Introduction
Both the Northern and Southern medical teams were willing to accept anyone with ANY medical background at all because of the dire need for help, and most of the doctors treated patients by referencing a book (they often didn't have enough medical knowledge to diagnose on their own). Also, most doctors thought pus was a positive sign that something was healing, not a sign of infection. So they would purposefully transfer pus from someone who had it to someone who didn't, transmitting infections. Doctors didn't know how germs were spread, so they had basically no sterile procedures (bare hands, putting bloody knives in their teeth, etc.) (1)
The majority of the military surgeons in the Civil War received their training from non-rigorous 2 year medical schools and were very unprepared for the quick evaluations and treatments needed on site during the war. Anesthesia was available but rarely used (as not many were qualified or had significant experience with it) and thus many of the "surgeons" had never actually performed a surgery. The only true surgical treatment that was used in a significant way was amputations (the key surgical skill to those on site). (2) Overall, both the North and South were sorely unprepared for the mass casualties involved with the war and inadvertently caused many unnecessary deaths because of their ignorance regarding hygiene.
The majority of the military surgeons in the Civil War received their training from non-rigorous 2 year medical schools and were very unprepared for the quick evaluations and treatments needed on site during the war. Anesthesia was available but rarely used (as not many were qualified or had significant experience with it) and thus many of the "surgeons" had never actually performed a surgery. The only true surgical treatment that was used in a significant way was amputations (the key surgical skill to those on site). (2) Overall, both the North and South were sorely unprepared for the mass casualties involved with the war and inadvertently caused many unnecessary deaths because of their ignorance regarding hygiene.
Illnesses and Conditions
Diseases like dysentery, typhoid fever, pneumonia, mumps, measles and tuberculosis were common in the army camps, and spread quickly among the soldiers due to their close proximity and the poor hygiene around the camps. Also, the soldiers' intense fighting schedule and poor diet added to their weakened states as poor organization in the makeshift hospitals led to more casualties because of miscommunications and inefficiency.(3) Underhill, a soldier, commented that "everything [in the hospitals] concerning sickness and its management seems so repulsive that the thought of being sick or of having one of your friends in the Hospital, is filled with gloom."(4) The battlefield was almost a better alternative to the disease ridden, horror filled hospitals. Ironically, people associated the hospitals (where people are supposed to get better) more so a place of death than actually going into battle.
Many of the soldiers had not experienced the rigor and cramped quarters of a war camp, since they had come from more rural areas. Because they had lived in these rural areas, the soldiers had not experienced the diseases that were quite common in the city, so they had virtually no immune system to start with.(5) The combination of poor nutrition, shelter, and diet, while physically exerting themselves on campaigns only increased the soldiers' susceptibility to disease.
Many of the soldiers had not experienced the rigor and cramped quarters of a war camp, since they had come from more rural areas. Because they had lived in these rural areas, the soldiers had not experienced the diseases that were quite common in the city, so they had virtually no immune system to start with.(5) The combination of poor nutrition, shelter, and diet, while physically exerting themselves on campaigns only increased the soldiers' susceptibility to disease.
Amputations
Union soldiers suffered 174,000 extremity wounds (arms and legs). Of these, 30,000 resulted in amputations and only three-fourths of the amputees survived. The doctors quickly discovered that the sooner the amputation was performed, the better the chance of survival. If amputation was delayed more than 48 hours, blood poisoning, bone infection, or gangrene would occur, and the death rate would double. Before this time factor was emphasized, simply waiting to operate on critical condition patients led to many preventable deaths during the war. During surgery, many doctors used chloroform or ether as anesthesia, especially near the end of the war. (6) Although the two substances successfully numbed the patients, they each had downsides. Ether was highly flammable, yet chloroform could result in death of the patient if applied incorrectly.
If a soldier was shot, the Infirmary Corps would take the wounded soldier to a first aid station where an assistant would give them painkillers and swigs of whiskey to numb the pain, while they packed the wound with lint from linen fabric. If the bleeding continued, they would apply a tourniquet which would lead to the need for an amputation. They would be transferred to a hospital where the amputation would occur and then sent to a recovery hospital. (7) Carl Schurz, a Union army general, observed a common hospital post-battle, "There stood the surgeons, their sleeves rolled up to the elbows, their bare arms as well as their linen aprons smeared with blood, their knives not seldom held between their teeth, while they were helping a patient on or off the table, or had their hands otherwise occupied; around them pools of blood and amputated arms or legs in heaps, sometimes more than man-high. As a wounded man was lifted on the table, often shrieking with pain as the attendants handled him, the surgeon quickly examined the wound and resolved upon cutting off the injured limb. Some ether was administered and the body put in position in a moment. The surgeon snatched his knife from between his teeth, where it had been while his hands were busy, wiped it rapidly once or twice across his blood-stained apron, and the cutting began. The operation accomplished, the surgeon would look around with a deep sigh, and then-"Next!"(8) Many unrelated illnesses resulted in amputations, as it was one of the only reliable surgeries that seemed to fix an infection or bullet wound, etc. The process often took much longer than the ideal 48 hour window of survival, mainly because of the high number of casualties and lack of organization in hospitals and first aid stations. Union and Confederate figures like William Alexander Hammond and Hunter Hayes McGuire addressed these concerns and improved organization and efficiency in hospitals.
If a soldier was shot, the Infirmary Corps would take the wounded soldier to a first aid station where an assistant would give them painkillers and swigs of whiskey to numb the pain, while they packed the wound with lint from linen fabric. If the bleeding continued, they would apply a tourniquet which would lead to the need for an amputation. They would be transferred to a hospital where the amputation would occur and then sent to a recovery hospital. (7) Carl Schurz, a Union army general, observed a common hospital post-battle, "There stood the surgeons, their sleeves rolled up to the elbows, their bare arms as well as their linen aprons smeared with blood, their knives not seldom held between their teeth, while they were helping a patient on or off the table, or had their hands otherwise occupied; around them pools of blood and amputated arms or legs in heaps, sometimes more than man-high. As a wounded man was lifted on the table, often shrieking with pain as the attendants handled him, the surgeon quickly examined the wound and resolved upon cutting off the injured limb. Some ether was administered and the body put in position in a moment. The surgeon snatched his knife from between his teeth, where it had been while his hands were busy, wiped it rapidly once or twice across his blood-stained apron, and the cutting began. The operation accomplished, the surgeon would look around with a deep sigh, and then-"Next!"(8) Many unrelated illnesses resulted in amputations, as it was one of the only reliable surgeries that seemed to fix an infection or bullet wound, etc. The process often took much longer than the ideal 48 hour window of survival, mainly because of the high number of casualties and lack of organization in hospitals and first aid stations. Union and Confederate figures like William Alexander Hammond and Hunter Hayes McGuire addressed these concerns and improved organization and efficiency in hospitals.
Dentistry
Soldiers often didn't properly care for their teeth usually because the dental operations cost too much money, but proper dental hygiene was vital to battle because the soldiers constantly needed to bite off the end of powder cartridges in rifles. Oral surgeons were regarded as regular surgeons who specialized on teeth, while dentists usually had the rank of either a hospital steward or a full surgeon (depending on the hospital). The dentists typically "plugged, cleaned and extracted teeth" and "adjusted jaw fractures and performed operations on the mouth". A dentist from Atlanta, Dr. James Bean, created a splint that was widely used in Confederacy dentistry that helped keep loose teeth from falling out and distribute the biting force among several teeth, rather than just a few. (9) Overall, the Confederate's Dental Corps retained a small advantage over the Union army, mainly because their system was more sophisticated and they often hired out regular available dentists from the South to work on the soldiers.
Typical material used for filling cavities are as follows:
Typical material used for filling cavities are as follows:
- Lead- Lead was far from ideal because it wore down quickly and caused health problems that were known at the time.
- Gold- Gold was the best filling material (agreed upon by Northern and Southern dentists alike) because it was strong, didn't disintegrate over time and it wasn't harmful to the patient.
- Tin- Tin was a cheaper version of gold, and it could be quickly and easily replaced, but most dentists only recommended it for posterior teeth (back molars) because it could oxidize and blacken, giving an undesirable visual appearance.
- Platinum- Platinum was occasionally used, but it was not ductile or malleable, thus it was difficult to shape to fit the unique mouths of the patients.
- Silver- Silver was similar to platinum; it was non-malleable and difficult to work with and would oxidize. But, despite the downsides, dentists still used and experimented with it.
- Amalgams- Amalgams (mixtures) were the most popular, mainly because it was less expensive than pure metal. A popular combination was of silver, tin and mercury, and while this worked for a while, it eventually turned the teeth black. (10)
Hospital Observation
Walt Whitman, a Civil War nurse and American poet visited a makeshift hospital in Falmouth, VA in 1862 and discussed the disgusting layout of amputated limbs and dead bodies in piles and strewn about, as well as the claustrophobic and disorganized atmosphere with wounded soldiers unclean and bloody lying down wherever there was room. Also, from a makeshift hospital on site, he said that they were barely even tents, with all the wounded men lying on the ground. (11)
A soldier told his first hand account of the first aid tents, "Here a number of assistants took charge of the poor fellows, and as some of them lifted a man on to the first table others moved up the window so that no time nor space should be lost. Then some of the surgeons administered an anesthetic to the groaning and writhing patient, exposed his wound and passed him to the center table. There the surgeons who were operating made a hasty examination and determined what was to be done and did it, and more often than not, in a very few moments an arm or a leg or some other portion of the subject's anatomy was flung out upon a pile of similar fragments behind the hospital, which was then more than six feet wide and three feet high, and what remained of the man was passed on to the third table, where other surgeons finished the bandaging, resuscitated him and posted him off with others in an ambulance." (12) This showed the hasty and haphazard work of the surgeons, where they were more concerned with removing all possible problematic areas than correctly assessing the issue and treating just that problem.
The soldier also goes onto explain the uncleanliness of the working sites, how many of the wounds have half inch maggots crawling in the bloody flesh, and how the ruthless ambulance drivers had no regard for the excruciating pain the soldiers were enduring in the back, so assistants would have to hold up their amputated stumps of limbs to help ease the pain during the trip from the temporary field hospitals to the real hospital further away from the battlefield. (13)
A soldier told his first hand account of the first aid tents, "Here a number of assistants took charge of the poor fellows, and as some of them lifted a man on to the first table others moved up the window so that no time nor space should be lost. Then some of the surgeons administered an anesthetic to the groaning and writhing patient, exposed his wound and passed him to the center table. There the surgeons who were operating made a hasty examination and determined what was to be done and did it, and more often than not, in a very few moments an arm or a leg or some other portion of the subject's anatomy was flung out upon a pile of similar fragments behind the hospital, which was then more than six feet wide and three feet high, and what remained of the man was passed on to the third table, where other surgeons finished the bandaging, resuscitated him and posted him off with others in an ambulance." (12) This showed the hasty and haphazard work of the surgeons, where they were more concerned with removing all possible problematic areas than correctly assessing the issue and treating just that problem.
The soldier also goes onto explain the uncleanliness of the working sites, how many of the wounds have half inch maggots crawling in the bloody flesh, and how the ruthless ambulance drivers had no regard for the excruciating pain the soldiers were enduring in the back, so assistants would have to hold up their amputated stumps of limbs to help ease the pain during the trip from the temporary field hospitals to the real hospital further away from the battlefield. (13)
(1) "Civil War Curriculum Medicine."
(2) Antietam: Aspects of Medicine.
(3) Dixon, "Civil War Medicine- Modern."
(4) Townsend, Alfred, Small, "Firsthand Accounts."
(5) “Civil War Medicine”
(6) "Civil War Curriculum Medicine."
(7) Ibid.
(8) Townsend, Alfred, Small, "Firsthand Accounts."
(9) "Civil War Dentistry."
(10) "Dental Filling Materials in the Confederacy," Pierre Fauchard Academy.
(11) Dixon, "Civil War Medicine- Modern."
(12) Townsend, Alfred, Small, "Firsthand Accounts."
(13) Ibid.
(2) Antietam: Aspects of Medicine.
(3) Dixon, "Civil War Medicine- Modern."
(4) Townsend, Alfred, Small, "Firsthand Accounts."
(5) “Civil War Medicine”
(6) "Civil War Curriculum Medicine."
(7) Ibid.
(8) Townsend, Alfred, Small, "Firsthand Accounts."
(9) "Civil War Dentistry."
(10) "Dental Filling Materials in the Confederacy," Pierre Fauchard Academy.
(11) Dixon, "Civil War Medicine- Modern."
(12) Townsend, Alfred, Small, "Firsthand Accounts."
(13) Ibid.