Monday, September 7, 2015

Medicine in the Bloodiest War

By Thomas Sweeney, M.D.

The Civil War was the bloodiest war ever fought by the United States. More lives were lost in it than in all other American wars combined, from the Revolutionary War to the Korean War. The Civil War saw the death of some 618,000 souls--the Union 360,000, the Confederates, 258,000.

Disease as a Cause of Death.
The principal killer in the Civil War was not the cannon or the musket but disease; 414,000 died from disease.

The prevalence of disease and the high death rate resulted from a number of factors. A majority of soldiers were from rural areas and had not been exposed to measles and other diseases of urban living. When they did develop these diseases they did not take care of themselves and died from complications. There was ignorance of the cause and treatment of diseases on the part of both patients and physicians. Bacteriology was an underdeveloped science and little known of it outside England and Europe. Malaria and some other diseases were attributed to "bad air" or "vapors" arising out of the lowlands. "Bad humors'' in the blood were also blamed as the cause of other maladies.

Diet was deficient both in camp and in the field. Fruit, vegetables, and milk were difficult or impossible to obtain. Lack of these caused scurvy and other gastrointestinal problems. Filth contributed greatly to dysentery and other maladies that plagued the camps. Most soldiers thought only of convenience in disposing of their waste. Thus many flies accumulated to contaminate the food. Germ-spreading mosquitoes, fleas, and lice tormented the soldiers as well, even worse than the flies.

The common maladies were malaria, typhoid fever, dysentery, and measles. Pneumonia, smallpox, yellow fever, and tuberculosis were less prevalent; but all took a heavy toll of lives. The most frequent killers were typhoid and intestinal infections. Typhoid was probably responsible for one-fourth of all the deaths from disease among Civil War participants. As many soldiers died from diarrhea as from death in combat.

Medicine, the Government, and the Citizens
At the outbreak of the war, the Federal government was unprepared to meet the medical needs of the military. The personnel of the Union medical department consisted of one surgeon-general with the rank of colonel, 30 surgeons with rank of major, and 84 assistant surgeons with rank of 1 st lieutenant.

There was no hospital or ambulance corps. Nursing was performed by inexperienced soldiers, usually those recovering from illness or wounds, temporarily detailed to hospital duty. The members of the medical corps were not assigned to any particular regiment or command, but were assigned or utilized as the need arose.

Civil war hospitals were scarcely places of succor. They tended to be filthy, overcrowded and stinking. The stench was terrible, according to one surgeon. Smallpox and measles added complications. The smallpox was controllable, but the measles got out of hand. Many patients died from pneumonia caused by measles.

Dr. Charles S. Tripler was the first medical director during the Civil War. He and his organization accomplished an immense amount of work but could not cope with such a large number of casualties as occurred early in the war. During McClellan's Peninsular Campaign, for instance, confusion resulted from trying to care for the 100,000 man army involved, and tragic suffering followed.

Dr. Jonathan Letterman succeeded Tripler on July 1, 1862. He was a man of great ability who organized an ambulance corps, improved the field hospital service, and procured a greater quantity of medical supplies.

An organization called "The Sanitary Commission'' was formed in the war emergency by concerned citizens of the North to supplement the medical services of the Federal government. The Commission had its beginnings at a meeting held by the Women's Central Association of Relief in New York on April 25, 1861. Because the methods of the Commission were flexible they were able to meet emergencies well, and often brought supplies to the field days ahead of government stocks. Theirs was the main source of supply at the battles of Second Bull Run, Antietam, and Fredricksburg.

Fresh vegetables, chloroform, brandy and other stimulants, condensed milk, beef stock, bandages, surgeon's silk, and many other articles are supplied by the Western Sanitary Commission of St. Louis (not connected to the larger eastern group). It was efficient in relief and in fund raising. Workers were both male and female. During its existence the Western Sanitary Commission received about five million dollars in money and fifteen million dollars in supplies, much of it through fund-raising fairs.

No such organizations existed in the South, although there were women' s-aid societies and individuals willing to feed the hungry and nurse the sick.

A noteworthy example was Mrs. Ella K. Newsom of Arkansas, widow of a physician, who took it upon herself to work in various hospitals in the South while providing supplies with her own money. Her acts earned her the title, Florence Nightingale of the South.

Wounds and Amputation
Wounds might be divided among those to head, trunk, and limbs. Head and chest wounds were often fatal; wounds in the abdomen that involved a perforated bowel were almost always fatal.

Amputation was the common treatment for severe wounds to the limbs because of the probability of infection. If the wound had caused loss of a large amount of soft tissue, or if it involved a joint, the limb was always amputated. The same if there was a compound fracture (the bone sticking through the skin). Survival from surgery was more likely if the patient were wounded, and operated on, in places free from animal droppings and other filth. The survival rate from amputation ranged widely from about 15% to 65%.

It was usual to amputate the wounded limb as soon as possible. If it were not removed, the patient often quickly developed ared swelling, which would then drain "laudable pus." Next, a fever would follow and, in a few days, death. In short, the wound would become infected and result in fatal blood poisoning. Simply nothing was known of infection or its prevention. Not until the 1870s would there would be widespread understanding of the nature of bacteria or the causes and prevention of infection.

Not all wounded limbs were amputated. Simple fractures were set and placed in a splint. Wounds without fracture were cleaned of dead tissue and irrigated with various solutions such as potassium permanginate or dilute acid.

Major effective drugs were quinine, morphia, and other opium derivatives. Chloroform and sometimes ether were used as anesthetics. Whiskey was frequently administered to the wounded to induce "reaction." Whiskey was also mixed with quinine and administered daily to suppress malaria. Other drugs were pepsin, various emetics to induce vomiting, cathartics, iodine, and calomel. Dysentery might be treated with oil of turpentine or ipecac, though neither was very effective.

Medicine in the Civil War Ozarks
Medicine in the Ozarks during the Civil War was practiced much as it was elsewhere. Inasmuch as the Ozarks was still a frontier region, some supplies might be difficult to obtain; but both Union and Confederate armies carried supplies and physicians with them. For the most part, the Federal armies here had more supplies than the Confederates, particularly in the latter years of the war. Both sides had volunteer physicians fresh from civilian life, most of whom had no experience with the type of wounds and the massive numbers of wounded they would be forced to handle. A few were veterans of the Mexican War. During and after battles, local civilian doctors might volunteer to take immediate care of the sick and wounded.

Military physicians of both the North and the South were primarily responsible for taking care of soldiers' ailments. If a battle were imminent his responsibility was to set up a field hospital close to the battlefield, but not so close as to endanger the lives of the patients and doctors.

But at the Battle of Wilson's Creek, as a result of the Federal surprise attack, both sides cared for the wounded on the edge of the battlefield while the battle raged. Federal physicians placed their field hospital in a ravine on the north end of Bloody Hill. They did not perform surgery on the field except for the extraction of balls. They sent the wounded to nearby Springfield after bandaging because of the severity of the fight and the shifting positions of the troops.

The Federal force had only two ambulances, so after the battle every available conveyance was used to remove the wounded---baggage wagons, caissons, litters, and six-mule spring wagons. Through a flag of truce, all the wounded who could be moved were taken offbetween 11:30 a.m. and midnight the day of the fight.

Assistant Surgeon H.M. Sprague, U.S. Army, wrote subsequently that the great want in the medical department at the time of the battle was a medical director. "Had the commanding general [Lyon] designated an officer of rank as his medical director, there could have been no reason why nine-tenths of the wounded could not have been cared for and sent to General Hospital [Springfield] by the time our forces retreated." Apparently the physicians were too busy taking care of the wounded in their own immediate area to see this general problem.

In his report, Assistant Surgeon S.H. Melcher of the Fifth Missouri Volunteers wrote, "The flies were extremely troublesome after the battle, maggots forming in the wounds in less than an hour after dressing them, and also on any clothing or bedding soiled by blood or pus. The wounded left on the field in the enemies [sic] hands were swarming with maggots when brought in."

Confederate physicians set up field hospitals soon after the battle commenced. Apparently they used the Ray house and a barn or outbuilding across from the Skeggs house at the spring. Early in the battle cannon shots were fired over the Ray house, so a yellow and green hospital flag was raised on the roof to let the Federals know it was being used as a hospital.

Dr. Caleb Winfrey, a volunteer from Lone Jack, Missouri, on duty with General Price's force left a short journal describing how he went onto the battlefield and carried off the wounded in his buggy. The next day, August 11, Winfrey noted in his journal that he performed numerous operations which included multiple amputations of limbs and extractions of musket balls.

Before the battle, typhoid fever and dysentery had broken out in Springfield. General Lyon ordered Federal surgeon E.C. Francis, U.S.V. (United States Volunteer), to establish a "General Hospital" in the unfinished courthouse on the square to handle sufferers from these diseases. In addition to the General Hospital, churches, hotels, the courthouse, and many private homes were turned into hospitals and filled with the wounded from both sides.

After the battle, the Federals remained but a short time in Springfield before falling back to Rolla, carrying with them everything except medicine, hospital stores, and supplies accumulated for use in the General Hospital. General Franz Sigel ordered surgeon Phillip C. Davis, a U.S. Army physician, to stay with the wounded who were left behind.

The Confederates entered Springfield at daybreak on August 11, 1861. They appropriated what they wanted from the hospital, leaving the Federal surgeons short of supplies. They did just as the Federals had done--brought the wounded from the field in wagons, carriages, litters, merchants' wagons, and every possible conveyance in the absence of ambulances. The process took five or six days. Notations in the General Hospital's log book suggest about 412 wounded from Wilson's Creek. Added to the number already in the building, . the result was overcrowding, and more misery for all.

Dr. Winfrey wrote that on August 12, he and probably the other Confederate surgeons packed their instruments and supplies and, with the wounded, left the battlefield for Springfield. Winfrey stayed in Springfield with the wounded Confederate soldiers, amputating limbs and performing other procedures. He noted that Missouri Governor Claiborne Fox Jackson visited Springfield on September 2, but left the same day for Jefferson City. He also mentions the use of chloroform while amputating a leg. (The Federal surgeons wrote that chloroform was all they had; ether was apparently in short supply.)

During 1862 and 1863 three hospitals were in existence in Springfield: The General Hospital (unfinished courthouse), Red Top hospital and the Campbell house hospital on south Jefferson. A convalescent hospital located in the old Berry mansion at Berry Springs was called the New U.S. Hospital. This was located just north and east of Fort No. 5 (east of present Sherman Avenue at Chestnut Expressway). Springfield had thus become a large storehouse of supplies and a central hospital location for the wounded from all over southwest Missouri and northwest Arkansas. It remained so throughout the war.

Many ladies of the town volunteered their services and became hospital nurses. Civilian physicians aided in the care of the wounded in Springfield throughout the war, although little is written either of their contributions or those of lay citizens.

Dr. Beverly A. Barret was one who did leave a written account. He had moved to Springfield from Dallas County in 1858. His sympathies were for the South, but for his safety and that of his family he did not express those sympathies openly. Barret wrote of going to the battlefield after the Battle of Pea Ridge, Arkansas, some 75 miles southwest of Springfield. He went there with his brother George Barret, a Dr. E.L. Robinson, and another person after obtaining permission from the authorities to search for some of their friends whom they suspected to be among the wounded or dead. They set out on horseback; and long before they arrived at the battleground they began to see signs and effects of war: dead horses, wounded men, and here and there a corpse. Three miles from Pea Ridge they happened upon an old Federal surgeon lying in a cabin, dreadfully wounded by a cannon ball which had taken off a portion of his hip. Although both the old surgeon and the Barret party knew it to be a mortal injury, they dressed the "miserable" wound, shook hands, and went on their way. With great difficulties they found their friends and tried to assuage the suffering of the wounded as much as possible. Dr. Barret hired a sutler's wagon and one horse which he harnessed with his own horse to make a team. They loaded the wagon with the wounded and headed toward Springfield.

As a result of the battles of Pea Ridge and Prairie Grove, Arkansas, in March and December, 1862, Fayetteville also became a medical treatment center. Hospitals were hastily organized in the town as the wounded were brought in from both battles. The U.S. General Hospital, Western District of Arkansas, was established there. It consisted of the Cottage Branch Hospital, the Seminary, the "School Room," the Masonic Hall Branch, the Ward A. Smith House, and the Methodist Church Branch Hospitals.

Anticipating Confederate General Marmaduke' s attack on Springfield in January, 1863, convalescent soldiers from the hospitals were mustered to help defend the town. Organized by Dr. Melcher, the medical director of several hospitals in Springfield, it was known as the "Quinine Brigade." About 300 boys responded to the call and took up muskets, taking their place with the rest of the soldiers and civilians defending Springfield.

At the time of the Battle of Springfield, Dr. Barret resided on Booneville Street north of the town square. He heard the sounds of picket musket fire, and then cannon fire:
A cannon ball knockedoff our chimney and another hit a tree in the yard near where I was standing. For a few hours fighting was lively, everyone scared....Our house was full of friends from early morning on that memorable day until late in the evening. My wife was lying in bed with a baby boy eight days old. Most of the day I was busy taking care of the wounded of both sides. I dressed many a wound that day never inquiring which side he belonged to. Several arms and legs I amputated also. I remember well amputating the arm of a colonel with no one to assist but a Mrs. Richardson, a very timid and frail woman. It was a success.

My custom is always in amputations as well as other surgery [to] use cleanliness, warm water with Boraic of Soda in it. With my amputations I enjoy great success. I remember well in the fall of 1861 I amputated some young women's arms, from being crushed in mills from mashing sargum sticks and did not loose her [sic]. One or two amputations of the soldiers were at the shoulder joint all of whom recovered speedily. Though we blunder along good results are had in surgery, considering. Brigadier General F.B. Brown, the Federal commander in the battle, was wounded in the left ann by a musket ball. According to the account of Surgeon Melcher, the ball splintered the shaft and fractured the head of the left humerus in the upper arm. It also fractured the articulating rim of the scapula. Dr. Melcher made a V-shaped incision and removed the head and five inches of the shaft of the humerus. Upon healing, the left arm was several inches shorter than the right but still useful.

The contributions to medical care which were developed during the Civil War have been largely overlooked because the nature and quality of care administered is improperly compared to modem standards, rather than to the standards existing at the time. Major advances were achieved however, of which the following is a summary:

1. Development of a system to take care of mass casualties, including aid stations, field hospitals and general hospitals. It was the system used to manage the wounded in World War I, World War II, and the Korean War.

2. The accumulation of detailed records which, for the first time, made possible a complete military medical history. The publication of the Medical and Surgical History of the War of the Rebellion was identified in Europe as the first major academic accomplishment by U.S. medicine.

3. Pavilion-style general hospitals, well ventilated and clean, which were copied in the design of large general hospitals over the next 75 years.

4. Recognition of the importance of immediate and definitive treatment--including amputations--of wounds and fractures, optimally carried out within the first 24 hours after wounding.

5. Dawning comprehension of the importance of sanitation and hygiene to prevent disease and death in the field.

6. Introduction of female nurses to hospital care and the entrance of Catholic religious orders to the hospital business.

7. Upgrading of the education of physicians as they were introduced to new ideas and standards of care, including the prevention and treatment of infectious diseases, anesthetic agents, and new surgical techniques which rapidly advanced the overall quality of American medical practice.

8. Formation of the United States Sanitary Commission, which set the pattern for the development of the American Red Cross.

9. The development of an Ambulance Corps and a new ambulance design that would be copied around the world.

As for Springfield: After the Battle of Spring-' field, the town remained in the hands of the Federals. It was a supply depot, and its hospitals took care of wounded from both southwest Missouri and northwest Arkansas. Many federal and state volunteer physicians were assigned to Springfield for the remainder of the war. The presence of medical personnel, experienced auxiliary assistants, and medical institutions laid the foundation for Springfield's development as a major medical center in the succeeding 130 years.

Dr. Thomas Sweeney is a Springfield physician and professional collector of Civil War artifacts. He is an authority on medical aspects of the War.



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