The U.S. Civil War chained slave emancipation to war's violence, destruction and deprivation. The resulting health crisis, including illness, injury, and trauma, had immediate and lasting consequences. This essay explores the impact of ideas about race on the U.S. military's health care provisions and treatment of former slaves, both civilians and soldiers.

Ask any Civil War historian about the cost of the Civil War and they will recite a host of well-known assessments, from military casualties and government expenditures to various measures of direct and indirect costs. But those numbers are not likely to include an appraisal of the humanitarian crisis and suffering caused by the wartime destruction of slavery. Peace-time emancipation in other regions and in other societies certainly presented dangers and difficulties for the formerly enslaved, but wartime emancipation chained the (...) new opportunities and possibilities for freedom to war’s violence, civil chaos, destruction and deprivation. The resulting health crisis, including illness, injury, and trauma, had immediate and lasting consequences for black civilians and soldiers. Although historians are more accustomed to thinking of enslaved people as the beneficiaries of this war, rather than its victims, we cannot assess the cost of this war until we answer two important questions: first, what price did enslaved people have to pay because their freedom was achieved through warfare rather than a peacetime process; and secondly, in this war in which so many Americans paid such a high cost, to what extent did racism inflate the cost paid by people of African descent? In answering these questions, we reconsider this specific war, but we must also tie the U.S. Civil War to a larger scholarship on how wars impact civilians, create refugee populations, and accelerate harsh treatment of people regarded as racial, religious, or ethnic outsiders. We are reminded that war is not an equal-opportunity killer. (shrink)