Lessons Learned – and Forgotten — From the Horrific Epidemics of the Civil War
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.