July 30, 2025 • 26 mins
"War is 99 parts diarrhea and one part glory." Walt Whitman had a point when he wrote this. Diseases like dysentery, typhus, and malaria were responsible for 2/3 of the deaths in the Civil War.
So, how did illness kill more soldiers on the battlefield than cannons and bayonets? It helps to look at the living conditions and atrocious medical practices in field hospitals during the deadliest war in American history. And it didn't help that sexually transmitted diseases like syphilis were rampant among soldiers.
GUEST: Kathryn Olivarius, Associate Professor of History at Stanford University. Check out her book: Necropolis: Disease, Power, and Capitalism in the Cotton Kingdom
See omnystudio.com/listener for privacy information.
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Speaker 1 (00:03):
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Speaker 1 (00:11):
Hey there, American History Hotliners. Your host Bob Crawford here,
happy to be joining you again for another American History Hotline.
You're the ones with the questions. I'm the guy trying
to get some answers and keep those questions coming. The
best way to get us a question is to record
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(00:31):
email it to Americanhistory Hotline at gmail dot com. That's
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And remember we are American History Hotline. I love ancient
Egypt as much as the next guy, but there's plenty
to talk about on this continent. Okay. Today's question is
(00:53):
about the Civil War. Here to help me answer the
question is Catherine Oliverius. She's an associate professor of history
at Stanford University, specializing in nineteenth century US history. Catherine,
thanks for being on the show.
Speaker 2 (01:09):
I am delighted to be here, and I love talking
about the Civil War.
Speaker 1 (01:13):
It is so much fun, isn't it.
Speaker 2 (01:16):
Yeah, for us, for us A few years later, a
few you know, decades after the fact, it's certainly fun.
Speaker 1 (01:22):
Yes, uh, cent century and a half after the fact. Yeah,
not too soon.
Speaker 2 (01:27):
Yeah, I wouldn't necessarily want to be a Gettysburg myself,
so yeah, no, or or Andersonville, yes, yes, big no.
Speaker 1 (01:36):
Right. So our question today comes from Cheryl from Santa Fe,
New Mexico. She says, I heard that more soldiers died
from disease during the Civil War than they did in battle.
Is that true?
Speaker 2 (01:52):
Yes? Yes, Actually, in the Civil War, approximately two thirds
of all the Civil War dead died from disease, not
from bullets, from battlefield injuries. So that's about two thirds
of approximately seven hundred and fifty thousand people who died
during the war. And that number itself, that three quarters
of a million number, is up for debate. We actually
(02:14):
don't have the best records, but if you were a
soldier on either side of the war, whether you were
with the Union Army, the Federal Army, or the Confedetitates
of America, you had a very high chance of dying
from disease, especially diseases like dysentery, crowd diseases, on diseases
of malnutrition, things like this, far away from any kind
of battlefield.
Speaker 1 (02:35):
And like you said, it didn't matter which army you
were with, But was one army better equipped to prevent
disease than another.
Speaker 2 (02:45):
Yes, certainly so by far. The Union Army, this is
the Northern Army, the United States Army. It had a
high death rate, but it was a much You would
have a much better chance, sort of proportionally, of surviving
this war if you were in the North, the Southern Army,
they the Confetittives of America. They never had the kind
of medical service or ambulance corps that was required to
(03:08):
lodge this total, this total modern war, you know, filled
with mini balls and shrapnel and things like this, and
so if you were in the South, you had a
much higher chance of dying from disease. One little twist
to this, of course, is that if you were in
the Union Army, Black soldiers in the Union Army had
a much higher chance of dying from disease than did
white soldiers, generally because they received worse medical care and
(03:31):
because they were often given much deadlier assignments and sort
of dirtier assignments too, so you were more in contact
with pathogens and also more in the line of fire.
If you are a black soldier.
Speaker 1 (03:42):
Can you paint a picture for us of the conditions
soldiers were living in during the war and how that
contributed to the spread of disease.
Speaker 2 (03:52):
Yeah, so, I mean think about it. So we have this,
you know, Abraham Lincoln calls for seventy five thousand troops
in eighteen sixty one from volunteers from across the North,
and he gets those volunteers in many, many more, and
suddenly you have this sort of massive churn of people.
So a lot of historians actually talked about the Civil
(04:13):
War as a kind of biotic soup and that you
are just like stirring this pod constantly with people moving
around the country, bringing with them diseases, immunities, things like this,
pathogens with them to the front. So if you're a soldier,
suddenly you are arriving at a camp. This is a
very crowded place. You are often responsible for cooking your
own food and procuring it, or you might be given
(04:36):
some rations or you know, some kinds of you know,
you know, meat or corn or something like this, but
you are generally in charge of cooking it yourself. And
these are for the most part, pretty young boys who
have very little experience with food preparation. They're not so
good at keeping things clean. This is also this is
around the time that germ theory is happening, so that
people are understanding that, you know that germs can cause diseases.
(05:00):
But most people, most soldiers, most commissols, would have had
no idea on This is very much in the sort
of early state of development at this point, so they
would have had very little idea about that. And if
you were in a camp, you're you know, this is
it rains, it's muddy generally speaking, people would you know,
if there was a water source close by, like a stream,
you would washing it, you would drink from it, you
would probably defecate into it too, So it's we're talking
(05:22):
about this just this is a a germ bonanza suddenly,
and we're talking again also about people from all across
the country, people who maybe never been exposed to diseases
like wooden cough or diseases like measles before. Suddenly you're
being put into very close contact with people who are
maybe bringing these pathogens in. And of course you remember
(05:43):
too that every single soldier was screened before coming into
the army, so you know this is this means that
you're if you're obviously you know, infectious with something, you
would be denied entry into the army if you had
if you were you know, blind, or if you were
in paired in capacity to But as the war is
dragging on, as the draft is being instituted to, medical
(06:07):
examiners are being sort of leaned on to kind of
look the other way about this, you know, about pretty
obvious diseases because they just need bodies, they need soldiers,
and so they're adopting a laxer and laxer attitude towards
infectious disease. So therefore, more and more people are entering
this army bringing these kinds of infectious ailments again, you know, smallpox, measles,
(06:27):
things like this. But then also they're arriving in these
camps and when they're you know, when you're on the front,
you are just inundated by these crowd diseases, these diseases
of malnutrition and back, you know, these bacteria that can
cause really serious gas throw you know, ailments that will
eventually kill you. I think something. I think that what
women said something like, you know, ninety nine point ninety
(06:49):
nine percent of war is diarrhea, and one percent is
glory or something they're you know, it's and I think
that that's true of all wars in the you know,
before the modern era, but it's certainly true the Civil War,
which is just again, this biotic soup is being churned.
Speaker 1 (07:04):
So you talk about the the untenable conditions that these
guys were in. What were the main diseases that were
killing people at this time?
Speaker 2 (07:12):
So typhus that big, This is a big one of soldiers.
This basically means that you are you know, you are
ingesting this bacterium and you are essentially becoming dehydrated over
time because you developed diarrhea. This is a huge, huge
element during the war, as is malaria. If you were
posted in the South, and if you are a boy
(07:32):
from instead of let's say Boston or from Connecticut, you
probably had not been exposed to malaria at some point
at any point in your life before this. If you
are on a Southern campaign, and most of this war,
of course was fought in the South, you are suddenly
faced with this you know, mosquito born ailment, which may
not kill you, but it could you know, massively reduce
(07:53):
your health, your fighting capacity. And of course all of
these diseases. We're you know, we're used to talking about
this now with COVID, but we have we're talking about many,
many comorbidities, people who have a very high viral or
bacterial load, who are vulnerable to other kinds of opportunistic infections.
And so that you know that by far the sort
of the biggest most you know, the you know, the
(08:16):
sort of prototypical disease of wars. Of course, you know, typhus, typhoid, diphtheria,
these kinds of very contagious diseases that can kill you
very quickly. And if you know, and that's again it's
far and away the sort of the most common kinds
of ailments that you would get away from the front,
but also to the you know, if you are a
soldier in this war and you were shot by a
(08:38):
mini ball, or you were you know, got a piece
of shrapnel in your arm, you were also in big trouble.
You could potentially die quite quickly of sepsis, often after
being you know, having a limitiputated. Things like this new
gangering could could set in with frightening rapidity in one
of these very very honestly disgusting field hospitals that were
(09:00):
a sort of mainstay of medical care in this war.
Speaker 1 (09:03):
This is American History Hotline. I'm your host Bob Crawford. Today.
My guest is Catherine Oliverius. She's an associate professor of
history at Stanford University. We're talking about diseases in the
Civil War. Let's talk about sexually transmitted diseases. I read
that syphilis and gonorrhea weren't really killing a lot of soldiers,
(09:27):
but they were spreading like crazy during the war. Is
this why we think it would be?
Speaker 2 (09:34):
So? Yes, this is potentially the subject of my next book,
or at least a chapter of my next book, about
the rapid rise of syphilis during and after the Civil War. So,
when I was researching my last book, this is there
were sort of two datas points that came to mind
very quickly or that really stood out to me. One
is that physicians in and around New York they estimated
(09:56):
that before the war so eighteen sixty, that approximately ten
percent of American adult American men at one point would
have had gone rhea or syphilis. That this is this
is the data that it's very shaky for a lot
of different reasons, and it's certainly has a New York
City urban bias, which would inflate those numbers, but that's
still you know, that's a sizeable percent. But fast forward
(10:20):
to generations to nineteen hundred. The American Public Health Association,
they're stunding the alarm bells because they're saying now that
between eighteen and twenty percent of adult American men over
the age of twelve had active syphilis. That this is
you know, this is a serious and this is a
serious sexually tridmitted infection, probably the most terrifying disease before antibiotics.
(10:44):
And so during this war, well basically you can sort
of think about this war as a kind of again,
this biotic soup is being stirred here, but you can
think about this as the kind of super spreader event
for syphilis, where you have a lot of young boys
who were you know, between sort of lighteen's early twenties.
They come into this war. They are reckless with the future,
(11:04):
as many men from boys of course are today, as
you know even still and I've seen this in many,
many letters where you know, you have soldiers who say, basically,
I want to have sex for the first time or
maybe for the last time, and so they sleep with prostitutes,
and this becomes again this kind of just recurring and
snowballing problem where increasingly officers are sounding the alarms about this,
(11:27):
where they're saying, you know, these boys are coming in,
you know they have they maybe have syphilis. They don't,
they don't necessarily have symptoms, or maybe they do have symptoms,
but they've made it past the medical examination, and suddenly
you know they're they are they're they're worried that basically
this is actually hurting their ability to wage and fight
war because so many men, so many young boys were
(11:49):
in the hospital ward in the Beady Hospital wards in
Tennessee or in Washington, d C. And that is this
this recurring problem. And then sort of secondary to this,
which is the kind of real I think tragedy so
syphilists is you know, many people will not really ever
develop major symptoms. For some people they'll be okay, but
for many people you'll as you develop into the secondary,
(12:11):
So you go from some of the primary to the
secondary to the tertiary stage. And the tertiary stage is
probably what most people are sort of familiar with. This
is where you might lose your nose, you might wear sunglasses.
Speaker 1 (12:21):
Yeah yeah, why lose your nose.
Speaker 2 (12:25):
Yeah yeah, yeah so this so this can happen also
decades after the primary infection. But you know, the sort
of the most famous and horrifying symptoms of syphilis ors
that you develop these kind of gummas, these kind of
like indentations in your head. A lot of people will
lose their nose tissue and tissue on their face. In general,
a lot of people become paralyzed, permanently paralyzed, or they
(12:46):
go blind, they go deaf. It's this, and it's you know,
and up and up through the secondary stage. This is
the tertary stage we're talking about now, when you can
lose your mind and you descend into death in this
really horrible manner. You know, you're you're you can spread
this very easily, not just to the people that you
sleep with, but also to your children and to your children.
(13:08):
This is you know, this is one of the sort
of saddest parts about this that's so called at the time,
it was called the infection of innocence. These are unsuspecting
wives and children, and if you had a child who
survived to be born, very often they would be bought.
If they were syphilitic. They would be born blind or
otherwise deformed, and many many would be still born and
wouldn't live very long after being born. So it's a
(13:31):
really horrible illness. And it was the sort of biggest
tragedy of this, of course, is that it's now extremely curable,
curable by penicillin. In fact, penicillina is so effective in
treating syphilis that even if you are allergic to penicillin,
doctors will still recommend that you take penicillin. And so
this is yeah, yeah.
Speaker 1 (13:50):
Well, so what were the treatments back then? Were there
were there any treatments back then?
Speaker 2 (13:55):
So doctors recommended a bunch of stuff, none of which
we we know this today that they were not there
are these are? They weren't? These were not cures for
syphilis actually, but these were what doctors prescribed, essentially to
do something. So the major cure would have been mercury
or kalamel. And so if you were if you were
(14:19):
let's say, you know, a twenty five year old lawyer
who goes to your doctor, he would say to you, Okay,
so here's what we're gonna do. Where, first of all,
you know, you don't I'm if even if your wife
comes in with this disease, I won't tell her first
of all that she has syphilis, because that would be
betraying your confidence. But you have to do a few things.
You shouldn't sleep with anybody for four to six years.
(14:40):
You should ingest mercury on a daily basis sometimes, or
bathe in it if you had a rash, bathe in
it and put it all over your body, vapor bath
in it sometimes. They would, you know, ask you to
do this and basically to kind of kill things within
your body. The idea was kind of it's in a
similar way that sort of therapy work today that you're
(15:02):
kind of I think their idea was that you sort
of if you kill off enough healthy tissue, you also
or you know, to kill off the civilism bacterim, you
would also have to kill off plenty of healthy tissue too,
And that was sort of the therapeutic idea behind it.
But of course mercury, this is this is really toxic stuff.
It can easily kill you if you take too much
(15:23):
of it. So and you have many many cases of this,
so in you know, before killing you, you will also
probably lose your teeth, You lose your hair. Many people
talk about being sort of salivated constantly. You're you produce
a tons of saliva. It's this is a it's a
really neat and you feel horrible because again it's it's toxic,
it's a poison. So this many many people in fact
(15:46):
thought that, you know, they would rather take their chances
with the disease rather than the alleged cure. It was.
That was how horrible it was.
Speaker 1 (15:54):
You know, we mentioned your book a little bit earlier.
I just want to let our listeners know that your
book is Necropolis, Disease, Power and Capitalism in the Cotton
Kingdom that came out in twenty twenty two, and we
look forward to your next book me too. So were
there any preventative measures for syphilis other than don't have sex?
Speaker 2 (16:17):
So actually condoms that exist there, you know, vulcanized rubber
was had been had been around, but generally speaking though
they were not used, and often they would be used
and reused and reused, so they kind of get rid
of their efficacy of course, but really the cure for
syphilis is abstinence. And then back in those days at
least which is that you know, at least when you're
(16:40):
when the person's infectious, which varies, you know, widely, but
generally you're infectious for the during the primary and secondary stages,
and that can be anywhere from a few weeks to
a few years, and it's really hard to know, of course.
So that's that is the only cure at the time.
And some you know, some people again they never developed
serious symptoms. They were you know, okay, they were largely asymptomatic,
(17:03):
so you know it could kind of but yet, you know,
asymtomatic while still being contagious. That's sort of the dangerous
part here too. So you're spreading this unknowingly or knowingly
sometimes too, but quite unknowingly. And this is the thing
where you have all these boys who when they muster
out in eighteen sixty five after appomatics, they go home
and they're at this age where they're gonna get married.
There's also a marriage boom after this war where suddenly
(17:25):
everyone seemed to be wanted to get married real fast
to have kids. And so you see this transmission of
diseases of syphilis in particular from the battle front to
the home front. And this is this is a really
like you can you can see this basically, this sort
of connection between you know, war and home in a
really serious and really devastating way with syphilis.
Speaker 1 (17:55):
This is American History Hotline. I'm your host, Bob Crawford.
Today my guest is Katherine Oliverius. She's an associate professor
of history at Stanford University. We're talking about how rough
it was to be a soldier during the Civil War
because of disease. Remember to send us your burning questions
about American history. Record yourself using the voice memo app
(18:18):
on your phone and email it to American History Hotline
at gmail dot com. Now back to our show. We've
been talking about diseases during the Civil War. Let's talk
about medical treatment. It's the early eighteen sixties. What's the
state of medicine at this time? Was there antibiotics? What
(18:38):
about sterilization techniques?
Speaker 2 (18:41):
So the sort of simple answer to this is no
and no, no antibiotics and no real concept of sterilization techniques. However, actually,
the Crimean War had happened in the eighteen fifties, and
this is the war that made Florence Nightingale famous and
kind of gave birth to modern nursing and this idea
of keeping hospital wards in ward. That basically the in
(19:04):
controlling disease, you could actually really lessen you could obviously
lessen the death rate of any disease, and you could
do that by keeping hospitals and medical facilities sanitary. So
these ideas were out there, they were percolating around. But again,
most people would have had very little concept of germs, certainly,
no concept of viruses being different from bacteria, none of
(19:25):
these things. They would have had various ideas about what
kinds of diseases sort of geographically or climatically fit within
the United States most certainly so a lot of northern
boys were very nervous about being posted not just to
the South, but to the Deep South. This is because
of yellow fever and because of malaria. And these are
boys with very little exposure to tropical diseases previous exposure,
(19:49):
so they're nervous about this. And the you know sort
of what would happen if you became sick is that,
you know, during your morning roll call, you would, if
you were really, really sick, you would announce to your
commanding officer that you needed to go to the hospital,
you need to see a doctor. And then you would,
you know, if they thought that was appropriate then you
(20:10):
would go to a hospital where you might be for
a long time. But actually, fundamentally soldiers wanted to avoid
hospitals as much as possible because these were places that
were considered to be disease factories. Right.
Speaker 1 (20:23):
I wanted I wanted to ask you, were there things
that doctors were doing that were contributing to soldiers' deaths?
Speaker 2 (20:29):
Yes, And you know this is a lot. This is
sort of one of the I would say, maybe the
grossest elements of this war in many ways. So every
single field hospital had what was called a pile outside
of the back door. Basically this is a pile of
limbs that had been amputated by the surgeons. By doctors.
I remember there were never enough doctors or surgeons in
(20:50):
this war, especially in the South. We're talking like one
surgeon for every I think thousand soldiers by the end
of the war. And you know that's that's not good
at all. You know, your chances of recovering if you're
six So what would happen? So if let's say you're
at a big battle like Gettysburg. So a part of
the infrastructure of war, of course, is that you know
(21:11):
you have the sort of the front lines who are fighting.
You also have the kind of back matter. You have
people who are establishing field hospitals, You have people, you
have ambulance drivers who are going onto the battlefield seeking
to get people off as quickly as possible. And their
job was incredibly important because your chances for survival if
you were taken off of the battlefield, if you were
seen by a surgeon and you had an invitation, for example,
(21:34):
your chances for survival went way up if that happened
within twenty four hours. If you start taking past that
twenty four hours, chances that you're going to develop gangreen
sepsis and then die often after being sort of hacked
apart by a surgeon are pretty high. So these surgeons
also too, Remember this is not really their fault because
(21:54):
they don't understand how diseases works, and you know, they
did not disease under how bacteria worked. But you know,
you have a surgeon who's going down the line after
a very chaotic battle like Gettysburg for example, or Cold Harbor,
and they're using the same exact saw on every single person.
They're not using gloves, and they're just literally you know,
they're going down the line. This is you know, cutting
(22:16):
off hands, cutting off limbs and things like this. So
and then you know those legs are you know, those
those imitated body parts are then being put into the
pile outside. And so you have not just doctors, but
also you know, you have nurses who are going down
between the lines of each person too, so they're basically
kind of acting as vectors between each person, unknowingly of course,
but still you have this. This is why we see this,
(22:36):
you know, very rapid spread of infection, very often after
many battles.
Speaker 1 (22:41):
How do deaths from disease during the Civil War stack
up against other US wars?
Speaker 2 (22:47):
Well, the Civil War is the deadliest war in American history.
This is three quarter of a million people died during
this war. It is a per capita and you know
your chances again, if you were in the South, you're
you're the sort of proportionate death rate was much much,
much higher. I think it's something like one in four
Confederate men who enlisted died during the war something and
(23:10):
many more were made casualties. It's you know, it's a
large work jump or maybe one in three. So you
know this this is an extremely deadly event. And you
see also of course, you know, the sort of the
as we move into the twentieth century, you see diseases
you know that are you know, like World War One,
for example, And I grew up in the UK, and
(23:31):
then the World War One was kind of the sort
of paradigmatic disease that I was taught about, that sort
of exists in the kind of culture and the way
that the Civil War perhaps does here. But in every
town you have in England you have a little sort
of obelisk, a little memorial to the war dead. And many, many,
many of those soldiers died from diseases. Syphilists too in fact,
but you know it's not you know, war isn't as before.
(23:54):
You know that the modern era, many many penny people
would have died from what we would considered today to
be quite curable diseases. And so armies, the sort of
brass of every army was really dedicated, of course, towards
you know, increasingly dedicated towards making sure that conditions were sanitary,
that hospitals were established and well staffed. These this became
(24:14):
a sort of imperative of waging a modern war. And
so we see, you know, deaths from disease decrease as
time goes on to you know today it's it's you know,
much much much, much much much lower than it was
during the Civil War. But but really before the twentieth century,
this is this is a kind of active life in war,
which is that disease is going to really be what
gets you for the most part. And disease also or
(24:37):
especially in this Civil war too, where we have mini
balls which are designed that this is the bullet that
was sort of used. These are designed not to They're
designed to sort of basically splinter your bones and fragment
in your body, so they kind of spread out and
therefore can cause within your body, and that's why infections
became so serious. So we have you know, this is
(24:58):
this is just again biotic soup, and this is the
sort of the most condensed, most concentrated version of biotics
soup happening in the strengths ofvil war.
Speaker 1 (25:08):
Catherine, thank you so much for answering our question today.
Catherine Oliverius, she's an associate professor of history at Stanford University.
Thank you for joining us.
Speaker 2 (25:18):
My pleasure.
Speaker 1 (25:25):
You've been listening to American History Hotline, a production of
iHeart podcasts and Scratch Track Productions. The show is executive
producer is James Morrison. Our executive producers from iHeart are
Jordan Runtall and Jason English. Original music composed by me,
Bob Crawford. Please keep in touch. Our email is Americanistory
(25:47):
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(26:08):
Thanks so much for listening, See you next week.
You've reached American History Hotline. You asked the questions, We
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Speaker 2 (00:09):
Leave a message.
Speaker 1 (00:11):
Hey there, American History Hotliners. Your host Bob Crawford here,
happy to be joining you again for another American History Hotline.
You're the ones with the questions. I'm the guy trying
to get some answers and keep those questions coming. The
best way to get us a question is to record
a video or a voice memo on your phone and
(00:31):
email it to Americanhistory Hotline at gmail dot com. That's
American History Hotline all one word at gmail dot com.
And remember we are American History Hotline. I love ancient
Egypt as much as the next guy, but there's plenty
to talk about on this continent. Okay. Today's question is
(00:53):
about the Civil War. Here to help me answer the
question is Catherine Oliverius. She's an associate professor of history
at Stanford University, specializing in nineteenth century US history. Catherine,
thanks for being on the show.
Speaker 2 (01:09):
I am delighted to be here, and I love talking
about the Civil War.
Speaker 1 (01:13):
It is so much fun, isn't it.
Speaker 2 (01:16):
Yeah, for us, for us A few years later, a
few you know, decades after the fact, it's certainly fun.
Speaker 1 (01:22):
Yes, uh, cent century and a half after the fact. Yeah,
not too soon.
Speaker 2 (01:27):
Yeah, I wouldn't necessarily want to be a Gettysburg myself,
so yeah, no, or or Andersonville, yes, yes, big no.
Speaker 1 (01:36):
Right. So our question today comes from Cheryl from Santa Fe,
New Mexico. She says, I heard that more soldiers died
from disease during the Civil War than they did in battle.
Is that true?
Speaker 2 (01:52):
Yes? Yes, Actually, in the Civil War, approximately two thirds
of all the Civil War dead died from disease, not
from bullets, from battlefield injuries. So that's about two thirds
of approximately seven hundred and fifty thousand people who died
during the war. And that number itself, that three quarters
of a million number, is up for debate. We actually
(02:14):
don't have the best records, but if you were a
soldier on either side of the war, whether you were
with the Union Army, the Federal Army, or the Confedetitates
of America, you had a very high chance of dying
from disease, especially diseases like dysentery, crowd diseases, on diseases
of malnutrition, things like this, far away from any kind
of battlefield.
Speaker 1 (02:35):
And like you said, it didn't matter which army you
were with, But was one army better equipped to prevent
disease than another.
Speaker 2 (02:45):
Yes, certainly so by far. The Union Army, this is
the Northern Army, the United States Army. It had a
high death rate, but it was a much You would
have a much better chance, sort of proportionally, of surviving
this war if you were in the North, the Southern Army,
they the Confetittives of America. They never had the kind
of medical service or ambulance corps that was required to
(03:08):
lodge this total, this total modern war, you know, filled
with mini balls and shrapnel and things like this, and
so if you were in the South, you had a
much higher chance of dying from disease. One little twist
to this, of course, is that if you were in
the Union Army, Black soldiers in the Union Army had
a much higher chance of dying from disease than did
white soldiers, generally because they received worse medical care and
(03:31):
because they were often given much deadlier assignments and sort
of dirtier assignments too, so you were more in contact
with pathogens and also more in the line of fire.
If you are a black soldier.
Speaker 1 (03:42):
Can you paint a picture for us of the conditions
soldiers were living in during the war and how that
contributed to the spread of disease.
Speaker 2 (03:52):
Yeah, so, I mean think about it. So we have this,
you know, Abraham Lincoln calls for seventy five thousand troops
in eighteen sixty one from volunteers from across the North,
and he gets those volunteers in many, many more, and
suddenly you have this sort of massive churn of people.
So a lot of historians actually talked about the Civil
(04:13):
War as a kind of biotic soup and that you
are just like stirring this pod constantly with people moving
around the country, bringing with them diseases, immunities, things like this,
pathogens with them to the front. So if you're a soldier,
suddenly you are arriving at a camp. This is a
very crowded place. You are often responsible for cooking your
own food and procuring it, or you might be given
(04:36):
some rations or you know, some kinds of you know,
you know, meat or corn or something like this, but
you are generally in charge of cooking it yourself. And
these are for the most part, pretty young boys who
have very little experience with food preparation. They're not so
good at keeping things clean. This is also this is
around the time that germ theory is happening, so that
people are understanding that, you know that germs can cause diseases.
(05:00):
But most people, most soldiers, most commissols, would have had
no idea on This is very much in the sort
of early state of development at this point, so they
would have had very little idea about that. And if
you were in a camp, you're you know, this is
it rains, it's muddy generally speaking, people would you know,
if there was a water source close by, like a stream,
you would washing it, you would drink from it, you
would probably defecate into it too, So it's we're talking
(05:22):
about this just this is a a germ bonanza suddenly,
and we're talking again also about people from all across
the country, people who maybe never been exposed to diseases
like wooden cough or diseases like measles before. Suddenly you're
being put into very close contact with people who are
maybe bringing these pathogens in. And of course you remember
(05:43):
too that every single soldier was screened before coming into
the army, so you know this is this means that
you're if you're obviously you know, infectious with something, you
would be denied entry into the army if you had
if you were you know, blind, or if you were
in paired in capacity to But as the war is
dragging on, as the draft is being instituted to, medical
(06:07):
examiners are being sort of leaned on to kind of
look the other way about this, you know, about pretty
obvious diseases because they just need bodies, they need soldiers,
and so they're adopting a laxer and laxer attitude towards
infectious disease. So therefore, more and more people are entering
this army bringing these kinds of infectious ailments again, you know, smallpox, measles,
(06:27):
things like this. But then also they're arriving in these
camps and when they're you know, when you're on the front,
you are just inundated by these crowd diseases, these diseases
of malnutrition and back, you know, these bacteria that can
cause really serious gas throw you know, ailments that will
eventually kill you. I think something. I think that what
women said something like, you know, ninety nine point ninety
(06:49):
nine percent of war is diarrhea, and one percent is
glory or something they're you know, it's and I think
that that's true of all wars in the you know,
before the modern era, but it's certainly true the Civil War,
which is just again, this biotic soup is being churned.
Speaker 1 (07:04):
So you talk about the the untenable conditions that these
guys were in. What were the main diseases that were
killing people at this time?
Speaker 2 (07:12):
So typhus that big, This is a big one of soldiers.
This basically means that you are you know, you are
ingesting this bacterium and you are essentially becoming dehydrated over
time because you developed diarrhea. This is a huge, huge
element during the war, as is malaria. If you were
posted in the South, and if you are a boy
(07:32):
from instead of let's say Boston or from Connecticut, you
probably had not been exposed to malaria at some point
at any point in your life before this. If you
are on a Southern campaign, and most of this war,
of course was fought in the South, you are suddenly
faced with this you know, mosquito born ailment, which may
not kill you, but it could you know, massively reduce
(07:53):
your health, your fighting capacity. And of course all of
these diseases. We're you know, we're used to talking about
this now with COVID, but we have we're talking about many,
many comorbidities, people who have a very high viral or
bacterial load, who are vulnerable to other kinds of opportunistic infections.
And so that you know that by far the sort
of the biggest most you know, the you know, the
(08:16):
sort of prototypical disease of wars. Of course, you know, typhus, typhoid, diphtheria,
these kinds of very contagious diseases that can kill you
very quickly. And if you know, and that's again it's
far and away the sort of the most common kinds
of ailments that you would get away from the front,
but also to the you know, if you are a
soldier in this war and you were shot by a
(08:38):
mini ball, or you were you know, got a piece
of shrapnel in your arm, you were also in big trouble.
You could potentially die quite quickly of sepsis, often after
being you know, having a limitiputated. Things like this new
gangering could could set in with frightening rapidity in one
of these very very honestly disgusting field hospitals that were
(09:00):
a sort of mainstay of medical care in this war.
Speaker 1 (09:03):
This is American History Hotline. I'm your host Bob Crawford. Today.
My guest is Catherine Oliverius. She's an associate professor of
history at Stanford University. We're talking about diseases in the
Civil War. Let's talk about sexually transmitted diseases. I read
that syphilis and gonorrhea weren't really killing a lot of soldiers,
(09:27):
but they were spreading like crazy during the war. Is
this why we think it would be?
Speaker 2 (09:34):
So? Yes, this is potentially the subject of my next book,
or at least a chapter of my next book, about
the rapid rise of syphilis during and after the Civil War. So,
when I was researching my last book, this is there
were sort of two datas points that came to mind
very quickly or that really stood out to me. One
is that physicians in and around New York they estimated
(09:56):
that before the war so eighteen sixty, that approximately ten
percent of American adult American men at one point would
have had gone rhea or syphilis. That this is this
is the data that it's very shaky for a lot
of different reasons, and it's certainly has a New York
City urban bias, which would inflate those numbers, but that's
still you know, that's a sizeable percent. But fast forward
(10:20):
to generations to nineteen hundred. The American Public Health Association,
they're stunding the alarm bells because they're saying now that
between eighteen and twenty percent of adult American men over
the age of twelve had active syphilis. That this is
you know, this is a serious and this is a
serious sexually tridmitted infection, probably the most terrifying disease before antibiotics.
(10:44):
And so during this war, well basically you can sort
of think about this war as a kind of again,
this biotic soup is being stirred here, but you can
think about this as the kind of super spreader event
for syphilis, where you have a lot of young boys
who were you know, between sort of lighteen's early twenties.
They come into this war. They are reckless with the future,
(11:04):
as many men from boys of course are today, as
you know even still and I've seen this in many,
many letters where you know, you have soldiers who say, basically,
I want to have sex for the first time or
maybe for the last time, and so they sleep with prostitutes,
and this becomes again this kind of just recurring and
snowballing problem where increasingly officers are sounding the alarms about this,
(11:27):
where they're saying, you know, these boys are coming in,
you know they have they maybe have syphilis. They don't,
they don't necessarily have symptoms, or maybe they do have symptoms,
but they've made it past the medical examination, and suddenly
you know they're they are they're they're worried that basically
this is actually hurting their ability to wage and fight
war because so many men, so many young boys were
(11:49):
in the hospital ward in the Beady Hospital wards in
Tennessee or in Washington, d C. And that is this
this recurring problem. And then sort of secondary to this,
which is the kind of real I think tragedy so
syphilists is you know, many people will not really ever
develop major symptoms. For some people they'll be okay, but
for many people you'll as you develop into the secondary,
(12:11):
So you go from some of the primary to the
secondary to the tertiary stage. And the tertiary stage is
probably what most people are sort of familiar with. This
is where you might lose your nose, you might wear sunglasses.
Speaker 1 (12:21):
Yeah yeah, why lose your nose.
Speaker 2 (12:25):
Yeah yeah, yeah so this so this can happen also
decades after the primary infection. But you know, the sort
of the most famous and horrifying symptoms of syphilis ors
that you develop these kind of gummas, these kind of
like indentations in your head. A lot of people will
lose their nose tissue and tissue on their face. In general,
a lot of people become paralyzed, permanently paralyzed, or they
(12:46):
go blind, they go deaf. It's this, and it's you know,
and up and up through the secondary stage. This is
the tertary stage we're talking about now, when you can
lose your mind and you descend into death in this
really horrible manner. You know, you're you're you can spread
this very easily, not just to the people that you
sleep with, but also to your children and to your children.
(13:08):
This is you know, this is one of the sort
of saddest parts about this that's so called at the time,
it was called the infection of innocence. These are unsuspecting
wives and children, and if you had a child who
survived to be born, very often they would be bought.
If they were syphilitic. They would be born blind or
otherwise deformed, and many many would be still born and
wouldn't live very long after being born. So it's a
(13:31):
really horrible illness. And it was the sort of biggest
tragedy of this, of course, is that it's now extremely curable,
curable by penicillin. In fact, penicillina is so effective in
treating syphilis that even if you are allergic to penicillin,
doctors will still recommend that you take penicillin. And so
this is yeah, yeah.
Speaker 1 (13:50):
Well, so what were the treatments back then? Were there
were there any treatments back then?
Speaker 2 (13:55):
So doctors recommended a bunch of stuff, none of which
we we know this today that they were not there
are these are? They weren't? These were not cures for
syphilis actually, but these were what doctors prescribed, essentially to
do something. So the major cure would have been mercury
or kalamel. And so if you were if you were
(14:19):
let's say, you know, a twenty five year old lawyer
who goes to your doctor, he would say to you, Okay,
so here's what we're gonna do. Where, first of all,
you know, you don't I'm if even if your wife
comes in with this disease, I won't tell her first
of all that she has syphilis, because that would be
betraying your confidence. But you have to do a few things.
You shouldn't sleep with anybody for four to six years.
(14:40):
You should ingest mercury on a daily basis sometimes, or
bathe in it if you had a rash, bathe in
it and put it all over your body, vapor bath
in it sometimes. They would, you know, ask you to
do this and basically to kind of kill things within
your body. The idea was kind of it's in a
similar way that sort of therapy work today that you're
(15:02):
kind of I think their idea was that you sort
of if you kill off enough healthy tissue, you also
or you know, to kill off the civilism bacterim, you
would also have to kill off plenty of healthy tissue too,
And that was sort of the therapeutic idea behind it.
But of course mercury, this is this is really toxic stuff.
It can easily kill you if you take too much
(15:23):
of it. So and you have many many cases of this,
so in you know, before killing you, you will also
probably lose your teeth, You lose your hair. Many people
talk about being sort of salivated constantly. You're you produce
a tons of saliva. It's this is a it's a
really neat and you feel horrible because again it's it's toxic,
it's a poison. So this many many people in fact
(15:46):
thought that, you know, they would rather take their chances
with the disease rather than the alleged cure. It was.
That was how horrible it was.
Speaker 1 (15:54):
You know, we mentioned your book a little bit earlier.
I just want to let our listeners know that your
book is Necropolis, Disease, Power and Capitalism in the Cotton
Kingdom that came out in twenty twenty two, and we
look forward to your next book me too. So were
there any preventative measures for syphilis other than don't have sex?
Speaker 2 (16:17):
So actually condoms that exist there, you know, vulcanized rubber
was had been had been around, but generally speaking though
they were not used, and often they would be used
and reused and reused, so they kind of get rid
of their efficacy of course, but really the cure for
syphilis is abstinence. And then back in those days at
least which is that you know, at least when you're
(16:40):
when the person's infectious, which varies, you know, widely, but
generally you're infectious for the during the primary and secondary stages,
and that can be anywhere from a few weeks to
a few years, and it's really hard to know, of course.
So that's that is the only cure at the time.
And some you know, some people again they never developed
serious symptoms. They were you know, okay, they were largely asymptomatic,
(17:03):
so you know it could kind of but yet, you know,
asymtomatic while still being contagious. That's sort of the dangerous
part here too. So you're spreading this unknowingly or knowingly
sometimes too, but quite unknowingly. And this is the thing
where you have all these boys who when they muster
out in eighteen sixty five after appomatics, they go home
and they're at this age where they're gonna get married.
There's also a marriage boom after this war where suddenly
(17:25):
everyone seemed to be wanted to get married real fast
to have kids. And so you see this transmission of
diseases of syphilis in particular from the battle front to
the home front. And this is this is a really
like you can you can see this basically, this sort
of connection between you know, war and home in a
really serious and really devastating way with syphilis.
Speaker 1 (17:55):
This is American History Hotline. I'm your host, Bob Crawford.
Today my guest is Katherine Oliverius. She's an associate professor
of history at Stanford University. We're talking about how rough
it was to be a soldier during the Civil War
because of disease. Remember to send us your burning questions
about American history. Record yourself using the voice memo app
(18:18):
on your phone and email it to American History Hotline
at gmail dot com. Now back to our show. We've
been talking about diseases during the Civil War. Let's talk
about medical treatment. It's the early eighteen sixties. What's the
state of medicine at this time? Was there antibiotics? What
(18:38):
about sterilization techniques?
Speaker 2 (18:41):
So the sort of simple answer to this is no
and no, no antibiotics and no real concept of sterilization techniques. However, actually,
the Crimean War had happened in the eighteen fifties, and
this is the war that made Florence Nightingale famous and
kind of gave birth to modern nursing and this idea
of keeping hospital wards in ward. That basically the in
(19:04):
controlling disease, you could actually really lessen you could obviously
lessen the death rate of any disease, and you could
do that by keeping hospitals and medical facilities sanitary. So
these ideas were out there, they were percolating around. But again,
most people would have had very little concept of germs, certainly,
no concept of viruses being different from bacteria, none of
(19:25):
these things. They would have had various ideas about what
kinds of diseases sort of geographically or climatically fit within
the United States most certainly so a lot of northern
boys were very nervous about being posted not just to
the South, but to the Deep South. This is because
of yellow fever and because of malaria. And these are
boys with very little exposure to tropical diseases previous exposure,
(19:49):
so they're nervous about this. And the you know sort
of what would happen if you became sick is that,
you know, during your morning roll call, you would, if
you were really, really sick, you would announce to your
commanding officer that you needed to go to the hospital,
you need to see a doctor. And then you would,
you know, if they thought that was appropriate then you
(20:10):
would go to a hospital where you might be for
a long time. But actually, fundamentally soldiers wanted to avoid
hospitals as much as possible because these were places that
were considered to be disease factories. Right.
Speaker 1 (20:23):
I wanted I wanted to ask you, were there things
that doctors were doing that were contributing to soldiers' deaths?
Speaker 2 (20:29):
Yes, And you know this is a lot. This is
sort of one of the I would say, maybe the
grossest elements of this war in many ways. So every
single field hospital had what was called a pile outside
of the back door. Basically this is a pile of
limbs that had been amputated by the surgeons. By doctors.
I remember there were never enough doctors or surgeons in
(20:50):
this war, especially in the South. We're talking like one
surgeon for every I think thousand soldiers by the end
of the war. And you know that's that's not good
at all. You know, your chances of recovering if you're
six So what would happen? So if let's say you're
at a big battle like Gettysburg. So a part of
the infrastructure of war, of course, is that you know
(21:11):
you have the sort of the front lines who are fighting.
You also have the kind of back matter. You have
people who are establishing field hospitals, You have people, you
have ambulance drivers who are going onto the battlefield seeking
to get people off as quickly as possible. And their
job was incredibly important because your chances for survival if
you were taken off of the battlefield, if you were
seen by a surgeon and you had an invitation, for example,
(21:34):
your chances for survival went way up if that happened
within twenty four hours. If you start taking past that
twenty four hours, chances that you're going to develop gangreen
sepsis and then die often after being sort of hacked
apart by a surgeon are pretty high. So these surgeons
also too, Remember this is not really their fault because
(21:54):
they don't understand how diseases works, and you know, they
did not disease under how bacteria worked. But you know,
you have a surgeon who's going down the line after
a very chaotic battle like Gettysburg for example, or Cold Harbor,
and they're using the same exact saw on every single person.
They're not using gloves, and they're just literally you know,
they're going down the line. This is you know, cutting
(22:16):
off hands, cutting off limbs and things like this. So
and then you know those legs are you know, those
those imitated body parts are then being put into the
pile outside. And so you have not just doctors, but
also you know, you have nurses who are going down
between the lines of each person too, so they're basically
kind of acting as vectors between each person, unknowingly of course,
but still you have this. This is why we see this,
(22:36):
you know, very rapid spread of infection, very often after
many battles.
Speaker 1 (22:41):
How do deaths from disease during the Civil War stack
up against other US wars?
Speaker 2 (22:47):
Well, the Civil War is the deadliest war in American history.
This is three quarter of a million people died during
this war. It is a per capita and you know
your chances again, if you were in the South, you're
you're the sort of proportionate death rate was much much,
much higher. I think it's something like one in four
Confederate men who enlisted died during the war something and
(23:10):
many more were made casualties. It's you know, it's a
large work jump or maybe one in three. So you
know this this is an extremely deadly event. And you
see also of course, you know, the sort of the
as we move into the twentieth century, you see diseases
you know that are you know, like World War One,
for example, And I grew up in the UK, and
(23:31):
then the World War One was kind of the sort
of paradigmatic disease that I was taught about, that sort
of exists in the kind of culture and the way
that the Civil War perhaps does here. But in every
town you have in England you have a little sort
of obelisk, a little memorial to the war dead. And many, many,
many of those soldiers died from diseases. Syphilists too in fact,
but you know it's not you know, war isn't as before.
(23:54):
You know that the modern era, many many penny people
would have died from what we would considered today to
be quite curable diseases. And so armies, the sort of
brass of every army was really dedicated, of course, towards
you know, increasingly dedicated towards making sure that conditions were sanitary,
that hospitals were established and well staffed. These this became
(24:14):
a sort of imperative of waging a modern war. And
so we see, you know, deaths from disease decrease as
time goes on to you know today it's it's you know,
much much much, much much much lower than it was
during the Civil War. But but really before the twentieth century,
this is this is a kind of active life in war,
which is that disease is going to really be what
gets you for the most part. And disease also or
(24:37):
especially in this Civil war too, where we have mini
balls which are designed that this is the bullet that
was sort of used. These are designed not to They're
designed to sort of basically splinter your bones and fragment
in your body, so they kind of spread out and
therefore can cause within your body, and that's why infections
became so serious. So we have you know, this is
(24:58):
this is just again biotic soup, and this is the
sort of the most condensed, most concentrated version of biotics
soup happening in the strengths ofvil war.
Speaker 1 (25:08):
Catherine, thank you so much for answering our question today.
Catherine Oliverius, she's an associate professor of history at Stanford University.
Thank you for joining us.
Speaker 2 (25:18):
My pleasure.
Speaker 1 (25:25):
You've been listening to American History Hotline, a production of
iHeart podcasts and Scratch Track Productions. The show is executive
producer is James Morrison. Our executive producers from iHeart are
Jordan Runtall and Jason English. Original music composed by me,
Bob Crawford. Please keep in touch. Our email is Americanistory
(25:47):
Hotline at gmail dot com. If you like the show,
please tell your friends and leave us a review in
Apple Podcasts. I'm your host, Bob Crawford. Feel free to
hit me up up on social media to ask a
history question or to let me know what you think
of the show. You can find me at Bob Crawford Base.
(26:08):
Thanks so much for listening, See you next week.
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