Disease during the Civil War

Disease was a major problem among the armies serving in Arkansas during the Civil War. Large numbers of men living in close confines made the spread of illness likely. As many as 700,000 members of the military across the country lost their lives during the war, and approximately two-thirds of them died from disease.

Outbreaks of disease were common in the state even before the beginning of the war. In 1855, a yellow fever epidemic struck Helena (Phillips County), and minor outbreaks of other diseases such as cholera and typhoid were common. The lack of major centers of population and difficulty of travel, however, prevented many large-scale epidemics before the Civil War. The state had a number of doctors in the antebellum period, but, while they did undergo some training, these men were not required to obtain any formal certification or standardized education.

With the outbreak of war in 1861, thousands of men began to gather in towns across the state to create military units. The close proximity of these men made the spread of disease much easier, as many were from rural areas and had never been exposed to common illnesses such as measles. Both a lack of trained medical professionals and little understanding of how cleanliness impacted health led to large-scale outbreaks of disease during the war. Camp Nelson near Cabot (Lonoke County) housed thousands of Confederate troops from Arkansas and Texas in 1862 before being struck by a number of epidemics. Measles, mumps, typhoid, and other diseases ran through the camp, leading to the deaths of around 1,500 men, including Brigadier General Allison Nelson. The camp was soon abandoned.

Federal units were also susceptible to outbreaks of disease. After the Battle of Pea Ridge, the Army of the Southwest marched across southern Missouri and northern Arkansas in an effort to take Little Rock (Pulaski County). Unable to do so, the army instead captured Helena, which had a strategically important location along the Mississippi River. As the Federal army crowded into the town, it was joined by hundreds of newly freed slaves. The close proximity of thousands of people in the riverside location quickly led to outbreaks of disease. Many waterborne illnesses that were spread through mosquitoes swept through the army due to a lack of sanitation in the camps. Hospitals were established in the city but could not treat the growing number of sick men. Federal military surgeons were trained to handle battlefield casualties but were ill-prepared to handle the large numbers of soldiers suffering from diseases.

The large number of sick troops hampered Union operations in eastern Arkansas for the remainder of the war. In the summer of 1863, a force under the command of Major General Frederick Steele moved from Helena in an effort to capture Little Rock. In the short march from Helena to Clarendon (Monroe County) on the White River, thousands of troops fell ill from various maladies. Steele was forced to transport his sick troops to DeValls Bluff (Prairie County), where a new hospital was established. As the expedition continued, hundreds more troops became ill crossing the Grand Prairie. After Little Rock fell to the Union army, men who had fallen ill were housed at St. Johns’ College. Confederate forces left about 1,400 sick men in the city when they retreated.

As Federal forces moved across the state and created outposts at strategic locations, they were joined by countless slaves who fled their masters. By the end of the war, Pine Bluff (Jefferson County), Helena, and Little Rock all had large populations of former slaves. Union authorities struggled to provide basic services for these freedmen but were unsuccessful in preventing numerous outbreaks of disease that quickly spread through the encampments. The former slaves commonly suffered from smallpox, as well as diarrhea caused by any number of illnesses. Some estimates put the number of deaths suffered by freedmen at twenty-five percent in their first weeks in the camps. In March 1864, Quakers in Indiana sent two missionaries to Helena to establish an orphan asylum to provide for the children who had lost their parents to disease in the city. With such large numbers of sick former slaves, white troops continued to fall ill even in the face of better healthcare. Eventually, Union authorities responded to this medical crisis by establishing military farm colonies for former slaves in the Arkansas Delta. This allowed the freedmen to become self-sufficient and lowered the population inside Helena and other towns.

Men who were former slaves also enlisted into the Federal army. Stationed at Helena and other Union strongholds, these men continued to suffer from high rates of disease. This was in part due to both continued poor sanitation, as the United States Colored Troops (USCT) units often received the worst camping locations within the city, as well as resulting from a continued shortage of qualified medical professionals willing to serve in African-American units. A single general hospital operated in Helena, while the nearest medical facility for USCT soldiers was located in DeValls Bluff. Little Rock and Memphis, Tennessee, also had hospitals open to soldiers in Helena.

The large numbers of sick troops affected Union military operations and prevented commanders from continually launching large-scale operations. In Arkansas, more than 182,500 white Federal troops became infirm during the war. Only about 4,450 were directly related to wounds, accidents, and other injuries, and the remaining was from some type of illness. Some 2,348 Union men suffering from illness died in the state during the war. The number of USCT troops that became ill in the state cannot be precisely determined, but the national mortality rate for USCT troops due to disease was 148 per 1,000, compared with 88 per 1,000 for white troops.

Confederate troops continued to suffer from disease during the war, although seemingly not in as large numbers as did their Union counterparts. After the Battle of Shiloh in April 1862, the Confederate government organized a medical department in Little Rock. This organization used a medical board of local physicians to examine applicants for commissions as surgeons and assistant surgeons. This system effectively weeded out inferior doctors. A facility for the manufacture of medicines was established in Arkadelphia (Clark County).

Outbreaks of disease continued throughout the war in southwestern Arkansas after the fall of Little Rock to Union forces in 1863. Treatment of these men was often exacerbated by dwindling supplies of medical supplies. Reliable numbers on the number of Confederates who suffered from disease in the state are not available.

The end of war saw the rate of disease in the state slowly lowering. With a major reduction of troops in the state, coupled with freedmen no longer being forced to live in confined quarters, outbreaks of disease in Arkansas dropped to prewar levels.

For additional information:
Adams, George W. Doctors in Blue: The Medical History of the Union Army in the Civil War. New York: Collier Books, 1961.

Bell, Andrew. Mosquito Soldiers: Malaria, Yellow Fever, and the Course of the American Civil War. Baton Rouge: Louisiana State University Press, 2010.

Finley, Randy. “In War’s Wake: Health Care and the Arkansas Freedman, 1863–1868.” Arkansas Historical Quarterly 51 (Summer 1992): 135–163.

Foster, Gaines M. “The Limitations of Federal Health Care of Freedmen, 1862–1868.” Journal of Southern History 48 (August 1982): 349–372.

Freemon, Frank R. Gangrene and Glory: Medical Care during the American Civil War. Madison, NJ: Fairleigh Dickinson University Press, 1998.

Hacker, J. David. “A Census-Based Count of the Civil War Dead.” Civil War History 57 (December 2011): 307–348.

Kellum, Rachel M. “Surgeons of the Severed Limb: Confederate Military Medicine in Arkansas, 1863–1865.” MA thesis, Jackson College of Graduate Studies, 2014.

Pitcock, Cynthia DeHaven, and Bill J. Gurley. I Acted from Principle: The Civil War Diary of Dr. William M. McPheeters, Confederate Surgeon in the Trans-Mississippi. Fayetteville: University of Arkansas Press, 2002.

Steiner, Paul E. Disease in the Civil War: Natural Biological Warfare in 1861–1865. Springfield, IL: Charles C. Thomas, 1968.

United States Department of the Army, Office of the Surgeon General. The Medical and Surgical History of the Civil War. 12 vols. Washington DC: Government Printing Office, 1870.

David Sesser
Henderson State University


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