Medicine in the American Civil War

by Dr. Mary Williams, R.N. D.C.

The Civil War came at a time when there were very few advancements in terms of medicine and the treatment of injuries and ailments. Even some of the most basic life-saving techniques, such as CPR, were not heard of or developed at that time. Although medications and methods of treating injuries were in their infancy, the weapons of war were advancing, as was their ability to wreak havoc on the human body. As a result, this created problems when it came to saving the lives of soldiers; however, a lack of modern techniques such as CPR was only a part of the problem. Severe infections were also common and hindered treatment and the healing process. Because the overall living environment of the soldier was unsanitary, as were field hospitals and dressing stations, disease also ran rampant. When it came to the death of Civil War soldiers, illness was twice as likely to be the culprit versus an injury sustained in battle.

Hospitals

At the onset of the war, makeshift camps and hospitals were set up to treat the injured. These hospitals were generally warehouses, churches, barns, or other buildings that were confiscated for this purpose. They were often not large enough or equipped for meeting the needs of the injured. In addition, these camps and hastily created hospitals were often disorganized and chaotic. As the war continued, the use of these centers and hospitals changed and became increasingly more organized. Field stations, which were located near battle, were a first stop for the injured. Here, the wounded soldiers received some form of help for pain, typically whiskey. In addition, this is where any initial bandaging took place. Soldiers who required more intervention were taken to field hospitals. These hospitals developed a system of triage in which soldiers were divided by need. The three categories of need were those who were in need of surgery, injuries that were of a mortal nature, and injured soldiers who did not require surgery and were not mortally wounded. Soldiers needing more or longer care were then sent to larger, general hospitals, which were set up in some of the big cities.

• Medicine in the Civil War: The University of Toledo briefly discusses injuries sustained during the Civil War, sanitation, changes in hospitals and staffing, and disease and infection. The development of an ambulance corps is also touched upon.

• Medicine in Virginia During the Civil War: The Encyclopedia Virginia discusses medical treatment of soldiers in this in-depth article. On this page, readers can read about hospitals, diseases, pain control, transportation, and other problems with Civil War treatment.

Transportation

The transportation of injured and ill soldiers went through many changes during the Civil War. The beginning of an organized ambulance corps was developed to cart soldiers to hospitals. Hospital trains were also commonly used to carry soldiers to general hospitals. These could transport large numbers of injured people at one time, which made good use of the budding train system. Steamers, known as sanitary steamers, were also used to carry soldiers to hospitals for care.

• Civil War Medicine: 37 Pieces of History: This CBS News slide show features 37 images and their descriptions that portray the state of Civil War medicine. This information includes materials from medical train images to instruments used in surgery and medications.
• Vicksburg National Military Park: Civil War Medicine: The National Park Service offers this PDF that outlines medical care during the Civil War. Information regarding the care that was provided is divided into sections such as transportation, hospitals, amputation, etc.

Sanitation

Although hospitals underwent some advancements, sanitation continued to be a problem, particularly in field dressing stations and field hospitals. Doctors did not have a concept of germs and bacteria or how they spread infection. Surgeons often tended one patient after another without use of gloves or proper cleansing of the hands or equipment. Sterilization of instruments did not occur, and when instruments were wiped off, it was often with soiled surgery aprons, soiled cloth, or even the surgeon's dirty boot strap. Thick and creamy pus, which was referred to as laudable pus, from wounds was mistaken as a good sign of healing and was not recognized as a sign of infection. It, along with blood and other bodily fluids, could be found on surgical aprons, bedding, and even the floors. Soldiers who received care often remained in their filthy uniforms while in field hospitals, even after treatment. In terms of healing, poor sanitation often led to infection, which was a significant hurdle for injured soldiers at the time. In addition to infection, poor sanitation was also commonly the cause of disease among the troops.

• Two-Thirds of Civil War Soldiers Died of Disease, Not Wounds: This link opens up a PDF that reviews the poor sanitation and lack of sterile technique during the Civil War. A large part of the article also lists diseases that were responsible for a large number of deaths.

• Civil War Medicine: An Overview of Medicine: Read about Civil War-era medicine and surgery issues in this overview by Ohio State University. It covers the types of diseases that threatened the lives of soldiers as well as the nature of the unsanitary conditions that made infections so common. Battlefield surgery and the success rate of anesthesia are also covered here.

Anesthesia

In 1846, the first record of using anesthesia was made, just 15 years before the Civil War. Anesthesia was used as much as 90 percent of the time during surgeries such as amputations. The two most common types of anesthesia were chloroform and ether. Chloroform was used roughly 75 percent of the time during Civil War surgeries. It was often given to the patient by applying it to a cloth and draping it over the nose and mouth until unconsciousness. This was known as a technique called open drop. Ether was a combination of alcohol and sulfuric acid and was a common anesthetic during the war. At times, patients were not fully unconscious during their surgeries. When this happened, they often did not feel the pain but were aware of what was happening.

• Anesthesia Came of Age During Civil War: This link is associated with the UAB School of Medicine and discusses anesthesia during the Civil War. The page discusses chloroform and ether.

• Civil War Medicine: General Information: By clicking on this link, readers are taken to information regarding the Civil War and how medicine was practiced. Information found on this page includes videos about anesthesia, biting the bullet, and African-American surgeons.
• Civil War-Era Medicine: Physician and Civil War history expert Thomas Sweeney explains the myths and realities of Civil War medicine in this article. Logistical problems, overwhelmed medical staff, and wartime inexperience are some of the problems he talks about. He also covers advancements in anesthesia, the survival rate of different types of wounds, and when doctors actually performed amputations.

Amputations

New types of ammunition during the Civil War, like the Minie ball, created injuries with damage that had never been encountered during wars of the past. The extent of destruction from this slug was massive, as it would not only crush the bone at impact but also destroy the bone three inches around the impact. Because of the extreme damage, surgeons often felt removing a limb was the best way to quickly save a life. In addition, gangrene also played a major role in the high number of amputations that took place. There were an estimated 50,000 amputations made over the course of the war, leaving many soldiers without arms, legs, or feet. At the beginning of the war, many of the surgeons were unfamiliar and inexperienced with performing amputations. The sheer number of amputations quickly changed this, and doctors were soon doing numerous surgeries daily. There were two surgical techniques, or methods, that were employed when performing an amputation. The most beneficial technique in terms of speed and convenience was the circular method. This method allowed the surgeon to cut right through the limb and could be done even in dim lighting. While this method left the amputated site open, the fish-mouth flap method did not. With this method, the surgeon made a flap of skin that resembled the mouth of a fish and used it to cover the amputation site.

• Amputations in the Civil War: Review this article on NCPedia to learn about amputations that took place during the Civil War. In the article, readers will also learn about methods used to perform the surgery, see a picture of an amputation kit, and also read about fake limbs.

• The Horrors of War: Click on this link to open up a page of the Life and Limb exhibition program featured on the U.S. National Library of Medicine website. The page discusses both wounds and diseases of the war.

• Civil War Medicine and the RCH: Rochester City Hospital was one of the hospitals that provided care for soldiers in the later years of the Civil War. Click this link to read about their most notable Army surgeons as well as the health threats they faced, including diseases. They also talk about issues concerning battlefield surgery.

Medications

There were a number of medications that were frequently used in the treatment of Civil War soldiers. These medications were used to treat disease, infection, and pain. An example of a medication for the relief of pain was Dover's Powder. This was a mixture of ipecac and opium. In fact, opium had many uses during the Civil War, as it was used not only to treat pain but also in the treatment of severe diarrhea, pneumonia, and bronchitis. Quinine, another common drug at the time, was used to treat common deadly diseases such as malaria. Calomel, which was used in the treatment of dysentery, was a powdered medication that contained mercury and was carried in paper pouches. As previously noted, alcohol in the form of whiskey was also used as a pain-relieving medication and was carried by medical personnel.

• Disease in the Civil War: Click on this link to learn about diseases and infections caused by poor sanitation in camps and during treatment. This article also reviews some of the common medications used at the time, such as opium.

• Medicine and Its Practice During the American Civil War: This is an in-depth PDF on medicine during the Civil War. It extensively covers topics such as hospitals, medications, disease and lack of proper sanitation, and the transportation of injured soldiers.