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NARRATIVE ACCOUNTS
Why did the Vermonters die at Andersonville?
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The raw statistics are well known.6 The over-all morality of the Federal prisoners-of-war held at Andersonville (probably 32%) was more than twice the average for POWs, north and south, which was actually little different from the risk of Federal and Confederate soldiers dying of disease in the field---about 13%.7 However, there is more to the story. About 41,000 Federal soldiers shuffled into Andersonville between February 1864 and the end of the war.8 Although only 13,000 of the prisoners are buried in the National Cemetery at Andersonville, it is probably no exaggeration to state that 50% of the prisoners who entered Andersonville died before reaching home or arrived home mere wrecks of men.9 One can speculate to what size the Andersonville cemetery would have grown had not General Sherman’s campaign in Georgia forced the evacuation of its prisoners, many of whom died elsewhere in the Confederacy. Although at times, conditions in other Confederate and Northern military prisons rivaled those at Andersonville, overall, Andersonville, as pronounced by James M. McPherson, “was in a class by itself.”10
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 explained:
The terrible things which happened in [the Civil War prison camps] seems to have taken place not because anyone meant it so but simply because men were clumsy and the times were still rude.11
This explanation seems thin and judging by the history of war and the treatment of prisoners in subsequent 20th century warfare, men are still clumsy and the times are still rude. Catton added the observation: “A certain combination of incompetence and indifference can cause almost as much suffering as the most acute malevolence.”12 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.
Late in the war following the termination of prisoner exchange, 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.”13 Following the war, ex-Confederates like Edward A. Pollard, the editor of The Richmond Examiner, denied there was any “problem” at Andersonville proclaiming the prison was of “unquestioned healthfulness” and cited “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…”14 Later Southerners and others have apologized for the Andersonville prison camp horrors by pointing out that the Confederacy simply did not have the necessary resources and also blamed the policy of the Lincoln government that halted prisoner exchange ostensibly over the issue of “white-for-white” repatriation.15 One modern Southern historian described the Federal prisoners as constituting “a large bother” to the Confederate government and conceded rations were “appalling scant” (but “identical” with that provided Rebel soldiers in the field).16
A Vermont mother clearly explained on a cenotaph in Greenwood Cemetery at St. Albans, Vermont, her belief about Andersonville:
| JOSEPH PARTRIDGE BRAINERD, SON OF JOSEPH H. BRAINERD and his wife Fanny Partridge, a conscientious, faifhful, brave, Union Soldier, was born on the 27th day of June 1840, graduated from the University of Vermont in August 1862, enlisted into Co. I of the Vermont Cavalry, was wounded and taken prisoner by the Rebels in the Wilderness, May 5,1864, was sent to Andersonville Prison Pen in Georgia where he died on the 11th day of September 1864, entirely and wholly neglected by President Lincoln and murdered with impunity by the Rebels, with thousands of our loyal Soldiers by Starvation, Pri- vation, Exposure and Abuse." |
Another Vermonter woman 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.”17 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…”18
Somehow, while all these views are not necessarily mutually contradictory and each may contain a kernel of truth, none of these explanations seem entirely sufficient in explaining why “Andersonville was in a class by itself.” Employing what McPherson calls “the fallacy of reversibility,” it can be argued that all these and other factors were present to a more or less extent at various times in the other Civil War military prisons both in the South and in the North without producing another Andersonville. To the medical mind seeking a definitive answer or, in contemporary parlance, searching for “a smoking gun,” studying the ordeal and mortality at Andersonville of specific small groups such as Benedict’s Vermonters or the “Plymouth Pilgrims,” 2nd Tennessee Infantry, 9th Minnesota Infantry, and 7th Tennessee Cavalry provides another compelling explanation of the disaster at Andersonville.19
The proud Vermont Brigade of the Army of the Potomac was not only one of the best but was also among the healthiest units in the army.20 The Vermont farm boys turned soldiers were remarkably free of illness with only 9% dying of disease. During most of the war, Vermonters captured from the Vermont Brigade fared about average as POW’s with 13% 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 (59%). This catastrophe was not unusual for Andersonville during the summer of 1864.21 Superficially and in retrospect, it is not difficult to understand what happened to these Vermonters. A recent historian of Civil War prisons states the obvious, while shedding little light, when explaining that the causes of the “sickly conditions” producing Andersonville’s high death rate were “quite clear” citing the “opprobrious circumstances” of the prison.22 Something unusual and quite lethal was occurring at Andersonvile during the summer of 1864 and a better explanation of the “sickly conditions” is called for.
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The Confederate Surgeon General, Dr. Samuel P. Moore, sent the South’s foremost medical expert on infectious diseases, Professor Joseph Jones (Princeton University 1853, University of Pennsylvania Medical School, professor at the Medical College of Georgia in Augusta), 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 the deaths.23 Actually, the prisoners appeared to be dying of “scorbutic dysentery.”24 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.”25 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).26 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 malabssorption and diarrhea.27 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.”28 The physicians at Andersonville also recognized this diet was unhealthy. Dr. R. Randolph Stevenson, the chief surgeon of the hospital 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.”29 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.”30
In his report to the Confederate Surgeon General, Dr. Jones stated: “From this examination we may conclude that there is no recognizable source of disease in the waters or soil of Andersonville.”31 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.
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Graph illustrating that the pattern of deaths at Andersonville during the period May through October followed the Gaussian distribution (normal distribution or bell-shaped curve) one might expect if the major cause of death was due to lethal epidemic produced by a single infectious agent propagating in a closed community in which every individuals is susceptible. Farr's Law of Epidemics ( William Farr 1807-1883), first promulgated in 1840 and resurrected by Brownlee in the early 1900s, states that epidemics tend to rise and fall in a roughly symmetrical pattern that can be approximated by a normal or bell-shaped curve.
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Intestinal worms contracted from the soil (soil transmitted nematodes or geohelminths) are prevalent throughout the developing world where primitive levels of sanitation, hygiene, and education are coupled with bare feet and the absence of properly constructed outhouses and flush toilets. Hookworm is the second most common of these helminthic infections (after Ascariasis) infecting over one billion people worldwide. The adult hookworm measures less than a centimeter in length and resides in the wall of the small intestine. Ova (eggs), as many as 10,000 per day per female worm, are passed in the stool where the larval stage thrives in the warm moist sandy or loamy soil of tropical and sub-tropical 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.32
Hookworm is endemic in tropical Africa and was brought to North America in the bowels of African slaves where it became a regional affliction below the Mason-Dixon Line. In the 19th century, probably as much as 40% of the region’s population harbored the parasite.33 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”) exhibited, in varying degrees, a prematurely aged, emaciated appearance with striking lankness of frame and slackness of muscle, a misshapen boney scarecrow look with a peculiar “fish eyes” stare, and a sallow complexion.34 These lethargic and shambling (interpreted by the outsider as lazy and ignorant) poor white farm folk were a hallmark of the Deep South.35 One Northern visitor caught this when he described the physical appearance of the white inhabitants surrounding Andersonville “as listless and apathetic in look, lank and haggard in form.”36
Comfortably and securely berthed in the bowels of millions of Southerners, the parrasite avoided detection for two centuries. It seldom killed its victims outright but produced a chronic anemia which left them feeling weak, listless, and out-of-sorts; hence it’s later identification in the popular press as the “germ of laziness.”37 This chronic illness operated as a “secret weapon” for the North by sapping the strength of the Confederate armies.38 A recent historian of the South observed, “No one can say just how much…hookworm helped to sustain the Union.”39 To a physician’s eye, Lee’s infantry, “Those gaunt, barefoot, whiskery scarecrows” described by Robert Penn Warren, actually have the typical appearance of sufferers of hookworm disease---a barefoot recruit from Dixie was sure to be a haggard and anemic Johnny Reb.”40
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 and probably freshly left by the gangs of Afro-American 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.41 These Federal prisoners were weakened by malnutrition and suffering from multiple nutritional deficiencies that produced “scorbutic dysentery.” Inadequate vitamins and protein in the diet produced malabsorption and the unbolted cornbread aggravated the diarrhea. The mind boggles picturing upwards 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 of excrement being smelled in Americus, Georgia, when the wind was “right”.42 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 the hands when grubbing for roots and digging wells and burrows for shelter. There were few eating or cooking utensils, and probably much eating of dirt. The drinking water from Stockade Creek must have been heavily contaminated with larvae, as were the wells. Even bathing, when possible, could produce lethal infection.43 The cycle of infection was repeated either by penetration of the skin or oral ingestion of the larvae until virtually every inmate was massively infested. The closed and densely populated conditions produced an explosion of infection. The Northerners lacked any natural immunity to the parasite and their resistance was impaired by malnutrition. Hookworm, that 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.” Between June and October, 10,000 prisoners died, including 57 of the Vermonters captured at the Weldon Railroad.
It has been suggested that the small number of Afro-American prisoners and the 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 outside of the daily ration.44 While true, it seems more important that the Afro-Americans survived because they are genetically less susceptible to hookworm infection and the guards rarely set foot inside the stockade.45
Medical Science, of course, did not identify hookworm for another 30 years. Colonel Bailey K. Ashford MC USA unraveled the mystery of the severe mortality associated with “scorbutic dysentery” at Andersonville. Dr. Ashford investigated the deadly epidemic that followed the San Ciriaco hurricane of 1899 that killed 11,875 Puerto Ricans.46 He discovered that hookworm becomes a deadly disease (”la anemia”) when the victim is also afflicted with the intestinal malabsorptive disease endemic in the Puerto Rican jibaro (peons).47 At Andersonville, the concurrence of “scorbutic dysentery” converted the hookworm into a killer as occurred in Puerto Rico.
Hookworm has always been a scourge of sub-tropical and tropical areas of the world. The anemia of hookworm disease is probably described in the Egyptian Papyrus of Ebers (c. 1550 B.C.) but the cause was not recognized until the late 19th century with the used of the medical microscope. In the 1880’s, a particularly virulent outbreak of anemia afflicted the laborers digging the St. Gotthard tunnel in Switzerland and Italian physicians discovered hookworm ova and hookworms on post-mortem examination in the body of a St. Gotthard miner.48 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 infection in the United States.49 A campaign to eliminate the “disease of laziness” from the Deep South began 1909 when Dr. Stiles persuaded the Rockefeller Foundation to set up a five-year Sanitary Commission for hookworm eradication.50
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. The infection rate among adults was 34 percent and 37 percent among school children. Southerners learned to practice proper sanitary methods to prevent the spread of hookworm eggs. Hookworm disease has been all but eliminated due to combined efforts involving identification and treatment, education (particularly the wearing of shoes), and improved sanitation disposal (especially by building outhouses). The parasite now is a minor health problem in the South. In 1981 sixty-nine cases of hookworm were reported to the Mississippi State Board of Health.51
Dr. W. J. W. Kerr was one of the Confederate physicians at Andersonville. In 1910 he retrospectively recognized that hookworm [along with pellagra] was “rife” at the prison.52
Dr. Stiles visited Andersonville early in the 20th 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. He conveyed his findings to Professor Edward P. Channing of Harvard University. 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.”53
Dr. Stevenson, writing in 1876, argued “that the sufferings at Andersonville were the results of a malignant pestilence.”54 Undoubtedly, many compounding factors contributed to the disaster at Andersonville, but Stevenson had it right. It was an explosive and lethal epidemic of hookworm that placed Andersonville “in a class by itself” and killed the Federal prisoners.
END NOTES
1 William Manchester, American Caesar: Douglas MacArthur 1880-1964 (Boston: Little, Brown & Co., 1978), p. 241.
2 Clara Barton toured the empty prison pen and prison hospital in May 1865 and found them "horrible beyond description." The Andersonville National Historic Site literature proclaims, "At Andersonville human misery reached its zenith." William G. Burnett, The Prison Camp at Andersonville (Published by Eastern National Park and Monument Association, 1995), p. 43: Carl Sandburg, Abraham Lincoln: The War Years vol. 3, (New York: Harcourt, Brace & World., 1939), p. 641; William Marvel, Anderssonville: The Last Depot (Chapel Hill: University of North Carolina Press, 1994) p. 242.
3 William B. Hesseltine, Civil War Prisons: a Study in War Psychology (Kent, Ohio: Kent State University Press, 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 vol. 5 (1864-1865), (New York: Macmillan, 1904; 1920 edition), chapter XXIX pp.483-515.
5 Demonstrating that Civil War partisan invective is still active, a former director of the Vermont Historical Society explained in a recent history of Vermont that 350 Vermont soldiers "died in Andersonville Prison, the Confederate Dachau in Georgia." Charles T. Morrissey, Vermont: A History (New York: W. W. Norton, 1982), p. 34.
6 Rhodes, History of the United States, vol. 5, pp. 507-508.
7 Hesseltine, Civil War Prisons, p. 6; James M. McPherson, Battle Cry of Freedom: The Civil War Era (New York: Oxford University Press, 1988), p. 802.
8 William Marvel, Andersonville: The Last Depot (Chapel Hill, North Carolina: University of North Carolina Press, 1994), p. ix.
9 William Marvel believes that only 26,000 of the 41,000 prisoners held at Andersonville made it home--an overall mortality of 37%. William Marvel, Anersonville: The Last Depot (Chapel Hill, North Carolina: University of North Carolina Press, 1994), ix: George G. Benedict, Vermont in the Civil War vol. 1 (Burlington, Vermont: Free Press Association, 1886), p. 481.
10 Gary Gallagher states, "No other prison camp, North or South, comes close to matching [Andersonville's] deadly statistics." McPherson, Battle Cry of Freedom, p. 798; Gary W. Gallagher, "Good Histories of Prisons are still Missing in Action," Civil War Magazine vol. 59 (December 1996), pp. 6-8.
11 Bruce Catton, A Stillness at Appomatox (Garden City, New York: Doubleday & Company, 1953), p. 227.
12 Ibid. p. 227
13 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.
The Confederate Assistant Adjutant &
Inspector General, Colonel D. T. Chandler, inspected Andersonville on August5, 1864 and reported to General Samuel Cooper that the prison was "a place of horrors of which it is difficult to describe, and which is a disgrance to civilization." General Cooper's department passed the report on to the Confederate government with the endorsement that "the condition of the prison at Andersonville is a reproach to us as a nation..." OR, ser. 2, vol. 7, 546- 550 (Chandler, Chilton).
14 Edward A. Pollard, The Lost Cause: A New Southern History of the War of the Confederacy (New York: Treat & Company, 1886), p. 627.
15 Marvel, Andersonville: The Last Depot, p. x; Joe Henry Segars, editor, Andersonville: The Southern Perspective Journal of Confederate History vol. XIII (Atlanta, Georgia: Southern Heritage Press, 1995), pp. 181-190 (Epilogue: "Who caused Andersonville" by Mauriel Joslyn).
16 Frank E. Vandiver, Their Tattered Flags: The Epic of the Confederacy (College Station, Texas: Texas A & M University Press, 1987), p. 294.
17 The Dorset Tribune (Dorset, Vermont) n.p. The undated newspaper clipping is in the Benedict Family Papers, Bailey Howe Library, University of Vermont, Burlington, Vermont.
18 Benedict, Vermont in the Civil War, vol.1, p. 482.
19 Following their capture at Plymouth, North Carolina, 2,364 Federal prisoners arrive at Andersonville in early May 1864. Fewer than 50% of these "Plymouth Pilgrims" survived Confederate imprisonment and reached home safely. Only 95 of 237 (40%) officers and enlisted men from the 9th Minnesota infantry captured at Brice's Crossroad in June 1864 survived beyond August 1865. The 2nd Tennessee Infantry (Union) had 583 enlisted men captured at Rogersville, Tennessee on November 6, 1863. Sent to Belle Isle and Andersonville, 417 (72%) died during their captivity. 450 troopers of the 7th Tennessee Cavalry (Union) were captured by Forrest at Union City, Tennessee on March 24, 1864 and the enlisted men sent to Andersonville. 291, or 65%, never returned home. Robert K. Kellogg, Life and Death in Rebel Prisons (Hartford, Connecticut: L. Stebbins, 1866), p. 19; personal communication from John B. Lunstrom, Milwaukee Public Museum; David Mathews, 2nd Tennessee Infantry Regiment USA; http://www.stkusers.com/lindas/history.html.
http://home.cinci.rr.com/secondtennessee/ ; Peggy Scott Holley, The Seventh Tennessee Volunteer Cavalry, West Tennessee Historical Society Papers vol. 52, 1998 see:
http://www.stkusers.com/lindas/history.html .
20 Catton, A Stillness at Appomattox, p.72.
21 For example, 49 enlisted men of Company A, 5th Rhode Island Heavy Artillery were captured en mass at Croatan, North Carolina on May 5, 1864. 34 (69%) died at Andersonville or later in Confederate captivity. Joel Abbot, Rhode Island at Andersonville, http://suvcwricamp21.tripod.com/anders.htm
22 Lonnie R. Speer, Portals to Hell: Military Prisons of the Civil War (Mechanicsburg, Pennsylvania: Stackpole Books, 1997), p. 260.
23 Official Records, The War of the Rebellion, series 2, vol. 8, pp. 589-632.
24 Alfred Jay Bollet, Civil War Medicine: Challenges and Triumphs (Tucson, Arizona: Galen Press, 2002), pp. 369-372.
25 R. Randolph Stevens, The Southern Side; or, Andersonville Prison (Baltimore: Turnbull Brothers, 1876), p.51.
26 Kenneth J. Carpenter, The History of Scurvy and Vitamin C (Cambridge, Massachusetts: Cambridge University Press, 1986), p. 114.
27 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), pp. 49-67; Alfred Jay Bollet, "Scurvy, Sprue, and Starvation: Major Nutritional Deficiency Syndromes During the Civil War" Part 1, Medical Times, November 1989, pp. 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.
28 William G. Burnett, The Prison Camp At Andersonville (Eastern National Park and Monument Association, 1995), p. 16.
29 Segars, Andersonville: The Southern Perspective, p. 16.
30 Stevenson, The Southern Side, p. 60.
31 Why didn't the Confederate physicians at Andersonville identify hookworm? Dr. Joseph Jones "instituted a series of post-mortem examinations to determine the true causes of the great mortality amongst the Federal prisoners." He reported, "The results of my post-mortem examinations showed that in many of the cases of diarrhea and dysentery of long standing no treatment whatever would have availed, so thoroughly was the mucous membrane of the intestine diseased. In those cases the congestion of the mucous membrane was intense, and was often accompanied with ulceration and mortification. The mortification appeared to be similar in its nature..as that form of mortification known as hospital gangrene." He added, "hospital gangrene, or a disease resembling it in all essential respects, attacked the intestinal canal of patients although there were no local manifestations of gangrene upon the surface of the body. This mode of termination in cases of dysentery was quite common" That Dr. Jones found no parasites in 128 post-mortem examinations is not surprising since their identification had to await use of the medical microscope as part of autopsies. Hookworm parasites and ova were not discovered on post-mortem examination until 1880 in Europe and 1898 in Puerto Rico by Dr. Ashford. Col. Ashford performed 7 autopsies on Puerto Ricans who died of "la anemia" and was able to identify the hookworm only on histological study. The "gangrene of the intestine" described by Dr. Jones would be translated today as "tissue necrosis." What Dr. Jones found probably resembled what is encountered in end-stage AIDS enteropathy today. OR Series 2, Volume 8, page 593; 618, 621; W. J. W. Kerr, "Pellagra and Hookworm at Andersonville" Confederate Veteran vol.. 18 (1910), p. 69; Segars, Andersonville: The Southern Perspective, p. 16.
32 Geer Williams, The Plague Killers (New York: Charles Scribner's Sons, 1969), pp. 3-17, Tropical Medicine Central Source, Chapter 12: Ancylostomiasis (Hookworm disease) http://tmcr.usuhs.mil/tmcr/chapter12/intro.htm
33 John Ettling, "The Germ of Laziness: Rockefeller Philanthropy and Public Health in the New South" (Cambridge, Massachusetts: Harvard University Press, 1981), p. 2; Thomas D. Clark, The Emerging South (New York: Oxford University Press, 1968), p. 25.
34 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." In the character "Will Benteen" Margaret Mitchell in Gone with the Wind describes this same sterotype: "He had the sallow malarial face of the south Georgia cracker, pale pinkish hair, and washed-out blue eyes...[this] lanky man with his boney stooped shoulders..." Ibid., p.2.; Wilbur J. Cash, The Mind of the South (New York: Knopf, 1941), pp. 23-25; William Faulkner, Doctor Marino and other stories (New York: Smith & Hass, 1934), p. 225; Margaret Mitchell, Gone with the Wind (New York: Macmillan Publishing Company, 1936), 465,467.
35 Clark, The Emerging South, pp. 25-26.
36 Augustus C. Hamlin, Martyria; or, Andersonville Prison (Boston: Lee & Shepard, 1866), p. 17.
37 Ettling, The Germ of Laziness, pp.1-2.
38 "By today'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., p. 2; Clark, The Emerging South, p. 24.
39 Ibid., p. 24.
40 A Virginia woman described "the gaunt starvation that looked from their cavernous eyes" as the Confederate infantry invaded Maryland in 1862. One recent Southern historian believes that during the Army of Northern Virginia's Antietam campaign of 1862 "as many as 80% of its soldiers were without shoes."Robert Penn Warren, The Legacy of the Civil War (New York: Knopf, 1961), p. 57; Mary Bedinger Mitchel"A Woman's Recollections of Antietam," Battles and Leaders: The Struggle Intensifies, vol. II, (New York: Yosleff, 1956), p. 687; Ettling, The Germ of Laziness, p. 2; David Williams, A People's History of the Civil War (New York: The New Press, 2005), 206.
41 The density within the Andersonville stockade at peak crowding has been estimated as 20 times the population density of Liverpool in the mid 19th century. Hamlin, Martyria; or, Andersonville, p. 49.
42 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" Bulletin of the History of Medicine vol. 47 issue 4 (July-Agusut) 1973, pp. 317-343; OR Series 2, Volume 8, pages 599, 617.
43 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: William Morrow & Co., 1934), pp. 440-408.
44 Marvel, Andersonville: The Last Depot, p.155; McPherson, Battle Cry of Freedom, p. 802.
45 Ettling, The Germ of Laziness, p 4.
46 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 death from all other causes for the preceding years was 375. Ashford, A Soldier in Science, p. 91.
47 William H. Crosby, "The deadly hookworm. Why did the Puerto Ricans die?" Archives of Internal Medicine vol. 147 (1987), pp. 577-78; A. E. Maldonado, "Hookworm disease: Puerto Rico's secret killer" Puerto Rico Health Science Journal vol. 12 (1993), pp. 191-96; Ashford, A Soldier in Science, pp. 35-63; Ettling, The Germ of Laziness, pp. 29-32.
48 For the first modern record of disease caused by hookworm see: A. Dubini, Ann. Univ. Med. Milano 106:5-13, 1843. H. Harold Scott, A History of Tropical Medicine vol. II, (Baltimore: Williams & Wilkins, 1939), pp. 840-853.
49 Charles Wardell Stiles, "Early History, in Part Esoteric, of the Hookworm (Uncinariasis) Campaign in Our Southern United States" The Journal of Parasitology vol. 25 (1939), pp. 283, 296-308; Ettling, The Germ of Laziness, pp.10-48.
50 Ibid., pp. 97-177.
51 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, The Plague Killers, pp. 17-97; Deanne Stephens Nuwer, "The Importance of Wearing Shoes: Hookworm Disease in Mississippi" Mississippi History Now (Jackson, Mississippi: Mississippi Historical Society, 2000), http://mshistory.k12.ms.us/features/feature31/hookworm.html
52 Kerr, "Pellagra and Hookworm at Andersonville" p. 69.
53 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 vol. 6 (New York: Macmillan, 1905-1925), p. 442; Hesseltine, Civil War Prisons, p. 6.
54 Stevenson, The Southern Side, p. 6.
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