Tuesday, December 27, 2016

Battlefield Medicine and Diet

By Robert Sterling, Historical Research and Narrative

And what killed Billy Yank and Johnny Reb? It was not the fighting at Gettysburg and the ghastly charge of Confederate troops under General Pickett across the open Pennsylvania fields, but the toxic manure on the camp streets of a stationary army during the hot summer months. It was not General Grant�that obstinate man from Galena, Illinois�burrowing through the impenetrable woods, but General Diarrhea penetrating the bowels of infected soldiers. It was not that long gray line stationed behind the stone wall at Fredricksburg, but that incessant "blue line" squatting at the 'sinks' with constipation. It was not the sharp slashes received from the cavalry swords of General Forrest's men, but the pricking of the needle-nosed mosquito as it transferred fatal malaria into the soldier, indiscriminately infecting the blue and gray alike. Forget about the glamour of war.

Today, six score and fifteen years later, however shocking the killed-in-action and died-of-disease statistics appear on the printed sheet, it is all the more horrifying when analyzed. After the war, tabulations reveal that at least 110,070 Union men had died on the battlefield. More than twice that number, 224,586 (of 6,000,000 cases of sickness) had succumbed to diseases. With Confederate dead, the human loss totaled 620,000.

Illinois endured a 30 percent higher loss of men than the Union, in proportion to the number serving, and southern Illinois was the home of four of the five regiments with the highest losses due to diseases. Why did western states and the southern portion of Illinois sustained greater disease casualties?

Physical examinations for recruits were required but not always administered. The enlistment of more than four hundred women suggests some laxity in requiring the recruit to strip for a thorough physical examination. An early Sanitary Commission report postulated that almost 75 percent of the recruits discharged for disabilities should not have been allowed to enlist in the first place. Regulations also directed medical officers to "vaccinate when it is required." Such a discretionary guide was rarely invoked. It has been speculated that men from rural areas, that is, western troops, and southern Illinois in particular, were especially vulnerable to infantile diseases: measles, mumps, and scarlet fever. At Camp Douglas, the prisoner-of-war facility in Chicago, almost 10 percent of all Confederate deaths occurred in a single month from a measles epidemic.

Once in camp, the novice soldier did not overly concern himself with cleanliness. Billy Yank's mother would have viewed with horror the accumulation of camp garbage, nearness of latrines to food preparation sites, manure piles on camp streets, and general filth.

Again, regulations recommended a weekly bath and required non-commissioned officers to observe their men washing hands and faces daily. It was not an easy duty for a nineteen-year-old corporal to command a forty-five year-old private. Said one soldier, "The first thing an army in the field does is to foul its own water supply and the second is to infect its food by the swarms of flies bred in the garbage dumps and manure heaps."

The typical Illinois regiment did not adopt any special arrangements to accommodate its culinary needs. Usually, the men prepared their own food, especially while on the march, or organized a "mess" of four to eight to pool the provisions supplied by the regimental quartermaster.

Fewer than half of the 119 regular (three-year) Illinois regiments assigned individuals�cooks�at the company level to the specific task of food preparation. In those forty-eight units, the "ration rustler" procured staples either from the subsistence department, or a sutler, or foraged.

An army manual mandated that the daily ration should consist of twelve ounces of salt pork (or fresh beef), one pound of flour (made into hard tack), one vegetable (usually beans), and coffee. The following widely popular doggerel indicates the general extent of poor Civil War nutrition:

The soldiers' fare is very rough,
The bread is hard,
the beef is tough; If they can stand it, it will
be, Through love of God, a mystery.
Beans killed more than bullets

Camp filth was ahead, only slightly, of the inept food preparation and unbalanced diet as the major health menace. The soldier's frying pan was more lethal than his musket. Although he was issued 20 percent more rations than European soldiers, shoddy preparation and poor diet produced massive illness. The explanation generally given for this major killer�"beans killed more than bullets"�may exaggerate, but the problem was worsened by a prevailing medical theory that purgatives must be administered to rid the body of its "ill-humors."

"My bowels moved 18 times in three hours," one soldier wrote home. The Medical Department reported nearly two million cases of diarrhea and dysentery during the conflict and an astounding 57,265 deaths. Although surgeons and soldiers classified it as the "flux", it was a one-celled animal� Entamoeba Histolytic� usually found in unsanitary conditions and introduced into the body by contaminated food and water.

Early in the war, the favorite purgative administered to diarrhea patients was calomel, a violent laxative that was probably therapeutically useless. Ultimately, this drug, chloride of mercury, was the excuse for eliminating the efficient, but brazen, Surgeon General William A. Hammond. The talented Hammond's long list of accomplishments was exceeded only by his long list of enemies. When the controversial Hammond issued an order banning the use of calomel, a court martial found him guilty of actions unbecoming of an officer and cashiered him.

An incredible example of over-medicating was the case of Private John Leopold of the Seventy-forth Pennsylvania, who entered a Philadelphia hospital after suffering from "chronic diarrhea" for three months. During a two-week stay, his medication included lead acetate, opium, aromatic sulfuric acid, tincture of opium, silver nitrate, belladonna, calomel, and ipecac. He died.

More common was the case of Private Daniel Newall, Company B, Eighty-eighth Illinois. The twenty-eight-year-old farmer from Tonica, Illinois, was honorably discharged with "severe and obstinate chronic diarrhea." The losses in Newall's northern regiment were light compared with the 120th Illinois Infantry from southern Illinois. Stricken in November 1862 with small pox, measles, and pneumonia, the unit lost 265 of 844 men. Add another 148 sent home with disabilities, and the non-battlefield losses represented an astonishing 49 percent of the original unit. This percentage does not include large losses in the infamous Andersonville prisoner-of-war camp. The 116th from Macon County lost 100 (of 239 disease-related deaths) in sixty days while digging a canal in the swamps near Vicksburg.

It weighed but a little over an ounce, and it passed through the air at a modest speed�not fast enough to be sterilized� but its destruction was indescribable. The mini ball, or conical lead bullet, tore through the soldier's tough skin, passed a few inches into the body and, its energy spent, stopped. It took with it bits of wool, skin, hair, and dirt. The soldier's damaged body tissue was several inches larger on all sides than the bullet's track. The mini ball produced 94 percent of all battlefield injuries; in 71 percent of all cases the arms, legs, hands, or feet had been hit. "When balls are lost in the capacity of the belly one need not amuse himself by hunting for them," wrote a hard-nosed surgeon.

The accepted surgical protocol was amputation, done quickly. The Sanitary Commission advised immediate amputation with as little delay as possible; later statistics supported the recommendation.

Usually the finger was used to probe the wound and assess bullet location and bone damage. Before Pasteur or Lister, washing the hands in soapy water was considered ample cleanliness. As one surgeon recalled, "we operated with clean hands in a social sense, but they were undisinfected hands... We used undisinfected instruments. .. and still worse, used marine sponges which had been used in prior pus cases and had only been washed in tap water." Patients were sedated with either chloroform or ether, and when supplies of those were unavailable, with whiskey. And, without anesthetic whatsoever, the soldier might quite literally 'bite the bullet,' that is, bite on a bullet during the operation. With the soldier "surgically asleep" the cutting and sawing began.

The surgeon then "removes the limb, ligates the vessels and when all oozing has ceased, secures the stump by points of suture placed at intervals of one inch." The amputation was over in less than fifteen minutes. One of the leading surgical advances of the war was the technique used in stopping the flow of blood. Too, the surgeons abandoned the ancient theory of producing "copious bleeding" by deliberate bloodletting by the leech or lancet. Some surgeons carried the heinous-looking spring-activated '"fleam" seated in its appropriately named holder called "the coffin." The fleam was a metal knife encased in a shell. When the trigger was pressed, the blade would slash into the vein to produce copious bleeding. Pain control was best facilitated by a generous use of opium or morphine. The surgeon "should have his pockets well stored with opium for immediate use" going onto the battlefield, wrote one surgeon.

Following his relocation from the field hospital to a general facility, the soldier's most feared disease might appear in a few days: hospital gangrene. Spreading from the size of a dime to eight or ten inches in diameter, the gray-coated rotting tissue soon turned black, emitting a vile odor and demanding attention. Early in the war, the cure was to cut away and ligate large arteries or burn it out with nitric acid till "you could see smoke rise, the flesh sizzle and crisp up, and all this time the patient's screaming in agony," recalled a doctor. By 1863 Dr. Middleton Goldsmith had introduced a treatment using lint soaked in bromine applied to the area after diseased tissue had been cut away. It was a major breakthrough, and hospital gangrene dropped to a low of 2.6 percent.

Army regulations required a board of not less than three officers "to examine applicants for appointment of assistant surgeons." Although some western states issued commissions without examinations, in Illinois, policy called for intensive interrogation of the prospective doctor. Nonetheless, although Dr. John Young of the Sixty-sixth Illinois failed to pass such examination, he remained the only chief surgeon in the unit for another six months before Dr. Pogue of Edwardsville replaced him.

Committed to the venerable Hippocratic Oath to be "loyal to the profession of medicine" and practice with honor, the Illinois surgeon steadfastly served his troops. A mere fourteen of the first appointed surgeons resigned within a year of the regiment's organization. More than a third of the three-year Illinois regiments had no chief surgeon turnovers. Indeed, the chief surgeon did not change but once for 85 percent of all the state's infantry regiments.

The surgeon's duties were not without danger. Drs. J. D. Haslett, Fifty-ninth Illinois, and Horace Porter of Chicago, 105th Illinois, were killed in battle during the Atlanta campaign. Dr. Shubal York of Paris, Fifty-fourth Illinois, was "murdered" by Copperheads during the infamous Charleston Riot early in 1864. At least forty northern surgeons were killed in the line of battle.

High battlefield losses produced an almost insurmountable task for the surgeons. Dr. Sam Hamilton of Monmouth and Dr. Emil Gulich of Alton, Ninth Illinois, probably thought it could not get any worse after the Fort Donelson engagement on the morning of February 16, 1862, than when 165 wounded from their regiment needed immediate medical attention. But less than two months later the same regiment, mainly from St. Clair County, and the same two doctors counted more than 300 injured after bloody Shiloh.

Who could have anticipated the astronomical numbers lost in some of the battles? At Fort Donelson just five regiments alone, with no more than a dozen doctors, had 809 injured men. At Shiloh less than twenty doctors had the herculean work load of assisting 1,416 wounded soldiers. At Gettysburg only 106 medical officers remained after both armies withdrew, (taking many of the surgeons with them) to attend to the nearly 20,000 Union and Confederate injured.

But assistance arrived as soon as the conflict commenced. Although the War Department did not officially recognize the status of female nurses until well into the war, the impact of these "angels" was immediate. Instructed by the Superintendent of Female Nurses, the ubiqitous Dorothea Dix, to present themselves as "devoid of personal attractions," the female became synonymous with "nurse."

Indisputably the hospital morale-builder was a godsend to the troops. As Louisa Alcott explained, the duties included "serving rations, giving medicine, and sitting on a very hard chair, with pneumonia on one side, diphtheria on the other, five typhoids on the opposite, and a dozen dilapidated patriots, hopping, lying, and lounging about, all staring more or less at the new 'nuss.'" All of this for forty cents a day.

Her name will always be associated with the American Red Cross, but Clara Barton also set up an elaborate relief program for supply distribution for the sick and wounded. Lincoln called upon this woman of mercy to prepare a bookkeeping record of burial locations, war prisoner sites, hospital enrollment and discharges, and communications with families. 'Mother' Mary Bickerdyke, the Catholic Sisterhoods, and later the Army Nurse Corps, also made lasting contributions.

The Civil War was the cataclysmic event that moved the country toward modernity and hastened the evolution of new medical theories and practices. The following medical practices ended with the Civil War: purging the body of liquids; indifference to sanitation; disdaining the use of vaccine; overuse of opium; laxity in expediting the transfer of wounded soldiers from the battlefield to the hospital; and resistance to female nurses. Myriad discoveries and improvements were prompted by the great conflict: the relationship between filth and disease, the procedure for amputations, the construction of hospitals organized with specialization wings, the birth of psychosomatic medicine, and the reevaluation of the impact of drugs.

From: lib.niu.edu


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