Few soldiers entered the conflict knowing what to expect. A young private wrote that his idea of combat had been that the soldiers “would all be in line, all standing in a nice level field fighting, a number of ladies taking care of the wounded, etc., etc., but it isn’t so.” See Document Project 13: Civil War Letters and Journals. Improved weaponry turned battles into scenes of bloody carnage. The shift from smoothbore muskets to rifles, which had grooves that spun the bullet, made weapons far more effective at longer distances. The use of minié balls—small bullets with a deep cavity that expanded upon firing—increased fatalities as well. By 1863 Union army sharpshooters acquired new repeating rifles with metal cartridges. With more accurate rifles and deadlier bullets, the rival armies increasingly relied on heavy fortifications, elaborate trenches, and distant mortar and artillery fire when they could. Still, casualties continued to rise, especially since the trenches served as breeding grounds for disease.

The hardships and discomforts of war extended beyond combat itself. As General Lee complained before Antietam, many soldiers fought in ragged uniforms and without shoes. Rations, too, ran short. Food was dispensed sporadically and was often spoiled. Many Union troops survived primarily on an unleavened biscuit called hardtack as well as small amounts of meat and beans and enormous quantities of coffee. Their diet improved over the course of the war, however, as the Union supply system grew more efficient while Confederate troops subsisted increasingly on cornmeal and fatty meat. As early as 1862, Confederate soldiers began gathering food from the haversacks of Union dead.

For every soldier who died as a result of combat, three died of disease. Measles, dysentery, typhoid, and malaria killed thousands who drank contaminated water, ate tainted food, and were exposed to the elements. And infected soldiers on both sides carried yellow fever and malaria into towns where they built fortifications. Prisoner-of-war camps were especially deadly locales. Debilitating fevers in a camp near Danville, Virginia, spread to the town, killing civilians as well as soldiers.

The sufferings of African American troops were particularly severe. The death rate from disease for black Union soldiers was nearly three times greater than that for white Union soldiers, reflecting their poorer health upon enlistment, the hard labor they performed, and the minimal medical care they received in the field. Southern blacks who began their army careers in contraband camps fared even worse, with a camp near Nashville losing a quarter of its residents to death in just three months in 1864.

For all soldiers, medical assistance was primitive. Antibiotics did not exist, antiseptics were still unknown, and anesthetics were scarce. Union medical care improved with the U.S. Sanitary Commission, which was established by the federal government in June 1861 to promote and coordinate better medical treatment for soldiers. Nonetheless, a commentator accurately described most field hospitals as “dirty dens of butchery and horror,” where amputations often occurred with whiskey as the only anesthetic.

As the horrors of war sank in, large numbers of soldiers deserted or refused to reenlist. As volunteers declined and deserters increased, both the Confederate and the Union governments were forced to institute conscription laws to draft men into service.