Civil War: Medicine

Doctors• Beginning of war: 30 surgeons, 83 assistants.

• End of war: 11,000 surgeons/assistant surgeons.

• Most civil war doctors got their diploma in 13 weeks.

• The most prestigious schools had 2 year doctor programs. The programs were a series of lectures that a “student” attended two times.

• If a surgeon was unavailable, anyone with a knife, saw, and tough stomach would perform surgery.

Level of Care: Field Dressing Station

• Set up behind the Set up behind the fighting lines. fighting lines.

• Wounded soldiers Wounded soldiers were evaluated, were evaluated, given morphine or given morphine or liquor, and liquor, and bandaged.bandaged.

• If they couldn’t If they couldn’t return to battle, return to battle, they were taken to they were taken to a field hospital.a field hospital.

Field Hospitals

• Located in barn or tent 1-2 miles from the battle.

• Wounded soldiers were triaged into 3 categories:

• mortally wounded (Soldiers wounded through the head, belly, or chest were left to one side because they would most likely die)

• slightly wounded• surgical cases

(amputations)

A surgeon recalled: "We operated in old blood-stained and often pus-stained coats, we used undisinfected instruments from undisinfected plush lined cases. If a sponge (if they had sponges) or instrument fell on the floor it was washed and squeezed in a basin of water and used as if it was clean."

Pavilion Hospital -Prior to the war, no real hospital systems exist in the US. - By the end of the war, hospitals in the North and South average an 8% mortality rate.

Medication• Chloroform was used

in most operations.– Liquid form in the

north. – The South invented an

inhaler to stretch their limited amounts.

-Morphine was known, but only available in small doses. - Opium was the drug most commonly used to relieve pain. HOWEVER, the surgeons did not know that opium was addictive. - Alcohol was used as a substitute for any of the above medications if they were unavailable.

Amputations• Total number for both

sides is over 50,000.• If performed within 24

hours, the victim had a 75% chance of survival.

• A good surgeon could amputate a limb in under 10 minutes. If the soldier was lucky, he would recover without one of the horrible so-called "Surgical Fevers.”

Complications

• There was no knowledge of disease causing bacteria, so antiseptics were not used during surgery.

• Due to a frequent shortage of water, surgeons often went days without washing their hands or instruments, thereby passing germs from one patient to another as he treated them.

Complications Continued:• Doctors believed that “laudable

pus” meant that the wound was healing correctly. We now know that visible pus means an infection.

• Infections set in after a surgical procedure, most commonly:• Gangrene, the rotting away of flesh

caused by the obstruction of blood flow.• Pyemia- blood poisoning with a 90% mortality

rate.• Antiseptics were provided only after a

fever was visible. At that point it was often too late.

Disease• Disease was the biggest killer of the war.

– Federals: three out of five died of disease– Confederates: two out of three died of disease

• Camps were unsanitary, and garbage, waste, and other refuse often polluted water sources and mixed with living conditions.

• Close living quarters caused disease to spread from man to man very quickly.

• Poor diet and exposure to the elements only added to the burden. A simple cold often developed into pneumonia.

       

Diseases•  NUMBER 1 KILLER: Typhoid fever (camp fever). Perhaps one-

quarter of noncombat deaths resulted from this disease, caused by the consumption of food or water contaminated by salmonella bacteria.

• NUMBER 2 KILLER: Bowel disorders constituted the soldiers' most common complaint. The Union army reported that more than 995 out of every 1,000 men eventually contracted chronic diarrhea or dysentery during the war; the Confederates fared no better.       

• NUMBER 3 KILLER: Colds turning into lung diseases like pneumonia and tuberculosis.

• Malaria spread through camps located next to stagnant swamps teeming with mosquito. Although treatment with quinine reduced fatalities, malaria nevertheless struck approximately one quarter of all servicemen.

Advancements- Chest wounds

• At the onset of the war, a sucking chest wound (punctured lung) was almost certainly a death sentence.

• Dr. Howard found that if he closed the wound with metal sutures, followed by alternating layers of lint or linen bandages and a few drops of collodion (a syrupy solution that forms an adhesive film when it dries), he could create an airtight seal.

• Survival rates quadrupled, and Howard’s innovation soon became standard treatment.

AdvancementsThe Plastic Surgery Revolution• Carleton Burgan of Maryland was in terrible shape. The 20-year-old

private had survived pneumonia, but the mercury pills he took as a treatment led to gangrene, which quickly spread from his mouth to his eye and led to the removal of his right cheekbone

• In a pioneering series of operations in 1862, a surgeon from City Hospital in New York used dental and facial fixtures to fill in the missing bone until Burgan’s face regained its shape.

• To some, it seemed pretty wacky, like sci-fi for the 19th century.

Advancements:Ambulances

- At Bull Run, the Union had hired civilian carriage drivers to take the wounded back to DC. - Not surprisingly, they saw the battle and fled. - The wounded from Bull Run walked the 30 miles back to DC.

Ambulances - Jonathan Letterman, medical director of the Army of the Potomac, established caravans of 50 ambulances, each with a driver and two stretcher bearers, to ferry the injured to field hospitals.

- On September 17, 1862, the Battle of Antietam left 2,108 Union soldiers dead and nearly 10,000 wounded. The Ambulance Corps moved all 10,000 wounded Union Soldiers from the battlefield to field hospitals in twenty-four hours.  For this success Letterman earned the title of “Father of Battlefield Medicine.”

Battlefield Angels!!!

CLARA BARTON“I went in while the battle raged," she recalled with pride. After the war, she was instrumental in the creation of an American branch of the International Red Cross.

DORTHEA DIXA week after the attack on Fort Sumter, Dix, at age 59, volunteered her services to the Union and received the appointment in June 1861, placing her in charge of all women nurses working in army hospitals.

•3,200 women served as nurses•Lived in tents or hospital wagons•Risked their reputation- targets of gossip•Paid $12 month

End Results…

• Nearly 3 million men fought in the Civil War.• Approximately 618,000 lost their lives, and nearly 400,000

of these to disease.  • The death toll was nearly 2% of the entire US population.• Of the men lucky enough to be in the 79% who survived

the war, nearly half a million returned home permanently maimed or disabled.

• * One million horses also died in the war.