Monday, July 14, 2014

Morbidity and Mortality During the War

by Dr Julius Bonello, MD


Traditional ideas of Civil War medicine are more similar to a Hollywood movie scene than reality: A tired and harried surgeon, his surgical frock covered with blood standing over a screaming patient, held down by his fellow soldiers. In reality, of the 600,000 soldiers who died during the conflict, two-thirds died from disease and only one-third on the battlefield or from wounds sustained in battle. (Table 2). The number one cause of death was the fluxes, now known as diarrhea or dysentery. Over three million cases were diagnosed during the Civil War, killing 400,000 soldiers. One entire volume of the six-volume Medical History of the War of the Rebellion is dedicated to soldiers suffering from diarrhea.
Table 2  Civil War Casualties
Total union
and confederacy

Of the injuries during the war, 94 percent were due to gunshot wounds, 6 percent to artillery, and less than 1 percent were secondary to bayonet or saber. According to official records, 33 percent of all wounds involved the arms, 35.7 percent involved the legs, 18 percent involved the trunk and 10 percent involved the head. The mortality of gunshot wounds were as follows:
·        Penetrating wounds of the abdomen and head: approximately 90 percent were fatal.
·        100 percent were fatal when the small bowel was injured; 59 percent when the colon was injured; and 100 percent when the stomach was injured.
·        A penetrating wound to the chest carried a 60 percent mortality rate.
Once the abdominal cavity had been entered, the surgeon had no recourse other than to give opium, whiskey or tobacco for comfort. No surgical interventions were available.

Three-quarters of all the operations performed during the Civil War were amputations. All limbs with open fractures were amputated, usually within the first 24 to 48 hours. The importance of early, prompt and swift surgical intervention was appreciated by the surgeons of this period. Samuel Gross, a surgeon during the war, wrote, “the success of amputations was very fair when they were performed early but most unfortunate when they were put off for any length of time.” He warned that the surgeon “must be careful to guard against procrastination. The case must be met promptly and courageously; delay of even a few hours may be fatal or at all events, place limb and life in eminent jeopardy.” John Chisolm, a Confederate surgeon, echoed this testament with the dictum, “the rule in military surgery is absolute viz; that the amputating knife should immediately follow the condemnation of the limb.”

Approximately 80,000 amputations were performed under chloroform or ether anesthesia. Most were the flap type—the arteries and veins were tied with silk suture. Of 174,000 Union army wounds of the extremities, almost 30,000 soldiers underwent amputation with an overall mortality rate of 26 percent.

The high mortality from injuries is secondary to injuries from the bullet that was used. The Minie ball, named after the French captain who first developed it, was a slow, heavy, soft-lead projectile, which penetrated a body at a velocity of 950 feet per second (slow compared to today’s weapons). In addition to the tumbling effect of the projectile, this bullet would cause extensive bleeding, resulting in severe and often lethal shock.

There were 494 thoracotomies attempted, with 200 deaths, resulting in a mortality of approximately 40 percent. In 900 cases, the skull was opened with a mortality of approximately 67 percent. Of 2,818 soldiers diagnosed with sepsis, only 71 lived. Osteomyelitis, erysipelas, gangrene and septicemia were common after surgery. Once gangrene had set in, almost 50 percent of the soldiers died.

Documented pneumonia took the lives of almost 20,000 federal and 19,000 Confederate soldiers; while smallpox killed 1,000 soldiers in three months in one Virginia hospital. Scarlet fever and measles occasionally caused a death. Gonorrhea and syphilis were treated fairly commonly in the North and South. There are no statistics on the number of women and subsequent children infected with venereal disease; however, considering the fact that Union physicians treated 170,000 cases of venereal disease, the figures must be staggering. One Civil War researcher estimated that one-third of the men who died in Union and Confederate veterans’ homes were killed by the later stages of venereal disease.

Excerpted from: Wellness Directory of Minnesota


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