In the heart of downtown Frederick, MD, stands the National Museum of Civil War Medicine. Frederick, itself, bore witness to the battles of South Mountain, Antietam, Gettysburg, and Monocacy, some of the bloodiest of the war. The city had to accommodate for the sudden influx of diseased, dead, and dying and constructed seven general hospitals and some twenty other field hospitals to do so. Needless to say, Frederick saw its fair share of wartime casualties and medical practices. There really is no better place for a Civil War medical museum to be.
Medical procedures and knowledge were still relatively primitive at the dawn of the Civil War. Even humoral medicine had some degree of relevance in the contemporary literature. According to humorism, there are four fluids (humors) in the body: blood, black bile, yellow bile, and phlegm. When these humors are unbalanced, they cause disease. This methodology instructed doctors to purge patients' bodies of excess fluids to make them better, whether it be through blood-letting, induced vomiting, or cupping and blistering. However, over the course of the war, doctors on both sides realized that traditional medical practices were obsolete and new operating procedures were pioneered for more effective treatments.
One of the most revolutionary minds of the war, in terms of military medicine, was Jonathan Letterman, Medical Director of the Army of the Potomac. He instituted drastic changes in field procedures, from procurement of medical supplies to implementation of the triage system. One of his most influential advancements was his highly-organized ambulance and stretcher system, designed to evacuate the wounded from the battlefield as quickly as possible. He also reorganized the way field hospitals were operated, ensuring that complex operations were performed by capable surgeons, not necessarily by higher-ranked ones.
There are two other notable surgeons of the war, the first being William Alexander Hammond. Hammond was the Surgeon General of the Union Army in 1862. He established a medical museum for research and strictly enforced hygiene and sanitation standards for surgery. Hammond was the center of controversy later that year when he removed the drug Calomel from army supply tables. This drug was used to treat diarrhea, dysentery, and typhoid; however one its main ingredients was mercury. Hammond saw that the mercury could do more harm than good, so he ordered the drug to be abandoned from practice. Despite his recommendation, many surgeons felt that the rewards outweighed the risks and in 1863, Secretary of War Edwin Stanton had Hammond court-marshaled over the controversy. After the war, Hammond founded the American Neurological Association, served as its president in 1883, and is considered one of the founders of neurology in the US. The second surgeon is Samuel Preston Moore, Surgeon General for the Confederacy. Moore created a chain of command, regulations, and training that improved the practice and quality of military medicine in the South. He instituted boards and committees to review and promote medical standards and implemented an examination system for surgeons entering the army or seeking promotion. He also took steps to increase the efficiency of pharmaceutical production to eliminate shortages. After the war, Moore left medicine to focus on public health and education.
As "War Fever" spread across the country, hundreds of thousands of eager volunteers rushed to recruitment stations to enlist. However, it wasn't as simple as 'sign-up and you're in.' There were guidelines, crude compared to today's standards, that physicians used to determine if volunteers could serve in the army. With many people under the impression that the war would last only a few months, physical examinations were very superficial and unverifiable. This neglect resulted in the admittance of recruits who were too young, mentally-unfit, or diseased--the biggest killer of the war.
There are a couple of stories that epitomize both the lax restrictions of enlistment and the poor execution of these physical exams. The first is of Sarah Edmonds, who posed as a man (under the alias Franklin Thompson) and enlisted in the 2nd Michigan Infantry. She served as a soldier from 1861-1863 before contracting malaria and subsequently leaving the army to seek treatment. Afterwards, she returned to serve as a nurse and published Nurse and Spy in the Union Army shortly after the war. Second is Loreta Janeta Velazquez from New Orleans, LA. She disguised herself as 'Harry T. Buford' to join her husband as officers in the Confederate Army. Her husband was killed shortly after her arrival, but she continued to serve as Buford. She fought in First Manassas, Balls Bluff, and Shiloh, receiving wounds in her foot and right arm. After the war, she moved to Europe, remarried, and finally settled in Rio de Janeiro, Brazil in 1878. Conservative estimates suggest that over 300 women disguised themselves as men to fight during the Civil War, although that number may be much higher. Case in point, many physical examinations were so superficial that they neglected to dig deeper than outward appearance.
Perhaps the most famous woman to serve in the Civil War is Clara Barton. In 1861, she organized volunteer efforts to deliver medical supplies to Union troops in Washington, DC. She soon realized that the greatest need for these supplies were out on the front lines. She tended soldiers on both sides at the battles of Cedar Mountain, Antietam, Fredericksburg, and many others. In 1864, General Benjamin Butler appointed Barton as supervisor of nurses for the Army of the James. On March 11, 1865, Barton established a list of missing Union soldiers to help gather information on them for their inquiring families. Shortly after the war, Barton traveled down to the infamous Andersonville POW camp in Georgia and identified over 12,500 unmarked graves. Her greatest claim to fame came in 1881 when she established the first American Red Cross chapter and was named President of the organization.
Dorothea Dix is also another notable female figure. Dix was made Superintendent of Nurses in 1861 and set high standards for nursing practices. Over 3,200 nurses under Dix's guidance aided Union doctors throughout the war. However, there was still a shortage of nurses. Communities of religious women volunteered to work as sister nurses. Over 600 sister nurses from twelve separate Catholic orders served in the hospitals, camps, prisons, and battlefields for both North and South.
During battles, access to formal medical facilities were nearly impossible. Field hospitals were established to treat wounded soldiers as quickly and effectively as possible. These were often nothing more than tents or barns. Inside the hospitals, the wounded were triaged into three categories: mortally wounded, slightly wounded, and surgical candidate. Mortally wounded patients suffered from wounds to the abdomen, chest, or head (life-threatening or not). They were made as comfortable as possible and essentially left to die or recover. Surgical candidates were placed on make-shift operating tables for examination. If a surgeon decided to perform surgery, 95% of the time the patient was under anesthesia. Three-quarters of battlefield operations were amputations, which gave surgeons bad raps as butchers. The mortality rate for amputations at the hip, thigh and knee were over 50%, lower leg 33%, and upper arm 25%. However, given the physical conditions of their patients and the bullet damages to their bodies, surgery was usually the most practical procedure to follow.
The Civil War saw a new era of firepower (and subsequent wounding) due to the introduction of rifled and carbine firearms, in contrast to the smoothbore, one-shot muskets of the Revolutionary War. The bullets, called Minie balls (named after the French ordinance officer who invented them), were cone-shaped, spun with the full force of the ignited gunpowder, and had a hollow base that expanded on impact. These guns and ammunition were more accurate, higher powered, and more lethal than muskets. The wounds received were also more devastating, which prompted surgeons to amputate immediately after injury. If delayed by more than 48 hours, death rates doubled due to the development of blood poisoning from the lead bullet, bone infection, or gangrene.
Disease plagued the troops and was the leading cause of death during the war, especially African American regiments. Black soldiers were typically assigned to garrison and other non-combatant duties, meaning they stayed in one place for long periods of time. This allowed for disease to fester and spread among the troops. The 65th US Colored Troops lost 755 men to disease, the most of any US regiment during the war. African Americans, in general, were exposed to a lot of death. Many contrabands and enslaved people were tasked with burial parties and constructing hospitals. Others, such as Harriet Tubman and Susie King Taylor, served as nurses and tended soldiers in care facilities.
With so many casualties that required long-term care, the American hospital system was completely revamped. Early in the war, there was no formal hospital network to accommodate mass casualties. Later, Union and Confederate armies adopted pavilion-style hospital systems that were large in size and efficient with care. The largest of these was the Chimborazo Hospital in Richmond, VA. With 150 wards and over 8,000 patients, this hospital served as its own community, with a massive bakery, brewery, soap factory, and numerous herds of livestock.
At sea, surgeons weren't so fortunate. Naval surgeons were often confined to the ship's lower deck--dark and damp--to carry out their business. They had to deal with ship-wide epidemics of typhus and yellow fever, treat nutritional deficiencies such as scurvy (and even then, medical nutrition was in its infancy), all while operating on a rocking, moving vessel. Later in the war, river boats and steamships were refitted as floating hospitals, large enough to hold hundreds of patients and a well-trained medical staff. One of the most famous of these boats is the Red Rover, the first hospital ship in US history. The Red Rover was originally purchased by the Confederacy in 1861, but was captured by the Union after it had run aground near St. Louis. It was repurposed as a hospital and traveled up and down the Mississippi River for the rest of the war. Approximately 50,000 patients were cared for during its three years of operation.
Despite the best efforts of doctors and nurses, death was far too common. Before 1863, the federal government didn't take responsibility for soldiers' bodies or have them shipped back home. They were usually interred in shallow graves at the battlefields, marked only by small headstones. It was usually up to the locals to bury the soldiers and for the families to ship the bodies back home. However, after the devastation and death witnessed at Gettysburg, the federal government began to take steps to ensure proper identification and burial of its soldiers. Embalmers, who were usually surgeons or pharmacists with a knowledge of chemical compounds, were used more frequently to preserve bodies for transportation. Other than this prior knowledge, there weren't many other regulations in terms of embalming practices. Fraud and extortion were rampant, prompting the practice to be increasingly turned over to undertakers and morticians.
When the Civil War ended in 1865, over 600,000 Americans died (some newer estimates suggest 750,000). Of the nearly 2.9 million Union enlistees, over 110,000 died in battle while 225,000 died from disease. In total, about 360,000 Union died (12.5% of their total army). On the Confederate side, 95,000 died in battle while 164,000 died from disease. About 258,000 troops (19.6% of the total army) died during the war. The Civil War also produced nearly 500,000 troops with permanent disabilities and over 50,000 amputations. Specialized hospitals, such as the Lincoln Institute in Philadelphia, PA, attempted to help aid and transition disabled veterans back to civilian life.
A multitude of prosthetic manufacturers were founded and made significant advances in terms of design and functionality. Many of the "new" prostheses were hinged and mimicked natural movement. One such company was the Hanger Company. James E. Hanger, founder, was a Confederate soldier who was wounded in June 1861 and required amputation. He recovered successfully and spent months developing his own prostheses. Later in the war, he marketed his products to the Confederate government. The company still exists today and is a leading innovator among orthopedic manufacturers.
Social programs were also established to allow veterans to associate with one another on a regular basis. These organizations lobbied the government to recognize the claims for soldiers' pensions, supported veterans for public office, honored the Civil War dead, erected monuments on battlefields and towns, and assisted destitute veterans in need. Two of the most recognized organizations are the Grand Army of the Republic (G.A.R.) and the United Confederate Veterans.
But no matter how many social support programs and initiatives were created, nothing could erase the psychological impact war brought upon a soldier. Very few enlistees were ready for the harsh realities of military life. The horrors of the battlefield compounded with the poor living conditions and amenities debilitated soldiers who were otherwise physically capable of fighting. Poor mental health contributed to negative coping behaviors, such as gambling and drinking. Some chose to desert and risked execution if caught. Others took their own lives. Even during peacetime, these feelings of horror and melancholy persisted. In hindsight, this would be characterized as PTSD (post-traumatic stress disorder), however medical knowledge had not progressed to the point to diagnose conditions without much of a physical ailment.
The National Museum of Civil War Medicine is by far one of the most interesting museums I have ever visited. It combines my two biggest interests--medicine and history--into one. There are many interesting exhibits, artifacts, and remains on display, including a severed arm recovered from the Antietam battlefield and remains from patients who were treated in some of the city's wartime hospitals! The museum is a peculiar and sobering reminder of what military medicine was and how it progressed during the most turbulent period in American history.