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11/16/24, 8:33 PMHistory - Article - medicine in the Civil War era

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medicine in the Civil War era       

Both hospitals and medical processes were rudimentary in the 19th century. Before the Civil War, hospitals played a small role in American medical care and were generally run not by doctors but by "civic-minded" leading citizens of the community where the hospital was located. The Civil War, which brought great numbers of people together into squalid military camps and brutal combat, only served to accentuate the shortcomings of medical care in the era. The doctors who treated soldiers had received their training almost exclusively from mentors who used the antiquated methods standard in American medicine at the time. While university and college courses of instruction were on the rise, even the most prestigious schools frowned upon clinical and laboratory work.

Adding to the health challenges facing the United States was the fact that medical methodology much more closely resembled medieval practices than anything "modern." Pharmacology was primitive and employed medicines that, in large doses, created the same symptoms as the targeted disease. In fact, several outright poisons, such as mercury, were commonly prescribed. Modern antibiotics were unavailable, and sterilization by heat was unknown. The concept of antiseptic surgery was introduced in Europe by Joseph Lister in 1867, but it took 10 to 15 years for its practice to become generally adopted. Training by apprenticeship perpetuated methods of diagnosis and treatment that fixated on bodily fluids, methods that dated back to Aristotle. Doctors observed urine, feces, blood, and pus to determine the nature of the problem. The prevailing medical opinion was that the body sought to cure itself by excreting toxins. Thus, diarrhea, vomiting, bleeding, or secretions resulting from infection were to be encouraged or induced. It is little wonder that the soldiers of the Civil War hid all but the most dreadful maladies from physicians.

As soon as the fighting broke out in earnest in 1861, the inadequacies of the respective medical corps of both the Union and the Confederacy became quickly and ominously evident. Clement A. Finley, the

11/16/24, 8:33 PMHistory - Article - medicine in the Civil War era

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newly appointed head of the Union's Army Medical Bureau, was widely regarded as grossly incompetent. Health examinations of recruits and volunteers were not a priority, and as soon as the camps formed, the federal o!icials found that nearly a quarter of their men were unfit to enter battle. Samuel Preston Moore was responsible for building the Confederate Medical Department, but he was hindered by drastic shortages of supplies. Neither the Confederate national government nor the individual states had a method for commissioning physicians.

At the first major clash of the war, the First Battle of Bull Run in July 1861, most of the doctors on both sides were regimental physicians supplied by the states, and their scant numbers le" them no chance of e!ectively tending to the wounded. Ambulances were nearly nonexistent; additionally, there was no system in place for their use. Horribly injured soldiers mostly had to fend for themselves wherever they happened to fall.

The Union created the United States Sanitary Commission in June 1861 with o!icial duties limited to conducting investigations and providing advice. Sta!ed by dedicated and diligent workers, the commission quickly became vital in improving conditions in the military camps. The commission submitted a scathing report of Clement Finley and his medical bureau in September 1861 and persuaded Congress to fully reorganize the army's medical services. Dr. William A. Hammond, Finley's replacement, established an excellent working relationship with the commission. He assigned Jonathon Letterman as medical director of the Army of the Potomac. Letterman was largely responsible for initiating the structure of the Army Medical Department that existed through World War II. Of immediate importance to the men in the field was the ambulance corps, which, by the Battle of Antietam in September 1862, was providing vital service in the evacuation of the injured to field hospitals. Letterman also authorized the assignment of a medicine wagon to each brigade.

Dr. Samuel Moore worked from within the blockaded Confederacy to build a military medical establishment comparable with that of the Union. He developed domestic pharmaceutical resources, recruited and trained nurses, established a systematic method for treating casualties, experimented with the manufacture of surgical instruments, and implemented a system for military evacuation and hospitalization. However, due to limited resources, his e!ectiveness in treating the sick and wounded fell short of his rivals in the North.

Timely treatment of wounded and sick soldiers in camp and in field hospitals was implemented widely by 1862 in many areas. Large hospitals in cities were also built. A prevailing antebellum societal opinion was that hospitals were dangerous and were to be avoided at any cost. Hospitals were considered necessary for free or low-cost care for the poor, and for teaching, research, and war, but

11/16/24, 8:33 PMHistory - Article - medicine in the Civil War era

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not for the treatment of the middle or upper classes. The terrible sights and sounds that one encountered (probably similar to those of a military field hospital) greatly deterred admissions. It was believed that most diseases came from "bad air," so Civil War hospitals were designed for maximum ventilation, emulating the success of military barracks hospitals operated by Florence Nightingale during the Crimean War. Peacetime citizens of the United States considered home medical care to be safer and more comfortable, and doctors obliged.

Both the Union and the Confederacy built large temporary military hospitals that became models of organization and models for "fresh air" ideas. The disparity in the availability of resources to the North and South that marked so much of the Civil War found astounding expression in the number and quality of hospitals. The North had erected 151 hospitals by 1863 and added another 53 by the end of the war with a total capacity of nearly 137,000 beds. The Confederacy had about 150 hospitals, although the number included improvised houses and barns. Richmond, Virginia, had the best of the Confederate facilities, including what may have been the largest military hospital ever, the 8,000-bed establishment at Chimborazo Heights. Hospital construction halted with the end of the Civil War, and the lessons learned both North and South in construction and e!iciency were not to be applied for nearly two decades. In fact, the United States had only 178 hospitals in 1873, but by 1909, the number grew to 4,359.

While hospitals had promoted some great medical leaps before—for instance, anesthesia—many of those benefits were not available to soldiers in the field. For example, in 1846 William Morton first demonstrated ether as an anesthetic in surgery at Massachusetts General Hospital, but the supplies and equipment necessary to make ether were not something armies generally carried with them into the field. (Even on the homefront, anesthesia use was circumscribed. While many physicians used anesthesia for "major" surgeries, most also refused to use it for "minor" operations.)

And while surgery without anesthesia was dreaded, a Civil War soldier's deadliest and most invincible enemy was disease. Union men actually had an almost two and a half times better chance of dying from disease than from combat; for Confederates, the chances were three to one. Contributions to a soldier's breakdown in health were many, including poor diet, bad weather, insects, and unsanitary camps. Diarrhea in its many forms, including dysentery, claimed more lives than battlefield wounds. Other chronic problems included pneumonia, bronchitis, scurvy, and "camp itch." Added to the equation were sporadic outbreaks of measles, smallpox, and malaria. Outbreaks of disease were known, especially in the earlier war years, to slow or halt entire military operations. The fate of Civil War military campaigns o"en hinged on the general health of the troops. Robert E. Lee's first field command in western Virginia experienced incessant, bone-chilling rains, and the resulting sicknesses

11/16/24, 8:33 PMHistory - Article - medicine in the Civil War era

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nearly crippled his army. The putrid swamps of Chickahominy contributed typhus, diarrhea, and scurvy to the list of problems encountered by George Brinton McClellan during his Peninsular campaign. Ulysses S. Grant's siege of Vicksburg was considerably slowed by disease.

Alcohol, in whiskey or brandy form, was the most commonly used "cure-all." Letterman's Union medicine wagons generally tried to contain some form of anesthetic (chloroform, ether, morphine, or opium) as well as alcohol, asafetida, calomel, castor oil, digitalis, spirits, turpentine, and assorted acids. And even with anesthetics and drugs, many doctors were educated to believe that pain in treatment was a good thing. The 1862 Manual of Military Surgery for the Use of Surgeons in the Confederate States Army argued that "the lusty bawling of the wounded" during surgery was a "powerful stimulant."

Though the Civil War did not produce any new "wonder drugs," it gave rise to the pharmaceutical industry that eventually made tremendous contributions to the medical advances of the 20th century. Since the Union relied heavily on imported drugs, readily accessible throughout the war, the majority of the advances were made out of necessity in the South. As the Confederacy began to feel the e!ects of the Union blockade, it depended on medicines captured in battle or provided by blockade-runners. Scientist-physicians were dispatched to find naturally occurring substitutes for unobtainable medicines. Francis P. Porcher subsequently discovered that green persimmon juice could be used as styptic, wood turpentine as an antiseptic, and red garden-poppy opium as an anesthetic. Joseph Le Compte used native plants to produce alcohol, silver chloride, sulfuric ether, and nitric ether. Despite the domestic alternatives, war drugs continued to run out. In the later years of the war, Confederate soldiers o"en endured illness, wounds, and amputations without medication.

Within the scope of the war e!ort were several medical advancements. Dentistry was singled out for the first time as an allied health profession. Early on, the Confederacy recognized the value of the discipline; it set up special pay for dentists serving in its ranks, gave dentists dispensations from the dra", and commissioned them to work in the medical corps. One such man commissioned was James Baxter Bean, who developed a system for immobilizing fractured jaws by use of inter-dental wiring and splinting.

The first women o!icers were also commissioned. The Confederacy desperately needed trained nurses, and many women's organizations were formed to help establish private hospitals. The Confederacy, desiring a method to ensure the quality of care in its hospitals, passed a law requiring that Confederate soldiers be treated only in hospitals directed by commissioned military o!icers of at least the rank of captain. Subsequently, Capt. Sally Louisa Tompkins was commissioned in September

11/16/24, 8:33 PMHistory - Article - medicine in the Civil War era

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1861, enabling her continued direction of her excellent hospital. A sign of the times, her letter of appointment from the secretary of war began, "Sir: You are hereby informed that the President has appointed you Captain in the army of the Confederate States…." On the Union side, Mary Edwards Walker, a physician and winner of the Medal of Honor, was commissioned in October 1864.

Modern public health was energized as specialized doctors on both sides of the lines were sent out to look for causes of disease outbreak in troops. Joseph Jones, a Confederate surgeon, was the first physician in the United States to use a clinical thermometer and one of the first to employ a microscope for clinical research.

A"er the Civil War the professionalization of America's hospitals and medical profession continued. In 1873 three schools for the training of nurses were opened in the Northeast, greatly improving the care available in America's hospitals. By the 1880s Lister's antisepsis techniques were in use in U.S. hospitals, but they were quickly replaced by aseptic surgery practices, thus making surgical procedures safer. With these processional developments came a growth in both surgical procedures and hospital stays.

The mid-19th century saw generally slow but steady development in the medical care system in the United States. Like all wars, the Civil War provided the dreadful conditions under which a generation of medical practitioners found invaluable clinical experience. A few decades later, aided by the work of germ theorists such as Louis Pasteur, they helped transform medical care and surgery in the United States to its modern form, and by the beginning of the 20th century, the U.S. medical education system was standardized and professionalized, as was the hospital system.

Further Information

George Worthington Adams, Doctors in Blue: The Medical History of the Union Army in the Civil War (Baton Rouge: Louisiana State University Press, 1996);

Horace H. Cunningham, Doctors in Gray: The Confederate Medical Service (Baton Rouge: Louisiana State University Press, 1993);

Frank R. Freeman, Gangrene and Glory: Medical Care during the Civil War (Urbana: University of Illinois Press, 2001);

Charles E. Rosenberg, The Care of Strangers: The Rise of America's Hospital System (Baltimore: Johns Hopkins University Press, 1995).

11/16/24, 8:33 PMHistory - Article - medicine in the Civil War era

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RECORD URL

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Record Information

From: Civil War and Reconstruction, Third Edition

Series: Encyclopedia of American History

By: Ruth A. Behling; Richard J. Roder

Published: 2017 [Last updated: 2018]

Record Type: Encyclopedia Entry

Tags

Anesthesia Army Medical Department (United States) emergency medical services Field Hospital Hospital

Medical Corps (United States Army) Military personnel Nursing Sally Louisa Tompkins

Union (American Civil War)

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