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army medical services to issue medical discharges. Fearing abuse of the discharge system by conniving soldiers, regimental surgeons in the Civil War turned themselves into the first line of defense against military “malingering.” William Fuller, Second Assistant Surgeon of the 1st Michigan Volunteers, seems to have treated men who reported on sick call to a classic case of military catch-22—the more serious an illness, Fuller reasoned, the more likely it was faked. “Vast strides have been made in the proficiency of malingering in this country since the first year of the war,” Fuller intoned solemnly. “When a surgeon has reason to think that a man has an object or a motive for feigning, no statement of his should be accepted as true. …”68 The result of Fuller’s zeal, however, was that sick men were sent back into camp or onto the march, where they only managed to infect other men and further spread sickness.

Eventually, much of the neglect and malpractice in both the Federal and Confederate army medical systems was ironed out. A new Federal surgeon-general, Lieutenant William Alexander Hammond, was appointed in 1862, and from then on Union army medical care drastically improved: 190 new army hospitals with 120,000 beds were established under Hammond’s aegis, and 15,000 new surgeons were recruited. Even the Confederates, shorthanded and undersupplied as they were, created 28 military hospitals in and around Richmond and took over 57 other buildings, the largest of which, Chimborazo Hospital, could hold 4,300 men (making it the largest hospital in the world at that time), and treated more than 77,000 cases during the war.

In the Army of the Potomac, Jonathan Letterman (who was appointed the army’s medical director in June 1862) organized a three-tiered system of field hospitals, post hospitals, and general hospitals for processing battle casualties. The reformer Dorothea L. Dix lobbied successfully to have women recruited as army nurses, and was herself appointed superintendent of army nurses, after the model of Florence Nightingale, in 1861. Additionally, the federal War Department authorized the operation of the civilian-run United States Sanitary Commission and the Christian Commission to act as voluntary auxiliaries for providing nursing and hospital care. As a result, actual disease mortality rates fell from 73 percent of all wartime deaths in the Revolution and 86 percent of all war-related deaths during the Mexican War to little more than 61 percent in the Civil War (the rates of death from disease would actually go back up in the Spanish-American War to over 84 percent of all wartime deaths among American soldiers). The disease statistics are appalling all the same, and sickness often decimated a regiment long before it ever fired a gun in anger.69

Without question, the greatest damage to the volunteers’ health was done by the soldiers’ diet. Food preservation was only in its infancy in the 1860s, and as a result, the soldier on campaign was issued only the most portable—and most indigestible—of rations. The marching ration of the Federal soldier in the Army of the Potomac was “one pound of hard bread; three-fourths of a pound of salt pork, or one and one-fourth pounds of fresh meat; sugar, coffee, and salt.” The bread was, in the most literal sense of the word, hard, and so it went by the name of hardtack.70 John Billings described it as “a plain flour-and-water biscuit” measuring “three and one-eighth by two and seven-eighths inches, and… nearly half an inch thick.” Hardtack resembled a large, hard cracker more than anything that could be called bread, and “they may have been so hard that they could not be bitten” and “required a very strong blow of the fist to break them.”

On the other hand, Billings admitted that “hardtack was not so bad an article of food… as may be supposed,” and devising ways of eating it stretched the soldiers’ imaginations in odd ways. “Many of them were eaten just as they were received—hardtack plain,” while others were “crumbed in coffee” and “furnished the soldier his breakfast and supper.” Others “crumbled them in soups for want of other thickening” or “crumbed them in cold water, then fried the crumbs in juice and fat of meat,” and still others simply “liked them toasted, either to crumb in coffee or… to butter.” The invariable accompaniment to hardtack, and to any other circumstances, was the soldier’s coffee.

One of the most interesting scenes presented in army life took place at night when the army was on the point of bivouacking. As soon as this fact became known along the column, each man would seize a rail from the nearest fence, and with this additional arm on the shoulder would enter the proposed camping-ground. In no more time than it takes to tell the story, the little camp-fires, rapidly increasing to hundreds in number, would shoot up along the hills and plains, and as if by magic acres of territory would be luminous with them. Soon they would be surrounded by the soldiers, who made it an almost invariable rule to cook their coffee first, after which a large number, tired out with the toils of the day, would make their supper of hardtack and coffee, and roll up in their blankets for the nights. If a march was ordered at midnight, unless a surprise was intended, it must be preceded by a pot of coffee; if a halt was ordered in mid-forenoon or afternoon, the same dish was inevitable, with hardtack accompaniment usually. It was coffee at meals and between meals; and men going on guard or coming off guard drank it at all hours of the night, and to-day the old soldiers who can stand it are the hardest coffee-drinkers in the community, through the schooling which they received in the service.

Last in the soldier’s estimate was the army’s standard meat ration, salt pork, which Billings found “musty and rancid… flabby, stringy, ‘sow-belly’” that was frankly indigestible to anyone but a hungry soldier. “We ignored the existence of such a thing as a stomach in the

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