“Many more lives were saved than was possible in earlier wars, and many lives were saved later because of knowledge gained during the Civil War.”

By Carole Adrienne

THE U.S. CIVIL War marked the beginning of modern advancements in medicine that were generated in response to the new weapons technologies that created a wholesale mechanical slaughter.

The medical community of the Civil War achieved an outstanding record for survival rates from disease and wounds. They designed, built, and operated revolutionary new hospitals. They served as the medical directors of huge armies and completely reorganized the medical corps. They initiated programs and research and left a legacy of skill and honor.

Organized, systemized medical care did not exist in America of the 1860s. Skilled nursing as a profession or a staff position did not exist.

Methods of getting wounded men from the battlefield to a place of care were haphazard at best and nonexistent at worst. There were no large-scale treatment facilities and surgery was rarely performed in the country. By the end of the war, there were great hospitals like Chimborazo and Satterlee, hospital trains and ships, skilled nurses, and a working ambulance corps.

Civil War doctors embraced a practical approach to medicine, setting up new systems and methods, sometimes learning surgical techniques in camps and hospitals from the diagrams in books. Many of the physicians and surgeons were recent medical school graduates with no practical experience, but they were able to share ideas and information with their more experienced colleagues. They quickly implemented the discoveries of other men, and what they hadn’t learned in the medical schools, they learned on battlefields and in field hospitals. The more immediate the care, the greater the likelihood of survival.

Many more lives were saved than was possible in earlier wars, and many lives were saved later because of knowledge gained during the Civil War. Both the Confederate and Union medical departments exercised good, solid, logical organization and changed the vista of health care. The war trained thousands of surgeons at a time when there were very few doctors in America who knew how to treat gunshot wounds. The technology of the time also gave them options that had not been available in earlier wars: surgical tools, anesthesia, and improved conveyances for the wounded.

Wounded Civil War soldiers usually received the first emergency attention at a field dressing station. The stations were set up prior to any action on the battlefield, and some were identifiable by a red hospital flag or other visual marker to help guide the wounded and their rescuers.

A sorting system that would become known as “triage” by World War I was employed—most head, chest, and abdominal wounds were considered to be untreatable, and those patients were made comfortable, frequently left to die, or they became the last to be evacuated. The slightly wounded and those needing surgery were separated and transported or treated onsite.

Limb fractures were splinted, tourniquets applied to bleeding wounds until they could reach the surgeons at the field hospital, and gaping open wounds were packed with lint that had been scraped from linen or cotton fabrics, then bandaged until they could reach the field hospital or a general hospital.

If the soldier’s wounds were such that he was thought to have a strong chance of survival, he was transported to the field hospital farther back in the rear to be given further assessment and treatment.

The field hospital was the second stage of medical attention, a treatment center staffed by each regiment’s surgeon and assistant surgeon. The surgeon’s first goal was to stop bleeding. He then might administer morphine to address the pain and provide the victim with clean drinking water. Sometimes whiskey was given as well, then the patient was taken to an ambulance to be delivered to a general hospital for further treatment.

The most common surgery at a field hospital was amputation, which was the most rapid way to save the life of a soldier wounded in a limb. During and after a large battle, the scene around a field hospital was a macabre vista of horribly wounded men, frantic bloody activity, and severed limbs.

Most fighting took place in daylight, so there was an influx of injured brought in as night fell, when surgeons worked feverishly for hours on end, operating by candle or torchlight. Many field stations were set up in converted houses, barns, or other available structures; some were tents or simply open-air operating setups where the emergency amputations were performed in front of soldiers awaiting their own surgeries.

The Civil War changed the long-held tradition that government did not have responsibility for the health of the individual soldiers. Before the war, no one who was injured had expected to be nursed by a trained professional, had envisioned that hospitals would be clean, or counted on the administration of anesthesia before surgery. The arrival of an ambulance was not anticipated by anyone who was wounded either in war or in peacetime, but by the end of the Civil War, expectations on the part of the patient, the military, and civilians had changed forever.

Confederate General Alexander E. Porter of Georgia looked back at the medical outcome of the terrible conflict. 

Was all our blood shed in vain? Was all the agony endured for the Lost Cause but as water spilled upon the sand? No! A thousand times, no! We have set the world record for devotion to a cause. We have taught the armies of the world the casualties to be endured in battle; and the qualities of heart and soul developed both in our women and men, and in the furnace of our afflictions, have made a worthier race, and have already borne rich reward in the building up of our country.

These medical departments gained great insights and understanding from the horrific carnage.

They grouped patients with similar injuries and made revolutionary observations. They worked with astonishing efficiency, saving lives by getting the wounded off the battlefields more quickly and transported to hospitals faster. They created centers of medicine that did not exist before the Civil War. They changed the substance of health care in America.

Dr. Robert D. Hicks of the College of Physicians of Philadelphia noted:

“Before the war, an M.D. was someone who attended a year of medical lectures and then repeated them for a second year. The war created a new process with measurable standards. A military doctor not only had to graduate with an M.D. and show apprenticeship to an established physician but had to pass an oral and written examination. Before the war, doctors were all M.D.s; after the war, specialisms began in neurology, trauma management, and ophthalmology, for example. Doctors became specialists. Hospitals were no longer just for indigent and dying people. Today, when we see an injured person transported to hospital emergency care via ambulance, we are witnessing Civil War medicine.”

Carole Adrienne is the author of Healing a Divided Nation: How the American Civil War Revolutionized Western Medicine (from which this article is excerpted). She received her B.F.A. from Moore College of Art and Design in Philadelphia.  She has organized an archive for Old St. Joseph’s National Shrine, twice chaired “Archives Week” in Philadelphia, and has served on advisory panels for the Philadelphia Archdiocesan Historical Research Center, The Mutter Museum’s “Civil War Medicine” exhibit and its “Spit Spreads Death: The 1918 Flu Epidemic” exhibit.  She is working on a documentary film series on Civil War medicine and lives in Philadelphia, PA. This is her first book.