Advances in Medicine

In a time before bacteriology and aseptic surgery were understood, before many of the technological advances of the twentieth century, Civil War doctors were making great advances in medicine, not only in battlefield techniques in caring for the injured, but also in medicine as a whole. Doctors practicing medicine and learning through trial by fire on the front lines of the Civil War took exceptional care of the wounded.

Advances in Medical Techniques and Understanding

For the first time in the United States, compiling a complete medical history was possible due to an accumulation of adequate records and detailed reports. This led to the publication of the Medical and Surgical History of the War of the Rebellion (1870), which was identified in Europe as the first major academic accomplishment in U.S. medicine (Blaisdell 1988, p. 1046). Thomas Ellis, an army surgeon during the Civil War, wrote, "Among the few benefits derived from the war, is the marked improvement in military surgery. Some of the surgeons; who now skillfully perform the necessary operations, and judiciously decline to amputate where a hope of saving the limb exists, were[,] at the commencement of the rebellion[,] inadequate to the positions they occupied" (1863, p. 231). Among advances in medical techniques there were modifications of surgical apparati and appliances, and doctors soon after the war learned about hospital gangrene, septicemia, and the effects of malnutrition, such as diarrhea. Although the use of anesthesia was not new at the time, during the war surgeons developed an inhaler for its administration; the previous method involved placing a chloroform or ether-doused rag over the face of the patient (Belferman 1996).

Over the course of the war, surgeons learned about treating head injuries and how to ligate arteries and better treat chest wounds, and they expanded their knowledge of spinal injuries. After the war, thermometers became widely available, as did stethoscopes, ophthalmoscopes, and hypodermic needles, which already had been widely used in Europe (Adams 1985, p. 176).

Infectious wounds proved to be the bane of both the Union and Confederate armies. The concept that cleanliness led to fewer complications was understood, but the reasons why were yet unknown. It was not until 1865 that Joseph Lister introduced antiseptic surgery. Prior to this, it was common for doctors to dig bullets and mortar fragments out with their bare fingers, sometimes using unsanitized instruments and employing only a quick rinse in cold water to rinse off the blood before moving on to the next patient (Belferman 1996).

Chronic diarrhea was a serious problem for both armies, and was responsible for more deaths than any other disease. Soldiers' rations consisted of dried beef or pork, coffee, and hard-tack biscuits that were often infested with weevils. Fresh fruits and vegetables were a luxury for a soldier. Malnutrition resulted in vitamin deficiencies. In turn, a vitamin-C deficiency led to scurvy and niacin deficiency led to pellagra. These conditions often caused skin infections, dementia, diarrhea, and sometimes, death (Bollet 2002, p. 87).

U.S. mortality rates from disease were about 65 per 1,000 for the troops that fought in the Civil War. Comparatively, mortality rates for U.S. troops fighting in the Mexican War of 1846 and those of the British troops in the Crimean War of 1854 were about 104 per 1,000 and 232 per 1,000 troops, respectively (Otis 1865, p. 93).

Medicines

Sarah Emma Edmonds, a nurse for the Union army, noted the "liberal distribution of quinine and blue pills, and sometimes a little eau de vie, to wash down the bitter drugs," given to the soldiers to cure a multitude of illnesses (1865, p. 282). Although morphine and quinine were plentiful and did much good, the "blue pill," calomel, and tartar emetic contained high levels of mercury and antimony, which led to heavy metal poisoning. This was such a problem that General William Hammond of the North forbade the use of mercurials, calomel, and tartar emetic by the end of the war.

Mercury was also the treatment of choice for syphilis, diarrhea, dysentery, and typhoid (Adams 1985, p. 154). Treatment included hourly administration of mercurous drugs, which often resulted in heavy metal poisoning of the patient. Ensuing symptoms included tongue swelling, bone necrosis, gangrene, loosening and loss of teeth, and excess salivation—anywhere from a pint to a quart a day was common.

Ambulance Corp

Ghastly accounts were told of men being left to die on the battlefield. In one instance, after the Battle of the Wilderness (May 5-7, 1864), so many men were wounded that they became lost in the brush and were not rescued. Then a fire erupted, burning to death hundreds of men. Henry Bowditch, a soldier in the Union army, beseeched Congress to arrange and equip an ambulance corp of detailed soldiers, similar to those that the English and French armies had at the time. Bowditch had lost many comrades in battles fought around Centreville, Virginia, and also had lost his son, a lieutenant with the First Massachusetts Cavalry. He remarked, "a wounded soldier is liable to be left to suffer, and die… on the battle-ground, without the least attention….This happens, first, because Congress readily refuses to establish any definite and efficient Ambulance Corps in the armies of the Republic; and second, because the War Department declines to do anything in the premises" (1863, p. 6).

Dentistry in the Civil War

Dentistry in the United States had made a number of advances in the decades preceding the Civil War. Like veterinary medicine, dentistry had become a profession separate from general medicine and surgery in the nineteenth century. In the early part of the century most American dentists qualified for the profession by apprenticing themselves to established practitioners. The first independent school of dentistry in the United States, the Baltimore College of Dental Surgery, was established in 1840. By the time of the Civil War there were four American dental schools, all of them in the North. Southern as well as Northern dentists trained in these schools, and dentists on both sides used the same textbooks, A Practical Treatise on Operative Dentistry (1859) and The Principles and Practice of Dental Surgery (1863), both published in Philadelphia.

The American Dental Association (ADA), founded in 1859, was headquartered in New York City. Bitterness following the Civil War led Southern dentists to form their own professional organization, the Southern Dental Association, which did not rejoin the ADA until 1914.

The Confederacy established a separate dental corps to treat soldiers at the front. Dental surgeons in the Confederate Army were assigned to hospitals and combat regiments as medical surgeons. Union soldiers who did not have a dental corps either had to make do with local dentists in the towns where they were stationed, or request treatment from contract dentists hired by the Union Army or from dentists who had joined Union regiments as soldiers and were practicing dentistry unofficially.

Behind the lines Civil War dentists performed fillings and tooth extractions as well as instructing soldiers in basic oral hygiene. On the battlefield itself, injuries to the mouth and jaw were often treated by military surgeons as well as dentists, and instruments used to prepare teeth for fillings were part of many doctors' surgical field kits.

The dental textbooks in use in the early 1860s indicate that American dentists were knowledgeable about the advantages and drawbacks of different types of fillings. Unlike some of their European counterparts, they did not use lead to fill teeth because it was known to be dangerous to one's health. Gold was the preferred filling material because it was strong, easily placed in the tooth, and compatible with the body's tissues. Other dentists used an amalgam made of silver and tin. On the battlefield, dentists and surgeons used a mixture of zinc chloride and zinc oxide to make temporary fillings that could be replaced later with permanent ones.

Because of the Northern blockade, Southern dentists had difficulty obtaining gold for use in fillings during the war; there was only one dental supply company in Atlanta that was able to obtain gold for either civilian or military dentists. As the Confederate currency lost its value, the cost of a gold filling soared to $120— more than ten months' pay for a private in the Confederate Army.

Some information about Civil War dentistry has been obtained from the skulls of Confederate soldiers from the Battle of First Bull Run (1861) and the Battle of Glorieta Pass (1862) in New Mexico. The fillings in the soldiers' teeth were mostly gold, probably placed before the war, although one soldier had had his teeth filled with a mixture of mercury and tin. In another case the soldier's dentist had filled a tooth with thorium, not knowing that it is a radioactive material. He may have mistaken it for tin.

rebecca j. frey

BIBLIOGRAPHY

Asbell, Milton B. Dentistry: A Historical Perspective: Being a Historical Account of the History of Dentistry From Ancient Times, with Emphasis on the United States from the Colonial to the Present Period. Bryn Mawr, PA: Dorrance and Co., [1988].

Glenner, Richard A., and Willey, P. "Dental Filling Materials in the Confederacy," Journal of the History of Dentistry 46, no. 2 (July 1998): 71-75.

By the war's end, Jonathan Letterman, the medical director of the Union's Army of the Potomac, had developed a system for evacuating the wounded, and established ambulances and dedicated personnel for each regiment to take the wounded off the battlefield.

Hospitals

Initially, both the Union and the Confederacy thought the engagements between the two armies would be small, pitched battles. The country was unprepared when, in 1862, large-scale, devastating battles resulted in mass casualties. As the war raged, larger and better field hospitals developed. According to George Adams, regimental hospitals clustered together as brigade hospitals, with some differentiation of duty for the various medical officers; the chief surgeon of the brigade was in charge. Soon, brigade hospitals clustered into division hospitals, and 1864 saw the formation of corps hospitals. There the best surgeons would operate; another surgeon would be responsible for records, another for drugs, another for supplies, and yet another would treat the sick and lightly wounded (Adams 1981). Confederates developed the prototypes of mobile army surgical hospital (MASH) units as they fled before General William Tecumseh Sherman's advance (Belferman 1996).

At this time, female nurses were introduced to hospital care, and Catholic orders entered the hospital business. Nursing was elevated to a profession, with thousands of women working in hospitals for the first time. Civilians joined the Sanitary Commission, a soldiers' relief society that set the precedent for the development of the American Red Cross. By the last year of the war, in 1865, there were 204 Union general hospitals with beds for 136,894 patients (Adams 1981). The pavilion-style general hospitals were wood-built, clean, and had ample ventilation and sufficient bed space for eighty to one hundred patients; they became the model for large civilian hospitals over the next seventy-five years (Blaisdell 1988, pp. 1045–1046). Furthermore, specialist hospitals and departments to treat the specific problems of wartime soldiers appeared for the first time. The famous neurological hospital Turner's Lane was founded in Philadelphia, where W. W. Keen (1837–1932) is considered by some to have originated neurology in the United States. Silas Weir Mitchell (1829-1914) further advanced neurology by characterizing new syndromes of causalgia—triggered by nerve damage—and "phantom limb," and Jacob Da Costa (1833-1900) described "soldier's heart," the medical concept known today as posttraumatic stress disorder (PTSD) or "shell shock" (Bollet 2002, p. 363). The gains in medical knowledge during and immediately after the Civil War led to the development of a system of managing mass casualties that included the establishment of aid stations, field hospitals, and general hospitals. This system set the pattern for management of the wounded during World War I, World War II, and the Korean War (Blaisdell 1988, p. 1050).

In the Union army 30.5 percent of soldiers died during battle or from battle wounds; in the Confederate army the percentage was 36.4. Although the Civil War produced a high number of casualties, mortality rates due to direct combat and to disease both decreased. By the end of 1865 army doctors had set up large hospitals. The benefits of asepsis and general prevention of disease were better understood. The training of nurses became standardized. Medical professionals, soldiers, and civilians were also educated in issues of public health. Finally, the importance of specialization for certain diseases and the need for expanded laboratory studies were recognized (Adams 1985, p. 240).

BIBLIOGRAPHY

Adams, George W. "Fighting for Time." In The Image of War, 1861-1865, vol. 4, ed. William Davis. Garden City, NY: Doubleday, 1981. Available from http://www.civilwarhome.com/.

Adams, George Worthington. Doctors in Blue: The Medical History of the Union Army in the Civil War. Dayton, OH: Morningside, 1985.

Belferman, Mary. "On Surgerys Cutting Edge In Civil War: Medical 'Turning Point' Is Focus of New Museum." Washington Post, Washington, DC, June 13, 1996.

Blaisdell, F. W. "Medical Advances during the Civil War." Archives of Surgical History 123 (1988): 1045-1050.

Bollet, Alfred J. Civil War Medicine: Challenges and Triumphs. New York: Galen Press, 2002.

Bowditch, Henry I. A Brief Plea for an Ambulance System for the Army of the United States, as Drawn from the Extra Sufferings of the Late Lieut. Bowditch and a Wounded Comrade. Boston: Ticknor and Fields, 1863.

Edmonds, S. Emma E. Nurse and Spy in the Union Army: Comprising the Adventures and Experiences of a Woman in Hospitals, Camps, and Battle-fields. Hartford, CT: W. S. Williams, 1865.

Ellis, Thomas T. Leaves from the Diary of an Army Surgeon, or, Incidents of Field, Camp, and Hospital Life. New York: John Bradburn, 1863.

Marks, James Junius. The Peninsular Campaign in Virginia, or, Incidents and Scenes on the Battle-fields and in Richmond. Philadelphia: J. B. Lippincott, 1864.

Otis, George A. Reports on the Extent and Nature of the Materials Available for the Preparation of a Medical and Surgical History of the Rebellion. Philadelphia: J. B. Lippincott, 1865.

Anurag Biswas