The American Civil War as a Biological Phenomenon
THIS WORK HAS EXAMINED THE EVENTS OF THE American Civil War from several different positions. We experienced the Battle of Gettysburg through the eyes of the wounded soldier. We studied the Vicksburg campaign from the so-called objective point of view. While appreciating the growth and improvement of medical care in the Union army, we saw the War through Northern eyes; the states in rebellion against the lawful government were the enemy. We alternated this with the view from the Confederate Surgeon General's Office in Richmond; the brutal Yankee invader was, in the words of Simon Baruch, “a drunken and infuriated foe.”1
While great armies clashed on the North American continent, Louis Pasteur in France was developing the idea that disease could be caused by a living being so small that it was invisible. This chapter views the American Civil War from the viewpoint of that living infectious agent. For this invisible organism, the huge Civil War armies represented an opportunity for expansion, a gigantic petri dish.
Diarrhea was the soldier's companion during the Civil War. Diarrhea is not a specific disorder but a symptom of many diseases. Fecal contamination of the food and water supply was responsible for this syndrome in the vast majority of soldiers. Infectious agents that produced diarrhea during the Civil War included viruses, parasites, such as Giardia and Entamoeba, and bacteria, such as Shigella, Salmonella, Campylobacter, and E. coli. These organisms developed in the gastrointestinal tract of one person and were discharged onto the ground, possibly in a latrine, but perhaps anywhere. They made their way into food or water and were ingested by other individuals.
In the gastrointestinal tracts of these other people, the organisms multiplied. Acute diarrhea occurred. If the organism survived in the colon, the diarrhea became chronic. The fluid loss of chronic diarrhea led to dehydration, fatigue, and debilitation. The salivation produced by calomel worsened this dehydration.2 Diarrhea occurred in civilian life, of course, but the congregation of large numbers of men increased the opportunity for infectious agents to disperse and multiply.
Outbreaks of diarrhea were also caused by food poisoning. Cooks fed soup or broth to the troops for lunch, then allowed the remaining food to sit until supper. This broth was a perfect medium for the multiplication of bacteria and parasites. The biological effect of bringing many hundreds of thousands of men together is an analogy to the warm broth: an opportunity for infectious agents to pass from one gastrointestinal tract to many, to multiply, and to flourish.
The bacterium Salmonella typhi entered the soldier through contaminated food and water. It fastened to the lining of the gastrointestinal tract, producing diarrhea. In many soldiers, the disease ended with the expulsion of the