The Syphilis Explosion of the American Civil War

Summary

Betwixt The Sheets: The History of Sex, Scandal & Society

Episode: The Syphilis Explosion of the American Civil War
Host: Dr. Kate Lister
Guest: Dr. Katherine Olivarius, Stanford University
Date: January 20, 2026

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Episode Overview

In this episode, historian Dr. Kate Lister is joined by Dr. Katherine Olivarius to dive into the explosive spread of syphilis during the American Civil War. Far from a mere footnote in military history, syphilis helped shape not only the health of soldiers, but also American society, gender relations, and social stigma for generations. The conversation explores why syphilis proliferated during wartime, how it was perceived and managed (or not) by authorities, the lived experience of sufferers, and the long shadow it cast after the war ended.

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Key Discussion Points and Insights

The Historical Role of Syphilis

• Syphilis as an Unseen Killer: While bullets and bayonets dominated the imagery of the Civil War, disease—including syphilis—was responsible for most fatalities. Around two-thirds of Civil War deaths were from disease, not combat (06:10).
• Syphilis as ‘Dark Matter’: Dr. Olivarius emphasizes the tendency of historians to treat disease as “background noise,” while she sees it as “dark matter,” profoundly shaping societal and individual experience (05:16).

What is Syphilis? Lived Experience and Social Stigma

• Stages of the Disease: Dr. Olivarius clearly explains the progression of syphilis—from painless chancres (primary), to full-body rash and fever (secondary), to horrifying destructive symptoms like “gummas,” brain damage, and organ failure (tertiary) (09:49).
• Shame and Social Death: The tertiary stage’s visible disfigurements compounded societal shame. Sufferers faced ostracism, were advised never to marry or have children, and often lied about or denied their illness (13:02).
• “There’s no social benefit to admitting you have it.” (Dr. Olivarius, 13:01)
• Mercury Treatment: Mercury was used as a harsh, risky, and often ineffective treatment. Its use reflects a “chicken and egg” dynamic: sometimes coinciding with the natural dissipation of symptoms, leading people to mistakenly credit the therapy (16:18).

Syphilis and the Civil War: A Super Spreader Event

• Military’s Dilemma: Recruiting as many soldiers as possible meant overlooking or failing to detect many infections. Syphilis was considered primarily a poor person’s disease before the war; the conflict revealed it was far more widespread (21:48).
• Massive Infection Rates: Eyewitnesses like one New York City medical examiner found “literally one tenth” of recruits had syphilis (23:54).
• Invisible in Records: Despite its prevalence, syphilis is “virtually absent from the official record”—with only “55 words” on syphilis in a six-volume official medical history (21:53).
• Notable Quote:
  “One medical examiner…said basically like, oh my gosh, literally one tenth of all the people that I’m seeing have syphilis.” — Dr. Olivarius (23:54)

Management, Morality, and Regulation

• Military Approaches: The American military’s efforts were a patchwork:
  • Some officers promoted abstinence and chided men for visiting brothels.
  • Official attempts to regulate prostitution (like the Contagious Diseases Acts) were rare and largely ineffective.
  • Condoms existed but were rarely used (and often reused, reducing their effectiveness) (27:22).
• Social Context of Sex Work: War brought mass displacement and dire poverty for women, especially in the South. Many turned to sex work for survival or bartered sex for food and protection (28:05).
• Brothels: Hundreds operated in Washington D.C., with one near the White House even nicknamed “the Hospital” (26:07).
• Sexual Violence: Records show prosecution only for a small number of rape cases—nearly always involving white women in the North, while sexual violence against Black women, especially enslaved women, went unrecorded and unpunished (29:00–29:50).

Finding Syphilis in the Historical Record

• Shame and Evasion: Unlike yellow fever, which survivors bragged about, people with syphilis avoided documenting their experience (30:30).
• Euphemisms and Codes: The term “rheumatism” was often used on postwar pension records as coded language for syphilis-related symptoms (33:52).
  • Notable Quote: “Margaret Sanger…said that no man under the age of 40 should have rheumatism.” (34:16)
• Long-Term Suffering: After the war, the impact of syphilis lingered in increased rates of miscarriage, stillbirth, and disability. The social stigma persisted, affecting entire families (37:17).

The Limits of Medical Response

• Hospitals and Treatment Availability: There were venereal disease wards, especially in Tennessee, but treatment (mostly mercury) was costly, often useless, and out of reach for the poor and many soldiers (39:47).
• Class and Access: Wealthier, educated sufferers might see a doctor; most suffered in silence or sought quack remedies (41:07).

Enduring Legacy and Speculation

• Unspoken Tragedy: The “super spreader” event of the Civil War went largely unspoken at the national level, but its intergenerational impact was enormous (37:17); trauma and shame were passed down in silence.
• Speculation: Dr. Olivarius suggests that even if syphilis had been curable, another disease or form of shame would likely have filled its role—society is resourceful in finding sources of stigma (42:21).

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Notable Quotes and Memorable Moments

• On Military Denial and Disease:
  “There are only 55 words in these six volumes about syphilis directly… It’s basically just as hidden as straight up—how many people? Don’t exactly.” – Dr. Olivarius (21:53)
• On Regulation and Blame:
  “The one [brothel] closest to the White House was nicknamed the Hospital, which suggests something.” – Dr. Olivarius (26:07)
• On Women’s Suffering:
  “You can sort of see the mark of this disease intergenerationally. The shame and the silence surrounding that shame spread in these really heartbreaking ways…” – Dr. Olivarius (37:17)
• On Currency of Rheumatism as Syphilis Code:
  “Margaret Sanger…said that no man under the age of 40 should have rheumatism. Categorically that this should not exist.” – Dr. Olivarius (34:16)
• On Living with Disease:
  “For them, the war never really ends. And it never ends for their families either, who live daily with the consequences of this infection.” – Dr. Olivarius (42:21)

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Timestamps for Key Segments

• [01:21] — Podcast and episode introduction, focus on adult topics, historical context for syphilis in the Civil War
• [04:23] — Dr. Olivarius’ career arc and the importance of disease history
• [09:49] — What is syphilis? Medical explanation, symptoms, outcomes, and shame
• [13:02] — Stigma of syphilis and its inescapability in advanced cases
• [16:18] — Mercury treatment: efficacy and dangers
• [19:59] — Military attitudes, recruitment dilemmas, and early war detection efforts
• [23:54] — First-hand reaction to widespread syphilis among recruits
• [25:50] — Varied approaches to regulation: abstinence, brothel control, ineffective condom use
• [27:34] — Economic and social factors that fueled explosion in sex work
• [30:30] — Hidden histories: why syphilis is rare in personal documents and how to find clues
• [33:52] — “Rheumatism” as a code for syphilis in pension records
• [37:17] — Heartbreaking legacy: intergenerational impacts and silence
• [39:47] — Limited health system responses, class impacts, and cost obstacles
• [42:21] — Speculation: how the absence of syphilis would (or wouldn’t) have changed history

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Tone and Style

Throughout, Dr. Lister and Dr. Olivarius balance scholarly insight with wry humor and empathy for long-suffering individuals. The tone is candid, witty, and sometimes dark but always humanizing—the sex, suffering, and scandal are treated with both curiosity and compassion.

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Further Information

• Dr. Katherine Olivarius: katherineolivarius.com
• Contact the Podcast: Email Betwixt the Sheets via History Hit
• Upcoming Episode Teaser: “Find out how filthy Leonardo da Vinci, Michelangelo, and Machiavelli would have been in the Renaissance period…”

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For listeners seeking to better understand the intersection of war, disease, shame, and society—a must-listen, both eye-opening and relevant for contemporary conversations about sexual health, stigma, and unseen histories.

Transcript

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[Helena Merriman]

Journalism is the first draft of history, what happens if that draft is flawed? In 1999, four Russian apartment buildings were bombed, hundreds killed. But even now we still don't know for sure who did it. It's a mystery that sparked chilling theories. I'm Helena Merriman and in a new BBC series, I'm talking to the reporters who first covered this story. What did they miss the first time? The History Bureau Putin and the apartment bombs. Listen on BBC.com or wherever you get your podcasts.

[Kate Lister]

Hello my lovely betwixters, it's me, Kate Lister. You are back once again and you are listening to Betwixt the Sheets. So well done for being in the right place. I'm so pleased that you have made it once again. But before we can go any further, I do have to tell you this is an adult podcast spoken by adults to other adults about adulty things in an adultery way, covering a range of adult subjects. News being adult too. Actually, we are getting a bit grim today. We're talking about syphilis, so you might just not want to listen to something about pustulus gangrenous. Oh these might not want to listen to that. In which case this is your fair dues warning. Get out now. We still can. And for the rest of you that are still hanging around, should we get on with it? I think we shall. America in the 1860s was a particularly dangerous time to be around. I mean, looking at current global events, it's not doing too great right now. But in the 1860s they were in the grip of a civil war. And that meant that every day brought a risk of being shot or blasted or stabbed with a bayonet. And even if you weren't on the battlefield, your house was constantly at risk of destruction. And food, well, that was in short supply as well. And then there was another risk, a danger muted somewhat by the shame that it brought. So it flew under the radar. But it was no less devastating. Syphilis. Hello, and welcome back to between the sheets, the history of sex scandal in society with me, Kate Lister. We've all been through Covid, so we are a group of people that know a thing or two about a super spreader event. And in history, there are so many of these kind of events, ones that wreaked horrendous devastation. And syphilis is definitely one of those. And it does tend to rear its ugly head around wartime. Perhaps it was the sheer volume of young men being away from home who were facing an impending cannon, who thought, do you know what? I'm gonna have a sh Before I go. That might have had something to do with the boom in syphilis. Well, today I'm joined by Stanford's Catherine Oliverius to find out about syphilis and civil war. Condoms at the ready. Betwixtas. Let's do this. Hello, and welcome to betwixt the Sheets. It's only Catherine Oliveras. How are you doing?

[Catherine Oliverius]

I'm excellent. How are you doing?

[Kate Lister]

Oh, I'm thrilled to have you here. This is one of my favorite subjects. Syphilis.

[Catherine Oliverius]

Syphilis, yeah. The jokes write themselves almost, don't they? Don't they?

[Kate Lister]

But, like, it's a fascinating subject. But as your research and what you do show, it is formative in our history. Like, it's played such a huge part that is often unacknowledged in our global history, especially military history.

[Catherine Oliverius]

Yes. And I feel like every day that I read sources that I'm sort of working on this book, I learn new things about syphilis. I learn new things about the ways in which this disease, particular, in fact, shaped so much of the culture and society of the 19th century and beyond.

[Kate Lister]

So the first question I asked to all the guests is a bit of an origin story. How did you go from a little girl in rural America to somebody that studied syphilis for a living? What was that journey?

[Catherine Oliverius]

So I actually grew up in the uk, and my family jokes that I am, they would call a historical hypochondriac. I would come home from school, and I would be obsessed. I would Say, mom, I have leprosy, you know, mom, I have cholera, mom, I have hiv, aids. There were some that were a little bit more worrying than others, perhaps when I'm, you know, 7 and 8 years old. But when I went to university, I always knew that I loved history. My family thought that I would be a medical doctor, but alas, I'm the wrong kind of doctor. I'm one of those doctors to solve all your historical needs, not the medical ones. But I wrote my first book about yellow fever in the American South. And when you see disease in the archive, it can be kind of like a sort of earworm or something, where suddenly you start to see it everywhere. And it's one of those funny things that I think a lot of historians can write disease off. They sort of consider it to be background noise, almost that everyone in the past was sick or they had these ailments which were staggering and devastating. But, you know, it's just not something that you have to take seriously as compared to the sort of more resonant political or economic stories. Whereas I consider this to be more like dark matter, that everyone gets sick, everyone gets ill. And, you know, we should dedicate as much time to thinking about how this shaped people's sense of self, how it shaped societies, how it shaped culture.

[Kate Lister]

And syphilis in the American Civil War. This is particularly fascinating. This isn't a history that I actually knew very much about, but this is your wheelhouse now.

[Catherine Oliverius]

Yes. So I've been at Stanford for eight years. I teach 19th century US history and teach a Civil War, which is the war that was fought at the mid century between 1861 and 1865, between the north and the South. And the result of this was at the end, 4 million people were emancipated from slavery. So this is the origin story war for many Americans, perhaps beyond the American Revolution. But also this is a war in which 750,000 people died. This is a total war. This is a war in which we have sort of. It looks actually quite sort of recognizable to us moderns in terms of the kind of weaponry and the kinds of tactics that were used. But also we had this sort of astronomical death rate, the vast majority of which actually was from disease, not from bullets. And so this is a disease in which probably two thirds of the war dead died from infections or typhus or camp diseases or one of the many different ailments that's always plagued militaries.

[Kate Lister]

Civil War is by its nature horrendously violent. But the American Civil War seems To have been like carnage on a scale that hadn't been seen before.

[Catherine Oliverius]

Yes. And you get sort of some teasers of this with the Crimean War, for example, where we have this kind of misalignment, if you might call it, between tactics and weaponry. In past wars you would have sort of men, you know, walking shoulder to shoulder at Bornadino or at Waterloo or one of these big battles. You have men sort of walking into fields shoulder to shoulder with muskets that also have a bayonet attached to them. Weaponry is not that accurate. And now what we are seeing in this war is actually sort of the complete reversal of this, which is that artillery can be accurate up to half a mile. You have men running into, you know, shellfire and mini balls. Also the major bullet that hit you in the body, they will fragment and they will sort of fester because they can sort of lodge themselves in bone or in muscle and then cause infection. So this is another huge cause of death and war is sepsis and then gangren.

[Kate Lister]

I suppose another thing that's particularly nasty about the American Civil War is it was a civil war. This is Americans turning against Americans. This isn't like an invading force, this is civilians fighting one another.

[Catherine Oliverius]

Precisely. So this is a war that was fought, it's been called many things at different times. Near the War of Northern Aggression or the War between the States. This is definitely a civil war in which the American south, the Confederate States of America, self styled nation, these are, you know, rebels who fought against the federal government. And it really, especially in the border states. So the sort of, if you can imagine the map of the United States, even the sort of Deep south states which these go to the Confederacy, these are also states that are incredibly dependent on slave labor and on the labor of our enslaved people. And this is, you know, cotton. Cotton. Cotton and sugar. And slavery is really this question that is increasingly dividing the north from the south, but especially in those border states. So in Kentucky and Tennessee, Missouri, when we talk about a civil war, you know, dividing families, we're really talking about actual families where they'll be brothers who fight on both sides, or fathers and sons who will fight on different sides. And it really did tear apart families. Abraham Lincoln, who was president, of course, during this war, his wife, Mary Todd, she was from a Southern slaveholding family and many of her brothers fought for the Confederacy. So this is quite literally tearing families apart.

[Kate Lister]

It's hard to imagine America being so divided.

[Catherine Oliverius]

Is it?

[Kate Lister]

Sorry, behave. Hate. Listen. So let's turn our attention then to syphilis. What is syphilis? It's got this kind of ring of like a historic leprosy. Like it's some weird or like scurvy. It's something that happened in the past, but it's not. It's very much with us. What is it?

[Catherine Oliverius]

So syphilis is. You're completely correct that this feels like a disease of the past. Like scrofula or like leprosy? Exactly. These sort of ancient ailments. It's actually not that old of a disease, or at least the sort of the way that it sprang onto the global scene in the late Middle Ages, and it caused a lot of havoc among various soldiers. Soldiers in various military campaigns in Europe. And so syphilis is this disease that classically presents in three stages. So in the first stage after infection, you will develop what is called a chancre. It's a little bump close to the site of infection. So that's generally on the groin. And you may notice this, you may not notice this. It's. It might come very quickly, it might go away very quickly. But at this point, you are contagious. Once you've hit this primary stage, you're very contagious. And then people will progress into secondary syphilis, in which you develop a rash, generally that can be on your torso. It will eventually sometimes envelop your entire body, including the palms of your hands and soles of your feet. You're also very contagious at this point as well. You develop high fevers, things like this. And then for some people, that will be maybe the end of their journey. With syphilis, it will stop there, but for about 30% of people, you'll progress to what we call tertiary syphilis. And this is the stage that probably most people are familiar with. This is the stuff of nightmares in which you develop often these sort of gummas on your head with these depressions on your head. Sometimes people will lose nose tissue, and so they'll lose. Literally, their nose will sort of disintegrate. Some people become extremely photosensitive and so have to wear sunglasses permanently. You have liver damage. You have damage to basically every one of your organs. And then in some very serious cases, you develop neurosyphilis, which means that you. You go insane or you develop general paralysis. General paresis is what it was called in the past. And eventually this will lead into death. And it's a horrifying way to end. This is also. Until penicillin. So until the 1940s, this was incurable. So if you develop syphilis there was no telling if you would progress to the very serious, dire third stage. And there was no telling if your symptoms would manifest in that way, because you might be lucky. And it becomes latent and never really contribute to health problems later on. But it's indistinguishable from other issues that you may have. But many people developed these sort of tertiary symptoms, and it's just a horrifying way to die. And you die in shame as well, too, because there's no. Again, there's no cure. It's highly contagious. You could have given it to other people, including children that you have born. But also that because there's no cure, you kind of exist in this state of almost social death, actually, where in which you are shut out from the mainstream of society. So you're told by doctors not to get married or not to have sex for five or six years. If you develop symptoms of this, you're told that you shouldn't have children, and you're facing all of these kind of social impediments. So in many ways it makes sense that people would a lie about their diagnosis if they had one, or also, why to themselves about it. To really just hoping against hope that you don't progress to that final third stage, that it's not gonna be the cause of your death, but also that this is something that you can sort of deny to yourself if possible, because there's no social benefit to admitting you have it.

[Kate Lister]

And so much shame and stigma. I mean, we're still doing work around destigmatizing sexually transmitted diseases to this day. But syphilis seems particularly cruel because if it did progress, you can't hide that. Like, if your nose has fallen off, that's. You can't hide that.

[Catherine Oliverius]

Yes. And there's something about syphilis that I find, as historians, sort of particularly poignant, I suppose, in which, you know, penicillin is a magical cure. This is an antibiotic. This is a magical cure for syphilis. So if you. If you go to see a doctor and you take penicillin, you're basically good to go. And there's something about studying diseases where the cure is sort of just on the horizon. It's, you know, just. It's the next generation down. It's 10 years from when somebody gets it. And there's something very. Just devastating almost, about seeing people in this sort of historical spot in which they would find little comfort in the idea that in 10 years and 20 years there'll be a cure or there'll be a test or any of these things. You know, it's talking about the sort of. When we talk about public health or the history of medicine, it can be easy to sort of think about the long arc and these magical cures, these magic bullets. But for individuals, of course, this is a lived experience that can cause incredible pain and suffering on an individual and familial level.

[Kate Lister]

There was no effective treatment, but mercury was a big one that was used for a very long time. And I've asked this question to every historian that we've had on of disease because I'm never quite sure. Does it do anything mercury, because they used it for so long, like, why did they keep using it? It's not helping.

[Catherine Oliverius]

So this is a great question, and I've had the exact, exact same question for many, many years because it's kind of the cure all that's given for a great many diseases. So does it have an effect? The answer is yes and no. So mercury is highly toxic. And in some ways you could kind of think of it as akin to a kind of chemotherapy in that it kills a lot of things in your body and it might kill syphilis or it might kill yellow fever, or it might kill smallpox, things like this. It might have a sort of a discernible effect for you, but it's actually highly toxic, as I say. And it's one of the sort of marks of a good doctor in the 19th century. And before that was their ability to mark the quote, unquote therapeutic point, the crucial therapeutic point of when mercury was actually beneficial versus when it was gonna dip into being toxic and potentially even killing you. Because it would be very easy to kill somebody by over prescribing them mercury. And the ways in which also it's, you know, people would ingest mercury, they would rub it on their body, they would vapor bathe in it. And you see this with a lot of people who have syphilis that they are literally sitting, you know, sort of vaporizing this and it's going all over their skin. It's incredibly painful. And of course it causes, you know, your teeth to fall out, eventually your breath to become very fetid. It can cause your hair to fall out, it can cause all sorts of other problems. Acute mercury poisoning is highly toxic. It's very dangerous. So the answer is not a very satisfying one, which is that, you know, there's a reason why they kept using it, which is because it did clearly had some kind of effect. And for some people it was quote unquote, Therapeutic though there was no one to one cure with disease and mercury being the cure, it was sort of, it just killed a lot of things. It had a kind of totalizing effect.

[Kate Lister]

And I suppose you might get into this correlate is not causation type of a situation because if syphilis, like it goes, it has its first appearance and then you get very poorly, but then it kind of dissipates into the body and becomes latent. You might be forgiven for thinking that the mercury you were taking had made it disappear. But it hasn't disappeared precisely.

[Catherine Oliverius]

There's always this kind of chicken and egg question with the history of medicine where you think, well, you know, if you're looking for reasons to think that mercury was doing its bidding for you, I'm sure that there are plenty of them and hindsight is 20 20, but actually hindsight was not really. So if you, in the absence of sort of greater knowledge about germ theory or the ways in which syphilis or any other disease manifested in the body and the sort of its actual etiology and the pathology of this disease, if you don't know that, then you can find all sorts of reasons to look to the mercury you took or calomel will be another one, or a mercury based tincture or one of the many other patent medicines that were available to consumers across North America, across Europe for most of the 19th century, which you would mail order away for something like Saprecilla syrup or Radway's Remedy Relief. These are basically sort of alcohol based treatments that a vast, vast majority of 19th century denizens were taking at some point in their lives to cure various ailments.

[Kate Lister]

I'll be back with Catherine and syphilis after this short break.

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[Kate Lister]

Syphilis has always been an issue of quite grave concern to the military. Obviously people are worried about public health and you know, civilians, general health. But in particular what seems to crystallize this is military issues. So before we move on to that, how poorly would you be in the initial stages of infection? Cause I don't think the military really cared that you were gonna maybe go mad 10 years down the line. How sick would you be in that initial Pauly bit?

[Catherine Oliverius]

It's a great question. And it varied by person. So some people will have quite serious symptoms up through the sort of primary and secondary stages. It'll be quite obvious that they have syphilis because they have this rash. You might even see the chancre on their mouth or on their groin. Something like this. If you're doing a medical exam and you'll see this rash that they have over their body and they'll be quite sickly. But some people could quite easily slip through their medical examination without this being detected. And I think you're exactly right, which is that syphilis is this kind of strange disease for militaries in that you're highly infectious, but it's not necessarily true that everyone will present with physically obvious symptoms. And of course the incentives of the military are to have as many enlistees as possible. They care of course, about the public's health. They are aware and you see this in many, many medical examiners private diaries and their letters to each other. When they're sort of doing these initial intaking medical exams in 1861, they are writing to each other about this. There are things they are concerned about and they know that especially syphilis and gonorrhea, that these are diseases that will spread very quickly if not checked. So they obviously don't want to have obviously contagious, obviously syphilitic men entering the army or the navy. But they are also always balancing this against the greater imperative perhaps that they feel, which is to have as many people as possible enlist poorly enough for.

[Kate Lister]

You to say, oh, I'm afraid I can't go over there and do that fighting Sergeant.

[Catherine Oliverius]

Yes. And so this is actually one of the things that I think is most interesting about how we see syphilis in the historical record with this war. So for two decades after the Civil War, various people were responsible for pooling field medical reports and hospital reports to try to develop a kind of larger medical picture of what happened during this war. And they produced six volumes, very thick volumes about field hospitals and all these sort of individual battles and casualties. It's an amazing document. There's only 55 words in these six volumes about syphilis directly. No, and it's only 55 words. And it's basically just as hidden of straight up, you know, how many people don't. Exactly. Yeah. And the instruction manuals for medical examiners who are doing these intaking exams there, there are these instruction manuals that say basically secondary syphilis is a cause for absolute rejection. But again, whether or not the medical doctors, these medical examiners are able to discern that quickly is it really depends on the person. But what is absolutely true is that very quickly when this war starts, you see these medical examiners really start to kind of become quite alarmed actually by the amount syphilis they see in the general population. So before the war, this is a disease that was basically exclusively associated with poor people. Every disease is basically associated with poor people, people who live in cities, especially in New York City, but also increasingly Chicago, and then of course with sex workers too. This is a disease that is blamed almost entirely on sex workers and on, you know, loose morals and lewdness and this kind of culture of sexual promiscuity and that's always how it's euphemized too. However, what these medical examiners are seeing very quickly is that, that it's not just, you know, men who live in Manhattan who are poor, but they're seeing farmer's boys, they're seeing the 40 year old husbands with, you know, five children who are living in Illinois and farm corn. It's the real mismatch between what they think they're gonna see and then what they actually do see, which is that syphilis is much more widespread.

[Kate Lister]

Do you get a sense of the reaction of just them going, holy shit, they've all got it? Yeah.

[Catherine Oliverius]

And there's one medical examiner from Houston. Basically, he was a medical examiner for New York City below Houston, so downtown, very cool area. Now he says basically, like, oh my gosh, like literally one tenth of all the people that I'm seeing have syphilis. This is. Or he was doing, you know, he did, I think, 3,500 medical exams and he saw an incredible amount of syphilis just in the general population. And these are cases. And remember that these are cases that he was able to actually see. And he could tell that these people had syphilis. Especially early on in the war. Again, the incentive for soldiers who were enlisting too. Maybe some would say, I have syphilis. And because they didn't want to fight or they have some kind of ailment. But a lot of them, you know, this was. Everyone believed this would be a short war and there was a lot of social pressure to, you know, get through. So they're incentivized basically to lie about this too and get on their way and get enlisted. And so you have officers who are taking notes on what's going on in their regiments. They're seeing that a lot of their soldiers, their enlisted men, they are developing these symptoms by the summer of 1861, and they're becoming very concerned. They become concerned because this becomes then a question of, can we even fight this war? Like, how if we have all these sick people, they start to care when this impacts their ability to wage and fight war effectively. And you see some officers in both the north and in the south becoming quite concerned with this quite quickly.

[Kate Lister]

So they're losing manpower.

[Catherine Oliverius]

Exactly.

[Kate Lister]

That's the issue. Yeah. Like, what tactic did the various authorities bring in with this one? Because if you Fast forward another 60ish years to the Second World War, the American approach to venereal disease in the troops was very much one of, let's put our fingers in our Ears. And we'll sing very loudly. And if anyone does get sick, we're gonna shout at them. We're gonna shout at them a lot. Whereas, like, the Germans were, like. They rolled out that German efficiency that they're so famous for. Of like, right. Everyone has condoms and everyone has instructions on how to use them. And we will. And we will monitor everything. But the Americans were just like, no, just don't do it. What was happening in the Civil War? What was the approach there?

[Catherine Oliverius]

It's a mixture of both of those sort of approaches, in fact. So you have some officers who say, don't do it, please. Do not sleep with sex workers. Do not sleep with each other. And they notice in every city. So in Washington, D.C. this is the nation's capital, there are. Are hundreds of brothels. Literally hundreds.

[Kate Lister]

Wow.

[Catherine Oliverius]

The one, in fact, closest to the White House was nicknamed the Hospital, which suggests something. Yeah, yeah, yeah. And also, the officers, they tend to talk about this as something that is impacting, you know, that venereal disease is something that's only impacting enlisted men. It's not true. The enlisted men made fun of the officers all the time and poked, sort of said, like, you know, they're the ones who are actually engaging in all of this misbehavior. Over the course of the war, there were 100,000 court martials for all kinds of sexual misbehaviors. And this runs the gamut from sodomy, but also to rape and also sometimes to engaging with sex workers. But that really, you know, this happened much more than it was ever sort of hit. The official record, Washington, D.C. has, you know, an explosion in the number of people who are engaged in sex work. So does Nashville. And Nashville is very important because this is the major sort of depot in the western theater of this war. It's on the Ohio, Mississippi rivers, sort of at the confluence of these. So here we have. This is the big port city. And in fact, the authorities, the union authorities in Nashville, they experiment with essentially trying to regulate sex work by introducing. And this and this. You've seen this in many wars, in fact, too, where they say there'll be weekly medical inspections of the women.

[Kate Lister]

Like the Contagious Diseases act in Europe.

[Catherine Oliverius]

Exactly, exactly. Exactly. And also in this time, condoms exist. They're not widely used, and they would have been reused many times, too. Which sort of meets the purpose for a disease like this. Exactly. So.

[Kate Lister]

So all but useless then, really.

[Catherine Oliverius]

Exactly. Yeah.

[Kate Lister]

Why do you think? Because this happens whenever you get war. You get women that go, I'm gonna go on the game. I'm gonna. I'm gonna start selling sex. Why do you think, as a historian, do you suddenly see this explosion of sex for sale? You see it in the first World War, the second World all war. Is it just. Is it supply and demand? Is it that. Because I've heard various explanations for it, that the women are suddenly left without. Without a protector. This is the only thing they've got to turn to, like what is going on.

[Catherine Oliverius]

So I think it's a lot of things, and I think you're exactly right, which is that supply and demand is sort of a guiding principle here. Most certainly, that is true. I also think if you read letters from women who are on the home front, and this is in the north, but especially in the south, where the currency is collapsing, there's increasingly little money in the economy, and there's also bread riots by 1863, it's not quite a famine, but people are starving. This is in many ways, this is the only ways that asset that women would have. And so you see a lot of women, especially in the south, who I don't think they would necessarily consider themselves to be sex workers in any kind of official, quote, unquote sense, but they certainly are using this. Using sex and engaging in sex work to really seek to, you know, protect their family, to feed themselves. They're bartering it essentially, for protection, for sundry items. It's a really sort of mixed bag here in terms of the motivations of various people. And of course, too, when we're talking about sex in this war, and there are various court martials, again, for men who committed sexual assault on women. But the ones that go to these are. We only have records actually for the Union army, not for the Confederacy in general. The records are much, much poorer for the South. But these crimes of rape against where men were found guilty of this and were hanged or executed or punished for this, we're talking about mostly women in the north, white women, many of whom were also the wives of soldiers who were off at war too. But there's a sort of social profile of the people that were taken seriously for being sexually assaulted in this war. Whereas in the south, there's widespread sexual assault, of course, especially of enslaved women, who would, for many reasons, not probably appear in the same kinds of records that would maybe capture even this sort of small sliver of women in the north who were captured in this way. They would be sort of written off. It would not be taken seriously and might not even be seen as a crime. So the sexual constellation of this war is complicated and it's very idiosyncratic. And it's also, of course, filled with violence and filled with venereal disease.

[Kate Lister]

So how is syphilis spoken about in the records then? Cause you've already explained that this is an illness that was caught up with tremendous amounts of shame. It's actually quite hard to identify a lot of the time as well. It can be mistaken for other things. What are your sources? What do you look for? Because, because I mean other diaries of people going, I definitely have syphilis and this is my detailed account of my experiences.

[Catherine Oliverius]

If anybody can find that one magical diary of the person saying, I have syphilis, and here's all of my thoughts about this and how it impacts my identity, please send it my way. I'll love you forever. That source does not exist. That's exactly correct. And so I'm historic of disease. And I wrote my first book about yellow fever. And if you survived yellow fever in New Orleans in 1830, you shouted this from the rooftop. You would put your entire, this sort of harrowing tale into every single letter you wrote to business associates. You would write about it in your diary, you put it in your autobiography. Years later it would be in, you know, you would try to sell your shorts in a newspaper. It's just a different thing entirely where when you have syphilis, you don't write about it, quite understandably. You would not write about it in letters home to your mother or to your wife or to your girlfriend. You would, would again try really to lie to yourself so as to sort of go about your day feeling, you know, just hoping against hope that you can beat this and not be stricken and eventually progress to tertiary syphilis. So how do you find this? So where is this in the actual record? There are some official places. So for example, in this compendium of the diseases, the medical history of the Civil War, this six volume compendium, these 55 words, there are some little sort of snippets, bits of things that you can find. Little stories of doctors talking about gonorrhea, for example, or venereal disease that I would suspect are actually syphilis. But again, it's hard to tell in the historical record. And this is one of the most difficult parts for being a medical historian, which is that diagnosing people through the ether of time is a really tricky thing, especially for a disease like syphilis, which was actually nicknamed the great imitator. It can resemble a great many things and you know, especially it can. It's very easy to confuse with gonorrhea, but also sometimes with flu or with smallpox or other diseases that have perhaps similar symptoms. There are some official sources that note this. Then you have the records of these medical examiners. They kind of have provide this kind of snapshot almost of what these armies were like going into the war. And then you do have various letters home of these soldiers who are writing home about what army life is like. And they will write to their fathers and mothers and they'll talk about quote, unquote, misbehavior and alcohol use and you know, what army life is like at night. And they'll talk about syphilis and gonorrhea. They'll talk about what was called then the clappin pox. But it will not be something that afflicts them. It's always something that happens to somebody else. Yes, there is misbehavior, but don't you worry, I'm still keeping true to the gospel. I'm still a good Christian. I'm not misbehaving, I'm not being lewd. I'm abiding by the sort of Victorian morals that structured life in the mid 19th century. The sort of most interesting source, I think, to see the sort of truest picture are pension records that exists from after the war. So you can see in these records, oftentimes people will apply and reapply and reapply. Because initially if you had a venereal disease, that would be disqualifying for a pension. The laws were liberalized after the war quite a bit. After the war, they basically said that anybody who served for 90 days in the Union army, no matter what their ailment was, whether it was, quote, unquote, self inflicted, like syphilis, or it was, you know, a bullet wound or you had your leg amputated, you still qualified by the 1890s. But you can see in the these pension records people are developing symptoms over time where, you know, people are going deaf, people are going blind. And always the key word to look out for is rheumatism.

[Kate Lister]

This is.

[Catherine Oliverius]

It's not a one to one, but rheumatism was the way in which people sort of spoke about the kinds of pains, the muscle pains that you would get. And it's not a one for one again. So plenty of people who had rheumatism had rheumatism. But if you're gonna look for syphilis, this is often the sort of way into thinking about the whole case history.

[Kate Lister]

How did you crack that code, how did, like when did the penny drop? Like they can't all have rheumatism.

[Catherine Oliverius]

Actually, I did not crack this code. Margaret Sanger did, in fact. And many, many female reformers in the Gilded Age, they saw this connection too. So this becomes a major feminist issue after the war. And this is, you know, well before suffrage. But one of the sort of rallying cries was that actually, you know, it's a travesty that women are married to these men who are infecting them with syphilis. And this becomes a sort of way in which, which a part of the wctu, the Women in Christians Temperance Union, this is, becomes one of their sort of defining issues. And Margaret Sanger, who was a reformer in the 20th century, she says that no man under the age of 40 should have rheumatism. Categorically that this should not exist. This becomes the kind of way that you can get medical treatment. It would be something on your medical record, your pension record, but it wouldn't be syphilis. It's sort of a red flag for historians and it was certainly a code for word for people in the 19th century.

[Kate Lister]

I'll be back with Catherine and syphilis after this short break.

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[Kate Lister]

So what did the various authorities do then? So that they're quite shocked at the levels of this. It seems that it was significant before the war. We're going into the war. And I guess you can understand the attitude of like, well, I'm to walk slowly towards a cannon. Maybe I'll have sex the night before. And so it explodes. But then what are they doing to try and curtail this? They attempt to regulate the brothels. You see that in Britain and in France and Italy. Was the treatment available? Not effective treatment. But what did they do about it?

[Catherine Oliverius]

They couldn't do very much about it. The union brass and the Confederacy too, they sort of throw their hands up with this saying, like, you know, there are ways that we can try these experiments. Perhaps like they did in Nashville, where they were seeking to basically regulate sex work, by which that means that they were blaming this solely on women. There's some serious public health concerns here. Serious people are trying to curtail this problem, but really what they are hoping for is that this war will end and hopefully people will go home and they won't be contagious and that this will somehow sort of dissipate. And you have this data on this, as we've talked about, is really difficult to discern. But you know, some of the best estimates from 1850, 1860 suggest that maybe 1 in 15, maybe 1 in 20 adult American men had syphilis or gonorrhea at some point in their lives before the Civil War. It's basically impossible to do on a kind of global or national, or even on a state level. It's so hard to disambiguate because no body was responsible for collecting this data. But fast forward to a generation or two after the war to 1900, and you have the American Public Health association estimating that up to 20% of adult American men, and by adult American men they mean over the age of 12, have had active syphilis at some point. This is a huge. This is like a super spreader event that has never really been talked about in this way. So we had this basically silent epidemic and there's never been an epidemic of syphilis declared. The rate of infection is enormous. Of course, this is huge. This is as close to basically a universal experience as you're going to get with the disease, except that it's one that is not talked about. So the military during the war, people know this is a problem and they just basically say, well, we're gonna just cross our fingers and hope that this is not a problem that explodes. And of course it did, but it did so in this really heartbreaking silent way where you can sort of see in records again and again, you don't have these letters from wives saying, I have syphilis. But you'll see women who. They get married after the war, during what was called then a marriage boom, there was a huge uptick in the number of marriages. You'll see that they. In the late 1860s, in the 1870s, they will have miscarriage after miscarriage. They'll give birth to children who are stillbor or who are deformed or who are blind or who are deaf. And this. You can sort of see the mark of this disease intergenerationally. The shame and the silence surrounding that shame spread in these really heartbreaking ways where you can see the tragedy playing out in these individual families and one that's never acknowledged publicly by any kind of national border authority.

[Kate Lister]

Did they have lock hospitals or anything like that where they would send the soldiers? Or was it just a. You're just gonna have to go and fight the war with soldiers. Syphilis.

[Catherine Oliverius]

Yes. There were venereal disease wards at certain hospitals, especially in Tennessee and during this war. And this is. This is true in also other wars, too, going with the Spanish American War in 1898, but then also in various European wars, you'll see that there are ways in which they're seeking to isolate venereal disease from other ailments. For the most part, if you could fight, if you were not debilitated to a point where you couldn't fight, you would go back to the front line, or you'd go back to your unit, and then you'd be sort of integrated again. And maybe. Maybe you wouldn't be be fighting or if you weren't feeling well, maybe you'd be doing sort of duties around camp. That would mean that you could sort of take it a little bit easier. But again, there are some systems, but these systems are not working to contain this disease. But again, it's also really idiosyncratic where it's kind of up to the person who's in, you know, the commanding officer of this unit, what they're going to do, or it's up to this general over in, you know, the Virginia theater to figure out how they're going to solve the. Their own sort of individual problem on their front and not think more sort of systematically about the hundreds and hundreds of thousands, the millions of soldiers who were mobilized during this war.

[Kate Lister]

Plus the treatment, such as it was mercury. It's hell of expensive, isn't it? They're not going to give that out to every single person that's fighting in this conflict. Yeah.

[Catherine Oliverius]

And this is something that also when we talk about all disease in the 19th century and all disease today in fact too, there's a class element to so much of this, which is that if you were a poor person who had syphilis, you wouldn't go to a doctor necessarily because a, you don't want them to confirm your diagnosis, but also because what are the treatments they're going to give you? They're expensive, so you can't afford that. And so, you know, a richer person might have access to more quote, unquote advanced therapies or to a medical professional who had some specific training in syphilis. But for soldiers in the war too, they have very little control over their medical treatment too. So army is not especially in the south too. They ran out of medical, basically any kind of medicine within a couple years into the war. Again, this is a four year war. It stretches on, but they're seeking basically to steal medical supplies from the Union Army. So we're talking about, you know, this is very expensive. And you know, of course also dosing mercury is kind of. It can debilitate a person too. So it has the sort of double effect, of course, of taking people out of the action.

[Kate Lister]

Anyways, so as a final question then, and we're into the realm of speculation here, but it's fun to speculate if there had been a cure for syphilis, or if syphilis and gonorrhea and venereal disease didn't exist, how would have impacted the outcome of that war?

[Catherine Oliverius]

It's a great question and I think probably that we would have seen if venereal disease didn't somehow exist, there would be some other way in which shame would be attached to disease in general too. So they'd find a way to create this. But the thing that interests me most is not just the experience of having this disease in the war, but actually how this disease then goes out across the nation, sort of like tentacles after this war. And in this way that is again, it's very tragic to see because so much of this is happening in silence. So much of the suffering happens sort of behind closed doors within individual families. You were given syphilis by your husband. This is a hugely shameful and heartbreaking thing on so many levels. You have to deal with not just medically but also emotionally. And so some of the trauma of this war, the way that this keeps on sort of, you see these soldiers who really can't escape their war years, they are ashamed of their war experience because of syphilis. For them, the war never really ends. And it never ends to their families either, who live daily with the consequences of this infection.

[Kate Lister]

Catherine, you have been marvelous to talk to. I knew that you would be. And if people want to know more about you and your work, where can they find you?

[Catherine Oliverius]

I'm on X. You can find me there. I never really check it, but also my personal website, which is katherine oliverius.com.

[Kate Lister]

Well, thank you so much for dropping by. You've been phenomenal.

[Catherine Oliverius]

Thank you. This has been, I struggle to say, fun when talking about, but. But you know, take it or leave it simple.

[Kate Lister]

Except can be.

[Catherine Oliverius]

Exactly, exactly.

[Kate Lister]

Thank you for listening and thank you so much to Catherine for joining me. And if you like what you heard, don't forget to like, review and follow along whatever it is you get. Your podcasts coming up. Find out how filthy Leonardo da Vinci, Michelangelo and Machiavelli would have been in the Renaissance period. And if you'd like us to explore a subject or if you just wanted to say hello, then you can email us at Betwixtory Hit this podcast was edited by Tim Arstel and produced by Sophie G. The senior producer was Freddie Chick. Join me again Betwixt the Sheets the History of Sex Scandal in Society, a podcast by History Hit. This podcast contains music from Epidemic Sound.

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