The Civil war was one of the bloodiest battles in history, but the majority of the deaths came from infection and disease, not from perishing in battle. With the lack of medical knowledge of the time, disease was a soldiers worst enemy, no matter what side of the war they were on. Due to this lack of knowledge, 63% of all deaths (224,586 deaths) to Union soldiers and an estimated 64% of Confederate deaths were due to disease.
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The Southern states data is estimated, but they sustained heavy losses compared to the north, especially to their young male population. The Souths army consisted of many younger men (youngest being 16 years old) and through combat, infection, and disease nearly all of the youth in the southern states was wiped out.
These unfathomable losses to the Confederate and Union armies caused heartbreak and advancement in medical knowledge. Union and Confederate physicians learned how to tend to their patients regardless of the atmosphere and worked hard and passionately. Even with the tenacity of the physicians, they still lost the battle against diseases time and time again. Throughout this battle, the medical professionals learned skills that they would be able to put into use later in their practice. Collective medical knowledge in the form of cures, proper hygiene, and health-based infrastructure was also gained from the war that advanced America into the next period of medicine. This paper will cover the types of infections and diseases prevalent during the Civil War and how they were treated during the war, along with how the war changed the treatment and prevention of infection and disease.
Some of the main infections and diseases that tore through the ranks of Union and Confederate soldiers include; pneumonia, yellow fever, influenza, bronchitis, gangrene, bacteremia, typhoid, diarrhea/dysentery, smallpox, and malaria. Many of these diseases were preventable if the correct prevention steps were taken. For example, typhoid could have been prevented if the water sources were protected properly from defecation and waste. Malaria could also have been prevented through the use of quinine. Many of these deaths occurred due to the fact that American practitioners at the time did not know how to treat or prevent these diseases. The only infection that had a useful vaccine was smallpox, with a few other diseases like malaria not having well-established cures.
Many of these deaths due to disease could also have been prevented with proper training of sanitation procedures. Some of the sanitation issues include latrines too close to water sources, slaughter pens near mess areas, and soldiers sleeping with all their clothes on to stay warm. While these sanitation concerns did aid in the spread of disease, a large portion of the infected individuals came from injuries they had received in combat. It was estimated that there was a total of 221,000 soldiers wounded in the war. Most of the wounded went to army hospitals where they would be exposed to more disease that lay prevalent in the hospitals. Disease was so common in Civil War hospitals that medical personnel would put out chemicals like alcohol, bromine, carbolic acid, mercuric chloride, and sodium hypochlorite to freshen the air. This helped to not only deodorize the air but to clean it of diseases. In the book called Reminiscence of the Hospitals of Columbia, S.C. During the Four Years of the Civil War by Campbell Bryce, many stories are told of poor hospital conditions. One story speaks about a sixteen-year-old boy who was on the road for four days to the Columbia hospital due to there not being room at a Richmond hospital for him. He had a blister that had not been removed in Richmond by accident and due to the motion of the long ride, it had multiplied into six blisters that were said to be filled with life (infection). The nurses at the hospital took off his soiled clothes, put him in a warm bath and dressed his blisters, even though they knew he will most likely not make it. After suffering for a week, he died from his ailments. Bryces book is covered with heartbreaking stories of disease and infection like this, which helps to paint a picture of just how unsanitary these hospital conditions were.
In order to prevent death from infection and disease in many of these hospitals, surgeons generally opted to remove the infected area from the patient as soon as possible. Generally, this was done through amputation. Three-quarters of all operations were amputations, totaling approximately 60,000 amputations. These amputations were generally preventative because if the infected area was not removed the patient would most likely die from the infection. This was shown in an excerpt from the United State Service Magazine. The journal article was written by a hospital surgeon who references doing procedures on patients and the reactions from each patient. The patients referenced in the journal article work to paint a vivid picture of the struggles of these amputees during their operations. One of the stories written was about a soldier with a thigh injury caused by a cannonball. The doctor stated that the patient was almost a hopeless case whether the limb was amputated or treated. The doctor decided the best chance was to remove the limb after the patient broke into tears and proclaimed: Oh, doctor, for Gods sake save my life, for I am not fit to die! But sadly, after his operation, he passed away.
The stigma around many of the Civil War army surgeons of the time is that they had very little training, were clumsy and were not very knowledgeable in medicine and hygiene. Because of this, war zones were a medical disaster. While some of this may be true, most of the Civil War physicians were sincere and very hard working. They knew how to tend to injuries like fractures, amputations, and general wound care. The issue did not come from their lack of surgical knowledge as much as their lack of hygiene knowledge. These battlefield injuries were done hastily, and physicians almost never worried about strict hygiene, which led to infection and the eventual death of many of their patients. Most of the individuals in the medical community at the time gained their knowledge through apprenticeships. Because of this, there was a massive need for university-educated medical doctors to help in the diagnosing and treatment of diseases. Because of this ill-preparedness and lack of knowledge, there was a surge in medical advancements during and after the war in order to keep up with the demand for medicine and patient care.
One of the ways these advancements came about was the use of surgeon general sponsored investigations. An example of this is when surgeon general, William Hammond, sponsored a study of the treatment, pathology, transmission, and causes of hospital gangrene. From this study, it was found that bromine was effective in treating gangrene. The procedure used was, to soak the dressings that are used on the patients wounds in bromine. To find these cures, doctors started to use more modern tools like the microscopes. This helped in finding these cures because the doctors were able to look at the disease at a cellular level and make assumptions from their finding that would never have been found from solely studying the patients. The deaths of the soldiers acted as a catalyst for medical research which helped to propel American medicine forward after the war.
Another aspect that emerged from the Civil war was ambulance systems. The medical director of the army of the Potomac, Jonathan Letterman, Surgeon General William Hammond, and General George B McClellan worked together to create the ambulance corps. These early ambulance systems would pave the runway for todays modern ambulance services. An example of one of these early ambulances can be seen below in figure 1. These ambulances were horse-drawn and consisted of two trained attendants much like the ambulance systems of today.
Surgeon General William Hammond also created the Army Medical Museum after the war. He had a large collection of pathological specimens gathered from surgeons working in the war. This museum eventually became the Armed Forces Institute of Pathology in the twentieth century and became one of the top establishments for researching and consulting in the field of pathology.
Prosthetic technology also took a leap forward due to the high number of amputations during the Civil War. Prosthetic limbs were designed to be lightweight, easy to use, durable and comfortable for the amputee. Many returning union soldiers received limbs from the government, but the Confederate veterans did not receive compensation for a prosthetic until the 1880s. Many inventors also created products to help amputees return to normal life. Some of these products include hand-powered tricycles for lower extremity amputees and a combination knife and fork utensil for upper extremity amputees.
The death toll from both side due to infections and diseases was 660,000 soldiers at the end of the war. This massive loss to human life was in part due to the severe lapse in knowledge by the medical community at the beginning of the war. Although, the medical professionals who were a part of the Civil War gained valuable knowledge and experience in treating diseases and severe injuries like amputations. This helped to push medical technologies and methods forward and paved the way for many aspects of our medical system today. After the war, these physicians went on to change the world of medicine. They created new types of prosthetics that worked better and were more comfortable for the users. The physicians achieved in curing many of the diseases that plagued their work during the war. Lastly, they worked to create a better, healthier world using knowledge gained from the war. While the path to this knowledge was dark and tragic, it helped to bring about one of the biggest changes in American medical treatment.
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