By Carolyn Kimmel for Body & Mind Magazine, 11-13-12
The words "butcher" and "barbaric" may often be used to describe medical practices during the Civil War, but today's soldiers owe a lot to the forefathers who tended to the sick and wounded in Gettysburg and elsewhere.
"There were definitely medical advances that came out of the Civil War that are benefiting soldiers in Iraq and Afghanistan today," said Peter J. D'Onofrio, president of the Society of Civil War Surgeons, based in Ohio. "When I give talks, I say 'if you get nothing else out of tonight's talk, remember we can't look back at the surgeons of the Civil War and judge them in the context of today's medicine.'"
Our ambulatory and evacuation systems that carry wounded soldiers to help, our understanding of sanitization and even our respect for female nurses all trace their roots to the Civil War, historians say.
“One of our slogans here is ‘Civil War medicine — it’s not what you think,’” said George Wunderlich, executive director of the National Museum of Civil War Medicine in Frederick, Md. “Much of our modern neurology, plastic and reconstructive surgery, even occupational therapy — these people were inventing it and what’s amazing to me is how well they were doing, considering they were inventing it as they went along.”
As the battle unfolded around them, major players in the Civil War realized they were woefully unprepared.
“They never anticipated the war lasting that long or that kind of carnage,” D’Onofrio said.
As a result, they were writing medical procedure manuals as they went, inventing protocol and demanding better, more expedient care than was ever seen on the battlefield prior to 1862.
“By today’s standards, people think it was pretty primitive, but there was a lot of progress made during the Civil War,” said John Heiser, historian at the Gettysburg National Military Park.
Today’s soldier’s well-executed journey from battlefield to life-saving medical attention began with a war surgeon named Jonathan Letterman from Washington, Pa., who was medical director of the Army of the Potomac, the major northern army.
“Letterman is considered the father of battlefield medicine. He put all the parts of modern emergency medicine as we know it today into a chain,” Wunderlich said. “The movement of troops from injury to a medic to a field hospital to a general hospital to a bigger hospital is exactly how troops are moved today.”
Prior to this, when a soldier was injured, he would be helped off the field by several fellow soldiers who were not trained to give aid.
Letterman introduced the four-wheeled, horse-drawn wooden ambulance, piloted by trained drivers and carrying stretchers and medical supplies to the field, D’Onofrio said.
“Letterman also set up aid stations about 50 to 100 yards behind the firing line, hopefully in a wooded area or ravine, where basic first aid could be given. Then the soldier could be taken by ambulance to a field hospital, which might be a half mile to a mile away,” he said.
The improvements were readily apparent — at the battle of Antietam, there were only one or two first aid stations whereas at Gettysburg, there were more than 271 such stations, Wunderlich said.
Our triage system — a quick assessment to determine priority for treatment based on severity of injury — also came out of the Civil War.
During the Battle of Gettysburg, nearly every barn, building and home was turned into a makeshift field hospital to care for the more than 23,000 wounded soldiers left behind. Letterman’s new administrative plan assured good communication among field hospitals, and his insistence upon a surgical team composed of the most experienced surgeons in the military division meant better care, Wunderlich said.
“We’re still following Letterman’s plan,” D’Onofrio said. “You usually have a medic with a unit who will patch up the wounded soldiers as best they can and they will be helicoptered out to one of the permanent bases in, say, Afghanistan, or later transported to Germany or to Walter Reed [Army Medical Center] in Washington. That helicopter is the equivalent of that wooden ambulance and that tiered system of evacuation is from Letterman.”
“The concept of moving someone swiftly to a place where they could be better cared for came from the Civil War,” agreed G. Craig Caba, Civil War author and member of the Harrisburg Civil War Round Table.
At the National Museum of Civil War Medicine, which specializes in training military medical professionals, Letterman’s principles of 150 years ago are still taught as best practices, Wunderlich said. “You can have all the technology in the world, but if you can’t get the patient there while he’s still alive, it’s no good,” he said.
Sanitary conditions are standard protocol in medical facilities today, but in Civil War times, scientists Joseph Lister and Louis Pasteur had yet to link bacteria with infection.
“For every one soldier killed outright, two died from disease and infection,” D’Onofrio said. “Doctors knew about these things; they just didn’t know what caused them.”
Consequently, army surgeons amputating limbs — the preferred remedy of the day especially when bone was shattered — in a makeshift field hospital didn’t give a thought to bacteria, Heiser said. They might even use the same instrument on multiple patients.
“The amputation might be successful, but could he survive the possibility of gangrene or infection that might set in?” Heiser said.
An understanding of the correlation between sanitization and diseases and infection came out of the Civil War, historians said.
Some of the advances were stumbled upon, Heiser said. For example, some hospitals that had washed bandages in hot soapy water, out of desperation to reuse them, noted their infection rates were lower than most and realized they had unwittingly been sanitizing bandages, he said.
The medical realities of the Civil War led to a greater interest in the field of medicine, Caba said. He owns an 1864 edition of Samuel D. Gross’s “System of Surgery,” a thick, yellowed directory on everything from gangrene to amputation. Who knows but a Civil War doctor might have referred to this very volume even as shells exploded around his field tent, Caba said.
“You began to see greater numbers at medical schools and greater numbers of females going into nursing,” he said. “This was really the first time that you began to see women respected for the medical care they offered. They were called angels of mercy. Fifty years later, at reunions, men would still be giving them three cheers.”
At the time of the Civil War, there were only 600 trained nurses in the nation and all of them were Catholic nuns, D’Onofrio said. During the war, some 5,000 to 6,000 women came forward to serve as nurses for the North; records for the South were lost in a later fire in Richmond, he said.
“Few of them were formally trained, but remember back then, women took care of the family when they were sick or injured so they had that experience,” he said.
All Americans, soldier or civilian, are benefiting from the medical services introduced during the Civil War, historians said.
“We didn’t have ambulance services and emergency rooms in hospitals until well after the Civil War. Why not? The answer is because of the war,” Wunderlich said. “The Civil War changed the expectations of hundreds of thousands of men who went through a medical system that was changing, and they are ones who instigated these improvements in major cities across the country.”
Image: A field exhibit at The National Civil War Museum in Harrisburg depicts Civil War medical practices.