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Wartime Health Disparities And Their Aftermath

One might wonder why a book about the health of the black solider is being reviewed in a health policy journal. Margaret Humphreys’ slender volume, Intensely Human, however, also marks the beginning of our understanding of racial disparities in health and health care in the United States. It is through her careful investigation of numerous records collections, newspapers, letters, and other sources that we can view the health of the black Civil War soldier through dual prisms—that of racism in nineteenth-century social thought and that of our contemporary understanding of the social determinants of health such as housing, nutrition, the work environment, and education. Approximately 180,000 African American men served as soldiers in the Union Army during the Civil War. This was the first large-scale encounter between the U.S. government, African Americans, and an organized health care system. It was the first time that many Americans were forced to confront what they thought of, how they cared for, and how they lived with African Americans. As such, the Civil War also functions as a useful starting point for investigating the history of racial disparities in both health and health care in the United States. It also marked the first effort at scientific record gathering for all of the Americans who served in the war—white, black, male, and female. Although the quality of the Civil War records might drive a current-day scientist or policy wonk to distraction, they have been a gold mine for historians investigating the role of black soldiers in the war. Humphreys, the Josiah Charles Trent Professor in the History of Medicine at Duke University, starts from the startling disparity in causes of death during the Civil War for white versus black troops. About 33,000 black soldiers died during the war, but only 4,000 of them from combat. The vast majority died from disease. All told, about 13.5 percent of white soldiers died of all causes during the war, but 18.5 percent of the black soldiers did, despite the fact that white soldiers were two and half times more likely to die in combat. African American soldiers were much more likely to die from the infectious diseases that afflicted camp life: diarrhea and dysentery, pneumonia, TB, malaria (despite the belief that they were less susceptible), and smallpox. Against these startl ing numbers, Humphreys lays out what was known about black soldiers: how tall they were; where they came from; and where they served. She then describes what society thought it knew about blacks and the various racial tropes that characterized thought and scientific discussion during the nineteenth century. This chapter might prove tough sledding for those not charmed by historical analysis of racial tropes. Humphreys, however, reminds the reader that much of the “science” or the data involved in the study of the black body must be viewed through the racism of nineteenth-century social thought. These themes connect in her discussion of the particular disease environment faced by African American soldiers. This is best seen in Humphreys’ discussion of malaria, where she describes the acquired immunity of African Americans whose West B o o k R e v i e w s