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Wednesday, August 7, 2013

Civil War Medicine (Part I)

By Jenny Goellnitz
During the 1860s, doctors had yet to develop bacteriology and were generally ignorant of the causes of disease. Generally, Civil War doctors underwent two years of medical school, though some pursued more education. Medicine in the United States was woefully behind Europe. Harvard Medical School did not even own a single stethoscope or microscope until after the war.
Most Civil War surgeons had never treated a gun shot wound and many had never performed surgery. Medical boards admitted many "quacks," with little to no qualification. Yet, for the most part, the Civil War doctor (as understaffed, under-qualified, and under-supplied as he was) did the best he could, muddling through the so-called "medical middle ages."
Some 10,000 surgeons served in the Union army and about 4,000 served in the Confederate. Medicine made significant gains during the course of the war. However, it was the tragedy of the era that medical knowledge of the 1860s had not yet encompassed the use of sterile dressings, antiseptic surgery, and the recognition of the importance of sanitation and hygiene. As a result, thousands died from diseases such as typhoid or dysentery.
The deadliest thing that faced the Civil War soldier was disease. For every soldier who died in battle, two died of disease. In particular, intestinal complaints such as dysentery and diarrhea claimed many lives. In fact, diarrhea and dysentery alone claimed more men than did battle wounds. The Civil War soldier also faced outbreaks of measles, small pox, malaria, pneumonia, or camp itch.
Soldiers were exposed to malaria when camping in damp areas which were conductive to breeding mosquitoes, while camp itch was caused by insects or a skin disease. In brief, the high incidence of disease was caused by a) inadequate physical examination of recruits; b) ignorance; c) the rural origin of my soldiers; d) neglect of camp hygiene; e) insects and vermin; f) exposure; g) lack of clothing and shoes; h) poor food and water. Many unqualified recruits entered the Army and diseases cruelly weeded out those who should have been excluded by physical exams. There was no knowledge of the causes of disease, no Koch's postulates. Troops from rural areas were crowded together for the first time with large numbers of other individuals and got diseases they had no immunity to. Neglect of camp hygiene was a common problem as well. Ignorance of camp sanitation and scanty knowledge about how disease was carried led to a sort of "trial and error" system.
An inspector who visited the camps of one Federal Army found that they 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." The Federal government even founded a Sanitary Commission to deal with the health problems in army camps. Mary Livermore, a nurse, wrote that... "The object of the Sanitary Commission was to do what the Government could not. The Government undertook, of course, to provide all that was necessary for the soldier, . . . but, from the very nature of things, this was not possible. . . . The methods of the commission were so elastic, and so arranged to meet every emergency, that it was able to make provision for any need, seeking always to supplement, and never to supplant, the Government." Both Armies faced problems with mosquitoes and lice. Exposure turned many a cold into a case of pneumonia, and complicated other ailments. Pneumonia was the third leading killer disease of the war, after typhoid and dysentery. Lack of shoes and proper clothing further complicated the problem, especially in the Confederacy.
The diet of the Civil War soldier was somewhere between barely palatable to absolutely awful. It was a wonder they did not all die of acute indigestion! It was estimated that 995 of 1000 Union troops eventually contracted chronic diarrhea or dysentery; their Confederate counterparts suffered similarly. Disease was particularly rampant in the prisoner-of-war camps, whose conditions were generally worse than the army camps.
To halt disease, doctors used many cures. For bowel complaints, open bowels were treated with a plug of opium. Closed bowels were treated with the infamous "blue mass"... a mixture of mercury and chalk. For scurvy, doctors prescribed green vegetables. Respiratory problems, such as pneumonia and bronchitis were treated with dosing of opium or sometimes quinine and muster plasters. Sometimes bleeding was also used. Malaria could be treated with quinine, or sometimes even turpentine if quinine was not available.
Camp itch could be treated by ridding the body of the pests or with poke-root solution. Whiskey and other forms of alcohol also were used to treat wounds and disease ... though of questionable medical value, whiskey did relieve some pain. Most medicines were manufactured in the north; southerners had to run the Union blockade in order to gain access to them. On occasion, vital medicines were smuggled into the South, sewn into the petticoats of ladies sympathetic to the Southern cause.
The South also had some manufacturing capabilities and worked with herbal remedies. However, many of the Southern medical supplies came from captured Union stores. Dr. Hunter McGuire, the medical director of Jackson's corps, commented after the War on the safeness of anesthesia, saying that in part the Confederacy's good record was due in part from the supplies requisitioned from the North.

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