Robert E. Lee is said to have opined during the Battle of Fredericksburg (a Confederate victory) that "It is well this [war] is so terrible! we should grow too fond of it!"[1] In Living Hell, historian Michael Adams (Northern Kentucky Univ.) fleshes out Lee's famous observation with ample use of relevant primary sources in his close analytical narrative. He strips the conflict of any veil of romanticism it may have acquired in the popular imagination over the decades: Living Hell "describes the vicious nature of combat, the terrible infliction of physical and mental wounds, the misery of soldiers living amid corpses, filth, and flies. It also concerns the many civilians who endured loss, deprivations, and violations" (ix).

Adams begins by describing how soldiers, sailors, and civilians during the war soon lost their unrealistic expectations of spring 1861. Men joined the Union and Confederate armies expecting a brief war in which their own side would decisively prevail. Instead, some of them, especially farm boys, died in camp of infectious diseases their urban counterparts had acquired immunities to as children. Those who made it into battle quickly lost their taste for war and, as casualties mounted, the instituting of conscription to keep the ranks filled caused unrest among civilians in both the North and the South.

Civil War armies were virtual cities on the move, difficult to supply adequately with even basic necessities. Soldiers often ate spoiled, foul-tasting food and went hungry when provisions ran short. Getting sufficient water was a perpetual problem, especially in summers or during battle. And when it did rain, roads and camps turned to mud. Lack of proper hygiene bred dysentery, cholera, and other diseases that killed or incapacitated a significant proportion of many armies.

Yet, Adams ably demonstrates, battle was much worse. The technological advances of the first half of the nineteenth century increased the accuracy and rates of rifle- and cannon-fire and made Civil War battlefields much more dangerous than those of earlier wars, especially during the outdated massed assaults that commanders were still loath to abandon. The resulting slaughter was compounded by medical care still uninformed by germ theory: the skill of the surgeons who performing countless life-saving amputations and other surgeries was undone within days or weeks by post-operative infections, assuming the wounded lived long enough to receive medical treatment.

The scale of the slaughter often meant the wounded lay on the battlefield for long periods before help arrived; and then jarring transportation in ambulances, many without springs, killed them on their way to medical treatment. Truces might have saved lives of the wounded, but were rare because opposing commanders distrusted each other and feared any pause in the fighting might allow the enemy to better prepare for renewed conflict. The author writes that it was sometimes possible to walk across a Civil War battlefield on a carpet of corpses without ever touching the ground. Surviving soldiers often had to live among decomposing bodies for days and even weeks on end. And when the dead were finally interred, individual burials were impossible owing to the masses of corpses and lack of time and manpower. Hence, "most common soldiers ended up in anonymous mass graves" (101).

Little wonder, then, that the Civil War left many survivors traumatized mentally as well as physically. Though nineteenth-century Americans lacked the terminology to describe mental conditions with precision, it is obvious that cases of post-traumatic stress disorder (PTSD) and similar afflictions were commonplace. The stress of combat frequently led to desertion or "skulking" by soldiers who slipped away to safety before or during battles and returned once the fighting ended. Adams finds that entire units sometimes broke down psychologically in the midst of combat, especially when their leadership failed. Civil War officers, even high-ranking ones, were required to lead upfront and so suffered the same psychological traumas as their men. However, Adams notes, officers, unlike the rank and file, had the option of leaving service by resigning their commissions.

Adams highlights the horrors confronting civilians as well as soldiers, especially in communities that became battlefields. Civilians were killed both intentionally and unintentionally, and their property damaged, destroyed, or plundered. Even those living far from the front endured economic inflation and shortages of all kinds, especially in the South. And, too, the war everywhere eroded social mores. Prostitution became rampant as soldiers, removed from familial and community restraints, encountered women desperate to make ends meet in an economy where they had few options for decently-paid work. And even when they could find the means to survive, women and families on the home front had to worry about the soldiers they loved and hope their names would not appear on the latest casualty lists.

Finally, Adams considers how the shocks of war lingered long after the guns fell silent. The conflict left the South much poorer and caught in an exploitive neo-colonial relationship with northern capital. Slaves gained their freedom, but faced extralegal violence during and after Reconstruction; they lost the rights gained during that period as politicians with little sympathy for African Americans acquiesced to Jim Crow in the South.

In the North, the only real winners, the author observes, were businessmen, who had grown rich as war suppliers; after the war, they gained control of the levers of government and crushed organized labor and any other obstacle during the era Mark Twain aptly named the "Gilded Age" (ca. 1870–1900). Indeed, the war left a legacy of violence in both North and South, as crime rates soared and generations of taxpayers bore the costs of rebuilding the nation and caring for disabled and elderly veterans, their widows, and dependents.

The book has its shortcomings. In particular, its author seems unfamiliar with some pertinent recent scholarship on specific topics. For example, J. David Hacker's persuasive adjustment of Civil War deaths from 620,000 to 750,000[2] would have strengthened Adams's thesis. Still, though its subject matter will be familiar to serious students of the US Civil War, Living Hell should be required reading for anyone who harbors any sentimentality about the most destructive war in American history.