By Bruce Clarke
Civil War Medicine
Most material adapted
from CWI’s 2006
Conference.
Introduction…
Before the war broke out, the
US army had 108
surgeons/doctors
24 went to the Confed.
3 discharged for treason
81 remained…most in the
eighty western forts…
?? How many surgeons by
‘65???
North?
South?
Green sash, piping on uniform
for medical officers
Answer
Union: 12,000
Confederacy: 3,200

The “war was
fought at the end
of the medical
Middle Ages”
 Surgeon General William
Hammond
40

The number of army
hospital beds in
Washington on the eve
of Bull Run, 1861.
1861: several small infirmaries
1865: 204 large hospitals
186,894

The number of beds in
army hospitals by
1865.
A brief survey of the state of pre-Civil
War Medicine




18th century: Benjamin Rush
Jacksonian era disputes
Education
Anesthesia
The American Hippocrates
(1745-1813)

Dr. Benjamin Rush
 Educated in Edinburgh &
Paris
 Continental Congress
 Abolitionist
 Instructor in Philadelphia

2250 students
 “Heroic therapy”

Bleed (phlebotomy)
 blister and purge
 What sets him apart:
Convincing writer, speaker
and a tireless teacher
Greco-Roman Formula Updated


A “fever” was a catchall term for virtually any
illness
Imbalance of 4 elemental fluids or humors
 Blood (sanguine), Black bile (melancholy),
Yellow bile (choloric),Phlegm (phlegmatic)
 “there is but one exciting cause of fever and that
is stimulus that consists in a…convulsive action
of the blood vessels” - Rush
Jacksonian Era gave rise to the
Antebellum Doctor Wars…




Democratic spirit
Reform movements
Skepticism about heroic
method
The regulars fought the
irregulars
 “Heroics” vs:

Thomsonism
 Excess of cold in body



Hydropaths
Graham’s vegetarianism
Homeopathy
 Like is cured by like
2500 homeopaths in 1861
With society, colleges, etc
Medical Education



Apprentice for 2-3 years at $100
year
Attend a local diploma factory
Or the more ambitious attended
one of 8 medical schools 2
years @$125 term
 (content repeated)



Textbooks were shared.
If passed exam...
Pay $30 for diploma
And…presto
you can do amputations!
Education


Joseph Pancoast’s
manual:
"A Treatise on Operative
Surgery", Philadelphia,
1844
 Daguerreotypes added in
1852
 Note that most of these
procedures done without
anesthesia until late 40s,
early 50s!!
Ether first successful in1846

At Mass General
Hospital (Harvard)
 “Gentlemen, this is no
humbug” - John Warren

In the Civil War, ether
and chloroform were
used using a paper or
cardboard cone with
drops of the liquid, or
using device shown.
Ether’s combustibility made the army prefer chloroform, however…
Dr. Morton
Dr. Bigelow
Dr. Warren
Guy with growth on neck
Dirty hands
First Successful Operation Using Ether
1846
http://neurosurgery.mgh.harvard.edu/Rounds
What was the impact of the Civil
War on medicine?


Thomas Eakins
“The Gross Clinic”
 1875
 Sophisticated for
its time;
What do you see?
Or not see?
One clue…
Lasting impact should be measured by
administrative care that was systematic
and organized, impacting Western world
1.
2.
3.
4.
5.
6.
7.
Discipline imposed on an undisciplined profession
A huge body of excellent medical records made.
Awakening populace to importance of hygiene and nutrition.
Created a huge number of doctors and nurses that spread out to
nation after war, improving health care.
Experience with rarer pathologies that all took with them to smaller
practices after the war.
Mingling of men with higher medical training with those of less had
educational and democratic great value.
State of the art hospital design exported to the world.

Union :
 1861: Finley: bad
 1862-64: Hammond: excellent

Issued hygiene regulations





Water horses downstream
Locations of latrines
Burying trash
Enlarged record keeping
Photographs of pathologies,
procedures, results
 Many good hospitals built
 1864-65: Barnes: (due to
Stanton/Hammond clash)

Confed: Samuel Moore:
excellent
Surgeon Generals
Major Jonathan Letterman: “Father
of Modern Battlefield Medicine”


Gen. McClellan’s choice
as Medical Director, Army
of the Potomac
Completely reorganized
 a triage and evacuation
system
 implemented Battle of
Antietam
 system still used today.
Antietam:

Pry Farm Barn: 1862
Rebirth of Medicine
Preserved Today
Field hospitals were very often people’s homes
commandeered by the army; The Pry farm near Antietam
was so devastated economically that its owners declared
bankruptcy soon after.
Ambulance Corps Started

Begins training of
ambulance corps with
set drills.
 How to walk with a
stretcher

Rosencrans
ambulance designed with springs for patient
comfort!
Lincoln at Antietam

Recognizes Letterman
 Gets a tour of the
“Letterman Plan” in
action.
How were black soldiers treated?

There is no substantial
body of evidence of
how black soldiers
were treated medically
 A few black surgeons
were assigned to black
units
3/4 who die, die of disease

Largest killer was dysentary
 Typhoid
 Measles, chicken pox, syphillus, tb, heat stroke,
reptile bites, battle fatigue
 And gangrene…
 Minie
balls entered with bits of dirty uniform, grease
from the barrel…
Nursing as serious work


Sisters of Charity
US Sanitary Commission






Secular
National org.
Dr. Elizabeth Blackwell : idea
Dr. Henry Bellow Pres.
Frederick Law Olmstead Gen Sec
US Christian Commission
 saving souls and bodies
 State by state

Nursing Corps.
 Dorothea “Dragon” Dix
Superintendant

Not a nurse: Clara Barton:
collecting donations, aid and
resources for medical and
humanitarian aid: later …
 American Red Cross
Myth: Surgeons were heartless butchers
who had patients bite a bullet during
surgery…
Camp Letterman Gettysburg

Team of 3 would look at patient, and all would
have to agree that amputation was required to
save the patient’s life. Amputations were avoided
whenever thought possible.
 Teeth would break…they bit on wood or leather if
chloroform was not available.
Orthopedics are rooted in the
War: Prostheses
Postwar: Joseph Lister Lectures
in USA, Garfield Dies Anyway

Developing Pasteur’s (1869) germ theory at
Philadelphia : Worlds Fair 1876




Wash your hands
Clean everything
Don’t use a scalpel twice
Controversy ensues: general acceptance only
comes in late 1880s
The Case of James Garfield

1881, Garfield is shot in Washington DC by a
disgruntled office seeker.
 Bullet only hits muscle, no organs

His doctor, Dr. Doctor W. Bliss was anti-listerian
 Put fingers into wound, put tubes in to drain fluids
 Garfield didn’t eat for 7 weeks due to all the morphine,
and opium given him
 Bliss writes a long report, justifying all he did

Young doctors who’d trained in Europe thought
Bliss crazy: ……“ignorance is Bliss”
Transformation of Western Medicine

The Medical and
Surgical History of the
War of the Rebellion
 Read widely
Transformation of US Medicine

Gerster: publishes
major textbook in 1888
 Senn :
Bacteriology1889
 Johns Hopkins
Hospital (1889) and
School of Medicine
 Required much more
 First to allow women
enter on equal basis
Between 1890 and 1911, the US will leapfrog forward to
become a leader in surgery and medicine.
Eakins “The Agnew Clinic” 1889, Philadelphia
1890s


Within months of Roentgen’s discovery of
the x-ray (1895), US doctors explored it and
wrote a good textbook on it.
US doctors are the first to advance the
proper treatment of appendicitis by surgery,
which becomes a textbook operation.
Book and Internet Resources

Rutgow, Ira. Bleeding Blue and Gray. New York: Random
House, 2005.
Web sources:
 Civil War Homepage. http://www.civil-war.net (18 Aug
2006).
 Civil War Medical Care, Battle Wounds and Diseases.
http://www.civilwarhome.com/civilwarmedicine.htm (10 Aug
2006)
 National Museum of Civil War Medicine, Frederick,
Maryland
 http://www.civilwarmed.org/index.cfm (Aug 10 2006)