The American Civil War was known for its brutality – its harsh weapons and tactics produced the highest causality rates in any American conflict. Over 600,000 Americans were killed in the conflict. At the Battle of Antietam, 23,000 were killed or wounded in a single day. In spite of these conditions, medicine in the Civil War has taken its share of hard knocks. In reality, for soldiers, life in a field hospital during the Civil War was grim. However, the Civil War actually marked a turning point in medicine – not only on the battlefield, but in the country as well.
What made medicine in the Civil War extremely deadly were three factors.
1. The Minie Ball
This 56 caliber bullet made any field surgeon’s job over before it could begin. The bullet shattered bones and tore through muscles leaving amputation as the only choice. In fact, 3/4 out of all surgeries in the Civil War were amputations. At the Battle of Gettysburg, doctors created separate piles for the hundreds of legs and arms outside the makeshift field hospital. Aside from the size of the minie ball, it was also known for accuracy. This combination created large numbers of casualties in the conflict.
2. The Tactics
While advances in weaponry took place in the 1800s, advances in tactics did not, and would not, until near the end of the war. The Generals used methods going back to the Revolution of marching in formation and alternating fire between rows of soldiers. The advances in the minie ball changed the distance a weapon could fire accurately making the column obsolete. In addition, artillery advanced to the point where it shred marching armies exposed on open ground. As a result, casualties flooded the field hospitals.
The conditions in most field hospitals were notoriously filthy. Contrary to popular opinion, 75% of the soldiers receiving an amputation survived. However, water-borne diseases and intestinal disorders killed twice as many soldiers as bullets ever did. The large number of people in small areas created conditions that the viruses Staphylococcus aureus and Streptococcus pyogenes were able to spread quickly. The problem was not a lack of knowledge about sterilization and cleanliness, it was the ability to stay sterile and have clean water for drinking, laundry, bandages, and sterilizing hands and instruments. Water, or the lack of clean water, was the main culprit. There just was not much clean water to be found. Also, Antibiotics and antiseptics did not exist yet. The Union Army reported that 99.5% of all Union soldiers contracted some sort of bowel disorder at one point during their enlistment. Despite the formation of the Sanitary Commission in 1861, the conditions failed to meet recommendations.
As a result of these three factors, the state of medicine had to change if soldiers were going to survive.
The Civil War changed many things about medicine.
1. Chloroform – Most movie accounts of th2e war show patients taking a swig of Whiskey or biting a belt or strap while doctors did their business. In fact, chloroform was standard issue for every doctor. The use of chloroform allowed for doctors to successfully amputate with the patient unconscious.
2. Triage – Union Medical Director Jonathan Letterman created a system of diagnosis and care that still exists today. Letterman’s system called for triage near the battlefield followed by ambulance care to a field hospital, a regular hospital, and then post operative care (if they survived infection and disease). This type of diagnosis is still in effect in the military and in modern society.
In addition, Letterman took copious notes on his craft. Letterman details an amputation here:
The surgery of these battle-fields has been pronounced butchery. Gross misrepresentations of the conduct of medical officers have been made and scattered broadcast over the country, causing deep and heart-rending anxiety to those who had friends or relatives in the army, who might at any moment require the services of a surgeon.
It is not to be supposed that there were no incompetent surgeons in the army. It is certainly true that there were; but these sweeping denunciations against a class of men who will favorably compare with the military surgeons of any country, because of the incompetency and short-comings of a few, are wrong, and do injustice to a body of men who have labored faithfully and well.
It is easy to magnify an existing evil until it is beyond the bounds of truth. It is equally easy to pass by the good that has been done on the other side. Some medical officers lost their lives in their devotion to duty in the battle of Antietam, and others sickened from excessive labor which they conscientiously and skillfully performed. If any objection could be urged against the surgery of those fields, it would be the efforts on the part of surgeons to practice “conservative surgery” to too great an extent.
3. Specialization – The large number of wounded from the civil war created a need in medicine. That need was for prosthetics and the new field of plastic surgery. After the war, these two fields had huge advances in usability and availability. What once was for soldiers was now used in the general population.
4. Ambulances – Much like baseball spread after the Civil War when soldiers brought home the game, the use of ambulances did the same albeit with horses and wagons. Stretcher bearers and ambulances have not changed much since.
5. Embalming – While many soldiers were buried where they died, many others requested to be sent back home. To do so, new methods for embalming evolved to make sure the body could make the journey home.
6. Standardization of supplies and training – By 1863, every doctor in the Union had to take an exam, do an apprenticeship, and receive a standard set of supplies including a kit that included all the tools needed to amputate and perform a variety of tasks. In addition, each doctor received what amounted to barrels (kegs) for storing water for sanitary purposes.
7. Knowledge – By doing a large number of surgeries, doctors gained a lot of experience not only in dealing with war wounds, but also in their knowledge about the human body – mainly the vertebrae, spine, and head.
8. The Role of Women – While men were needed in battle, women filled the need for bodies in the hospitals. It is estimated that 3200 women served as nurses. They risked their lives leaving home to work in the cesspools of infection. They lived separately from the soldiers and only made $12 a month. While many women are nurses today, their service in the war began their integration into the work force over the next 100 years. But in medicine, women nurses soon became commonplace.
George Wunderlich, executive director of the National Museum of Civil War Medicine, called the conflict, “a watershed that really changed all medicine to the point where it could never completely go back to the way it was before.” Unfortunately, the demise of any soldier in the Civil War was a sad affair. But the large numbers of casualties necessitated the need for more advanced medicine and forms of care to help the soldiers survive their wounds. Most did survive the wounds but not the infection.
For further reading and historical sites, go to http://www.civilwarmed.org/
For further research, the above site has a great reference page here: http://www.civilwarmed.org/research-materials
Also see, Civil War Medicine by C. Keith Wilbur
Here is another interesting site: http://www.huntermcguire.goellnitz.org/index.html