Civil War Medicine
By Chris Moulton ADVANCE Staff
In 1862 Dr. Julian John Chisom, a confederate surgeon, recommended to
Gen. Clifford Pemberton commander of the forces in South Carolina, that he
evacuate James Island off of Charleston because he believed malaria would
kill more of Pemberton men than the Union ever would.
Although events like this did not significantly sway the course of the
South's or the North's military fortune, disease in general did much to
decimate the numbers on both sides during the Civil War. More people died
from infection and disease during the four-year engagement than from the
bullets themselves.
According to Terry Hambrecht, MD, a research physician at the National Institutes of Health and editor of American Armamentarium Chirurgicum, a
book detailing Civil War surgical instruments, roughly two people died of
disease for every one that died of bullet wounds.
ALTHOUGH doctors during the Civil War knew about contagion and infection, they were not aware of the role of microorganisms.1
"Civil War medicine was a lot of learn-by-doing," said Michael Rhode, archivist at the National Museum of Health and Medicine in Washington, DC. "The
better doctors would have some training, but a lot were not educated. They
did not know about disease theory and so no one bothered about washing
their hands. However, if the doctors poured whisky over their hands the
patient would more likely survive."
Doctors would often use the same sponge to clean more than one patient's
wounds, said Dr. Hambrecht. The Confederacy, he said, was short on sponges
and would often use rags for this purpose. Occasionally they would wash the
ragout in hot water, inadvertently stopping the transmission of infection
from wound to wound.
The Confederate doctors also would sometimes run out of suture material
for sewing wounds and as a substitute would use horse hair. This was also
slightly advantageous to them since to make the horse hair pliable they
would boil it in hot water.
"Laudable pus" was the term physicians of the day applied to a certain kind
of pus which they felt was good. In a sense the surgeons were correct to believe this, since pus represents evidence that the white blood cells are doing
their job, Dr. Hambrecht noted.
MOST SURGEONS THOUGHT that probing wounds with their fingers was a
better way to trace the track of a bullet wound than the use of an instrument.
"They did not recognize the danger of introducing microscopic foreign
bodies into the wounds," said Dr, Hambrecht.
Some hospitals during the Civil War would use old dressings for use on new
patients.1 Considerable abuse resulted from the government's failure to
supply enough emergency dressings. Soldiers would use unclean
handkerchiefs and cloth torn from their shirts for this purpose.
Fevers such as tetanus, erysipelas, hospital gangrene and pyemia were
another great threat to wounded soldiers, many of whom had undergone
amputation. Erysipelas is believed to have been caused by Streptococcus
pyogenes. Tetanus is caused by Clostrium tetani
Pyemia, poisoning of the blood caused by the absorption of pyogenic microorganisms, was nearly always fatal to its victims.2 Those infected suffered
from multiple abscesses, jaundice, profuse sweating, chills and fevers. Of
the 2,818 reported cases of pyemia, in the Union army only 71 men
recovered3. In the South the disease reportedly caused 35 percent of all
deaths following amputation.
TREATMENT consisted of providing a nourishing diet and the application of
stimulants such as dilute sulphuric acid or quinine.
Tetanus, only slightly less fatal than pyernia, was much rarer.1 It was uneven
in its distribution. Whole battles could be fought that were free of the
bacterial infection, while other engagements would result in numerous
wounded sick with the disease. Tetanus at the time was attributed to many
causes—night air and drafts, exposure to excessive heat or cold, injuries to
nerves while a surgeon probed and operated, bone splinters or bandages and
neglect of thorough and early cleansing of a wound.
Although they did not know it during the Civil War, Clostridium is frequently
found in the soil. It can be carried in the intestines of horses so that ground
fertilized by horse manure is likely to be contaminated. This is possibly the
explanation why so many cases of tetanus appeared among injured Union
soldiers after the Battle of the Wilderness, Wounded soldiers belonging to
the Army of the Potomac were put to bed in stables in Fredericksburg after
the famous battle
ALTHOUGH bearing a far lesser fatality rate than pyemia, hospital gangrene
was the most feared surgical disease. Starting as a small black spot,
gangrene can appear on a healing wound and spread rapidly across a patient's
leg or arm resulting in extensive tissue death. The tissue death would result
from the cessation of blood circulation or by bacterial infection.
Records show that 2,642 cases of hospital gangrene afflicted soldiers of
the Civil War.3 Approaches to treating the disease varied, depending upon
the surgeon. Some preferred using the knife, while others preferred
corrosive chemicals such as nitric acid. Miscellaneous remedies such as
chlorine, turpentine, yeast and charcoal were also employed. By the time of
the Battle of the Wilderness in 1864, however, doctor in the Union had
discovered that bromine served as an effective remedy to hospital gangrene.
Erysipelas was characterized by reddening and swelling of the affected areas. It can be transmitted by dirty instruments, dressings and doctor's
hands. Death from the disease was about 8 percent. However it was known
to assume a more lethal form during epidemics. Besides drainage and cold
water treatment of the lesions patients were given nourishing food and much
whisky.
Hemorrhages of smaller vessels were packed with what a modern military
surgeon has described as "astringent, coagulant and generally harmful
drugs."' In the North the styptic most often used was persulphate of iron1.
In one recorded case nurses working in four-hour shifts pressed their
thumbs to a bleeding artery for a week to control hemorrhaging in a Union
hospital, while another tale is told of a similar nurse relay in a Confederate
hospital lasting three weeks.
Although the Civil War took place before Lister published his first paper on
antisepsis in 1867, Civil War surgeons did use carbolic acid and a number of
other substances which today are known as antiseptics. However, the surgeons did not know to use the antiseptics until the wound had reached a high
level of infection.
While Union surgeons considered maggots to be a pest that badly needed to
be cleaned from the wounds, the Confederates discovered that the grubs
could actually be beneficial. Maggots scavenge the tissue, eating away
diseased matter in a wound, leaving the clean and healthy tissue behind.
CIVIL WAR surgeons used chloroform and ether during operations.4
Chloroform, because of its smaller bulk, speedy action and noninflammability
was preferred to ether. A third agent, a mixture of the two, was also used.
During the war about 80,000 administrations of general anaesthetics were
given, 76 percent of which were chloroform. Only about 43 people died from
anaesthetic during the war.
The low death rate from anaesthetics possibly was due to the method of
administration. Dropped on to a folded cloth or towel or onto a paper cone '
with a sponge in its apex, the anaesthetic would be gradually lowered toward
the patient's nose and mouth and withdrawn on full anaesthetic.
Since most operations were performed in tents or outdoors, fresh air would
mix with the anaesthetic vapors.
Aside from the infections that afflicted those with wounds, there were
several diseases ravaging the men in blue and grey.
While many diseases were recognized clinically, no one knew how they were
transmitted, caused or how to control them.4 The one exception to this was
smallpox. Although the treatment for this disease was not completely effective, Civil War doctors could modify the epidemiology of the sickness.
Vaccination was used to prevent smallpox, explained Dr. Hambrecht, Cowpox
is caused by a virus very similar to smallpox, but cowpox produces only a mild
disease in humans. Soldiers who are inoculated with the relatively harmless
cowpox virus, became immune to smallpox. In the Civil War, this was done by
placing a cowpox scab from a person with cowpox or from a previously
vaccinated person on the skin of the person to be inoculated and then poking
the scab with a sharp, pointed instrument such as a needle. This introduced
some of the virus beneath the skin, resulting in immunity.
Dysentery and diarrhea were among the most common diseases during the
Civil War,4 The impact of these diseases on the Federal army is shown by
the number of cases—1,739,135. And the death rate increased during the
war. The death rate per 1,000 mean strength increased from 4.2 in the first
year to 21,3 in the last year. Information on the death rates from dysentery
and diarrhea is not available for the Confederate Army, but there is
evidence to suggest that it was at least as common in the South.
ALTHOUGH there were numerous treatments for enteritis, none were
specific and in all likelihood none were effective. Since the disease was selflimited, many different treatments seemed beneficial for acute diarrhea.
Among the many remedies used was sulphate of magnesia which one surgeon
thought to be effective in the Corinth campaign of 1862. Supposedly, 150
barrels of it were ordered by the medical director of Grant's command.
The second most common camp disease was malaria. Present in all military
districts, it was predominant in those that were warm and wet. Mostly
striking in September and October, the disease could hit earlier in the year
as well The most severe outbreaks of malaria occurred in the South where
there was a combination of much water and a long warm season. Although
malaria was common in the South, the Northern troops had encountered the
disease before. However, it was the Union regiments from the New England
states, Michigan, Wisconsin and Minnesota that were hit the hardest.
According to Dr. Hambrecht, malaria was thought to be caused by miasmas,
the poisonous atmosphere believed to rise from swamps. They did not know
the mosquitoes from the swamps were carrying the disease. Perhaps the
most effective therapy during the Civil War was the use of quinine. It was
also used as a prophalactic for malaria.
Typhoid fever was an important threat to the troops.4 Its occurrence was
attributed to prolonged stays in unsanitary camps.
Other diseases that affected the soldiers were measles, mumps and pneumonia, with the latter thought to be caused by bad air. If a building was not
well ventilated, it was thought this could cause disease. Indeed, soldiers in
tent hospitals fared better than those in wooden hospitals.
The doctors of the time did not know that while the tents were moved often
leaving the microbes in the ground behind, the wood in more permanent
hospitals became contaminated with the many different bacteria and so
posed a continued threat to the convalescing troops.
It was also true that soldiers from rural areas were more likely to be
stricken with disease than their urban counterparts. Those from the city
had been exposed to more childhood diseases and had developed immunity to
some of them, while those from the countryside did not tend to have this
advantage.
THE MYSTERY and uncertainty surrounding the fight against disease is
summed up by a volunteer who committed to print his views on the subject
when he wrote from Harper's Ferry, in November, 1861, where his regiment
was stricken with illness:4
I hope we shall steadily improve. There is a hopeless desperation chilling one
when engaged in a contest with disease. The unseen malaria has such an
advantage in the fight I had rather meet anything for the regiment than the
enemy who surprised us in our former camping-ground and who seems hardly
yet to have given up beat... A week on a high piece of ground three miles
from the river would put us all on our feet again. But as long as the morning
sun rises only to quicken the fatal exhalations from this pestilential Potomac,
and the evening dews fall only to rise again with fever in their breath, the
contest is unequal and the victory uncertain.
Hospitals during the Civil War were divided into three types of treatment
facilities. Behind the battlefield, among the troops in the rear was the field
dispensary. Here emergency bandages were applied and splints placed on
broken legs, according to Dr. Hambrecht, the Civil War historian. Major
hemorrhages were stopped and occasionally tourniquets would be applied.
The wounded were then loaded on ambulances, which were either two-or
four-wheel carts or wagons. The two-wheeled wagons were said to cause
more pain because they tended to rock.
SITUATED A mile or so from the battlefield was the field hospital Here
amputations were performed, wounds explored and foreign bodies removed.
Finally, there were the general hospitals located in the cities where the
wounded were sent for long-term care.
As the war developed the medical corps in the South were required to move
their hospitals more often. When Sherman's army marched through Georgia,
the South's general hospitals were constantly being moved, said Dr.
Hambrecht.
Medically speaking, many opportunities for important discoveries and advances in the Civil War had been missed. Only limited advances were made in
diagnosing, classifying or treating diseases.4 But the stage was set for the
major breakthrough to be produced by the germ theory and the concept of
antisepsis which were soon to follow.
Obviously, the Civil War was not fought just on the battlefields against
enemy soldiers, but also in hospital wards and surgical tents against the
scourge of disease, gangrene and infected amputations.
References
L Adams, George, Doctors in Blue, 1952. New York: Henry Schuman.
Cunningham, H.H., Doctors in Gray, 1958.
New York: Louisiana State University Press.
Brooks, Stewart, Civil War Medicine, 1966.
Springfield, IL: Charles C. Thomas.
Steiner, Paul E., Disease in the Civil War
1968. Springfield, IL: Charles C. Thomas.