by Carl Coppolino
The following is an excerpt from the article by the same title appearing in the January 2012 issue of The Gettysburg Magazine. For more information about the issue, click here.
Gettysburg was the bloodiest battle fought on American soil. More than 50,000 men were killed, wounded, or captured. It was the pinnacle of Gen. Robert E. Lee’s career, and it was a failure.
Efforts to interpret what happened those days leading up to and through the battle have focused on many things. Certainly the Army of the Potomac was better supplied and equipped and outnumbered Lee and the Army of Northern Virginia. This was not new. That situation existed before every previous engagement and Lee still won. The unavailability of Maj. Gen. Jeb Stuart and his three brigades of cavalry was a hindrance, but Lee had 3,000 other cavalrymen, available to him. Participants and historians have fought over whether or not Lt. Gens. Richard S. Ewell, James Longstreet, and A. P. Hill followed orders and this may or may not have played a role in the final outcome. Was Lee really headstrong and did not listen to his commanders or was he so ill, confused, and unfocused that his judgment was impaired? Finally, was Lee not only ailing, but too proud to seek medical help and contemplate giving up command temporarily to Longstreet?
In the days and weeks following Gettysburg, the officers and enlisted men were dismayed on Lee’s lack of generalship at Gettysburg. “Our wise Gen. Lee made a great mistake in making the attack,” commented a South Carolinian. “I further think,” stated an Alabamian in a letter to his mother, “that it was the worst piece of generalship I ever knew General Lee to exercise in undertaking to storm the enemy’s fortifications.”Robert Kern of the War Department wrote in his diary on July 26, “Gettysburg has shaken my faith in Lee as a general.” Less than a month after the battle, Brig. Gen. Wade Hampton wrote a letter to Gen. Joseph E. Johnston characterizing the battle as a “complete failure.” Hampton also stated “The position of the Yankees there was strongest I ever saw & it was in vain to attack it.”
This is only a sampling of the conclusions of participants concerning Lee’s generalship at Gettysburg.
Why did this happen? To begin to answer that question we need to start at the beginning.
Robert E. Lee was in excellent health at the age of twenty-two, when he graduated from the West Point Military Academy in 1829. His health remained good until August 1849 when, while supervising the construction of Fort Carroll at Soller’s Point in Baltimore Harbor, he developed a fever. His symptoms of sporadic fever with aches sound like malaria, which may have been contracted during his service in the Mexican War or at Soller’s Point itself. When he resigned his commission in the United States Army on April 20, 1861, and joined the Confederacy, he was fifty-four years old, strong, active, with no physical complaints.
At the end of March 1863 General Lee developed a serious illness. He was near Fredericksburg, encamped by the Rappahannock River when he complained of sharp pains in his chest, back, and arms. He also had a heavy cold. His physicians, Lafayette Guild and Dr. S. M. Bemiss, treated him. Both physicians came to the conclusion that Lee was having “an inflammation of the heart-sac.”
They ordered that he leave his tent. He took up quarters in a house five miles south of Fredericksburg. There he was confined to bed for several weeks because of the continuous pains in his chest and was feverish. Lee remained in bed, much against his wishes, and complained in a letter home that the doctors were “tapping me all over like an old steam boiler before condemning it.”
Modern historians have concluded that Lee suffered a heart attack. We need, however, to look at and judge as to what Doctors Guild and Bemiss knew and did in the context of medicine in the 1860s.
Physicians in the Confederate army encountered various heart ailments. Acute endocarditis and pericarditis were known, but considered rare. The term “angina pectoris” was used to describe arterial degeneration of the arteries of the heart. It was associated with violent, stabbing pains in the chest.
In 1809, it was known that angina pectoris could damage the heart and cause death. In 1833, the reason for the development of angina pectoris was given as being arteriosclerosis. In 1846 arteriosclerosis became the focal point in the study of coronary artery disease. Therefore, Doctors Guild and Bemiss, being well trained, knew about heart disease and its treatment.
Did they misdiagnose? Did they diagnose pericarditis instead of angina pectoris and accompanied heart damage? (It was not until 1912 that the diagnosis of “heart attack” was made.)
Many times physicians practicing today cannot distinguish between heart attack and acute pericarditis in the first few hours. Cardiac enzyme values, EKG, and stethoscopic examination of the heart usually make the definitive diagnosis.
Let us look at Acute Pericarditis:
Chest pain in the cardinal symptom
a) Quality of pain may be sharp, dull, aching, burning, or pressing
b) Intensity varies from barely perceptible to severe
c) Pain is usually precordial (confined to the chest area) but can travel
Shortness of breath
Fever or a “cold”
1. Bacterial including tuberculosis
2. Viral which can be associated with influenza
3. Fungal and parasitic organisms
4. Rheumatoid arthritis
5. Rheumatic fever
6. Associated with inflammatory bowel disease
7. Myocardial Infarction. Pericarditis associated with a transmural infarction is not that unusual.
Therefore, it is conceivable that Lee had both cardiac diseases. In this writer’s opinion, it made no difference if Lee had a “heart attack,” or acute pericarditis, or a combination, since the treatment available for Doctors Guild and Bemiss in 1863 for any of the above conditions, or for any heart condition for that matter, was the same:
1. Bed rest and “quiet”
2. Peppermint water by mouth to soothe the stomach
3. Blood letting if there was extreme distress
There is no evidence that Lee was bled. Lee received quinine in addition to bed rest. By April 11, he was able to ride his horse. By the 12th, the pain was gone and his cough had improved. He was back in camp on the 16th, “but was still feeble and could do little.”
Numerous authors have written about General Lee’s digestive problems at Gettysburg. Glenn Tucker wrote in High Tide at Gettysburg that on June 27:
. . . Lee apparently made the mistake of eating an abundance of fresh fruit. The entire army indulged. . . . Fresh raw fruit undoubtedly was the cause of Lee’s partial indisposition on the second day of the battle of Gettysburg.
Diarrhea during the Civil War caused a staggering loss of lives. Bowel disorders were the most prevalent illnesses on both sides and killed more men than battle.
Diarrhea causes the body to lose tremendous amounts of electrolytes, especially potassium and magnesium. The loss of significant amounts of magnesium in patients with either “inflammatory myocarditis” (pericarditis) or recovering from a heart attack (like General Lee), causes serious problems in that patient.
Magnesium is a mineral needed by every cell of your body. About half of your body’s magnesium stores are found inside cells of body tissues and organs, and half are combined with calcium and phosphorous in bone. Only one percent of magnesium in your body is found in blood. The body works very hard to keep blood levels of magnesium constant. Magnesium is needed for more than 300 biochemical reactions in the body. It helps maintain normal muscle and nerve function and keeps heart rhythm steady.
Certainly Lee could have replaced his lost magnesium by eating certain foods: green vegetables, nuts, seeds, fruits, and whole grains. A careful review of Civil War literature demonstrated that when food was available, it consisted mainly of fried meat, fat-back, bread, and coffee.
Low magnesium levels in today’s hospitals are a common imbalance found in critically ill patients from gastrointestinal losses. These losses (causing hypomagnesium) take the form of drainage from nasogastric suction, diarrhea, or fistulas.
Let us look as some of the characteristics resulting from magnesium deficiency found in patients other than heart:
Hypomagnesium’s impact on the heart includes metabolic changes that may contribute to heart attacks. There is also evidence that hypomagnesium increases the risk of abnormal heart rhythms. Therefore, it is my opinion that Robert E. Lee suffered from hypomagnesium because of his diarrhea and that hypomagnesium caused certain characteristics to be observed by participants during Gettysburg and commented upon by historians.
His capacity for leadership may well have been diminished due to his physical condition. As Lee himself wrote to Davis on August 8:
I sensibly feel the growing failure of my bodily strength. I have not yet recovered from the attack I experienced the past spring. I am becoming more and more incapable of exertion. . . .
During the preceding year of battles Lee was never characterized as nervous, restless, confused, irritable, and unaware of his surroundings. During the preceding year of battles, his orders were not confusing.
At first blush it would seem that his heart illness (acute pericarditis? heart attack? or a combination of both?) alone would be sufficient to explain Lee’s actions at Gettysburg. Yet his successful campaigns following his heart illness, especially Chancellorsville, do not lend itself to that conclusion.
No, in my opinion General Lee’s diarrhea caused such a loss of magnesium that severely impacted on his mental and physical condition. Physical, because physicians today would immediately hospitalize and treat any patient who weeks ago suffered acute pericarditis or myocardial infarction and now suffered from severe diarrhea. The physician would be concerned that his patient would suffer another heart attack if the loss of electrolytes were not immediately corrected.
Because the Civil War physician did not have the knowledge or equipment available today, it would be impossible to demonstrate that diarrhea/dysentery, with its concomitant massive loss of electrolytes, caused heart disease in some of these discharged soldiers. We now know, however, that this pattern occurs.
It is my hope that this opening “salvo” will spur further scholarship on my premise and conclusions.
About the Author
Doctor Carl Coppolino is a medical doctor specializing in research (he hold various U.S. Patents) whose avocation is the study of the medical history of historical figures and how their maladies impacted history. His current project involves showing that Julius Caesar had a brain tumor developed from bouts of malaria and not epilepsy.