Civil War MedicineCivil War Medicine

Most material adaptedfrom CWI’s 2006 Conference.

By Bruce Clarke

Introduction…Introduction…Before the war broke out, the Before the war broke out, the

US army had 108 US army had 108 surgeons/doctorssurgeons/doctors

24 went to the Confed.24 went to the Confed.

3 discharged for treason3 discharged for treason

81 remained…most in the 81 remained…most in the eighty western forts…eighty western forts…

?? How many surgeons by ?? How many surgeons by ‘65???‘65???

North?North?

South?South? Green sash, piping on uniform for medical officers

AnswerAnswerUnion: 12,000Union: 12,000

Confederacy: 3,200Confederacy: 3,200

The “war was The “war was fought at the end fought at the end of the medical of the medical Middle Ages”Middle Ages”

Surgeon General William Surgeon General William HammondHammond

4040 186,894186,894

The number of army The number of army hospital beds in hospital beds in Washington on the eve Washington on the eve of Bull Run, 1861.of Bull Run, 1861.

The number of beds in The number of beds in army hospitals by army hospitals by 1865.1865.

1861: several small infirmaries1865: 204 large hospitals

A brief survey of the state of pre-Civil A brief survey of the state of pre-Civil War MedicineWar Medicine

1818thth century: Benjamin Rush century: Benjamin Rush Jacksonian era disputesJacksonian era disputes EducationEducation AnesthesiaAnesthesia

The American Hippocrates The American Hippocrates (1745-1813)(1745-1813)

Dr. Benjamin RushDr. Benjamin Rush Educated in Edinburgh & Educated in Edinburgh &

ParisParis Continental CongressContinental Congress AbolitionistAbolitionist Instructor in PhiladelphiaInstructor in Philadelphia

2250 students2250 students ““Heroic therapy”Heroic therapy”

Bleed (phlebotomy)Bleed (phlebotomy) blister and purgeblister and purge

What sets him apart: What sets him apart: Convincing writer, speaker Convincing writer, speaker and a tireless teacherand a tireless teacher

Greco-Roman Formula UpdatedGreco-Roman Formula Updated

A “fever” was a catchall term for virtually any A “fever” was a catchall term for virtually any illnessillness

Imbalance of 4 elemental fluids or humorsImbalance of 4 elemental fluids or humors Blood (sanguine), Black bile (melancholy), Blood (sanguine), Black bile (melancholy),

Yellow bile (choloric),Phlegm (phlegmatic)Yellow bile (choloric),Phlegm (phlegmatic) ““there is but one exciting cause of fever and that there is but one exciting cause of fever and that

is stimulus that consists in a…convulsive action is stimulus that consists in a…convulsive action of the blood vessels” - Rushof the blood vessels” - Rush

Jacksonian Era gave rise to the Jacksonian Era gave rise to the Antebellum Doctor Wars…Antebellum Doctor Wars…

Democratic spiritDemocratic spirit Reform movementsReform movements Skepticism about heroic Skepticism about heroic

methodmethod The regulars fought the The regulars fought the

irregularsirregulars ““Heroics” vs:Heroics” vs:

ThomsonismThomsonism Excess of cold in bodyExcess of cold in body

HydropathsHydropaths Graham’s vegetarianismGraham’s vegetarianism HomeopathyHomeopathy

Like is cured by likeLike is cured by like

2500 homeopaths in 18612500 homeopaths in 1861With society, colleges, etcWith society, colleges, etc

Medical EducationMedical Education Apprentice for 2-3 years at $100 Apprentice for 2-3 years at $100

yearyear Attend a local diploma factoryAttend a local diploma factory Or the more ambitious attended Or the more ambitious attended

one of 8 medical schools 2 one of 8 medical schools 2 years @$125 termyears @$125 term (content repeated)(content repeated)

Textbooks were shared. Textbooks were shared. If passed exam... If passed exam... Pay $30 for diplomaPay $30 for diploma

And…presto you can do amputations!And…presto you can do amputations!

EducationEducation

Joseph Pancoast’s Joseph Pancoast’s manual: manual:

"A Treatise on "A Treatise on Operative Surgery", Operative Surgery", Philadelphia, 1844Philadelphia, 1844 Daguerreotypes Daguerreotypes

added in 1852added in 1852

Note that most of Note that most of these procedures these procedures done without done without anesthesia until late anesthesia until late 40s, early 50s!!40s, early 50s!!

Ether first successful in1846Ether first successful in1846

At Mass General At Mass General Hospital (Harvard)Hospital (Harvard) ““Gentlemen, this is no Gentlemen, this is no

humbug” - John Warrenhumbug” - John Warren

In the Civil War, ether In the Civil War, ether and chloroform were and chloroform were used using a paper or used using a paper or cardboard cone with cardboard cone with drops of the liquid, or drops of the liquid, or using device shown.using device shown.

Ether’s combustibility made the army prefer chloroform, however…

18461846First Successful Operation Using EtherFirst Successful Operation Using Ether

Dr. Bigelow

Dr. Morton

Dr. WarrenGuy with growth on neck

Dirty hands

http://neurosurgery.mgh.harvard.edu/Rounds

What was the impact of the Civil What was the impact of the Civil War on medicine?War on medicine?

Thomas EakinsThomas Eakins ““The Gross Clinic”The Gross Clinic”

18751875

Sophisticated forSophisticated forits time; its time;

What do you see?What do you see?

Or not see?Or not see?

One clue…

Lasting impact should be measured by Lasting impact should be measured by administrative care that was systematic administrative care that was systematic and organized, impacting Western worldand organized, impacting Western world

1.1. Discipline imposed on an undisciplined professionDiscipline imposed on an undisciplined profession

2.2. A huge body of excellent medical records made.A huge body of excellent medical records made.

3.3. Awakening populace to importance of hygiene and nutrition.Awakening populace to importance of hygiene and nutrition.

4.4. Created a huge number of doctors and nurses that spread out to Created a huge number of doctors and nurses that spread out to nation after war, improving health care. nation after war, improving health care.

5.5. Experience with rarer pathologies that all took with them to smaller Experience with rarer pathologies that all took with them to smaller practices after the war.practices after the war.

6.6. Mingling of men with higher medical training with those of less had Mingling of men with higher medical training with those of less had educational and democratic great value.educational and democratic great value.

7.7. State of the art hospital design exported to the world.State of the art hospital design exported to the world.

Surgeon GeneralsSurgeon Generals Union : Union :

1861: Finley: bad1861: Finley: bad 1862-64: Hammond: excellent1862-64: Hammond: excellent

Issued hygiene regulationsIssued hygiene regulations Water horses downstreamWater horses downstream Locations of latrinesLocations of latrines Burying trashBurying trash Enlarged record keepingEnlarged record keeping Photographs of pathologies, Photographs of pathologies,

procedures, resultsprocedures, results Many good hospitals builtMany good hospitals built

1864-65: Barnes: (due to 1864-65: Barnes: (due to Stanton/Hammond clash)Stanton/Hammond clash)

Confed: Samuel Moore: Confed: Samuel Moore: excellentexcellent

Major Jonathan Letterman: “Father Major Jonathan Letterman: “Father of Modern Battlefield Medicine”of Modern Battlefield Medicine”

Gen. McClellan’s choice Gen. McClellan’s choice as Medical Director, Army as Medical Director, Army of the Potomacof the Potomac

Completely reorganized Completely reorganized a a triagetriage and evacuation and evacuation

system system implemented Battle of implemented Battle of

AntietamAntietam system still used today. system still used today.

Antietam: Antietam: Rebirth of Medicine Rebirth of Medicine

Pry Farm Barn: 1862Pry Farm Barn: 1862 Preserved TodayPreserved Today

Field hospitals were very often people’s homes Field hospitals were very often people’s homes commandeered by the army; The Pry farm near Antietam commandeered by the army; The Pry farm near Antietam was so devastated economically that its owners declared was so devastated economically that its owners declared bankruptcy soon after.bankruptcy soon after.

Ambulance Corps StartedAmbulance Corps Started

Begins training of Begins training of ambulance corps with ambulance corps with set drills.set drills. How to walk with a How to walk with a

stretcherstretcher

Rosencrans Rosencrans ambulance ambulance designed - with designed - with springs for patient springs for patient comfort!comfort!

Lincoln at AntietamLincoln at Antietam

Recognizes LettermanRecognizes Letterman Gets a tour of the Gets a tour of the

“Letterman Plan” in “Letterman Plan” in action.action.

How were black soldiers treated?How were black soldiers treated?

There is no substantial There is no substantial body of evidence of body of evidence of how black soldiers how black soldiers were treated medicallywere treated medically

A few black surgeons A few black surgeons were assigned to black were assigned to black unitsunits

3/4 who die, die of disease3/4 who die, die of disease

Largest killer was dysentaryLargest killer was dysentary TyphoidTyphoid Measles, chicken pox, syphillus, tb, heat stroke, Measles, chicken pox, syphillus, tb, heat stroke,

reptile bites, battle fatiguereptile bites, battle fatigue And gangrene…And gangrene…

Minie balls entered with bits of dirty uniform, grease Minie balls entered with bits of dirty uniform, grease from the barrel…from the barrel…

Nursing as serious workNursing as serious work Sisters of CharitySisters of Charity US Sanitary CommissionUS Sanitary Commission

SecularSecular National org.National org. Dr. Elizabeth Blackwell : ideaDr. Elizabeth Blackwell : idea Dr. Henry Bellow Pres.Dr. Henry Bellow Pres. Frederick Law Olmstead Gen SecFrederick Law Olmstead Gen Sec

US Christian CommissionUS Christian Commission saving souls and bodiessaving souls and bodies State by stateState by state

Nursing Corps.Nursing Corps. Dorothea “Dragon” Dix Dorothea “Dragon” Dix

Superintendant Superintendant Not a nurse: Clara Barton: collecting Not a nurse: Clara Barton: collecting

donations, aid and resources for donations, aid and resources for medical and humanitarian aid: later medical and humanitarian aid: later …… American Red CrossAmerican Red Cross

Myth: Surgeons were heartless butchers Myth: Surgeons were heartless butchers who had patients bite a bullet during who had patients bite a bullet during

surgery…surgery…

Team of 3 would look at patient, and all would Team of 3 would look at patient, and all would have to agree that amputation was required to have to agree that amputation was required to save the patient’s life. Amputations were avoided save the patient’s life. Amputations were avoided whenever thought possible.whenever thought possible.

Teeth would break…they bit on wood or leather if Teeth would break…they bit on wood or leather if chloroform was not available.chloroform was not available.

Camp Letterman Gettysburg

Orthopedics are rooted in the Orthopedics are rooted in the War: ProsthesesWar: Prostheses

Postwar: Joseph Lister Lectures Postwar: Joseph Lister Lectures in USA, Garfield Dies Anywayin USA, Garfield Dies Anyway

Developing Pasteur’s (1869) germ theory at Developing Pasteur’s (1869) germ theory at Philadelphia : Worlds Fair 1876Philadelphia : Worlds Fair 1876 Wash your handsWash your hands Clean everythingClean everything Don’t use a scalpel twiceDon’t use a scalpel twice Controversy ensues: general acceptance only Controversy ensues: general acceptance only

comes in late 1880scomes in late 1880s

The Case of James GarfieldThe Case of James Garfield

1881, Garfield is shot in Washington DC by a 1881, Garfield is shot in Washington DC by a disgruntled office seeker.disgruntled office seeker. Bullet only hits muscle, no organsBullet only hits muscle, no organs

His doctor, Dr. Doctor W. Bliss was anti-listerianHis doctor, Dr. Doctor W. Bliss was anti-listerian Put fingers into wound, put tubes in to drain fluidsPut fingers into wound, put tubes in to drain fluids Garfield didn’t eat for 7 weeks due to all the morphine, Garfield didn’t eat for 7 weeks due to all the morphine,

and opium given himand opium given him Bliss writes a long report, justifying all he didBliss writes a long report, justifying all he did

Young doctors who’d trained in Europe thought Young doctors who’d trained in Europe thought Bliss crazy: ……“ignorance is Bliss”Bliss crazy: ……“ignorance is Bliss”

Transformation of Western MedicineTransformation of Western Medicine

The Medical and The Medical and Surgical History of the Surgical History of the War of the RebellionWar of the Rebellion Read widelyRead widely

Transformation of US MedicineTransformation of US Medicine

Gerster: publishes Gerster: publishes major textbook in 1888major textbook in 1888

Senn : Senn : BacteriologyBacteriology18891889

Johns Hopkins Johns Hopkins Hospital (1889) and Hospital (1889) and School of MedicineSchool of Medicine Required much moreRequired much more First to allow women First to allow women

enter on equal basisenter on equal basis

Eakins “The Agnew Clinic” 1889, Philadelphia

Between 1890 and 1911, the US will leapfrog forward to become a leader in surgery and medicine.

1890s1890s

Within months of Roentgen’s discovery of Within months of Roentgen’s discovery of the x-ray (1895), US doctors explored it and the x-ray (1895), US doctors explored it and wrote a good textbook on it.wrote a good textbook on it.

US doctors are the first to advance the US doctors are the first to advance the proper treatment of appendicitis by surgery, proper treatment of appendicitis by surgery, which becomes a textbook operation.which becomes a textbook operation.

Book and Internet ResourcesBook and Internet Resources

Rutgow, Ira. Rutgow, Ira. Bleeding Blue and Gray. Bleeding Blue and Gray. New York: Random New York: Random House, 2005.House, 2005.

Web sources:Web sources: Civil War Homepage. Civil War Homepage. http://www.civil-war.net (18 Aug (18 Aug

2006).2006). Civil War Medical Care, Battle Wounds and Diseases. Civil War Medical Care, Battle Wounds and Diseases.

http://www.civilwarhome.com/civilwarmedicine.htm (10 Aug (10 Aug 2006)2006)

National Museum of Civil War Medicine, Frederick, National Museum of Civil War Medicine, Frederick, MarylandMaryland http://www.civilwarmed.org/index.cfm (Aug 10 2006) (Aug 10 2006)