The Illustrious Dead (5 page)

Later in his career, he learned to use disease. When the English took the island of Walcheren off the coast of the Netherlands in 1809, he refused to send his troops in. “Walcheren has for its defense fever and poor air,” he told his marshals. “In this season the island is one of the unhealthiest places on earth.” The British fell in droves to Walcheren fever, a mixture of dysentery and assorted fevers. “Health is indispensable in war” became one of the emperor’s maxims.

Napoleon had actually overseen a host of advances in war medicine, including Larrey’s invention of the “flying ambulance,” which, combined with his insistence that doctors bring their field hospitals close to the lines of battle, reduced the time that doctors could reach and treat wounded men from many hours to fifteen minutes. (For these innovations, and his policy of treating enemy wounded in the same way he treated French ones, Larrey is often considered the spiritual father of the modern Red Cross.) The doctor was genuinely loved by the soldiers; when in 1808 a rumor shot through the Army of Spain that Larrey had been killed by enemy fire, the troops of the elite Imperial Guard broke down and swore to avenge him. The rumors turned out to be untrue.

But when it came to funding his army, Napoleon’s prejudices came through. On the Russian campaign, the surgical corps was a shell of its former self. Young men unfit for army service, the dregs of the French population, could get an appointment as a junior regimental surgeon after only three months at a medical school. One medical student remarked on how many of his classmates were “hunchbacks and cripples.” Napoleon had systematically cut at the control that doctors had over their own work, handing supervision over to bureaucrats and even stripping physicians of the epaulettes they had worn on their uniforms. A significant portion of his doctors were regarded as cowards, malingerers, or hacks.

T
HE
F
RENCH HAD FACED
the killer that was gathering power in its ranks before. It had struck the French army during the wars in Spain (where 300,000 of Napoleon’s men died of disease, and only 100,000 in battle). The pathogen had aided them immensely at the siege of Saragossa in the summer of 1808, when 54,000 of the city’s 100,000 citizens died of the disease, along with 18,000 of the 20,000 Spanish soldiers within its walls, forcing the city to surrender. After Austerlitz, a bout of the illness struck that Dr. Larrey described in the complex nosological formulation of the day as “a malignant, nervous and putrid hospital fever (adynamicoataxic).” During the epidemic, a Polish officer, Heinrich von Brandt, caught the disease and was taken to a military hospital. “[The dead] were thrown from the windows stark naked,” he wrote, “and they fell, one on top of the other, with a muffled thud just as though they were sacks of corn.”

In 1796, during the siege of Mantua, Italy, the malady, along with malaria, killed or incapacitated 14,000 of Napoleon’s force of 24,000. The French still managed to prevail during the Italian campaign, but afterward one army surgeon reported the cost. “Like an enormous fire [the illness] is sweeping our hospitals,” he wrote. “That mortal plague afflicting all campaigning armies is caused by the filth of these quarters, the lack of fresh air, the negligence of the troops, and the total lack of concern by our own general staffs.”

Public health officials in France knew the disease. Spanish prisoners sent back from the ongoing war there brought the pathogen with them; they were forbidden to fraternize with the local French inhabitants, and after they left the straw they had slept on was burned and their barracks fumigated. The precautions weren’t thorough enough, however: in one hospital, the nuns who nursed the prisoners, the guards, the porters, the gendarmes who guarded the convoys, the medical students, the chaplain, and even the secretary of the War Commissioner—nearly everyone who came in contact with the Spanish patients even for the briefest time—caught the illness. Many of them died.

During the Wars of the First Coalition, while Napoleon was making his name, an especially lethal strain swept through the Prison du Bouffay in Nantes, killing twenty-one of twenty-two sentinels and most of the committee sent to investigate. Even the grave diggers hired to bury the victims succumbed. Any doctor with long experience in France would have been familiar with the disease. In a popular medical journal, a physician wrote in April 1812: “I warn all military physicians not to congregate all their fever patients in a single room by themselves, for few would come forth from such a room alive.”

In its encounters with French society, the pathogen had confirmed further clues about itself: Once entrenched in a population (how it achieved that was still a mystery), it appeared to be highly contagious. And the evidence showed that it was, as the army surgeon suspected, intimately connected with hygiene. Those two simple facts could have given Napoleon’s doctors a key insight into the malady’s nature and radically altered their approach to it, if they had learned the correct lessons from the outbreaks. Those bits of information would, a century and a half later, help to solve the riddle of the disease’s origin, a riddle unraveled by a French doctor at another hospital in another far-flung colony of empire.

C  H  A  P  T  E  R     4

Crossing

T
HE FIRST OF
N
APOLEON’S SOLDIERS CROSSED THE
N
IEMEN
River into Russia on a beautiful summer’s day. Napoleon’s army, the greatest he had ever led, in fact the greatest since the time of the Persian conqueror Xerxes, tramped above the rushing waters that marked the border between Poland and Russian Lithuania on June 24, 1812. Crossing the river was itself the signal, the trigger for war. It would take only hours for the news to reach Tsar Alexander I, reclining in a chair at a party scented by groves of orange trees in bloom, seventy miles to the east.

Anticipation and uncertainty and dreams of riches swirled in the minds of everyone from the emperor to raw privates pulled away from sleepy Normandy farms. The towns in Germany, the natural staging ground for an attack on Russia, had for months been full to bursting with troops waiting to know if it would be war or not. In his diary, Captain Roeder, the veteran Hessian soldier with a new wife back home, wrote how he was drinking in a restaurant when a passing Frenchman cried out on seeing him. They had tried to kill each other five years before at the Napoleonic Battle of Altenkirchen, when they were fighting on different sides. But the emperor’s reach was now so all-encompassing that ancient enemies marched shoulder to shoulder. The two men fell into each other’s arms.

In the noise and billowing clouds of dust and the percussive tramping of thousands of horses’ hooves, the shouts and orders in a half-dozen different languages, the men who staggered out of the ranks and collapsed by the roadside were hardly noticed. A few remarked on the bodies. No one was unduly alarmed. Napoleon was already ensconced in his richly appointed carriage, pulled by six horses and equipped with volumes of history and literature, scores of maps, a writing table, and candles for reading.

The deaths could easily be attributed to exhaustion or bad alcohol. The Grande Armée had swelled enormously beyond its core of veterans for the attack on Russia, and the new recruits weren’t as well conditioned as the survivors of Austerlitz and other campaigns. Cossacks, long distances, the Russian winter: these were the things that worried the men, if they worried at all. Supremely confident in its leader, the army bore down on its enemy.

For the sick, falling behind and watching their regiments disappear into a cloud of dust, the disease announced itself in various, even contradictory ways. Some victims felt at first a brush of giddiness; they became dizzy and light-headed with an almost pleasant sensation, as if they had taken a quick drink of schnapps after a long march. But this was often followed by “a very uncommon feeling …which is impossible to describe,” as if the pit of the stomach had dropped suddenly and the heart had stopped for a few seconds, then began vibrating instead of beating. Afterward, the symptoms could disappear for hours at a time, and the person would feel perfectly healthy and perhaps dismiss the episode as a spell of heatstroke or something equally benign. But the sickness was only gathering strength, and when it returned, as it always did, its wounding and malignant nature was impossible to miss.

A blinding headache shut the men’s eyes tight. Nausea and chills racked the entire body, soon followed by “universal pain,” body aches so excruciating, especially in the back muscles, that they could drop a man to the ground. Heat followed cold, as after three or four days a “river of fire” spread from the stomach upward across the chest and then shot along the pectoral muscles to the fingertips. The heat pulsated like a bonfire onto which fresh timber was being thrown every few hours or so; dying down, it was replaced by chills that could cause the teeth to knock together, then the river of fire would flame up again. A fever arrived and the temperature rose quickly to 105 degrees or higher (109 was recorded), where it would stay for days. Some patients grew so weak that they could barely move their head or stick out their tongue when asked by a physician. Others raved or laughed uproariously.

The army’s doctors could do little for the men. The disease was feared, but little understood. The best the physicians could offer was bleeding and folk cures such as bark or other herbs. The men were carried to hospitals along the route or put up in houses of local peasants, so filthy that they shocked even the poor French farm boys who had enlisted for adventure or a chance at an army career. In their beds, the symptoms appeared, disappeared, mutated, reversed into new areas of the body, drawing on a seemingly unlimited repertoire of agonies. Sunlight caused knifelike jabs in the eyes; “flying, wandering, or shooting pains” arced across the body, especially the groin and back; the voice coarsened and dropped; the face grew darker and puffy; the eyes lost their affect and appeared corpselike. Some patients reported “sensations of gnawing or tearing” in their bodies, and the headache was constant. “It felt to me as if an immense weight were pressing down the bones of the head,” wrote one survivor of the disease, “and as if the brain were reacting against this pressure by violent and rapidly successive throbs.”

As early as the second or third day, the mind began to be affected, with men muttering to people who weren’t there or singing nursery rhymes in ghastly voices. Complete exhaustion set in; if raising a cup of water to his lips could have saved his life, one sufferer recalled, he couldn’t have managed it. Others during the brief respites found it unbearable to stay in their beds and wandered constantly. The appetite disappeared and the men began to lose weight. Around the fifth day, tiny red spots usually appeared and spread from the chest and groin all over the body, except for the face and the palms of the hands.

These are the classic, unmistakable signs of a disease known by many names: famine fever, the Hungarian disease, hospital fever,
hauptkrankheit
(“head disease”), and the most famous alias, “war fever.” But it is most commonly known as epidemic typhus.

After ten to twelve days, the illness entered its crucial phase. Some of the severely affected saw their toes and fingers blacken with gangrene. Death came slowly. “Spotted typhus is beyond description, the patient wastes to nothing under your eyes,” wrote one woman watching her famous lover die in a Russian epidemic. “Of the illness I can scarcely write—there was so much pain.” Guessing who would die was a kind of hobby. One theory held that the number of tiny spots on the body could predict the end: the more there were, the deadlier the strain. Another school held that it was the
color
of the spots that gave the best clue: the closer the pea-size eruptions came to purple, the more certain it was that the patient wouldn’t survive. It was a long, often terrible death.

Gathering the ill together and mixing them with men afflicted with other, milder ailments was the worst thing Napoleon’s doctors could have done. The mistake was compounded by the fact that the bodies of the dead (left unburied in heaps in the army’s haste) were often stripped by local peasants and the clothes sold or worn. Many recipients of the uniforms soon fell ill and died; entire families were found dead in their homes. In the clothes was the answer to the riddle that had eluded doctors and thinkers for centuries, the cause of the deadly illness that was incubating in the Grande Armée as it advanced toward Moscow.

For centuries, typhus had excelled in attacking large armies. Now as Napoleon attempted to force Tsar Alexander to heed his singular rule, the signs of a new epidemic began to appear.

And Napoleon’s doctors could do almost nothing to stop it.

T
O UNDERSTAND WHAT
the Grande Armée’s doctors were thinking as they tried to save these dying men, one must understand the complex and often contradictory state of medical thought on disease in the early nineteenth century. The theory of the humors developed by Hippocrates in the fifth century
B.C.
was still the dominant mode of understanding health and sickness. According to it, black bile, yellow bile, phlegm, and blood were perfectly balanced in the healthy person. When diet or routines introduced an excess or a shortage of one of the humors, disease appeared.

But competing theories, superstitions, and straight-out quackery were layered over this belief. Medicine was very much an intuitive art as opposed to a rigorous science, and what treatment one received could vary widely, depending on what school of thought one’s physician favored. There was no universal cure for certain diseases. Age, occupation, living situation, physical build, and even temperament were key factors in determining the cause and cure for diseases. In addition, one had to consider the circumstances under which the victim had fallen ill: Was a northwest wind blowing? Was he depressed? Had he been exhausting his vitality by drinking to excess? Each patient was a world unto himself. This was a concept called “specificity.”

Specificity was fatal to the idea of common diseases and common treatments. One man’s cure was considered useless for the next patient, who had a different set of life factors to consider.

When it came to infectious diseases, there were two working theories: miasmism and contagion. Miasmism remained the dominant disease theory of the seventeenth through the nineteenth centuries. The influential English doctor Thomas Sydenham championed the idea beginning in the mid-1600s and developed the notion that noxious vapors emerged from the earth’s rotting center and infected the air of towns and villages, which were then struck by epidemics. It was a dark view of Mother Earth, much different from our own. Odor was a telltale sign of danger to one’s health. “All smell is disease,” wrote the English sanitary activist Edwin Chadwick.

The theory dissipated through European and American life. In
Jane Eyre
, the orphan asylum where Jane and her sisters live sits in a forest dell that is a “cradle of fog and fog-bred pestilence” and that eventually causes a typhus epidemic that kills a number of the girls. Edgar Allan Poe’s 1839 short story “The Fall of the House of Usher” contains perhaps the most palpable description of miasmism in modern literature. The twenty-first-century reader might interpret the passage as a gothic premonition of death, but the nineteenth-century one would also see something else—a realistic portrayal of airborne disease:

But the under-surfaces of the huge masses of agitated vapor, as well as all terrestrial objects immediately around us, were glowing in the unnatural light of a faintly luminous and distinctly visible gaseous exhalation which hung about and enshrouded the mansion. “You must not—you shall not behold this!” said I, shuddering, to Usher, as I led him, with a gentle violence, from the window to a seat. “… The air is chilling and dangerous to your frame.”

The doctors who advocated miasmism weren’t only following tradition, they were obeying common sense. Who could believe disease was spread by invisible organisms that somehow floated from body to body, instead of the odors from rotting corpses that one could smell and even taste on the tongue? Which made more sense? The idea of contagion was more radical in its view of a hidden world of germs. The miasma theory fell in easily with centuries of folklore about the dangerousness of swamps and bogs, and it chimed with the evidence of one’s own senses. It’s no wonder that it proved remarkably resilient.

Contagion—the idea that disease spreads by direct or indirect contact—was the father of modern germ theory. Its roots went back to the Muslim statesman and medical thinker Avicenna in the eleventh century. By the nineteenth century, it had many supporters but just as many detractors.

M
OST OF
N
APOLEON’S
doctors followed the categories of illness invented by Philippe Panel, a groundbreaking French specialist in mental illness, in
Nosographie philosophique ou méthode de l’analyse appliquée à la médecine
(1798). Panel divided illness into five categories: fevers, phlegmasias (inflammations), hemorrhages, neuroses, and organic lesions. Fever was divided into antiotenic, meningogastric, adenomeningeal, adynamic, ataxic, and adenonervous, each with subdivisions and each requiring its own course of treatment. But as to cause, the miasmatic model ruled.

During the Egyptian campaign of 1798-1801, Napoleon’s future surgeon general, Dr. Larrey, spoke of winds “loaded with the putrid effluvia of animal and vegetable substances decomposed by the heat in the lakes.” A hot southwest wind was believed to bring the plague, while a brisk wind from the north brought health. In a study of the 1806-7 Prussia-Poland campaign, an army doctor reported that “one cannot give a good history of the diseases which are epidemic in the army without having first described the medical topography of the theater of war and the state of the atmosphere whilst the army was in the field.” The doctor had to be an amateur surveyor and meteorologist to diagnose an epidemic.

But Larrey also conceded that
once plague had rooted itself in the ranks
, it could become contagious. The rapid spread of the plague in Egypt, in differing meteorological circumstances and across different terrains, made it clear that disease wasn’t just arising from bad air. He and other doctors borrowed from both theories to fit the patterns they observed.