by 1861, medical knowledge and equipment still had far to go. treating wounds, infections and diseases often did more harm than good. doctors did not understand what caused infections and could do very little to treat them. estimates are that twice as many soldiers died from disease as died from gunshot wounds. camp hygiene was extremely poor. sanitation facilities, the lack of shelter, clothing, shoes and food all contributed to high death rates in the camps. prisoners of war lived under the most miserable conditions. dysentery was extremely common in most camps because of poor sanitation and contaminated water. doctors did not wash instruments or their hands as they moved from patient to patient. nurses who tended the sick risked catching the diseases themselves. with the crude state of medicine at the time, most diseases could be fatal. while medical knowledge and conditions gradually improved during the war, it still wasn't enough to save thousands of lost lives.