Civil War Medicine Since I am a dental assistant and currently enrolled in the Dental Hygiene Program, the topic of Civil War Medicine seemed quite appropriate. Medicine and the advances being made have always intrigued me. Researching Civil War Medicine allowed me to find out about the early days of anesthesia, which continues to be used in the dental office today. In this term paper, I have tried to give an overview of what took place in the Civil War as it relates to medicine.
A combination of many factors contributed to the number of war casualties other than that of immediately fatal wounds. The factors covered in this term paper include: the recruiting process and the physical state of the recruits, the sanitary conditions of the camps, the evacuation procedures of the injured, experience level of the doctors, and the medicine and known procedures available at the time. Great improvements were made in all aspects of medicine, including the prevention of disease. Therefore, I see Civil War Medicine as the turning point in the medical history of the United States.
Civil War Medicine is a story of care, healing, courage, and devotion amidst the death and destruction of America’s bloodiest war, in the four years from 1861 to 1865. The deadliest thing that faced the Civil War soldier was disease. For every soldier who died in battle, two died of disease. Both the Federal and Confederate governments did their best to provide proper medical care for their soldiers, but even the best was not very good. Civil War Medicine was in a time before the doctors even knew much about bacteriology and were ignorant of what caused disease.
Most Civil War surgeons had never treated a gun shot wound, many had never even performed surgery. Major advances changed medicine forever and thousands of men and women risked everything to make a terrible situation better. Civil War Medicine is a story of hope, even in the worst of times. The traditional image of Civil War Medicine is all brutality and ignorance. In spite of the horror, the war provoked change that ended the medical middle ages and set medicine on a path toward the modern era. At the beginning of the Civil War, little was known about what caused disease, how to stop it from spreading, or how to cure it.
Surgical techniques ranged from the barbaric to the barely competent. Along with advances in the use of anesthesia, evacuation of the wounded, hospitals, nursing, surgery, and sanitation, there was the example of tens of thousands of men and women who risked lives and fortunes to aid the sick and wounded. Their experience is an inspiration to all subsequent generations. “To Arms! ” was the cry in the North and the South. Tens of thousands of young men were attracted to the armies seeking comradery and adventure. The recruiting process involved a medical examination.
This exam required a new recruit to undress and be examined from head to foot. The eyes, ears, nose, and teeth were checked as well as the abdomen, extremities, and the trunk of the body. Recruits were made to jump, kick, bend over, and were thumped in the chest and back to test for “soundness”. Doctor’s inquired about their present state of health and determined the diseases suffered from in the past. Initially the requirements were relatively strict, but as the war dragged on, the process became simpler. Thousands of recruits were passed through regardless of their health problems.
In fact, by late 1862, some 200,000 recruits originally accepted for service were judged physically unfit and discharged, either because they had fallen ill or because a routine examination revealed their frail condition. As the armies settled in for a long war, camps sprang up across the nation. Military personnel struggled to cope with unsanitary conditions, widespread disease, and inadequate support services. Many soldiers had never been exposed to childhood diseases such as small pox, mumps, and the measles and this lack of immunity caused entire camps to be under bacterial siege.
Complete regiments could be debilitated for weeks. The culprit in most cases of wartime illness was the shocking filth of the army camps. They were littered with refuse, food, and other rubbish. As a result, bacteria and viruses spread through the camps like wildfire. The Union Army reported 995 out of every 1,000 men eventually contracted diarrhea or dysentery during the war, which was the largest killer of men during the Civil War. The brief times that the armies were engaged in battle, produced wounds that took months, and many times years, to care for and heal.
The timing of evacuation was crucial for soldiers suffering from these wounds. Casualties with bone shattering wounds mounted because of the newly invented Minie ball, small arms ammunition that tore an enormous wound on impact. It was so heavy that an abdominal or head wound was almost fatal, and a hit to an extremity usually shattered any bone encountered. In addition, bullets carried dirt and germs into the wound that often caused infection. The armies developed Ambulance Corps, which implemented an efficient evacuation system known as the Letterman Plan named after its originator, Surgeon Jonathan Letterman.
In this system the ambulances of a division moved together, under a mounted line sergeant, with two stretcher-bearers and one driver per ambulance, to collect the wounded from the field. The first place a soldier would be taken to was a field dressing station. This was located within 100 yards of the main battle line. From there the wounded would be moved to a more stable and safe area, the field hospital. These were located in a church, public building, barn, or a private home usually a few miles from the fighting.
This system was a vast improvement over earlier ones, where bandsmen in the Union command and men randomly specified in the Confederacy, were simply appointed to drive the ambulances and carry the litters. Frequently, prior to the Ambulance Corps, the most unfit soldiers were detailed, which often meant that not being good fighters, they were little better medical assistants. Often in the first year of the war, they got drunk on medicinal liquor and ignored their wounded comrades in order to hide themselves from enemy fire.
Despite the vast improvement in the evacuation of the wounded from the battlefield, it was not until March 1864 that Congress published the act to create an Ambulance Corps for all the Union Armies. Hospital design improved dramatically during the Civil War. The major design developed is still used today. The “pavilion” style hospital; long, wooden buildings with ample ventilation and sufficient bed space; was the last stop for a wounded or sick soldier. In a general hospital, the soldiers grew stronger in a cleaner and more efficient environment than that of a field hospital.
Both the Union and the Confederacy mobilized to meet the need for these hospitals. General hospitals were located in all the major cities of the north and south. Most had a bed capacity of 2,000 to 3,000. The largest such hospital was Chimborazo, located in Richmond, with a bed capacity of 10,000. Civilian agencies raised money and provided food, supplies, and comfort to the soldiers. These were known as the Sanitary Commission and the Christian Commission. These volunteer groups performed some of the functions of the present day Red Cross. Their efforts sustained hospitals for the duration of the war.
As women entered the hospital workplace, nursing as a profession was accepted. There was little change in the way medicine was practiced in the years leading up to the Civil War. A few new techniques, like the use of anesthetics were being developed. A Civil War soldier’s chances of dying in the war were about one in four. The fallen men were cared for by woefully under-qualified, under-staffed, and under-supplied medical corps. Working against incredible odds, the medical corps increased in size, improved its techniques, and gained a greater understanding of medicine and disease every year the war was fought.
During the period just before the Civil War, a physician received minimal training. Even those who had attended one of the few medical schools were poorly trained. When the war began, the Union Army had a total of about 98 medical officers and the Confederacy just 24. By 1865 some 13,000 Union doctors had served in the field and the hospitals, in the Confederacy about 4,000 medical officers and an unknown number of volunteers treated war casualties. The dental profession had gained some standing during the two decades that preceded the Civil War.
Soldiers tended to neglect basic care of their teeth. Toothbrushes were somewhat scarce and the average diet left a lot to be desired. Dentists plugged, cleaned, and extracted teeth, in addition to adjusting fractures of the jaw and operating on the mouth. Dentist Dr. James B. Bean of Atlanta made significant contributions to the treatment of fractured maxillary bones. Bean used an interdental splint made of vulcanized India rubber that had cup shaped indentations for the teeth. The Confederacy in particular should be praised for it’s Dental Corps.
The act of drafting dentists in January 1864, gave the Confederate soldier at least a small advantage over his Union counterpart, since all attempts at the Union Dentistry Corps were turned down. Surgical techniques for treating gunshot wounds improved due to the sheer number of operations performed. Plastic surgery was in its infancy and many developments came about because of the facial wounds that needed to be treated. Many advances, like germ theory, which states that bacteria can cause disease, and the use of antiseptics, came at the very end of the war.
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. The most common anesthetics used during the Civil War were chloroform and ether. Most of the patients were anesthetized while being operated on. The common belief that they were awake during amputations is untrue. The screams heard were usually from soldiers just informed that they would lose a limb or those who witnessed the plight of other soldiers under the knife.
Chloroform was the preferred anesthetic since only a small quantity was needed and its effect was rapid. It was administered by placing the chloroform on a sponge at the top of a cone of either paper or cloth, and putting the open end over the patient’s nose and mouth. Once the patient was affected, the cone was removed. The average time needed for the administration of chloroform was nine minutes. Ether, or a combination of chloroform and ether, was used less frequently since more of the substance was needed to produce the desired effect and it took an average of seventeen minutes to work.
Another drawback of using ether was that it was flammable, a dangerous matter in an era of gas and candle lighting. A patient’s limpness served as the sign that the anesthetic was working and surgery could begin. Pre-operative pain control was left to opium and morphine, which could be administered by three routes. Oral application produced unpredictable and slow pain relief, often due to the incomplete absorption from the Gastrointestinal Tract. Direct application was done by sprinkling or rubbing the powder onto the wound.
A relatively new technique of morphine injections became increasingly popular during the Civil War because a much smaller dose could reach its full effectiveness in a matter of minutes. Sometimes, a soldier received a premedication of whiskey to calm his nerves and desensitize him, which also reduced the amount of anesthetic needed. The supply of anesthetic agents during the war remained more than adequate for the North, but just marginal for the South. While the average soldier believed that the bullet was his biggest enemy, disease was the biggest killer of the war.
On the Union side, three out of five died of disease and on the Confederate side it was even two out of three. Soldiers who survived their wounds and surgeries still had another hurdle to overcome, the high risk of infection. While most surgeons were aware of a relationship between cleanliness and low infection rates, they didn’t know how to sterilize their equipment. Due to a frequent shortage of water, surgeons often went days without washing their hands or instruments, thereby passing germs from one patient to another.
About half of the deaths from disease during the Civil War were caused by intestinal disorders, mainly typhoid fever, diarrhea, and dysentery. The remainder died from pneumonia and tuberculosis. Throughout the Civil War, both the North and the South struggled to improve the level of medical care given to their soldiers. In many ways, their efforts assisted in the birth of modern medicine in the United States. Anesthesia came into its own during the Civil War. Military surgeons demonstrated its usefulness beyond doubt and improved its safety through the knowledge acquired from thousands and thousands of administrations of ether and chloroform.
Medical procedures were developed and refined, as any surgeon would if he operated on so many patients a day. Another important advance took place in the field of nursing where respect for the role of women in medicine rose considerably among both doctors and patients. Perhaps most importantly, the medical establishment and the public gained a greater understanding of the relationship between cleanliness, diet, and disease. Bibliography Adams, George W. Doctors in Blue, The Medical History of the Union Army in the Civil War. Baton Rouge: Louisiana State University Press, 1996.
Beller, Susan. Medical Practices in the Civil War. Cincinnati: Betterway Books, 1992. Chisolm, J. J. A Manual of Military Surgery for the Use of Surgeons in the Confederate Army. Richmond: West and Johnston, 1861. Cunningham, H. H. Doctors in Gray, The Confederate Medical Service. Baton Rouge: Louisiana State University Press, 1993. Starr, Paul. The Social Transformation of American Medicine. Basic Books, 1982. Wiley, Bell I. The Life or Johnny Reb, The Common Soldier of the Confederacy. Baton Rouge: Louisiana State University Press, 1990.