Union and Confederate soldiers faced a common enemy: disease. Typhoid, measles, diarrhea and pneumonia were among the most common, but the most feared was smallpox. “Smallpox was a devastating disease. On average, three out of every 10 people who got it died,” the Centers for Disease Control and Prevention notes.
Death from disease was much greater for both armies at the beginning of the war, according to Dr. Jonathan O'Neal, a physician in Woodstock, Va., who speaks frequently on Civil War medicine. He recently made presentations for the Chesterfield Historical Society of Virginia at the County Museum.
“They were not good at killing people,” Dr. O'Neal said. As a result, for every soldier killed in battle, 10 died of disease during the early months of the war. As the war progressed, medical practices improved and killing became more efficient. By the end of the war, the rate of death from battle was about equal to that caused by disease, he added.
“Filthy living conditions in army camps, nonexistent surgical equipment, spoiled and poorly prepared foods, unwashed surgeons' hands and other poor health conditions” also caused the high disease rate, according to the Yale University School of Medicine. Infections hit new recruits particularly hard.
“Men from rural areas were especially vulnerable, lacking immunity to the childhood diseases to which their urban counterparts most likely had been exposed,” according to a 2012 New York Times article.
The National Museum of Civil War Medicine, of which Dr. O'Neal is a board member, points out that vaccinations for diseases, including smallpox, were developed in 1798 and were widely accepted by the 1830s.
“A doctor would place pus from the lesion of an infected person into a healthy patient’s bloodstream through a small cut. Scabs from smallpox lesions also were crushed and used to vaccinate patients. Smallpox scabs look like scabs from syphilis patients, so scabs from children were preferred because they were considered safer,” Dr. O’Neal said.
However, when the war began, most states had outlawed vaccinations because of the fear that the practice could actually spread disease.
“By the 1840s, vaccination was beginning to be neglected, and there was a generation of Americans which had never been exposed to smallpox. As a result, the incidence of smallpox began to rise in the decades before the civil war,” according to the medical museum.
“Doctors quickly recognized the need to vaccinate soldiers against smallpox. But, at the start of the war, military doctors were in short supply. The Northern army had 98 doctors and the South had 24. Many soldiers self-vaccinated by cutting their skin with pocket knives, rusty nails or other handy sharp objects. The pus or scab from the smallpox lesion of another soldier was then rubbed into the cut. Family members even mailed smallpox scabs to soldiers to self-vaccinate,” Dr. O'Neal said.
Dr. O'Neal, an anesthesiologist, said amputations during the war were performed using ether or chloroform, when they were available. After cutting the flesh and using a bone saw to complete the operation, the surgeon would bandage the wound rather than suturing it, allowing the wound to drain.
By the time the war ended, both sides had developed “complex and well organized systems” to treat wounded soldiers and prevent disease, Dr. O’Neal said. The North had 13,000 doctors and the Confederates had 4,000. Vaccinating for diseases, including smallpox, became common. Much of what was learned helped reduce casualties in future wars and improve the practice of medicine.
In 1980, the World Health Assembly declared the world free of smallpox. “Eradication of smallpox is considered the biggest achievement in international public health,” according to the Centers for Disease Control and Prevention.