Thursday, February 6, 2014

Battlefield Medicine and Surgery at the Beginning of the Civil War

By John Tooker, MD, MBA, FACP
Excerpted from: "Antietam: Aspects of Medicine, Nursing and the Civil War"

To put the Civil War in perspective, the U.S. population at the war's beginning was about 34 million. Nearly 4 million men, more than 11 percent of the entire American population, were engaged in the war (1). Most came from rural backgrounds, lacked immunity to communicable disease and were unprepared to be concentrated in close, unsanitary quarters, making them susceptible to illnesses such as dysentery, measles, smallpox and malaria. Military surgeons had little understanding of the causes of communicable disease and most treatments were ineffective. Basic necessities, particularly in the Confederacy later in the war, such as shoes, clothing, food and clean water, were in short supply. On average, the Confederate soldier was estimated to be ill or injured about 6 times over the course of the war. The viewpoint of the average soldier is more telling than statistics. From Pvt. Alexander Hunter, Company A, 17th Virginia Infantry on arrival at Hagerstown near Sharpsburg, Maryland before the Battle of Antietam: “Another day's march brought us to Hagerstown where the cornfields and orchards furnished our meals. The situation, in a sanitary point, was deplorable. Hardly a soldier had a whole pair of shoes. Many were absolutely bare-footed, and refused to go to the rear. The ambulances were filled with the foot-sore and sick”.

Most Civil War military surgeons were graduates of unregulated two-year medical schools. At the beginning of the conflict, most had never treated a gunshot wound, and very few were experienced in evaluating and treating the injuries of war. Although general anesthesia became available in 1846, most surgeons were untrained in surgical techniques and had not performed surgery. Lister's theory of sepsis and subsequent antiseptic techniques were not applied to surgical and post-operative care until after the war. While chest, abdominal and neurological surgery were rarely possible, treatment of extremity injuries was possible and necessary. Amputation was commonly practiced and became the primary surgical skill of the Civil War battlefield surgeon. The organization of medical care in 1861 when the war began was centered on the role of individual physicians rather than systems of care designed to handle mass casualties. Both armies were shocked at the high casualty rates and unprepared for the management of these casualties.

Prior to the onset of hostilities in 1861, the Medical Department of the Union army was small, numbering only one Surgeon General, thirty Surgeons, and eighty-four Assistant Surgeons. Some of these surgeons resigned their Union commissions to join the Confederate Medical Department. By the end of the war four years later, the Union Medical Department expanded to more than 10,000 surgeons.

The Medical Department of the Confederate States of America was established in February, 1861 by the “Act for the Establishment and Organization of a General Staff for the Army of the Confederate States of America” of the Provisional Congress. The act provided for a medical department of one Surgeon General, four surgeons, and six assistant surgeons. By the end of the war, the South had about 4,000 military surgeons.



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