Bureau of Medicine and Surgery Established by Congress in 1842

By Thomas L. Snyder 9-1-10

31 August marks the establishment by Congress of the U S Navy Bureau of Medicine and Surgery in 1842. Up to this time, all aspects of Naval operations were handled out of the office of the Secretary of the Navy, or by a general Board of Commissioners. Increasingly sophisticated technology however, called for concentration of expertise in discrete areas, and so Congress created the “Bureau System” for managing the Navy’s activities. These concentrated expertise under specified directorates like the Bureau of Yards and Docks (Civil Engineering), Construction, Equipment and Repairs (Ship Building), Ordnance and Hydrography (weapons), and Medicine and Surgery (health care).

The Bureau of Medicine and Surgery (BuMed), the central administration for Navy medicine, was given responsibility for all medicines, hospitals and their furnishings, surgical instruments, the care of Navy and Marine Corps patients and all contracting and procurement related to these functions. Until 1871, the sole title of the head of the Bureau was “Chief of the Bureau of Medicine and Surgery”. In 1871 Congress conferred the additional title of Surgeon General of the Navy.

The first major challenge to face the Bureau was the Civil War, when the number of medical officers nearly quadrupled and hospitals at Boston, Philadelphia, New York and Washington DC opened in older facilities or enlarged, and temporary hospitals sprung into existence in New Bern, NC, Beaufort and Port Royal South Carolina and Pensacola. The Naval Hospital at Norfolk, VA, lost to the Confederates early in the war, reopened for Union forces upon its recapture in 1862. Other hospitals opened in Mound City, Illinois (later moved to Memphis) and New Orleans. The first Navy hospital ship–the Red Rover–saw service to Naval forces on the Mississippi. In addition, Bureau Chief William Whelan established the Naval Laboratory in Brooklyn, under the direction of Surgeon Benjamin Bache and Edward R Squibb. Squibb was responsible for creating a system for producing medicaments of reliable quality.

World War I saw a five fold increase in hospital beds for the Navy, and an equivalent increase in personnel. In addition to overseeing the expansion of several existing hospitals in the continental United States and in Hawaii, the Bureau undertook to construct or lease space for two hospitals in France and at least one in the United Kingdom. Naval authorities tasked Surgeon General William C Breasted with developing and manufacturing an effective gas mask system, a project that achieved success. Finally, the Bureau began the first faltering steps in establishing the science of aviation medicine in the Navy.

BuMed faced its largest challenges by far during World War II. The medical department grew tremendously, with 10,000 physicians entering the service from civilian life. Hospital ships were built, and with Marines deployed in large numbers throughout the Pacific Theater of War, the Navy hospital establishment, both at home and overseas, grew immensely. In California alone, the Navy built new hospitals in Long Beach, Santa Margarita, Oakland, Shoemaker (now Dublin) and San Leandro and expanded standing facilities at Mare Island, San Diego and Treasure Island. In addition, in California alone, the Navy opened convalescent hospitals in hotels at Santa Cruz, Yosemite National Park and Norco, and in abandoned Army hospitals in Banning and Beaumont. A rapidly expanding submarine force required the Bureau to undertake training of physicians in hyperbaric medicine; the aircraft carrier Navy called for a large increase in doctors trained in aviation medicine. Under Surgeon General Ross T McIntire’s leadership the Bureau also developed research programs to find effective insect repellents to fight malarial mosquitoes in the South Pacific, occupational medicine research seeking means for improving the atmosphere in submarines, nutritional improvements for shipboard and combat personnel, development of flash-burn prevention techniques, improvement in oxygen delivery systems for aviators, research in tropical diseases and a vast variety of other areas of inquiry.

Today the Bureau oversees the care of Navy and Marine Corps personnel at home and in deployment around the world. Its research facilities concentrate in problems of infectious disease, combat casualty care, and the care of people serving in environments unique to the navy and Marine Corps–on, above and below the sea surface, in cold, tropical, high altitude and desert locations.

From: ofshippssurgeons.wordpress.com

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The Evolution of the Military Dog Tag: From the Civil War to Present Day

By Savannah Labbe, 10-24-16

In doing research for my previous post on the U.S. Christian Commission, I came across an intriguing artifact: a Civil War era identification tag, or dog tag. When I picture a military dog tag I see a metal rectangle suspended from a necklace, like those worn by today’s soldiers. One doesn’t usually associate dog tags with the Civil War, which is why I was interested to find one. However, it is not surprising that the basic human fear of dying unknown, of robbing one’s family of closure and certainty, was present during the Civil War just as it is today. This is why there are accounts of Civil War soldiers crudely fashioning their own dog tags before going into battle. At Cold Harbor, soldiers wrote their names and addresses on a piece of paper and pinned them to their uniforms before charging to their deaths during the suicidal attack that occurred at that battle. There are also accounts of soldiers making dog tags out of old coins and pieces of metal and wood. In addition, they would carve their initials into items of clothing or carry around photographs of family members to help ensure their identification.

During the Civil War the government did not have the capacity or the willingness to issue dog tags to every soldier. A request was made to Secretary of War Edwin Stanton to issue a dog tag to every Union Soldier, but it was denied. Thus, soldiers had to look elsewhere for their dog tags, prompting some of them to make or purchase their own. They could buy silver or gold disks with their names stamped on them from the sutlers that followed the army. The U.S. Christian Commission also issued identification tags and distributed approximately 40,000 personal identifiers to Union soldiers.

I got a chance to examine one of these identifiers. It was made out of paper with a hole punched in the top surrounded by a metal ring. Soldiers were instructed to hang this piece of paper from their neck with a cord. On the front side there were spots for the soldier’s name, regiment, brigade, division, and corps; on the back there was a place for the soldiers address. In addition, the front read, “God so loved the world that he gave his only begotten Son, that whosoever believeth in him should not perish but have everlasting life-,” a fitting statement to put on an item that would be most useful after a soldier’s death, a reassurance that the soldier would be able to live on.

The Civil War was the first time it became evident that there was a need for some form of identification tag for soldiers. However, it took a long time for dog tags to become standard issue of the army. During the Spanish-American War a chaplain named Charles C. Pierce pioneered soldier identification techniques. It became practice of the army during this war to temporarily bury its dead and later exhume and identify the bodies, which was Pierce’s duty. He did this by collecting all known information about the casualties–characteristics, place of death, and nature of wounds–then comparing the information with the bodies of the soldiers he exhumed. Using these techniques Pierce was able to identify all the bodies he exhumed while working in the Philippines. He was also one of the first people to suggest that the army should provide aluminum disks with the soldier’s identification information to every soldier.

By the First World War these disks became very common and were made mandatory by the army. The Second World War saw the evolution of the modern rectangular dog tags suspended from metal chains that provided the soldier’s name, service number, blood type, and religion. Now the dog tag has evolved into a wearable flash drive detailing the soldier’s medical information. From its humble beginning as a piece of paper to its latest incarnation, the invention of the dog tag in the Civil War has had a great impact on the ability of the army to identify soldiers’ bodies. The relative rarity of dog tags and unstandardized burial practices in the Civil War made it so 40% of the dead are still unidentified to this day. The dog tag, while a small and seemingly insignificant object, has prevented many soldiers from dying in obscurity, like so many did during the Civil War.

Sources

“DOG TAGS.” Military History 24, no. 7 (October 2007): 13. Accessed September 25, 2016.

Hirrel, Leo P. “The Beginnings of the Quartermaster Graves Registration Service.” Army Sustainment 46, no. 4 (July 2014): 64-67. Accessed September 24, 2016.

McCormick, David. “Inventing military dog tags.” America’s Civil War 25, no. 2 (May 2012): 56-59. Accessed September 24, 2016.

Musil, Melinda. “MOLDED BY WAR.” America’s Civil War 29, no. 3 (July 2016): 40-49. Accessed September 25, 2016.

U.S. Christian Commission Dogtag. Civil War Vertical File Manuscripts. Special Collections/Musselman Library, Gettysburg College, Gettysburg, Pennsylvania.

Image 1: A Civil War dog tag that would have been issued by the U.S. Christian Commission. Photo credit: Special Collections, Musselman Library.

Image 2: The back of the dog tag. Photo credit:  Special Collections, Musselman Library.

From: gettysburgcompiler.com

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Prostitution and the Civil War

By Annika Jensen ’18

It was to my slight disappointment that I found out that the term “hooker,” one of many referring to prostitutes (or, as they were called during the Civil War era, “public women), is not actually a play on the name of Joseph Hooker, the infamous and promiscuous Union general. Fighting Joe may, however, have helped elevate the term to its current popularity; after all, a certain red light district in Washington, D.C. was dubbed “Hooker’s Division.”

Pushing past the etymology, however, I discovered a vast array of sources, anecdotes, and documents leading to the world of prostitution in the Civil War era. In an earlier post I explored the prudish nature of domestic sex, a topic not often discussed or even performed. Indeed, prostitution and sex work was held in contempt by the majority of Victorian society: William Quesenbury Claytor on Virginia penned in his diary in 1852 that “impudent prostitutes” were often seen in Alexandria at night, and Union officer Josiah Marshall Favill wrote that in the same city in 1862 houses were “thronged” with sex workers. As discouraged and taboo as the practice was, however, it continued to expand and thrive during the Civil War era.

Sexually transmitted diseases indicate the prevalence of prostitution during the war itself; an estimated 8.2% of Federal soldiers were diagnosed with either syphilis or gonorrhea throughout the war, and far more likely went undiagnosed. These venereal diseases were a tremendous setback for the army, as treatment could put troops out of combat for long periods of time; officers had to ensure discipline and order to keep their men from frequenting brothels. Such problems proved especially prevalent in Union-occupied Southern cities like Nashville and New Orleans.

One effort taken by the Union to eradicate this fraternization was to ship the prostitutes to other states. This was attempted in Nashville, where women were put on trains and sped off to surrounding cities. However, many of them were close enough to find their way back, and more drastic measures were sought. The army decided the solution was to transport the women to different states by boat; they called upon Captain John Newcomb of the steamboat “Idahoe” to transport 100 prostitutes to Kentucky. The captain protested, not willing to tarnish the reputation of his ship, which he claimed would becoming known as a “floating whorehouse,” but he could not stand up to the army, and his trip went underway. Unfortunately for Newcomb, no city in Kentucky, or any other state, would accept his cargo, and he was forced to circle back to Nashville. The result was a ruined ship and a city that had not rid itself of its prostitutes.

The documentation of prostitutes and legalization of their work became an effective—though not necessarily morally sound—solution. This system was implemented in Nashville in August 1863, when public women were required to report to a newly-transformed clinic and be tested and licensed. Thus, prostitution essentially became legal and much safer, as sex workers were required to be tested every two weeks; if they failed the medical exam, they were sent to the hospital until they were deemed “cured,” after which they could return to their work. Unlicensed prostitutes caught working were incarcerated.

In the roughly two years that this system was used in Nashville, nearly 400 licenses were issued and the city and Union army alike became considerably healthier. The moral question was naturally raised, to which the army could only conclude that the safety and health of its soldiers transcended ethical values.

So, while the Civil War era is generally regarded as a part of prudish Victorian society, in which intimacy in the home was of a taboo nature, there was no lack of sex.

Sources:

Claytor, William Quesenbury. Diary of William Claytor, 1849-1896, vol. 1. Alexandria, VA: Alexander Street Press, 2002.

Favill, Josiah Marshall. The Diary of a Young Officer Serving with the Armies of the United States during the War of the Rebellion. Chicago, IL: R.R. Donnelley & Sons Co., 1909.

Lowry, Thomas P. “The Army’s Licensed Prostitutes.” Civil War Times Illustrated 41, no. 4 (August 2002): 30-36. America: History and Life.

Schogol, Jeff. “Do ‘hookers’ Owe Their Moniker to a Civil War General?” Stars and Stripes. April 28, 2011. stripes.com.

Serratore, Angela. “The Curious Case of Nashville’s Frail Sisterhood.” Smithsonian. July 8, 2013.

Image: General Benjamin Butler enforced harsh discipline on the people of Union-occupied New Orleans; he is noted for threatening to publicly denounce women as prostitutes if they acted out against his soldiers. This editorial cartoon illustrates the resulting change in behavior.

From: gettysburgcompiler.com

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Badass of the Week: Mary E. Walker

By Ben Thompson

"Tables about breast high had been erected upon which the screaming victims were having legs and arms cut off. The surgeons and their assistants, stripped to the waist and bespattered with blood, stood around, some holding the poor fellows while others, armed with long, bloody knives and saws, cut and sawed away with frightful rapidity, throwing the mangled limbs on a pile nearby as soon as removed." -- Lt. Col. W.W. Blackford, 1st Virginia Cavalry

Detonating artillery shells and the non-stop rattling of musketry menacingly rumbled in the distance, barely audible over the groans and agonizing cries of dying men as droves of new arrivals steadily flooded into the ordinary, single-family home that was now being utilized as a front-line field hospital.  Horse-drawn ambulance carts packed full of trauma victims lined the driveway to a grisly facility that mashed together a barely-serviceable emergency room, operating room, and morgue into a painfully-typical three-bedroom house on the outskirts of Chattanooga, Tennessee, the hospital's overworked, exhausted nurses desperately trying to triage the wounded between those who are possibly treatable and those who aren't going to make it.

Outside the city walls the Union Army, pushed back to Chattanooga following their crushing defeat at Chickamauga, was making a desperate stand to hold the city against a massive Confederate counter-attack.  46,000 men of Braxton Bragg's Army of Tennessee were entrenched on the heights overlooking the critical strategic rail and communications center, with the Union forces backed up against the Tennessee River, but now a massive assault led by General George Thomas was rushing straight up a steep ridge, straight into hardened enemy positions that included 112 cannons, and were taking murderous fire from the enemy in an all-out attempt to smash the Confederates' defensive positions and break out of the siege.  Those wounded soldiers lucky enough to find their way back to friendly lines found themselves here, in a stinking, unsterilized, makeshift hospital surrounded by malaria-infected men and saw-wielding surgeons practicing a particular brand of medicine that had more in common with medieval torture than anything resembling a modern-day visit to the pediatrician, their only consolation being a cup of cold water and the soothing voice of nurses trying to comfort them and ease their pain in some small way.

During the Civil War, over ten thousand women worked as nurses in field hospitals across the war zone.

Mary Edwards Walker of the 52nd Ohio Volunteer Infantry is the only one who served as a surgeon.  She's also the only woman in history to ever receive the Medal of Honor, the highest award for military bravery offered by the United States of America.

Walker was a woman who was roughly a hundred and fifty years ahead of her time.  Routinely criticized by women and men alike for her desire to wear men's clothing (at a time when "men's clothing" basically meant "any article of clothing that allowed you to walk through doorways or work in any capacity whatsoever), Walker paid her own way through Syracuse Medical College in 1855, becoming just the second woman in American history to complete physician training and work as a doctor.  When the Civil War broke out in 1861, Walker had already been running her own private practice for six years, but even though there were just 86 licenses surgeons in the Union Army at the start of the hostilities she was still turned away by every recruiting officer she approached.  Undeterred, the 29 year-old surgeon signed on as a volunteer  nurse, working on the front lines at the First Battle of Bull Run, then working as an unpaid volunteer surgeon at Indiana Hospital later that year.

Walker continued her practice of "I'll just show up wherever people are dying and see if they'll maybe let me help fix them for free", volunteering at the Battle of Fredericksburg in 1862, performing front-line operations, and taking control of a medical train that was ferrying wounded men back to Washington.  Her skills at slicing and dicing men up in the name of science so impressed Union General Ambrose Burnside that the Federal commander nominated her for a commission.  At first she met with the resistance she was so used to encountering, but thanks to Burnside's recommendation, she was finally commissioned as an Assistant Surgeon in the 52nd Ohio Volunteer Infantry, issued a U.S. Army surgeon's uniform, and sent to Tennessee to help treat wounded and dying men during the siege of Chattanooga.  She would be the only woman in the war to receive this honor.

Now, in order to fully appreciate how intense the job of a Civil War surgeon actually was, try to think of it as something of a cross between the Spanish Inquisition and an Eastern European butcher shop.  Since artillery shells, canister fire, and cannonballs typically resulted in the instant, untreatable, and horrific death of anyone unlucky enough to be standing in front of a cannon muzzle, the majority of Civil War surgical cases were from gunshot wounds caused by a .58-caliber minie ball – a soft metal, mostly hollow, incredibly heavy projectile over half an inch in diameter that was shaped very much like a modern bullet, and one that not only hit so hard that any bone it came in contact with shattered like a fluorescent lightbulb being smacked against a brick wall, but that also mushroomed on impact much like a modern-day hollow-point bullet, expanding to about an inch in width, ripping through muscle, blood vessels, organs, and all of those other important things that people keep inside their skin.

Because there was no such thing as organ transplantation, internal surgery, or blood transfusions, if a soldier got hit in the head, chest, or abdomen, he had a 90% chance of death – all you could do for the poor bastard was give him morphine and water and find a shady tree for him to sit under until he died.  Wounds to the arms and legs had better odds, however, which is why fully three-quarters of surgeries performed during the war were amputations performed on these appendages.

Here's how it worked.  After a guy got shot, he had 48 hours to get his arm cut off with an unsterilized hacksaw or he was probably going to die a painful death from gangrene.  You, as the doctor, working in terrible conditions at someone's kitchen counter, would slosh the blood off the operating table with a bucket, get the guy up there, then you'd have a couple minutes to figure out what kind of shape he was in.  If his arm wasn't broken, he might be ok – you can just wash it out, slap a tourniquet on there, and move on to the next guy.  If it was broken, you'd need to operate.  One of your nurses would anesthetize the dude with a chloroform-soaked rag (if it was available – in some field hospitals all you got was a shot of whiskey and a bullet to bite down on) until he was unconscious, then you'd have to stitch the broken artery closed with a needle and thread, dig the bullet out of there with your forceps, cut through the muscle with a sharp knife, saw through the bone with your hacksaw, tie off the arteries with another piece of thread, and then sew it all shut into a stump.

A good surgeon could perform the operation in under ten minutes.  And he'd do it dozens of times in a row, all of this while people were pounding the city with artillery shells and stray bullets were slamming into the walls around them.  One nurse at the Battle of Antietam recalled working on a guy in the hospital tent and then having a stray bullet pass through the tent, through the sleeve of her dress, and then kill him right in front of her, which, honestly may have been more of a humane way to go – because this was back before we knew you had to sterilize your equipment before you operated on a patient, almost 25% of people who underwent amputation surgery ended up dying from infected wounds.

Saving human lives by performing barbaric work with her bone saw under hellish conditions in the middle of a raging war zone as bullets and artillery shrapnel ripped through the skies around her, Mary Edwards Walker continued working as a front-line surgeon throughout the three-day Battle of Chattanooga.  After a heroic, unlikely charge by George Thomas's men broke the Confederate position and sent Bragg retreating back to Georgia, Walker continued her work, not only assisting wounded Federal troops but also crossing enemy lines and providing medical care to Confederate troops and civilians in Tennessee and Georgia.

On one of these trips to Georgia to aid sick and injured civilians, Walker was ambushed by Confederate pickets, who found her in her Union uniform carrying two pistols and arrested her as a spy, a detail that may or may not actually have been true (we can't prove it either way).  Her captors, who noted in their report that she argued "enough for a regiment of men", recommended sending her to a lunatic asylum for being a woman doctor, but instead she was sent to Richmond and thrown in a jail for Federal prisoners of war.  She spent four months in brutal conditions in the POW Camp, Walker was sent back to Yankee lines as part of a prisoner exchange (she later confessed that she was very proud to have been traded straight-up for a male Confederate surgeon).

After the war, Walker was sent back to the Union Army, where she was attached to Sherman's army during the Atlanta Campaign.  After the Battle of Atlanta, she was appointed Chief Surgeon at a women's military prison in Louisville, Kentucky, where she served until the end of the war.  After her service, Walker collected an Army pension, wrote a couple books, became a women's suffrage activist, founded a weird commune, and got arrested a couple times for wearing pants instead of a dress.

During her time in the Union Army, Dr. Mary Edwards Walker had been recommended for promotion both by General George Thomas and by General William Tecumseh Sherman.  Since she technically wasn't a uniformed service member, these requests for promotion could not be granted, but in honor of her service Mary Edwards Walker was awarded the Congressional Medal of Honor in 1866.  Of the 1.8 million women who have served the United States military, she is the only one to ever receive the award.  The Federal government tried to correct this in 1917 when they changed the guidelines for the Medal of Honor, stipulating that it could only be awarded for actions that occurred in combat, and stripped 900 people – including Dr. Walker – of their awards.  Walker, obviously, told them to get bent – she wore the medal until her death in 1919.  It was officially reinstated by order of the President in 1977.

Sources:

Bollett, Alfred J.  "The Truth about Civil War Surgery."  Civil War Times.  June 12, 2006.

Davis, William.  Civil War Journal.  Thomas Nelson, 1999.

De Pauw, Linda Grant.  Battle Cries and Lullabies.  University of Oklahoma Press, 2000.

Schroeder, Glenna R.  The Encyclopedia of Civil War Medicine.  M.E. Sharpe, 2008.

Wilbur, C. Keith.  Civil War Medicine.  Globe Pequot, 1998.

From: military.com

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Was Civil War Surgery Effective? (Abstract)

By Matthew Baker

Economics Working Paper Archive at Hunter College from Hunter College Department of Economics

Abstract:
During the U. S. Civil War (1861-65) surgeons performed a vast number of surgical procedures such as amputations, resections, excisions, and bullet extractions. The efficacy of wartime surgery has been the subject of continuing debate since the start of the war. One reason debate continues is the dearth of empirical evidence on the (in)effectiveness of surgery. To shed light on the subject, I analyze a data set created by Dr. Edmund Andrews, a Civil war surgeon with the 1st Illinois Light Artillery. Dr. Andrews’s data can be rendered into an observational data set on surgical intervention and recovery, with controls for wound location and severity. The data also admits instruments for the surgical decision. My analysis suggests that Civil War surgery was effective, and increased the probability of survival of the typical wounded soldier, with average treatment effect of 0.25-0.28.

Downloads: (external link)
http://econ.hunter.cuny.edu/wp-content/uploads/sit ... /HunterEconWP444.pdf (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

More papers in Economics Working Paper Archive at Hunter College from Hunter College Department of Economics 695 Park Avenue, New York, NY 10065. Contact information at EDIRC.
Series data maintained by Jonathan Conning (jconning@hunter.cuny.edu).

From: econpaprs.repec.org

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Letter Showed Primitive Civil War Medicine

From: georgiainfo.galileo.usg.edu

November 03, 1862
A Georgia soldier in Virginia wrote home to his wife, telling her of being sick, and of the many Georgians who had died there; then added a note showing the primitive nature of Civil War medical treatment.

“…I have had some fever every day for four days. I think I will go to taking some medicine this Eavening…I have a very soar throat an bad cold. I have not got my strenghth back yet but it is improving. …I just got back from the soldiers grave yard I have been out and saw one Buried. there is more Georgia soldiers Burried there than any other state. I think there must be 4 or 5 hundred Georgians. when a soldier gets bad sick here they nearly all dy. The doctors cut off somebodys Leg, arm, hand, or foot or some other part nearly every day here. …” Source: Katherine S. Holland (ed.), Keep All My Letters: The Civil War Letters of Richard Henry Brooks, 51st Georgia Infantry (Macon: Mercer University Press, 2003), pp. 52-53.

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The Garthright House Served as a Union Field Hospital at the Battle of Cold Harbor

By Mark, 10-28-16

At the time of the Civil War, Miles and Margaret Garthright lived in a two story home a few miles east of Richmond, Virginia. While the location near the city was no doubt convenient in peacetime, it was very much in harm’s way during the war, and was on the battlefield of two major battles during two campaigns.

The house was on the edge of the June 27th, 1862 Battle of Gaines Mill, one of the Seven Days Battles of the Peninsula Campaign on 1862. It was more in the middle of the action two years later during General Ulysses S. Grant’s Overland Campaign, specifically, during the Battle of Cold Harbor from the end of May into early June of 1864. Cold Harbor is probably most infamous for the ill advised Union assault against entrenched Confederate positions on June 3rd, when the Federals suffered over 6,000 total casualties. Units from both the 2nd and 6th Corps charged through the property during that fateful assault.

The Federals turned the building into a field hospital, forcing the Garthright family into the basement. As the historical marker on the site notes, blood from the wounded dripped through the floorboards and into the basement. Some 97 Union soldiers died there and were hastily buried in the Garthright’s yard. In 1866, the bodies were removed to the Cold Harbor National Cemetery across the road. After the Union army moved on from Cold Harbor, the Confederates also used the house as a hospital.

Portions of the Garthright House date to the 1700′s. The house was damaged by a fire in 1970 and was restored, and is a part of the Richmond National Battlefield Park. The house is an exterior exhibit only and the interior is not open to the public.

Image: Garthright House, Richmond National Battlefield Park

From: ironbrigader.com

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Gangrene

From: humanillnesses.com

Gangrene (gang-GREEN) is a condition that leads to the death of living tissue. It is caused by blocked blood flow or by bacterial infection.

KEYWORDS
for searching the Internet and other reference sources

Arteriosclerosis

Bacterial infections

Debridement

Frostbite

Hyperbaric chamber

What Is Gangrene?
Gangrene is a condition in which living tissue (skin, muscle, or bone) dies and decays. Gangrene most often affects the legs, feet, arms, and fingers, but it also can affect internal organs such as the intestine or gallbladder. Gangrene can occur when blood flow to an area of the body is blocked or when certain types of bacteria * invade a wound.

* bacteria are round, spiral, or rod-shaped single-celled microorganisms without a distinct nucleus that commonly multiply by cell division. Some types may cause disease in humans, animals, or plants.

Dry gangrene
Dry gangrene can occur when blood flow to a part of the body is blocked. When tissues in the body are deprived of the nutrients and oxygen carried by blood, they begin to die. Dry gangrene

Military Medicine
U.S. Civil War (1861-1865)
The biggest killer in the U.S. Civil War was not instant death by bullet or by cannonball: it was disease resulting from wounds. An estimated 388,500 men died from wounds and other illnesses, including gangrene. Doctors with dirty hands unknowingly infected wounds with gangrene-causing bacteria while trying to treat the injured soldiers.

During this war, doctors noticed that the wounds of some of the soldiers were infested with maggots, which are the larvae of houseflies or blowflies. Those maggot-infested wounds tended to heal faster than those without maggots, because the maggots were eating the dead or decaying tissue that resulted from gangrene infection. Thus, the maggots were cleaning out the dead and decaying tissue, allowing the remaining tissue to heal. They were doing the work that surgeons do today to treat gangrene through debridement of wounds.

World War I (1914-1918)
During World War I, 15,000 miles of trenches stretched along the western front in Europe. Troops who spent many weeks in these cold, wet trenches often developed swollen limbs, damaged sensory nerves, and inflammation, a condition that they called "trench foot."

Trench foot often resulted in gangrene, loss of tissue, and sometimes in loss of limbs to amputations. Physicians and military officers responded to the problem by instituting strict standards of hygiene that became part of the military's ongoing preventive health regimen.

can result from injury or frostbite * , but it most commonly is a complication of diabetes. Diabetes can lead to hardening of the arteries (arteriosclerosis), which restricts blood flow. This is especially common in the legs and feet.

Dry gangrene usually starts in the toes. A person might first feel numbness or tingling in the feet. As gangrene progresses and tissue starts to die, the person will experience severe pain in the affected area. Eventually, the tissue turns black, marking where tissue has died. This type of gangrene needs to be treated promptly, but it is usually not life threatening.

Wet gangrene
Wet gangrene occurs when certain types of bacteria invade an injured area of the body. It occurs most often after an injury in which a body part was crushed or when blood flow was obstructed by a blood clot or a tight bandage. The lack of blood flow causes some cells to die and leak fluid, which moistens the surrounding tissue. The moist environment allows bacteria, such as Streptococci (strepto-KOK-sy) and Staphylococci (staf-i-lo-KOK-sy), to invade the wound and multiply. Wet gangrene causes swollen and blistered skin, and it has a foul odor. Once wet gangrene sets in, it spreads quickly to surrounding tissue. If left untreated, it can kill a person in a few days.

Gas gangrene
Gas gangrene is a type of wet gangrene that usually is caused by the bacterium called Clostridium (klo-STRID-e-um). This type of bacteria requires very little oxygen to live, and it releases gases and toxins as waste products. Gas gangrene causes a high fever, brown pus * , and gas bubbles on the skin.

How Is Gangrene Treated?
When a person has diabetes, frostbite, or an injury, preventing gangrene is a high priority. Taking medications, maintaining good blood circulation, avoiding foot injuries, and not smoking are essential for preventing dry gangrene in people with diabetes. Prompt cleaning of wounds to avoid bacterial infection can prevent wet gangrene.

* frostbite is damage to tissues as the result of exposure to low environmental temperatures. It is also called congelation (kon-je-LAY-shun).

* pus is a thick, creamy fluid, usually yellow or greenish in color, that forms at the site of an infection.

* amputation (am-pu-TAY-shun) is the removal of a limb or other appendage or outgrowth of the body.

* antibiotics (an-ti-bi-OT-iks) are drugs that kill or slow the growth of bacteria.

See also
Bacterial Infections
Cold-related Injuries
Diabetes

If a person develops gangrene, dead tissue needs to be surgically removed before healing can begin (a process called debridement). Doctors try to improve circulation to the affected part of the body and surgeons remove dead tissue. Because bacterial forms of gangrene can spread quickly, part or all of the affected limb might require amputation. * People with wet gangrene also are treated with antibiotics. * Sometimes, people with gangrene are treated in a hyperbaric chamber. This procedure exposes the body to oxygen at high pressure, which promotes healing of the gangrenous tissue.

Image: Amputation saws for treating gangrene infections were part of the military doctor's field equipment.

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