Tuesday, May 27, 2014

Civil War Medicine

by Dr Julius Bonello, MD

The Union generals stood silently and watched as the long line of wounded made their way back to Washington. Although the morning had started out as glorious for the United States, it had quickly turned into a military debacle. Almost 2,700 Union Soldiers had been killed or wounded in a battle fought near a meandering stream known as Bull Run. The generals now knew that this engagement would be a long and costly one. They had greatly underestimated the strength of their enemy. They also realized, at that moment, that there were woefully unprepared for what was to come. Medical supplies that had been sent to the battlefield had never arrived and, according to official reports, not one wounded soldier returned by ambulance after the battle.
From 1862 to 1865, the American Civil War would cause almost 10 million soldiers to need medical assistance. At the beginning of the war, the military had only 113 doctors to meet this demand. Something had to be done and done quickly.
The Army Medical Department entered the war unprepared. Its chief, Colonel Tom Lawson, who was more than 80 years old, considered the purchase of medical books an extravagance and was reported to have flown into a rage upon hearing that one post had two sets of surgical instruments. In January 1861, the United States Army numbered 16,000 soldiers and had a medical staff of 113 surgeons. Soon after the war started, 24 surgeons left for the South leaving 89 surgeons to administer the Union army. Although nearly all doctors of this period had received their medical education on an apprenticeship basis, younger ones usually had a medical school diploma. Because medical schools had no standardized testing and licensing requirements, and testing varied state by state, the medical knowledge of a doctor of the 1860s varied in education, skill and experience.

At the time of the Civil War, there were 100 medical schools in the United States. School consisted of two years, the second year being a complete repetition of the first year. At the beginning of the war; some schools reduced their requirement to one year and counted a year on the battlefield as a year of apprenticeship. Some schools required only six weeks of formal learning before their students began an apprenticeship. Since many states had laws that prevented medical students from dissecting cadavers, graduates often did not see internal organs or any major trauma until their first experience in battle.

After the bombardment at Fort Sumter, southern students left the northern schools to attend southern medical schools. However, by 1863, because of the manpower shortage in the South, these medical schools closed, thereby adding to the woes of the southern medical department toward the end of the war.

Once they received their diploma, whether they liked it or not, the doctor of the day was a surgeon. Civilian doctors had little experience. At that time, civilian surgery involved what we would consider minor procedures, i.e. tooth extractions, laceration repair, drainage of abscesses, foreign body removal and similar conditions. Orthopedic practice was limited to splinting, and a joint space was never entered. True surgery was confined to a few obstetrical and gynecological procedures. No one was prepared for the carnage that was coming.

Because of these changes in medical school requirements and apprenticeships, the northern states were able to field almost 12,000 doctors during the Civil War. The Confederacy probably utilized a total of 8,000 doctors during the same time. Surgeons usually carried a rank of major and assistant surgeons were captains. Depending upon their length of service, a surgeon was paid between $162 and $200 per month.

In June 1861, two men met in New York with a group of devoted women, including Dr Elizabeth Blackwell, the first female physician in the United States. They formed the Women’s Central Association of Relief for the Sick and Wounded. On May 16, delegates of this group descended on Washington, DC, demanding the creation of a sanitary commission. Lincoln, the Secretary of War and the medical department opposed the idea. Fortunately, General Lawson was at home sick, and his replacement, Dr Robert Wood, saw the logic of this proposal. On June 9, 1861, the United States Sanitary Commission was formed. In theory, the commission was to investigate and advise in matters of sanitation and hygiene; in practice, it effected a purging and cleansing of the medical department; monitored camps, hospital food, clothing, medical supplies, ambulance services and recruitment; sent workers into the fields and hospitals to nurse and nourish; and provided everything from chloroform to tobacco. By war’s end, the commission had distributed almost $15 million worth of supplies, wholly provided by the citizens of the United States. (Table 1)

 Table 1: A partial list of the supplies and goods that the sanitary commission sent to Gettysburg after the July 1863 battle.
Drawers, Woolen
5,310 Pairs
Drawers, Cotton
1,833 Pairs
Shirts, Woolen
Shirts, Cotton
5,818 Pairs
4,000 Pairs
250 Pounds
Basins and Cups
Bandage Linen
110 Barrels
Splinting/Dressing Plaster
16 Rolls
1,200 Pairs

The most significant act produced by the commission was the White Paper of 1861. The commission reorganized itself, created new posts and, best of all, removed Lawson from the position of Surgeon General, replacing him with William Hammond. Hammond was an intelligent, able man with unbound energy and vision. His first move was an order that proper records be kept for all the sick, wounded and killed. This record is available today in a six-volume work found in most urban libraries. 

Hammond introduced a meaningful system for classifying disease, wrote and edited medical journals, accelerated the procurement of supplies and constantly fought to improve medical care. He recommended an ambulance corps, an army medical school and an army museum. He also proposed that the men, who drove ambulances and nursed the sick, be trained by the medical department. In May 1863, Hammond issued a decree restricting calomel (mercurous chloride), a powerful laxative, which had been used to treat diarrhea. The medical thinking of the 1800s focused on the bowels and bladder. If a good bowel movement or a good stream of urine could be produced, a patient was considered healthy. However, Hammond saw the high rate of mortality among patients with diarrhea and wanted calomel’s use restricted. Most medical doctors considered this directive heresy, and they brought their complaint to Washington. Forcing a trial while Hammond was on tour, they found him guilty of conduct unbecoming an officer and relieved him of duty. Joseph K Barnes replaced him, but continued all of Hammond’s proposals.

Until the Civil War, nurses in the United States were either veterans of earlier wars or the handicapped and mentally retarded. During the war, some nursing was performed by hospital stewards who were non-commissioned officers. Their duties were fully described by Joseph Woodward, a leading physician of his day. Woodward’s manual for stewards outlined, in today’s terms, the responsibilities of a registered nurse. During battles, the musical band that accompanied every regiment provided nursing care. Although almost every major engagement attracted local women who wanted to help administer medical care, their assistance was generally discouraged. The prospect of young women taking care of young men concerned the conservative faction of the nation.

In 1861, Dorothy Dix, well-known founder of institutions for the mentally insane, offered to provide trained nurses to staff military hospitals. In June 1861, she became superintendent of female nurses. Such a radical idea created a degree of public outcry; however, the plan was generally well received by the military and the US Sanitary Commission. In mid 1861, thousands of women submitted their applications in response to Dix’s call. Each candidate had to be “past 30 years of age, healthy, plain almost to repulsion in dress and devoid of personal attractions.” They had to know “how to cook all kinds of low diet” and avoid “colored dresses, hoops, curls, jewelry and flowers on their bonnets.” One such woman was Marianne Bickerdyke of Galesburg, Illinois. While on a trip to Cairo, Illinois, to supply the Union soldiers with medical supplies, she found a number of the soldiers hospitalized on beds of filthy straw laid over muddy tent floors, and dying of dysentery and typhoid. Enraged at Army inefficiency and without authorization, she went to work. She washed the casualties in bathtubs, dug the mud off the tent floors and fed her patients food sent down from Galesburg. For the duration of the war, Bickerdyke rode with the Western Army setting up hospitals, feeding her boys before they went into battle and working in front-line dressing stations. Not surprisingly, she was less popular with the brass. When the wife of an important colonel summoned her to care for her son’s measles, “Mother Bickerdyke” unceremoniously refused stating that she had plenty of soldiers to work for. The colonel complained to General Sherman who replied, “You have picked on the one person around here who outranks me. If you want to lodge your complaint against her, you will have to take it up with President Lincoln.” By the end of the war, 3,000 to 4,000 female nurses had worked for the Union.

At the outbreak of the war, the United States was not operating a single general military hospital. The country began a gigantic building program, and by January 1863, the North had built 151 hospitals with 58,000 beds. By 1865, the North operated 204 general military hospitals with 137,000 beds, and by the end of the war, the Confederacy also had 150 hospitals, with one-third centered around Richmond, Virginia. The largest at Chimborazo held 8,000 beds.

“Island of Mercy: The Pry Mill at Antietam” was painted by Keith Rocco, who is a member of the Society of American Historical Artists. Gordon E Dammann, MD, commissioned the painting to benefit the National Museum of Civil War Medicine in Frederick, Maryland.

On September 17, 1862, Samuel Pry’s grist mill near Antietam Creek’s upper bridge served as a field hospital for the men wounded in the Miller Cornfield, the East and West Woods, and the Bloody Lane. At the time, surgeon Jonathan Letterman served as the new medical director of the Army of the Potomac and was reorganizing the medical corps.

This was the bloodiest single day of the conflict, yet the mill where approximately 200 seriously wounded soldiers are being treated seems almost tranquil. A red flag is apparent rather than the more common yellow hospital flag which was finally standardized in 1864. The four-wheeled Rosecrans ambulances are preferred, but the two-wheeled vehicles are still in use. Dr Letterman, who is constantly moving during and after the battle, gives instructions to surgeons in the foreground. Clara Barton and her assistant Cornelius Welles dispense blankets and other supplies that she has personally brought to the soldiers.

Wounded from both sides receive care and medical personnel from the Union Second Corps who wear the green hat bands and half chevrons assist the surgeon in triage before each wounded soldier is carried into the mill on a Satterlee stretcher.

Excerpted from: Wellness Directory of Minnesota


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