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CIVIL WAR MEDICINE:

The "Medical Middle Ages"

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by Jenny Goellnitz
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Too often, Civil War buffs and even historians get caught up in the glory of that all too awful War. We remember Pickett's Charge, for example, as the long perfect gray lines advancing gallantly through shot and shell, red banners snapping in the wind, up the ridge, and then being repulsed. Of course, in these descriptions men "fall," and at the end there is some sort of number given for how many were killed, wounded, or turned up missing. But, then the historian turns to the intricate game of chess that made up the tactics of the decision, the what should have been and what could have been done instead, aided always by hindsight. This is all fine, and it adds to our knowledge about the Civil War. However, too often forgotten, is that the ground passed over in the attack was littered with gory footprints that marked the ebbs and flows, gory footprints made up of broken human beings. For those who survived and were wounded, there came a new type of battle: the fight for life in what the Union surgeon general appropriately termed the "medical middle ages."

The medical situation of the 1860s was indeed a sort of medical middle age. For example, let us turn to the Civil War surgeon on the battlefield. Unless he is unusual, he has never treated a gunshot wound before the War. His medical training, by our standards today, is almost laughable. To work with, he has a barn, a house, or perhaps a church or school building; his table for operations might be a dining table or a heavy door pulled off hinges. If he operates at night, it is by candle or lantern, and there is no assurance the hospital will not come under fire. His surgical equipment is housed in a plush lined case that is not sterile, for the Civil War doctor has very little idea on tiny microbes causing disease. The water to work with is usually cool and after a while, bloody. The doctor is faced with hundreds of patients all needing attention. Faced with the destructive powers of the minie bullet, the Civil War surgeon finds himself face to face with shattered bones, ripped arteries, and very little time. Considering all this, it is not surprising that doctors more often than not, opted for amputation of a wounded extremity. The medical director of the Army of the Potomac, Jonathan Letterman, famed for his ambulance corps idea, after Antietam reacted to criticism of his doctors being too liberal cutting off legs and arms by stating in his opinion any criticism to them should be because they were too conservative. A good surgeon could remove a limb in around ten minutes, far faster than trying to piece together a shattered bone that might develop an infection anyway and lead to an amputation at a later date.

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Approximately 7 out of 10 wounds seen by the surgeon were to an extremity, and about the same amount the cause of the wound were bullets, with shells, sabres, and bayonets rounding out the other 3 cases. Triage was already being performed: those wounded in the belly, for example, would most likely die and therefore the doctors ignored these patients, pretty much setting them aside to die to work on those who could be saved.

The amputation was the most common surgery done. The surgeon would probe the wound, looking for fragments. If the bones were broken or a major blood vessel wrecked, the doctor would decide on amputation. The surgeon would administer chloroform to the patient. Anesthesia's first recorded use was in 1846, making it still in it's infancy at the time of the Civil War. Anesthesia was almost always, as a rule, used in surgery, in fact, there were 800,000 cases of it's use. Chloroform was used about 75% of the time. Of 8,900 cases of use of anesthesia, only 43 deaths were attributed to the anesthetic, a remarkable mortality rate of 0.4%. Anesthesia was usually administered by the open-drop technique. The anesthetic was applied to a cloth held over the patient's mouth and nose and was withdrawn after the patient was unconscious. With the patient insensible, the surgeon would take his scalpel 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. 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.

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As awful as the surgery sounds, it was not the deadliest thing faced by the soldier of the Civil War. Disease ran rampant courses. There were so-called surgical fevers for example. These were infections arising from the septic state of Civil War surgery. The Civil War surgeon was interested not so much in cleanliness (careful hand washing was not even done), but speed. As such, and not knowing anything about antiseptic surgery, fevers arose. Of these, the most deadly was probably pyemia. Pyemia means, literally, pus in the blood. It is a form of blood poisoning. Nothing seemed to halt pyemia, and it had a mortality rate of over 90%. Other surgical diseases included tetanus (with a mortality rate of 87%), erysepilas, which struck John B. Gordon's arm after he was wounded at Antietam, and osteomyelitis which is an inflammation of the bone. Also, there was something called "Hospital Gangrene." A black spot, about the size of a dime or so, would appear on the wound. Before long, it would spread through, leaving the wound an evil smelling awful mess. The Hospital Gangrene of the Civil War is an extinct disease now.

Camp diseases also ran rampant, especially amongst rural recruits who had little immunity to them. Childhood diseases like measles and mumps became epidemic problems. For every soldier who died in battle, two died of disease. In particular, intestinal complaints such as dysentery and diarrhea claimed many lives. Diarrhea and dysentery alone claimed more men than did battle wounds. The Civil War soldier also faced outbreaks of measles, small pox, malaria, pneumonia, or camp itch. Malaria was brought on by usually camping in damp areas while camp itch was caused by insects or a skin disease. In brief the large amount of disease was caused by a) inadequate physicals before entering the Army; b) plain old ignorance; c) the fact many troops came from rural areas; d) neglect of camp hygiene; e) insects and vermin; f) exposure; g) lack of clothing and shoes; h) poor food and water. Disease particularly ran rampant in the prisons.

To halt disease, doctors used many cures. For bowel complaints, 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. Respiratory problems, such as pneumonia and bronchitis were treated with dosing of opium or sometimes quinine and muster plasters. Sometimes bleeding was also used. Malaria could be treated with quinine, or sometimes even turpentine if quinine was not available. Camp itch could be treated by ridding the body of the pests or with poke-root solution. Whiskey and other forms of alcohol also were used to treat wounds and disease ... though questionable medical valuably, whiskey did relieve some pain. Ignorance of camp sanitation and scanty knowledge about how disease was carried led to a sort of "trial and error" system.

The medical side of the Civil War is as important as any other study to the understanding of this tragic period in our nation's history. The Civil War came at the end of the medical middle ages. Little was known of bacteriology for example. Surgery was septic. Yet, to label the Civil War surgeon in derisive terms does him a great injustice. Forty Union doctors lost their lives in battle. Dr. J. B. Fontaine, of the cavalry corps of the ANV, was killed in the line of treating a wounded soldier, Dr. E. S. Galliard had to have his arm amputated after being wounded treating Joe Johnston. Many medical officers, including Jonathan Letterman, died young. The Civil War surgeon often sacrificed his health to do what he could to save life. To call him a butcher does him a great injustice.

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Petersburg, Va. surgeons of 3rd Division before hospital tent, August 1864 - Library of Congress

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