(Presented on January 20, 2011 by Jennifer L. Beddoe)
The state of medicine in the 1860’s was bleak. Most medical advances were made during, or after the War Between the States. It has been said that the War Between the States was fought at the end of the “medical Middle Ages”, that is how backward medicine was during this time.
The Confederacy quickly saw the need for a recognized group of army doctors and established a medical corps right away. Many doctors and surgeons who enlisted just to fight were quickly made officers and given the responsibility of caring for the sick and wounded troops. Up until 1862 doctors were required to bring their own equipment, bandages, medicines, etc. but in 1862 the government realized the need to supply the doctors with the tools they needed. Even with an established medical corps, there was no true organization of medical staff. On July 1st, 1861, Samuel Preston Moore was appointed acting Surgeon General of the Confederacy. He was an experienced physician and a regimented
organized individual and immediately began turning things around. He designed a barracks type hospital layout that is still used by the Army to this day. He also increased the recruiting standards for doctors, employing an entrance exam that had to be passed before someone could enlist as a doctor. He pushed for better sanitation and a uniform standard of care that all military doctors had to conform to. He was able to get around the lack of medicines available because of blockades by creating laboratories that produced most of what was needed from plant materials that were indigenous to the South. Moore transformed the medical corps into the most effective department in the Confederate Army and his leadership was responsible for saving thousands of lives.
There were two main causes of death for soldiers during the war. The biggest cause of death was from illness. Twice as many men died from illness then gunshot wounds. The environment in the camps was horrible. The dirty conditions, lack of good food, clothing or shelter led to dysentery, measles, small pox, pneumonia and malaria outbreaks that ran unchecked. Because of the close quarters, it was almost impossible to avoid any illness that might be running through the camp. Prison conditions were even worse.
The second major cause of death was from wounds suffered in battle. Nothing was known about infections or the importance of keeping things clean and sterile. Even a small wound could easily get infected and lead to death or amputation.
A gunshot wound in the torso, especially a serious one almost always resulted in death. A serious wound to the arm or leg was dealt with in the only way the doctors knew – amputation. Chloroform was used routinely as an anesthetic and was very effective in reducing the trauma associated with the procedure. When done correctly, the soldier would feel no pain, but not be fully knocked out. Stonewall Jackson stated that he remembered the sound of the saw cutting through his arm but did not recall feeling any pain. Good doctors could perform an amputation in less than 10 minutes and sometimes worked 20 hours a day. It was not unusual to see a stack of limbs five feet high at the end of a day. Doctors didn’t take the time to wash their hands or instruments between surgeries, but even in these unsanitary conditions approximately 75% of soldiers that had a limb amputated survived.
As far as medications, there were not many available at this time. There was no such thing as antibiotics or vaccines. Doctors did not even realize that germs caused disease. Even so, pharmaceuticals played an important role during the war. Doctors carried a small amount of medications with them at all times, and there were supply trucks that followed the troops with larger quantities of the commonly used items. Chloroform and ether were used as anesthetics for amputations. Morphine was used as a pain killer, in spite of its highly addictive properties. Calomel, a mercury based substance was used as a tonic for constipation, dysentery and diarrhea. Because its main component was mercury, it was highly toxic and its use was banned in 1863. This caused great controversy among the military doctors. Probably the most common ingredient in many of the medicines and tonics that were prescribed during this time was whiskey. Other medicines that were carried by doctors included:
Hydrochloric acid (HCl) was used to stop severe bleeding; a solution was poured on the wound which burnt the skin causing great scarring and deformities but stopped the bleeding. HCl is a very corrosive acid that is currently used to remove rust from steel and in other large scale cleaning projects. It also has other industrial uses.
Other common medicines used during this time include:
- Atropine – derived from jimson weed and used as an anesthetic when chloroform was not available
- Alum – used to stop bleeding
- Baking Soda – for upset stomach
- Castor Oil and olive oil – for constipation
- Citrine Ointment – mercury and nitric acid (both very toxic materials) used to cure syphilis
- Creosote– embalming fluid and also as a laxative and cough treatment
- Ipecac – to induce vomiting, comes from a plant native to Brazil whose name translates to “road side sick making plant”
- Dover’s Powder – ipecac and opium, used to fight against colds and flu, made people sweat
- Ginger – for stomach upset
- Turpentine – topically it was used to rub on wounds, taken internally to fight parasites
- Quinine – used to treat malaria, in short supply in the south so the bark of the dogwood tree was used as a substitute
- Rochelle Salt – a type of salt which today is used in electronics was used as a laxative
- Cerate – mixture of wax and lard, combined with herbs and used as an ointment
Because of the horrible conditions faced by doctors during the war, many went on to become pioneers in medical advancements. For example, a Union officer named Eli Lilly developed a pharmaceutical company after the war that is today the 10th largest pharmaceutical company in the world and was the first company to mass produce penicillin.
The war also saw great advancements in embalming practices. Since families wanted their deceased loved ones returned to them, doctors were called upon to develop methods for preserving the bodies for the trip home.