Medical Care for the Civil War Soldiers

This entry is part 9 of 21 in the series A Soldier's Life

Wounded menThe American Civil War was not a time of innovative health care. One Union surgeon said that the Civil war was fought “at the end of the medical Middle Ages.” Caring for the Civil War soldiers was an inexact science at best and at its worst it ranged from barbaric to barely competent.

At the start of the war the medical corps in both armies was woefully underqualifled, understaffed, and undersupplied. Doctors simply had no experience in handling the medical needs of large numbers of men, much less any experience with the treatment of battle wounds.

The Civil War armies lacked proper hygiene practices, proper food and proper nutrition practices. Most doctors had served in small towns and cities where all of the above was available. Health was not the primary concern of an army on the march, finding and defeating the enemy was.

Let’s start with the training of doctors in the antebellum United States. Unlike Europe where four-year medical schools were common, most American doctors served a two-year apprenticeship under another doctor. They received practically no clinical experience and had no laboratory training, even if they did attend one of the few medical schools in the United States. To say medicine was primitive is an understatement.

At the beginning of the war the Union army had 98 medical officers while the Confederacy had just 24. In the four years of the war some 13,000 men served as medical officers in the Union army while 4,000 served with the Confederate Army. Both armies had an unknown number of male and female volunteers who served as nurses and medical orderlies. It is estimated that more than 4,000 women served as nurses in Union hospitals.

Civil War doctors treated more than 10 million cases of injury and illness in the 48 months of the Civil War. Poet Walt Whitman, who served as a volunteer in Union army hospitals, had great respect for the hardworking physicians, claiming that “All but a few are excellent men…”.

The current official figure of death during the Civil War is 620,000, although gradual acceptance of the higher figure of approximately 750,000 is gaining among historians. Of that number 110,000 Union soldiers and 94,000 Confederate soldiers are believed to have died from battlefield wounds. That means that two-thirds or more of Civil War fatalities were caused by illness.

Of the more than 175,000 wounds to the extremities of Union troops, about 30,000 led to amputation. Approximately the same proportion occurred to Confederate troops. This counteracts the accepted belief tat every wound immediately led to amputation.

The Minie ball was the most common Civil War ammunition. It tore an enormous wound on impact: it was so heavy that an abdominal or head wound was almost always fatal. A hit to an extremity usually shattered any bone encountered. In addition, all bullets carried dirt and germs into the wound and that often resulted in infection, gangrene and ultimately amputation of the affected limb.

One witness described a common surgeon’s tent this way: “Tables about breast high had been erected upon which the screaming victims were having legs and arms cut off. The surgeons and their assistants, stripped to the waist and bespattered with blood, stood around, some holding the poor fellows while others, armed with long, bloody knives and saws, cut and sawed away with frightful rapidity, throwing the mangled limbs on a pile nearby as soon as removed.” It sounded like a scene from the Dark Ages.

Contrary to popular belief (and Hollywood movie making) anesthetic was readily available for amputations and other surgeries. Chloroform and other pain-deadening medicines were usually available to Civil War doctors on both sides of the conflict.

Soldiers who survived a battlefield wound and primitive surgery very often succumbed to infection. General Stonewall Jackson survived being shot and having his arm being amputated only to die a lingering death from  pneumonia.

Very often soldiers contracted Staphylococcus aureus and Streptococcus pyogenesbacterial cells which generate pus, destroy tissue, and release deadly toxins into the bloodstream. The risk of gangrene was high in the Civil War. Despite all of these issues, nearly 75% of amputees survived.

Even though most surgeons were aware of the relationship between cleanliness and germs, they didn’t know how to sterilize their equipment. Battlefield hospitals where most surgeries occurred were not conducive to washing their hands or their instruments after every operation. Often fresh, clean water was not available. Time was of the essence as the surgeons performed amputations in mere minutes.

Despite the belief of the soldiers that bullets and shells were their deadliest enemies, disease was the main killer of troops. In the Union Army approximately 60% of all fatalities occurred due to disease while in the Confederate Army it may have been 2 out of three.

Many of the troops on both sides were in poor health when they joined due to poor conditions in civilian life. It appears that many of the early recruits were unfit for service but were still allowed to join. In late 1862, the Union Army discharged approximately 200,000 men as unfit for duty.

About half of the deaths from disease were due to intestinal disorders: typhoid fever, diarrhea, and dysentery. The remainder died from pneumonia and tuberculosis. Camps populated by young soldiers who had never before been exposed to a large variety of common contagious diseases were plagued by outbreaks of measles, chickenpox, mumps, and whooping cough. In many cases these childhood diseases were fatal.

Much of these illnesses were caused by the filthy, unsanitary conditions of the camps. One Union health inspector in 1861 said that the camps were “littered with refuse, food, and other rubbish, sometimes in an offensive state of decomposition; slops deposited in pits within the camp limits or thrown out of broadcast; heaps of manure and offal close to the camp.” 

Disease spread through camps like wildfire. Bowel disorders were the most common illness. 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.

Typhoid fever was even more devastating. Perhaps one-quarter of noncombat deaths in the Confederacy resulted from this disease, caused by the consumption of food or water contaminated by salmonella bacteria.

Epidemics of malaria spread through camps located next to stagnant swamps teeming with anopheles mosquito. Although treatment with quinine reduced fatalities, malaria nevertheless struck approximately one quarter of all servicemen; the Union army alone reported one million cases of it during the course of the war.

As the war progressed the medical corps of both sides struggled with all of these issues. At the Siege of Petersburg the Union Army built several hospitals capable of handling up to 10,000 men each, an indication of the medical problems.

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