Civil War Hospital Ship
The U.S.S. Red Rover, a captured Confederate vessel, was refitted as a hospital ship.
Evolution of Civil War Nursing
The evolution of the nursing profession in America was accelerated by the Civil War.
Army Medical Museum and Library
Surgeon-General William Hammond established The Army Medical Museum in 1862. It was the first federal medical research facility.
Civil War Amputation Kit
Many Civil War surgical instruments had handles of bone, wood or ivory. They were never sterilized.
Saturday, January 14, 2012
Sunday, October 9, 2011
Civil War Medicine Vocabulary
AMPUTATION
A surgical operation to remove an arm, leg, hand, foot or digit of the body. Amputations were the most frequently performed surgeries in the Civil War. Massive damage was done to bones and tissue by the new ammunition, the Minié ball. Amputation was the fastest way for doctors to save a life, and 75 percent of the amputees survived their surgeries.
ANEMIA
A condition characterized by weakness and pallor. It is a reduction of hemoglobin in the red blood cells, and also a reduction in the number of red blood cells in most forms of anemia, resulting in a deficiency of oxygen. During the war, it was twice as common among black soldiers from the southeastern states. It was discovered many years later that intestinal parasites are usually the cause.
ANESTHESIA
A loss of feeling, awareness or sensation; loss of the ability to feel pain.
ANESTHETIC
A drug used to make patients unconscious and insensitive to pain. It is administered before surgery and allows surgeons to perform more extensive procedures. Anesthesia, in the forms of ether and chloroform, was used most commonly by dentists before the Civil War. President Lincoln brought his own supply of chloroform to a dental appointment in 1862. It was adopted by and available to military surgeons of both armies and used for almost all Civil War surgeries.
ARTILLERY
Large weapons including cannons, mounted projectile-firing guns or missile launcher; or the branch of an army using artillery.
BARK JUICE
A slang term for liquor.
BAYONET
A dagger-like weapon attached to the muzzle of a gun for hand-to-hand combat. Civil War bayonet wounds were far fewer than in previous wars, as the new guns and ammunition allowed for combat at a longer range.
BEDROLL
Blankets or bedding carried by troops. They were rolled for storage and transport and usually contained a soldier’s personal belongings.
BLOODLETTING
The ancient practice of withdrawing quantities of blood to aid the body’s healing. Considered a “heroic therapy”, bloodletting had been practiced for almost 2,000 years before the Civil War. By the 1830’s it was much less common in America, although some bloodletting through the use of leeches was practiced during the war.
BLUE MASS (BLUE PILLS)
Calomel or mercurous chloride, was a clay-like compound of mercury and chalk. “Blue Mass” was administered to troops suffering diarrhea, dysentery, typhoid fever and other ailments. “Blue Pills” contained mercury, licorice, rose water, powdered rose, honey and sugar. President Lincoln used Blue pills to treat his constipation. The recommended dose contained more than 9,000 times the amount of mercury considered safe by today’s standards. Some soldiers died from mercury toxicity.
BONESAW
A surgical tool for amputations. Many Civil War bonesaws resemble hacksaws; some were flexible chainsaws. Before the war, bonesaws had been imported from France and England. The Chief Medical Purveyor for the United States Army requisitioned 4,900 amputating and general operating instrument cases from American manufacturers during the war.
CAMP ITCH
A highly communicable skin disease usually caused by scabies. It was easily spread among soldiers in crowded camps and is caused by a mite, Sarcoptes scabiei.
CAVALRY
Troops or groups of men who fight from horseback.
CHISOLM INHALER
A device for the administration of anesthesia. Invented by Confederate physician Dr. John Julian Chisolm, the inhaler provided a more controlled dosage to the patient and less exposure to drug fumes by doctors and nurses. Previously, most anesthesia was administered with a soaked cloth.
CHLOROFORM
A colorless, heavy, sweet-smelling liquid used as a solvent and administered widely as anesthesia during the Civil War. Chloroform was preferred over ether, as it was not explosive and had less bulk to transport.
CONSUMPTION (Pulmonary tuberculosis)
Progressive wasting of the body, usually through pulmonary tuberculosis. It is a contagious bacterial infection that involves the lungs, but can also spread to other organs. Caused by the bacteria Mycobacterium tuberculosis, it is spread by breathing air droplets from the cough or sneeze of an infected person. It was one of the most deadly wartime diseases.
DIARRHEA
An intestinal disorder that is characterized by frequent and fluid bowel movements. Chronic diarrhea was one of the top killers in the Civil War. Diet, poor sanitary practices, spoiled food and contaminated water all made the disease epidemic throughout both armies. Sometimes the terms “diarrhea” and “dysentery” were used interchangeably by the doctors; sometimes the distinction was made that “dysentery” indicated blood in the stool. The phrase “He hasn’t got the guts to stand it” was coined by Civil War soldiers.
DRESSINGS
Material to dress or bandage a wound. Physicians used any fabric available, even re-using bandages from previous patients. Wounds were frequently packed with lint. Dressings were commonly coated with cerate, a soothing ointment made of beeswax.
DYSENTERY
An infectious disease of the large intestines which causes severe diarrhea. Chronic dysentery and diarrhea killed more Civil War soldiers than any other disease.
EPIDEMIC DISEASE
A widespread or highly contagious disease that affects many individuals at the same time. Civil War doctors contended with deadly epidemics including smallpox, yellow fever, measles, mumps and chickenpox. Typhoid fever was the biggest killer among the epidemic diseases.
ERYSIPELAS
A severe skin infection characterized by redness and tenderness. It can spread quickly beneath the skin, destroying tissues, and sometimes passes into the bloodstream. It had a very high death rate.
ETHER
Widely used during the war as an anesthetic, ether is colorless and highly volatile. It was less unpredictable than the more popular but occasionally more deadly chloroform, but had greater bulk to transport and could be explosive.
FEVER
An abnormally high body temperature.
FIELD HOSPITAL
A temporary facility in the field staffed by medical personnel for the support of troops in battle. Locations were carefully selected near available shelter. Clean water, wood and a dry and even surface were the ideal prerequisites. Arrangements were established for transportation of the wounded, maintaining supplies and burying the dead.
FIELD TOURNIQUET
A device to stop bleeding by compression. Soldiers were advised to carry a stick of wood and a handkerchief or piece of cloth to create a tourniquet for a wounded limb.
GONORRHEA
A common venereal disease among Civil War soldiers, known since Biblical times. Civil War doctors used the term “gonorrhea” to diagnose all types of urethral discharges.
GRAYBACKS
A slang term for Southern soldiers or for lice.
HOMEOPATHY
A method of treating disease by administering minute doses of drugs that in a healthy person would produce symptoms similar to those of the disease. In the Civil War, homeopathic treatments were sometimes utilized as a more mild alternative to procedures like bloodletting.
HORNETS
A slang term for bullets.
HOSPITAL GANGRENE
One of the most feared and deadly wound infections, it was highly contagious. It destroys tissue and can spread through the bloodstream to other parts of the body.
INFANTRY
The branch of an army composed of soldiers who fight on foot.
INTESTINAL WORMS
Parasites that can cause mild itching, diarrhea, vomiting or extreme abdominal pain. Black soldiers who had been in slavery in the southern states showed a higher incidence of intestinal worms.
JAUNDICE
A yellow discoloration of the skin and whites of the eyes, due to an increase of bile pigments in the blood. Jaundice is characteristic of the disease yellow fever.
JOY JUICE
A slang term for liquor
LAUDABLE PUS (See also “PUS” and MALIGNANT PUS)
Civil War physicians welcomed the sight of thick, creamy pus, believing that it was a necessary part of the body’s healing process. They did not know that it was a sign of infection owed to the staphylococci bacteria.
LEECHES (See also BLOODLETTING)
A bloodsucking annelid worm once used for bloodletting.
LIGATION
One of the few clinical advances attributed to Civil War surgeons is “arterial ligation”, the tying off of a major artery to constrict blood vessels and stop hemorrhaging. It was not widely known or used during the first part of the war, but by the second half, surgeons had improved and shared their techniques for this life-saving procedure. The veins or arteries were usually tied off with wire or silk thread.
LINT
Minute shreds or ravelings of yarn or cotton fiber. Lint was commonly used to pack and dress wounds. Women volunteers scraped their sheets and tablecloths to gather lint for dressings.
LYMPH
Liquid taken from the lesion of a cow infected with cowpox, or a person infected with smallpox. It was inserted into a cut on a healthy person to create a crude vaccination.
MAGGOTS
The soft-bodied, legless larva of certain flies. Soldiers were tormented by the appearance of maggots in their wounds. Some physicians realized that the insects only ate the dead tissue, cleaning the wounds effectively and painlessly. The use of maggots continues to be explored in the 21st century.
MALARIA
A disease named after the Italian “Mala Aria”, or “bad air”. Debilitating and recurring chills, fever and sweating are its usual symptoms. Almost a million cases of malaria or “intermittent fevers” among Union soldiers were recorded, and it is thought that even more Confederate troops may have suffered. The disease was thought to be caused by “miasmas” or vapors that rose from swamps, although it was later found to be transmitted by the anopheles mosquito.
MALIGNANT PUS
Pus that is watery and bloody, usually attributed to the streptococci bacteria. Malignant pus spread rapidly, and frequently had a fatal outcome due to pyemia or “blood poisoning”.
MALINGERING
Pretending to be ill, especially in order to shirk work or duty. Some soldiers feigned disease or injury in order to obtain a Medical Certificate of Discharge. Known malingerers were sometimes called to duty as stretcher-bearers.
MEASLES
A highly infectious disease characterized by fever, small red spots and cold-like symptoms. The rash was frequently accompanied by pneumonia, making measles very deadly. It ravaged the young troops from rural areas, who had minimal exposure to disease and few immunities. It is estimated that in the Union army, measles were fatal in 6% of white troops and 11% of black troops. Measles epidemics were lethal in Confederate camps, sometimes necessitating the temporary disbanding of companies, battalions and whole regiments.
MINIÉ BALL
The Minié ball caused most of the Civil War wounds. Invented by a French army officer and adapted by American manufacturers, the large conical lead missile was a radical advance in ammunition. It was used in the new rifled weapons and caused massive damage to bones and tissue.
MORPHINE
An addictive narcotic obtained from opium, morphine is used as a powerful pain-killing drug or a sedative. Civil War surgeons frequently dusted morphine powder directly into wounds, sometimes applying it with a moist finger.
NEUROLOGY
The branch of medicine that deals with the nervous system. The large numbers of nerve injuries in the war wounded led to the founding of a specialty hospital called Turner’s Lane in Philadelphia. The medical team was led by Dr. Silas Weir Mitchell of Philadelphia, who had begun to study the phenomenon of “phantom limb” in amputees. Dr. Mitchell gathered valuable data and experimented with treatments, including electrical. He is regarded as one of the founders of American neurology.
NOKUM STIFF
A slang term for liquor
OPTHALMOSCOPE
An instrument utilizing a series of lenses to see inside the eye. Early models used sunlight or an oil lamp as a light source. During the war, both the Federal and Confederate armies established specialty hospitals to treat eye injuries.
PAVILION HOSPITALS
Long, narrow, well-ventilated wooden buildings, commonly built like spokes on a hub. By 1862, Union and Confederacy favored the newly designed “pavilion hospital”. Specialized areas at the hub included operating rooms, kitchens, offices, supply rooms and “dead house”. Although overall sanitation was still poor, pavilion hospitals were usually equipped with rudimentary toilet facilities. Medications, food, laundry and supplies moved much more efficiently through the pavilion hospitals and the quality of convalescent care improved.
PEPPERBOX
A slang term for a pistol.
PHANTOM LIMB
The sensation experienced by some amputees that a missing limb is still attached. This phenomenon was noticed and studied during the Civil War by Dr. Silas Weir Mitchell, now considered one of the founders of the field of neurology.
PHOTOMICROSCOPY
The creation of a photographic reproduction of an object as viewed through a microscope. The Federal Surgeon General’s Office purchased a compound microscope in 1863 for the use of Dr. Joseph Janvier Woodward, an international pioneer in the field of photomicroscopy. Dr. Woodward led the research being conducted by the Army Medical Museum.
PLASTIC OPERATIONS (PLASTIC SURGERY)
A medical specialty focused on the correction or restoration of form and function. Facing many serious head and facial wounds, Civil War surgeons began to attempt some major facial reconstructions. The surgeries were done in multiple steps and used flaps of skin and cork to repair structural damage. Union army records list 32 “plastic operations”.
POULTICES
A soft, moist, mass of cloth, meal, or herbs that was applied to wounds. They were frequently made of bread or flaxseed. Yeast poultices were commonly applied to suppurating wounds in the belief that they would stop infection.
PROBE (NÉLATON PROBE)
A long, thin, flexible metal wand with a ceramic tip. Invented by a French military surgeon named Nélaton, it was used to detect the presence of a bullet in a wound. The probe was never sterilized, and probably carried germs deep into the body. President Lincoln’s fatal head wound was examined with a Nélaton probe.
PURGATIVES
Cleansing or purging, usually by inducing evacuation of the bowels. Civil War doctors used purgatives to draw fluids into the gastrointestinal tract, in the belief that they were draining the fluids from other areas of the body. They also used emetic agents to induce vomiting.
PUS (See also “LAUDABLE PUS”)
A yellow-white viscous substance composed of bacteria, white blood cells and dead tissue. It is characteristic of infected wounds. Civil War physicians believed that it was part of the healing process.
PYEMIA
Infections that spread throughout the bloodstream, also known as “blood poisoning”. During the Civil War, the death rate of soldiers with this condition was 97%.
QUICK-STEP
A slang term for diarrhea, one of the deadliest ailments of the war.
QUININE
A drug made from cinchona tree bark, whose active ingredient is the alkaloid “quinine.” Spanish missionaries observed its use in South America in the 1500’s. It was an effective treatment for malaria and widely used by Civil War doctors.
SAWBONES
A slang term meaning “surgeon”.
SCALPEL
A small, usually straight knife used in surgery to cut through skin and other soft tissue.
SCURVY
Scurvy is a disease related to dietary deficiency, known during the Civil War as a “dietetic disease”, their term for malnutrition. It is caused by a lack of vitamin C and other nutrients. It is a debilitating disease, frequently characterized by swollen and bleeding gums and livid spots on the skin. The effectiveness of the military was sometimes severely affected by the widespread nature of this affliction in some units. Scurvy remained a problem in the U.S. military through World War I.
SMALLPOX
A viral disease characterized by fever and pustular eruptions of the skin. The fatality rate was 20-40%. Those who survived usually bore its scars. Smallpox was known to be highly contagious, and separate hospital units, called “pest houses” were used to house those with the disease. Smallpox was one of the few diseases for which vaccinations were available, but not always enforced. President Lincoln suffered a mild case of smallpox in November, 1863.
SUPPURATION
The discharge or formation of pus. Also a term for pus.
SUTURES
Stitches that join the edges of a wound or vessel. Civil War surgeons used silk or cotton thread. When severe supply shortages affected the Confederacy, surgeons used horsehair that was boiled to make it more pliable.
SYPHILIS
A chronic infectious, usually venereal disease caused by a spirochete. Syphilis was not as feared as gonorrhea by Civil War soldiers, as the serious nervous system and cardiovascular system effects can take years to appear and were not well known until the late 19th century. Syphilis was sometimes transmitted through the smallpox vaccine when “lymph” from an infected person was transmitted to someone else.
TAR WATER
A slang term for liquor.
TENNESSEE TROTS
A slang term for ordinary (not chronic) diarrhea.
TOURNIQUET
Any device that is used to stop bleeding by compressing a blood vessel. A tourniquet can be a device that wraps around a limb, or even a bandage that is tightened by twisting.
TURPENTINE
A strong-smelling liquid frequently used as a paint thinner and solvent. It is distilled from a substance derived from coniferous trees. Civil War physicians used turpentine orally for chronic diarrhea and sometimes for typhoid fever. They used it topically on the skin in the belief that it would increase blood flow and reduce inflammation. It was sometimes applied to bandages to discourage maggot infestation in wounds.
TYPHOID FEVER
An infectious disease that is characterized by fever, general malaise and intestinal inflammation. It is spread by food or water contaminated with the bacteria Salmonella typhi. Such contamination was common in army camps and caused terrible epidemics. Thousands of soldiers died from Typhoid fever, the biggest killer among the epidemic diseases.
VACCINATIONS
The introduction into the body of a preparation of weakened or killed bacteria or viruses for the purpose of preventing disease by stimulating antibodies against it. Civil War physicians usually used material taken from a cow infected with cowpox (the term “vaccine” refers to the Latin word “vaccus”, meaning “cow”), or sometimes material taken from a patient with a mild form of smallpox. Sometimes, during an outbreak of the disease, mass inoculations were carried out.
WOUND
An injury, usually one that involves the cutting or tearing of tissue.
YELLOW FEVER
A form of fulminating viral hepatitis usually found in warm climates. It is characterized by fever, hemorrhages, and jaundice, which turns the skin yellow. The disease is carried by the Aedes aegypti mosquito, which transmits it from person to person. Outbreaks of yellow fever were greatly feared, and there was no effective treatment at the time; there is still none today.
© 2011 JAMCO Films. All Rights Reserved.
A surgical operation to remove an arm, leg, hand, foot or digit of the body. Amputations were the most frequently performed surgeries in the Civil War. Massive damage was done to bones and tissue by the new ammunition, the Minié ball. Amputation was the fastest way for doctors to save a life, and 75 percent of the amputees survived their surgeries.
ANEMIA
A condition characterized by weakness and pallor. It is a reduction of hemoglobin in the red blood cells, and also a reduction in the number of red blood cells in most forms of anemia, resulting in a deficiency of oxygen. During the war, it was twice as common among black soldiers from the southeastern states. It was discovered many years later that intestinal parasites are usually the cause.
ANESTHESIA
A loss of feeling, awareness or sensation; loss of the ability to feel pain.
ANESTHETIC
A drug used to make patients unconscious and insensitive to pain. It is administered before surgery and allows surgeons to perform more extensive procedures. Anesthesia, in the forms of ether and chloroform, was used most commonly by dentists before the Civil War. President Lincoln brought his own supply of chloroform to a dental appointment in 1862. It was adopted by and available to military surgeons of both armies and used for almost all Civil War surgeries.
ARTILLERY
Large weapons including cannons, mounted projectile-firing guns or missile launcher; or the branch of an army using artillery.
BARK JUICE
A slang term for liquor.
BAYONET
A dagger-like weapon attached to the muzzle of a gun for hand-to-hand combat. Civil War bayonet wounds were far fewer than in previous wars, as the new guns and ammunition allowed for combat at a longer range.
BEDROLL
Blankets or bedding carried by troops. They were rolled for storage and transport and usually contained a soldier’s personal belongings.
BLOODLETTING
The ancient practice of withdrawing quantities of blood to aid the body’s healing. Considered a “heroic therapy”, bloodletting had been practiced for almost 2,000 years before the Civil War. By the 1830’s it was much less common in America, although some bloodletting through the use of leeches was practiced during the war.
BLUE MASS (BLUE PILLS)
Calomel or mercurous chloride, was a clay-like compound of mercury and chalk. “Blue Mass” was administered to troops suffering diarrhea, dysentery, typhoid fever and other ailments. “Blue Pills” contained mercury, licorice, rose water, powdered rose, honey and sugar. President Lincoln used Blue pills to treat his constipation. The recommended dose contained more than 9,000 times the amount of mercury considered safe by today’s standards. Some soldiers died from mercury toxicity.
BONESAW
A surgical tool for amputations. Many Civil War bonesaws resemble hacksaws; some were flexible chainsaws. Before the war, bonesaws had been imported from France and England. The Chief Medical Purveyor for the United States Army requisitioned 4,900 amputating and general operating instrument cases from American manufacturers during the war.
CAMP ITCH
A highly communicable skin disease usually caused by scabies. It was easily spread among soldiers in crowded camps and is caused by a mite, Sarcoptes scabiei.
CAVALRY
Troops or groups of men who fight from horseback.
CHISOLM INHALER
A device for the administration of anesthesia. Invented by Confederate physician Dr. John Julian Chisolm, the inhaler provided a more controlled dosage to the patient and less exposure to drug fumes by doctors and nurses. Previously, most anesthesia was administered with a soaked cloth.
CHLOROFORM
A colorless, heavy, sweet-smelling liquid used as a solvent and administered widely as anesthesia during the Civil War. Chloroform was preferred over ether, as it was not explosive and had less bulk to transport.
CONSUMPTION (Pulmonary tuberculosis)
Progressive wasting of the body, usually through pulmonary tuberculosis. It is a contagious bacterial infection that involves the lungs, but can also spread to other organs. Caused by the bacteria Mycobacterium tuberculosis, it is spread by breathing air droplets from the cough or sneeze of an infected person. It was one of the most deadly wartime diseases.
DIARRHEA
An intestinal disorder that is characterized by frequent and fluid bowel movements. Chronic diarrhea was one of the top killers in the Civil War. Diet, poor sanitary practices, spoiled food and contaminated water all made the disease epidemic throughout both armies. Sometimes the terms “diarrhea” and “dysentery” were used interchangeably by the doctors; sometimes the distinction was made that “dysentery” indicated blood in the stool. The phrase “He hasn’t got the guts to stand it” was coined by Civil War soldiers.
DRESSINGS
Material to dress or bandage a wound. Physicians used any fabric available, even re-using bandages from previous patients. Wounds were frequently packed with lint. Dressings were commonly coated with cerate, a soothing ointment made of beeswax.
DYSENTERY
An infectious disease of the large intestines which causes severe diarrhea. Chronic dysentery and diarrhea killed more Civil War soldiers than any other disease.
EPIDEMIC DISEASE
A widespread or highly contagious disease that affects many individuals at the same time. Civil War doctors contended with deadly epidemics including smallpox, yellow fever, measles, mumps and chickenpox. Typhoid fever was the biggest killer among the epidemic diseases.
ERYSIPELAS
A severe skin infection characterized by redness and tenderness. It can spread quickly beneath the skin, destroying tissues, and sometimes passes into the bloodstream. It had a very high death rate.
ETHER
Widely used during the war as an anesthetic, ether is colorless and highly volatile. It was less unpredictable than the more popular but occasionally more deadly chloroform, but had greater bulk to transport and could be explosive.
FEVER
An abnormally high body temperature.
FIELD HOSPITAL
A temporary facility in the field staffed by medical personnel for the support of troops in battle. Locations were carefully selected near available shelter. Clean water, wood and a dry and even surface were the ideal prerequisites. Arrangements were established for transportation of the wounded, maintaining supplies and burying the dead.
FIELD TOURNIQUET
A device to stop bleeding by compression. Soldiers were advised to carry a stick of wood and a handkerchief or piece of cloth to create a tourniquet for a wounded limb.
GONORRHEA
A common venereal disease among Civil War soldiers, known since Biblical times. Civil War doctors used the term “gonorrhea” to diagnose all types of urethral discharges.
GRAYBACKS
A slang term for Southern soldiers or for lice.
HOMEOPATHY
A method of treating disease by administering minute doses of drugs that in a healthy person would produce symptoms similar to those of the disease. In the Civil War, homeopathic treatments were sometimes utilized as a more mild alternative to procedures like bloodletting.
HORNETS
A slang term for bullets.
HOSPITAL GANGRENE
One of the most feared and deadly wound infections, it was highly contagious. It destroys tissue and can spread through the bloodstream to other parts of the body.
INFANTRY
The branch of an army composed of soldiers who fight on foot.
INTESTINAL WORMS
Parasites that can cause mild itching, diarrhea, vomiting or extreme abdominal pain. Black soldiers who had been in slavery in the southern states showed a higher incidence of intestinal worms.
JAUNDICE
A yellow discoloration of the skin and whites of the eyes, due to an increase of bile pigments in the blood. Jaundice is characteristic of the disease yellow fever.
JOY JUICE
A slang term for liquor
LAUDABLE PUS (See also “PUS” and MALIGNANT PUS)
Civil War physicians welcomed the sight of thick, creamy pus, believing that it was a necessary part of the body’s healing process. They did not know that it was a sign of infection owed to the staphylococci bacteria.
LEECHES (See also BLOODLETTING)
A bloodsucking annelid worm once used for bloodletting.
LIGATION
One of the few clinical advances attributed to Civil War surgeons is “arterial ligation”, the tying off of a major artery to constrict blood vessels and stop hemorrhaging. It was not widely known or used during the first part of the war, but by the second half, surgeons had improved and shared their techniques for this life-saving procedure. The veins or arteries were usually tied off with wire or silk thread.
LINT
Minute shreds or ravelings of yarn or cotton fiber. Lint was commonly used to pack and dress wounds. Women volunteers scraped their sheets and tablecloths to gather lint for dressings.
LYMPH
Liquid taken from the lesion of a cow infected with cowpox, or a person infected with smallpox. It was inserted into a cut on a healthy person to create a crude vaccination.
MAGGOTS
The soft-bodied, legless larva of certain flies. Soldiers were tormented by the appearance of maggots in their wounds. Some physicians realized that the insects only ate the dead tissue, cleaning the wounds effectively and painlessly. The use of maggots continues to be explored in the 21st century.
MALARIA
A disease named after the Italian “Mala Aria”, or “bad air”. Debilitating and recurring chills, fever and sweating are its usual symptoms. Almost a million cases of malaria or “intermittent fevers” among Union soldiers were recorded, and it is thought that even more Confederate troops may have suffered. The disease was thought to be caused by “miasmas” or vapors that rose from swamps, although it was later found to be transmitted by the anopheles mosquito.
MALIGNANT PUS
Pus that is watery and bloody, usually attributed to the streptococci bacteria. Malignant pus spread rapidly, and frequently had a fatal outcome due to pyemia or “blood poisoning”.
MALINGERING
Pretending to be ill, especially in order to shirk work or duty. Some soldiers feigned disease or injury in order to obtain a Medical Certificate of Discharge. Known malingerers were sometimes called to duty as stretcher-bearers.
MEASLES
A highly infectious disease characterized by fever, small red spots and cold-like symptoms. The rash was frequently accompanied by pneumonia, making measles very deadly. It ravaged the young troops from rural areas, who had minimal exposure to disease and few immunities. It is estimated that in the Union army, measles were fatal in 6% of white troops and 11% of black troops. Measles epidemics were lethal in Confederate camps, sometimes necessitating the temporary disbanding of companies, battalions and whole regiments.
MINIÉ BALL
The Minié ball caused most of the Civil War wounds. Invented by a French army officer and adapted by American manufacturers, the large conical lead missile was a radical advance in ammunition. It was used in the new rifled weapons and caused massive damage to bones and tissue.
MORPHINE
An addictive narcotic obtained from opium, morphine is used as a powerful pain-killing drug or a sedative. Civil War surgeons frequently dusted morphine powder directly into wounds, sometimes applying it with a moist finger.
NEUROLOGY
The branch of medicine that deals with the nervous system. The large numbers of nerve injuries in the war wounded led to the founding of a specialty hospital called Turner’s Lane in Philadelphia. The medical team was led by Dr. Silas Weir Mitchell of Philadelphia, who had begun to study the phenomenon of “phantom limb” in amputees. Dr. Mitchell gathered valuable data and experimented with treatments, including electrical. He is regarded as one of the founders of American neurology.
NOKUM STIFF
A slang term for liquor
OPTHALMOSCOPE
An instrument utilizing a series of lenses to see inside the eye. Early models used sunlight or an oil lamp as a light source. During the war, both the Federal and Confederate armies established specialty hospitals to treat eye injuries.
PAVILION HOSPITALS
Long, narrow, well-ventilated wooden buildings, commonly built like spokes on a hub. By 1862, Union and Confederacy favored the newly designed “pavilion hospital”. Specialized areas at the hub included operating rooms, kitchens, offices, supply rooms and “dead house”. Although overall sanitation was still poor, pavilion hospitals were usually equipped with rudimentary toilet facilities. Medications, food, laundry and supplies moved much more efficiently through the pavilion hospitals and the quality of convalescent care improved.
PEPPERBOX
A slang term for a pistol.
PHANTOM LIMB
The sensation experienced by some amputees that a missing limb is still attached. This phenomenon was noticed and studied during the Civil War by Dr. Silas Weir Mitchell, now considered one of the founders of the field of neurology.
PHOTOMICROSCOPY
The creation of a photographic reproduction of an object as viewed through a microscope. The Federal Surgeon General’s Office purchased a compound microscope in 1863 for the use of Dr. Joseph Janvier Woodward, an international pioneer in the field of photomicroscopy. Dr. Woodward led the research being conducted by the Army Medical Museum.
PLASTIC OPERATIONS (PLASTIC SURGERY)
A medical specialty focused on the correction or restoration of form and function. Facing many serious head and facial wounds, Civil War surgeons began to attempt some major facial reconstructions. The surgeries were done in multiple steps and used flaps of skin and cork to repair structural damage. Union army records list 32 “plastic operations”.
POULTICES
A soft, moist, mass of cloth, meal, or herbs that was applied to wounds. They were frequently made of bread or flaxseed. Yeast poultices were commonly applied to suppurating wounds in the belief that they would stop infection.
PROBE (NÉLATON PROBE)
A long, thin, flexible metal wand with a ceramic tip. Invented by a French military surgeon named Nélaton, it was used to detect the presence of a bullet in a wound. The probe was never sterilized, and probably carried germs deep into the body. President Lincoln’s fatal head wound was examined with a Nélaton probe.
PURGATIVES
Cleansing or purging, usually by inducing evacuation of the bowels. Civil War doctors used purgatives to draw fluids into the gastrointestinal tract, in the belief that they were draining the fluids from other areas of the body. They also used emetic agents to induce vomiting.
PUS (See also “LAUDABLE PUS”)
A yellow-white viscous substance composed of bacteria, white blood cells and dead tissue. It is characteristic of infected wounds. Civil War physicians believed that it was part of the healing process.
PYEMIA
Infections that spread throughout the bloodstream, also known as “blood poisoning”. During the Civil War, the death rate of soldiers with this condition was 97%.
QUICK-STEP
A slang term for diarrhea, one of the deadliest ailments of the war.
QUININE
A drug made from cinchona tree bark, whose active ingredient is the alkaloid “quinine.” Spanish missionaries observed its use in South America in the 1500’s. It was an effective treatment for malaria and widely used by Civil War doctors.
SAWBONES
A slang term meaning “surgeon”.
SCALPEL
A small, usually straight knife used in surgery to cut through skin and other soft tissue.
SCURVY
Scurvy is a disease related to dietary deficiency, known during the Civil War as a “dietetic disease”, their term for malnutrition. It is caused by a lack of vitamin C and other nutrients. It is a debilitating disease, frequently characterized by swollen and bleeding gums and livid spots on the skin. The effectiveness of the military was sometimes severely affected by the widespread nature of this affliction in some units. Scurvy remained a problem in the U.S. military through World War I.
SMALLPOX
A viral disease characterized by fever and pustular eruptions of the skin. The fatality rate was 20-40%. Those who survived usually bore its scars. Smallpox was known to be highly contagious, and separate hospital units, called “pest houses” were used to house those with the disease. Smallpox was one of the few diseases for which vaccinations were available, but not always enforced. President Lincoln suffered a mild case of smallpox in November, 1863.
SUPPURATION
The discharge or formation of pus. Also a term for pus.
SUTURES
Stitches that join the edges of a wound or vessel. Civil War surgeons used silk or cotton thread. When severe supply shortages affected the Confederacy, surgeons used horsehair that was boiled to make it more pliable.
SYPHILIS
A chronic infectious, usually venereal disease caused by a spirochete. Syphilis was not as feared as gonorrhea by Civil War soldiers, as the serious nervous system and cardiovascular system effects can take years to appear and were not well known until the late 19th century. Syphilis was sometimes transmitted through the smallpox vaccine when “lymph” from an infected person was transmitted to someone else.
TAR WATER
A slang term for liquor.
TENNESSEE TROTS
A slang term for ordinary (not chronic) diarrhea.
TOURNIQUET
Any device that is used to stop bleeding by compressing a blood vessel. A tourniquet can be a device that wraps around a limb, or even a bandage that is tightened by twisting.
TURPENTINE
A strong-smelling liquid frequently used as a paint thinner and solvent. It is distilled from a substance derived from coniferous trees. Civil War physicians used turpentine orally for chronic diarrhea and sometimes for typhoid fever. They used it topically on the skin in the belief that it would increase blood flow and reduce inflammation. It was sometimes applied to bandages to discourage maggot infestation in wounds.
TYPHOID FEVER
An infectious disease that is characterized by fever, general malaise and intestinal inflammation. It is spread by food or water contaminated with the bacteria Salmonella typhi. Such contamination was common in army camps and caused terrible epidemics. Thousands of soldiers died from Typhoid fever, the biggest killer among the epidemic diseases.
VACCINATIONS
The introduction into the body of a preparation of weakened or killed bacteria or viruses for the purpose of preventing disease by stimulating antibodies against it. Civil War physicians usually used material taken from a cow infected with cowpox (the term “vaccine” refers to the Latin word “vaccus”, meaning “cow”), or sometimes material taken from a patient with a mild form of smallpox. Sometimes, during an outbreak of the disease, mass inoculations were carried out.
WOUND
An injury, usually one that involves the cutting or tearing of tissue.
YELLOW FEVER
A form of fulminating viral hepatitis usually found in warm climates. It is characterized by fever, hemorrhages, and jaundice, which turns the skin yellow. The disease is carried by the Aedes aegypti mosquito, which transmits it from person to person. Outbreaks of yellow fever were greatly feared, and there was no effective treatment at the time; there is still none today.
© 2011 JAMCO Films. All Rights Reserved.
Sunday, September 4, 2011
Crossroads of the Civil War
Find out why Frederick, Maryland is an important place in American Civil War history. From the Museum of Civil War Medicine's Executive Director George Wunderlich.
To learn more about the National Museum of Civil War Medicine, visit - www.civilwarmed.org
Saturday, September 3, 2011
Frontline Pharmacies
by Robert Hicks /
A few months after the Civil War began, on July 4, 1861, a group of patriotic young volunteers stood in the shadow of the Capitol, waiting to be sworn into the Union Army on a 90-day enlistment. Among them was William W. Keen. Less than three weeks later, and with only nine months of medical training, Keen stood clueless, in his blue uniform with the green sash of a medical officer, near the battlefield at Bull Run in Virginia.
“It was an exceedingly hot day, and we marched and halted in the thick dust under a broiling sun until about noon. . . . During the entire engagement, I never received a single order.” Inside a church he and fellow soldiers placed two boards on boxes in front of a pulpit for an operating table. Hearing that the Confederates were about to overrun the makeshift hospital, Keen’s patient, a soldier with a fractured humerus from a Minié ball (a powerful new rifled bullet), jumped up and ran for the woods, his bandage unraveling from his arm as he went. Keen later wrote, “My experience in this battle is a good illustration of the utter disorganization, or rather want of organization, of our entire army at the beginning of the war.”
Had Keen received an adequate briefing before battle, he would still have been left frustrated with a medical infrastructure unchanged in its essentials since the Mexican War of the 1840s. His experience typified the Federal government’s lack of preparedness in wartime. In fact, the lack of infrastructure, particularly ambulances, meant that many Bull Run casualties waited for days on the battlefield before soldiers or civilians removed them to hospitals.
At Bull Run, Keen received a crash course in misery. Battlefield hospitals were triage centers: stacks of amputated limbs marked the surgeons’ tents. Soldiers with severe abdominal or chest injuries were left to die: no surgical intervention was possible without the sure consequence of infection. The soldier’s life may have been punctuated with combat terror, but disease and illness afflicted far more troops than did battlefield wounds. Germ theory and antisepsis entered medicine only after the war. Counting deaths from wounds or disease, the war claimed between 600,000 and 700,000 lives, more than the number of soldiers killed in all other American wars combined. Beyond battlefield wounds, soldiers suffered malnutrition (including scurvy), dysentery, typhus, typhoid, respiratory illnesses, rheumatism, and outbreaks of malaria, yellow fever, and even smallpox (despite the prevalence of vaccination).
By the end of the war a radical reorganization of the medical field had occurred. The Medical Department could boast of an ambulance system, a sequence of care facilities from battlefield surgery to general hospitals, evacuation of the sick and wounded by train, and a nascent nursing profession. A new system—of government-funded pharmaceutical research and manufacturing—had taken hold. The demand for new chemical and botanical sources for medicines and for the production of reliable vaccines accelerated laboratory-based research and guided postwar pharmacology—including the growth of major manufacturing firms John Wyeth and Eli Lilly. In addition, Civil War pharmacology produced competing therapies and bitter disagreements that brought the Union Army surgeon general to court-martial and established the position of one of the most versatile and effective medicines of the late 19th century: quinine.
Hospital Systems
On July 21, however, Keen was unable to benefit from these future developments. During the fall of 1861 he went to Philadelphia to complete his formal studies, which at that time required a year of anatomy classes, which was then repeated and followed by several years of apprenticeship with an established physician. Keen returned to the army to find the medical service invigorated. The military had created a cadet corps, a comprehensive examination procedure, and a training school, and decided rank and assignments based on merit. Although Keen had a good knowledge of materia medica—pharmacy—the army’s organization of medicine might have impressed him with its diversity and complexity. Physicians generally relied on the Supply Table—the army’s standard table of drugs, their effects, and their preparation for use. During the war the army created a system that began with acquiring raw materials (eventually creating its own laboratories), included quality control, continued with the preparation and distribution of medicines to armies in the field or to hospitals, and went on to a method of prescribing and dispensing to ill soldiers.
Initially, both the Union and Confederate armies immediately distributed any medicines purchased. Later, the Union Army purchased raw materials, such as cinchona bark for quinine, for processing at its own or contract laboratories. The South, with no drug-manufacturing centers, was forced to smuggle medicines, capture them, or invent alternatives. When Keen required medicine for his patients, medical purveyors—usually a military officer or physician—bought drugs on the market or obtained them from one of many depots, and then shipped them; medical storekeepers took receipt and stored medicines until needed; surgeons wrote prescriptions; and in the Union Army hospital stewards filled them. With a rank equivalent to a sergeant the hospital steward was an apothecary who supervised lesser hospital staff and occasionally performed minor surgery. As the war progressed, purveyors for the Union Army learned which wholesalers or companies delivered trustworthy and reliable products. The most influential laboratories serving the Union Army included Charles Pfizer and Company, Edward R. Squibb, Schief¬felin and Company, Powers and Weightman (many years later to become Merck), Rosengarten and Sons, and John Wyeth—many of which still dominate the industry today.
These developments formed the background of a desperate war. A year after Bull Run, Keen found himself back for the Second Battle of Bull Run. He set up a field hospital at nearby Centreville “and soon afterward began to distribute the instruments, blankets, medicines, stimulants, etc., I had brought. . .. Before I left Washington I had been directed to be rather sparing in distributing these, and I obeyed orders.” He regretted his parsimony when a regiment of Virginia Confederate Cavalry overran the field hospital. Keen was forced to hand over the key to the storehouse of “medicines, stimulants, operating cases, and . . . more valuable things that I had brought along—how their eyes widened and their faces were wreathed in smiles as the doctor, after a rapid survey of the boxes on the walls, turned to the colonel and said, with an expletive: ‘There is more good whiskey in this little smoke-house than there is in the whole city of Richmond!’”
Stranded with about 100 wounded men without supplies, Keen surveyed the misery. Some pitying Confederates even donated canned soup. He received important assistance from two Northern quasi-governmental relief organizations, the U.S. Christian and U.S. Sanitary Commissions, both of which showed up with food. While others prepared soup, Keen “took a bottle of morphine and [his] pocket penknife and did not worry over any superfluous exactitude in doling out the blessed relief which morphine brings to men in pain. All of this was done in total darkness, with two or three slim lanterns, in a drizzling rain, and in six inches of Virginia mud.” Keen faced rampant infections owing to severe internal injuries. “Wounds of the abdomen involving the viscera were almost uniformly fatal. . . . Opium was practically our only remedy [for abdominal surgery] and death the usual result.”
Pharmaceutical Development
In 1862 Jonathan Letterman, medical director of the Army of the Potomac, ordered Keen to commandeer two Washington, D.C., churches and convert them into hospitals in five days. Keen complied, but the army way of doing things remained obscure. “I was not lacking in ordinary intelligence and was willing to work, but I was utterly without training. . . . As to drugs I did not know whether to order six ounces or a gallon of laudanum, an ounce or two or a pound or two of opium.”
The pharmacopoeia at Keen’s disposal, which centered on the Supply Table, presented a sophisticated constellation of substances. Nineteenth-century understanding of the origins of disease is both familiar and strange; the restoration of balance within bodily systems, a relic of humoral theory (in which black bile, yellow bile, blood, and phlegm made up the humors), still informed much of medicine. The category of “fevers” represented a type of disease rather than a symptom. Some diseases, such as typhoid and typhus, were not easy to distinguish, and as a result received identical treatments.
In the hospital Keen wrote prescriptions in Latin, the universal custom, and gave them to the steward to compound. To a 21st-century pharmacist, some of the substances popular then, like Dover’s Powder and calomel—the former containing opium, the latter, mercury—have no recommended therapeutic purpose. Some, like antimony- and lead-based drugs, are downright dangerous, while others remain in use—such as iodine and quinine. With no laboratory methods available to establish drug usefulness through testing, no systematic antisepsis, and no germ theory, Keen worked within a system of medical knowledge based on observation of symptoms rather than causes.
Many of the soldiers Keen saw at his Washington hospitals arrived not only ill or wounded but debilitated by poor nutrition and the harsh physical demands of campaigning. Keen was harrowed by the sight of sick soldiers. After the Second Battle of Bull Run he wrote: “I passed such a night as I had never before experienced in my life. Long trains of ambulances arrived, carrying our wounded from the field of battle. . . . Fifty poor, thirsty fellows were crying for water; fifty more were crying with the pain from a jolting ride [to Washington] of nine miles over a corduroy road. Most of them had had nothing to eat for one, two, or three days, save what they had obtained from the haversacks of poor fellows who were dead in their neighborhood. Some had such horrible wounds that they could absolutely go no farther, and must be got out on stretchers and taken into the hospital.”
Given the major role illness played in war, military strategy had to weigh the health of entire regiments; every soldier suffered diarrhea at least once, and many experienced dysentery. Patients at Keen’s hospital were fed a healthy, vegetable-rich diet. Calomel and opium were also favored treatments. He wrote later, “What we did not have in those days was almost more noticeable than what we did have. Among our blessings, however, were ether and chloroform. . . . We had, however, no antiseptics, for antisepsis was as yet even undreamed of.” He classified fevers as common, remittent, or intermittent, some of which accompanied dysentery or may have been symptomatic of typhus or typhoid, both of which flourished in the unhygienic camps. Keen prescribed quinine or cinchona for the fevers associated with both, just as he might have for malaria. Where Keen saw the most life-threatening respiratory disease, pneumonia (then recognized as an inflammation of the lungs), he may have prescribed tartar emetic or antimony, a therapy that became the focus of a controversy within the Union Army Medical Department.
Quinine proved the true medicinal miracle of the war. Malarial fevers were omnipresent during Southern campaigns, and the Union Army’s mandated prophylactic use of quinine prevented much illness, a benefit widely lauded by military commanders. Rosengarten and Sons, a major drug supplier to the Union Army in Philadelphia, excelled at producing quinine. The company employed French chemists versed in the techniques of isolating the alkaloid quinine, a process worked out 40 years before the war.
Hospitals were not always safe for patients. Keen worried about outbreaks of “hospital gangrene” owing to staphylococcus or other causes not known at the time. Gangrenous patients were immediately removed and isolated, and Keen may have ordered an effective treatment recognized during the latter part of the war: bromine. Mortality from these infections approached 97%. Worse than these diseases—from a military commander’s viewpoint—were epidemics. Yellow fever and smallpox epidemics afflicted both civilian and military populations in the North and South. Both armies required military recruits to be vaccinated for smallpox, but vaccine supplies were irregular and of uncertain quality. In the absence of vaccines some soldiers practiced the 18th-century technique of variolation, that of removing lymph from a smallpox-infected person and introducing it subcutaneously (with a knife) to others to engender a hopefully mild infection.
The battlefield presented even more challenges. At Gettysburg, with almost 30,000 soldiers awaiting treatment, Keen probed a soldier’s gunshot wound near the upper shoulder and neck, trying to stop the bleeding. “The bullet had not emerged; its direction was unknown; the hemorrhage was profuse. . . . I etherized the man and proceeded to search for the wounded vessel.” Contrary to popular opinion, more than 95% of major Civil War surgeries were performed under ether or chloroform. Ether’s flammability, however, was yet another danger. “My only light was a square block of wood with five auger holes,” Keen continued, “in each one of which was placed a candle. . . . As the wound was so near the mouth, of course the light had to be near the ether cone [the mask placed over the patient’s face to receive the anesthesia]. . . . Suddenly the ether took fire and the etherizer flung away both cone and bottle. Luckily the bottle did not break or we might have had an ugly fire in a hospital constructed wholly of wood.”
Medical Victories
The chief medical achievements during the war were organizational. Apart from the banning of mercury, wartime medicines underwent little change until germ theory became understood. At first physicians applied medicines based on their own observations of the results, which created different philosophies of medication. The huge demand for drugs during the war allowed physicians to investigate and study the effectiveness of their pharmacopoeia more systematically and created the infrastructure for large-scale drug manufacturing and testing. As the federal government operated processing laboratories, government support and testing gradually became more important. Quinine and its various forms were abundantly tested, and their value was confirmed.
The distance in time between the beginning of World War II and today is equivalent to the time between the end of the Civil War and the beginning of World War II—not so long, but distant in medical ideology and practice. Keen’s wartime practice heeded the holistic perspective demanded by medical director Jonathan Letterman, who pointed out “that the duties of Medical officers are not confined to prescribing drugs, but that it is also their duty . . . to preserve the health of those who are well. . . . The prevention of disease is the highest object of medical science.”
Keen himself, the only physician to serve in uniform in both the Civil War and World War I, participated in the transformation of American medicine and therapeutics into the 20th century. He eagerly embraced antisepsis and germ theory, kept current with such new technologies as X-rays, and abandoned counterproductive medicines. Recollecting the War of the Rebellion, as he called it, “Only too sharply do we remember the dreadful things that we did do and the good things that we did not dare to do."
Robert D. Hicks is director of the Mütter Museum and Historical Medical Library of the College of Physicians of Philadelphia.
Reprint: Chemical Heritage Foundation - www.chemheritage.org
Ambulance train, early 1860s. New York Public Library.
A few months after the Civil War began, on July 4, 1861, a group of patriotic young volunteers stood in the shadow of the Capitol, waiting to be sworn into the Union Army on a 90-day enlistment. Among them was William W. Keen. Less than three weeks later, and with only nine months of medical training, Keen stood clueless, in his blue uniform with the green sash of a medical officer, near the battlefield at Bull Run in Virginia.
“It was an exceedingly hot day, and we marched and halted in the thick dust under a broiling sun until about noon. . . . During the entire engagement, I never received a single order.” Inside a church he and fellow soldiers placed two boards on boxes in front of a pulpit for an operating table. Hearing that the Confederates were about to overrun the makeshift hospital, Keen’s patient, a soldier with a fractured humerus from a Minié ball (a powerful new rifled bullet), jumped up and ran for the woods, his bandage unraveling from his arm as he went. Keen later wrote, “My experience in this battle is a good illustration of the utter disorganization, or rather want of organization, of our entire army at the beginning of the war.”
Had Keen received an adequate briefing before battle, he would still have been left frustrated with a medical infrastructure unchanged in its essentials since the Mexican War of the 1840s. His experience typified the Federal government’s lack of preparedness in wartime. In fact, the lack of infrastructure, particularly ambulances, meant that many Bull Run casualties waited for days on the battlefield before soldiers or civilians removed them to hospitals.
At Bull Run, Keen received a crash course in misery. Battlefield hospitals were triage centers: stacks of amputated limbs marked the surgeons’ tents. Soldiers with severe abdominal or chest injuries were left to die: no surgical intervention was possible without the sure consequence of infection. The soldier’s life may have been punctuated with combat terror, but disease and illness afflicted far more troops than did battlefield wounds. Germ theory and antisepsis entered medicine only after the war. Counting deaths from wounds or disease, the war claimed between 600,000 and 700,000 lives, more than the number of soldiers killed in all other American wars combined. Beyond battlefield wounds, soldiers suffered malnutrition (including scurvy), dysentery, typhus, typhoid, respiratory illnesses, rheumatism, and outbreaks of malaria, yellow fever, and even smallpox (despite the prevalence of vaccination).
By the end of the war a radical reorganization of the medical field had occurred. The Medical Department could boast of an ambulance system, a sequence of care facilities from battlefield surgery to general hospitals, evacuation of the sick and wounded by train, and a nascent nursing profession. A new system—of government-funded pharmaceutical research and manufacturing—had taken hold. The demand for new chemical and botanical sources for medicines and for the production of reliable vaccines accelerated laboratory-based research and guided postwar pharmacology—including the growth of major manufacturing firms John Wyeth and Eli Lilly. In addition, Civil War pharmacology produced competing therapies and bitter disagreements that brought the Union Army surgeon general to court-martial and established the position of one of the most versatile and effective medicines of the late 19th century: quinine.
Hospital Systems
On July 21, however, Keen was unable to benefit from these future developments. During the fall of 1861 he went to Philadelphia to complete his formal studies, which at that time required a year of anatomy classes, which was then repeated and followed by several years of apprenticeship with an established physician. Keen returned to the army to find the medical service invigorated. The military had created a cadet corps, a comprehensive examination procedure, and a training school, and decided rank and assignments based on merit. Although Keen had a good knowledge of materia medica—pharmacy—the army’s organization of medicine might have impressed him with its diversity and complexity. Physicians generally relied on the Supply Table—the army’s standard table of drugs, their effects, and their preparation for use. During the war the army created a system that began with acquiring raw materials (eventually creating its own laboratories), included quality control, continued with the preparation and distribution of medicines to armies in the field or to hospitals, and went on to a method of prescribing and dispensing to ill soldiers.
Hand-colored lithograph of the Second Battle of Bull Run, August 29, 1862. Keen was present at the first battle—in 1861—as a volunteer medical officer. Library of Congress.
Initially, both the Union and Confederate armies immediately distributed any medicines purchased. Later, the Union Army purchased raw materials, such as cinchona bark for quinine, for processing at its own or contract laboratories. The South, with no drug-manufacturing centers, was forced to smuggle medicines, capture them, or invent alternatives. When Keen required medicine for his patients, medical purveyors—usually a military officer or physician—bought drugs on the market or obtained them from one of many depots, and then shipped them; medical storekeepers took receipt and stored medicines until needed; surgeons wrote prescriptions; and in the Union Army hospital stewards filled them. With a rank equivalent to a sergeant the hospital steward was an apothecary who supervised lesser hospital staff and occasionally performed minor surgery. As the war progressed, purveyors for the Union Army learned which wholesalers or companies delivered trustworthy and reliable products. The most influential laboratories serving the Union Army included Charles Pfizer and Company, Edward R. Squibb, Schief¬felin and Company, Powers and Weightman (many years later to become Merck), Rosengarten and Sons, and John Wyeth—many of which still dominate the industry today.
These developments formed the background of a desperate war. A year after Bull Run, Keen found himself back for the Second Battle of Bull Run. He set up a field hospital at nearby Centreville “and soon afterward began to distribute the instruments, blankets, medicines, stimulants, etc., I had brought. . .. Before I left Washington I had been directed to be rather sparing in distributing these, and I obeyed orders.” He regretted his parsimony when a regiment of Virginia Confederate Cavalry overran the field hospital. Keen was forced to hand over the key to the storehouse of “medicines, stimulants, operating cases, and . . . more valuable things that I had brought along—how their eyes widened and their faces were wreathed in smiles as the doctor, after a rapid survey of the boxes on the walls, turned to the colonel and said, with an expletive: ‘There is more good whiskey in this little smoke-house than there is in the whole city of Richmond!’”
Stranded with about 100 wounded men without supplies, Keen surveyed the misery. Some pitying Confederates even donated canned soup. He received important assistance from two Northern quasi-governmental relief organizations, the U.S. Christian and U.S. Sanitary Commissions, both of which showed up with food. While others prepared soup, Keen “took a bottle of morphine and [his] pocket penknife and did not worry over any superfluous exactitude in doling out the blessed relief which morphine brings to men in pain. All of this was done in total darkness, with two or three slim lanterns, in a drizzling rain, and in six inches of Virginia mud.” Keen faced rampant infections owing to severe internal injuries. “Wounds of the abdomen involving the viscera were almost uniformly fatal. . . . Opium was practically our only remedy [for abdominal surgery] and death the usual result.”
Pharmaceutical Development
In 1862 Jonathan Letterman, medical director of the Army of the Potomac, ordered Keen to commandeer two Washington, D.C., churches and convert them into hospitals in five days. Keen complied, but the army way of doing things remained obscure. “I was not lacking in ordinary intelligence and was willing to work, but I was utterly without training. . . . As to drugs I did not know whether to order six ounces or a gallon of laudanum, an ounce or two or a pound or two of opium.”
The pharmacopoeia at Keen’s disposal, which centered on the Supply Table, presented a sophisticated constellation of substances. Nineteenth-century understanding of the origins of disease is both familiar and strange; the restoration of balance within bodily systems, a relic of humoral theory (in which black bile, yellow bile, blood, and phlegm made up the humors), still informed much of medicine. The category of “fevers” represented a type of disease rather than a symptom. Some diseases, such as typhoid and typhus, were not easy to distinguish, and as a result received identical treatments.
In the hospital Keen wrote prescriptions in Latin, the universal custom, and gave them to the steward to compound. To a 21st-century pharmacist, some of the substances popular then, like Dover’s Powder and calomel—the former containing opium, the latter, mercury—have no recommended therapeutic purpose. Some, like antimony- and lead-based drugs, are downright dangerous, while others remain in use—such as iodine and quinine. With no laboratory methods available to establish drug usefulness through testing, no systematic antisepsis, and no germ theory, Keen worked within a system of medical knowledge based on observation of symptoms rather than causes.
Watercolor illustration from the 1860s of hospital gangrene. Hospitals, with their frequent and serious outbreaks of disease, could be as dangerous as battlefields. New York Public Library.
Many of the soldiers Keen saw at his Washington hospitals arrived not only ill or wounded but debilitated by poor nutrition and the harsh physical demands of campaigning. Keen was harrowed by the sight of sick soldiers. After the Second Battle of Bull Run he wrote: “I passed such a night as I had never before experienced in my life. Long trains of ambulances arrived, carrying our wounded from the field of battle. . . . Fifty poor, thirsty fellows were crying for water; fifty more were crying with the pain from a jolting ride [to Washington] of nine miles over a corduroy road. Most of them had had nothing to eat for one, two, or three days, save what they had obtained from the haversacks of poor fellows who were dead in their neighborhood. Some had such horrible wounds that they could absolutely go no farther, and must be got out on stretchers and taken into the hospital.”
Given the major role illness played in war, military strategy had to weigh the health of entire regiments; every soldier suffered diarrhea at least once, and many experienced dysentery. Patients at Keen’s hospital were fed a healthy, vegetable-rich diet. Calomel and opium were also favored treatments. He wrote later, “What we did not have in those days was almost more noticeable than what we did have. Among our blessings, however, were ether and chloroform. . . . We had, however, no antiseptics, for antisepsis was as yet even undreamed of.” He classified fevers as common, remittent, or intermittent, some of which accompanied dysentery or may have been symptomatic of typhus or typhoid, both of which flourished in the unhygienic camps. Keen prescribed quinine or cinchona for the fevers associated with both, just as he might have for malaria. Where Keen saw the most life-threatening respiratory disease, pneumonia (then recognized as an inflammation of the lungs), he may have prescribed tartar emetic or antimony, a therapy that became the focus of a controversy within the Union Army Medical Department.
Quinine proved the true medicinal miracle of the war. Malarial fevers were omnipresent during Southern campaigns, and the Union Army’s mandated prophylactic use of quinine prevented much illness, a benefit widely lauded by military commanders. Rosengarten and Sons, a major drug supplier to the Union Army in Philadelphia, excelled at producing quinine. The company employed French chemists versed in the techniques of isolating the alkaloid quinine, a process worked out 40 years before the war.
Hospitals were not always safe for patients. Keen worried about outbreaks of “hospital gangrene” owing to staphylococcus or other causes not known at the time. Gangrenous patients were immediately removed and isolated, and Keen may have ordered an effective treatment recognized during the latter part of the war: bromine. Mortality from these infections approached 97%. Worse than these diseases—from a military commander’s viewpoint—were epidemics. Yellow fever and smallpox epidemics afflicted both civilian and military populations in the North and South. Both armies required military recruits to be vaccinated for smallpox, but vaccine supplies were irregular and of uncertain quality. In the absence of vaccines some soldiers practiced the 18th-century technique of variolation, that of removing lymph from a smallpox-infected person and introducing it subcutaneously (with a knife) to others to engender a hopefully mild infection.
Army surgeons in front of a hospital tent in Petersburg, Virginia, 1864. Contrary to popular belief, most surgeries during the Civil War were performed under some kind of anesthesia—either ether or chloroform. Library of Congress.
The battlefield presented even more challenges. At Gettysburg, with almost 30,000 soldiers awaiting treatment, Keen probed a soldier’s gunshot wound near the upper shoulder and neck, trying to stop the bleeding. “The bullet had not emerged; its direction was unknown; the hemorrhage was profuse. . . . I etherized the man and proceeded to search for the wounded vessel.” Contrary to popular opinion, more than 95% of major Civil War surgeries were performed under ether or chloroform. Ether’s flammability, however, was yet another danger. “My only light was a square block of wood with five auger holes,” Keen continued, “in each one of which was placed a candle. . . . As the wound was so near the mouth, of course the light had to be near the ether cone [the mask placed over the patient’s face to receive the anesthesia]. . . . Suddenly the ether took fire and the etherizer flung away both cone and bottle. Luckily the bottle did not break or we might have had an ugly fire in a hospital constructed wholly of wood.”
Medical Victories
The chief medical achievements during the war were organizational. Apart from the banning of mercury, wartime medicines underwent little change until germ theory became understood. At first physicians applied medicines based on their own observations of the results, which created different philosophies of medication. The huge demand for drugs during the war allowed physicians to investigate and study the effectiveness of their pharmacopoeia more systematically and created the infrastructure for large-scale drug manufacturing and testing. As the federal government operated processing laboratories, government support and testing gradually became more important. Quinine and its various forms were abundantly tested, and their value was confirmed.
The distance in time between the beginning of World War II and today is equivalent to the time between the end of the Civil War and the beginning of World War II—not so long, but distant in medical ideology and practice. Keen’s wartime practice heeded the holistic perspective demanded by medical director Jonathan Letterman, who pointed out “that the duties of Medical officers are not confined to prescribing drugs, but that it is also their duty . . . to preserve the health of those who are well. . . . The prevention of disease is the highest object of medical science.”
Keen himself, the only physician to serve in uniform in both the Civil War and World War I, participated in the transformation of American medicine and therapeutics into the 20th century. He eagerly embraced antisepsis and germ theory, kept current with such new technologies as X-rays, and abandoned counterproductive medicines. Recollecting the War of the Rebellion, as he called it, “Only too sharply do we remember the dreadful things that we did do and the good things that we did not dare to do."
Robert D. Hicks is director of the Mütter Museum and Historical Medical Library of the College of Physicians of Philadelphia.
Reprint: Chemical Heritage Foundation - www.chemheritage.org
Thursday, September 1, 2011
The Minie Ball
Amputation was the most common surgery during the Civil War. Most amputations owed their unfortunate necessity to the minie ball.
The smoothbore musket had been the standard American infantry weapon throughout the 1850s. It fired a round ball and was reliable at close range in an era when the main military tactic was the massed infantry attack.
Civil War battlefields hosted a new generation of rifled weapons. Grooves inside the barrel of the gun gave the ammunition greater velocity, penetration and long-range accuracy. The ammunition of choice was the new, deadly minie ball.
Designed in France by Captain Claude-Etienne Minie, the ball was adapted by American manufacturers and was the most common ammunition used in the Civil War. The minie ball changed the face of warfare and of battlefield wounds.
The American version of the bullet was a large ellipsoid made of lead with a hollow cavity at its base. The cavity expanded when the powder was ignited, to fill the grooves of a rifled musket barrel. The grooves, or rifling inside the gun barrel caused the bullet to revolve as it left the muzzle.
The 0.58-caliber conical minie ball tore an enormous wound on impact, in part because the soft lead deformed, enlarging its dimensions. The ball was so heavy that head and abdominal wounds were almost always fatal; wounds to the extremities ripped through the tissues and shattered the bones.
As the missiles broke through the skin, they usually carried dirt, skin and fabric into the body. The wounds almost always became infected.
The minie ball caused massive tissue destruction and crushed the bones. This type of battlefield wound had never been seen before in America. Huge numbers of casualties and a lack of time, equipment, supplies and surgical experience made amputation the most rapid and effective technique to save the largest number of lives. Despite the frightening destructive power of the minie ball, an astonishing 75% of the Civil War amputees survived their surgeries.
Tuesday, August 30, 2011
Founding the United States Sanitary Commission
by Carole Adrienne /
The United States Sanitary Commission was a model of reform for the medical services, inspiring the Federal War Department to reorganize its medical policies. When the Civil War began, supplies presented a major problem. No quality controls existed. Uniforms were poorly made. There was extensive profiteering in food and horses. Surgeons and the wounded sometimes waited for days after a battle before supplies arrived, if they arrived at all.
The Sanitary Commission inspected the conditions at camps and hospitals and published reports, pamphlets, and circulars written by Commission Agents and physicians. They published a hospital directory with the names of over 600,000 hospitalized men, including the black soldiers, who were sometimes treated in segregated hospitals. The Commission advocated the adoption of sanitary principles by the United States Army.
By late 1863, the work of the Sanitary Commission had made remarkable improvements in the evacuation and treatment of the wounded, demonstrated at the Battle of Chattanooga.
The United States Sanitary Commission laid a foundation for discoveries that would be revealed after the war. They knew that cleanliness mattered, although they weren’t sure why. They knew that sanitary conditions led to fewer infections and slowed the spread of disease.
Louis Pasteur would later point out that living organisms did not arise spontaneously, but only from previous organisms. Joseph Lister provided the link to infection, and the Commission’s work paved the way for the acceptance of these discoveries.
Sunday, August 28, 2011
Daughters of Charity Nursed Wounded Civil War Soldiers at West Philadelphia Hospital
by Christine McCullough-Friend /
Women’s religious orders have served both Catholics and non-Catholics within the Philadelphia community since the establishment of the Diocese of Philadelphia two centuries ago. These women, who have and who continue to devote their lives to the betterment of society have played a pivotal role in social work, education and medicine.
As we begin to commemorate the 150th anniversary of the start of the Civil War, one example of this service that should be highlighted is the work of the Daughters of Charity (formerly Sisters of Charity) at Satterlee Military Hospital. The sisters ministered to thousands of wounded and dying Civil War soldiers from 1862 until the hospital closed in 1865.
The 12-acre site where the Satterlee Hospital was located in West Philadelphia, bounded roughly by 40th to 44th Streets, from Spruce to Pine Streets, was at that time very rural, far removed from the cramped and crowded conditions of urban Philadelphia. The ‘pure country air’ afforded the soldiers an opportunity to rest and recover from their wounds.
The hospital, initially called West Philadelphia Hospital, was renamed Satterlee Military Hospital in honor of Richard Smith Satterlee, a distinguished army surgeon. The surgeon in charge was Dr. Isaac Hayes, an Artic explorer before he joined the army. The hastily constructed buildings were completed in just over 40 days. The 2,500-bed facility was not quite finished when 22 Daughters of Charity arrived on June 9, 1862.
Initially, the hospital was fairly ill equipped, especially with regard to the accommodations for the sisters. Beverages were served in wash pitchers and the food in basins. The sisters ate their meals earlier than the officers, sharing just four eating utensils reserved for officers’ use. The chapel was so small that some sisters had to exit the room so others could enter and receive Holy Communion.
Satterlee Hospital became a self-contained city when a tent city was built on the grounds in 1863. The hospital increased its capacity to accommodate 4,500 wounded soldiers. A 14-foot high fence surrounded the property, which now sprawled south to Baltimore Avenue and west to 46th Street. On the grounds there was a post office, clothing store, laundry facility, carpenter shop, printing shop, dispensary, library, and three kitchens referred to as restaurants.
Although the official capacity of Satterlee was 4,500, the actual capacity exceeded this number. After the Battle of Bull Run, the wounded arrived by the hundreds. After the Battle of Gettysburg, they arrived by the thousands, swelling the hospital population to more than 6,000. During the Battle of Gettysburg which occurred during July 1863, the greatest number of wounded were admitted to the hospital in a single month. The following month of August saw the greatest number of deaths in any one month, averaging at least one per day. In just one year, patients consumed more than 800,000 pounds of bread, 16,000 pounds of butter and 334,000 quarts of milk.
During the war, more than 100 Daughters of Charity passed through the doors of Satterlee Hospital, ministering to the wounded soldiers’ spiritual and medical needs. The tiny chapel was soon expanded to seat 400 worshippers. Many soldiers often arrived several hours before mass to obtain a seat. Several wounded soldiers contributed generously to outfit the chapel properly, purchasing a set of stations of the cross and taking great pains to decorate the chapel for feasts and special occasions.
The hospital’s chaplain was Father Peter McGrane who was stationed at St. Patrick’s at 20th and Locust Streets. Every day, Father McGrane traveled from St. Patrick’s to Satterlee to say mass, hear confessions, instruct and baptize and frequently arrange for burial. He labored throughout the war ministering to the wounded and dying. Archbishop James Wood also visited Satterlee several times to confirm many adult converts.
The practice of military medicine during the war was an eye-opening experience. The wounds caused by the new and improved artillery met the outdated medical practices of understaffed field hospitals, resulting in an epidemic of needless deaths. Conditions began to improve with the advent of permanent army hospitals like Sattelee, staffed by experiences surgeons and dedicated sisters.
During its four-year existence, more than 50,000 wounded soldiers were treated at Satterlee. The contributions made by the medical professionals and the Daughters of Charity who staffed the hospital are immeasurable.
PAHRC holds a copy of a diary kept by a Daughter of Charity at the hospital from 1862 to 1865.
Credit: Philadelphia Archdiocesan Historical Research Center
References:
Smith, Sara Trainer, ed. “Notes on Satterlee Military Hospital…from the journal kept at the hospital by a Sister of Charity.” Records of the American Catholic Historical Society of Philadelphia (Volume 8)
, no. 4 (December 1897): 399-449.
West, Nathaniel. History of the Satterlee U. S. A. Gen. Hospital, at West Philadelphia, Pa., from October 8, 1862, to October 8, 1863.
The Hosptial Press, 1863. (Call# IC0135)
Women’s religious orders have served both Catholics and non-Catholics within the Philadelphia community since the establishment of the Diocese of Philadelphia two centuries ago. These women, who have and who continue to devote their lives to the betterment of society have played a pivotal role in social work, education and medicine.
As we begin to commemorate the 150th anniversary of the start of the Civil War, one example of this service that should be highlighted is the work of the Daughters of Charity (formerly Sisters of Charity) at Satterlee Military Hospital. The sisters ministered to thousands of wounded and dying Civil War soldiers from 1862 until the hospital closed in 1865.
Nurses and staff
The 12-acre site where the Satterlee Hospital was located in West Philadelphia, bounded roughly by 40th to 44th Streets, from Spruce to Pine Streets, was at that time very rural, far removed from the cramped and crowded conditions of urban Philadelphia. The ‘pure country air’ afforded the soldiers an opportunity to rest and recover from their wounds.
The hospital, initially called West Philadelphia Hospital, was renamed Satterlee Military Hospital in honor of Richard Smith Satterlee, a distinguished army surgeon. The surgeon in charge was Dr. Isaac Hayes, an Artic explorer before he joined the army. The hastily constructed buildings were completed in just over 40 days. The 2,500-bed facility was not quite finished when 22 Daughters of Charity arrived on June 9, 1862.
Initially, the hospital was fairly ill equipped, especially with regard to the accommodations for the sisters. Beverages were served in wash pitchers and the food in basins. The sisters ate their meals earlier than the officers, sharing just four eating utensils reserved for officers’ use. The chapel was so small that some sisters had to exit the room so others could enter and receive Holy Communion.
Satterlee Hospital became a self-contained city when a tent city was built on the grounds in 1863. The hospital increased its capacity to accommodate 4,500 wounded soldiers. A 14-foot high fence surrounded the property, which now sprawled south to Baltimore Avenue and west to 46th Street. On the grounds there was a post office, clothing store, laundry facility, carpenter shop, printing shop, dispensary, library, and three kitchens referred to as restaurants.
Although the official capacity of Satterlee was 4,500, the actual capacity exceeded this number. After the Battle of Bull Run, the wounded arrived by the hundreds. After the Battle of Gettysburg, they arrived by the thousands, swelling the hospital population to more than 6,000. During the Battle of Gettysburg which occurred during July 1863, the greatest number of wounded were admitted to the hospital in a single month. The following month of August saw the greatest number of deaths in any one month, averaging at least one per day. In just one year, patients consumed more than 800,000 pounds of bread, 16,000 pounds of butter and 334,000 quarts of milk.
During the war, more than 100 Daughters of Charity passed through the doors of Satterlee Hospital, ministering to the wounded soldiers’ spiritual and medical needs. The tiny chapel was soon expanded to seat 400 worshippers. Many soldiers often arrived several hours before mass to obtain a seat. Several wounded soldiers contributed generously to outfit the chapel properly, purchasing a set of stations of the cross and taking great pains to decorate the chapel for feasts and special occasions.
The hospital’s chaplain was Father Peter McGrane who was stationed at St. Patrick’s at 20th and Locust Streets. Every day, Father McGrane traveled from St. Patrick’s to Satterlee to say mass, hear confessions, instruct and baptize and frequently arrange for burial. He labored throughout the war ministering to the wounded and dying. Archbishop James Wood also visited Satterlee several times to confirm many adult converts.
Father Peter McGrane, no date
The practice of military medicine during the war was an eye-opening experience. The wounds caused by the new and improved artillery met the outdated medical practices of understaffed field hospitals, resulting in an epidemic of needless deaths. Conditions began to improve with the advent of permanent army hospitals like Sattelee, staffed by experiences surgeons and dedicated sisters.
During its four-year existence, more than 50,000 wounded soldiers were treated at Satterlee. The contributions made by the medical professionals and the Daughters of Charity who staffed the hospital are immeasurable.
PAHRC holds a copy of a diary kept by a Daughter of Charity at the hospital from 1862 to 1865.
Credit: Philadelphia Archdiocesan Historical Research Center
References:
Smith, Sara Trainer, ed. “Notes on Satterlee Military Hospital…from the journal kept at the hospital by a Sister of Charity.” Records of the American Catholic Historical Society of Philadelphia (Volume 8)
, no. 4 (December 1897): 399-449.West, Nathaniel. History of the Satterlee U. S. A. Gen. Hospital, at West Philadelphia, Pa., from October 8, 1862, to October 8, 1863.
The Hosptial Press, 1863. (Call# IC0135)
Friday, August 26, 2011
The First Women Nurses
The first women carried as nurses aboard a U.S. Vessel were Sister Mary Adela and Sister Veronica, nuns of the Order of the Holy Cross. They served throughout the war on the U.S.S. Red Rover, a captured Confederate vessel that was refitted as a hospital ship.
The health care challenges of the war changed the role of American women in medicine and in the military. For the first time in the United States, female personnel held responsible positions in traditionally male environments.
Thousands of women, North and South, volunteered as nurses in the hospitals and at the front. Many “Angels of the Battlefield” served throughout the war, lay women as well as Catholic nuns from orders including the Sisters of Charity, Sisters of St. Joseph, Sisters of Mercy and Sisters of the Holy Cross.
Unknown numbers of women simply showed up on the battlefields and helped to relieve the work load of the medical staff.
The health care challenges of the war changed the role of American women in medicine and in the military. For the first time in the United States, female personnel held responsible positions in traditionally male environments.
Thousands of women, North and South, volunteered as nurses in the hospitals and at the front. Many “Angels of the Battlefield” served throughout the war, lay women as well as Catholic nuns from orders including the Sisters of Charity, Sisters of St. Joseph, Sisters of Mercy and Sisters of the Holy Cross.
Unknown numbers of women simply showed up on the battlefields and helped to relieve the work load of the medical staff.
