; and that, I think, was not due to any neglect, but to the fact of the unusually large number of wounded….”^[22] Additionally, Denney proposed that thousands of soldiers died from lack of medicine, lack of facilities, inattention, and in some cases, cruelty.^[23]

Denney, by using personal diaries and letters, provided great insight into the conditions of the field hospitals, camps and regular hospitals. He explained, in early 1861, medical services were not at the forefront of war thought; in fact, many expected either the war would not happen at all, or it would be over in a short period of time. Additionally, it is through the personal papers of Mary Ann Bickerdyke, a nurse and administrator in a regimental hospital in Cairo Illinois, and that of Sgt. Jonathan Stowe, Co. G, 15th Mass., that allowed Denney to accurately recall the hospitals’ sights and smells. From Bickerdyke, on June 1861, “Inside the first tent were ten men, only one or two with cots…The dirt floor of the tent, the part that wasn’t covered with human bodies, was covered with human excrement, and flies swarmed over the sick men. The men…only in shirts and underwear, which were covered with filth and vomit and smelly with stale sweat.”^[24] Sgt. Stowe, on September 28,1862, while in the hospital at Sharpsburg (Antietam), Md., stated, “The horrid smell from mortifying limbs is nearly as bad as the whole we have to contend [with].”^[25] By using such personal correspondence, Denney provides the reader with a surreal feeling of being there, stepping, so to speak, in their shoes.

Michael R Gilchrist looked at surgical innovations in his article, Disease & Infection in the American Civil War (1998). In it, he discussed how the Union Blockade of the Southern ports limited the Confederacy’s medical supplies, forcing them to improvise, to be creative in substituting their missing medical provisions. He explained how some Southern doctors, out of necessity, when needing surgical sponges, substituted them for cotton rags.^[26] Furthermore, he reported, one doctor, when silk ligatures could not be acquired, decided to use the hair from a horse’s tail for his patient’s stitches.^[27] And other doctors, Gilchrist explained, experimented with maggots, using them to eat away the patient’s dead tissue around their amputation, thus allowing healthy tissue to grow in its place. Furthermore, he noted, some investigative doctors witnessed a decrease in their patients’ death rates after experimenting with applying various chemicals to their wounds. He also remarked, some doctors found sodium hypochlorite (bleach), bromine, potassium permanganate, iodine, nitric acid, chlorine, and creosote to be useful in treating patients.^[28]

Anesthesia, created in the early 1830’s, was another medical supply surgeons depended on. According to Terry Reimer, Research Director for the National Museum of Civil War Medicine, the image of the wounded soldier biting a bullet during surgery is a myth, when in fact, 95 percent of all Civil War surgeries used one of two anesthesias, either Chloroform or Ether.^[29] Wilbur C. Keith, M.D, (1923-2009) in his book Civil War Medicine 1861-1865 (1998), provided great details on the use of anesthesia in field hospitals. While Gilchrist gave information on how surgeons discovered the effects of certain chemicals on wounds, Keith gives interesting facts on the application of anesthesia. He explained how in the 1863 Confederate Manual of Military Surgery, it indicated for Confederate doctors, prior to applying anesthesia, it was a “universal practice” to first give the patient brandy and if needed, they would also supply some amount of laudanum. Additionally, the doctor was to “reassure the patient that any feeling of suffocation would soon pass.” Furthermore, in order to prevent facial blistering when applying the anesthesia, it was best to keep the chloroform cone at least ½ inch from the patient’s face. Likewise, the manual indicated the possible reaction patients may experience with chloroform, such as excitement, wide eyed cries, and hallucinations. It also noted, while giving the anesthetic, the anesthetist should pay the “strictest attention to the patient’s, pulse, respiration and countenance.^[30]

Frank R. Freemon continued discussing the many medical innovations born out of necessity in his book, Gangrene and Glory: Medical Care During the American Civil War (1999). In it, he presented additional information on how Confederate doctors were forced to improvise when they ran out of the malaria fighting medicine Quinine. He explained, when out of Quinine, Confederate Surgeon General Samuel Preston Moore (1813-1889) personally recommended the following ingredients to combat malaria, “dogwood bark, thirty parts, popular bark, thirty parts, willow bark, forty parts; two pounds of dried bark to one gallon of whiskey, macerate fourteen days, then take one ounce three times a day.” Gilchrist also conveyed, none of these homemade remedies offered proof the patient experienced any relief from the effects of malaria.^[31]

Douglas Savage offers further insight into the effects that illnesses and diseases had on military campaigns in his book, Civil War Medicine (2002). In it he explains, between April and June 1862, an outbreak of disease and illness in Corinth, Mississippi forced General Pierre G. Beauregard (1818-1893) and 112,000 Rebels to abandon the city to General Grant and his 90,000 Yankees. Savage indicates, Beauregard must have felt he had little choice but to surrender the city, as 28,000 of his men were sent either to general hospitals or home, and another 26,000 were listed sick in Corinth. When combined, these numbers indicate more than half of his troops were immobile due to disease or illness. ^[32]

Regarding troops being incapacitated, Alfred Bollet, MD., in his book, Plagues & Poxes: The Impact of Human History on Epidemic Disease (2004), mentioned how spontaneous diarrhea and dysentery completely diminished the ability of the soldier. He explained how during the American Civil War, “diarrhea was ubiquitous”, and that both Union and Confederate soldiers would not shoot a man “while he is attending to the urgent call of nature”. He continued with a quote from Civil War nurse and poet, Walt Whitman, [the war was] “about nine hundred and ninety-nine parts diarrhea to one part glory.”^[33]

Ira Rutkow also explores the intestinal issues of soldiers in his book, Bleeding Blue and Gray (2005), in which he discussed how the “twin diarrhea producers’ dysentery and typhoid” ran rabid throughout the camps, affecting more than 50,000 soldiers. Furthermore, he stated, once soldiers started complaining of headache and back pain their symptoms typically morphed quickly into unpredictable episodes of diarrhea. He noted, this emergency evacuation soon became known as the “trots or the two-step”. Moreover, Rutkow expressed, this unfortunate and volatile condition occurred between fifteen to twenty times a day, thus, it would quickly exhaust a soldier to ineffectiveness. Rutkow also suggested, to combat the malady, doctors would prescribe their own version of “Benjamin Rush’s bleed, blister and purge gambit”, or create a mixture of calomel and tartar. ^[34]

Rutkow was not the only one to shed light into the intestinal issues of the soldiers. Drew Glipin Faust in her book, This Republic of Suffering (2008) further expounded on dysentery and typhoid. She conveyed, throughout the war, nearly three-fourths of all Union soldiers experienced some form of serious bowel complaints, that by 1865, the rate for diarrhea and dysentery was 995 per 1000. She noted throughout the war, the key causation for this condition was contamination of water supplies.^[35]

Furthermore, Scott McGaugh, in his Surgeon in Blue: Jonathan Letterman, the Civil War Doctor Who Pioneered Battlefield Care (2013), added deeper analysis on dysentery than Faust reported. McGaugh described, during the war the Union army experienced more than 1.5 million cases of dysentery and acute diarrhea. He stated, “Chronic diarrhea led to ulcerated intestines, amebic and bacillary dysentery, which included the involuntary discharge of blood, could rupture intestinal walls, and produce abscesses that reduced liver, lung, and brain function.” Additionally, he recounted, many of those who survived the war faced a lifetime of lingering dysentery and possibly an early death.^[36].

Along with Sartin’s discussion on the 1862 Peninsula Campaign, Judkin Browning, in his article, Nature and Human Nature: Environmental Influences on the Union’s Failed Peninsula Campaign, 1862 (2018), explained in further detail how the peninsula’s natural environment adversely affected McClellan’s campaign. He described how the campaign was situated between two major rivers, St Johns and Chickahominy, which was comprised of low-lying marshes and several smaller streams. Additionally, he explained McClellan had used inaccurate maps of the area, thus, when coupled with days of thunderstorms, not only was McClellan’s troops delayed from moving forward to attack, but it also delayed their receiving fresh supplies such as meat, fresh vegetables and fruit. Browning suggested, it was this low-lying, rain-soaked environment, combined with the lack of good nutrition and fresh water, which caused McClellan’s men to become infected with malaria, typhoid, dysentery and scurvy.^[37]

By using an environmental lens, Browning provided a unique view into the problems facing McClellan’s 1862 Peninsula Campaign. He suggested part of McClellan’s problems was his belief that the reports and maps of the region were accurate. McClellan’s information indicated there were “good natural roads” which would allow rapid advancement of his troops, supply wagons, and heavy artillery pieces for the battle of Richmond. The editor of The Richmond Examiner expressed, weeks before McClellan’s men started on their ill-fated peninsula campaign, “If his [McClellan’s] troops push their invasion into the interior, they will have to become amphibious, and borrow some of the qualities of alligators and mud turtles. Instead of marching, they will have to wade against the secessionists.”^[38] Also, Browning noted Confederate General Lafayette McLaws (1821-1897) felt the campaign’s location and its “tremendous odds against us can not be so formidable as elsewhere in more open country.” He declared, “The country is so much cut up by these arms of the sea, called rivers, with their accompanying marshes and boggy fresh- water tributaries that it is impossible to move through it except along the main roads.”^[39]

Furthermore, McGaugh related how illness crippled McClellan’s army, that it suffered from what was called “Chickahominy Fever,” and bowel problems referred to as “the Virginia Quickstep.” Moreover, he explained these conditions of diarrhea, nausea and fatigue, usually left soldiers unable to fight, and occasionally killed them.^[40] Also, Browning related how Union General Régis de Trobriand (1816-1897) commented on McClellan’s army, stating [the army’s] “sanitary condition became worse from day to day.” Browning also added, nearly 1700 Union soldiers by the end of the campaign had been formally diagnosed with typhoid.”^[41] This was known because the typhoid generated a unique rose-rash which aided in its diagnosis. Additionally, he explained, there was also the possibility of delirium, severe stupor, intestinal bleeding or in extreme cases, kidney failure – followed by death. Moreover, typical recovery was around four weeks; but many men remained weakened for months. Browning also stated, “Infected individuals pass the bacteria onto the landscape in their stool, a process that can go on for up to a year after a person recovers from the disease.”^[42] Thus, the disease can contaminate others long after they leave an area.

To support his argument, Browning cited the Union medical director, Jonathan Letterman, who stated, “The malaria from the borders of the Chickahominy and from the swamps throughout the Peninsula…now began to manifest its baneful effects upon the health of the men… In this way it had affected the fighting power of the army.”^[43] In addition, July 1862, more than any other month of the war, produced the highest percentage of sickness. Of McClellan’s 106,069 soldiers, 19,776 were afflicted with diarrhea or dysentery along with more than 40,000 cases of illnesses.^[44]

During the Civil War, doctors struggled to understand illness and disease, yet there were doctors on the cutting edge of technology as described by Shauna Devine, in her book, Learning from the Wounded: The Civil War and the Rise of American Medical Science, (2014). In it, she explored Civil War doctors and the early uses of the microscope. In her section titled The Microscope and Civil War Medicine, she related how some doctors used the microscope to peer into the body of both living and dead soldiers, examining components of blood, urine and tissue, thus seeking a causation and cure for many of the inflicting diseases.^[45]

Additionally, she related how Doctor William Williams Keen, was introduced to the microscope while a medical student in 1860 at Jefferson Medical College. Here she explained, he became part of a coalition that was interested in the search of scientific medicine. ^[46] One area he studied was gangrene; he remarked, “hospital gangrene or the ‘typhus of wounds’ is in its most marked form, a fearful and unwelcome guest in any hospital: most of all in a military hospital. It claims many victims in its fierce attacks, and often puts to naught all the resources of the most skillful surgeon.”^[47] Devine re-counted, through the microscope, Keen and his cohorts were trying to establish basic changes that occurred within tissue and cells of diseased bodies. She noted, Keen was looking at “inflammation, blood vessels and blood, pus, nerve and sense organs.”^[48] Furthermore, she added, Keen and his staff instructed hospitals and field doctors to examine microscopically their patient’s stool and report their findings back to Keen’s staff. ^[49]

Moreover, Devine stated, through much collected effort the multitude of cases of diarrhea and dysentery were analyzed and grouped, thus the finding “emphasized cellular, tissue, and fluid changes and was ‘illustrative of the normal histology of the intestine” along with the ‘changes they undergo in fever and diarrhea.’”^[50] Keen and his group also photographed these microscopic images, published their findings and had the combined information packaged and distributed to the field doctors, thus doctors could readily compare their patients wounds to available images of healthy and diseased tissues.

Conclusion

In following the numerous historians outlined in this article, a path was woven from each perspective, thus conveying a view of the depth, breadth, and effect that illnesses and diseases such as malaria, dysentery and typhoid had on the daily operations and strategic planning of the Civil War. And, along this historic trail, it was demonstrated how the war spurred medical intervention, innovation for new treatments, and the researching of cures via microscopes. Moreover, these diseases could stop entire offensives, such as the 1862, Peninsula Campaign of Union General McClellan.

Yet, out of the 413,000 who succumbed to diseases, the 6 million cases of sickness and the 620,000 soldiers who died, a phoenix arose in the form of medical progress from men like Doctor William Williams Keen and his colleagues. Seeking better understanding in the causation and effects that dysentery and diarrhea had on the intestines, these men led a collaborative effort using microscopes and photography to research, document, and image their findings; thus, these breakthroughs provided the medical community a better understanding of the normal histology of the intestines and the changes they underwent in both fever and diarrhea. This information helped provide Civil War doctors with progressive knowledge on how the diseases plagued the soldiers and affected the war effort.

Bibliography

Adams, George Worthington. Doctors in Blue: The Medical History of the Union Army in the Civil War. New York: Henery Schuman, 1952.

Bollet, Alfred MD. Plagues & Poxes: The Impact of Human History on Epidemic Disease. New York: Demos Medical Publishing, Inc. , 2004.

Browing, Judkin, and Timothy Sllver. Nature and Human Nature: Environmental Influences on the Union’s Failed Peninsula Campaign, 1862. 2018: 388-415. doi:10.2307/26483633.

Cunningham, H.H. Doctors in Gray: The Confederate Medical Service – 1958. Baton Rouge: Louisiana State University Press Kindle, 2014.

Denney, Robert E. Civil War Medicine:Care and Comfort of the Wounded. New York: Sterling Publishing Co., Inc., 1994.

Devine, Shauna. Learning from the Wounded: The Civil War and the Rise of American Medical Science. Chapel Hill: The University of North Carolina Press, 2014.

Faust, Drew Glipin. This Republic of Suffering . New York: Vintage Books Div. Random House, 2008.

Freemon, Frank R. Gangrene and Glory : Medical Care During the American Civil War . Madison, N.J.: Fairleigh Dickinson University Press, 1999.

Gilchrist., Michael R. Disease & Infection in the American Civil War. The American Biology Teacher 60, no. 4, 1998: 258-62.doi:10.2307/4450468.

Lein, Glenna R. Schroeder-. The Encyclopedia of Civil War Medicine. Armonk, N.Y.: Routledge, 2008.

McGaugh, Scott. Surgeon in Blue Jonathan Letterman, the Civil War Doctor who Pioneered Battlefiel Care. New York: Arcade Publishing, 2013.

Reimer, Terry. Anesthesia in the Civil War. 01 22, 2017. http://www.civilwarmed.org/anesthesia/

Rutkow, Ira. Bleeding Blue and Gray. Mechanicsburg, PA.: Stackpole Books, 2005.

Sartin, Jeffrey S. Infectious Diseases during the Civil War: The Triumph of the “Third Army” Clinical Infectious Diseases, Vol. 16, No. 4, 1993: 580-584. https://www.jstor.org/stable/4457020 .

Savage, Douglas. Civil War medicine. Philadelphia: Chelsea House Pub, 2000.

Wilbur, C. Keith. M.D. Civil War Medicine 1861-1865. Philadelphia: Chelsea House Publishers, 1998.

1. Scott, McGaugh, Surgeon in Blue Jonathan Letterman, the Civil War Doctor who Pioneered Battlefield Care. 9New York: Arcade Publishing, 2013), 281. ↑
2. Glenna R. Schroeder-. Lein, The Encyclopedia of Civil War Medicine. (Armonk, N.Y.: Routledge, 2008), xiii. ↑
3. George Worthington Adams, Doctors in Blue: The Medical History of the Union Army in the Civil War. (New York: Henry Schuman, 1952), 3. ↑
4. Jeffrey S. Sartin, Infectious Diseases during the Civil War: The Triumph of the “Third Army” (Clinical Infectious Diseases, Vol. 16, No. 4 , 1993), 583. ↑
5. Adams, George Worthington. Doctors in Blue: The Medical History of the Union Army in the Civil War. (New York: Henry Schuman, 1952), 196. ↑
6. Ibid.196. ↑
7. 223. ↑
8. 224. ↑
9. 197. ↑
10. 191. ↑
11. Adams, George Worthington. Doctors in Blue: The Medical History of the Union Army in the Civil War. (New York: Henry Schuman, 1952), 115. ↑
12. H.H. Cunningham, Doctors in Gray: The Confederate Medical Service – 1958. (Baton Rouge: Louisiana State University Press Kindle, 2014), 163. ↑
13. Ibid.168. ↑
14. H.H. Cunningham, Doctors in Gray: The Confederate Medical Service – 1958. (Baton Rouge: Louisiana State University Press Kindle, 2014), 218. ↑
15. Ibid. 67. ↑
16. Jeffrey S. Sartin, Infectious Diseases during the Civil War: The Triumph of the “Third Army” (Clinical Infectious Diseases, Vol. 16, No. 4, 1993), 580. ↑
17. Ibid.580. ↑
18. 581. ↑
19. 581. ↑
20. Jeffrey S. Sartin, “Infectious Diseases during the Civil War: The Triumph of the “Third Army” .”(Clinical Infectious Diseases, Vol. 16, No. 4 , 1993), 582. ↑
21. Ibid. 583. ↑
22. Robert E. Denney, Civil War Medicine: Care and Comfort of the Wounded. (New York: Sterling Publishing Co., Inc., 1994), 112. ↑
23. Ibid. 12. ↑
24. 25. ↑
25. 166. ↑
26. Michael R Gilchrist. Disease & Infection in the American Civil War. (The American Biology Teacher 60, no. 4, 1998) 259. ↑
27. Ibid. 260. ↑
28. 260. ↑
29. Reimer, Terry. Anesthesia in the Civil War. (01 22, 2017. http://www.civilwarmed.org/anesthesia/) ↑
30. Wilbur C. Keith, M.D. Civil War Medicine 1861-1865. (Philadelphia: Chelsea House Publishers, 1998), 43. ↑
31. Frank R Freemon, Gangrene and Glory: Medical Care During the American Civil War. (Madison, N.J.: Fairleigh Dickinson University Press, 1999), 218. ↑
32. Douglas Savage, Civil War Medicine. (Philadelphia: Chelsea House Pub, 2000),48. ↑
33. Alfred Bollet, MD. Plagues & Poxes: The Impact of Human History on Epidemic Disease. (New York: Demos Medical Publishing, Inc., 2004) 6. ↑
34. Rutkow, Ira. Bleeding Blue and Gray. (Mechanicsburg, PA, Stackpole Books, 2005),91. ↑
35. Drew Glipin Faust. This Republic of Suffering. (New York: Vintage Books Div. Random House, 2008),4. ↑
36. Scott McGaugh, Surgeon in Blue Jonathan Letterman, the Civil War Doctor who Pioneered Battlefield Care. (New York: Arcade Publishing, 2013), 231-32. ↑
37. Browning, Judkin, and Timothy Silver. Nature and Human Nature: Environmental Influences on the Union’s Failed Peninsula Campaign, 1862. (Journal of the Civil War Era 8, no. 3, 2018), 393. ↑
38. Ibid.393. ↑
39. Browning, Judkin, and Timothy Silver. Nature and Human Nature: Environmental Influences on the Union’s Failed Peninsula Campaign, 1862. (Journal of the Civil War Era 8, no. 3, 2018), 393. ↑
40. Ibid. 401. ↑
41. 402. ↑
42. Browning, Judkin, and Timothy Silver. Nature and Human Nature: Environmental Influences on the Union’s Failed Peninsula Campaign, 1862. (Journal of the Civil War Era 8, no. 3, 2018), 401. ↑
43. Browning, Judkin, and Timothy Silver. Nature and Human Nature: Environmental Influences on the Union’s Failed Peninsula Campaign, 1862. (Journal of the Civil War Era 8, no. 3, 2018), 406-7. ↑
44. Ibid. 407. ↑
45. 40. ↑
46. 40. ↑
47. 34. ↑
48. Shauna Devine, Learning from the Wounded: The Civil War and the Rise of American Medical Science. (Chapel Hill: The University of North Carolina Press, 2014), 66. ↑
49. 85. ↑
50. 85. ↑

Cover Photo: Ward in the Carver General Hospital, Washington, D.C. 111-B-173. National Archives Identifier: 524592