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 Posted: Fri Nov 14th, 2008 12:21 am
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Dixie Girl
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   In the early 1800's medicine was just starting to advance. With breakthroughs in medical technology made by the scientists like  Louis Pasteur and Joseph Lister, older methods of practicing medicine were dying out. Southern medical schools were starting to become as popular as Northern schools. In the North the average course was four to five months of nothing but lectures; however, in the South, a nine month course of lectures and demonstrations were given.

   When the cry of war went out, men and doctors were quickly recruited to serve on both sides. At the time, President Lincoln called for 75,000 volunteers, the U.S. Medical Department had one surgeon general, thirty surgeons, and eighty-three assistant surgeons spread across the entire country. Because of the large number of volunteers, the War Department ruled that one surgeon and one assistant surgeon was to be assigned to each regiment.

   The new Confederacy formed a medical department similar to that of the Union. The Confederate Medical Department was authorized by the Provisional Congress on February 26, 1861 to pass the "Act for the Establishment and Organization of America." This gave the Confederate Medical Department one surgeon general, four surgeons, and six assistant surgeons. It also meant that if the Confederacy needed any more help, the War Department could hire any assistant surgeons necessary. This was a good thing because the Confederacy experienced a shortage of surgeons throughout the war.

   In both the Union and Confederacy, there were boards of people to review the surgeons qualifications. Unfortunately, those with political connections passed the review whether they knew what they were doing or not. Many of the surgeons were incompetent and had a dislike of the sick and wounded men. While there were a few surgeons who did care for the wounded and sick men, most of them just helped to fill graves. Many men got horrible infections from the negligence of the surgeons that were supposed to care for them. Soon Medical Inspectors were assigned to watch over the treatment that was given to the sick and wounded men.


   Both sides required that all enlisted men be given a physical examination before being allowed to go into battle. In haste to get the soldiers where they were needed the men were given very poor exams and many went into battle that were not fit to be there.

   Every surgeon had his own way of dealing with disease. Medicines often used were: turpentine, calomel, castor oil, whiskey, quinine, morphine, brandy, laudanum, opium, ipecac, and blue mass (a mercury and chalk compound),  to name a few. Because of lead, mercury, and other harmful chemicals in the medicines, and the massive doses given, soldiers often died from blood poisoning. If a soldier was lucky enough to survive treatment, he was often addicted to some of the medicines like laudanum, whiskey, brandy, and opium.

   Treatment for wounds was also crude at best. When a regiment went into battle, the medical staff would set up the hospital tent as close to the front lines as possible. Assistant surgeons would then give orders to stretcher bearers and have then comb the battlefields in search of wounded men. Soldiers taken from battlefields were put into two groups: those the surgeon thought would survive and those who would not.

   Soldiers wounded in the chest, abdomen, and head were put aside and looked after only when time permitted. Soldiers with flesh  wounds were treated by having the surgeon insert his fingers into the wound and pulling the bullet out. Then the surgeon would apply a cold water compress and administer liquor or opium for pain. Most soldiers with wounds like these survived, but even with the smallest wounds there was always the risk of infection or gangrene.

   Most surgeries were done while the patient was under anesthesia. Chloroform was the most common anesthetic used by Southern medical officers. Surgeons would pour the chloroform on a sponge   or piece of cloth and hold it over the patients mouth and nose until anesthesia had been produced. One surgeon said "a sponge was usually covered in chloroform and then allowed to set in the open air."




   
    This was done in an effort to lessen the mortality rate from anesthesia. In order to prevent too much evaporation from the sponge they would put a funnel over it that served not only as a ventilated cap for the sponge but also as an inhaler for the patients. If either chloroform or ether wasn't available surgeons would administer brandy or whiskey until a soldier passed out or was so drunk he didn't feel pain.

    To help replenish the supplies the U.S. Sanitary Commission was formed. It was formed in June of 1861 by Northern civilians to help support the Union side of the war. President Lincoln originally opposed the organization because he was embarrassed by the Commission's reports of their findings after inspecting Army camps and then the doubters of the Commission volunteered their time to make life better for their troops.

   The Commission began to produce booklets to help out the surgeons. They covered a wide range of topics like scurvy, dysentery, and amputation. The Sanitary Commission also had the Union Army relieve Union Surgeon General Clement A. Finley because they thought he was to old to properly do his job. Finley was offered a job reviewing suggestions Commission members made about improving the medical department and he grudgingly accepted.

    Another job the Commission did was prepare healthy meals for the wounded soldiers. More often than not the meals turned out to be too high in fats and calories and too low in the much needed vitamins and minerals. The Commission would send them by trains and wagons along with boxes of other useful items like tins of dried beef, coffee, matches, shoe laces, stationary and envelopes, wool socks, and gloves, among other things.

   By October 1862 the Commission had used up all of its money that had been raised the year before. The Commission was in desperate need of money. If they didn't raise money soon they would have to disband. To raise money two members came up with the idea of a sanitary fair. They put up ads and auctioned off and displayed items. The fair averaged 5,000 people a day for twenty days. The Commission charged 75 cents for admission, and by the


end of the fair they had made $100,000 dollars.

   Due to the success in Chicago (where the first fair was held) other states started to hold their own fairs. In 1864, New York City held the largest fair ever. It raised over $1 million dollars and by the end of the war all the Sanitary Fairs combined had taken in over $5 million dollars in donations.

   Chimborazo Hospital, the first general hospital built in Richmond, was planned by Confederate Surgeon General Samuel P. Moore.  The hospital was built in October of 1861 on hills beside the James River. This gave Chimborazo a excellent drainage system and it mean that it always had a good supply of clean water. This made Chimborazo one of the cleanest hospitals of its time.

    When the hospital was opened Dr. James B. McCaw was placed in charge of it and the Confederate Army provided the funds needed by Dr. McCaw to ensure that every patient got a balanced diet and the care needed. There were 120 wards, each was 75 feet long and   could hold 40 patients. The entire hospital could hold 3,000 patients but always had many more patients than the doctors could tend to. The doctors were often so overworked with the extra patients that other sick and wounded men often went four to five days without  care.

   To fix this problem the Confederate Congress passed a law in September 1862 that allowed the hiring of matrons to help medical staff. Many men did not consider nursing a woman's job and refused to work with them, but by some miracle the head of Chimborazo was able to hire many matrons without fuss from the male staff.

   Though Chimborazo was one of the cleanest hospitals of its time, it was still a typical Army hospital. The smell of sick, dying men and gangrene permeated every ward. The men often complained of the awful stench, and it often made the sick men sicker. Many lost lots of weight from where the smell was so awful they simply could not eat  or if they did eat they couldn't keep it down for long.




    Chimborazo also faced many shortages throughout the war of food, silverware, dishes, soap, bedding, clothing, bandages, and more. Dr. McCaw fought constantly with his superior officers to improve  hospital conditions and get the supplies that were needed. There was little the officers could do, only the Medical Board could change the  conditions and get the needed supplies but they often chose not to.

    Field hospitals were very much the same as a general hospital. The main differences were they ran out of supplies much faster and men were much more likely to get an infection or gangrene and die from it; whereas a man in a general hospital could get an infection, but it was less likely since he was out of the weather and conditions a man in a field hospital was in.

   Once regiments were formed and camps were assembled soldiers became susceptible to communicable diseases. There was no sanitation due to the lack of care about hygiene, and that meant that camps soon turned into a breeding ground for germs and diseases. Every camp had latrines, but the men instead chose to relieve themselves wherever they pleased.

   Bacteria and germs thrived on the human waste, garbage, and the decaying remains of slaughtered animals that were left lying around the camps causing diseases and epidemics to run through the  camps like wildfire. Every man was a victim to disease, some survived but more did not. Reports show  that 57,000 Union soldiers died from dysentery, which is only 10,000 less than the total number of men that were killed in battle.

   Insects also took their part in causing disease. Flies, mosquitoes, gnats, chiggers, roaches, fleas and lice plagued the soldiers day and night and spread diseases from one man to another. One soldier stationed on the South Carolina coast said "sand flies and miserable fleas devour my flesh like a mangy cur would a nice slice of Virginia ham."





    Mosquitoes would attack in hoards, mostly at night and the clothes and blankets the soldiers had provided very little protection from them. The soldiers would have fires going at night and sleep around them in hopes to drive away the mosquitoes. While that helped some, it did not drive away all mosquitoes and some soldiers would awake in the morning to fever and chills. The cause of the fever and chills were from the malaria ridden mosquitoes. The soldier contracted it from one of the hundred mosquito bites he had received the night before.

   Malaria caused fever, chills and in extreme cases it seriously crippled the soldiers. Treatment for malaria was usually quinine, but when supplies got low Confederate surgeons had to improvise. They found that if they mix dogwood tree bark, poplar tree bark, and willow tree bark with whiskey they could make a "tonic" and issue it to men as often as they needed to. This tonic proved to be a successful treatment for malaria and cured the men in about the same time as it would take the quinine to cure the men.

   The worst insect of all was the Army louse, or more commonly called by the soldiers the grayback. Lice infested every camp and covered every man. One veteran said "every soldier has a brigade of lice on him" and that was often an understatement. Lice caused constant itching and misery for every man. There was no real cure for lice except a good bath with some lye soap, but they didn't get that until they were at home when the war was over.

   Exposure also played a big part in the cause of disease. Constantly being in the cold, heat, wet, wind and and other bad weather caused for a number of problems like frostbite, respiratory diseases, catarrh, rheumatism, continued fever, and glandular swelling.

   One of the worst disorders a soldier could suffer from was intestinal disorders. Soldiers were often bothered with dysentery and diarrhea. Being that diarrhea isn't really a disease or disorder itself, but more a symptom of many, it was said to be dysentery and was treated as such.



    
    A medical officer named Bedford Brown, reported that nine-tenths of all new recruits were easy victims of diarrhea and dysentery. Surgeon Peyer Porcher said "no matter what else a man had, he always had diarrhea." He said this because every patient either had a history of diarrhea or had diarrhea at the time of hospital admittance.

    Another surgeon named Joseph Jones concluded that "chronic diarrhea and dysentery were the most abundant and the most difficult to cure amongst Army diseases, and whilst the more fatal diseases as typhoid fever, progressively diminished, chronic diarrhea and dysentery progressively increased and not only destroyed more soldiers than gunshot wounds, but more soldiers were permanently disabled and lost to service from these diseases than from the disability following the accidents of battle."

   Treatment for diarrhea and dysentery consisted of a surgeon lubricating an anal speculum with soap and washing out the intestines, or feeding raw beef (with the fibers scraped out)  covered in vinegar, salt, and pepper to the patient. Both treatments were a considerable success. When this was not done, a surgeon would sometimes prescribed a round of medicines such as, blue mass, astrgt pills, or diarrhea mixture which also were considered to work well. No matter what treatment was used the soldiers most often chose to suffer with their ailment.

   The continued fevers were typhoid fever, typhus fever, and the common fever associated to ailments like a cold or a virus. Typhoid had plagued people for years and was often fatal. Typhoid fever comes on in four stages,causing a slowly rising fever, head-ache and cough in the first week. The second week brings a fever of 104 (the highest it gets with typhoid) delirium, rose spots upper on chest and abdomen, and diarrhea (the color and smell of pea soup) six to eight times a day occur.

    By the third week internal hemorrhaging of the Peyer's Patch, intestinal perforation in distal ileum, encephalitis, or etastatic abscesses, cholecystitis, endocarditis and osteitis can all occur. The fever is also still very high and changes little in a twenty-four hour period. Dehydration ensues and the patient is delirious or in the


typhoid state. By the beginning of the fourth week the fever starts to decrease, the patient is no longer delirious and usually starts to get re-hydrated. By the end of the week the rash goes away and the diarrhea stops, and all the other symptoms cease.

   Typhoid is caused by contact with someone with typhoid, salmonella contaminated food or eating or drinking something that has been contaminated by feces or body fluids from a person with typhoid. Treatment of typhoid consisted of saline purgatives, oil of turpentine, or tympanists along with cold cloths laid over the body and sponge baths every hour.

   Smallpox was also a major epidemic to spread throughout a camp. In January 1863, 2,513 cases of smallpox were admitted to the hospital, and 1,120 of the cases died from it. Smallpox is named so because of the small raised bumps that cover the body. Smallpox is transmitted from one person to another by contact with an infected person, contact with contaminated items such as clothing or bedding, or contact with the body fluids of an infected person.

   Prevention for smallpox had been found many years earlier but many of the soldiers had never had the vaccination. Many of the men never thought they'd leave their homes and had never been in close contact with other people where disease ran so rapid. A vaccination for smallpox consists of taking fluid from one of the "pox" on an infected person and then putting it under the skin of an uninfected person.

   After such a rapid outbreak and such a high number of deaths Confederate Surgeon General Samuel P. Moore ordered that all hospital patients were the first men to be vaccinated and then the  rest of the soldiers were to follow. Other than vaccination to prevent smallpox, there was no cure or treatment for it.

   Confederate soldiers also had a problem with respiratory diseases. The main problem with respiratory diseases was that the surgeons didn't know how to diagnose them. Surgeon Joseph Jones estimated that pneumonia caused the death of one-fourth of the Confederate Army.


   Confederate soldiers were also highly bothered with tuberculosis, catarrh, and bronchitis.There was no treatment for tuberculosis, and any man that had tuberculosis or was believed to have it was discharged immediately. Treatment for catarrh (mucus build up in the head and chest due to the common cold or sinus infection) and bronchitis was sweetened horehound juice given only during the day.

    If a bullet hit a bone, it was often shattered beyond the repair of a cast. Because surgeons of the time didn't know how to surgically fix a shattered bone, the option that was most used was amputation. If a soldier's wound was extremely bad, it was qualified as a primary operation, and surgery was performed within twenty-four hours of receiving the wound. It was thought that if a surgeon amputated within twenty-four hours of a soldier receiving a wound, inflammation and infection would have less of a chance to set in, or it would not set in  at all. If a wound was not quite as bad, it was qualified as a secondary operation, and surgery was performed twenty-four hours after receiving the wound.

   When amputation was deemed unnecessary a resection was done. A resection required the surgeon to remove a joint in hopes to save an extremity. Resection proved to be more successful in an arm rather than in a leg. There was, however, some major doubts about resection, many patients who had a resection (except in small joints like a finger) had little to no use of the extremity that had been saved.

   In some cases a disarticulation (amputation) at the joint was attempted. It was successful if some time was allowed to pass between receiving the wound and surgery. Few men could survive  the shock from receiving the wound and then the shock of surgery right after.

    Unfortunately, with every surgery there was always a risk for infection or gangrene. Very little was known at the time about antiseptics and prevention and treatment of infection. Confederate medical officers thought the best way for a wound to heal was for it to become inflamed and form a laudable pus. The appearance of laudable pus three or four days after the wound was received was looked upon as a good thing.


    The few "disinfectants" the Confederate surgeons had were, turpentine, all the chlorides, permanganate of potash, diluted pyroilgneous acid, and powdered charcoal. These "disinfectants" were not used unless deemed necessary, and when they were required they were applied liberally until the wound healed. Another way to help prevent infection was to properly dress a wound.

   Southern women gave up their old sheets, skirts, spreads, and other things to make bandages for the men. Doctors scraped the linen with a knife and made a cotton-like lint. Surgeons also had women give up some silk, so they could use it as sutures. To make the silk go farther the surgeons would add horse hair, flax thread, or cotton to it. The main problem with these things is that they weren't pliable enough and surgeons had to boil them to make them usable.

      The surgeons soon discovered that if they boiled the material before they put it on a wound, it helped to reduce the infection rate. This practice would continue into modern day medicine, and become known as sterilization. Today smallpox is the only disease to be completely irradiated and we now have a vaccine for typhoid.

   While today we look upon Civil War medicine as primitive, and crude at best, it was actually quite advanced for the time. A lot of today's medical practices came out of the advances made by Confederate and Union surgeons and without their contributions to medicine we might not have the knowledge and resources we have today.

Last edited on Sun Nov 16th, 2008 02:18 am by Dixie Girl



____________________
War Means Fighting And Fighting Means Killing - N. B. Forrest When war does come, my advice is to draw the sword and throw away the scabbard." Stonewall Jackson
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