The Illustrious Dead (6 page)

C
RUCIALLY, THERE WAS
no accepted way to test which theory was true. Nor was there a way to find out which treatments worked best: the rest cure, the bark cure (using the outer layer of trees, the original source of aspirin), the cold-water cure, cupping, bleeding, and the split carcasses of small animals applied to the body—all of these were common treatments for typhus in the early 1800s, each with its own followers and detractors. There were fad causes and fad cures. In 1811 the American doctor Elisha North was compelled to study typhus by the dread it was causing in his patients. “Upon [its] first appearance,” he wrote, “in any place, so many fall sudden victims to the jaws of death, that a universal terror seizes the minds of all, and of physicians among the rest.” He began to study the illness.

After months of research, he published his results. The disease wasn’t the result of outside causes, North found, of bad air or invisible creatures passed from victim to victim. Instead, he blamed “the typhus temperament.” Certain qualities made a person susceptible to the disease: a vigorous constitution, a rich and highly seasoned “animal diet,” living in a dry environment, and frequent alcohol intake, along with an “ardent spirit.”

The idea took its place in the medical literature. But no one could definitely say what was true and what was bunk.

One physician had attempted to change that. On May 25, 1747, twenty-two years before Napoleon’s birth, an experiment took place on board the Royal Navy warship
Salisbury
that would change the course of medicine.

The doctor’s name was James Lind, and he was a Royal Navy surgeon and a specialist in diseases that affected mariners. Just thirty-one, the Scottish-born doctor had sailed all over the world as a surgeon’s mate, watching men die from typhus and scurvy from the west coast of Africa to the ports of Jamaica. He knew that the two maladies killed far more sailors than the king’s enemies ever managed to. Lind would do remarkable work in the understanding of both.

Lind’s 1747 experiment looked at scurvy. Twelve sailors who had the illness were divided into six groups. The accommodations and diet of all the sailors were identical, but each received a different remedy: one group received cider; one got seawater; another, “elixir of vitriol”; the fifth group, two oranges and a lemon; and the sixth, a mix of spices with barley water. It was the first documented clinical trial in medical history.

“I shall propose nothing dictated merely from theory,” wrote Lind. “But shall confirm all by experience and facts, the surest and most unerring guides.” This in itself was revolutionary, in an age when so much superstition and ancient theory overlay the world of medicine. When the sailors who received the citrus recovered completely, and the others did not, Lind had proved that orange and lemon juice was the true and universal corrective for the disease. He had created a blind test whose results were irrefutable.

It wasn’t the oranges and the lemons that constituted the breakthrough, as using citrus had been one of the folk remedies against scurvy for well over a century. And, in fact, Lind didn’t propose that scurvy was a deficiency disease caused by lack of a mineral (vitamin C, as it turned out) contained in the fruit. He thought that moist air blocked the pores in scurvy patients, and that lemon juice helped toxins escape the body through the skin. But he didn’t need to know
why
the cure worked so long as he knew that it
did.
This is what the blind test proved. He had invented a way of evaluating medical knowledge.

When it came to the other great killer of mariners, typhus, Lind made a signal contribution in a 1763 paper. The Royal Navy at the time took anybody for its ranks, often by force: slums, criminal courts, and taverns were swept for new recruits, who often came to the ships infested with lice and bacteria. The surgeon recommended that the newcomers be sent to a receiving ship and quarantined there for a few weeks to see if any diseases revealed themselves. They were given hot baths, and their old clothes were thrown away and a fresh set provided. By the time the men went on board their new ships, the sick had been culled from their ranks.

The British Admiralty didn’t implement the typhus-defeating quarantine until 1781 and didn’t fully provide an allotment of citrus until the 1790s, but when these measures were implemented piecemeal, the results were astonishing. In the months before the 1795 Battle of Quiberon, Lind instructed that provision ships carrying fresh vegetables and citrus fruits be ferried to the twenty-three ships of the line blockading French ports. On the day of battle, out of 14,000 men, only about 20 were listed as sick and unfit for duty, an unheard-of number for an eighteenth-century fleet. One of Lind’s biographers estimated that his recommendations added the equivalent of six warships to the British fleet that day, in which the British decimated the French. The Royal Navy’s policy of blockading ports, so devastating to Napoleon’s plans for defeating the English commercially, would have been unthinkable had scurvy or typhus been allowed to ravage its crews.

Taking Lind’s warning about noxious air seriously, British captains paid attention to the cleanliness of their ships, regularly airing them out and scouring the bedding and sailors’ clothing. The incidence of typhus in the Royal Navy dropped dramatically. Lind remarked that for the first time in history, sailors “enjoy a better state of health upon a watery element, than it can well be imagined so great a number of people would enjoy, on the most healthful spot of ground in the world.”

The navy’s procedures proved that a large military institution could keep infectious disease at bay indefinitely. In a sense, typhus had been “cured.” But there were many times when the mystery of typhus was believed to be solved; in fact, it was “solved” over and over again, but the insight kept slipping away.

Why didn’t Lind’s insight hold? Why didn’t Dr. Larrey and his colleagues adopt Lind’s protocols for preventing typhus? And why, at the very least, didn’t they use his idea of the blind test to evaluate different treatments and prevention methods?

Simply put, because the breakthrough Lind ushered in—the idea of an empirical test that measured the effects of disease on all men uniformly—went so radically against the reigning ideas of the time: specificity and miasmism. The blind test entered a different mental and theoretical world than exists today. Medicine was not the uniform place we know, where a discovery in Berlin or California is tested, reviewed, published, put through clinical trials, and then adopted worldwide. Lind couldn’t with one stroke realign centuries of thought on the humors, on the origins of different kinds of fevers and the effects of the weather. Medicine was a spooky art, and Lind’s insights would need many decades, and further breakthroughs in the areas of disease theory, to change history.

In 1812, his theory was one among many. If Lind had found success with strict hygiene and quarantine, Dr. Larrey could point to his colleagues’ work that produced results through other methods (although he himself was not averse to keeping patients clean and their clothing disinfected). Standard practices for avoiding and treating diseases did exist, but they were far less ironclad than they are today, and a doctor was free to pick and choose among them. Medicine was still a bespoke pursuit, still decades away from being a true science.

And even if Larrey, convinced that the Englishman was right, had come to Napoleon with a plan for defeating contagious diseases—which would have slowed the Grande Armée down and required a huge infrastructure and an infusion of money—he would have been dismissed out of hand. A century later the Russian army, knowing the cause of typhus, would be unable to stop it during World War I. Lind’s protocols were far easier to implement in a fleet of ships than in a massive, multinational army.

So the pathogen that the English surgeon had successfully revealed and defeated was free to strike again.

A
ND NOW SOMETHING
never noted by Dr. Lind was happening within the army. The massing of an unprecedented number of troops meant that typhus suddenly had an almost unlimited selection of potential hosts, and an easy way to infect them. The disease was spreading fast and becoming deadlier by the week.

After millions of years, the fatal mechanism had found its most efficient form, its ideal expression.

C  H  A  P  T  E  R     5

Pursuit

W
HEN THE ARMY CROSSED THE
N
IEMEN ON
J
UNE
24,1812, a shocked Alexander wrote Napoleon a hurried note as he scrambled to retreat. The tsar had been preparing for the possibility of war but still couldn’t quite believe Napoleon had initiated it. His note offered a solution: If the French turned around and retired behind the Niemen, the two sides would settle their problem amicably. “Alexander is laughing at me,” Napoleon said, astonished at the apparent mock-naïveté of the letter.

The Grande Armée swept east. X Corps headed northeast to confront General Barclay, the German-speaking commander of all the tsar’s forces, while V and VII Corps, at the southernmost tip of Napoleon’s lines, moved east toward the Berezina River, chasing the Russian divisions under General Peter Wittgenstein, which were now in full retreat. Napoleon and the main body of troops headed for Vilna (modern-day Vilnius), where Alexander had attended a ball among the fountains and cultivated gardens of a country estate. The emperor arrived there on June 28 and found signs that the Russians had prepared to defend the city but then had left hastily, burning the bridge over the Vilia River as they retreated. The bridge was the first tangible evidence of Alexander’s evolving strategy of retreat-and-lay-waste, the first sign of total war. But Napoleon believed the withdrawal could be the prelude to a counterattack that would give him a chance at a quick, decisive victory. He had much to learn about the young campaign.

The timing of the invasion had come as a surprise to Alexander, and his forces were too widely dispersed to mount a serious defense. Nor did he have accurate information on the numbers or positions of Napoleon’s forces. The analytical General Barclay, knowing that he would be annihilated if he attempted to stand and fight, ordered the hotheaded General Bagration in the south to fall back and avoid contact with the French, already causing friction with his rival. Napoleon’s forward units managed brief encounters with the fleeing troops, but anything resembling a decisive battle evaded Napoleon in the first weeks of the campaign.

Alexander, whose words to his people during the campaign were consistently more effective and rousing than the French emperor’s, issued a proclamation telling the Russians what Napoleon had done: “He has come with treachery in his heart and loyalty on his lips to enslave us with the help of this legion of slaves. Let us drive this plague of locusts out! Let us carry the Cross in our hearts, and steel in our hands! Let us pluck the fangs out of the lion’s mouth and overthrow the tyrant who would overthrow the earth!” The biblical imagery was clear. The fusing of the campaign into a combination of nationalist struggle and holy war had begun.

The Grande Armée’s mood was buoyant, even though a series of bad omens had plagued the beginning of the march. When Napoleon went to review the army, huge thunderheads rolled in, hail pelted down, and the sky darkened so that soldiers could see only by the flashes of lightning. “I have never witnessed so horrific, so frightful a storm,” wrote Dr. Larrey. Napoleon, superstitious to a fault, canceled the review. But it would be hard to overestimate the faith that Napoleon’s veterans placed in his leadership, and the lengths they were willing to go to win him another victory.

Alexander had placed all his hope in a strategy devised by his German general Karl Ludwig von Phull, who had settled on the idea of creating a fortresslike camp at Drissa, 140 miles northeast of Vilna, which would tempt Napoleon into a disastrous siege. Once the French, eager for a single overwhelming victory, attacked this impregnable position, the emperor’s flanks would be crushed from the north by General Barclay and the First Army and from the south by General Bagration and the Second Army. For eight months before the invasion, fortifications were built and entrenchments dug at a spot devoid of a natural defensive feature—a hill or a stream—to give the Russians an advantage against the hordes that would sweep down on it. When the German strategist Carl von Clausewitz was sent to inspect Drissa, he reported to Alexander on July 8 that the work had been a complete waste of time and that the camp offered no tactical advantages to the troops who would defend it. Drissa was a trap not for Napoleon but for the Russians.

The tsar was crushed. Phull had left him defenseless against an invader already on the march. On July 12, he ordered his bewildered troops to abandon Drissa and retreat west to the city of Vitebsk, near the border of modern-day Latvia.

Napoleon could hardly contain his joy. The Italian general Rossetti, who was assigned to the cavalry corps under the dashing Marshal Murat, gave the emperor the news of the Russian withdrawal from their defensive prize, and Napoleon began striding back and forth, galvanized, preening. “You see, the Russians no longer know how to make peace or war!” he cried. “It’s a degenerate nation. What! They abandon their ‘palladium’ without striking a blow! Let’s go! Let’s go! One more final push and my brother will repent for having followed the advice of my enemies.”

As the Russian defense collapsed, typhus and other diseases were beginning their work. The army’s health had been excellent when the soldiers began their march to their rendezvous in Germany. The Belgian doctor J. L. R. de Kerckhove accompanied III Corps led by “the Bravest of the Brave,” Marshal Ney, and kept a lively diary that would closely mirror the condition of the troops. At the beginning, he rated the men highly: “The army was not only the most beautiful,” he wrote in his medical account of the campaign, “but there was none which included so many brave warriors, so many heroes.” During the march to the Niemen River, he had noted “with astonishment” how low the sick rate was in such an immense army. “Nothing announced a disastrous future.” The bountiful food of the Dutch lowlands and Germany had delivered an unusually fit force.

But when they were deep into Poland, Dr. Larrey reported disturbing news. He noted in his memoirs, “60,000 [troops] were admitted by their commanding officers to be sick. The true figure was probably double this.” Clausewitz, on the Russian side, was also hearing disturbing reports about the French forces. “The French, in the first weeks of their march,” he wrote, “had undergone an enormous loss in sick and stragglers, and were in a state of privation which gave early warning of their rapid consumption.” The Bavarian soldiers of VI Corps, to choose one element of Napoleon’s forces, were hit hard: one colonel reported a “terrible epidemic” had swept through their ranks, infecting almost every last recruit and killing thousands.

When the normally imperturbable Marshal Ney of III Corps reviewed his infantry, which had yet to fire a shot, he was shocked to find that half the effective troops had vanished. Sir Robert Wilson, a British soldier of fortune who had been expelled from Russia for spying, only to return to fight against Napoleon in the 1812 invasion, wrote that in late June, the Grande Armée “was already stricken with a calamity which seemed to be a prelude to its future catastrophe.” He estimated that 30,000 men had already fallen out of their ranks after “numbers fell sick.” Nor was this a matter of leaving garrisons along the route they had passed, as the French had “scarcely made” any such arrangements.

Soon after crossing the Niemen, the Belgian surgeon de Kerckhove reported that a crowd of soldiers had separated from their regiments and, unable to keep up with the blistering pace, “dragged themselves behind” the main group. By Vilna, nunneries and churches were converted into makeshift hospitals, without bedding or adequate supplies or basic provisions. Napoleon was losing 4,000 to 6,000 soldiers a day, and 30,000 sick packed every inch of space in the converted sick houses, which were really staging grounds for fresh infection. Another 30,000 men (and possibly many more) had deserted the ranks.

Based on journals of the army doctors, memoirs of the soldiers themselves, and epidemiologists’ subsequent analysis of the campaign, the Grande Armée was clearly under attack from a host of pathogens. By July it had become a vast petri dish in which microbes competed for supremacy. Pleurisy, jaundice, diarrhea, hepatitis, enteritis, and other ailments all preyed on the tired, hungry men. But it was dysentery and “nerve fever”
(fièvre nerveuse)
, as typhus was often called by the French doctors, that rose to epidemic conditions during the summer. “Under these circumstances,” wrote one lieutenant, H. A. Vossler of the Würrtemburg Chasseurs, “it wasn’t surprising that within two or three days of crossing the Niemen the army and in particular the infantry was being ravaged by a variety of diseases, chief among them dysentery, ague, and typhus.”

Dysentery ruled for the first weeks, with 80,000 sick by the beginning of August. The bloody diarrhea that the men suffered from was causing “the most horrible infection in our hospitals,” as the men were packed so closely together, with little available cloth to wash them or keep them clean. Epidemic dysentery is caused by a bacterium,
Shigella dysenteriae
type 1, which enters the system through contaminated food or via contact with an infected person. Its telltale symptom is bloody diarrhea, with rectal pain, fever, and abdominal cramps also frequently present. But even at its deadliest, dysentery most often has a mortality rate of 5 to 15 percent (although recent outbreaks in Africa have found that raised to 30 to 40 percent), which doesn’t match up with the huge numbers of sick who were dying on the march. And one of the most common symptoms mentioned in diaries and memoirs of soldiers on the road to Moscow—extreme exhaustion and stupor—is not common to the illness.

Dysentery certainly killed men early on. Johannes von Scherer, a surgeon with the Württemberg regiments, would later write his doctorate on the 1812 campaign and included details of the diseases racking the men. At one hospital, where he served for six weeks, the doctor recorded 902 dysentery patients, of whom 301 died during the first three weeks. When the care and nutrition improved in the next three weeks, only 36 died. The doctors used anything they could find to treat the soldiers, including the huckleberries and root of tormentil, as well as plants such as common sweet flag, which has been used for thousands of years.

Typhus would soon overtake its rival infection. De Kerckhove remembers the beginning of the epidemic, painting it as an example of pure miasma.

Typhus was present among us. It first appeared spontaneously from the dirtiness of the clothes, which one could not change or even take off at night, and from bad food, from deprivations, from exhaustion, from tiredness and congestion. It became more frequent and more serious as a result of the large assemblies of men. We were breathing putrid smells all the time along roads that were full of dead bodies and rotting animal remains…. Typhus began to stand out because it was so infectious.

The French commanders were appalled by the losses but felt powerless to stop them; the bulletins and hurried conferences called to address the epidemic that one would expect from a modern army simply never happened. Illness and hunger were a cost of making war in the nineteenth century. Disease, in the miasmatic worldview, was an inescapable part of conquering backward territory full of gloomy swamps swept by drenching rains and towns pocked by filthy, malodorous hovels. One major, Friedrich Wilhelm von Loss-berg, who saw thousands of troops dying by the roadside and fell desperately ill himself, became convinced that it was merely a case of simple callousness on the part of an emperor who believed he had men to spare. “Napoleon doesn’t give a damn how many of his soldiers collapse by the roadside,” he wrote to his wife.

Most Napoleonic historians have noted the drastic reduction of the French forces on the road east, attributing it to a combination of sickness, hunger, and thirst—and the last two certainly played a significant part. But almost no histories of the war, or of Napoleon’s fall, probe deeply into the outsized role of typhus. The disease, as it preferred, remained remarkably hidden, both to the army itself and to its chroniclers.