‘The Northern men are not only of stronger bone and muscle than the men of the South, but a very large proportion of them are mechanics and agriculturists, who are inured to labour and fatigue; whereas few, or none of the Southern men have been brought-up to bodily exertion or fatigue.’
(Extract from a ‘Letter from New York’, by J. Outram, dated 23rd April 1861 and published in The Glasgow Herald, Tuesday 7th May 1861)
One of several research projects I am working on at present is a study of the career of Dr Mary Edwards Walker (1832-1919), a female Surgeon in The American Civil War. During the course of my research I have become increasingly interested in the broader topic of American Civil War medicine, so I thought I would share with you a few basic details of this incredibly interesting subject.
The American Civil began at Fort Sumter in South Carolina on April 12th 1861 and ended on 9th April 1865, with the final shot being fired on 22nd June. The Surgeons and Assistant Surgeons in the US Medical Army faced a daily struggle on the battlefield to keep their soldiers alive. There has been much written about the manner in which Surgeons often ‘mangled to death’ the wounded soldiers, earning them the less than flattering nickname of ‘Sawbones’. Although this did happen in certain cases, it is pretty much a distortion of the truth. The Surgeons were highly skilled and found themselves working in unimaginable conditions on the battlefield with limited resources. The growing number of casualties simply overwhelmed a lot of the Surgeons and facilities in the field hospitals were pretty rudimentary. Knowledge of germ theory was not yet fully developed and it wasn’t until after the Civil War had ended that the germ theory of disease was discovered by Louis Pasteur. Then in 1867 Joseph Lister proved his theory on the importance of aseptic surgery. If more had been known about these two important discoveries at the time of the American Civil War, then many, many thousands of lives could have been saved. The Surgeons were simply unaware that holding bloody instruments in their unwashed hands and performing amputations on one soldier then wiping the blood off onto their apron and gown before moving on to the next procedure, was the cause of cross-contamination and infection. However, even with the advent of aseptic surgery, physicians simply sprayed an antiseptic solution in the operating room prior to procedure believing this would kill all germs. Many Surgeons still carried on performing operations with dirty aprons and unsterilised instruments, a practice that continued in many places throughout the rest of the nineteenth century.
Surgeon’s on both sides in the American Civil War faced a daily battle with disease, the silent but deadly ‘third army’. Approximately two thirds (63%) of fatalities among Union troops were from disease rather than battle wounds. Surgeon General William A. Hammond of the Union Medical Corps kept excellent records and his statistics support this fact. In J. Outram’s ‘Letter from New York’, an extract of which is quoted above, he states that soldiers from the North were likely to be physically stronger than the ones from the South. Medically speaking the statistics blow Outram’s theory clear out of the water. Physical strength may equate to a developed immune system but if you are living and fighting in insanitary conditions you are just as susceptible to disease as any soldier would be whether from the North or the South. Soldiers often urinated and defecated near to the water source and would then bathe or drink from the same source, unaware of the implication of their actions.
Scurvy was also common due to the Scorbutic effect of a limited diet. The solder’s daily ration consisted of salt pork which was often rancid, stale crackers (hardtack) and coffee. Typhus infection and lack of sleep affected a majority of soldiers at some point too. The nights were often freezing and to keep themselves warm the soldiers would sleep with all of their changes of clothes on and as you might imagine body lice was very common.
Malaria was rife in the South and hospital staff tried everything to control its spread. One method involved placing heated irons into bowls of vinegar in the hope that the vapours would deter the lethal, ‘Anopheles’ mosquito. Emetics were readily prescribed to cure diarrhea, dysentery and jaundice, a popular prescription was simply warm water and honey. Not all prescribing was so mild, blue mass (a mix of mercury, honey and licorice) lead acetate and silver nitrate were also popular remedies. Blue mass was extremely dangerous and resulted in mercurial gangrene, tooth loss and gum damage. The South suffered quite a bit with shortages of medical supplies due to the Union naval blockade. Desperate for ligatures for sewing-up wounds, one Southern doctor improvised by using the hair from a horse’s tail which was softened by boiling it in water. Statistics detailing cause of death amongst soldiers of the Confederacy are much trickier to come by. Many of the Surgeon General’s office records were destroyed during the burning of Richmond at the end of the War.
There are too many books and resources on this topic to list them all here. However, here are a selection that you may find useful if you wish to read further on this topic:-
Alfred Jay Bollet M.D., (2001) Civil War Medicine: Challenges and Triumphs (Galen Press)
H. H. Cunningham, (1993), Doctors in Gray: The Confederate Medical Service (Baton Rouge: Louisiana State University Press)
George Worthington Adams, (1996), Doctors in Blue: The Medical History of the Union Army in the Civil War (Baton Rouge: Louisiana State University Press)