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The medical profession at the start of the Civil War was hardly organized. There
was no set standard for practicing medicine, and the information pertaining to maladies
and treatments was based on speculation, wives tales, and trial and error. In an age when
little was known about the causes of infectious disease, medicinal discovery through
experimentation was the most pervasive form of treatment and the patient was expected
to submit to the process. In reality the patient had little choice in the matter, as the
alternative was no treatment at all. Additionally, a stubborn unwillingness to halt
established care practices caused a medical vacuum, institutionalizing common medical
procedures. It became increasingly difficult for physicians and scientists to refute or
discontinue accepted medical practice, regardless of evidence that it was not useful, or
worse, harmful to a patient.
In this paper, I argue that although the Civil War itself was the point of origin in
the subsequent injury and death of thousands of people, there was a multitude of
additional factors that led to the low survival rates of soldiers injured in battle. The lack
of medical knowledge, coupled with a disorganized criteria for medical qualifications and
a shortage of trained surgeons added strain on both the Union and Confederate Armies.
The chaos created by poor planning and preparation resulted in a lack of supplies, and
clean facilities. This environment was ideal for disease and infection, and ultimately
contributed significantly to many deaths during the Civil War.
In terms of the qualifications of the medical staff that worked in the fields and
medical tents during the Civil War, their medical experience and training was diverse, or
in some cases lacking almost completely. One of the biggest issues was the lack of
uniform standards when it came to medical degrees. Schools like Harvard, Columbia and
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the University of Pennsylvania had highly functional medical programs, and had been
producing capable doctors since the 18th Century. The graduates from these esteemed
schools were known as The Regulars, and were considered within the medical
community to be the most qualified practitioners of medicine. The problem was that there
were also many other schools with unscrupulous medical programs that were free to train
and certify students in the medical profession.1 The graduates from substandard
institutions were no less qualified on paper than a graduate from a reputable school, and
therefore there was no way of knowing if a patient was going to receive care from a
capable doctor, or one posing as such. Oliver Wendell, a celebrated physician essayist
wrote on the sorry state of medicine and unworthy doctors saying, “I firmly believe if the
whole material medica, as now used, could be sunk to the bottom of the sea, it would be
all the better for mankind- and all the worse for the fishes.”2 And on the eve of the Civil
War these same deplorable doctors and medical practices would be called upon for their
services and expertise, no questions asked.
The problem of capable physicians during the Civil War was compounded by the
great urgency in the amount of medical staff needed, which because of the belief that the
war would be short left both sides unprepared both in medical infrastructure and policy.
The battle at Bull Run on July 21, 1861 is a good example of this lack of preparation,
both militarily and medically. Because of the lack of medical supplies, or adequate
staffing of physicians many Union soldiers were left to die in the battlefields where “the
injured lay for days on the ground where they fell, suffocating on their own vomit and
delirious from infection. Many received neither medical attention nor so much as a
C. Keith Wilbur, Civil War Medicine 1861-1865, p. 10
Ira M. Rutkow, Bleeding Blue and Gray; Civil War Surgery and the Evolution of American Medicine,
p.65
1
2
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mouthful of water.”3 After the catastrophe at Bull Run both the Union and Confederate
armies set up secondary hospitals, positioned between the battle lines and the general
hospitals, allowing physicians to provide immediate assistance to those soldiers in the
most need of attention.4
The camps themselves were magnets for disease and sickness, and often the
healthy soldiers living within them were struck down with illness, making them sorely
unprepared for battle. The soldiers were always within close proximity from one another,
sharing cookware, food and sleeping quarters. The drinking water often came from a
contaminated source, due to the inefficient disposal of sewage and garbage matter. As a
result of contaminated drinking water, coupled with filthy conditions, loss of sleep and
lack of nutritious sustenance, many of the soldiers suffered from an array of diseases.5
The list of illnesses included diarrhea, malaria, scurvy, typhoid fever, cholera and
dysentery. Adding to the increasingly miserable conditions was the arrival of disease
carrying vectors such as lice, mosquitoes and rats.6
On the topic of infectious disease and germs, the popular belief among the 18th
Century medical community was that ailments proceeding injury were due to the
"nervous irritability" of the patient’s internal organs or external extremities. Physician
John Brown of Eidenburgh attempted to explain the medical condition, later to be known
as septic infection, by founding the theory known as Brunmain. This theory outlined the
factors that led a patient to septic infection, which due to the medical community’s
Ira M. Rutkow, Bleeding Blue and Gray; Civil War Surgery and the Evolution of American Medicine, p.
5-6
4 Frank R. Freemon, Gangrene and Glory; Medical Care during the American Civil War, p.46
5 Ira M. Rutkow, Bleeding Blue and Gray; Civil War Surgery and the Evolution of American Medicine, p.
139
6
Christopher J. Olsen, The American Civil War; A Hands-On History, p.195-196
3
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ignorance of germs and bacteria was identified simply as inflammation. Brown argued
that any excessive stimulation to a patient during initial recovery could cause physical
overexcitement, resulting in “inflammation.” Lacking the knowledge of the real cause of
infection, Brown recommended treating patients with purgatives, narcotics, bloodletting
and counterirritants.7 Combining concoctions of oils and herbs and administering this
medicine by enema, or setting leeches on an individual suffering from septic infection
seems cruel and bizarre by today’s standards. But during the era of the Civil War such
treatments were perfectly reasonable, and standard practice in military hospital tents
throughout the Union and Confederate territories.
The limited knowledge of disease, germs and treatment severely curtailed the
physicians and their helpers ability to treat wounded soldiers. During the Civil War,
ninety-four percent of all wounds were a result of bullets. When soldiers were carried off
the battlefields, their bodies a mangled mess, there was only a limited choice regarding
how to treat the wound. The Minie bullet was the ammunition of choice, and unlike past
bullets caused severe and often fatal damage to its victims. Named after the French army
Captain Claude Etienne Minie, the Minie bullet expanded when fired, and because of its
conical point was more aerodynamic and therefore was capable of increased speed.8
Unlike modern bullets, the Minie did not pass through flesh and bone neatly, but instead
ripped through the body tearing bone and muscle along the way, leaving the physician
little choice but to amputate the damaged extremity. According to the Union’s official
list, “major’ amputations of limbs, that is to say hands, feet or whole limbs, peaked at
thirty thousand. However, in light of the fact that there was wholesale disorganization
7
8
C. Keith Wilbur, Civil War Medicine 1861-1865, p. 3
Ibid, p.45-46
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within the medical sector of the Union military, it is safe to assume that the true numbers
may have been higher.9
Surgery itself was a nasty business, often taking place with little more than a
table, a bone saw and a chloride soaked rag. The physician would render the patient
unconscious by holding the rag over his face until he went limp, and then amongst the
company of nurses, physicians assistants, soldiers and those in line next for surgery, the
surgeon would quickly saw off the extremity, toss it into a pile and patch up the wound
before moving on to the next victim. Often those who survived the surgery contracted
gangrene, which in the Oxford Pocket Dictionary is defined as “death and decomposition
of a part of the body tissue, usually resulting from obstructed circulation.” Many soldiers
who suffered from a gangrene infection had their wounds re-amputated, and if this did
not stop the infection from spreading, there was little to no hope of survival.10
The Civil War was a military disaster in terms of the scale and length required in
order to end it. The scope of loss can be summarized by comparing the numbers of
enlisted men who died in battle compared to those who died of disease. According to the
National Library of Medicine, 110,070 Union soldiers perished in battle, while another
224,586 died from disease. On the Confederate side, 94,000 were killed in battle, while
another 164,000 died from disease.11 In both cases, the number of soldiers who died due
to disease is more than twice the numbers of those killed in battle. Many others suffered
the miseries of infection, loss of limbs, while the “lucky ones” lived through
excruciatingly painful recoveries. During the war, organizations like the Sanitary
9
Christopher J. Olsen, The American Civil War; A Hands-On History, p.196
C. Keith Wilbur, Civil War Medicine 1861-1865, p. 48-49
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11
Ibid, 108
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Commission sought to clean up military camps and hospitals, believing that sanitary
conditions combined with nutritious meals and clean drinking water would greatly
improve the health of Union soldiers. Their mission paved the way for future medical and
military practice, but for Civil War soldiers it was too little, too late. By the end of the
Civil War, those who had suffered a battle related injury were typically dead, or missing
a limb, and future medical advances could not change the horrific suffering, mutilation
and loss of life experienced by hundreds of thousands of soldiers and their families
during the Civil War.