Civil War Medicine: Part 4/4

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.***

Civil War Medicine: Part 3/4

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.***

Civil War Medicine: Part 2/4

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.***

Civil War Medicine: Part 1/4

I’m pleased to host Erin Rainwater as she shares her expertise concerning Civil War Medicine.

Welcome, Erin!

Pre-war medical system.

This year marks the Sesquicentennial (150-year anniversary) of the beginning of the Civil War. If you’ve never studied it much, I recommend you use these four commemorative years as an incentive to expand your knowledge of it.

That war was a watershed time in our nation’s history like no other event before or since, in war or peacetime. It even changed the way citizens referred to their nation. From the time of the Revolution until then the country was thought of as a collection of independent states. Shelby Foote, the Civil War historian who made you feel like you were there, said that prior to the war people would say, “The United States are…” As a result of the war, it was grammatically spoken as “The United States is…” That’s what that war accomplished, Foote said. It made us an is.

There are many interesting facets regarding the standards of medical care and how it was delivered back when we were still an are. Some of what we read about seems barbaric to us now, yet American surgeons were up to international standards of medical science of the time. Furthermore, as often happens in time of war, this conflict quickly propelled physicians into the role of leaders in medical and surgical breakthroughs.

Prior to the war, cleanliness was regarded as insignificant except in respect to gross contamination by foreign matter. Surgeons operated in street clothes or donned a surgical apron. They might wipe bloody and pus-laden instruments on their aprons or a rag, but washing them wasn’t routine. Clean linens and washed hands were statistically proven to be of value but rejected as non-scientific.

Medical school in the 1860s was normally two years long. Microscopy was taught, as was the cell theory of tissue structure. Tissue samples were stained and analyzed, urinalyses and stool studies were performed.

The primary anesthetics available were ether and chloroform, each having its pros and cons. Chloroform was non-flammable, which made it preferable during the war when gunpowder was lying about and bullets flying about. It was also faster acting. On the down side, it was easier to overdose a patient with chloroform, and anesthesia-related fatalities were higher. Surgeons and attendants, however, were more easily overcome by the vapors of ether while performing surgery.

At the outbreak of hostilities, there were few military physicians, fewer military hospitals, and lack of a hospital corps. Nursing and other duties were performed by soldiers temporarily assigned to hospital detail, and who were not necessarily qualified nor of upstanding character. After the fighting began, civilian doctors flooded into the military system. Others chose not to join up but worked as contract physicians. Doctors not only were required to be skilled but were expected to organize, equip, supply and administrate their hospitals. The enlisting, training and disciplining of subordinates was also in their job description.

Female nurses were rarely tolerated. They were believed to lack the physical strength to help wounded men, and especially in the South they were considered too delicate and refined to assist a rough soldier in bathing and tending to personal hygiene. It was generally conceded, however, that women were more attuned to the emotional needs of the sick and more skilled at “sanitary domestic economy.”

As word of Florence Nightingale’s notable work in the Crimean War spread, women’s abilities in the field of nursing became more widely acknowledged. Some American physicians who had gone to the Crimea to assist the British came home reporting that the female nurses were undeniably competent and able to care for soldiers with war-related wounds and illnesses. It was finally becoming more seemly for females to care for male patients. Their pay, however, was half of what civilian male nurses received to care for military patients. In my novel, True Colors, Cassie Golden receives the standard pay for civilian female nurses working in a government hospital—twelve dollars a month plus meals. That is for twelve-hour shifts, usually five days per week but often more. And she was glad to have it.

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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”.

***Contest reposted from January 10th, 2011.***

 

Phantom Limb Pain: 2/2

Today, author and Christy Award nominee (two nominations!) Jocelyn Green concludes her two-part series on phantom limb pain. You can find Part I here

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood’s on May 12th, 2013.

Jocelyn has also graciously said she’ll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

You can view Jocelyn’s previous posts at Redwood’s here and here.

Welcome back, Jocelyn!

What We Know Today

The study of PLP continues with today’s generation of amputee veterans. Most contemporary studies confirm what Mitchell found, but add to it some new information. Most recent studies report PLP at rates of 50% to 80%. A few of these are in constant pain, but for most, the episodes can last a few seconds or one to two hours.
Since the beginning of the conflicts in Iraq and Afghanistan more than 1000 amputees have been treated at Walter Reed Army Medical Center in Washington, DC. Almost all experience PLP, either within the first 24 hours of amputation, or within two weeks. The following insight comes from an article in a 2010 issue of The Neurologist:
“As part of routine treatment efforts, the patients are asked to describe their experience with phantom sensation and phantom pain. There have been a plethora of responses regarding the onset, duration, description, and location of phantom sensations and phantom pains from those queried. Furthermore, some explain they have volitional control over their phantom, and can move their phantom at will, while others report their phantoms being fixed in a specific position. Some even report the inability to make movements with the phantom, despite the presence of a strong sensation or pain emanating from their residual limb. For example, one service member reported that his phantom hand was in a distinct position: he felt he was pulling the trigger on his rifle with his index finger, and was unable to move his hand to a different position. He also felt cramping pains in his hand muscles. Another service member, a bilateral, above knee amputee, described the feeling of heavy legs, asserting that the feeling was similar to weights attached to his calf muscles. He also described that it felt as though his combat boots were on too tightly.”
There are multiple theories as to the cause of PLP, all of which can be read in this online article [http://sunburst.usd.edu/~cliff/Courses/Advanced%20Seminars%20in%20Neuroendocrinology/Pain/Weeks10.pdf]. 
The most successful treatments have been with opioids and mirror therapy, the latter considered the most promising treatment plan.
In this treatment, the patient views the reflection of their intact limb moving in a mirror placed between the arms or legs while simultaneously moving the phantom hand or foot in a manner similar to what they are observing. The virtual limb in the mirror appears to be the missing limb.
Patients have reported a relief of cramping and “frozen limb” phantom pains as a result of even one session with the mirror. In one study in which patients used mirror therapy for 15 minutes each weekday for four weeks, significant decreases in pain were reported. More about mirror therapy can also be found in the online article hyperlinked above.
For further reading:
Mitchell, Silas Weir. The Case of George Dedlow. (fictional account of quad amputee) New York: The Century Co., 1900. Read it online at Google Books here, and begin on page 115. http://bit.ly/ZixtJd
 
Gunshot Wounds and other Injuries of Nerves. Philadelphia: J.B. Lippincott, & Co., 1864. Read it online at Google Books here: http://bit.ly/17hhuvf
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 A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

 

Phantom Limb Pain: 1/2

Author and Christy Award nominee (two nominations!) Jocelyn Green joins us again this week for a two-part series on phantom limb pain.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood’s on May 12th, 2013.

Jocelyn has also graciously said she’ll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

You can view Jocelyn’s previous posts at Redwood’s here and here.

Welcome back, Jocelyn!

Though the phenomenon of phantom limb pain had been recorded long before the Civil War, it was Silas Weir Mitchell, a Philadelphia physician specializing in nerve injuries during the Civil War, who coined the term. Phantom limb pain, or PLP, occurs when a patient feels pain in an arm or leg that has been amputated. Mitchell studied PLP (or sensory hallucinations, as he also called them) in depth at the Turner’s Lane hospital in Philadelphia, dubbed the Stump Hospital because it focused on caring for amputees.

If a character in your story is an amputee, like one of my characters in Widow of Gettysburg, the following will be helpful to you.
What Mitchell Found
·         Almost every amputee at Turner’s Lane Hospital experienced PLP. 
·         Most of them came out of anesthesia feeling the presence of the amputated limb.
·         Those who did not immediately feel PLP usually felt it within three weeks.
·         Usually, the patients felt the missing hand/foot but not the section of limb directly beyond the stump.
       Mitchell wrote: “The patients describe themselves as knowing that they have a hand which is connected to a stump, and feel able to move it, but of the rest of the limb they are unconscious, and the subjective sensations which are so common are always referred to the hand or foot, and rarely to the continuity of the member.”
·         In about one-third of the leg cases, and in one-half of the arm amputations, the patient felt that the foot or hand is nearer to the trunk than the extremity of the limb.
·         The type of pain could be burning, itching, stabbing, or cramping.
·         Missing legs usually felt as though they are hanging straight down, while missing arms felt as though they were bent at the elbow or locked in the last position they were in prior to the operation.
·         Treatment of water dressings on the stump helped with burning sensations in some cases, but most efforts to relieve PLP were ineffectual.
·         Amputee veterans wrote to Mitchell decades after their operations and shared that in their dreams, they had all their limbs perfectly whole.
    
      Return Friday as Jocelyn finishes up her Civil War medical series.

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A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

              
       


Opium Abuse during the Civil War Era: 2/2

Author Jocelyn Green returns with another installment in her series of posts on Civil War Medicine. Jocelyn was here last week discussing amputees and prosthetics. You can Part I and Part II by following the links.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts over the next three weeks WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood’s on May 12th, 2013.


Jocelyn has also graciously said she’ll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

Good Luck!

Today, Jocelyn continues her discussion on opium abuse during the Civil War. Here is Part I.


In severe cases, the individual may have a weak pulse, lower blood pressure, reduced heart rate, difficulty or labored breathing, and changes in the color of lips and fingertips. Seizures, convulsions, hallucinations, confusion and psychomotor retardation also take place.

Common Opium Abuse Withdrawal Symptoms

If the patient suddenly stops taking opium, either by choice or from lack of supply, which often happened among Confederate soldiers especially, the following symptoms could be present.

§  emotional instability
§  depression
§  feeling shaky
§  nightmares
§  exhaustion
§  general body weakness
§  lethargy
§  mental fogginess
§  anxiety
§  nervousness

Signs of Opium Abuse Withdrawal

§  trouble sleeping
§  nausea and vomiting
§  heart palpitations
§  headaches
§  clammy
§  sweaty skin
§  decreased appetite
§  unusual movements
§  hand tremors
§  alterations of the pupils
§  pale skin

Severe Opium Withdrawal Symptoms

In extreme cases, the following might present themselves.

§  irrational thoughts
§  irritability
§  anger
§  confusion
§  fever
§  seizures
§  convulsions
§  hallucinations

Treatment

So what did doctors do when a patient was overdosed on opium? The following case study from the archives of the University of Virginia offers some answers. Though this example took place a decade before the Civil War broke out, we can imagine many doctors may have used similar methods.

“On May 7, 1850, Dr. John William Ogilvie traveled eight miles to a plantation in Barnwell County, SC in response to a reported overdose of Laudanum, or a tincture of opium. The patient had attempted suicide, swallowing the tincture at 4:15 that morning. Arriving at 7:15 AM, Dr. Ogilvie found him still alive. Apparently in a state of melancholy, the patient was conscious and calm, but expressed regret that the doctor had come as he still wished to die. Dr. Ogilvie, however, proceeded to treat the patient without any apparent difficulty. Initially, he administered ten doses of zinc sulphate solution, five minutes apart. The patient began to vomit fifteen minutes after the last dose, and Dr. Ogilvie smelled and saw the drug in his regurgitated fluids. The doctor then proceeded to put a tube down his patient’s throat and forced four pints of warm water into the man’s stomach. Dr. Ogilvie left at 10:45 AM, his patient stabilized and quickly recovering.”

Historically, southern whites were the most susceptible to opium addiction, and prior to 1900, the addiction primarily affected the middle- and upper-class. Country physicians actually had the highest rate of addiction among nineteenth-century professions, so it was not a big leap for me to give an opium addiction to a Confederate surgeon in my novel.

Dependency on the drug during the Civil War was likely magnified by soldiers’ traumatic experiences. Opium helped calm frayed nerves and brought sleep to those who otherwise may not have been able to rest. Not only did it numb physical pain, but it numbed emotional pain, as well.

Up until the Civil War, opium use and abuse was so widespread it was not frowned upon. It was not until the significant abuse during and after the Civil War that doctors began to take drug abuse seriously and medical opiate addiction finally began to disappear.

For further reading:

Courtwright, David T. Dark Paradise: Opiate Addictionin America Before 1940. Cambridge: Harvard University Press, 1982.

Hodgson, Barbara. In the Arms of Morpheus: The Tragic History of Laudanum, Morphine, and Patent Medicines. Buffalo: Firefly Books, 2001.

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A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.