Civil War Medicine

Most think that the Civil War was gruesome, and that the amputations were without anesthesia, but most of that is false. Only 1 in 3 soldiers that died in the Civil War died of wounds in battle. Most of the soldiers had lived and worked on small or large rural farms. These men were not accustomed to diseases such as, measles, mumps, and whooping cough. The soldiers did not die of wounds in battle, but of common diseases which they had never been exposed to before.(see Links for definitions of diseases)

Because most people believed the war was going to last only a few months or weeks there was no real effort to recruit doctors, or surgeons as they were called during that time. At the beginning of the Civil War, there were 36 surgeons in the whole United States. When the war started 12 of these surgeons went to the South to serve. Surgeons had no formal training in the art of medicine. Most "medical schools" were more like diploma factories, and gave almost no training for the surgeons. At that time there was no licensing board for the surgeons, so these "factories" were allowed to continue. The established colleges, Princeton, Yale, and others only required their students to take 3 semesters of medical training. There were no residencies or internships; it was just bookwork. The college recommended you take 2 years of medical training. The first year was bookwork, but you never worked in the field or did anything hands on. The second year was just an exact repeat of the first. They figured that if you did not "catch anything the first time you would get it the second time around".

Another way to become a surgeon was to earn it. Usually a man started out as a litter bearer. These litter bearers were used to carry wounded men off the battlefield. If any of these men showed any interest in the medical field, they would probably be promoted to a Steward. The Steward's job was to take care of patients with minor wounds such as, scratches, and bumps. The other duties of a Steward were to pull teeth. They would also take care of medicines for the surgeons. The Steward would carry a firearm to guard the medicinal stores. Often soldiers would try to break into the medicinal stores where the morphine, opium, laudanum, and whisky were stored. If a Steward proved to complete these duties, then he might be allowed to assist a surgeon in an operation, which could sometimes lead to being promoted to the position of assistant surgeon. By the end of the war one who had started out as a litter bearer, might have already become a full-fledged surgeon.

During the war, it became apparent that some sort of "manual" was needed for doctors performing their duties on the battlefield. This "manual" was written in 1863 by J.J. Chislom, a confederate surgeon. It was used as a textbook for those surgeons who had had little or no medical training.

Contrary to popular belief there was anesthesia for soldiers during the war. The surgeons would apply a cloth soaked in chloroform. The surgeons knew enough to remove the rag often so that the patient would not get chloroform poisoning. There were few operations that the surgeon did not use anesthesia in. A patient only having a bullet to bite was basically a myth.

The most common operation during the Civil War was amputation. Almost 3 out of every four operations were an amputation. Most amputations were necessary because when a Minie Ball struck a soldier, it carried into the wound dirt and bacteria. The Minie Ball also shattered the bone, so the surgeons had no other choice but to amputate.

The amputation was performed on a board supported between two barrels. The first thing that a surgeon would do was cut off the blood flow with a tourniquet. Then he would take a scalpel and cut through the flesh and tissue to the bone. The surgeon would then have to cut through the bone. To do this he used a saw-like tool called a capitol saw. When everything was done the surgeon would sew up the arteries, and veins with silk thread if they were in the North, and cotton thread if they were in the South.

(Picture of an amputation)(Picture of surgical tools) Surprisingly many soldiers survived amputations. If the amputation was done within 24 hours of the injury then there was a 50% chance that he would survive. This may not seem like much, but considering the level of cleanliness and awareness about infection this mortality rate was very good.

If after an operation thick pus (laudable pus) started to form, the surgeons thought this to be a good sign that the wound was healing. This however was not true. If pus stared to form it was a sign of a massive infection that a soldier was likely to die of.

During the Civil War, the painkiller used most often was morphine. The morphine was often given as opium pills. The surgeons of that day had no idea what an addiction was. As a result, most of the soldiers that came back form the war were addicted to opium. Opium, however, was not hard to come by and could be found at a local drug store. If Opium pills were not available, then Dr. Chisolm suggested that first the patient should take morphine by mouth. If this was not effective then the surgeon would administer the morphine by injection. Dr. Chisolm wrote: "Finding that one-half grain of morphine every two to three hours produced no alleviation of the patient's suffering, I tried the experiment of injecting one third of a grain, dissolved in two minims of water, under the skin covering the sternum. Absorption was immediate: in two minutes the patient was relieved; in five all pain had disappeared, and in ten minutes from the time of injection the patient was sleeping soundly, after seventy hours of unmitigated torture."

As you can see from the above description the surgeons of that day had no real knowledge of what certain things would do to the body. For instance, in Dr. Chisolm's book he suggests that each man should soap his socks in water each day, to avoid sores to the feet. Not only did this remedy not work, but also the soaps of that day were made of lye. Lye is very corrosive, and would have made the sores even worse. Another remedy that the doctor prescribed was that while soldiers were "on march", he writes "bacon can be eaten raw, as on a march, whether time nor convenience exists for cooking it. Our soldiers who are very fond of this alternative, have not, apparently, suffered from its very frequent repetition." Bacon raw in itself contained bacteria, and killed many soldiers. If a soldier did not die of a bacterial infection, then he was likely to die of malnutrition. The raw bacon caused a person's digestive tract to become inflamed. Any other food that the soldier might eat passed right through the digestive system. The soldier could not get enough nutrition to stay alive. Thus, that soldier would die of malnutrition.

One of the improvements during the Civil War was Hospital design. (Picture). Before the War, hospitals were just one building. In this building there was no separation by illness, so many died not of what they were in the hospital for, but of what someone else was suffering from. This changed during the Civil War. Hospitals were then divided into wards for certain illnesses. This helped stop the spread of disease within the hospitals themselves.

When a regular hospital was not available, a field hospital was created. (Picture)[same picture]These hospitals were merely places where the wounded soldiers were laid. A field hospital can also be seen in the movie "Gone With The Wind".

To get to either a field hospital or a large hospital the wounded would have to be carried in an ambulance. These ambulances came in two varieties, four wheeled wagons, which were very stable on the dirt roads, and two wheeled ambulances. The two-wheeled ambulance was less stable on the dirt roads than the four-wheeled ambulance. (Picture)

During the Civil War embalming became very important. Families wanted their dead soldiers returned to them. A family could hire and embalming surgeon, to embalm the dead body, and return it to their family members. (Picture)

One of the better things that came out of the war was that surgeons, and other medical staff were not fired upon, or taken hostage. At the start of the war there were only about 20 clinical thermometers. The modern microscope was not even invented until 1863. There were no stethoscopes or hypodermic syringes to administer medicine. The surgeons of the time knew of bacteria, but did not know that it was what was killing entire camps of soldiers. Yet all through this people died, but some did survive. Medicines only improved from the point of the Civil War and on to develop into our medical system today.


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