A surgeon during the Civil War was typically busy, running from surgery to surgery without washing his utensils or hands. The wounded were plentiful, but doctors were scarce. One soldier recounted a memory in which he witnessed a soldier rushed in on a stretcher, and dumped on a bloody table while a surgeon with his filthy scalpel waited. Without a pause, the doctor proceeded to amputate, and the witness remembered the anguished screams of unmasked terror that came from the undrugged man’s mouth.
When the doctor was finished, he threw the amputated arm into a large pile of discarded limbs. This simple yet disturbing scene portrayed the harsh reality of Civil War medicine (Goellnitz 3). During the war, surgeons were described as “butchers because limbs would be amputated in an effort to minimize pain and prevent the further spread of infections to others” (Hamidullah 2) though that was seldom the case. Throughout the war, the importance of medical advancement and treatment were more important than ever. Many diseases ran rampant due to the conditions that soldiers were forced to live in. Typhoid, dysentery, pneumonia, blood poisoning, and infection plagued both the Union and Confederate armies.
Of the 620,000 soldiers who died in the war, 400,000 of them fell victim to a disease, a staggering 57% (Dorwart 3). This large mortality rate raises the question: what effect did the Civil War have on medicine? How did it cause improvement over the years? Ultimately, the Civil War had a positive effect on medicine as it revealed a need for new medical techniques and technology, standardization in both the training of new doctors and sanitation in camps, and the creation of new hospitals and general healthcare facilities.
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The Civil War was fought from 1861 to 1865, between the North and South over their differing views on issues such as slavery, the economy, and political control. Throughout the course of the war, there were deadly battles that ended up claiming many lives. In fact, one in four soldiers did not return home. Some of the various battles fought between the four year period started off with the Battle at Fort Sumter, and continued at the Battle at Bull Run, Shiloh, Antietam, and the Battle of Gettysburg.
Although the majority of the diseases contracted during the war were due to the conditions and sanitation of the camps, some diseases were caught due to the fact that some soldiers lacked immunity. Many of the soldiers who fought in the war were white caucasian males so it was normal to spend their early childhood in isolation on their farms. Because of this, they had not come into contact with various childhood diseases, an example being measles.
This caused soldiers to suffer dramatically during the war, as they were exposed to many different people carrying many different diseases (Dorwart 3). Such diseases included diarrhea, dysentery, malaria, pneumonia, and diseases caught by lice and mosquitoes. The doctors of that time did not have the supplies nor the manpower to personally treat each patient, so they attempted to fit each patient into a category, and treated each category with one type of treatment. For example, “open bowels were treated with a plug of opium. Closed bowels were treated with the infamous “blue mass”… a mixture of mercury and chalk.
For scurvy, doctors prescribed green vegetables…” (Goellnitz 2). Such prescriptions were based on the very limited knowledge and information provided, and were lacking compared to the prescriptions and treatments that we have today. Although there were many diseases prevalent of that time, there were not many treatments available to a common soldier.
The Civil War turned medicine in a positive direction as it revealed a need for new medical techniques and technology, allowing for medical advancements in the future. An example would include Jonathan Letterman, an American surgeon credited with the creation of transportation for battlefield medicine. During May of 1862, Letterman established a positive reputation as he was appointed as medical director of the Department of West Virginia. He also remained in the good graces of political influential figures in both the Army and the Government (Liebig 23).
Later, he was eventually promoted to the medical director of the Army of the Potomac, arguably the largest army in the Union. McClellan, a Union general, under Letterman’s request, issued an order that created a regulated ambulance corps “with an established structure for its management, regulation, and evaluation” (Liebig 24). Each individual ambulance was maintained by a single driver and two men who had no combat duties, but were tasked with caring for the injured while they lay in the cart.
These early versions of ambulances were known as “Wheeling Wagons” and were able to carry 2-6 patients at a time, along with supplies and extra storage space, similar to the ambulances that are used today. The creation of such a vehicle was crucial for effectively and efficiently removing the wounded from the battlefield, and as a result, lowered the mortality rate of soldiers during the battles. Although Letterman had a great impact on medicine during the Civil War, his technology was not the only one that was created to help the soldiers.
The use of anesthesia was also introduced to the medical field during this era, allowing surgeons to perform surgery on unconscious patients, making each surgery quicker, more efficient, and more comfortable for the patients. The most common form of anesthesia used was chloroform, which was utilized starting in 1846. In total, there are around 800,000 documented cases of its use, and it was used in 75% of Civil War operations. 45 deaths out of 8,900 uses accounted for a remarkable mortality rate of 0.4% (Surgeons at Petersburg 2).
Chloroform was typically administered using the open-drop technique, where a cloth soaked with the chemical was held over the patient’s mouth and nose until the patient was unconscious. Although anesthesia was used before the war, it wasn’t used as broadly or to such an extent as it was during the war. The war showed Civil War doctors that anesthesia was useful and necessary when treating battlefield wounds. In both examples, the use of anesthesia and the creation of an ambulance were both created due to the issues brought to light by the Civil War.
Letterman himself said that he created the ambulances as he saw the high mortality rate of people that lay dying on the battlefield, after watching the inefficiencies of the stretcher bearers (Liebig 24). These methods and technology lowered the mortality rate of soldiers, but the war also affected other aspects of medicine in a positive way.
The Civil War also caused a need for standardization in their training of doctors, and an increase of awareness in the sanitation condition of soldier camps. Civil War doctors typically had two years of medical school training. Prior to the war, the majority of surgeons never treated a gunshot wound, or preformed surgery. In other words, they were new to the field, fresh out of school. Oftentimes, medical boards admitted ‘quacks’; people with no qualifications to be doctors.
All in all, an average Civil War doctor was understaffed, underqualified, and undersupplied (Goellnitz 1). Jonathan Liebig, MD at the Naval Medical Center of San Diego stated that “there were few military surgeons with adequate training and expertise. In 1860, the US army only had 100 doctors for 16,000 soldiers, a ratio that became only worse when the Union army reached its peak strength of 2 million, at which point it had 10,000 surgeons” (Liebig 23).
Because there was often no standards to who could become a doctor during the Civil War era, many under qualified applicants were accepted, which lead to more deaths at the battlefields. In addition, not only was each surgeon underfunded, many medical colleges also lacked the funding to properly train their students. Harvard Medical School didn’t own a stethoscope or microscope until the end of the war. This lack of uniformity throughout training led to the increase of the mortality rate during the wars, as the doctors and surgeons themselves were underprepared for the reality of the war. However, besides regulating the doctors who practiced during the war, there was also a need for sanitary regulations as well.
Dr. Bonnie Dorwart stated that, “one reason for poor sanitation was a lack of discipline in many camps, perhaps because surgeons were not aware of implications for health, or were so busy with twice daily Surgeons’ Call where troops in camp reported for sick bay” (5). If surgeons were less busy, or perhaps if they took the time to closely examine the various causes of infection, many more lives could have been spared. However, due to the hectic and demanding needs required from each doctor and surgeon, sanitation became a low priority.
Sanitation during the War was also a large problem, and a cause of many of the diseases that were spread. Joseph Jones, a Confederate surgeon inspecting the Andersonville stockade in GA wrote about a stream that was “filled with the filth and excrement of twenty thousand men, the stench was disgusting and overpowering; and if it was surpassed in unpleasantness by anything, it was only in the disgusting appearance of the filthy, almost stagnant waters moving slowly between stumps and roots…” (Dorwart 4).
Dr. Bonnie Dorwart also wrote in her book, Death is In Breeze of the various field conditions, that unsanitary conditions were very common throughout the war. Many witnesses talked of the interplay of four fs: fingers, feces, food, and flies. The abysmal conditions of military sanitation caused the creation and emergence of the Sanitation Commission, which aimed to help standardize expectations of sanitary requirements in the war camps.
They were founded by the United States, and was formed and approved by President Lincoln in the early stages of the war. All the evidence points to an ever increasing need for regulations and standardization in both the doctors and surgeons themselves, but also the sanitation problems that constantly reappeared in the camps during the Civil War. The war revealed the various inconsistencies throughout the medical institutions, and facilitated the change into the standardized practices today. The Civil War led to the founding of many institutions focused around aiding soldiers.
The need for better field hospitals and care facilities was also a result of the Civil War. Alongside these new care centers rose various groups of people dedicated to improving the lives and wellbeing of soldiers. One piece of evidence that stands to prove the need for these new hospitals takes place after the Battle of Bull Run in 1861. It was said that it took a week to clear the wounded from the battlefield. Although this was a shock, what was said next was even more interesting.
The wounded had to make their own way back to Washington to receive medical care, as there were no closer facilities nearby (Leibig 22). Although these men were injured, with one man shot in the thigh and scrotum, they had to trek 25 miles to remove a bullet from their injured body. In response, new hospitals were founded near battlefields for quick treatment, “the largest of these hospitals was Chimborazo in Richmond, Virginia. By the end of the war, Chimborazo had 150 wards and was capable of housing a total of 4,500 patients. Some 76,000 soldiers were treated at this hospital” (Goellnitz 3).
There were two main reasons for the creation of these new hospitals. One was the sudden influx of patients could not be supported by the nearby hospitals. The second was that the founded hospitals were simply too far for the soldiers to be transported. Therefore, many of the new hospitals were near the battleline, effectively simplifying the transport between these two places. In addition to care facilities, various groups focused on healthcare were also important, as they supplied the man power needed to effectively care for the soldiers.
Many groups were dedicated towards helping the soldiers, the most important of those being staffed by women. These groups included the National Association of Army Nurses during the Civil War, The American Red Cross, and Ladies’ Aid Societies. A picture of Annie Bell, a nurse caring for patients after the Battle of Nashville, shows one example of how important a group such as the National Association of Army Nurses were. Besides providing medical assistance and care for the patients, nurses often fed, wrote letters, prayed, read, and comforted many soldiers.
These nurses in the National Association often worked near the battlefield, and assisted in the various popup and grounded hospitals, anywhere that required their assistance. They not only increased the general welfare and health of the soldiers, but also gained some respect for their jobs in a time where women were generally looked down upon (Annie Bell 1). Clara Barton was another female nurse that provided care and comfort in the midst of the war. She was the founder of the American Red Cross, who assisted soldiers in the war. They packed and shipped food to the front line, and volunteered as nurses (US Home Front 1).
In addition, J. S. Newberry, in his report to the Sanitary Commission, wrote that he was indebted to “the earnest, systematic, and most efficient aid of a large number of our associate members, and of auxiliary Ladies’ Aid Societies, without whose assistance but a small portion of the work done could have been accomplished” (Newberry 2). It is evident that Civil War had a lasting impact on medicine as it allowed women into the primarily male dominated field, which had seldom happened. The War expressed a need for new facilities that were larger and closer to major battles.
Although the time and methods may have changed, it is evident from analyzing prior methods and comparing them to modern techniques that the Civil War changed medicine to become more advanced. As such, when the conditions of the Civil War worsened, many found an increased need for more qualified doctors, more advanced technology, and more healthcare and sanitary groups.
Through their creation, many more lives were changed and improved in the following years. The medicine throughout the Civil War had a great importance as it dictated who lived to fight another day, and who perished without a funeral. The advancements in medicine that took place during the Civil War improved the lives of soldiers and their families, along with civilians in the future. This topic had a long lasting importance in history. Overall, it exposed a need for more advanced medicine.
The war had taught the doctors practicing how to effectively and efficiently treat their patients, which in turn, helped develop new technology. In addition, it served as a reminder that although they were not conscious of it, unknown and invisible dangers exist when practicing medicine, along with serving as a reminder of the reasons behind regulations. Perhaps if the same scene was replayed in a modern day war, the witness might recall something like this. “I was standing in a sterile medical bay when an ambulance pulled up to the front doors. Two men rolled a gourney out and placed the man onto a waiting bed.
A doctor on the side dressed in sterile scrubs, rushed to assess the damage, before calling over nurses and a surgeon. They all headed into a secluded operating room adjacent, an anesthesiologist on the way. They came out two hours later, and the sedated patient was rolled into a hospital room to fully recover.” There was no bloody, unsanitized scalpel, no doctor waiting with a lab coat covered in body fluids, no pile of limbs by the wall. Everything was clean and orderly, the way it should have been during the war.
