“War is cruelty. There is no use trying to reform it. The crueler it is, the sooner it will be over.”

Union General William T. Sherman reportedly spoke these words shortly prior to his Savannah Campaign (“March to the Sea”) during the last months of 1864.  American attitudes toward war had completely changed since the start of the war in 1861, when many Americans clung to the prospect of a short and romantic war.  Surely, they believed, the war would be over in a month or two.

Instead, the Civil War became an all-consuming national tragedy that claimed a staggering number of American lives. Modern war collided with the “medical middle ages.”  Neither side was prepared for the astounding death toll that the war wrought.  Although many casualties were caused by firearms and loss of blood from wounds, the greatest number of soldiers’ lives were claimed by widespread illnesses and poor camp conditions, exacerbated by a simple lack of medical knowledge.


  • The Civil War soldier was eight times more likely to die of a wound and ten times more likely to die of disease than an American soldier in World War I.
  • Simply being in the army killed more soldiers than participation in battle:
    • Total Union deaths: over 360,000 men.  Number killed in action: 110,000.
    • Total Confederate deaths: approx. 258,000 men.  As many as three-fourths of these men died from illness.
  • The combination of efficient weapons technology and the lack of modern medical knowledge had a crushing effect on soldiers’ chances of survival.
  • Much of the damage wreaked upon the armies by disease occurred within the soldiers’ first year in the service, before they developed resistance to common diseases.
    • The three principal killer diseases of the war were diarrhea/dysentery, typhoid, and pneumonia.  Service in the South often exposed the soldiers to malaria, and venereal disease, sometimes reported as measles or mumps, also plagued both armies.
  • The other major cause of death was camp illness, caused by impure water, poor food supplies, over-exposure to the elements, mosquitoes, and filthy, inadequate sewage systems.


  • American women in both the North and South took inspiration from Florence Nightingale, who revolutionized the British army’s medical system, established a school of nursing, and dignified nursing as a real profession during the Crimean War (1853-56).
  • Before the Civil War, nursing was widely regarded as a male preserve.  Americans frowned upon the idea of a woman working among the grisly sights, smells, and sounds of hospitals.  Yet, the total mobilization required by the Civil War provided women from both sides with new opportunities.
  • Thousands of women offered their services, and although many of them had no prior medical experience and others were turned away due to their youth, many women became vital parts of the Union and Confederate war efforts.
  • The duties of nurses were varied and numerous. Matrons were generally in charge of the order of their ward, the direction of the male nurses, supervising patients’ diets, assisting with their letter-writing, and handling the drugs and ointments to be administered to the sick and injured soldiers.
  • In the Union, the war led to the creation of the United States Sanitary Commission (USSC), led in part by women with previous experience in forming societies — in abolition movements, for example — and inspired by the British Sanitary Commission of the Crimean War.
    • About five hundred paid men and national officers made up “the Sanitary,” but the tens of thousands of volunteers for the institution were largely women, who organized everything from bazaars to “Sanitary Fairs” and sent supplies such as bandages, food, and volunteer nurses to army camps and hospitals.
    • The Sanitary Commission even paid personal visits to the soldiers’ camps, performing inspections and instructing men on the proper positions of latrines and camp drainage, water supply, and cooking procedures.  Although some soldiers did not follow through on these instructions, those who did so experienced improvements in their health and camp conditions.
    • Surgeon General William Hammond was so impressed by the work of the women serving as nurses in general hospitals that he issued an order declaring that such hospitals’ nurse staffs should be made up of one-thirds women.
  • In the Confederacy, where resources were more scarce, general hospitals were first created in response to the shock of overcrowding following the Seven Days’ Battles near Richmond.
    • Women, especially in the South, were criticized by men for their presence in army hospitals; however, these women were so intent on serving as volunteer nurses that they overcame such prejudices and contributed significantly to the Confederate war effort.
    • One of the most successful Civil War hospitals was established in Richmond, the Confederate capital, by a woman named Sally Louisa Tompkins, who was given a captain’s commission by Jefferson Davis, the President of the Confederacy.