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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.

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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.

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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.”

  • The young men from rural areas being susceptible to disease was played out across the western world as rural folks moved to cities for work during the start of the industrial age , In this case both men and women ..

  • @Bray: you are the one doing the bait-and-switch. This article is *about* public health and lessons learned and not, including how people with less power were treated, especially (given that the subject is the US Civil War era) how “epidemics compound preexisting structural racism.” It is *not* about “the future of the nation” or “what we did right.” Diverting from the core message does nothing to refute it. You want an article about “what we did right?” You go write it — and see if you can get published without the kind of scholarly work evidenced here.

    @Sharon: How does the author “inject ridiculous comments that dismiss all of the hand washing, sanitizing, isolating, travel bans, etc that were widely broadcast to the public?” The fact that the public was given instructions and regulations does not – in any way – negate the author’s claim that government “fail[ed] to provide equitable testing and high-quality care” to people of color. Illogical.

    @Ron: you need to back up your claim that “The higher rates were due to density and the gathering of people” or it’s just an assertion. No evidence, no argument.

    What is “disgusting” here is the predominance of irrational voices whose apparent sole and shared goal is to deny racism and its impact, whether historical or current. What is sad is how illogical, uninformed, and unsupported the “arguments” are (for, without logic or backing of evidence, they are hardly arguments).

    and @Joe, I guess you’re the arbiter of which crimes are worse, including ones that don’t affect you. For myself, I’m on the “left” and vehemently condemn both of Cuomo’s alleged crimes. The amusing thing about the right is they don’t even know who the left is. They think Democrats are “the left.” That’s funny.

  • There was NO treatnent for anything back in those days, It’s not like whites just left blacks to die as your article incorrectly implies No treatment in medicine for either side.

    • Treatment for Malaria in 1860 – Quinine or Arsenic.
      Treatment for Smallpox in 1860 – Vaccination/inoculations using vaccinia virus (Cow pox puss from scabs) & quarantine.
      Treatment for cholera in 1860 – Quinine, opium
      Treatment for pneumonia and bronchitis in – 1860 Quinine, turpentine, opium, muster plasters.

      People flocking into refugee camps would have been left to die if they got sick because the army did not have supply wagons large enough to treat thousands of people outside of their own military unit. Wagons traveling from over 100 miles away, would take five days to a week to arrive. Wagons did not travel at night.

      Whites most certainly left black people to die, as well as Indians, and the enemy. (North or South). They would have also left the severely injured to die, as there was no real expedient way to get a soldier to a hospital. Soldiers who were shot with a Minie Ball round would have exploded bone fragments and shrapnel inside of a wound, that most of the time the limb had to be amputated. This was accomplished by amateurs, and some with skills to saw through bone in four minutes. (This is only after the muscles around the wound were properly cut, and the arteries hooked, pulled, and cauterized). This was usually performed without antithetic. However some Union units had access to chloroform, which would also sometime kill the patient. Since, field sanitation had not been implemented (Like the article talks about). The act of probing to find a bullet lodged in a victim sometimes led to a gangrene infection, meaning that a successful removal of a bullet could mean an amputation or death for the injured a few days later.

      In the army, there is still a pecking order of which people receive care in a war. Officers are first, non-commissioned officers are next, then general enlisted, then the conscripts, civilian contractors (scouts, interpreters, trackers, mercenaries…) and if there is anything left over, the enemy, then civilians. This is the way it is conducted in 2021, and it is the same pecking order that would have existed in the 1860s.
      Nobody fighting in the civil war catered to slaves, or put them up at the Marriott. In most places they armed them, taught them how to shoot, and sent them into battle.

  • Wow, postdoctoral scholar If I were Penn State University’s George and Ann Richards Civil War Era Center. I would serious doubts on you scholastic future!

  • Jonathan needs to stop watching main stream media & start listeninng to the real doctors & researchers who tell us that the virus cannot live on the beach, in fresh air, in swimming pools nor on surfaces. That the state of South Dakota never closed businesses, never closed their schools and never had any major death spikes. That the virus isn’t transmitted by surfaces. Geez, be a real reporter, instead of a propagandist! Stop with the socialist narrative already.

  • The virus does not discriminate. But Governor Cuomo killed thousands of nursing home residents who were black, brown, white & polka dot by putting infected people in nursing homes. Then he covered it up. All of which is much worse than his sexual harassment, while in office, as alleged by his nine accusers. #ibelieveherXnine. #metoo. And the Left looks the other way.

  • Had no idea that disease killed so many during the Civil War.
    Otherwise, comparisons to today’s crisis with Covid are quite a stretch. Lose scholarly credibility when you inject ridiculous comments that dismiss all of the hand washing, sanitizing, isolating, travel bans, etc that were widely broadcast to the public.
    I suggest you stick to history.

  • You removed my comments from earlier.

    The title: “Lessons learned — and forgotten — from the horrific epidemics of the U.S. Civil War”

    It eventually gets to this, which was really the whole purpose of the article, in part because it’s the strain du jour: “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.”

    It’s a bait and switch article.

    My point is that nobody talks about how the U.S. took on slavery and the moral problem, went to war, internecine war, — many people lost their lives for an idea. But nobody today — talks about that. Instead, as with this article, they find fault with something. How’s about an article about what we did right.

    I think they had more things to think about 150 years ago during the war than public health. Hows about the very future of the nation?

    People of color have a great opportunity today to do great things — less than 5 year ago we had a black president. But alls one hears anymore is whining, and need for reparation, white-bashing, and DEI. Nobody of color and half the whites any more will be satisfied until the entire white population is driven from the land or pushed down to the lowest rung. Witness the many white people living on the streets these days. I don’t see many people of color, just whites… We’re almost there, almost at the bottom, but just not quite yet.

    • Actually, you didn’t delete my earlier comment. Thank goodness. My mistake (I didn’t see the “older comments” link). So that’s good. I still have a voice. 🙂

  • 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. This is not true.. This statement is a simply not fact driven. No where was “race ” or as you say black and brown Americans overlooked. The higher rates were due to density and the gathering of people. Most of these non rural areas are run by liberal black and brown government officials who would not allowed black and brown people to be “overlooked.” . Disgusting comment.

    • Johnny, you failed to mention the countless soldiers who brought back venereal disease to their community. Also, why is it a black issue? I know many white “folk” who died of Covid.

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