DAVID F. CROSS, M.D.

WHY DID THE YANKEES DIE AT ANDERSONVILLE?

THE NAME ANDERSONVILLE EVOKES STRONG PASSIONS TO THIS DAY. As Carl Sandburg put it in 1939, "'Andersonville' in the North ,,' meant horror beyond words:'^2 Someone, it would seem, must be culpable. There have been one hundred forty years of recrimination, finger-pointing, and "waving the bloody shirt."3 James Ford Rhodes in his 1904 multiple-volume History of the United States of America devoted an entire chapter to the treatment of prisoners in the Civil War. "No subject:' he began, "is so difficult of discussion between Southern and Northern men as that suggested by the word 'Andersonville:"4 Even today there remain many people with an axe to grind. The current view is that the unspeakable conditions and grim mortality at Andersonville were not the result of a Confederate conspiracy-there was no organized malice (although, perhaps, there was considerable active indifference). What happened was that Federal prisoners were victims of the "Law of Unintended Consequences:' In the third year of the war, and with their railroads in chaos, the Confederates created a huge prison camp (larger than the city of Hartford, Connecticut, at the time) in the pine barrens of rural southwestern Georgia that was served by a single-track railroad. The prison population swelled uncontrollably to over 30,000 without the infrastructure to sustain it, The result was a human disaster. The raw statistics are well known.5 The average mortality rate for POWs, North and South, was about thirteen percent-which was in fact little different from the rate at which Federal and Confederate soldiers died of disease in the ___________________________________ Right: this Northern caricature reflects the regional stereotype of the Southern "Cracker" serving as infantry in the Confederate armies (Harper's Weekly, 1862),

field.⁶ But the overall mortality rate of Federal prisoners held at Andersonville was more than twice that. Even that does not tell the whole story. About 41,000 Federal soldiers shuffled into Andersonville between February 1864 and the end of the war.⁷ Although only 13,000 prisoners are buried in the National Cemetery at Andersonville, it is probably no exaggeration to state that fifty percent of the prisoners who entered the camp died before reaching home, or arrived home mere wrecks of men.8 One can only speculate what size the Andersonville cemetery would have been had General Sherman's campaign in Georgia not forced the evacuation of the prisoners, many of whom died elsewhere.

Bruce Catton set the modern tone for the explanation of the tragedy of Andersonville. Along with the poor planning, inadequate resources, mismanagement, and bureaucratic bungling, he wrote:

The terrible things which happened in [the Civil War prison camps] seem to have taken place not because anyone meant it so but simply because men were clumsy and the times were still rude.⁹

Catton added the observation: ''A certain combination of incompetence and indifference can cause almost as much suffering as the most acute malevolence."¹⁰ While undoubtedly true, this would seem to apply to all the Civil War prisons (and probably all wars), and fails to explain what set Andersonville apart.

Certainly, following the termination of prisoner exchanges late in the war, the Richmond government was paralyzed in dealing with the large number of Federal prisoners. The conditions in the Confederate military prisons "presents a great embarrassment:' confessed the Confederate Secretary of War James Seddon. But, he added, "I see no remedy which is not worse than the evil …We are not responsible for the miserable sufferings of the captives:' ^II

After the war ex-Confederates such as Edward A. Pollard, editor of The Richmond Examiner, denied there had been any "problem" at Andersonville, proclaiming the prison was of "unquestioned healthfulness" and citing "the history of the extraordinary efforts of the Confederate authorities to relieve the suffering of Andersonville." He added, "It is simply in opposition to all that is known of Southern generosity in the war to believe that the sufferings of Andersonville were the result of neglect, still less of design on the part of the Confederate government'¹² Others since have apologized for the Andersonville prison camp horrors by pointing out that the Confederacy simply did not have the necessary resources, and have also blamed the policy of the Lincoln government that halted prisoner exchange ostensibly over the issue of "white- for-white" repatriation. ¹³

Northerners had another take on the situation. A Vermonter explained quite simply what had occurred in a letter to her local newspaper in 1866: "Uncle William H. Colvin (mamma's brother) was starved to death in Andersonville prison:' 14 George G. Benedict, Vermont's official Civil War historian, concluded in 1888, "The southerns have been more sensitive to the charge of inhuman treatment of their prisoners than to any other brought against them, and southern writers and statesmen have written many pages and utter many words to refute it; but no statements or sophistries can wipe out or gloss over the stain of such facts as these.” ¹⁵

Nevertheless, while each of these explanations may contain a part of truth, none seems entirely sufficient to explain why Andersonville was in a "class by itself:' Employing what historian James M. McPherson calls "the fallacy of reversibility:' it can be argued that all these factors were present to some extent at various times in other Civil War military prisons, both in the South and in the North, without producing another Andersonville. In this respect, an examination of the fate of mernbers of the Verrnont Brigade is instructive. ¹⁶

The proud Vermont Brigade of the Army of the Potomac was not only one of the best combat units, but was also among the healthiest in the army. ¹⁷ The Vermont farm boys turned soldiers were remarkably free of illness, only nine percent of them dying of disease. For most of the war, members of the Vermont Brigade who were captured fared about the same as the majority of Union POW's, thirteen percent dying in Confederate captivity. However, something very different happened to 379 enlisted men captured on June 23, 1864, at the Weldon Railroad south of Petersburg. Initially sent to Andersonville, 224 died during or as a direct result of their captivity, a total of fifty-nine percent! This was extreme even for Andersonville.

Lithograph of Andersonville by former prisoner Thomas O'Dea of the 16th Maine Infantry.

The chief surgeon at Andersonville was Dr. Isaiah H. White. In May 1864 he reported that "The diseases now prevailing are those of the digestive system, diarrhea and dysentery, which have in most instances a scorbutic connection."18 Scurvy combined with diarrhea was a particularly lethal combination, not only at Andersonville but also in London prisons (1823), polar expeditions (1853), among the British and French troops in the Crimea (1854-56), and during the Boer War (1899-1902).¹⁹ The severe malnutrition at Andersonville produced a nutritional multiple deficiency state in which scurvy was the more or less prominent feature. The diet deficient in protein and vitamins, particularly B12 and folic acid (in addition to vitamin C), produced intestinal malabsorption and diarrhea.²⁰ The Confederates fed the prisoners a ration consisting chiefly of unbolted corn meal (corn kernel, husks, and cobs all ground in together.) Captain Henry Wirz, the commander of the inner stockade, reported on June 6, 1864, that "the bread which is issued prisoners is of such an inferior quality, consisting fully of one-sixth of husk, that it is almost unfit for use and increases dysentery and other bowel complaints:'²¹ The physicians at Andersonville also recognized this diet was unhealthy. Dr. R. Randolph Stevenson, another chief surgeon at Andersonville, recalled, "The bread was made from cornmeal... [that] produced diarrhea, and hence laid the foundation of all those symptoms resulting from defective nutrition."²² Dr. White appears to have deduced the connection between the unbolted corn bread, accelerated scurvy, and diarrhea. In early August he noted that feeding the prisoners the unbolted corn meal was "unwholesome" and added that "amongst the older prisoners, scurvy prevails to a great extent, which is usually accompanied by diseases of the digestive organs." ²³

The Confederate Surgeon General, Dr. Samuel P. Moore, sent the South's foremost medical expert on infectious diseases, Professor Joseph Jones, to Andersonville in September 1864 to "determine the true causes of the great mortality amongst the Federal prisoners." Dr. Jones found 9,501 prisoners afflicted with scurvy and concluded this disease of vitamin C deficiency was responsible either directly or indirectly for nine-tenths of inmates' deaths.²⁴ Actually, the prisoner! appeared to be dying of "scorbutic dysentery."²⁵

Putting the sickness among the prisoners down to an inadequate diet, Dr. Jones in his report to the surgeon general concluded, "there is no recognizable source of disease in the waters or soil of Andersonville."²⁶ Dr. Jones had no way of knowing how wrong he was. With the other Confederate physicians at Andersonville, he was witnessing a massive and lethal epidemic of hookworm.

Intestinal worms contracted from the soil (soil transmitted nematodes or geohelminths) are prevalent throughout the developing world, where primitive levels of hygiene and education are coupled with bare feet and the absence of properly constructed outhouses and flush toilets. Today hookworm is the second most common of these helminthic infections, affecting over one billion people worldwide.

The adult hookworm measures less than a centimeter in length and resides in the wall of the small intestine. The female worm lays as many as 10,000 ova (eggs) per day, and these are passed in the stool after which the larval stage thrives in the warm moist sandy or loamy soil of tropical and subtropical countries. This larval stage penetrates the human skin, particularly between the toes of bare feet, and is transported by the blood stream to the lungs, where it is coughed-up and swallowed. The mature worm burrows into the lining of the small intestine and causes illness primarily by ingestion of the host's blood, leading to chronic anemia.²⁷

Hookworm is endemic in tropical Africa and was brought in the bowels of African slaves to North America, where it became a regional affliction below the Mason-Dixon Line. In the nineteenth century, probably as many as forty percent of the region's population harbored the parasite.²⁸ So prevalent was hookworm infection and for so long was it a feature of Southern rural life that Americans mistook the physical appearance of hookworm sufferers to be the distinct genetic expression of an unfortunate economic and social class. This regional stereotype for the poor white rural population (the "Georgia Cracker") incorporated, in varying degrees, a prematurely aged, emaciated appearance, with striking lankness of frame and slackness of muscle, a misshapen bony scarecrow look with a peculiar "fish eyes" stare, and a sallow complexion.²⁹ These lethargic, shambling poor white folk were a hallmark of the Deep South, and their appearance and lack of energy caused many outsiders to describe them as lazy and ignorant. ³⁰

Comfortably and securely berthed in the bowels of millions of Southerners, the parasite avoided detection for two centuries. The chronic anemia it produced seldom killed its victims outright, but left them feeling weak, listless, and out-of sorts; hence its later identification in the popular press as the "germ of laziness."³¹ During the Civil War it operated as a "secret weapon" for the North by sapping the strength of the Confederate armies.³² As a recent historian of the South observed, "No one can say just how much... hookworm helped to sustain the Union."³³ To a physician's eye, Lee's infantry, "Those gaunt, barefoot, whiskery scarecrows" described by Robert Penn Warren, actually had the typical appearance of sufferers of hookworm disease-a barefoot recruit from Dixie was sure to be a haggard and anemic.³⁴

At Andersonville during the summer of 1864 a "perfect storm" of conditions produced within the stockade a lethal epidemic of hookworm infection. First, there were the hookworm larvae endemic in the Georgia soil, probably freshly left by the gangs of slaves employed in clearing the area and constructing the stockade. Next came the heat of the Georgia summer and the influx of thousands of Yankees densely crowded into the stockade.³⁵ These Federal prisoners suffered from multiple nutritional deficiencies that produced "scorbutic dysentery." Inadequate vitamins and protein in the diet resulted in malabsorption, and the unbolted cornbread aggravated the diarrhea. The mind boggles picturing upward of 30,000 prisoners suffering what must have been near universal diarrhea, and the traffic of 60,000 feet kneading the interior of the stockade into a reeking bog, the stench at times reaching the nearby settlement of Americus when the wind was "right."³⁶ Infected men passed millions of hookworm ova into the soil and the stockade quickly became a quagmire teeming with larvae. Many of the prisoners were shoeless and all slept on the ground. Hookworm larvae penetrated the skin of prisoners' hands when they were grubbing for roots and digging wells and burrows for shelter, and there were few eating or cooking utensils, so prisoners probably ate a good deal of dirt. The drinking water from Stockade Creek must have been heavily contaminated with larvae, as were the wells. Even bathing could produce lethal infection.³⁷ The cycle was then repeated either by penetration of the skin or oral ingestion of the larvae, until virtually every inmate was massively infested, the crowded conditions producing an explosion of infection. Hookworm, which existed in the Southern population as a nonlethal and indolent illness, lived up to its scientific name (Necator americanus) in the Yankees, becoming an "American killer;' as the northerners lacked a natural immunity. Between June and October, 10,000 prisoners died, including fifty-seven of the Vermonters captured at the Weldon Railroad.

It has been suggested that black prisoners and white Confederate guards experienced a lower mortality rate at Andersonville because the former were better fed, being employed on burial and other work details outside the stockade, while the latter had access to supplemental food beyond their daily ration.³⁸ While true, it seems more important that the Afro-Americans survived because they were genetically less susceptible to hookworm infection, and the guards rarely set foot inside the stockade.³⁹

Medical science, of course, did not identify hookworm for a further thirty years. Marine colonel Ashford K. Bailey investigated the deadly epidemic that followed the San Ciriaco hurricane of 1899, in which 11,875 Puerto Ricans died.⁴⁰ He discovered that hookworm becomes deadly when the victim is also afflicted with the intestinal malabsorptive disease endemic in the Puerto Rican jibaro (peons).⁴¹ In the same way, at Andersonville the concurrence of "scorbutic dysentery" converted the hookworm into a killer.

Hookworm has always been a scourge of sub-tropical and tropical areas of the world-the anemia described in the Egyptian Papyrus of Ebers (c. 1550 B.c.) is probably that caused by hookworm. But the cause was not recognized until the late nineteenth century, when the medical microscope became available. In the 1880s a particularly virulent outbreak of anemia afflicted the laborers digging the St. Gotthard tunnel in Switzerland, and during post-mortem examination of the body of a St. Gotthard miner Italian physicians discovered hookworm ova and the adult worm.⁴²

Dr. Charles Wardell Stiles, the putative "discoverer of hookworm disease;' was trained in Europe and, beginning in 1892, with single-minded persistence he championed the cause of hookworm eradication in the United States.⁴³ 'the infection rate was thirty-four percent among adults in the South and thirty-seven percent among school children. A campaign to eliminate the "disease of laziness" from the Deep South began in 1909 when Dr. Stiles persuaded the Rockefeller Foundation to set up a five year sanitary commission for hookworm eradication.⁴⁴ The first dispensary for treating hookworm disease opened in 1910 in Columbia, Mississippi, and was so successful that it became the model for others throughout the South. In the five years from 1910 to 1914 nearly 1.3 million Southerners were examined and 700,000 treated. Over time Southerners learned to practice proper sanitary methods to prevent the spread of hookworm eggs, and the disease has now been all but eliminated. Today the parasite is only a minor health problem in the South; for example, in 1981 a mere sixty-nine cases were reported to the Mississippi State Board of Health.⁴⁵

Dr. Stiles visited the Andersonville area early in the twentieth century and questioned inhabitants who could provide information about the illnesses of the Federal prisoners. He concluded that hookworm infection was present and had caused a lethal epidemic. Stiles conveyed his findings to Professor Edward P. Channing of Harvard University, and in his six volume History of the United States, Channing stated: "Moreover, Andersonville was within an area seriously affected with hookworm… It would have been a marvel if the disease which affected the bodies of the natives who brought supplies and of the soldiers who guarded the stockade, had not penetrated within and resulted in an explosive epidemic that has few counterparts."⁴⁶

Dr. Stevenson, writing in 1876, argued "that the sufferings at Andersonville were the results of a malignant pestilence."⁴⁷ Undoubtedly, many compounding factors contributed to the disaster at Andersonville, but Dr. Stevenson had it right. In all the subsequent controversy over the culpability or otherwise of camp commandant Henry Wirz, this earlier finding has all but disappeared from view. But whatever other factors mayor may not have been at work at Andersonville, it was an explosive and lethal epidemic of hookworm that placed the prison "in a class by itself'.”

..

HOOKWORM DISEASE ILLUSTRATIONS

(1) Worldwide distribution of endemic hookworm (Necator americanus). Courtesy of the Mississippi Historical Society

(2) Early twentieth century cartoon conveying the message that the road to "happiness" for the southern population afflicted with hookworm leads through proper "sanitation" to "good health:' Courtesy of Professor Linda Hulton, James Madison University

(3) "The 10,000 hookworm family" from Alabama in 1924. Treatment of the entire family yielded 10,861 worms. Courtesy of the Rockefeller Archive Center

(4) The Bryant family of McCreary County, Kentucky, in 1913, all with severe infection. Courtesy of the Rockefeller Archive Center

(5) A young sharecropper at Chesnee, Spartanburg County, South Carolina. Library of Congress

(6) John Dewitt, age twenty-nine, ofWalterboro, Colleton County, South Carolina, exhibiting the ravages of hookworm disease. Courtesy of the Rockefeller Archive Center

(7) Demonstration of the Kentucky Sanitary Privy to a rural population in the early twentieth century. Courtesy of Professor Linda Hulton, James Madison University

(8) School boys from Alabama, left to right age seventeen, fifteen, and eighteen, in 1924. The boy in the center had light hookworm infection, the two on either side were heavily infected. Courtesy of the Rockefeller Archive Center

(9) George Tripp, age twenty-six, of Marengo County, Alabama, revealing the typical features of hookworm disease. Courtesy of the Rockefeller Archive Center

(10) Intestine of a three-month-old child in the Democratic Republic of the Congo. The hookworm (ancylostoma duodenale) is attached to the epithelium of the intestine by its mouth. Courtesy of the Armed Forces Institute of Pathology.

DAV1D F. CROSS, M.D. of Charlotte, Vermont, is a retired internist. His book, A Melancholy Affair at the Weldon Railroad, recounting the story of four hundred Vermonters captured in an engagement south of Petersburg, Virginia, in June 1864 and imprisoned at Andersonville, will be published by White Mane this autumn.

NOTES:

1. William Manchester, American Caesar:

Douglas MacArthur, 1880-1964 (Boston,

1978), p. 241.

2. Carl Sandburg, Abraham Lincoln: The

War Years (New York., 1939), vol. 3, p. 641.

3. William B. Hesseltine, Civil War Prisons:

A Study in War Psychology (Kent, Ohio,

1962), p. 5.

4. James Ford Rhodes, History of the United States of America: From the Compromise of 1850 to the McKinley-Bryan Campaign of 1896 (New York, 1904; reprint, 1920), vol. 5, chapter XXIX, pp.483-515.

5. Rhodes, vol. 5, pp. 507-508.

6. Hesseltine, 6; James M. McPherson, Battle Cry of Freedom: The Civil War Era (New York, 1988), p. 802.

7. William Marvel, Andersonville: The Last

Depot (Chapel Hill, 1994), p. ix.

8. George G. Benedict, Vermont in the Civil

War (Burlington, Vermont: Free Press As

sociation, 1886), vol. 1, p. 481.

9. Bruce Catton, A Stillness at Appomattox

(Garden City, New York, 1953), p. 227.

10. Ibid., 227

11. The War of the Rebellion: A Compilation of the Official Records of the Union and Confederate Armies 128 volumes (Washington, D.C.: 1880- 1906), series 2, vol. 7, p. 856. (Hereafter cited as O.R.)

12. EdwardA.Pollard, The Lost Cause: A New

Southern History of the War of the Con

federacy (New York, 1886), p. 627.

13. Marvel, p. x; Joe Henry Segars, ed., "Andersonville: The Southern Perspective" in Journal of Confederate History vol. XIII (1995), pp. 181-190; Gerald J. Prokopowicz, "Word of Honor: The Parole System in the Civil War;' North & South, vol. 6, no. 4 (May 2003): 24-33.

14. The Dorset Tribune (Vermont) n.p. The undated newspaper clipping is in the Benedict Family Papers, Bailey Howe library, University of Vermont, Burlington, Vermont.

15. Benedict, vol. 1, p. 482.

16. Following their capture at Plymouth, North Carolina, 2,364 Federal prisoners arrived at Andersonville in early May 1864. Fewer than fifty percent of these "Plymouth Pilgrims" survived Confederate imprisonment and reached home safely. Robert K. Kellogg, Life and Death in Rebel Prisons (Hartford, 1866), p. 19.

17. Catton, 72.

18. R. Randolph Stevenson, The Southern Side; or, Andersonville Prison (Baltimore, 1876), p.51.

19. Kenneth J. Carpenter, The History of Scurvy and Vitamin C (Cambridge, Massachusetts, 1986), p. 114.

20. Alfred Jay Bollet, "Scurvy and Chronic Diarrhea in Civil War Troops: Were They Both Nutritional Deficiency Syndromes?" Journal of the History of Medicine and Allied Sciences 47 (1992): 49-67; Alfred Jay Bollet, "Scurvy, Sprue, and Starvation: Major Nutritional Deficiency Syndromes During the Civil War" Part 1, Medical Times (November 1989): 69-74; Alfred Jay Bollet, "To Care for Him That Has Born the Battle: A Medical History of the Civil War" Part 2, Medical Times (June 1990): pp. 39-44.

21. William G. Burnett, The Prison Camp At Andersonville (Eastern National Park and Monument Association, 1995), p. 16.

22. Segars, 16.

23. Stevenson, 60.

24. O.R., series 2, vol. 8, pp. 589-632.

25. Alfred Jay Bollet, Civil War Medicine: Challenges and Triumphs (Tucson, Arizona, 2002), pp. 369-372.

26. Segars, 16.

27. Geer Williams, The Plague Killers (New York, 1969), pp. 3-17.

28. John Ettling, The Germ of Laziness: Rockefeller Philanthropy and Public Health in the New South (Cambridge, Mass., 1981), p. 2; Thomas D. Clark, The Emerging Sou th (New York, 1968), p. 25.

29. William Faulkner's "Wash Jones" in the short story Wash is a perfect fictional representation of the stereotypical Southern poor white. He is described as "a gaunt, malaria-ridden [actually hookworm infested] man with pale, questioning eyes:' Ibid., 2.; Wilbur J. Cash, The Mind of the South (New York, 1941), pp. 23-25; William Faulkner, Doctor Marino and other sto ries (New York, 1934), p. 225.

30. Clark, 25-26.

31. Ettling, 1-2.

32. "By to day's standards;' quipped an historian of the South, "half of Lee's army that invaded Maryland in 1862 would be classified as 4-F:' Ibid., 2; Clark, 24.

33. Clark., 24.

34. A Virginia woman described "the gaunt

starvation that looked from their cavernous eyes" as the Confederate infantry invaded Maryland in 1862. Robert Penn Warren, The Legacy of the Civil War (New York, 1961), p. 57; Mary Bedinger Mitchel "A Woman's Recollections of Antietam" in Battles and Leaders: The Struggle Intensifies (New York, 1956), vol. 2, p. 687; Ettling, 2.

35. The density within the Andersonville stockade at peak crowding has been estimated as twenty times the population density of Liverpool in the mid-nineteenth century. Hamlin, 49.

36. 'Almost every prisoner," Dr. Jones noted, was "affected with either diarrhea or dysentery." He saw prisoners "urinating and evacuating their bowels at the very tent doors" and observed that small pits "not more than a foot or two deep newly filled with soft offensive faeces were found through the stockade." James O. Breeden, "Andersonville-A Southern Surgeon's Story" in Bulletin of the History of Medicine vol. 47, issue 4 (July-August 1973): 317343.

37. Dr. Bailey Ashford described two near-lethal cases of hookworm disease in Puerto Rico contracted from bathing or swimming in contaminated water. Bailey K. Ashford,

A Soldier in Science: The Autobiography of Bailey K. Ashford (New York, 1934), pp.440-408.

38. Marvel, 155; McPherson, 802.

39. Ettling,4.

40. In the municipality of Adjuntas, Puerto Rico, during the two years following the hurricane, there were 1,600 deaths due to "la anema" out of a population of 18,000. The average number of deaths from all other causes for the preceding years was 375. Ashford, 91.

41. William H. Crosby, "The Deadly Hookworm. Why did the Puerto Ricans die?" Archives of Internal Medicine vol. 147 (1987): 577-78; A. E. Maldonado, "Hookworm Disease: Puerto Rico's Secret Killer" Puerto Rico Health Science Journal vol. 12 (1993): 191-96; Ashford, 35-63; Ettling, 2932.

42. H. Harold Scott, A History of Tropical Medi cine (Baltimore, 1939), vol. 2, pp. 840-853.

43. Charles Wardell Stiles, "Early History, in Part Esoteric, of the Hookworm (Uncinariasis) Campaign in our Southern United States" The Journal of Parasitology 25 (1939): 283-308; Ettling, 10-48.

44. Ibid., 97-177.

45. In 1910, when the Rockefeller Sanitary

Commission for the Eradication of Hookworm began its work, many Southerners were not convinced there was a problem. "Where;' The Macon Telegraph wanted to know, "was this hookworm or lazy disease when it took five Yankee soldiers to whip one Southerner?" Williams, 17-97; Deanne Stephens Nuwer, "The Importance of wearing Shoes: Hookworm Disease in Mississippi" Mississippi History Now (Jackson, Mississippi, 2000), http:// mshistory.k 12.ms. us!features! feature31/ hookworm.html

46. Willian Hesseltine noted Channing's "suggestion that the prisoners in Andersonville probably had contracted hookworm;' adding the observation, "[This] suggestion could open other speculations." Edward Perkins Channing, History of the United States (New York, 1905-1925), vol. 6, p.442; Hesseltine, 6.

47. Stevenson, 6.