General Information About Civil War Medicine
An Article Contributed by Jenny Goellnitz
Civil War medicine was in a time before the doctors even knew much about bacteriology and were ignorant of what caused disease. Doctors during the Civil War for the most part had two years of medical school, though some pursued higher amounts. We were woefully behind Europe. Harvard Medical School didn't even own a single stethoscope or microscope until after the war. Most Civil War surgeons had never treated a gun shot wound, many had never performed surgery. Medical boards let in many "quacks" who were not qualified.
Yet, for the most part the Civil War doctor , as understaffed, sometimes underqualified, and very usually under supplied as he was, did the best he could, exploring through the so-called "medical middle ages."
Some 10,000 surgeons served in the Union and about 4,000 served the Southern Confederacy.
Each year, medicine advanced a little more. However, it was the tragedy of the era that medical knowledge of the 1860s had not yet encompassed the use of sterile dressings, antiseptics and antiseptic surgery, and the realization of sanitation and hygiene was still inadequate and many died as a result from diseases such as typhoid or dysentery.
The deadliest thing that faced the Civil War soldier was disease. For every soldier who died in battle, two died of disease.
In particular, relatively simple intestinal complaints such as dysentery and diarrhea claimed many lives. Diarrhea and dysentery alone claimed more men than did battle wounds. The Civil War soldier also faced outbreaks of measles, small pox, malaria, pneumonia, or camp itch. Malaria was brought on by usually camping in damp areas (that were conductive to breeding mosquitos) while camp itch was caused by insects or a skin disease. In brief the large amount of disease was caused by a) inadequate physicals before entering the Army; b) plain old ignorance; c) the fact many troops came from rural areas; d) neglect of camp hygiene; e) insects and vermin; f) exposure; g) lack of clothing and shoes; h) poor food and water. Many unqualified recruits entered the Army and diseases cruelly weeded out those who should have been excluded by physical exams. There was no knowledge of the causes of disease, no Koch's postulates. Rural area troops were crowded together for the first time with large numbers of other individuals and got diseases they had no immunity to.
Neglect of camp hygiene was a common problem as well. Ignorance of camp sanitation and scanty knowledge about how disease was carried led to a sort of "trial and error" system. An inspector who visited the camps of one Federal Army found that they were, "littered with refuse, food, and other rubbish, sometimes in an offensive state of decomposition; slops deposited in pits within the camp limits or thrown out of broadcast; heaps of manure and offal close to the camp." There was formed a Sanitary Commission in the North even because things were so bad in Army camps. Mary Livermore, a nurse, wrote that... "The object of the Sanitary Commission was to do what the Government could not. The Government undertook, of course, to provide all that was necessary for the soldier, . . . but, from the very nature of things, this was not possible. . . . The methods of the commission were so elastic, and so arranged to meet every emergency, that it was able to make provision for any need, seeking always to supplement, and never to supplant, the Government." Both Armies faced problems with mosquitos and lice. Exposure turned many a cold into a case of pneumonia, and complicated other ailments. Pneumonia, was the third leading killer disease of the war, after typhoid and dysentery. Lack of shoes and proper clothing further complicated the problem, especially in the Confederacy as the War progressed.
The diet of the Civil War soldier was somewhere between barely palatable to absolutely awful. It was a wonder they did not all die of acute indigestion. It was estimated that 995 of 1000 Union troops eventually contracted chronic diarrhea or dysentery; his Confederate brother suffered similarly. Disease particularly ran rampant in the prisons of course as many of these conditions that led to disease were very much present.
To halt disease, doctors used many cures. For bowel complaints, open bowels were treated with a plug of opium. Closed bowels were treated with the infamous "blue mass"... a mixture of mercury and chalk. For scurvy, doctors prescribed green vegetables. Respiratory problems, such as pneumonia and bronchitis were treated with dosing of opium or sometimes quinine and muster plasters. Sometimes bleeding was also used. Malaria could be treated with quinine, or sometimes even turpentine if quinine was not available. Camp itch could be treated by ridding the body of the pests or with poke-root solution. Whiskey and other forms of alcohol also were used to treat wounds and disease ... though questionable for its medical validity, whiskey did relieve some pain.
The medicines brought in to try and halt diseases were manufactured in the north for the most part; the southerners had to deal with running the Union blockade. On occasion, vital medicines were smuggled into the South, sewn into the petticoats of ladies sympathetic to the Southern cause. The South also had some manufacturing capabilities and worked with herbal remedies. However, many of the Southern medical supplies came from captured Union stores. Dr. Hunter McGuire, the medical director of Jackson's corps, commented after the War on the safeness of anesthesia, saying that in part the Confederacy's good record was due in part from the supplies requisitioned from the North.
Battlefield surgery (see separate web page describing an amputation) was also at best archaic when held against the modern standard. Doctors often took over houses, churches, schools, even barns for hospitals. The field hospital was located near the front lines-- sometimes only a mile behind the lines-- and was marked with (in the Federal Army from 1862 on) with a yellow flag with a green "H".
Though anesthesia was usually used, the Civil War period operation was still not pretty. Anesthesia's first recorded use was in 1846, making it still in it's infancy at the time of the Civil War. Anesthesia was almost always, as a rule, used in surgery, in fact, there were 800,000 cases of it's use. Chloroform was used about 75% of the time. Of 8,900 cases of use of anesthesia, only 43 deaths were attributed to the anesthetic, a remarkable mortality rate of just 0.4%. Anesthesia was usually administered by the open-drop technique.
The anesthetic was applied to a cloth held over the patient's mouth and nose and was withdrawn after the patient was unconscious. A good capable surgeon could amputate a limb in 10 minutes.
Surgeons worked all night, with piles of limbs reaching four or five feet. Lack of water and time meant they did not wash off hands or instruments. Bloody fingers often were used as probes. Bloody knives were used as scalpels. Doctors operated in pus stained coats. Everything about Civil War surgery was septic.
The antiseptic era, and Lister's pioneering works in this field were in 1865, right as the war was ending. Blood poisoning, sepsis or Pyemia (Pyemia meaning literally pus in the blood) were common and often very deadly. Surgical fevers also could develop, as could gangrene. One witness described surgery as such: "Tables about breast high had been erected upon which the screaming victims were having legs and arms cut off. The surgeons and their assistants, stripped to the waist and bespattered with blood, stood around, some holding the poor fellows while others, armed with long, bloody knives and saws, cut and sawed away with frightful rapidity, throwing the mangled limbs on a pile nearby as soon as removed." If a soldier survived the table, he faced the awful surgical fevers. However, about 75% of amputees did survive.
The numbers killed and wounded in the Civil War were far more than any previous American war. As the lists of the maimed grew, both North and South built "general" military hospitals. These hospitals were usually located in big cities. They were usually single storied, of wood construction, and well-ventilated and heated. The largest of these hospitals was Chimbarazo in Richmond, Virginia. By the end of the War, Chimbarazo had 150 wards and was capable of housing a total of 4,500 patients. Some 76,000 soldiers were treated at this hospital.
There were some advances, mainly in the field of military medicine. Jonathan Letterman, who you will read about later in this site, revolutionized the Ambulance Corps system. With the use of anesthesia, more complicated surgeries could be performed. Better and more complete records were kept during this period than they had been before. The Union even set up a medical museum where visitors can still see the shattered leg of flamboyant General Daniel Sickles who lost his leg at the Trostle Farm at the battle of Gettysburg when a cannon ball literally left it hanging by shreds of flesh.
The Civil War "sawbones" was doing the best he could. Sadly when American decided to kill American from 1861 to 1865, the medical field was not yet capable of dealing with the disease and the massive injuries caused by the minie bullet and by the outmoded tactics practiced by the generals who had learned about War in the Napoleonic Age.