Civil War and Medicine - An Overview

Over the course of the last century notable advancements have been made in the area of medical science. In addition to improving the technology available for use in medicine, professionals have come to realize the importance of basic hygiene as a means for infection control. As such, the quality of medical care has improved drastically in recent years. Interestingly, the progress that has been achieved in this area would not be possible without an historical understanding of the problems of medical care in the past.

With the realization that understanding the history of medical care is important to understanding current practices in this field, there is a clear impetus to examine medical practices of the past such that a more integral understanding of historical discourse in the area can be understood. Using this as a basis for investigation this research considers what has been written about medical practices during the Civil War. Given that the modern practice of nursing evolved from women's experiences with soldiers that had been injured in the Civil War, this period of time marks a notable starting point for investigating the history of medical practice. Through a careful consideration of what has been noted about Civil War medicine, a more integral understanding of the challenges facing physicians and nursing during this time period will be elucidated.

Civil War and Medicine-An Overview

Critically reviewing what has been written about medicine during the time of the Civil War, it becomes evident that historians have widely noted the importance of this aspect of the conflict. One author, examining the overall importance of medicine to understanding the Civil War notes that, "if the war's medical aspects are omitted, the story is not only incomplete but is unrealistic as a total picture."[1] What this effectively suggests is that any explication of the history of the Civil War must consider some overview of the issue of medicine and its evolution during this period of time. This author goes on to note that in an effort to expand current understanding of the importance of medicine to the Civil War a host of guides and articles have been written that specifically examine the medical procedures and problems of Civil War soldiers. This information has provided a broad base for understanding the complex nature of medicine during this period of time.[2]

Sanitation and the Spread of Disease

A precursory overview of what has been written about medicine in during the Civil War suggests that, when compared to modern day medicine, the methods and procedures that were utilized to care for Civil War soldiers were quite barbaric. Although the methods could be considered barbaric in comparison to modern medical practices, the conditions under which physicians and nurses were forced to practice medicine were less than optimal. For instance, Ira Rutkow, in his text Bleeding Blue and Gray : Civil War Surgery and the Evolution of American Medicine, notes in the early pages of his text that churches had been transformed into makeshift hospitals in an effort to manage all of the soldiers that had been wounded in battle. Because of these conditions medical procedures were performed in the open: "Amputations were performed in full view of the assembled, with blood spattering those too near, including the next victim of the surgeon's scalpel."[3]

What this clearly implies is that the conditions under which medical care was provided were less than optimal. Thus, it is not surprising to find that many of the conditions that patient's suffered from were a direct result of this environment. For instance, Rutkow goes on to note that in the early years of the war, camp sanitation was so poor that a diseases quickly outnumbered injuries when it came to mortality and morbidity. In particular, Rutkow notes the case of "flux" or "the quick step," a condition identified with loose stools. During the war, physicians recorded more than 500,000 cases of this disease.[4] Although physicians could not pinpoint the cause of this condition, it was later discovered that contamination of the water system with human fecal matter was to blame. "In the hastily erected and vastly overcrowded camps, latrines commonly situated adjacent to ponds, streams and other water sources, were dug to shallowly and chronically overflowed. The inevitable result was that water contaminated with human waste was also used for bathing, cooking and drinking."[5]

Primary documents from the time of the Civil War demonstrate that physicians working in the field did not have the proper tools needed to ensure the health of soldiers wounded in battle. In a "Report from the Union Medical Director at the Battle of Shiloh" dated 1962, the Medical Director notes the problems with providing medical care for such a large number of patients:

We were poorly supplied with dressings and comforts for the wounded and with ambulances for their transportation, and it Was several days after the battle before all could be brought in. Our principal difficulty, however, in providing for the wounded was in the utter impossibility to obtain proper details of men to nurse them and to cook and attend generally to their wants, and in the impossibility of getting a sufficient number of tents pitched, or in the confusion which prevailed during and after the battle to get hay or straw as bedding for the wounded or to have it transported to the tents.[6]

This account goes on to note that physicians and nurses were unable to meet some of the basic needs of soldiers leaving many men in a panic stricken state. Thousands of injured soldiers were crowded into a few wet tents on the wet ground.[7] This only served to exacerbate the development and spread of disease.

Other reports from medical camps established during this time period make reference to similar problems. For instance, Surgeon Charles S. Tripler in his report on "Sanitation in the Army of the Potomac" observes, "The diseases from which our men have suffered most have been continued remittent and typhoid fevers, measles, diarrhea, dysentery, and the various forms of catarrh. Of all the scourges incident to armies in the field I suppose that chronic diarrheas and dysenteries have always been the most prevalent and the most fatal."[8] Although Tripler reports that his branch has done well with controlling the outbreak and spread of infectious disease, he does note that almost 40,000 soldiers had contracted some form of infectious disease within the previous 10 months.[9] Thus, the impact of the spread of infectious diseases among the soldiers in hospital camps was quite extensive overall.

With the realization that so many soldiers suffered as a result of the spread of disease-researchers note that by the end of the War twice as many deaths due to the spread of the diseases were recorded than deaths due to wounds acquired in battle[10]-it is pertinent to consider the methods that physicians used in an effort to improve health outcomes for patients. According to one author, open bowels were typically treated with a plug of opium; whereas closed bowels were treated with "blue mass," a mixture of chalk and mercury. "Respiratory problems, such as pneumonia and bronchitis were treated with dosing of opium or sometimes quinine and muster plasters. [...] Malaria could be treated with quinine, or sometimes even turpentine if quinine was not available [...] Whiskey and other forms of alcohol also were used to treat wounds and disease."[11] Clearly, what this research demonstrates is that the medicines that were used for treating disease were not only ineffective, but in most cases, they were in appropriate.

In an effort to fully demonstrate the impact that the spread of infectious disease had on the outcomes for patients during the Civil War, one author observes that: "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. Camps populated by young soldiers who had never before been exposed to a large variety of common contagious diseases were plagued by outbreaks of measles, chickenpox, mumps, and whooping cough."[12] This author goes on to note that the principle culprit in this case was the overwhelming filth of the hospital camp. Human refuse, trash and decomposing body parts could all be found within close proximity to the hospital.[13]Thus, it is not surprising to find that infectious diseases were the root cause of death during the Civil War.

Wounds from Battle

While it is quite evident that the spread of infectious disease was a critical problem for physicians and nurses working in war camps at the time, the wounds garnered by soldiers on the battlefront also posed a unique challenge to providing care. According to one author, gunshot wounds were among the most common wounds that were seen in the battlefront hospitals. Treatment of these wounds typically only included dressing, as most gunshot wounds were left to heal on their own.[14] Synthesizing data collected from reports on the battlefield, researchers note that there was some controversy over the specific type of dressing that should be used for an open wound. "If the wound were small and very recent, the doctor might attempt to close it with suture. Most wounds were treated with out any attempt at closure, however, and healing was a long process involving the slow growth of granulation tissue."[15] In most cases, wounds developed infections, drainage and pus. Physicians simply allowed the body to heal itself when it could. If a bone was fractured as a result of the bullet wound, the bone was placed in a splint. If a splint would not work, the affected limb was amputated.[16]

Other researchers exploring the specific wounds that were incurred during the Civil War have noted that the various munitions that were used during battle had an impact on the type of wound that resulted. One of the most famous wounds recorded by physicians was that caused by the minnie ball. "The most common Civil War small arms ammunition was the dreadful minnie ball, which tore an enormous wound on impact: it was so heavy that an abdominal or head wound was almost always 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."[17] First hand accounts recorded from nurses in military hospitals also make reference to the minnie balls. In Sophronia Bucklin's account of her experiences on the battlefront, she recounts the wounds of the patients in her charge. "A minnie ball had passed through the ankles of one-another had a fractured thigh-a shot in the head destroyed the senses of another; and one with his backbone severely injured was compelled to lay upon his face though the tedious hours."[18]

Other researchers examining the impact of the minnie ball argue that wounds caused by these munitions caused the most horrific outcomes for patients. To illustrate this point the case of John Bell Hood is presented by one researcher examining the impact of this bullet on the human body. As noted by this author, "The two minnie bullets...that struck John Bell Hood's leg at Chickamauga destroyed 5 inches of his upper thigh bone. This left surgeons no choice but to amputate shattered limbs. Hood's leg was removed only 4 and 1/2 inches away from his body. Hip amputations, like Hood's, had mortality rates of around 83%."[19] Further Stonewall Jackson had to have his arm amputated as a result of being struck with a minnie ball. The procedure for removing the arm had a mortality rate of 24 percent.[20] Thus, the minnie ball clearly had an overwhelming impact on the type of wounds produced as well as the overall outcome for the patient.

The effects of the minnie ball on the human body have also been recounted in history. As noted by one author, the weight of the minnie ball caused it to expand when it hit a bone, shattering the bone altogether. For this reason, amputation was the most common means for dealing with the wounds caused by this bullet. While amputation was quite simple and commonly practiced when the minnie ball hit the soldiers "guts" or intestines, the surgery required to fix the damage could not successfully be completed during this time period. When it hit bone, it tended to expand. "When it hit 'guts' it tended to tear them in ways the old smoothbore musket ball didn't do. [...] Wounds to the stomach were almost always a death sentence."[21]

Minnie ball wounds were the most prevalent types of injuries seen by nurses and physicians on the battlefield. Even though the minnie balls produced the most common wounds in battle, researchers have noted that there were other wounds that were prevalent among this population. For instance, historians note that shell fragments from artillery were the second most common type of wound seen by medical professionals. "An exploding shell sent large fragments of iron sailing into the air and would cause terrible wounds as well."[22] As such, the victim did not have to be directly hit with a bullet to experience a painful or fatal wound. These wounds were typically treatable; however because of the threat of infection, many soldiers who sustained these wounds ultimately died.

Finally researchers note that bayonet wounds were also seen during the Civil War. Although these wounds were treated, researchers estimate that the wounds accounted for only 2 percent of all wounds seen by physicians.[23] "Soldiers were not always inclined to use them [bayonets] and close fighting usually called for clubs or swinging rifles like clubs..."[24] Further, when bayonets were used, the fatalities caused by these weapons were notably small when compared with the number of patients that died from infections caused by these wounds.[25] Thus, what has been recorded on bayonet wounds in the Civil War is not that extensive overall. Here again the spread of disease in the military hospital camps had more of an impact on the outcome for the solider than the actual wound incurred in battle.

Surgeries of the Civil War

While the specific wounds incurred as a result of the Civil War are quite gruesome to examine, the most horrific stories that have transcended history have been those of the operations performed during this time period. Amputations were perhaps the most common surgeries performed during this time. However, researchers have noted that these procedures were among the most horrifying and detrimental. Describing the process of amputations one witness to the process noted the following:

Tables about breast high had been erected upon which the screaming victims were having legs and arms cut off. The surgeons and their assistants, stripped to the waist and bespattered with blood, stood around, some holding the poor fellows while others, armed with long, bloody knives and saws, cut and sawed away with frightful rapidity, throwing the mangled limbs on a pile nearby as soon as removed.[26]

Although these accounts have since been discredited-as chloroform was used to sedate patients before the procedure, researchers have noted that, "the screams heard were usually from soldiers just informed that they would lose a limb or who were witness to the plight of other soldiers under the knife."[27]

Regardless of the specific methods that were used to anesthetize the patient before amputation, the reality of these procedures was quite gruesome overall. "We operated in old blood-stained and often pus-stained coats, we used undisinfected instruments from undisinfected plush lined cases. If a sponge (if they had sponges) or instrument fell on the floor it was washed and squeezed in a basin of water and used as if it was clean"[28] Other accounts of amputations that occurred on the battle front suggest that the there were no established protocols for patient care after the amputation had occurred. According to one physician working on the battlefield, patients were, at times, operated on during battle. Such was the case with Brigadier-General Gladden. Gladden had his armed shattered by a minnie ball on the first day of fighting. "Amputation was performed hastily by his staff surgeon, instead of being taken to the rear for quite and nursing, he mounted his horse...and continued to command."[29] Gladden continued on for three days, until an infection required a second amputation. Unfortunately, by the afternoon after the second amputation, law jaw seized the Brigadier-General causing death within a few minutes.[30]

Further describing the specific methods that were used in the context of performing an amputation, one author makes the following observations: "The surgeon would wash out the wound with a cloth (in the Southern Army sponges were long exhausted) and probe the wound with his finger (the finger being usually used), or a probe perhaps, looking for bits of cloth, bone, or the bullet. If the bone was broken or a major blood vessel torn, he would often decide on amputation."[31] Once amputation was decided upon, the surgeon used a bone saw, which was often not sterilized, to saw through the bone. Once the bone was severed, the limb was tossed onto a nearby pile containing the limbs of other amputees. "The operator would then tie off the arteries with either horsehair, silk, or cotton threads. The surgeon would scrape the end and edges of the bone smooth, so that they would not work back through the skin."[32] The leftover flap of skin was then sewn across the site. A drainage hole was left for the onset of infection.[33]

Among the most notable problems to arise as a result of the amputation surgery was the contraction of gangrene of the stump. As noted by Freemon gangrene occurred when problems with the blood supply to the amputated area occurred. When gangrene developed, it was due to the death of tissue surrounding the amputation site. In most cases gangrene warranted a second amputation. However, by the end of the war, physicians began giving amputees a sponge to clean their wounds. This sponge was to be rinsed thoroughly after each use and was not to be shared with any other patient. Through this process of care, fewer amputations were needed for gangrene. Overall, the wounds caused by amputation healed by granulation.[34]

Although Freemon gives a relatively sedate account of the manner in which gangrene was subsequently treated by physicians, first hand accounts describing the condition demonstrate that gangrene was indeed a serious medical condition. Thornburgh, an assistant surgeon during the war notes the most pertinent facets of gangrene describing the condition as one that progresses as follows: "...a weak and small pulse, great prostration of the already enfeebled vital powers, a dry, glazed tongue, great anxiety of countenance, with a foul grayish slough all over the surface of the wound or ulcer, which discharges a large quantity of filthy and very offensive sanies, destroying muscles and everything before it down to the bone."[35] In most cases gangrene spread quickly destroying tissue, muscle and bone. Operations to stop the spread of this condition were the only means that provided any salient results.

Conclusion

Overall, the data that has been presented in this investigation provides a gruesome picture of the problems facing both soldiers and physicians during the time period. The Civil War hospital had become a breeding ground for disease and as a result of unsanitary infection control practices. Although wounds sustained on the battlefield were the primary reason for many soldiers to be transported to the medical hospitals, in many cases these wounds were not the direct cause of their death. Rather, for many soldiers infection and disease provided the most significant basis for morbidity and mortality. What is perhaps most interesting about the situation is that if the basic hygiene practices-many of which are used in hospitals today-had been implemented, it is reasonable to assume that many soldiers would have survived their wounds. Unfortunately, it was not until the end of the war that many physicians began to realize the importance of basic hygiene and sterilization in the provision of medical care for Civil War patients.

Although it is evident that physicians and nurses could do very little to improve health outcomes for those transported to a hospital campus, it is evident that the information collected during this time period had a significant impact on the development of medical practice. Many of the current aspects of basic hygiene and sterilization were discovered as a result of the problems that occurred in the hospital campus of the Civil War. In this context, it is evident that without this experience modern medicine would not have been able to make such notable strides toward modernization. For this reason, it could be argued that the Civil War was a boon to the overall development of modern medicine. While it is clear that thousands of individuals had to die in order to make this modernization possible it is difficult to identify another situation that would have given physicians the opportunity to explore the human body and the process of disease development in the manner that occurred during the Civil War. Thus, even though the Civil War enacted a huge toll on the American population, medical science was able to significantly benefit from this process.

Bibliography

Bucklin, Sophronia. "In hospital and camp." In: Harold Elk Straubing (ed.) In Hospital and Camp: The Civil War Through the Eyes of Its Doctors and Nurses, (pp. 94-107). Harrisburg, PA: Stackpole Books, 1993.

Freemon, Frank R.. Gangrene and Glory: Medical Care During the American Civil War. Madison, NJ: Associated Press, 1998.

Goellnitz, Jenny. "Civil War battle field surgery." [2006]. US Civil War. Accessed April 3, 2006 at: .

Goellnitz, Jenny. "Civil War Medicine." [2006]. US Civil War. Accessed April 3, 2006 at: .

Hignman, Robin and Steven E. Woodworth. The American Civil War: A Handbook of Literature and Research. Westport, CT: Greenwood Press, 1996.

"Medical care, battle wounds and disease." [2002]. Encyclopedia of the Civil War. Accessed April 3, 2006 at: .

"Medicine in the Civil War." [2005]. Gettysburg National Military Park. Accessed April 3, 2006 at: .

"Report on gangrene by A. Thornburgh, Assistant Surgeon, Provisional Army, C.S., C.S. military prison hospital Andersonville, Ga." [1856]. US Civil War. Accessed April 3, 2006 at: .

"Report from the Union Medical Director at the Battle of Shiloh." [1862]. US Civil War. Accessed April 3, 2006 at: .

Rutkow, Ira. Bleeding Blue and Gray : Civil War Surgery and the Evolution of American Medicine. New York: Random House, 2005.

"Sanitation in the Army of the Potomac." [1861]. US Civil War. Accessed April 3, 2006 at: .

Stevenson, William G.. "Thirteen months in the rebel army." In: Harold Elk Straubing (ed.) In Hospital and Camp: The Civil War Through the Eyes of Its Doctors and Nurses. (pp. 26-37). Harrisburg, PA: Stackpole Books, 1993).

[1]Robin Hignman and Steven E. Woodworth. The American Civil War: A Handbook of Literature and Research, (Westport, CT: Greenwood Press, 1996): 433.

[2]Robin Hignman and Steven E. Woodworth, 434.

[3]Ira Rutkow. Bleeding Blue and Gray : Civil War Surgery and the Evolution of American Medicine, (New York: Random House, 2005): 4.

[4]Ira Rutkow, 14.

[5]Ira Rutkow, 14.

[6]"Report from the Union Medical Director at the Battle of Shiloh." [1862]. US Civil War. Accessed April 3, 2006 at: .

[7]"Report from the Union Medical Director at the Battle of Shiloh." [1862].

[8]"Sanitation in the Army of the Potomac." [1861]. US Civil War. Accessed April 3, 2006 at: .

[9]"Sanitation in the Army of the Potomac." [1861].

[10]Jenny Goellnitz. "Civil War Medicine." [2006]. US Civil War. Accessed April 3, 2006 at: .

[11]Jenny Goellnitz. Civil War Medicine. [2006].

[12]"Medical care, battle wounds and disease." [2002]. Encyclopedia of the Civil War. Accessed April 3, 2006 at: .

[13]"Medical care, battle wounds and disease." [2002].

[14]Frank R. Freemon. Gangrene and Glory: Medical Care During the American Civil War, (Madison, NJ: Associated Press, 1998): 23.

[15]Frank R. Freemon, 23.

[16]Frank R. Freemon, 23.

[17]"Medical care, battle wounds and disease." [2002].

[18]Sophronia Bucklin. "In hospital and camp." In: Harold Elk Straubing (ed.) In Hospital and Camp: The Civil War Through the Eyes of Its Doctors and Nurses. (Harrisburg, PA: Stackpole Books, 1993): 102.

[19]Jenny Goellnitz. "Civil War battle field surgery." [2006]. US Civil War. Accessed April 3, 2006 at: .

[20]Jenny Goellnitz. "Civil War battle field surgery." [2006].

[21]Jenny Goellnitz. "Civil War battle field surgery." [2006].

[22]"Medicine in the Civil War." [2005]. Gettysburg National Military Park. Accessed April 3, 2006 at: .

[23]"Medicine in the Civil War." [2005].

[24]"Medicine in the Civil War." [2005].

[25]"Medicine in the Civil War." [2005].

[26]"Medical care, battle wounds and disease." [2002].

[27]"Medical care, battle wounds and disease." [2002].

[28]Jenny Goellnitz. "Civil War battle field surgery." [2006].

[29]William G. Stevenson. "Thirteen months in the rebel army." In: Harold Elk Straubing (ed.) In Hospital and Camp: The Civil War Through the Eyes of Its Doctors and Nurses. (Harrisburg, PA: Stackpole Books, 1993): 31.

[30]William G. Stevenson, 32.

[31]Jenny Goellnitz. "Civil War battle field surgery." [2006].

[32]Jenny Goellnitz. "Civil War battle field surgery." [2006].

[33]Jenny Goellnitz. "Civil War battle field surgery." [2006].

[34]Frank R. Freemon, 114.

[35]"Report on gangrene by A. Thornburgh, Assistant Surgeon, Provisional Army, C.S., C.S. military prison hospital Andersonville, Ga." [1856]. US Civil War. Accessed April 3, 2006 at: .