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As the U.S. approaches 600,000 deaths from Covid-19, it is hard to fathom that this calamity pales in comparison to America’s worst outbreak of epidemic diseases during and just after the Civil War.

From smallpox and measles to dysentery and typhoid, the Civil War, which lasted from 1861 to 1865, triggered an explosion of deadly epidemics on a scale never seen in the U.S., before or since. A million sick soldiers, newly emancipated ex-slaves, families caught in the crossfire, and hungry refugees died during the war, about 3% of the U.S. population. Two-thirds of these deaths were from disease. For comparison, it would take nearly 10 million Americans deaths from Covid-19 to reach the Civil War’s death toll.

As a medical historian, I’ve spent countless hours poring through vintage medical journals, public health reports, and eyewitness accounts of the health nightmare that was the Civil War. These sources are full of sobering parallels between that war and Covid-19, as well as the valuable but essentially forgotten lessons it taught the country about public health.


The mass movement of millions of people taught the Civil War generation that epidemic diseases flourish when people travel and gather. At the time the war broke out, four-fifths of Americans lived in rural settings and rarely strayed far from home, so they had limited exposure to the era’s childhood diseases, sicknesses like measles and smallpox that were typically contracted in urban populations during childhood and adolescence. When the rural young men who comprised the Civil War’s gargantuan armies began mobilizing in 1861, millions of recruits without immunity to smallpox and measles packed into crowded training camps, which rivaled the population density of the biggest cities in America and Europe. With unprotected populations exposed to unfamiliar pathogens, huge disease outbreaks followed, killing hundreds of thousands and putting entire units out of commission.

Civil War commanders learned their lessons. As the war dragged on, new recruits were “seasoned” in special camps, where they contracted and (hopefully) recovered from measles before shipping out. Those with smallpox were isolated in special hospital wards, and surgeons embarked on vaccination drives to eradicate this disease in the army. The efforts helped bring the measles and smallpox epidemics among soldiers under control.


A similar scenario transpired in early 2020 and 2021 when college students without immunity to Covid-19 flocked to America’s beaches for spring break. They then scattered, taking the virus back home with them and spreading it there. In the fall of 2020, when universities brought unprotected students back to campus, coronavirus cases surged in college towns across America. Stricter adherence to Civil War-era seasoning and isolation practices could have avoided repeating history 150 years later.

The Civil War’s health crisis also taught Americans in the 1860s and 1870s that the rigid enforcement of public health measures saves lives.

This was especially true of dysentery and typhoid fever, both spread by feces-contaminated water. The gigantic, mobile cities that were Civil War armies lacked even the basic standards of 19th-century sanitation, like groundwater drainage, trash removal, and air ventilation. Tents were too close together, overcrowded, and lacked clean water or good airflow.

Latrines were an even bigger problem for armies. Army guidelines dictated that privies be located outside of camps, but this was often sacrificed to the exigencies of war. Armies moved frequently, and soldiers didn’t relish the tiresome work of digging proper latrines. Most camps had informal, open-air latrines just a few feet — and sometimes less — from sleeping, cooking, and eating areas. The nauseating, overpowering stink, or miasma, worried army surgeons and sanitary inspectors. But even when they managed to get festering latrines moved away from camps, it didn’t stop exhausted soldiers from defecating just outside their tents, with human waste seeping into nearby water sources.

At Andersonville, a notoriously deadly Confederate prisoner-of-war camp located in a Georgia swamp, latrines were set up just a few yards from the ramshackle lean-tos in which Union prisoners ate and slept. The prison’s grassless, muddy ground was invariably splattered with puddles of fecal matter teeming with pathogens. The only source of drinking water, a stream that flowed through the prison grounds, was contaminated with human waste from a nearby Confederate camp. Exposure and starvation left the prisoners especially vulnerable to sickness. It’s not surprising that 13,000 of those at Andersonville — about a quarter of the prison population — died of diseases like dysentery, “chronic diarrhea,” and typhoid.

The place was so unhealthy that its Confederate commander was later convicted of war crimes and hung for neglecting to address public health issues there.

Horrified Civil War observers realized the obvious: that poor sanitation was causing far too many soldiers to die. So wartime relief organizations, like the United States Sanitary Commission, set about trying to convince army leaders and rank-and-file soldiers to clean up their acts. They taught soldiers to dig latrines farther away from camps and how to properly ventilate living spaces and hospitals. This full-court press eventually paid off. In camps and hospitals where army officers rigidly enforced sanitation rules, disease deaths plummeted.

After the war, army surgeons and medical volunteers returned home, spreading the news that strong, consistent enforcement of public health standards could save lives. They set to work creating the nation’s first modern boards of health to combat diseases like cholera and yellow fever. Cities like Chicago and New York began cleaning up filthy rivers, draining standing water, and enforcing quarantines.

This work paid off. Deaths from cholera and yellow fever, which had been major killers before the war, plummeted in the decades afterward. The war’s public health lessons saved countless lives, long before modern medical revolutions like the discovery of germs.

Had that faith in — and support of — public health been maintained, hundreds of thousands of deaths could have been avoided when Covid-19 emerged.

The Civil War also teaches the lesson that epidemics compound preexisting structural racism, hitting people of color the hardest. When the Union army and navy advanced into the South, enslaved people seized the initiative and took freedom into their own hands, fleeing plantations by the thousands to refugee camps behind Union lines. But in this chaotic mass migration, the U.S. government failed to offer medical assistance to these freed people. Like rural white soldiers, most former slaves lacked acquired immunity to measles and smallpox. Predictable outbreaks ravaged the refugee camps, killing thousands of people who had nothing but the clothes on their backs and no means to obtain medical care. Army officers and government officials willingly turned a blind eye, not bothering to isolate or vaccinate Black refugees, who died in droves.

One-hundred and fifty years later, in the early days of Covid-19, American leaders also overlooked Black and brown Americans, failing to provide equitable testing and high-quality care. This neglect led to higher Covid-19 death rates among communities of color, just as happened with smallpox during the Civil War.

Although some of the Civil War’s public health lessons became mainstream practices in the 20th century, the sense of urgency the Civil War generation felt about public health has fallen by the wayside.

Had the lessons they learned remained fresh in our collective historical consciousness, the U.S. might have applied them and fared better during the time of Covid-19. Instead, we forgot about medical history, and as a result, we’ve endured the worst public health crisis in generations.

Jonathan S. Jones is a historian and postdoctoral scholar at Penn State University’s George and Ann Richards Civil War Era Center.

Hear Jones talk more about the Civil War on an episode of the “First Opinion Podcast.”

  • OMG, I FOUND ONE! Tuna Melt, tell us about these deaths that are absolutely not related to Covid. Who is experimenting with the vaccines? How much do you think Trump got paid by China to create a warp speed vaccine for them to test on the US population?

  • The population that was most impacted by covid-19 was those over 65 years of age and those of any age who had compromised immune systems due to an underlying health condition. These groups were the vulnerable groups that died, and they were of all colors. It is true however that the African-American community had a higher percentage of deaths from covid-19 on a percentage basis than the Caucasian community. This was due to socio-economic reasons, such as having a higher percentage of African Americans living in more densely populated, poor, urban areas. Other contributing factors were high levels of obesity & diabetes, again related to poorer economic situations resulting in poor diets, and finally, the African-American community was and is suspicious of the vaccines, exacerbated by Democratic politicians and pundits playing the politics of fear, saying they did not trust anything the Trump Administration had any involvement in, such as Operation Warp Speed.

    • Oh please- Pfizer didnt take a penny from Trump. His gang did plenty, if not more sowing fear (hello bleach, UV, remi, HCQ, etc….). Stop making it political, it’s primarily socio-economic causation

  • “One-hundred and fifty years later, in the early days of Covid-19, American leaders also overlooked Black and brown Americans, failing to provide equitable testing and high-quality care.”
    OK then…. So the author is stating there is flagrant racism because only white people are getting testing, vaccines and or medical care?
    The “white man” is segregating people based on race/color for treatment?
    As a member of the medical community I surely don’t see it. I see fair and equitable efforts to diagnose, treat, and administer vaccines to anyone in the state of New Jersey. This reads as guilt for someone, but not me. The author just jumps on the racism bandwagon, which perpetuates the racial divide in this country. It would have been an interesting article if it was a matter of facts. Instead, it is facts messaged into an opinion by the author. All credibility lost. And yes, I understand because I state an opinion which contradicts the majority of the comments posted here, I will be vilified for such an opinion.

  • Although the term “systemic racism” is accurate, we should probably just think of it as “racism.” The history of the USA and the colonial powers that preceded this country is shameful. I’m a white male, born in the USA shortly after WWII, and educated in Baltimore, MD in the 1950s & 1960s in what I think was a good public school system. But my own reading over the last 10 has convinced me that my education was woefully inadequate regarding the complete history of the white race in the New World, and in the USA from before 1776, 1787, 1865 and right up to the current time. If you don’t share this view, I’d suggest you need to read more history and further your own education. The resources are easily available these days. Read about what slavery in the USA was really like (and if you think slaves somehow had it ‘good’ before Emancipation, you’re not reading enough). Read about the Lincoln-Douglas Debates if you think there was no racism in the North at that time. Read about the 13th, 14th and 15th amendments and how the Southern States effectively re-enslaved Black Americans during Reconstruction and for decades after (if not up to the present time). Read about the 3000-plus lynchings between Reconstruction and about 1930 or 1940. Read about the insurrection in Wilmington, NC in 1898, and about the Tulsa, OK, “race massacre” in 1921. And more. Read about “redlining,” and how the US Interstate Highway System was used to degrade historically Black neighborhoods. That’s just scratching the surface. Just don’t sit there and think that the slaves were freed at the end of the Civil War, and that was that, everyone was equal from then onward, and what are the BLM people talking about? If you do, there’s lots more you need to learn.

  • you mention about US getting to 600,000 death if that was the case then why are is it that total deaths has not changed in 5 years? this takes into account the rise in suicides, Drug OD rises as well as the 450,000 death by medical errors doctors do per year

    • These data will answer your question. On 12/8/2020 NBC News analyzed this question with respect to elderly COVID victims who might have died, anyway. NBC used data from Johns Hopkins University. “Another way to see the effect of COVID-19 is that more people have died already this year than did in the entirety of either 2018 or 2019. There were 2,831,836 deaths in all of 2018 and 2,845,793 in all of 2019.

      “According to the U.S. Census Bureau, the population of the United States has increased by .48-.73 percent over the last five years. The increase in deaths to this point in 2020 is 10%, far outpacing population growth.”

      The number of confirmed and probable Covid deaths a/o 12/31/20 was 336,802 by CDC’s count. The first US deaths (2) were counted on 2/26/20. A/o 3/7/21 the total zoomed to 515,151. As of literally this minute, 4/19/21, the total is now 572,627. In about one-third of 2021, the USA has already reached 70% of the Covid deaths in about 44 weeks of 2020.

    • Norman, you say that “more people have already died this year than did in the entirety of 2018 or 2019”. You state the deaths of all of 2018 and 2019 but then fail to be transparent and state that in all of 2020, the year of COVID that a total 2,854,838 people died in the US (yes including all COVID deaths). Why leave out relevant context that challenges the narrative (which I’m sure will make my comment censored). Why have you ignored CDC’s statistic that 94% of all “COVID deaths” had an average of 2.7 comorbidities (meaning cancer, diabetes, heart disease which is little known as already the #1 killer in america for health reasons). Why are all these data-backed CDC-backed facts completely ignored by all of media, and actually censored?

  • Here is a story of the Andersonville Prision.

    During the worst time, when ~100 people were dying a day at Andersonville, a bolt of lightening struck and a spring came out of the ground. The clean water restored the health and spirit of many. This is what is now called providence spring which still flows. I had a friend who visited a year ago and got a sample of the water. Thanks John for the reminder of the medical lessons to be learned from this civil war experience. I hope this reference will also remind of the lesson in providence from this time which may also be of help in our current struggle.

  • To the extent that no one wanted to believe the government, it was a function of people like Fauci and the surgen general coming on TV telling us “don’t use masks they don’t work” and then later said they lied because they wanted to avoid a run on masks.

    It didn’t help that we believed the WHO when they said “there was no instance of human to human contact”. Nor did it help when government leaders said “limiting people from coming in from China is racist”.

    Once you lie, you lose all credibility. You don’t get it back with a “well, we lied for your own good”. You actually make it worse because you effectively admitting for convenience.

    • Dr Fauci was mistaken about masks, as were most in the medical community, he did not lie. Similarly, WHO was wrong but not wilful in stating there was no evidence of human contact.

      You seem troubled by the fact that sometimes, early information is wrong, often incomplete … but to ascribe a strategy of lying with an intent to deceive you are in fact simply circulating a ‘false news’ narrative and undermining the real advances that are made through rigorous study.

      For shame.

    • I think you have your information backward; It was the trump government that stated that mask did not work and was telling the masses not to believe anything the medical community,including Fauci was saying:wear mask,wash your hand, stay at a distance,exct. Stop spreading lies.

    • You (Henrietta) brought up some good points – nothing to be ashamed of. We did get conflicting information as well as the harmful encouragement to go party in Chinatown to ‘stick it’ to the officials who stopped the influx of people from the infected areas of China.

      I am looking forward to the investigations into Fauci and Gates’s ties to pharmaceutical companies, the WHO, and the lab in Wuhan.

      An investigation into the American mainstream press would be in order as well – why they made such vicious fun of the pursuit of an inhalant, which the medical community is now using, as well as Hydroxycholoroquine, which many doctors all over the world used from the beginning of this mess. Many doctors had good results from encouraging their patients to build up their immune systems and counted no deaths or serious illness as a result. Why the press did not seize on these successes makes me doubt their trustworthiness.

      There are many things that were done wrong – and many were right. As for me, it is time to be thankful.

  • “One-hundred and fifty years later, in the early days of Covid-19, American leaders also overlooked Black and brown Americans, failing to provide equitable testing and high-quality care. This neglect led to higher Covid-19 death rates among communities of color, just as happened with smallpox during the Civil War.”

    What one never says nowadays, whether one is a white or a person of color, is that the U.S. Federal Govt. fought the Civil War to end slavery. Some might say it was about states rights (and it was), others might say it was about slavery (and it was), or something else altogether, in any case, Lincoln made it clear (I believe) it also had to do with the moral need to end slavery. And so did lots of other white people feel that to be the case, of which, John Brown, Henry David Thoreau…

    I guess it does not count, though. Nobody talks about it. Nobody pats the U.S. on the back for tackling that tough problem. And America is still being accused of being slave nation (which we actually inherited from the British, FWTIW). “Sins of the fathers…” I guess.

    Besides, are not wars in the fertile field of the human race, like wild fires in ecology and forestry — necessary “evils.” If we keep having babies and keep saving ourselves from everything, we’ll all end up dead anyways from inability to feed ourselves. People in America and the West are such a lot of babies nowadays, it will be amazing if we can defend ourselves against a war on our soil anytime soon. Maybe we should all just lie down about it.

    • On my Senior trip to Washington DC in 1959, my friends and I (from Pennsylvania) were horrified to see a bus drive by with Whites in the front and Blacks in the back.

      As we walked about the town and got thirsty, we stopped in to a store to buy a soda. Seeing only Black people in there, we asked if it was alright that we buy a soda from them. They must have thought we were from the moon, and they smiled and were so kind to us. Racism is not systemic in America.

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