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nature of malaria, typhus, bronchitis, or pneumonia. As a result, men were taken into the armies carrying a number of diseases with them, and then packed into teeming military camps where they could easily spread a vast sampling of pathogens among themselves.

The volunteers unwittingly added to the odds against them by responding to sanitary discipline with the same contemptuous independence they displayed toward military discipline, and only with the greatest difficulty could they be persuaded to take appropriate health precautions. Camp life, for white American males in the nineteenth century, created an inversion of social roles, since male soldiers now found themselves responsible for a range of domestic labors—sewing clothes, cooking meals, cleaning—which were normally assigned at home to women, and many soldiers were unable to make the cognitive adjustment to the performance of these tasks even when their lives depended on it. “I am most heartily sick of this kind of life,” wrote Jacob W. Bartness, an Indiana soldier, to his wife in 1865. “Oh, what a pleasant retreete from the repulsive scenes of this man-slaughtering life, would be the society of my family in some secluded spot, shut out from the calamities of war.”65

On campaign, the constant exposure to all varieties of weather, and the vulnerability of northern-bred systems to the drastic ecological difference of the deep South’s climate and environment, made Northern soldiers particularly vulnerable to sickness. Charles Jewett of the 2nd New Hampshire wrote home in July 1862 warning a family friend of the rough living that would await him if he enlisted. “If he thinks it would be any Benefit to his health, tell him to try it at home first. Tell him to go out dores and sleep on the ground through two or three rain storms without any thing to put over or under him. If that don’t dishearten him put [a] half Bushel of corn on his back and march all day, then take a Shovel and shovel all night without any thing to eat or drink.”

The impossibility of washing and cleaning on long marches made the volunteer an easy target for infestations of lice, fleas, ticks, and other pests. For John Billings, the constant presence of lice was a great leveler of pretensions, the butt of a good soldiers’ joke. “Like death,” Billings wrote, lice were “no respecter of persons.” The pest “inserted its bill as confidingly into the body of the major-general as of the lowest private. I once heard the orderly of a company officer relate that he had picked fiftytwo graybacks from the shirt of his chief at one sitting.” Soldiers in the 154th New York wrote home in exasperation that “when we were on the march, we had every time we stopped to take off our shirts and drawers and kill the lice, to keep them from carrying us off.” Few soldiers suspected that these pests also helped to transmit bacteria through bites and open sores. In camp, the volunteers carelessly continued to make trouble for themselves. Water contaminated by poorly dug latrines, along with piles of waste and garbage that attracted flies and rodents, brought on waves of dysentery, diarrhea, and typhoid fever, but little could convince the volunteer to protect himself. “Our poor sick, I know, suffer much,” sighed Robert E. Lee, but “they bring it on themselves by not doing what they are told. They are worse than children, for the latter can be forced.”66

The army medical services compounded these problems instead of curing them. Like the army itself, army medical practice, at the outbreak of the war, was almost nonexistent. In 1861, the Union surgeon-general was Colonel Thomas Lawson, an eighty-four-year-old veteran of the War of 1812 who had only 113 other surgeons on the army rolls to assist him (26 of whom resigned to join the Confederacy). Medical screening of enlistees was virtually nonexistent. The volunteers who enlisted in the 143rd Pennsylvania in the summer of 1862 were examined “by a trio of surgeons who told the men “to strip to natures habiliments,” given a cursory inspection lasting no more than three or four minutes,” then told to dress “and get out of there.” The recruits of the 1st Minnesota were asked to walk, “face to the right or the left, and to march a few paces further, then face about,” and that was it. No provision had been made for a system of army general hospitals; not until August 1862 did McClellan recommend the creation of a military ambulance corps for the Army of the Potomac.

Even those surgeons and doctors who were on hand were liable to make matters worse instead of better. Not only were they necessarily as ignorant as everyone else of the most basic notions of bacteriology, but they relied on cures that were often worse than the disease. “God save me from being sick and having hospital care such as I have seen,” wrote one officer of the 154th New York. “Those in Washington perhaps are not as bad,” but in the field and in camp, “the medical treatment is a damning one. Blisters, then diarrhea powders next, then cough powders & damning and so on.” In addition to alcoholic stimulants, opium-based painkillers were unwisely ladled out in fantastic amounts: one estimate suggests that more than 10 million opium pills, plus 2.8 million ounces of opium-related medicines, were handed out by Federal medical officers during the war. The result was widespread addiction, either to opiates or to alcohol, in order to cope with pain and illness, and in some cases with battle fatigue and anxiety. Braxton Bragg’s erratic behavior as a Confederate field commander may have been related to opium addiction; John Bell Hood, an aggressive Confederate field general who suffered a mangled arm and an amputated leg, sustained himself on alcohol and opiates, and they in turn probably helped him lose his luckless campaign in Tennessee in 1864 by sapping his strength and deadening his judgment.67

What made all of this worse was the reluctance of the

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