Medical Care in the Civil War

History 269 The Civil War and Reconstruction
Medical Care (continued)

Unseen Enemies
Most of the killing during the Civil War was done by invisible enemies away from the battlefields. For every soldier slain by rifle or artillery fire, two succumbed to deadly microbes. A conservative estimate is 400,000 deaths from disease. Epidemics of measles and typhus infected many new recruits. Pneumonia, tuberculosis and influenza ("consumption") also were widespread, especially in the first two years. To a lesser extent, malaria, yellow fever, smallpox and scurvy occurred throughout the war. The most widespread illnesses were diarrhea and dysentery. (An unwritten rule was to refrain from shooting an enemy soldier "answering the call of nature" in the heat of battle.) Over 95% of the men experienced the Virginia Quickstep (also called the Tennessee Trot and various other names). From start to finish, 27,500 soldiers died from chronic diarrhea caused by bacteria (Salmonella, Shigella, Campylobacter, and E. coli) or amebas. The usual treatment for diarrhea was opium; for respiratory problems the treatment included mustard plasters. Whiskey and turpentine were also commonly administered. In a rare instance where the remedy actually helped, quinine was used to combat malaria.

Civil War doctors suspected that airborne germs ("vapors") often caused diseases, but the concept of inoculations for defense against viral infections was slow to develop.* With no knowledge of microbiology, they were years away from the use of antiseptics and antibiotics. Still, without knowing the nature of their unseen enemies, medical officers worked diligently to improve sanitary practices, thus helping to reduce the incidence of diseases spread by contaminated water.

The Bloody Crucible
Reliable estimates place the number of combat wounds at approximately 700,000 (including 204,000 fatalities). Over 90% of the wounds were from rifles, 5% from artillery, and less than 1% from "the cold steel" (bayonets and sabers). Relatively few soldiers were killed outright; most fatalities suffered a slow and agonizing death on the battlefield or died later in a hospital (with the relief of morphine). In the beginning there were no organized procedures and few facilities for treating the massive number of casualties. By the end of 1863, however, the Army of the Potomac had implemented a new system, organized by Union surgeon general William A. Hammond and medical director Jonathan Letterman. (A comparable system was put in place by Confederate surgeon general Samuel P. Moore). Stretcher bearers carried the not-too-seriously wounded to assistant surgeons, stationed just behind the font lines. Here they typically triaged the wounded, applied tourniquets or bandages, and administered morphine. Ambulance attendants transported the seriously wounded to temporary field hospitals in tents or existing buildings.
Continued