When Walt Whitman wrote that he believed the real war would never get into the books, this is the side he was talking about (Belferman 1996). Yet, it is important that we remember and recall the medical side of the conflict too, as horrible and terrifying as it was (Adams 1952). Long before doctors and people knew anything about bacteria and what caused disease was the time of Civil War medicine. Doctors during the Civil War (always referred to as surgeons) were incredibly unprepared. Most surgeons had as little as two years of medical school because very few pursued further education.
At that time, Harvard Medical School did not even own a single stethoscope or microscope until well after the war. Most Civil War surgeons had never treated a gun shot wound because they were accustomed to treating minor head colds and sore throats. Many had never performed surgery or even held a scalpel. Medical boards let extremely unqualified students practice medicine due to much needed help for wounded soldiers on the battlefield. Some ten thousand surgeons served in the Union and about four thousand served in the Southern Confederacy (Cunningham 1958).
By far, the deadliest thing that faced the Civil War soldier was disease and infection. For every soldier who died in battle, two died of disease (Cunningham 1958). Among the long list of terminal and fatal diseases that plagued the battlefield as well as the operating table and hospitals were dysentery (a severe form of diarrhea which was very common among the soldiers), measles, small pox, malaria, pneumonia, and camp itch which was caused by skin disease and insects. Malaria was usually brought on by camping in damp areas, where mosquitos were prone to.
There were many factors that came into play which explained why disease spread so rapidly. Among the explanations were as follows: inadequate physicals before entering the Army, the fact many troops came from rural areas, neglect of camp hygiene, insects and rodents in the area, exposure to other infected individuals, lack of clothing and shoes, and poor conditions of food and water. Many unqualified recruits entered the Army and diseases cruelly weeded out those who should have been excluded by physical exams prior to recruiting (Shildt 1986).
Both armies faced problems with mosquitos and severe lice which were both causes for many diseases. Exposure turned a mild head cold into pneumonia and worsened other conditions. Pneumonia was third ranking on the long list of killer diseases, after typhoid and dysentery. The diet of the Civil War soldier was somewhere between barely palatable to absolutely awful (Adams 1952). It was estimated that 995 of 1,000 Union troops eventually contracted chronic dysentery (Adams 1861-1865). Given the atrocious conditions, doctors tried many different cures.
To put an end to the common dysentery (which was one of the main worries of soldiers) a plug of opium was given. A mixture of mercury and chalk, which was called blue mass by surgeons, was used to treat closed bowels. Respiratory problems, such as pneumonia and bronchitis were treated with a dose of opium or sometimes quinine and muster plasters (Schildt 1986). Bleeding, an age old process which included cutting the main arteries and veins open length wise to rid the body of supposed bad blood, was also used. Malaria could be treated with quinine, or sometimes even turpentine if quinine was not available.
Whiskey and other forms of alcohol were also used to treat wounds and disease, mainly to relieve some pain although not nearly all of it. The medicines brought in to try and halt diseases were manufactured in the north for the most part; the southerners had to deal with running the Union blockade (Coco 1995). The medicines the South used were usually smuggled in although they south had some medicine manufacturing abilities and worked with herbal remedies. Battlefield surgery was horrific to say the very least when compared to modern medicine. Doctors and nurses took over houses, schools, churches, and even barns to use for hospitals.
The hospital was normally located near the front lines (sometimes only a mile) and was identified with yellow flag with a green H. This process started in the Federal Army from 1862 and on. Many people have a mental picture of a Civil War surgeon being a heartless individual that was the cause of so many fatalities involving amputations and unclean operations. In reality, this is a false statement. The medical director of the Army of the Potomac, Dr. Jonathan Letterman, wrote this report after the battle of Antietam: The surgery of these battle-fields has been pronounced butchery.
Gross misrepresentations of the conduct of medical officers have been made and scattered broadcast over the country, causing deep and heart-rending anxiety to those who had friends or relatives in the army, who might at any moment require the services of a surgeon. It is not to be supposed that there were no incompetent surgeons in the army. It is certainly true that there were; but these sweeping denunciations against a class of men who will favorably compare with the military surgeons of any country, because of the incompetency and short-comings of a few, are wrong, and do injustice to a body of men who have labored faithfully and well.
It is easy to magnify an existing evil until it is beyond the bounds of truth. It is equally easy to pass by the good that has been done on the other side. Some medical officers lost their lives in their devotion to duty in the battle of Antietam, and others sickened from excessive labor which they conscientiously and skillfully performed. If any objection could be urged against the surgery of those fields, it would be the efforts on the part of surgeons to practice “conservative surgery” to too great an extent. Still the Civil War surgeon suffers from being called a butcher or some other ignorant term.
Among the weapons used to create these fatal wounds, one was rare but still the most feared. The soft lead minie ball, with the ability to kill at over one thousand yards, this bullet caused large, gaping holes, splintered bones, and destroyed muscle tissue, arteries and vital organs beyond any possible hope of repair. Those shot with them through the body, or the head, would not be expected to live. The wounds from the minie bullet were ugly. Since they crushed and smashed bone so badly, the doctors did not have much choice but to amputate the injured limb.
Wounds to the stomach were almost always a certain death sentence (Cunningham 1958). The field hospital was hell on earth. (Adams 1952) The surgeon would have to stand over the operating table for hours without a break. Grown men screamed in pain, almost delirious. Some calling for loved ones, while others laid pale and silent with the effect of shock (Cunningham 1958). The soldiers that were wounded through the head, lower torso or chest were left to one side because they were the most likely to die. As cruel as this sounds, it allowed doctors to not waste precious time and to save those that could be saved with immediate attention.
The most common battlefield surgery was an amputation. It consisted of a routine procedure. A good, able surgeon could remove a limb in under ten minutes. Deciding upon an amputation, the surgeon would adminster chloroform to the patient. What is portrayed in “Hollywood” and in much “modern” conception of what surgery in the War was like during the war is false; anesthesia was in common and widespread use during the war…. it would make more complicated and longer operations possible as the era of antiseptic surgery was embarked upon (but too late for the poor Civil War soldier).
With the patient insensible, the surgeon would take his scapel and make an incision through the muscle and skin down to the bone. He would make incisions both above and below, leaving a flap of skin on one side. Taking his bonesaw (hence Civil War slang for a doctor is a “Sawbones”) he would saw through the bone until it was severed. one of the most graphic pictures from the Civil War… Limbs removed from their owners. He would then toss it into the growing pile of limbs. 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. The flap of skin left by the surgeon would be pulled across and sewed close, leaving a drainage hole. The stump would be covered perhaps with isinglass plaster, and bandaged, and the soldier set aside where he would wake up thirsty and in pain, the “Sawbones” already well onto his next case. (Adams 1952) If the soldier was lucky, he would recover without one of the infectious diseases swarming in the hospitals i. e. deadly pyemia or gangrene (Coco 1995).
As stated in the previous, Civil War surgeons were not interested nor concerned with so much cleanliness, as they were in speed. In turn, not knowing anything about antiseptic, infection arose. The most deadly was probably pyemia which was, literally, pus in the blood. In other words, a form of blood poisoning. It had a mortality rate of over 90%. There were other surgical diseases that were similar to this disease and included tetanus, erysepilas, osteomyelitis etc. Although given these horrid circumstances, the medical would improved with every year of the war.
The many men and women, North and South, who served in the hospital and sanitary services during the war were proud of their achievements (Adams 1861-1865). The morbidity and mortality rates of both armies showed marked improvement over those of other 19th century wars. The physicians and sanitarians held down the disease fatalities to levels that their generation considered more than reasonable. It was a gruesome business for doctors and patients alike; yet without the doctors and nurses in blue and gray, much of the young manhood of America at mid century might not have survived for the work of rebuilding. (Adams 1861-1865)