Medicine and Health

When the Civil War began in April 1861, American medicine was approaching what Union Surgeon General William Hammond called "the end of the medical Middle Ages." The Civil War was the last great armed conflict in the world fought without knowledge of the germ theory, which would in subsequent wars allow doctors to understand the cause and prevention of disease. Yet the war, despite its unparalleled death and destruction, revolutionized American medicine and improved medical care and public health in the postwar era.

Before the Civil War began, most Americans were skeptical of doctors' ability to heal them. Inadequate medical training accounts for some of this skepticism. In sharp contrast to today's high academic entrance standards, admission to medical school was based only on students' ability to pay tuition. Medical school curriculum consisted of a series of lectures delivered by the schools' professors. These lectures were repeated during the students' second year of study because it was assumed that students would learn more the second time around.

Public hospitals were rare in antebellum America. Only large cities like Boston, New York, and New Orleans offered sick people the option of hospital treatment. Few hospitals meant that most doctors received no clinical or surgical experience before they earned their medical degrees. Most Americans believed that family members, rather than doctors, were best suited to restore their loved ones' health. Thus, many mid-nineteenth-century Americans avoided hospital treatment and viewed hospitals as being primarily for poor people who had no family to care for them.

Two distinct schools of medical thought existed in antebellum America: those who advocated a scientific approach to healing and those who advanced unorthodox medical practices. Advocates of scientific medicine believed that excess bodily fluids caused sickness by pushing the body out of its natural balance. Recovery required that these fluids be expelled from the body through bleeding, blistering, purging, and vomiting. Because these procedures were often painful, many Americans sought relief in other medical treatments such as phrenology, mesmerism, homeopathy and hydropathy.

The Civil War, with its 620,000 deaths and ten million cases of disease, pushed scientifically-based medical care to the forefront of American society. When the war began, neither the Union nor the Confederacy was prepared to handle the large number of sick and wounded soldiers. Efficient medical care demanded that both the Union and Confederate governments create medical departments to accompany their armies. In April 1861, the scanty resources of both medical departments consisted of less than one hundred doctors, few ambulances, and no military hospitals.

In the spring of 1861, the lack of medical preparedness reached crisis proportions. Gathered in crowded training camps to drill and prepare for war, many Union and Confederate soldiers were exposed to childhood diseases (mainly mumps and measles) for the first time in their lives. Although these diseases were rarely fatal, they incapacitated thousands of soldiers at a time, necessitating the erection of large hospitals.

Civil War hospitals fell into two categories: field hospitals and general hospitals. Army doctors erected field hospitals near camps and battlefields. Designed for mobility and short-term care, field hospitals were located in tents or civilian buildings like churches, schools, or farm houses. Soldiers needing protracted medical care received treatment at more permanent general hospitals. Built in the "pavilion" style, each ward held about sixty patients and was detached on three sides from the main corridor, allowing patients to receive plenty of fresh air. Most general hospitals also contained kitchens, laundries, operating rooms, ice houses and morgues.

Diseases such as dysentery, diarrhea, typhoid fever, and malaria were the principal killers of Civil War soldiers. Poor hygiene and sanitation in army camps added to the rapid spread of disease. Although ideas concerning the importance of clean drinking water and the proper

disposal of human waste were in their infancy, some doctors and nurses saw the connection between unsanitary conditions and disease transmission. To aid in the cleanup of army camps, the United States government created the U.S. Sanitary Commission in June 1861. Directed by Frederick Law Olmsted, this commission worked to improve camp sanitation and preached the virtues of clean water, good food, and fresh air. Yet despite the Sanitary Commission's efforts, approximately 390,000 soldiers died from disease during the Civil War—twice the number of those killed by bullets.

Second to disease as a cause of death, battlefield injuries killed approximately 200,000 soldiers. Transporting wounded soldiers to field hospitals was problematic during the war's first year because musicians, cooks, and other noncombatants detailed as stretcher-bearers often fled during battle, stranding the wounded on the field for hours. The creation of a trained ambulance corps for the Army of the Potomac in August 1862 solved this problem by efficiently delivering the wounded to field hospitals. The Confederates adopted a similar strategy, and the Civil War ambulance corps became the American model for battlefield evacuation through World War I.

Army doctors performed a large number of Civil War surgeries at field hospitals. Because many wounds consisted of gunshots to arms and legs, amputation was the most common procedure. Surgery during the Civil War was risky because the importance of sterilization was unknown until 1867. Surgeons rarely washed their hands or knives and used the same dirty sponges and clamps for many patients. As a result, post-operative infections produced extremely high death rates.

Before amputation, most patients received anesthesia—chloroform or ether—which was sprinkled on a cloth and held over the patient's nose and mouth. After the surgeon removed the limb, he clamped the arteries and tied them off with oiled silk. Most surgeons could amputate a limb in two or three minutes.

Field hospitals were not equipped for long-term patient care. For this purpose, sick and wounded soldiers were transported to general hospitals located near supply and railroad depots. At the war's outset, both sides filled hospital positions with soldiers taken from the ranks. As wounds and sickness depleted each army's strength, governmental and military authorities moved to replace soldiers with civilian hospital workers.

Northern and Southern women made their most vital contribution to the war effort as hospital workers. Before the war, few people recognized the importance of nurses. Florence Nightingale's work on behalf of British troops during the Crimean War changed attitudes, but it took the Civil War to professionalize American nursing and to foster acceptance of women as nurses. To serve their respective countries, women overcame many obstacles including familial objections and prejudice from doctors.

Northern women often found their way to general hospitals through Dorothea Dix, whom President Abraham Lincoln named Superintendent of Female Nurses in June 1861. A pre-war reformer, Dix worked with the U.S. Sanitary Commission and demanded that nursing applicants be at least thirty years old and plainly clothed. Approximately 3,200 women served as Union army nurses during the war.

Because the Confederacy did not have a sanitary commission or a centralized nursing agency, Southern women applied directly to general hospital administrators for positions. In September 1862, manpower shortages forced the Confederate Congress to officially authorize the employment of female nurses, and thousands of women, both white and black, served as nurses, cooks, and laundresses in Confederate general hospitals.

Medical care during the Civil War served to modernize and professionalize American medicine. Women's work advanced the professional status of nursing in the United States, and after the war, several nursing schools were created. Based on the pavilion plan, public hospitals were constructed across the country, and many Americans received medical treatment there instead of in the home. Mobile field hospitals and permanent general hospitals, an innovation of the Civil War, provided the framework for modern military medicine. Because army doctors recorded and studied their patients' progress, scientifically-based medical care slowly overcame the popularity of less orthodox medical practices. Most importantly, the success from enhanced hygienic practices during the Civil War stimulated the sanitary movement in American cities, improving the health of postwar Americans.

Dix, Dorothea; United States Sanitary Commission.

Adams, George Worthington. Doctors in Blue: The Medical History of the Union Army in the Civil War. New York: Schuman, 1952.

Bollet, Alfred Jay. Civil War Medicine: Challenges and Triumphs. Tucson, AZ: Galen Press, 2002.

Brooks, Stewart. Civil War Medicine. Springfield, IL: C. C. Thomas, 1966.

Cunningham, H. H. Doctors in Gray: The Confederate Medical Service. Baton Rouge: Louisiana State University Press, 1958.

McPherson, James M. Ordeal By Fire: The Civil War and Reconstruction, 2d edition. New York: McGraw-Hill, 1992.

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