When the Civil War began in April 1861, medicine was approaching what Surgeon General William Hammond called "the end of the medical Middle Ages." In Europe, the work of Koch and Pasteur was just beginning and American physicians had little knowledge of the cause and prevention of disease and infection. The Army Medical Department, which was responsible for the care of the sick and wounded in the North, was unprepared. The staff of 90 doctors was experienced in dealing with the health problems of small military outposts, but had no idea of how to deal with large scale medical and logistical problems.
Early in the war it became obvious that disease would be the greatest killer. Two soldiers died of disease (dysentery, diarrhea, typhoid, and malaria) for every one killed in battle. Soldiers from small rural areas suffered from childhood diseases such as measles and mumps because they lacked immunity. Outbreaks of these "camp and campaign" diseases were caused by overcrowded and unsanitary conditions in the field. To remedy this, the U.S. government created the U.S. Sanitary Commission in June 1861.
The commission was directed by Frederick Law Olmstead. Preaching the virtues of clean water, good food, and fresh air, the commission pressured the Army Medical Department to improve sanitation, build large well-ventilated hospitals, and encourage women to join the newly-created nursing corps. Despite the efforts of the Sanitary Commission, some 560,000 soldiers died from disease during the war.
Second to disease as a cause of death was battlefield injuries, totaling some 200,000 casualties. The overwhelming number of wounded created problems in removing them from the battlefield. As late as 1862 there was no ambulance corps on either side. In August of that year, however, Union General George B. McClellan authorized the creation of a trained ambulance corps for the Army of the Potomac, and other armies, both Union and Confederate, soon did the same.
Risks from surgery were great. Doctors in the field hospitals had no notion of antiseptic surgery, resulting in extremely high death rates from post-operative infection. Surgeons ignored anesthesia, instead relying on the "surgical shock" of battle, when the patient's heart rate was greatest, to amputate.
Amputation of a wounded arm or leg was the most common operation, due largely to the .58 calibre Minie ball ammunition used during the war. This heavy conical-shaped bullet of soft lead distorted on impact causing large, gaping wounds filled with dirt and pieces of clothing. Its heavy weight shattered any bone it contacted. Because of the severity of the wounds and the overwhelming case load, surgeons usually elected for fast and easy amputation over trying to remove the bullet and save the limb.
While the efforts of the Army Medical Department during the Civil War did little to bring immediate relief for the victims, many medical advances did result from the war experience. Doctors treating hundreds of thousands of cases of dysentery, diarrhea, typhoid, malaria and gunshot wounds compiled copious notes that would aid researchers after the war. These case studies were later published between 1870 and 1888 under the title Medical and Surgical History of the War of the Rebellion. Medical army officers recognized that enforcing sanitary standards in the field could reduce the spread of disease. And the numerous cases of post-operative infections such as hospital gangrene led to increased study in ways to prevent it, eventually leading to the use of bromine.
But the largest medical achievements of the Civil War were in the areas of field hospital organization and personnel. At the beginning of the war, staffs were haphazardly organized on an "as needed" basis. But these staffs were usually too small, and healthy soldiers had to be left behind to care for the sick and wounded. Anyone, regardless of medical skill, could volunteer as a nurse. Hospital facilities were established in existing unsanitary buildings or erected wherever convenient. By war's end this all changed. Military hospital staffs became more permanent. In 1861, Dorothea Dix was appointed Superintendent of the United States Nursing Corps, and the idea of professional nursing was born. Finally, hospital facilities were improved by the use of large, well-ventilated hospital tents and more permanent, cleaner "pavilion hospitals."
Image: The brutality of the battlefield produced huge numbers of casualties, as seen in this rendition of the attack on Knoxville.