Sunday, February 8, 2015

Medicine in the Civil War


The doctor of a regiment in the Civil War was called a surgeon. These men were responsible for treating the sick and wounded of their regiment. Often there were so many wounded that they treated wounded men from many other regiments. This was especially true at Gettysburg where so many soldiers were injured.

Surgeons in both armies were taxed to the limits of their endurance and treated the most severe cases first. The remaining soldiers languished in the open air, waiting their turn on the surgeon's table. For the wounded, the horrors of the battlefield were only equaled by the horrors they experienced in a field hospital.

Most wounds during the Civil War were caused by gunshot. The Minie ball, which was the standard bullet of the war, was made from very soft lead. When it struck human tissue, it would create a very ragged wounded and could splinter once inside. This led to infection which could be fatal. The large bullets could also shatter bones.

Shell fragments from artillery were the next most common cause of wounds. An exploding shell sent large fragments of iron sailing into the air and would cause terrible wounds as well. Bayonet wounds were rare. Only about 2% of all wounds during the war were caused by the bayonet. Soldiers were not always inclined to use them and close fighting usually called for clubs or swinging rifles like clubs, though Colonel Harrison Jeffords of the 4th Michigan Infantry was mortally wounded by a bayonet thrust at Gettysburg.

Even when wounds were treated with great care, infection could easily set in. Medical knowledge in the 1860's did not understand bacteria and germs and how they could be transmitted. They did not properly sterilize the tools and equipment, and bacteria could easily spread from patient to patient during a days worth of operations. This lack of understanding of germs and bacteria led to the spread of disease that killed more soldiers than enemy bullets during the entire war.

This surgeon's operating kit is typical of those used by army doctors. Though they seem ancient by today's standards, the instruments were made of the finest metals with precision and encased in beautiful walnut cases. Confederate instruments were not as fine as those made in northern factories or in Europe, so captured instruments and medical supplies were highly prized.

Radical surgery took place in the crudest conditions. A typical "operating room" was in the open air where the surgeon had plenty of light. Otherwise, it was the room of a farmhouse, the center of a barn, or under a tree. Assistants held lamps over the surgeon to provide light. Patients were placed on a door removed from its hinges and set on sawhorses. With little more than a rag to wipe his hands, the surgeon then began the examination of the wounded soldier and then decided on what course to take.

Over 30,000 soldiers of both armies lay wounded in temporary field hospitals at the close of the Battle of Gettysburg. In every sense of the word, these were not real hospitals at all, but private homes and buildings which afforded some shelter and a nearby source of water. Every barn, church, warehouse, and outbuilding within a ten mile radius of Gettysburg was filled with suffering men, so many that they could not all be attended to at once.

Surgeons from the various regiments worked for days without rest to treat the wounded and medical supplies were hurried to the scene as rapidly as possible.

Still, many soldiers went without care or treatment for several days. "Houses and barns, but chiefly the woods were used as hospitals and the wounded, necessarily endured much suffering," wrote Dr. Jonathan Letterman. As the Medical Director of the Army of the Potomac, Dr. Letterman and his staff had an overwhelming job ahead of them. Before the battle ended, Dr. Letterman ordered more medical supplies to be brought to Gettysburg and he sent his ambulance corps over the field to move the wounded into a more central medical stations called corps hospitals. Dr. Letterman was forced to leave Gettysburg with the army in the pursuit of the Confederates, but he assigned Surgeon Henry James to the task of supervising the gathering and treatment of all the wounded in the area.

The first task was gathering all of the wounded into central field hospitals where adequate water supplies could be found, treatment could be rendered and wounds dressed. Further surgery could also be performed at these hospitals until the wounded could be taken to Gettysburg where they could be transported by railroad to hospitals in Philadelphia, Baltimore and Washington.

A central hospital was established on the York Pike east of Gettysburg and near the railroad and named Camp Letterman after Dr. Letterman. Wounded soldiers were taken from the field hospitals by horse-drawn ambulances to the new camp where they were housed in large canvas tents. Unlike the rigors of a field hospital, the new camp had cots with clean sheets and pillows. Nurses were assigned to each of the tents and surgeons stayed busy around the clock treating the more serious cases. Food was plentiful and the camp was remarkable for its sanitation. Cases considered too serious to move remained at the camp while an average of 800 men per day were shipped by rail to hospitals in northern cities.

Many of the nurses at Camp Letterman were women who were members of the U.S. Sanitary Commission and U.S. Christian Commission, organizations formed in the north for the benefit of Union soldiers wounded in battle. Clara Barton, who later founded the American Red Cross, was not at Gettysburg, but many women like her were. They put in long hours in the hospital wards, aiding the sick and injured soldiers, both Union and Confederate.

Surgical operations continued on the most serious cases at Camp Letterman. A visitor to the hospital witnessed the most gruesome of treatments in a surgeon's tent:

"In the operating tent, the amputation of a very bad looking leg was witnessed. The surgeons had been laboring since the battle to save the leg, but it was impossible. The patient, a delicate looking man, was put under the influence of chloroform, and the amputation was performed with great skill by a surgeon who appeared to be quite accustomed to the use of his instruments. After the arteries were tied, the amputator scraped the end and edge of the bone until they were quite smooth. While the scraping was going on, an attendant asked: 'How do you feel, Thompson?' 'Awful!' was the distinct and emphatic reply. This answer was returned, although the man was far more sensible of the effects of the chloroform than he was of the amputation."
(excerpt from A Strange and Blighted Land, Gettysburg: The Aftermath of a Battle, by Gregory Coco, Thomas Publications, Gettysburg, 1995.)

By August 7, 1863 all of the corps and field hospitals were closed and Camp Letterman was the only hospital remaining with over 3,000 patients. Union and Confederate wounded were both treated at the camp by army doctors and personnel of the United States Christian Commission and the United States Sanitary Commission. Still, not all of those wounded men could be saved and many died from the results of their wounds or infection. A cemetery was established near the camp and burials took place every day. The camp remained at Gettysburg until November 1863 when the last remaining patients left, the tents were packed, and the doctors and nurses left for other battlefield hospitals.


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