Today, we’re finishing up with Erin Rainwater’s amazing series on Civil War medicine. You can find Part I, Part II, and Part III by clicking the links.

Civil War Medicine: Hapless or Heroic in Retrospect? 

History has not always been kind to Civil War practitioners of medicine. The methods discussed in the previous posts seem barbaric to us now, and the lack of medical knowledge regarding foundational principles such as asepsis, infection, and sanitation is regarded as tragically antiquated. Their twenty per cent mortality rate is unacceptable by today’s standards. More horror stories abound. From our retrospective and often condescending viewpoint, we smugly judge one century’s standards by the current set. This is not only an unfair but a flawed verdict. The inadequacies of those medical care deliverers have received considerably more attention than their accomplishments, which were many.

If judged by the standards of their day, Civil War doctors and nurses should be hailed as remarkably successful.  With the existence of bacteria still only theoretical, with the available instruments and anesthesia, and with the indescribable numbers of patients inflicted upon them, the fact they saved lives in such unhoped-for numbers is a credit to their skill, creativity, and tenacity.

In the war that preceded this one, the Mexican-American War, ten men died of disease for every one killed in combat. During the Civil War, that ratio was reduced to 2:1. That alone is measurable evidence of an enormous advancement in medical care in the span of under two decades, much of which came about as a result of the war. The creation of frontline field hospitals, ambulance services, and the utilization of female nurses should cause modern historians to conclude that the maligned medical practitioners during the Civil War should be reckoned as heroic, not hapless. Their crude system of triage, setting aside men wounded through the head, chest or abdomen because they would most likely die seems brutal, but with the knowledge and little time available, it allowed surgeons to save those who could be saved. Modern mass casualty triage is not so far removed from this practice.

Aside from medical care administered to the living, advancements in post mortem measures took place as well. Prior to the war, embalming was usually only done to preserve specimens for scientific study. Because many families of killed soldiers desired to bring them home for burial, embalming became more commonplace.

I have only skimmed the surface in relating how the War Between the States necessitated numerous adaptations in the delivery of medical care, and how we benefit even today from some of those changes. These are just some examples of not only medical but also the many moral and social advancements that came as a result of the American Civil War. I truly hope these four posts have been educational and entertaining, and that perhaps this information will help you gain a greater appreciation of our sesquicentennial commemorations over the course of the next four years.

REFERENCES:

Burns, Stanley B., MD, FACS, “The Naldecon Gallery of Medial History,” Bristol Laboratories, © 1987.

Civil War Manuscripts, Library of Congress.

Downs, Robert B., Books That Changed Amercia.

Miller, Francis Trevelyan, ed., The Photographic History of the Civil War, Prisons and Hospitals

Ward, Geoffrey C., Burns, Ric, and Burns, Ken, The Civil War, An Illustrated History. Alfred A. Knopf, Inc., © 1990.

The Day Richmond Died.

www.civilwarhome.com/medicinehistory

www.civilwarsurgeons.org

www.members.cox.net/cwsurgn/civilwar

http://home.nc.rr.com/fieldhospcsa

*********************************************************************************************Erin Rainwater is a Pennsylvania native whose trip to Gettysburg when she was twelve enhanced her already deep interest in the Civil War. She attended Duquesne University in Pittsburgh, and entered the Army Nurse Corps upon graduation.  Serving during the Vietnam War era, she cared for the bodies and spirits of soldiers and veterans, including repatriated POWs and MIAs. Now living in Colorado, she is a member of a Disaster Medical Assistance Team, and has been deployed to disaster areas around the country. True Colors is partly based on her military and nursing experiences as well as extensive research. She also authored The Arrow That Flieth By Day, a historical love story set in 1860s Colorado, and Refining Fires, a uniquely written love story that was released in July, 2010. Erin invites you to visit her “virtual fireside”.

***Content reposted from January 31, 2011.***

We’re continuing Erin Rainwater’s four part series on Civil War Medicine. You can find Part I and Part II by clicking the links.

Conditions and Treatment

Unlike today, the majority of soldier deaths during the Civil War were attributed to disease. Unsanitary and close-quarter living conditions in the camps led to outbreaks of dysentery, typhoid, measles, smallpox, chicken pox, throat distemper (diphtheria), and other diseases. Scurvy and other nutritional disorders were prevalent, as was typhus from lice and fleas.

Mosquito-borne illnesses such as yellow fever and “ague” (malaria) also posed a threat, although they were believed due to “miasmic vapors” from stagnant waters. Minor wounds such as from a splinter, a scratched mosquito bite, or the rub of a boot could become infected and ultimately lead to septicemia and death. Lacking scientific knowledge regarding the causes of disease, physicians depended on a few standard remedies, such as quinine, calomel, ipecac and opium to cure most symptoms. Mercury was used to treat venereal disease, although it only cleared the symptoms and was not a cure. Nitric acid was poured on open wounds to kill infection. It also seared the flesh.

The physiology of some conditions, such as the gastrointestinal system, was surprisingly well known back then. The digestive process was understood, as well as the length of time for various foods to be digested. Much of this knowledge came from Dr. William Beaumont’s experiments and studies, including the observation of an open stomach wound in a man who’d been shot.

Gastrostomy tubes were used for feeding patients with such wounds, and drains were placed to remove infectious drainage and gastric juices. Cardiopulmonary-wise, physicians used stethoscopes to discern crepitant rales and rhonchi, heart murmurs, and friction rubs. They used percussion techniques in the physical exam to appreciate dullness and diminished resonance of the chest and abdomen. Mercury thermometers were available but rarely used. Fever was considered a disease, and temperatures were taken only to investigate unusual maladies or those of special concern. Doctors then were faced with some of the same frustrations of today: addicts pilfering drugs and alcohol, and well-intentioned family members offering food to patients with serious stomach and intestinal ailments and wounds.

Wounds, of course, were the other consideration in this war of inconceivable casualties. As bullet manufacturing changed during the war so did the wounds they left. The small- caliber round balls shot from a smooth bore musket often produced a different type of wound than the newer, faster velocity, conical-shaped slugs later produced. All had the capacity to incur catastrophic injuries beyond repair. In battlefront hospitals, there were few alternatives to amputation of limb wounds, and an experienced surgeon could perform the procedure in under ten minutes.

Later in the war, some surgeons experimented with blood vessel resection, but amputation remained far more common. Soldiers with head and chest wounds were given a poor prognosis, and often not considered treatable. Bullet wounds were the most common by far, but those from canister, cannonballs, shells, sword and saber had to be reckoned with as well.

It was considered routine that combat wounds become infected. Pus was considered “laudable” because the body was discharging poisons, a necessary adjunct to proper healing. In the rare instances pus did not appear, it was called “union by first intention” and considered an utter mystery. Yet there were five types of infections acknowledged as abnormal.

A triad of infections referred to as “hospitalism” included gangrene, erysipelas (a skin infection we now know is caused by strep), and pyemia (septicemia, or “blood poisoning.”) The mortality rate from these hospital-acquired infections reached ninety-five per cent. The survivor of a “routine” infection often became the victim of osteomyelitis, a chronic bone infection, and was doomed to a slow and painful death from a festering wound where entire sections of bone would be eaten away. Tetanus was present, though less common than other diseases, because most battles were fought on virgin soil unfouled by the manure that carries the tetanus spores.

Wet dressings could be applied utilizing a siphoning technique. One end of a strip of cotton or linen was placed in a container of water suspended over a wound. The other end of the material hung just above the wound but below the level of the water, thus providing a continuous drip. The nurse was freed up from having to return for frequent remoistening of the bandage. Oilcloths were placed to catch the excess water and drain it into a vessel on the floor.

With flies rampant, so were their eggs, or maggots. Although the critters caused no pain, female nurses were disgusted by them and their wiggling bothered the wounded men. Yet some discerning surgeons detected that wounds infested by maggots healed more rapidly, and that the little vermin actually cleansed wounds, digesting and removing dead tissue while leaving healthy tissue uninjured. Rats reportedly tendered similar results. Some modern day physicians have accepted maggot therapy as useful for debridement, although I’ve yet to see where rat therapy has become part of standard treatment.

Without the benefit of x-ray equipment, sometimes the only way to hit upon the location of a bullet was to take “soundings.” In my novel True Colors Cassie Golden, who at this point thinks she’s seen everything, watches in awe as a Confederate surgeon inserts a porcelain-tipped probe into a wound and taps it against various obstacles. She observes that the sound of tapping bone versus lead is distinguishable. Additionally, when the doctor rubs the white-tipped probe against lead it comes out streaked with gray—a sign it has detected its quarry. Like all nurses, she realizes that the learning process is never over.

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Erin Rainwater is a Pennsylvania native whose trip to Gettysburg when she was twelve enhanced her already deep interest in the Civil War. She attended Duquesne University in Pittsburgh, and entered the Army Nurse Corps upon graduation.  Serving during the Vietnam War era, she cared for the bodies and spirits of soldiers and veterans, including repatriated POWs and MIAs. Now living in Colorado, she is a member of a Disaster Medical Assistance Team, and has been deployed to disaster areas around the country. True Colors is partly based on her military and nursing experiences as well as extensive research. She also authored The Arrow That Flieth By Day, a historical love story set in 1860s Colorado, and Refining Fires, a uniquely written love story that was released in July, 2010. Erin invites you to visit her “virtual fireside”.

***Content reposted from January 24, 2011.***

We’re continuing our four part series with Erin Rainwater and her research into Civil War Medicine. You can find Part I here.

Changes in delivery of medical care resulting from the war.

When you look at the casualties wrought by the Civil War it is mind-boggling. The Battle of Antietam in Maryland was the single bloodiest day of the war. There were over 20,000 American casualties in a single day (North and South combined). The Battle of Gettysburg was fought over three days, and 51,000 men were killed, wounded or missing. In all, more than 620,000 men died during the four-year conflict.

Over half perished from disease, not battle wounds. These numbers are inconceivable, both in terms of lives lost and in the challenge of delivering medical care in a day prior to asepsis (germ-free), antibiotics, and helicopter aerovacs. As a result of the enormous casualties, many of whom were brought into nearby towns where churches, hotels, barns and even citizens’ homes were requisitioned by the armies and made into makeshift hospitals, a new system of medical care delivery was born of necessity.

Both governments ordered the swift construction of general hospitals to treat the injured and ill. Additionally, frontline hospitals were born of necessity. Initially, the ambulance service was maintained and run by the Quartermaster Corps. Around 1862, the medical director of the Union army, Jonathan Letterman (for whom the Army hospital in San Francisco was named) developed a system whereby ambulances and trained attendants were assigned to and moved with a division.

This provided for more immediate collection of the wounded from the battlefield and transport to dressing stations and on to field hospitals. The current system of rapid response and ambulance conveyance was conceived due to the necessities brought on by the Civil War. It is interesting to note that casualties from both sides were treated at the frontline hospitals.

When (unsterile) silk, cotton or catgut ligatures were at a premium, horse hair was boiled to soften the texture to make it pliable for use as suture material. It was noted by some that the infection rate dropped significantly when this was used. The same was true when a lack of reusable sponges led to the utilization of one-time use rags for cleansing wounds. Applying iodine to wounds and wiping instruments with chlorine between surgeries brought similar results, but without scientific data to prove a correlation, some physicians saw no sense in these procedures.

The surgeon general remained opposed to the use of civilians and women in the hospitals, but the lack of males to perform the required duties forced the issue. Dorothea Dix, highly respected as a crusader for improving conditions in prisons and hospital for the mentally ill, managed to convince skeptical military and government officials that certain women were capable of dealing with what the war did to men.

With the news of her appointment as Superintendent of Women Nurses in June, 1861 came torrents of applications from women offering their services. Working for no pay, Miss Dix personally looked after the well-being of the female nurses she hired as well as the soldiers to whom they ministered. However, in her attempt to weed out those merely looking for a husband, she would only hire women over thirty or married, strong, and plain of face and dress. Some hospitals’ chief surgeons rejected the hiring authority given Miss Dix, and in a show of defiance, refused to accept her nurses on their wards.

It took a literal Act of Congress to allow the surgeons to bypass her authority and hire nurses on their own. This is what happens to the heroine in my novel, True Colors, who is considered unacceptable by Miss Dix because she is under thirty, unmarried, and not so plain. Disappointed yet undaunted, Cassie follows in the footsteps of many of her fellow rejects and marches straightway to an Army hospital and applies directly to the surgeon-in-charge. She is fortunate in that this doctor had worked alongside British Army surgeons in the Crimean War a decade earlier, and was appreciative of the role of female nurses. He hires her on the spot.

The significance of the contribution of women nurses during this conflict should not be understated. Rather than being seen as mere helpers of the main players—interesting but insubstantial—available evidence indicates their activities had important ramifications in both the immediate medical sense and the broader social sense. Truly they were the forerunners of female nurses of our generation.

*********************************************************************************************Erin Rainwater is a Pennsylvania native whose trip to Gettysburg when she was twelve enhanced her already deep interest in the Civil War. She attended Duquesne University in Pittsburgh, and entered the Army Nurse Corps upon graduation.  Serving during the Vietnam War era, she cared for the bodies and spirits of soldiers and veterans, including repatriated POWs and MIAs. Now living in Colorado, she is a member of a Disaster Medical Assistance Team, and has been deployed to disaster areas around the country. True Colors is partly based on her military and nursing experiences as well as extensive research. She also authored The Arrow That Flieth By Day, a historical love story set in 1860s Colorado, and Refining Fires, a uniquely written love story that was released in July, 2010. Erin invites you to visit her “virtual fireside”.

***Content originally posted January 17, 2011.***