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Medical Advances from the Civil War

By: Evan Craig


Dr. Tew: History 217.01
November 17th 2014

Medical Advances from the Civil War


The Civil War of the United States, which occurred from the years 1961 to 1965, has the
most deaths of any war in this nations history. Many of these deaths were due to soldiers
succumbing to infection after they were injured on the battlefield. At least 3,000,000 men fought
in more than 2,000 battles, and more than 600,000 soldiers died. Many more soldiers returned
home severely injured and disfigured.1 The medical practices used by doctors at the beginning of
the war had been the same since medieval times. These methods were ineffective in saving the
injured, and caused more harm than good. When the Civil War started, and battlefields were
lined with injured soldiers in blue and grey, the techniques previously used by doctors caused
tremendous loss of lives. Numerous lethal diseases attacked the soldiers lying with open wounds
on the fields of battle. Physicians did not use proper sanitation when dealing with injuries, and
the gunshot wounded casualties usually died of infection. However, the theme of war producing
medical advancement proved to be the case. The large death toll sparked a revolution amongst
the medical world, and a common use of sanitary practices by physicians, an improvement on
anesthesia given to the soldiers, the invention of the first prosthetic limb, an organized patient
transport system, and the formation of the Red Cross. Each of these advancements were due to
the Civil War had an impact on modern day medical practices.
The medical practices that doctors applied until the year 1861 were dangerous, barbaric,
and stagnant. The practicing doctors at the start of the war were vastly unprepared for the
bloodbath that was to come. Medical schools in the United States available to aspiring physicians
were inadequate. According to John Tooker, from the American College of Physicians, Most

1 Metcalfe, N. H. "Military Influence upon the Development of Anaesthesia from the American Civil War (18611865) to the Outbreak of the First World War." Anaesthesia 60, no. 12 (2005): 1213-217.

Civil War military surgeons were graduates of unregulated two-year medical schools.2 For the
proper treatment of any injured human, a effective medical school education is a requirement.
The foundation of medical education curriculum in the United States was based on a
longstanding, medieval technique. Dale Smith, from the OAH Magazine of History, gives insight
into this by explaining that the formal profession recognized by the U.S. army was based on
ancient, experimental science.3 Therefore, Doctors in the United States did not have the
opportunity to become educationally prepared for the war between North and the South. Due to
the lack of a quality education, aspiring doctors had no opportunities for clinical time spent with
injured patients.
Another aspect that was a hindrance to the performance of Doctors during the Civil War
was the lack of experience with war-based injuries. Tooker states that, At the beginning of the
conflict, most had never treated a gunshot wound, and very few were experienced in evaluating
and treating the injuries of war.4 Due to the numerous gun shot wounds on the battlefield, the
doctors were clueless in how to effectively treat them, which led to many deaths. This
inexperience added more fuel to the fire of the numerous diseases that plagued 1800s America.
The nature of the injuries paved way to diseases that targeted open wounds, and
devastated both sides of the war. According to Barbara Floyd, Archivist of the University of
Toledo, Two soldiers died of disease (dysentery, diarrhea, typhoid, and malaria) for every one
killed in battle.5 These diseases rushed through the battlefields of injured soldiers and caused

2 Tooker, John, MD. "Antietam: Aspects of Medicine, Nursing, and the Civil War." The American Clinical and
Climatological Association, 2007, 215-23.
3 Smith, Dale C. "Military Medical History: The American Civil War." OAH Magazine of History 19, no. 5 (2005):
17-19.
4 Tooker, John, MD. "Antietam: Aspects of Medicine, Nursing, and the Civil War."
5
Floyd, Barbara. "Medicine in the Civil War." University of Toledo Libraries. January 3, 2012.
http://www.utoledo.edu/library/canaday/exhibits/quackery/quack8.html.

massive amounts of death to the two armies. The army physicians were in a state of chaos
attempting to stop the spread of these diseases through treating them with even more lethal
solutions. Ina Dixon, chronicler for Civil War Trust, describes the example that Physicians were
often encouraged to treat diseases like syphilis with mercury, a toxic treatment, to say the least.
6

These diseases and dangerous methods used to treat them added more death and horror to the

already gruesome atmosphere of the Civil War. These plagues continued to spread throughout the
landscape for most of the war. Physicians could not go back to receive more education during a
time of war, however the trial by fire experiences gained during the heat of battle proved
useful to surgical practices in the future.
The main cause of the spread of these lethal, contagious diseases throughout camp was
due to the unsanitary practices of the physicians when dealing with injured soldiers. D.L.
Griffiths, writer for Proceedings of the Royal Society of Medicine, describes a gruesome scenes
illustrating the practices of Civil War Surgeons: The Surgeons sleeves rolled up, arms and
aprons smeared with blood, not infrequently held their knives in their teeth in order to have both
arms free. 7This description gives a glimpse of the barbaric practices of physicians at the
beginning of the civil war. It was up to the army to provide a sanitation code for physicians, and
Surgeon Generals William Hammond and Samuel Preston Moore decided to take action.
The improvement in hygienic techniques can be attributed to two notable Surgeon
Generals serving in the Civil War. Ina Dixon reports William A. Hammond, Surgeon General of
the Union Army, as systematically putting in order hospitals designs and inspections. She
concludes Hammond "literally wrote the book on hygiene for the army. 8The Confederate
6 Dixon, Ina. "Civil War Medicine." Civil War Trust. October 29, 2013.
http://www.civilwar.org/education/history/civil-war-medicine/civil-war7 Griffiths, D.L. "Medicine and Surgery in the American Civil War." Proceedings of the Royal Society of Medicine,
March 1966, 204-08.
8 Dixon, Ina. "Civil War Medicine."

Army's Surgeon General, Samuel Preston Moore, also set high standards for health care. James
Robertson, author of The Untold Civil War, credits Moore with the insistence that patients must
be kept meticulously clean as well as provided with special nutrition. 9 In addition, he introduced
laboratories, which produced alternatives to medicine when not available. Robertson wrote, "The
Surgeon General prescribed cucumbers for burns and persimmons for diarrhea."10 Additionally,
Moore developed the "ward system" for treating patients instead of lumping all of the soldiers
together in one hospital. Modern hospitals and medical care has undoubtedly benefited from
these two Civil War physicians and their innovations for better, safer patient care.
The surgical procedures applied by the field surgeons mainly consisted of amputation.
This procedure was extremely painful to soldiers, and the surgeons had no proper anesthesia to
dull the pain. According to Floyd, Surgeons ignored anesthesia, instead relying on the surgical
shock of battle, when the patients heart rate was at its highest.11 The lack of an effective
anesthesia added to the agony of the soldiers who were in the process of losing their limbs.
However, two main advancements occurred to halt this atrocity. The development of effective
anesthesia and a prosthetic leg for soldiers missing amputated limbs.
Due to the large number of injured soldiers from both the North and South, historians
have estimated that almost 125,000 operations were performed under anesthesia during the war.12
N.H. Metcalfe from the University of Birmingham, United Kingdom, states, information from
the military records cited a recorded 80,000 cases from among the injured, and cited a study of
8,900 major operations done during the war.13 All of the records showed the use of chloroform
9 Robertson, James I. The Untold Civil War: Exploring the Human Side of War. Edited by Neil Kagan.
Washington, D.C.: National Geographic, 2011. 216-18.
10 Ibid 216
11 Floyd, Barbara. "Medicine in the Civil War."
12 Metcalfe, N. H. "Military Influence upon the Development of Anaesthesia from the American Civil War (18611865) to the Outbreak of the First World War." Anaesthesia 60, no. 12 (2005): 1213-217.
13 Ibid, 1213

as the most widely used anesthetic. Most of the recorded information came from the Union's
military since the Confederate Army's records were destroyed by fire in 1865. Stories were told
of supplies being exhausted, which led food and chloroform being prized possessions.
Chloroform was also found smuggled across borders in dolls.14 The Head Surgeon of the
Confederate Army, who himself had administered more than 10,000 anesthetics without a single
death, was alerted to the high waste of chloroform and ether and designed a new way to
administer the agents. Instead of using a handkerchief, napkin or sponge, he designed a type of
nasal inhaler that required an eighth of the amount of chloroform used in the older methods. Plus,
the inhaler would fit into the doctor's pocket. With this invention, field surgeons could safely and
conveniently access chloroform to better help the injured soldier.15 A quote by Metcalfe gives
excellent summary to the Civil Wars impact on modern anesthesia: "Nevertheless, the
importance of this was its location: anesthesia needed a strong first foothold in America before
any development could occur in the future. It is for this reason that the American Civil War
deserves a place in history of anesthesia."16
It may be a surprise to many that the emergence of the modern day prosthetic industry
began with the Civil War. One of the reasons for this demand was due to the invention of
weapons that would explode and expand when entering the body. These extensive wounds led to
difficult healing and brutal amputations. In the American Society of Mechanical Engineer's
article, The Civil War and the Birth of the Prosthetic Industry," Michael McRae introduces us to
James Edward Hanger. According to the article, Hanger was the first documented Confederate
soldier amputee.17 McRae stated, "Hanger, who lost his leg above the knee to a canon ball was
14 Ibid, 1213
15 Ibid, 1214
16 Ibid, 1214
17 MacRae, Michael. "The Civil War and the Birth of the U.S Prosthetics Industry." American Society of
Mechanical Engineers. June 2011. https://www.asme.org/engineering-topics/articles/bioengineering/the-civil-war-

first fitted with a wooden peg leg by Yankee surgeons."18 Hanger was unhappy with his inability
to sit and walk comfortably and proceeded to build an artificial leg from whittled barrel staves.
The innovative leg had hinges at the knee and foot and provided greater comfort when sitting and
walking. The ASME article goes further by reporting James Hanger eventually founded Hanger,
Incorporated, which remains an important part in the modern day prosthetic business. 19 James
Robertson brings the horror of Civil War amputations to life in powerful quote from Luther
Hopkins, a soldier from Virginia, describes a horrible night in July at The Battle of Gettysburg.
"The moon and stars came out, and doctors appeared with their knives and saws. When the
morning came, there were stacks of legs and arms standing in a field like shocks of corn." 20
Fortunately, James E. Hanger and the orthotic advancements he made during the Civil War
marked the end of the pegged leg and hooked arms. There were two main logistical
advancements made during the Civil War era.
The first logistical advancement in the medical field during the Civil War is the
development of an organized patient transport system. Jonathan Letterman invented a system that
saved numerous lives, and is known as the father of emergency healthcare. James Robertson
reveals Letterman's greatest achievement as being the invention of a fully equipped wagon that
took men directly from the fields of battle to designated medical stations.21 This innovation led to
the formation of an independent ambulance company, which gave soldiers a greater chance of
surviving the deadly front lines. Ina Dixon states that Letterman brought order to the medical
service with a regulated ambulance system and plans to evacuate the wounded soldiers. 22 With
and-birth-of-us-prosthetics-industry
18 Ibid 3
19 Ibid 3
20 Robertson, James I. The Untold Civil War: Exploring the Human Side of War.
21 Ibid 216
22 Dixon, Ina. "Civil War Medicine."

Letterman's development, our present-day standard of care, rapid response systems and
ambulances continue to get critically injured patients with medical emergencies to Hospitals for
quicker treatment.
The next second logistical advancement was the formation of an effective nursing system
to aid wounded soldiers on the battlefield. The harbinger of this new system was Clara Barton.
Perhaps the bravest woman, nurse and entrepreneur of the Civil War was Clarissa Harlowe
Barton, who wished to be called Clara. In Clara Barton, Founder of the Red Cross by Augusta
Stevenson, Miss Barton is described as an "Angel of the Battlefield." 23 Under constant enemy
fire and danger, she continued to nurse sick and wounded soldiers from 1861-1865. Clara
believed soldiers should be treated on the frontlines of battlefields, thus finding a way to save
many additional lives. Stevenson gives an example of Barton being in danger during the intense
shelling of a bridge that left her skirt riddled with bullet holes. 24 However, her bravery persisted,
and she never seemed fearful or backed down on her mission to serve. In addition to her heroism
on the battlefields, Clara Barton is most commonly known as the founder and president of the
American Red Cross. Barton insisted the Red Cross would be ready to serve whenever it could
relieve human suffering, regardless of their ability to pay. 25 From her valiant efforts on the
battlefields to the founding of the Red Cross, Clara Barton and her role in the Civil War made a
significant impact on the modern medical services available today.
The medical advances from the Civil War cannot be completed without mentioning Walt
Whitman. David Hsu, M.D., author of Walt Whitman: An American Civil War Nurse who
witnessed the Advent of Modern Medicine, enlightens the reader into Whitmans important role
23 Stevenson, Augusta. Clara Barton, Founder of the American Red Cross. New York: Aladdin Books, 1986.
24 Ibid, 183
25 Ibid 191

in the Civil War. Whitman became a nurse on accident, while traveling to Fredericksburg to
find his brother George, a wounded soldier, and during his stay there, he was first exposed to the
trauma of the war. 26 Being a writer and poet, Walt Whitman recorded everything he witnessed
while serving as a nurse. Among the horrific scenes witnessed by Whitman, were gangrenous
limbs, crude amputations, and diarrhea illnesses from dysentery. 27 Whitman recorded detailed
signs of symptoms of illnesses in his journals. After Whitman ended his Civil War Nursing
occupation, he continued to his medical endeavors by observing over forty hospitals in the
Washington, D.C. area.28 This added more knowledge to the journals of the famous, welleducated writer and poet Whitman. The fact that Whitmans poetic works are still studied today
shows that he was a beloved artist during his time. Therefore, the journals that Whitman wrote
on his medical observations during the Civil War would be more likely read and taken as fact.
Whitmans own nursing career ended after he cut his own thumb while caring for a patients
wound. However, Whitmans journals would influence modern medicine tremendously.
Whitmans personal experience involving many failures of medical practices during this
time event eventually lead to modern American medical advancement through development of
new scientific knowledge, specialization and greater efficiency in the medical field. By the time
of Whitmans death in 1892, William Osler had written his textbook on the practice of medicine,
Lister Hill had founded antiseptic surgery, and Joseph Mitchell had described injuries of nerves.29
Whitmans experience with the horrors of the Civil War was filled with traumatic scenes,
gruesome injuries, and numerous diseases. Whitman eventually became mentally unstable with
the inability to cope with all the atrocities he had witnessed during his duty as a nurse in the war.
26 Hsu, David. "Walt Whitman: An American Civil War Nurse Who Witnessed the Advent of Modern American
Medicine." Archives of Environmental & Occupational Health 65, no. 4 (2010): 238-39.
27 Ibid 238
28 Ibid 238
29 Ibid 239

This injury was perhaps the most important affliction that Whitman developed while nursing
Civil War patients. The case of Whitmans mental illness led to the chronic mental illness
described today as post-traumatic stress disorder (PTSD).30 Treatment of Whitmans mental
illness helped develop more modern approaches to clinic-pathologic case studies that are still an
important component of medical education today. Therefore, in a somewhat unfortunate way,
some credit for psychological medical advancement should be attributed to Walt Whitman, an
American Civil War nurse. He lived, witnessed, and recorded the beginning of a march toward
modern American medicine.
With all the death, disease, and suffering that occurred in the midst of the Civil War, it is
surprising that there was any advancement. However, fighting a war forces each side to push the
limit of discovery in order to be victorious. The American Civil War occurred at a time where the
techniques and training were not held to effectively treated the massive amounts of wounded
soldiers stumbling into camp from a gruesome battle. Soldiers who required amputation were in
tremendous pain due to the lack of effective anesthesia by the surgeons. The head surgeon of the
Confederate Army solved this by designed a small, compact, nasal inhaler to store anesthesia to
be conveniently available to physicians in the field. The brutal process of amputation produced a
soldier who invented the first prosthetic leg. Jonathan Lettermans organized ambulance system
helped transport injured soldiers to medical facilities quicker for more time to treat the wounds.
This system is still used to transport patients in todays medical world. Clara Bartons caring
personality and strong initiative led to a nursing overhaul that provided more individual
assistance to wounded soldiers. Bartons experience during the Civil War eventually led her to
found the American Red Cross, which is saves lives in the U.S., and World, on a daily basis in
present times. Walt Whitmans detailed observations of the specific ordeals of the wounded
30 Ibid 239

scientists to cures and preventions for many of the plagues that ailed his fellow countrymen
during the Civil War. His own mental illness led to the classification of a whole new, cognitive
disease now known as PTSD. In conclusion, the advancements that derived from the deadliest
war in American history shape the foundations of the medical practices we have access to today.

End Notes
1. Dixon, Ina. "Civil War Medicine." Civil War Trust. October 29, 2013.
http://www.civilwar.org/education/history/civil-war-medicine/civil-warmedicine.html.

2. Floyd, Barbara. "Medicine in the Civil War." University of Toledo Libraries. January 3,
2012. http://www.utoledo.edu/library/canaday/exhibits/quackery/quack8.html.

3. Griffiths, D.L. "Medicine and Surgery in the American Civil War." Proceedings of the
Royal Society of Medicine, March 1966, 204-08.

4. Hsu, David. "Walt Whitman: An American Civil War Nurse Who Witnessed the Advent of
Modern American Medicine." Archives of Environmental & Occupational Health 65,
no. 4 (2010): 238-39.

5. MacRae, Michael. "The Civil War and the Birth of the U.S Prosthetics Industry." American
Society of Mechanical Engineers. June 2011. https://www.asme.org/engineering-top
ics/articles/bioengineering/the-civil-war-and-birth-of-us-prosthetics-industry.

6. Metcalfe, N. H. "Military Influence upon the Development of Anaesthesia from the


American Civil War (1861-1865) to the Outbreak of the First World
War." Anaesthesia 60, no. 12 (2005): 1213-217.

7. Robertson, James I. The Untold Civil War: Exploring the Human Side of War. Edited by
Neil Kagan. Washington, D.C.: National Geographic, 2011. 216-18.

8. Smith, Dale C. "Military Medical History: The American Civil War." OAH Magazine of
History 19, no. 5 (2005): 17-19.
9. Stevenson, Augusta. Clara Barton, Founder of the American Red Cross. New York:
Aladdin Books, 1986.

10. Tooker, John, MD. "Antietam: Aspects of Medicine, Nursing, and the Civil War." The
American Clinical and Climatological Association, 2007, 215-23.

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