Intensely Human: The Health of the Black Soldier in the American Civil War (review)

The black man in the Civil War and the post-Civil War army fought on the battlefield and in camp and barracks to obtain the right to be called a soldier and serve a nation in which he was by preference ignored. It is a compelling story of perseverance against adversity, of triumph and defeat, acceptance, and the creation of a proud military heritage. In Intensely Human, Margaret Humphreys examines the health of and the health care provided to the black Union soldier and reveals that his struggle for acceptance also extended to the aid post and hospital.

After the Emancipation Proclamation went into effect, 1 January 1863, abolitionists saw the army as a stepping stone to full citizenship for blacks. The army could feed, clothe, educate, and provide discipline, and in so doing allow the black man to assume a dignity he had never known. While black soldiers, for the most part, responded positively to military life and performed well in combat, contemporary anthropological wisdom declared the black man not completely human. He lacked the character, capacity for learning, or endurance of the Caucasian, and, therefore, was incapable of being a whole man or a good soldier. Moreover, the assumption that the black body was physically different from the white was commonly held by many, even Abraham Lincoln. This assumed difference provided the basis for a number of medical misconceptions, such as the idea that blacks were more resistant to malaria and yellow fever, but more susceptible to pneumonia and scurvy. While these social and biological biases were questioned by officers and physicians with a more objective turn of mind, for the most part they overshadowed any black success and dictated what acceptable medical care was for black soldiers.

In an era of burgeoning proprietary medical schools, where a regular or irregular medical degree could be obtained after only four months of classes and with extremely few state methods to ensure competence, volunteer regiments, white or black, in the Union Army could be served by inexperienced and/or incompetent practitioners. Individual racism and the social stigma of serving with a black regiment decreased the pool of practitioners even further. Surgeon qualification standards were reduced to fill black regiments, and, if no practitioner could be found, a hospital steward might serve as regimental surgeon. To compound this malpractice and neglect, black soldiers were placed in segregated hospital facilities with marginal nursing care.

Given these conditions it is not surprising that the morbidity and mortality among black regiments was higher than white units. Regrettably, the mortality statistics provided lack precision. In Table 1. 1 , Death Rate from Specific Disease (11), no units are given (possibly a publishing error), white deaths are drawn from data over the entire war while black mortality data is from FY1864–66, and no denominator is specified. The author's choice of denominators (total wartime enlistments) leads to an understatement of specific disease mortality for both black and white soldiers and an overstatement of mortality differences. Using average troop strength provides a more accurate assessment of disease mortality. Hence, black soldiers were only 30% more likely to die from infectious diarrhea/dysentery than whites and 15% more likely to survive a bout of typhoid fever, and pneumonia carried off 2. 6 (not 4) more black soldiers than white.

In using proportional mortality, rather than mortality rates, to describe differences between black soldiers in the Atlantic and Central Regions (82–83) and in Table 5. 1 (83), mortality errors were compounded. Moreover, it masked changing mortality patterns in those regions. Atlantic soldiers were not twice as likely to survive a gunshot wound (82). In FY1864 eastern soldiers were 1. 6 times (6.2/1000 soldiers compared to 3.8/1000) more likely to die from gunshot than Central Region soldiers and in FY1865 that increased to 2. 5 times (13.2/1000 compared to 5...