From: medicalmuseum.mil
A fear to which every soldier could admit was death from an enemy bullet, but a greater unseen killer lurked in the camps. Disease, the product of poor hygiene, inadequate diet, crowded camps, and unseasoned troops, killed more than 400,000 soldiers. For every life lost to a bullet, disease claimed two lives. Union surgeons reported more than 6 million cases of disease, meaning that the average soldier became sick at least twice each year.
Doctors suspected that something in the odors emanating from swamps, privies, and garbage was the source of disease, even though the role of microorganisms in transmitting disease was still unknown. At first, the military commands were slow to acknowledge doctors' demands for fresh air, dry ground, and healthy food for the troops. However, citizens' groups such as the United States Sanitary Commission (USSC) pressured the military to make improvements. These changes reduced the rate of sickness and death by allowing physicians to introduce and enforce personal hygiene and camp cleanliness as well as other health-related regimens.
As regiments and companies formed, the soldiers brought with them their health histories as well as their rucksacks. Soldiers from rural areas who had not been exposed to childhood diseases like chickenpox, measles, and mumps, readily contracted and died from these diseases. As each new group of volunteers arrived in camp, the men with inadequate immune systems were weeded out by disease. Smallpox, another contagious disease, was often prevented through vaccination programs.
In broad terms, the number of Union soldiers falling ill from disease decreased over the course of the war. Improvements in sanitation and diet contributed to this decline. In addition, soldiers with inadequate immune systems were killed by disease in the early part of the war, leaving men who were less susceptible to illness. A reduction in the number of new recruits over the course of the war and the continued service of healthy veteran soldiers also reduced the rates of sickness and death.
The most common diseases encountered during the war were dysentery, typhoid, pneumonia, and malaria. Dysentery, a form of diarrhea, was known as the "runs" or the "bloody flux." It reduced the body's intake of energy and minerals from food. In some cases, the disease quickly ran its course and the patient survived. When the disease lingered, however, death was more frequent. One-quarter of all sicknesses reported to Union surgeons were the result of dysentery. A variety of drugs were used to treat dysentery, and most were ineffective. Typhoid, caused by contaminated food and water, resulted in fever, diarrhea, and headache. Because these symptoms were similar to dysentery, the treatments were much the same. Pneumonia killed 20,000 Union troops. It was treated with expectorants and cough-promoting drugs. Malaria, a disease carried by the Anopheles mosquito, was prevalent in the south. Quinine was particularly effective in reducing the fever and other symptoms of this disease.Volunteer organizations, both in the North and South, improved the soldiers' quality of life. The USSC worked to reform the U.S. Army Medical Department and provided private funds dedicated for the care of the sick and wounded. It convinced the Union medical command to issue orders requiring better sanitation, hygiene, and food for Union troops. The USSC and other groups funded hospital trains and ships, provided doctors and nurses to help wounded soldiers, and held "sanitary fairs" to raise money for medical supplies and equipment.
The acceptance of female nurses significantly changed Civil War medical care. Army physicians initially feared that women would be unable to work amid the difficult conditions of the field and general hospitals. Nurses like Dorothea Dix and Clara Barton persuaded the public and the medical command that they were able to provide effective and compassionate care. Many black women like Sojourner Truth and Harriet Tubman also served as nurses. In June of 1861, Dix was appointed the "Superintendent of Female Nurses." Soon after, Congress legislated that nurses be paid 40 cents per day. To reduce problems while caring for patients, Dix required her nurses to be more than 30 years of age, healthy, and "plain almost to repulsion in dress, and devoid of personal attractions."
The role of women extended beyond nursing. Mary Walker was the first woman to serve the U.S. Army as a contract physician. Contract physicians, also called Acting Assistant Surgeons, were civilian doctors who were contracted by both medical commands to supplement the work of military physicians. Many years after the war, Walker was awarded the Medal of Honor for her Civil War service.
Image: Watercolor of diseased colon section. The artist is Hermann Faber of the Army Medical Museum.
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