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Medicine in the Civil War

When the Civil War began in April 1861, medicine was approaching what
Surgeon General William Hammond called "the end of the medical Middle Ages."
In Europe, the work of Koch and Pasteur was just beginning and American
physicians had little knowledge of the cause and prevention of disease and
infection. The Army Medical Department, which was responsible for the care
of the sick and wounded in the North, was unprepared. The staff of 90
doctors was experienced in dealing with the health problems of small
military outposts, but had no idea of how to deal with large scale medical
and logistical problems.

Early in the war it became obvious that disease would be the greatest
killer. Two soldiers died of disease (dysentery, diarrhea, typhoid, and
malaria) for every one killed in battle. Soldiers from small rural areas
suffered from childhood diseases such as measles and mumps because they
lacked immunity. Outbreaks of these "camp and campaign" diseases were caused
by overcrowded and unsanitary conditions in the field. To remedy this, the
U.S. government created the U.S. Sanitary Commission in June 1861.

The commission was directed by Frederick Law Olmstead. Preaching the virtues
of clean water, good food, and fresh air, the commission pressured the Army
Medical Department to improve sanitation, build large well-ventilated
hospitals, and encourage women to join the newly-created nursing corps.
Despite the efforts of the Sanitary Commission, some 560,000 soldiers died
from disease during the war.

Second to disease as a cause of death was battlefield injuries, totaling
some 200,000 casualties. The overwhelming number of wounded created problems
in removing them from the battlefield. As late as 1862 there was no
ambulance corps on either side. In August of that year, however, Union
General George B. McClellan authorized the creation of a trained ambulance
corps for the Army of the Potomac, and other armies, both Union and
Confederate, soon did the same.

Risks from surgery were great. Doctors in the field hospitals had no notion
of antiseptic surgery, resulting in extremely high death rates from
post-operative infection. Surgeons ignored anesthesia, instead relying on
the "surgical shock" of battle, when the patient's heart rate was greatest,
to amputate.

  The brutality of the battlefield produced huge numbers of

casualties, as seen in this rendition of the attack on Knoxville.

Amputation of a wounded arm or leg was the most common operation, due
largely to the .58 calibre Minie ball ammunition used during the war. This
heavy conical-shaped bullet of soft lead distorted on impact causing large,
gaping wounds filled with dirt and pieces of clothing. Its heavy weight
shattered any bone it contacted. Because of the severity of the wounds and
the overwhelming case load, surgeons usually elected for fast and easy
amputation over trying to remove the bullet and save the limb.

  Lead bullets removed from victims show the distortion that occurred

on impact. From The Medical and Surgical History of the War of the

While the efforts of the Army Medical Department during the Civil War did
little to bring immediate relief for the victims, many medical advances did
result from the war experience. Doctors treating hundreds of thousands of
cases of dysentery, diarrhea, typhoid, malaria and gunshot wounds compiled
copious notes that would aid researchers after the war. These case studies
were later published between 1870 and 1888 under the title Medical and
Surgical History of the War of the Rebellion. Medical army officers
recognized that enforcing sanitary standards in the field could reduce the
spread of disease. And the numerous cases of post-operative infections such
as hospital gangrene led to increased study in ways to prevent it,
eventually leading to the use of bromine.

  The effects of hospital gangrene, from The Medical and Surgical

History of the War of the Rebellion.

But the largest medical achievements of the Civil War were in the areas of
field hospital organization and personnel. At the beginning of the war,
staffs were haphazardly organized on an "as needed" basis. But these staffs
were usually too small, and healthy soldiers had to be left behind to care
for the sick and wounded. Anyone, regardless of medical skill, could
volunteer as a nurse. Hospital facilities were established in existing
unsanitary buildings or erected wherever convenient. By war's end this all
changed. Military hospital staffs became more permanent. In 1861, Dorothea
Dix was appointed Superintendent of the United States Nursing Corps, and the
idea of professional nursing was born. Finally, hospital facilities were
improved by the use of large, well-ventilated hospital tents and more
permanent, cleaner "pavilion hospitals."

Tripler, Charles S., and George C. Blackman. Hand-book for the Military
Surgeon. Cincinnati: Robert Clarke & Co., 1861.

United States Army, Surgeon-General's Office. The Medical and Surgical
History of the War of the Rebellion. Washington: Government Printing Office,

  Grapeshot produced devastating wounds to limbs, usually treated

quickly and efficiently with amputation. From The Medical and Surgical
History of the War of the Rebellion.

Wheelock, Julia S. The Boys in White; The Experience of a Hospital Agent In
and Around Washington. New York: Lange & Hillman, 1870.
Barbara Floyd, University Archivist, University of Toledo