Review - "Civil War Camps and Soldier Health: Sanitation and Military Effectiveness in the Union Army" by Earl Hess

[Civil War Camps and Soldier Health: Sanitation and Military Effectiveness in the Union Army by Earl J. Hess (Kent State University Press, 2026). Softcover, photos, tables, illustrations, endnotes, bibliography, index. Pages main/total:279/335. ISBN:978-1-60635-505-3. $39.95]

History has left us with the general impression that Civil War camps were decidedly unsanitary places that caused untold thousands of unnecessary soldier deaths on both sides. But were they really as badly arranged and administered as the literature would have us believe? It is true that two out of three Civil War deaths were attributed to disease (a great proportion of those contracted in semi-permanent army encampments), but it is also true that the U.S. government was able to field a mass volunteer army more than healthy enough to win a continental-scale war fought across a wide range of challenging, even extreme, natural environments. Of course, the American Civil War occurred well within the period of global military history when disease killed many more men than bullets (and the means did not then exist to flip that gross imbalance), so the question arises did Union Army camps at least do a reasonably good job of managing preventable deaths. Prolific Civil War military historian Earl Hess's 'yes and no' answer to that question might be predictable, but the way he arrived at it through quantitative sampling and analysis, as revealed in his new book Civil War Camps and Soldier Health: Sanitation and Military Effectiveness in the Union Army, is an extraordinary new development.

The available body of firsthand commentary from Civil War officers and men regarding camp conditions is vast, and it isn't difficult to arrive at a wide range of conclusions on the basis of anecdotal evidence. What sets Hess's study apart is its unprecedented systematic approach using a reliable and consistent set of data. Hess is not the first scholar to consult the U.S. Sanitary Commission's camp inspection reports housed at the New York Public Library, which are roughly 1,500 in number, but he is the first to orient (with the assistance of Fifteenth Corps inspection reports) a full-length, scientific-based study around them. The author's extensive review of both the reports themselves and the commission agents who conducted them (primarily trained civilian physicians) confirms the reliability and value of the inspection returns. In the context of providing a representative picture of the whole, Hess's sample of 280 returns, selected across the full range of unit branches/types and theaters, is equally convincing. The commission's best standardized inspection form examined fifteen main subjects of interest to northern sanitarians, and Hess's book organizes those into groups of up to three related areas and assigns an in-depth, chapter-length examination to each.

In order to come up with a practical means of producing useful data for comparison, Hess devised a seemingly valid method of converting the many questionnaire answers into three general rating categories: good, fair, and bad. By applying those ratings to the fifteen categories explored in the returns, we are able to quantify which elements of camp health and sanitation were most successful and which practices and guidelines were most badly implemented or followed. First up is camp situation. As one might have guessed, attention paid to semi-permanent camp site selection, physical layout, drainage, and both air and water quality varied widely during the war and was highly dependent on environmental conditions and officer knowledge and judgment. Overall, camp situation passed most inspections, with just under 20% qualifying as bad.

When it comes to shelter, many readers will likely assume that military barracks were best for maintaining soldier health, cleanliness, and comfort over an extended period of confinement (ex. during winter quarters), but both army officials and sanitarians maintained that tents, which their combined portability, utility, and ventilation properties better than any other shelter type, were preferable to either huts or barrack buildings. Shelter provided by the Union armies achieved high marks from the inspectors.

Army issues of clothing received fairly strong ratings from the inspectors, with nearly half the regiments awarded with a good rating and only around 10% bad. There were more mixed results when it came to assessing a unit's personal cleanliness. Bathing, grooming, and personal hygiene were emphasized in the service, but volunteer officers and men (similarly imbued with the carelessness of youth) all too often failed to follow the dictates of army regulations or heed the recommendations of sanitarians.

Two of the most important issues related to camp sanitation involved due care in cooking and food garbage (slops) disposal and managing sites designated for collecting bodily waste (sinks). Generally speaking, Union regiments did a much better job of handling kitchen waste than they did human waste, with 58% achieving good ratings for the former and only 37% for the latter. Fully a third of regiments failed sink inspection, a confounding result given how much proper attention to that category (perhaps more than any other) should have been rather simple to understand and implement for officers and men alike.

Inspectors generally found food issued to soldiers to be more than adequate in quantity but poor in variety (too much meat and not enough fruits and vegetables). When it came to cooking, sanitarians and their camp inspectors favored an organized approach at the company level with regular officer oversight, but soldiers themselves found most satisfaction with their small, relatively independent messes (one of their few remaining sources of personal autonomy) and the officers generally consented. In Hess's opinion, cooking was one of the categories that the inspectors (for some reason) graded most leniently, with just over half rated good.

Water sources and quality, alcohol use and abuse, and morale boosting efforts were also targeted by the inspectors. Camp inspectors rated water quality high (with around 73% getting a good rating), but it is also astutely pointed out that semi-permanent encampments were much better suited for obtaining healthy water sources than were temporary camps established on the march. When it comes to alcohol, inspection findings push back strongly against the popular view that Civil War camps were rife with drunken disruption. In Hess's sample, nearly 80% of officers claimed that discipline problems related to alcohol abuse were manageable in their regimental encampments. Since indiscipline in this area would reflect badly upon those very same officers, it is possible (even likely) that some degree of concealment was involved, but Hess offers up a reasonable case that the scale of the problem remains exaggerated in the general literature. The inspectors did not find that the army paid any particular attention to shaping soldier morale and emotional well-being. Hess notes that institutional initiatives in those areas really only arrived decades later accompanied by the rise of industrial-era corporate culture.

There were mixed efforts in the medical examination of recruits and vaccination against disease. In the main, the leadership of volunteer regiments, primarily concerned with warm body count and reluctant to turn away eager recruits, did a poor job of initially weeding out those physically or mentally unable to perform their duties. That cost the war effort millions of dollars and a great deal of trouble. While smallpox inoculation was a priority, there were nevertheless significant outbreaks of the disease. The volunteer army received high marks for containing such outbreaks after they occurred, but overall prevention remained problematic. According to the inspection returns, less than 30% of the regiments followed in full the army's vaccination program regulations, and over 36% were almost completely non-compliant.

Being well-trained physicians themselves, camp inspectors were quite strict in assessing regimental hospitals, only giving just over 18% a good rating (and over 45% bad!). Hess attributes this to poor management from medical personnel along with inadequate army-wide systems for stocking medical equipment and supplies at the unit level. The most successful hospitals were those closely supported by the officers at the top, and the inspectors found such oversight and supervision all too rare. Frequent conflicts between military officers and assigned medical staff over matters of authority didn't help either.

While Hess's focus is on the Union Army, he does provide a fairly lengthy Confederate Army chapter for limited comparison. Over the decades leading up to the conflict, the South lacked a sanitarian movement similar in size and scope to the one the spread across the North, and there was no army camp inspection regimen anything like the one conducted by the U.S.S.C. Lacking reliable data of a similar nature, the author nevertheless presents a brief overview of the same fifteen inspection categories using anecdotal evidence. Smallpox outbreak containment was noteworthy for being one of the few ways in which Confederate forces matched their northern counterparts in effectiveness. Generally speaking, preventive healthcare was for a variety of reasons inferior, and southern camps and soldiers arguably earned their reputation as being dirtier than their foes.

If all this sounds like dry reading, it really isn't at all. Each chapter is packed with engaging anecdotes, details, and insights (all conveyed through vivid firsthand observations) about many aspects of Civil War camp life. Inspection findings are routinely contextualized through interesting micro-treatises on related topics (the book's extensive review of the army's evaluation and supply of various tent types and its detailed coverage of army vaccination regimens are ones that immediately come to mind).

In common with much of Hess's more recent scholarship, this one extends its reach far into the postwar period. Given what was experienced during the Civil War, one might have expected lasting institutional reforms in the area of preventive health measures, but that was not the case. Camp sanitation and widespread soldiers deaths from disease were little different during the Spanish-American War of 1898 as they were during the Civil War's early period. Hess traces most of this to the country's decentralized system of inducting volunteers, which were broadly similar in both conflicts. Real change only came with the two World Wars, during which the federal government assumed direct control and oversight of national mobilization.

Though the topic is only addressed in fleeting fashion, Hess notes that sanitation enforcement in the much more regimented U.S. Navy shipboard life was superior. It would also be interesting to find some comparison between Regular Army unit camps (which were not visited by the commission's civilian inspectors) and the volunteer unit camps that are the subject of this study, the former group presumably much more attuned to following army regulations in regard to camp sanitation.

Clearly, and for a variety of reasons outlined and discussed in the book, the principles and practices espoused by the North's sanitarian movement had only a limited impact on soldier health and preventive healthcare associated with the war's semi-permanent volunteer unit encampments. With that in mind, Hess cautions readers against adopting the view that the Civil War was a major turning point in military medicine. When it comes to evaluating the practical impact U.S.S.C. inspectors had on military officials charged with enforcing camp sanitation, there is little doubt in the author's mind that their influence on preventive health and healthcare was quite limited in effectiveness, far more useful in identifying problems then effecting actual change. Nevertheless, it is Hess's conclusion that the attempt itself should be recognized as a positive deviation from the past. While the commission's sanitary reports may have had only a minimal impact on actual army and unit effectiveness, the study persuasively argues that the program was still well worth the effort.

In Civil War Camps and Soldier Health, Earl Hess effectively moves beyond the limitations of anecdotal evidence and contributes mightily to the field by offering up a fresh scientific approach that teaches us just as much about Civil War camp life in general as it does about its great many sanitary issues and concerns. Highly recommended.