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By Bruce Clarke. Civil War Medicine. Most material adapted from CWI’s 2006 Conference. Introduction…. Before the war broke out, the US army had 108 surgeons/doctors 24 went to the Confed. 3 discharged for treason 81 remained…most in the eighty western forts…

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Civil war medicine l.jpg

By Bruce Clarke

Civil War Medicine

Most material adapted

from CWI’s 2006

Conference.


Introduction l.jpg
Introduction…

Before the war broke out, the US army had 108 surgeons/doctors

24 went to the Confed.

3 discharged for treason

81 remained…most in the eighty western forts…

?? How many surgeons by ‘65???

North?

South?

Green sash, piping on uniform for medical officers


Answer union 12 000 confederacy 3 200 l.jpg
AnswerUnion: 12,000Confederacy: 3,200

  • The “war was fought at the end of the medical Middle Ages”

    • Surgeon General William Hammond


40 186 894 l.jpg

The number of army hospital beds in Washington on the eve of Bull Run, 1861.

The number of beds in army hospitals by 1865.

40 186,894

1861: several small infirmaries

1865: 204 large hospitals


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A brief survey of the state of pre-Civil War Medicine Bull Run, 1861.

  • 18th century: Benjamin Rush

  • Jacksonian era disputes

  • Education

  • Anesthesia


The american hippocrates 1745 1813 l.jpg
The American Hippocrates Bull Run, 1861.(1745-1813)

  • Dr. Benjamin Rush

    • Educated in Edinburgh & Paris

    • Continental Congress

    • Abolitionist

    • Instructor in Philadelphia

      • 2250 students

    • “Heroic therapy”

      • Bleed (phlebotomy)

      • blister and purge

    • What sets him apart: Convincing writer, speaker and a tireless teacher


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Greco-Roman Formula Updated Bull Run, 1861.

  • A “fever” was a catchall term for virtually any illness

  • Imbalance of 4 elemental fluids or humors

    • Blood (sanguine), Black bile (melancholy), Yellow bile (choloric),Phlegm (phlegmatic)

    • “there is but one exciting cause of fever and that is stimulus that consists in a…convulsive action of the blood vessels” - Rush


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Jacksonian Era gave rise to the Antebellum Doctor Wars… Bull Run, 1861.

  • Democratic spirit

  • Reform movements

  • Skepticism about heroic method

  • The regulars fought the irregulars

    • “Heroics” vs:

      • Thomsonism

        • Excess of cold in body

      • Hydropaths

      • Graham’s vegetarianism

      • Homeopathy

        • Like is cured by like

          2500 homeopaths in 1861

          With society, colleges, etc


Medical education l.jpg
Medical Education Bull Run, 1861.

  • Apprentice for 2-3 years at $100 year

  • Attend a local diploma factory

  • Or the more ambitious attended one of 8 medical schools 2 years @$125 term

    • (content repeated)

  • Textbooks were shared.

  • If passed exam...

  • Pay $30 for diploma

  • And…presto you can do amputations!


Education l.jpg
Education Bull Run, 1861.

  • Joseph Pancoast’s manual:

  • "A Treatise on Operative Surgery", Philadelphia, 1844

    • Daguerreotypes added in 1852

    • Note that most of these procedures done without anesthesia until late 40s, early 50s!!


Ether first successful in1846 l.jpg
Ether first successful in1846 Bull Run, 1861.

  • At Mass General Hospital (Harvard)

    • “Gentlemen, this is no humbug” - John Warren

  • In the Civil War, ether and chloroform were used using a paper or cardboard cone with drops of the liquid, or using device shown.

Ether’s combustibility made the army prefer chloroform, however…


Slide12 l.jpg
1846 Bull Run, 1861.

Dr. Morton

Dr. Bigelow

Dr. Warren

First Successful Operation Using Ether

Guy with growth on neck

Dirty hands

http://neurosurgery.mgh.harvard.edu/Rounds


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What was the impact of the Civil War on medicine? Bull Run, 1861.

  • Thomas Eakins

  • “The Gross Clinic”

    • 1875

    • Sophisticated for

      its time;

      What do you see?

      Or not see?


Slide14 l.jpg

One clue… Bull Run, 1861.


Slide15 l.jpg
Lasting impact should be measured by administrative care that was systematic and organized, impacting Western world

  • Discipline imposed on an undisciplined profession

  • A huge body of excellent medical records made.

  • Awakening populace to importance of hygiene and nutrition.

  • Created a huge number of doctors and nurses that spread out to nation after war, improving health care.

  • Experience with rarer pathologies that all took with them to smaller practices after the war.

  • Mingling of men with higher medical training with those of less had educational and democratic great value.

  • State of the art hospital design exported to the world.


Surgeon generals l.jpg
Surgeon Generals that was systematic and organized, impacting Western world

  • Union :

    • 1861: Finley: bad

    • 1862-64: Hammond: excellent

      • Issued hygiene regulations

        • Water horses downstream

        • Locations of latrines

        • Burying trash

        • Enlarged record keeping

        • Photographs of pathologies, procedures, results

        • Many good hospitals built

    • 1864-65: Barnes: (due to Stanton/Hammond clash)

  • Confed: Samuel Moore: excellent


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Major Jonathan Letterman: “Father of Modern Battlefield Medicine”

  • Gen. McClellan’s choice as Medical Director, Army of the Potomac

  • Completely reorganized

    • a triage and evacuation system

    • implemented Battle of Antietam

    • system still used today.


Antietam rebirth of medicine l.jpg
Antietam: Rebirth of Medicine Medicine”

  • Pry Farm Barn: 1862 Preserved Today

    Field hospitals were very often people’s homes commandeered by the army; The Pry farm near Antietam was so devastated economically that its owners declared bankruptcy soon after.


Ambulance corps started l.jpg

Begins training of ambulance corps with set drills. Medicine”

How to walk with a stretcher

Rosencrans ambulance designed - with springs for patient comfort!

Ambulance Corps Started


Lincoln at antietam l.jpg
Lincoln at Antietam Medicine”

  • Recognizes Letterman

  • Gets a tour of the “Letterman Plan” in action.


How were black soldiers treated l.jpg
How were black soldiers treated? Medicine”

  • There is no substantial body of evidence of how black soldiers were treated medically

  • A few black surgeons were assigned to black units


3 4 who die die of disease l.jpg
3/4 who die, die of disease Medicine”

  • Largest killer was dysentary

    • Typhoid

    • Measles, chicken pox, syphillus, tb, heat stroke, reptile bites, battle fatigue

    • And gangrene…

      • Minie balls entered with bits of dirty uniform, grease from the barrel…


Nursing as serious work l.jpg
Nursing as serious work Medicine”

  • Sisters of Charity

  • US Sanitary Commission

    • Secular

    • National org.

    • Dr. Elizabeth Blackwell : idea

    • Dr. Henry Bellow Pres.

    • Frederick Law Olmstead Gen Sec

  • US Christian Commission

    • saving souls and bodies

    • State by state

  • Nursing Corps.

    • Dorothea “Dragon” Dix Superintendant

  • Not a nurse: Clara Barton: collecting donations, aid and resources for medical and humanitarian aid: later …

    • American Red Cross


Myth surgeons were heartless butchers who had patients bite a bullet during surgery l.jpg
Myth: Surgeons were heartless butchers who had patients bite a bullet during surgery…

Camp Letterman Gettysburg

  • Team of 3 would look at patient, and all would have to agree that amputation was required to save the patient’s life. Amputations were avoided whenever thought possible.

  • Teeth would break…they bit on wood or leather if chloroform was not available.



Postwar joseph lister lectures in usa garfield dies anyway l.jpg
Postwar: Joseph Lister Lectures in USA, Garfield Dies Anyway a bullet during surgery…

  • Developing Pasteur’s (1869) germ theory at Philadelphia : Worlds Fair 1876

    • Wash your hands

    • Clean everything

    • Don’t use a scalpel twice

    • Controversy ensues: general acceptance only comes in late 1880s


The case of james garfield l.jpg
The Case of James Garfield a bullet during surgery…

  • 1881, Garfield is shot in Washington DC by a disgruntled office seeker.

    • Bullet only hits muscle, no organs

  • His doctor, Dr. Doctor W. Bliss was anti-listerian

    • Put fingers into wound, put tubes in to drain fluids

    • Garfield didn’t eat for 7 weeks due to all the morphine, and opium given him

    • Bliss writes a long report, justifying all he did

  • Young doctors who’d trained in Europe thought Bliss crazy: ……“ignorance is Bliss”


Transformation of western medicine l.jpg
Transformation of Western Medicine a bullet during surgery…

  • The Medical and Surgical History of the War of the Rebellion

    • Read widely


Transformation of us medicine l.jpg
Transformation of US Medicine a bullet during surgery…

  • Gerster: publishes major textbook in 1888

  • Senn : Bacteriology1889

  • Johns Hopkins Hospital (1889) and School of Medicine

    • Required much more

    • First to allow women enter on equal basis


Slide31 l.jpg

Between 1890 and 1911, the US will leapfrog forward to become a leader in surgery and medicine.

Eakins “The Agnew Clinic” 1889, Philadelphia


1890s l.jpg
1890s become a leader in surgery and medicine.

  • Within months of Roentgen’s discovery of the x-ray (1895), US doctors explored it and wrote a good textbook on it.

  • US doctors are the first to advance the proper treatment of appendicitis by surgery, which becomes a textbook operation.


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Book and Internet Resources become a leader in surgery and medicine.

  • Rutgow, Ira. Bleeding Blue and Gray. New York: Random House, 2005.

    Web sources:

  • Civil War Homepage. http://www.civil-war.net (18 Aug 2006).

  • Civil War Medical Care, Battle Wounds and Diseases. http://www.civilwarhome.com/civilwarmedicine.htm (10 Aug 2006)

  • National Museum of Civil War Medicine, Frederick, Maryland

    • http://www.civilwarmed.org/index.cfm (Aug 10 2006)