Civil War Medical Notes

Civil War Medical Notes: adapted from http://www.civilwarhome.com/medicinehistory.htm and http://www.civilwarhome.com/civilwarmedicine.htm

Harvard University didn’t get it’s first microscope or stethoscope until after 1870.

When the war began, the Federal Army had 98 medical officers (for 16,000 men) and the Confederate Army had just 24. By the end of the war, more than 11,000 men had served in the Union medical corps, and more than 4,000 for the Confederacy.
These medicos treated over 10 million cases of injury and illness over the span of four years—talk about overwork!

Conditions were bad. But despite that the medical care was improved over previous wars. 90% of Mexican War deaths were non-battle related; only about 55-60% in the Civil War.

However, of the approximately 620,000 deaths in the war, 388,000 died from disease.

There were, however, lots of wounds. There, lying on clumps of hay or bare ground, the wounded awaited their turn on the operating table. Contrary to legend, there was usually little shouting, groaning, or clamor because the wounded were quieted by shock and the combination of liquor and opiate. It was an eerie scene, with a mounting pile of amputated limbs, perhaps five feet high, the surgeon and the assistant surgeon-after a few months both Union and Confederate authorities decided that two assistant surgeons were necessary in a regiment -cutting, sawing, making repairs, and tying ligatures on arteries. The scene was especially awesome at night, with the surgeons working by candlelight on an assignment that might sometimes go on for three or four days with hardly a respite. And there was always the smell of gore.

Because wounds to the head, neck and abdomen were nearly always fatal, surgeons did not often treat those patients. Instead, the focused on wounds to the extremities (legs and arms). Of the approximately 175,000 wounds to the extremities received among Federal troops, about 30,000 led to amputation; roughly the same proportion occurred in the Confederacy. One witness described a common surgeon's tent this way: "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."

Everything about the operation was septic. The surgeon operated in a blood- and often pus-stained coat. He might hold his lancet in his mouth. If he dropped an instrument or sponge, he picked it up, rinsed it in cold water, and continue work. When loose pieces of bone and tissue had been removed, the wound would be packed with moist lint or raw cotton, unsterilized, and bandaged with wet, unsterilized bandages. The bandages were to be kept wet, the patient was to be kept as quiet as possible, and he was to be given small but frequent doses of whiskey and possibly quinine.

Americans were largely unaware of the germ theory of disease, and anyway had little means of providing antiseptic conditions or sterile equipment.

Due to a frequent shortage of water, surgeons often went days without washing their hands or instruments, thereby passing germs from one patient to another as he treated them.

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.

The culprit in most cases of wartime illness, however, was the shocking filth of the army camp itself. An inspector in late 1861 found most Federal camps 'littered with refuse, food, and other rubbish, sometimes in an offensive state of decomposition; slops deposited in pits within the camp limits or thrown out of broadcast; heaps of manure and offal close to the camp." As a result, bacteria and viruses spread through the camp like wildfire. Bowel disorders constituted the soldiers' most common complaint. The Union army reported that more than 995 out of every 1,000 men eventually contracted chronic diarrhea or dysentery during the war; the Confederates fared no better.

Typhoid fever was even more devastating. Perhaps one-quarter of noncombat deaths in the Confederacy resulted from this disease, caused by the consumption of food or water contaminated by salmonella bacteria. Epidemics of malaria spread through camps located next to stagnant swamps teeming with anopheles mosquito. Although treatment with quinine reduced fatalities, malaria nevertheless struck approximately one quarter of all servicemen; the Union army alone reported one million cases of it during the course of the war. Poor diet and exposure to the elements only added to the burden. A simple cold often developed into pneumonia, which was the third leading killer disease of the war, after typhoid and dysentery.

The diets of both armies did not help and were deplorably high in calories and low in vitamins. Fruits and fresh vegetables were notable by their absence, and especially so when the army was in the field. The food part of the ration was fresh or preserved beef, salt pork, navy beans, coffee, and hardtack, large, thick crackers, usually stale and often inhabited by weevils. When troops were not fighting, many created funds to buy fruits and vegetables in the open market. More often they foraged in the countryside, with fresh food a valuable part of the booty. In late 1864, when Major General W. T. Sherman made foraging his official policy on his march from Atlanta to Savannah, his army was never healthier. As the war went on, Confederate soldiers were increasingly asked to subsist on field corn and peas. And the preparation of the food was as bad as the food itself, hasty, undercooked, and almost always fried.