Although Civil War combatants tossed and turned with the horror of nightmares of death by bullet, cannon ball or bayonet, it is a well-known truism of the bloody conflict that at least as many men died of disease as wounds.  Statistics for these fatalities vary widely, however.  (For instance, some sources give total casualties of 618,000; others give a figure of 1,100,000.)  Spotty record-keeping and lost muster-rolls account for the variances.  As new information is uncovered, numbers are continually being adjusted upward.  A source published in 2011, for example, cites 2.2 million men serving in the Union army and about 1 million in the Confederate, with 646,392 Union casualties and 483,000 CSA.  (Casualties are defined as killed or wounded.)(1)

Historians generally agree that diarrhea was the leading cause of death by disease, killing 45,000 men out of the 2 million—the usually cited total figure—who took part in the Civil War.  Stoddard and Murphy claim that twice as many men died from illness as wounds.  They note that an additional 25,000 died from causes like suicide, execution, sun­stroke, snakebite and accident.(2)  Cholera was promoted by primitive hygiene and the poor sanitation of the men and their camps.  Of course, death on the battlefield was often the result of multiple causes: significant wounds plus delayed medical care, with chances of survival lessened by lack of disinfectants complicated by sunstroke, shock, dehydration and unbalanced diet.  At the second battle of Manassas in August 1862 and especially nearer the end of the war, the majority of Confederate soldiers were barefoot and had not had a square meal for weeks.(3)  With uniforms in tatters, subsisting mainly on cornmeal cakes, the exhausted Rebels were ripe to catch cold—which often turned into pneumo­nia, which, in turn, often led to death.

Joseph Glatthaar recently completed a statistical study of Robert E. Lee's Army of Northern Virginia.  Glatthaar's conclusions are that of the approximately 200,000 men in this Confederate force, 12.3 percent were killed in action, 11.6 percent died of disease, .6 percent died of other causes and 6.4 percent were discharged for disability.  He finds that soldiers over 40 were more likely to die of disease than wounds.(4)

So what is the conclusion?  Disease killed just as many as bullets?  Slightly more?  Opinions continue to differ.  Andrew Bell goes so far as to say that ". . . disease and sickness from microbes killed twice as many soldiers as bullets did."(5)

Of the 10,000 separate conflicts of the war, many were fought in turbid swamps and salty tidal marshes between Florida and North Carolina and in remote bayous along the Mississippi River.  Wading or in boats, soldiers could not avoid the swarms of anopheles mosquitoes in such places.  Planters repaired to breezy seaside homes in cities like Charleston to escape summer's heat and insects, but combatants had no such choice.  Medical men of the nineteenth century often thought that malaria was caused by unwholesome air or "miasma" from marshy places, but modern science revealed it to be an infectious disease transmitted to humans by the bite of an infected anopheles mosquito.  It is characterized by severe chills and fever.  Malaria struck about one-quarter of all servicemen, making it the third leading killer of the war after typhoid and dysentery.(6)

John Dunban of the 77th Pennsylvania Veteran Volunteers wrote from Camp Jackson near New Orleans in July 1865: "There are a great many sick.  The sickness all begins in the head & pain in the bones.  It is called dumb ague [malarial fever].  They shake but none die.  There are as high as 17 men sick in our Company of 36 men."  Dunban mentions the plagues of lice and mosquitoes as well.(7)

Not only soldiers died of typhoid, of course.  Noncombatants were often stricken.  Lincoln's eldest son, Willie, 11, died of it on February 20, 1862.  General Ben Butler's father had died of yellow fever, another tropical disease, this one spread by the aedes aegypti mosquito; that fact motivated Butler to clean up New Orleans.(8)

A number of authors note that since many soldiers were recruited from secluded rural areas, the first wave of disease in camps consisted of infections of childhood including measles, mumps, whooping cough and smallpox.  The second wave included lice, diarrhea (dysentery) and cholera.(9)  Many men suffered from bowel complaints for their entire enlistments; some were so ill that they were discharged from active duty and served—ironically—in the cook tent.  (Andrew Bean of Bethel, Maine, was one of these.(10)  Others were so disabled that they were discharged from the service altogether, and died at home shortly after.  Alfred Bollet writes that diarrhea was second only to "consumption" (tuberculosis) as the reason for medical discharge.(11)  Others never recovered from their service illnesses; my grandmother's foster father, John Bodwell, for instance, was six feet tall.  He lived for five decades after his service for New Hampshire, ate with good appetite—but never weighed more than a hundred pounds.

Ohio infantryman William Keesy has left us a disgusting description of a Union encampment near Washington, D.C., in 1862.  Within the camp boundary was a slaughtering area that served 100,000 men: "The hides and offal of the beeves for miles upon miles around, under a sweltering sun and sultry showers, would gender such swarms of flies, armies of worms, blasts of stench and oceans of filth as to make life miserable.  Like the plagues of Egypt the pestilence would . . . pollute the very water of the pure springs . . . .  Taking into account the dead horses that were slain in battle . . . and add to this the refuse, the sinks [latrines], the garbage, the waste hides and entrails of the slaughtered beeves in droves and you will readily see that even the sanitary interests of the army is no small matter."(12)

A report from the Seven Days’ Battle in June 1862 demonstrates what combat can do to water supplies.  This first-person description comes from H. E. Brown, a Surgeon with Hooker’s Division: “Until June 24th, I was engaged with the duties of the regiment, encamped on the battlefield of May 31st. . . . A more horrible place for a camp could not be conceived.  Over three thousand dead had been buried there; the ground was covered with the remains of clothing and commissary stores.  Dead horses, which had been insufficiently buried or burnt, filled the air with a noxious effluvium, and the only water was that obtained from the surface by digging down a few feet, and this infiltrated with the decaying animal matter of the battlefield.  The duties of the men were very laborious, enough to break down a strong man under the most favorable circumstances. . . .  It is not to be wondered that sickness broke out [typhoid, diarrhea or dysentery] in the command.”(13)
 
A major contributor to death from exhaustion, sunstroke, scurvy and disease was dirty water.  As Coleridge wrote in his long poem The Ancient Mariner, "Water, water every where nor any drop to drink."  Of course, Coleridge was writing about the plight of sailors on a becalmed ship, surrounded by saltwater, and not about desperate soldiers on a summer march.  But the predicaments are similar: no palatable drinking water.  Bacteria and e-coli had not yet been identified, and men did not boil the water they put into their canteens.  Diarrhea was especially prevalent at prisoner of war camps like Andersonville.

Typhoid is one of the ailments caused by ingesting food or water contaminated by excreta; specifically, it is caused by the bacteria Salmonella tyhpi.  Yanks and Rebels knew it as Camp Fever.  It is characterized by fever and intestinal disorders.  Camp physicians treated it with mercury, chalk, opium, morphine, calomel and/or quinine, as well as cold compresses for fever.  Union records show that nearly 30,000 soldiers died from it.(14)

Despite the close connection of disease to thousands of fatalities in the Civil War, few sources include disease, typhoid or even medicine in their indices.  Furthermore, even fewer sources include drinking water as a subject in their indices.  One of the rare ones to do so is Gregory A. Coco.  In his The Civil War Infantryman, Coco also describes canteens, which were sized to hold 2.5 to 3 pints of water—the amount needed by an average infantryman on a daily march.  Union regulation canteens were soldered tin halves, with a metal stopper attached with a chain.  Confederate canteens were often made of wood "which had a tendency to leak after extended use."(15)  Filled canteens were heavy, and tended to slap against your ribs as you marched.  When columns were marching in complete silence, the "music" of hundreds of slapping canteens could still be heard.  In the winter, filled canteens might swell overnight and be ruined.  Thus a canteen—especially a full one in good condition—was prized when found on a battlefield.

Under the best of circumstances, a canteen was unwieldy.  After a lengthy march in the Shenandoah Valley in June 1862 under a broiling sun, 55th Ohio infantryman William Keesy wrote of the difficulty of filling a canteen: "It is a tedious experience. . . . You might as well try to hurry a balky mule, or frozen molasses on a cold day, as to hurry this business.  Try to immerse them as much as you will they will persist in bobbing up and getting their necks out of water."(16)

Vermonter Wilbur Fisk of the 2nd Vermont in an August 1864 letter complained, "One of the greatest evils we have to contend with is a scarcity of water."  One day he traveled five or six miles and asked at several houses but could find none.

Coco notes the unseen hazards of water sources: "Near battlefields there was always the chance that a water supply such as a well, pool, or brook would be contaminated by human or animal excrement or blood, and mud churned up from the bottoms by constantly moving troops, artillery carriages and supply wagons."(17)
 
Marion Fitzpatrick, a New England sergeant experiencing very hot weather near Chancellorsville, wrote ". . . water was scarce, good water could not be found the creeks were low, and near all the fording places were filled with dead horses or mules."(18)  Because of such conditions, the Union army found that 995 out of every 1,000 men contracted diar­rhea/dysentery at some point in their careers.(19)

John J. Pullen, in his The Twentieth Maine, the thrilling tale of Joshua Chamberlain and his volunteer regiment, also mentions water in his index, and justifiably connects it with disease.  In describing the lowlands of the Chickahominy in spring 1864, he writes, "Water for the troops had to come almost entirely from surface drainage.  Malarial ills, known as Chickahominy fever, began to be prevalent."(20)  In describing trench life in June of that year, Pullen writes, "For weeks there was no rain; the earth, torn up as it was, yielded itself easily to the wind; great clouds of fine, red dust swept up and down the earthworks.  Flies were thick.  Water was hard to get, disappearing from surface sources entirely, so that wells had to be dug, in addition to the day and night digging that was required in the entrenchments . . . .  The men of the 20th baked thin and brown, their eyes withdrawing into their skulls, faces becoming lean and lined."(21)
 
Often in the heat of battle, the buckets of water used to cool cannon would be used up, and men would contribute the water in their canteens to prevent explosions—leaving them nothing to drink.  Death by sunstroke was common—but seldom recorded.

Sam R. Watkins wrote in Co. Aitch of the sight after the firing ceased: "I never saw so many broken down and exhausted men in my life.  I was sick as a horse, and as wet with blood and sweat as I could be, and many of our men were vomiting with excessive fatigue, over-exhaustion, and sunstroke; our tongues were parched and cracker for water, and our faces blackened with powder and smoke, and our dead and wounded were piled indiscriminately in the trenches."(22)

In correspondence published as Letters Home from the Iron Brigade, Pvt. John Pardington of the 24^th Michigan wrote on June 16, 1863: “A soldier has to drink anything.  Sara [,] I have drank water out of a ditch where there has been a Dead horse lying a few rods above in the same Water, and glad to get it.”

After being assigned to bury the dead, Alfred Bellard of Hudson City, New Jersey, gives a clear-eyed account of how inured to death one could become during war: “All the horses killed at this battle [Fair Oaks], and there was quite a number of them, some batteries having lost them all, were covered over with brush and fence rails and burnt.  Our stomachs being so strong by this time that we cooked our coffee over their ribs . . . .  There was so many dead buried round our camp, that it was our morning’s work to clean the ground of worms . . . ."(23)

Thirsty Confederate infantryman Theodore Upson found the water in Mississippi unfit to drink—because it had been fouled by the enemy.  He wrote, the "Johnny's had killed hogs and cattle in the ponds and thrown dead dogs and cats in the cisterns and shallow wells, and I actualy [sic] saw men marching along through the awful dust with thier toungues [sic] hanging out of thier mouths."(24)

In the early days of 1861, when Lincoln was still calling for militia, a group of wealthy New Yorkers saw the fatal possibilities of campaigning in the South's swamps and marshes.  They formed the U. S. Sanitary Commission to preserve the health of soldiers, cure their wounds and diseases, and supply them with comforts like soap, writing paper and combs.(25)

Even in the first months of the war, lack of water could be a difficulty.  On July 17, 1861, as part of the Army of the Potomac marched out of Washington, D.C., headed for Fairfax Court House, the men found that their diet of salt pork produced a great thirst.  Men disregarded their officers' orders to run into farm yards looking for water.  But the retreating Southerners had cut the ropes which held the buckets in the wells. Some of the men stopped to eat blackberries to assuage their thirst.  General McDowell was not happy with the way the men did not keep their ranks.(26)

Sullivan Ballou of Rhode Island wrote home on July 19, 1861, to his wife Sarah: “We are about five miles from Manassas.  I am sitting under a few green boughs writing on a drum head . . . .  I am very tired but perfectly well; and would give a hundred dollars if I could get a good meal of victuals.  The streams are muddy & water very poor—however I am able to get a little vinegar to put in it and that is all.  Hard bread [hardtack] & joints of meat are all we can get to eat, and that goes hard 3 times a day.”(27)

Water had to be found for animals, too.  Watering-Call or Water-Call was part of the daily routine, coming right after Sick-Call, each signaled by its own bugle tune.  Artilleryman John Billings gives a full account of the difficulty of watering horses used by artillery and cavalry.  It was easy when soldiers were camped on a river like the Potomac.  But, at other times, things were quite different.  For instance, in 1864, the Army of the Potomac was served by 56,499 horses and mules.  "But, of course," Billings writes, "they were not all watered at the same pond or stream, since the army stretched across many miles of territory.  In the summer of 1864, the problem of water-getting before Petersburg was quite a serious one for man and beast.  No rain had fallen for several weeks, and the animals belonging to that part of the army which was at quite a remove from the James and Appomattox Rivers had to be ridden nearly two miles . . . for water, and then got only a warm, muddy, and stagnant fluid that had accumulated in some hollow.  The soldiers were sorely pressed to get enough to supply their own needs.  They would scoop out small holes in old water courses, and patiently await a dipperfull [sic] of a warm, milky-colored fluid to ooze from the clay, drop by drop.  Hundreds wandered through the woods and valleys with their empty canteens, barely finding water enough to quench thirst."  Soon shovels and pickaxes were issued to dig wells 10 to 12 feet deep.(28)

When water was scarce, liquids like milk, clabber, whiskey, and apple jack were liberated by foragers or "bum­mers.”(29)  And other thirst-quenchers were supplied by sutlers—private entrepreneurs who operated traveling general stores out of wagons.  In July 1864, a Confederate captive observed a sutler dispensing lemonade, beer, ice cream and other luxuries in the oppressive Georgia heat.(30)  This must have seemed like a mirage straight from Coleridge after the conditions the captive had been taken from.

1. Peter Cozzens, Battlefields of the Civil War, unpaged.