Medicine and the American Civil War – a nightmare in a worse case scenario at best. It was a war that saw the beginning of ambulances on the field, women as nurses and coordination between the volunteer units and the regular army.
In 1861, as the number of Southern states proclaimed secession and joined to become the Confederate States of America, the country geared for the armed conflict to come and found it was exceedingly lacking in soldiers and supplies. The Army Medical Department was unprepared for conflict of any type. The Surgeon General, Col. Thomas Lawson, was a vet of the War of 1812. He rarely brought medical books on the advances in medicine in an effort to conserve funds. In an era without retirement laws, he was still in charge 50 years after 1812. His staff consisted of 30 surgeons and 83 assistant surgeons (the army itself January 1861 numbered only 16,000 soldiers). With secession gripping the land, 3 surgeons and 21 assistant surgeons resigned their position to join their home state when it left the Union.
Lawson’s tightfisted rule ended when he died and Clement A Finley assumed the post. He was younger than Lawson, having joined the military in 1818. He didn’t last long because the US Sanitary Commission’s ability to inspect his military hospitals and report to higher ups, thus by-passing him, irritated him to the point of retiring in 1862. William Alexander Hammond was the Army Surgeon General from 1862 to the end of the war.
As to the actual army, in the 19th century, to become a doctor, three methods were available. Medical school was the best – the best medical schools were Europe, the top in Edinburgh but the expense kept most out. There were a few in the US, primarily in the North. For those unable to afford college, one could apprentice himself to an established doctor, though if he was a quack, they were learning the same bad methods. The third method was to check out three medical books from the library, read them through and call oneself a physician. The values per each method showed themselves.
Originally, the rule of thumb had been to send the wounded home, the theory at the time was patients would return to health faster in the embrace of loving arms. Hospitals at that time were more like hotels for the visitors or the poor to recoup and not considered as successful as home. But to send a soldier home in 1861, to say Michigan, could also mean he’d never return to the front. That factor sent Ulysses S Grant to issue a rule that hospitals were to be established near his army and the sick and wounded to remain there until they were well enough to return to the fight.
The incoming enlistees had to pass a physical – stripped to their drawers, they had to demonstrate they had working limbs, could hear, see and had a full set of teeth on the right side (to be able to rip the pig-tail end off a cartridge to load their rifle. All were taught the right-hand format to load their weapon; left-handers had to adapt for the shoulder-to-shoulder formation allowed no individuality). Yet the overwhelming numbers kept physicians busy – one even resorted to having a contingent of volunteers march down the street in rows and from viewing them march, the doctor passed them all regardless of the few who coughed, sniffled or limped. It was a plague on the armies North and South that incoming recruits could make it through carrying disease, like chickenpox, measles or strep throat, that infected the rest, putting whole units down sick. Robert E. Lee put an end to that in the Confederacy, after suffering through months of inactive troops, by requiring new units be quarantined at first.
Not only did command and soldiers gear for an upcoming battle, so did the medical staff. They commandeered a nearby residence or large building (i.e.: barn) to serve as their field hospital, evicting the owner in doing so. They cleaned their instruments, which meant they polished them, accumulated linen bandages and washed in soap and water for upcoming patients. On the battlefield itself, a hospital steward inspected the wounded, a triage of sorts, with army musicians following him, their instruments cast aside so they could carry the invalids off the field. No doubt it was more pain for the wounded, as the musicians feared the bullets that whizzed past them, faltering, dropping their patients occasionally.
Many soldiers, though, if conscious, feared arriving at the field hospital. To enter often meant the worst – amputation. The sight of sawed-off limbs piled high outside the building a warning to those who entered. The quick exam by the surgeons often involved trying to locate the bullet inside the wound if there was no exit wound. Without use of X-ray machines, they used a thin metal stick with porcelain-capped ends. Inserted into the injury, they maneuvered it around until it hit something. When they withdrew it, if the white end was grey, it meant it touched the bullet; if it was red, bone and back in it went. Of course, throughout the day, if it was dropped, it was picked up, wiped on their medical coat and back in use. Sometimes, it was left on the ground and they inserted their finger instead.
But the diagnosis, though, remained the same – amputation. Why? Fear of gangrene. This infection had no cure and meant a slow, painful death. To sever the limb was the only chance. The surgery’s survival rate was higher if it could be done within the first 36 hours of the injury. If the patient was in shock, they knew he needed to be revived so they poured whiskey down his throat – the burning alcohol made an impact and he reacted to it. They believed he was out of shock, unaware it only added to it.
“Most of the operating tables were placed in the open air, where the light was best, some of them partially protected against the rain by tarpaulins or blankets stretched on poles. There stood the surgeons, their sleeves rolled up to their elbows, their knives not seldom between their teeth, while they were helping a patient on or off the table, or their hands otherwise occupied.
As a wounded man was lifted upon the table, often shrieking with pain, the surgeons quickly examined the wound and resolved upon cutting off the wounded limb. Some ether was administered and the body put in position in a moment. The surgeon snatched his knife from between his teeth, wiped it once or twice across his blood-stained apron, and the cutting began. The operation accomplished, the surgeon would look around with a deep sigh and then – ‘next!'” Brig. General Carl Schurz
The massive number of wounded and the limited supply of surgeons made surgery itself a quick procedure. Anesthesia played an integral part in it. Developed during the Crimean War prior to 1860, the use of ether or chloroform was used by both the North and the South. Hollywood’s depiction of biting on a stick or to have four men hold the patient is false – teeth could bite through the stick and they needed men to fight, not hold others down. Once in place and the patient out, the surgeon inserted a knife above wound, cut through the tissue to the bone and around in circular fashion (the new flap method was sometimes used, making triangle cuts to leave more skin for suturing), pushed it back to expose the bone and then a serrated saw cut through it. The stump was sewn together with imported French black silk thread. The whole operation lasted fifteen minutes.
Black silk thread became impossible for the South to obtain due to the Northern blockade of the ports. Therefore, they used regular thread yanked from clothes but eventually, one surgeon tried a new method – horse’s tail hair. Long, strong but stiff, horsehair became pliable after it was soaked in boiling water. The results were amazing. Unlike the normal sutures, often resulting in swollen wounds, high fevers (104, 105 degrees) and pus – which was considered good, a healing step to recovery, boiled horsehair sewn stumps hardly swelled, minor fevers (101) and no pus, meaning quicker recovery for the patient.
How much was amputated played huge on survival rate. A hand gone equaled 90% survival; lower arm gone was 70%; entire arm meant 30%; arm, including shoulder blade, was 10%. For legs, it was the equivalent. Chest wounds had 1-2% survival rate. In a period when the make of the body’s trunk remained a mystery for the most part, stomach wound recovery was zero and with death infinite, they were placed beneath a tree, the “dying tree,” to meet the grim reaper there. Head wounds didn’t mean death but neurology was unknown to them therefore those mental disabilities were returned to loving family.
Military hospitals also at first operated under the concept that people, if kept there, would recoup better if they stayed with their wounded comrades. That meant, for instance, the 3rd Missouri was housed together – those with amputations with those ill from strep throat or worse. The result was all became ill and death rates climbed. From this the ward system was developed. They found segregation of the wounded from the ill and to divide the sick by their specific disease in wards equaled higher recovery rates. Malingers, those who claimed illness out of fear of death on the battle field, served as nurses, changing sheets and bedpans, as did those who were recovered enough to stand but not well-enough to fight yet.
It had been estimated for over a century that the war took 600,000 lives but latest research ups that amount to closer to 700,000 and growing. This is an era with no antibiotics, no Advil/Tylenol/Aleve, etc. Clinical thermometers, 100 of years old and urged by France for use, were scarce in the US Army Medical Department with only 20 in use. Stethoscopes were a novelty. And while hypodermic syringe was used by some, most still adhered to “dust” morphine into wounds or administer opium pills. These painkillers were addicting, later causing veterans craving them and the development of Veteran’s Homes to aid them.
While battle wounds killed several thousands, the biggest enemy was disease. Childhood illnesses, suffered as an adult, can kill. Mumps, whooping cough and many more were highly contagious and many soldiers missed having them as children because they were isolated on farms, kept home to till the field verses going to a schoolhouse with others, meaning avoiding early exposure. But the numbers climbed even higher with intestinal illnesses, mainly typhoid fever, diarrhea and dysentery. Many soldiers suffered diarrhea 3-4 times a year due to diet (i.e.: eating unripe berries in the early spring). The cure was Blue Mass, a mercury compound drug that stopped diarrhea. Patient’s nails and lips turned slightly blue and their tongue swelled but this was considered good. Unfortunately, blue mass also caused a reverse side effect – constipation. To loosen the bowels up, opium was distributed. Dysentery, a form of diarrhea with blood, also was prevalent. Pages upon pages of Jefferson Barracks Hospital read death caused by diarrhea or dysentery. The reason for death from these is the dehydration it causes in the patient.
This is a simple explanation of the surgeons. The fact that any soldiers survived is truly amazing. My fascination with Civil War medicine comes from the autobiography of an ancestor of mine who was a surgeon for the Confederacy, part of the 26th Mississippi, Dr. John Taylor. Captured by the Union, he had the ultimate test to tend to a commanding officer with brain fever – a risky task as patients often died but this one recovered. Dr. Taylor was forced to swear the oath not to take part again in the War of the Rebellion and returned home.
The use of women as nurses will be next.
Considering this sample, are you not happier to be alive today?