KILLED BY THE CURE: CIVIL WAR MEDICINE, PT. IX

XXVII. Records of the Office of the Surgeon General of the United States (RG 112)

The National Archives in Washington, DC holds some records of Civil War medical personnel and support staff:

1. Station Books of Medical Officers, 1857-1902.
2. Registers of Military Service of Hospital Stewards, 1856-1887.
3. List of Volunteer Medical Officers Who Served with the Civil War Army Corps, 1861-1865.
4. Registers of Deaths of Civil War Voluntary Medical Officers, 1863-1896.
5. List of Female Nurses, Cooks, and Laundresses Employed in Army Hospitals During the Civil War.

XXVIII. Books on Civil War Medicine

Adams, George Worthington. Doctors in Blue; The Medical History of the Union Army in the Civil War. New York: H. Schuman, 1952.

Barnes, Joseph K. The Medical and Surgical History of the Civil War. Wilmington, N.C.: Broadfoot Pub. Co, 1990.

Bollet, Alfred J. Civil War Medicine: Challenges and Triumphs. Tucson, Ariz: Galen Press, 2002.

Cunningham, Horace Herndon. Doctors in Gray; The Confederate Medical Service. Baton Rouge: Louisiana State University Press, 1958.

Flannery, Michael A. Civil War Pharmacy: A History of Drugs, Drug Supply and Provision, and Therapeutics for the Union and Confederacy. Pharmaceutical heritage. New York: Pharmaceutical Products Press, 2004.

Freemon, Frank R. Microbes and Minie Balls: An Annotated Bibliography of Civil War Medicine. Rutherford: Fairleigh Dickinson University Press, 1993.

Rutkow, Ira M. Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine. New York: Random House, 2005.

Smith, George Winston. Medicines for the Union Army; The United States Army Laboratories During the Civil War. Madison, Wis: Amer. Institute of the History of Pharmacy, 1962.

XXIX. Websites

Civil War Home- Civil War Medicine

CivilWarPhotos.net

Growing Research Into History of Drugs Used During Civil War

Library of Congress- American Memory -- NOTE: Under Search All Collections, type “Civil War medicine”.

National Museum of Civil War Medicine

Preparing and Dispensing Prescriptions During the Civil War

Society of Civil War Surgeons

Tom Pearson, Reference Librarian
Special Collections Department
St. Louis Public Library
1415 Olive Street
St. Louis, MO 63103

KILLED BY THE CURE: CIVIL WAR MEDICINE, PT. VIII

XXII. Amputations

The most commonly employed surgical technique during the Civil War was the amputation. Union Army medical records list 29,980 amputations. When amputations performed early in the war that went unrecorded, and Confederate Army amputation estimates are added to the total, it is reasonable to assume that Union and Confederate Army surgeons performed somewhere between 50,000-55,000 amputations during the war.

XXIII. Amputations- Categories

Amputations were placed in one of three categories, depending on how soon after the injury the procedure was performed:

1. Primary- Within 48 hours of the injury (23.9% mortality rate)
2. Intermediary- Three to thirty days after the injury (34.8% mortality rate)
3. Secondary- Thirty-one or more days after the injury (28.8% mortality rate)

XXIV. Amputations- Bodily Area of Injury

Injuries in the Civil War requiring amputation involved these sites on the body:

1. Hand (26.4% of total)
2. Thigh (21.2%)
3. Lower leg (18.4%)
4. Upper arm (18.4%)
5. Forearm (5.9%)
6. Foot (5.1%)
7. Shoulder (2.9%)
8. Knee (0.7%)
9. Ankle (0.5%)
10. Hip (0.2%)
11. Wrist (0.2%)
12. Elbow (0.1%)

XXV. Amputations- Mortality Rates by Type of Procedure

The fatality rate of amputations increased the closer the procedure was performed to the trunk of the victim. The mortality rate of various procedures was as follows:

1. Hip (88% fatalities)
2. Knee (58%)
3. Mid-Thigh (54%)
4. Lower leg (38%)
5. Shoulder (28%)
6. Ankle (24%)
7. Upper arm (24%)
8. Forearm (14%)
9. Wrist (10%)
10. Elbow (7%)
11. Toes (6%)
12. Foot (5%)
13. Fingers (3%)
14. Hand (2%)

XXVI. Artificial Limbs Furnished to Maimed Soldiers

After the war, the federal government and most Confederate states had programs to pay for (or to reimburse maimed veterans for) the purchase of artificial limbs and eyes. These programs could be very expensive- Mississippi in 1866 spent more than 1/3 of its entire state budget for these items. Some state archives have retained records of these purchases (South Carolina, for example, has published a printed record of such purchases).

Tom Pearson, Reference Librarian
Special Collections Department
St. Louis Public Library
1301 Olive Street
St. Louis, MO 63103

KILLED BY THE CURE: CIVIL WAR MEDICINE, PT. VII

XX. Diseases Most Commonly Contracted by Civil War Soldiers

Six million cases of disease were reported to or discovered by Union medical officers during the Civil War. These 15 diseases account for 3,966,828 (66%) of those cases:

Listings provide Disease; Number of Cases; Number of Deaths; and Death Rate.

1. Diarrhea or dysentery---1,585,196---37,794---(2.38 %)
2. Malaria---1,213,685---12,199---(1.01 %)
3. Pneumonia/diseases of respiratory tract---448,923---17,902---(3.99 %)
4. Catarrh/Bronchitis---281,294---1,185---(0.42 %)
5. Gonorrhea---95,833---6---(0.01 %)
6. Typhoid fever---75,368---27,056---(35.90 %)
7. Syphilis---73,382---123---(0.17 %)
8. Measles---67,763---4,246---(6.27 %)
9. Mumps---48,128---72---(0.15 %)
10. Scurvy---30,714---383---(1.25 %)
11. Tuberculosis---13,499---5,286---(39.16 %)
12. Smallpox---12,236---4,717---(38.55 %)
13. Chronic Alcoholism/Delirium tremens---10,253---605---(5.90 %)
14. Diptheria---8,053---777---(9.65 %)
15. Typhus---2,501---850---(33.99 %)

XXI. Anesthesia

Two main forms of anesthesia were used during the Civil War: chloroform and ether. In the 8,900 surgeries reported to the Union Surgeon General in which type of anesthesia was specified, chloroform was used in 76% of cases, ether in 15% of cases, and some combination of chloroform and ether in 9% of cases. Of the 6,784 cases using chloroform that were reported, death attributable to the anesthetic was involved in 37 cases, or 0.5%. 254 surgeries were reported in which no anesthetic was used (3%).

Tom Pearson, Reference Librarian
Special Collections Department
St. Louis Public Library
1301 Olive Street
St. Louis, MO 63103

KILLED BY THE CURE: CIVIL WAR MEDICINE, PT. VI

XVII. Confederate Medical Shortages- The Blockade

The blockade of the Confederate states by the Union Navy meant that surgical supplies and medications were soon in short supply in the South. New items could be acquired in one of three ways:

1. From smugglers who managed to slip through the Union blockade. But prices soon became exorbitant: quinine in late 1863 was selling in the South for $400-$600 per ounce!
2. Capture of Union medical supplies. But this method was of course unreliable.
3. Manufacture medicines in the south from available ingredients. Labs were set up in Atlanta, Charlotte, Montgomery, and Knoxville, to name just a few of the cities selected.

XVIII. Confederate Medical Shortages- "Indigenous Remedies"

The Confederate Medical Service in 1864 issued a “Standard Supply Table of Indigenous Remedies for Field Service and Sick in General Hospitals.” Among the listed herbs, plants, and trees which could be used medicinally were:

Calamus, Virginia Snakeroot, Sassafras, Lavender, Bearberry, Sumac, Sage, Blackberry, and Dewberry, plus the leaves and sometimes the bark of these trees:

Dogwood, Persimmon, White Oak, Wild Cherry, and Tulip (to name only some of the listed herbs, plants, and trees).

XIX. Confederate Medical Shortages- Medical Instruments

The South was never able to set up factories to manufacture precision medical instruments, so surgeons sometimes had to improvise. These substitutions were necessary on occasion:

1. Surgical saws- Carpenter’s saws
2. Scalpels- Penknives
3. Surgical hooks- Forks
4. Tenaculum- Knitting needles
5. Splints- Fence rails

Tom Pearson, Reference Librarian
Special Collections Department
St. Louis Public Library
1301 Olive Street
St. Louis, MO 63103

KILLED BY THE CURE: CIVIL WAR MEDICINE, PT. V

XV. Medicines in Common Use During the Civil War- Union Army

These items were among those carried with the Army of the Potomac during the May 1864 Wilderness Campaign:

1. Acacia
2. Alcohol
3. Alum
4. Ammonia water
5. Ammonium carbonate
6. Brandy
7. Camphor
8. Cantharides
9. Castor oil
10. Chloroform
11. Collodion
12. Ether
13. Ferric chloride
14. Lead acetate
15. Liquid soap
16. Mercury pills
17. Morphine
18. Opium
19. Quinine
20. Potassium iodide
21. Silver nitrate
22. Spirits of ammonia
23. Sulfuric acid
24. Tannic acid
25. Tartaric acid
26. Turpentine

XVI. Medicines in Common Usage During the Civil War- C.S. Army

These items were commonly found in Confederate Army medicine wagons:

1. Acetic acid
2. Adhesive plaster
3. Alcohol
4. Ammonia water
5. Arsenic oxide
6. Creosote
7. Digitalis
8. Ether
9. Hydrochloric acid
10. Morphine sulfate
11. Opium
12. Quinine sulfate
13. Rhubarb
14. Senna
15. Sugar
16. Sulfuric acid

Tom Pearson, Reference Librarian
Special Collections Department
St. Louis Public Library
1301 Olive Street
St. Louis, MO 63103

KILLED BY THE CURE: CIVIL WAR MEDICINE, PT. IV

XI. Nuns as Nurses

One female volunteer nurse noted that the plain, unornamented dresses she was required to wear “caused most people to mistake me for a nun.” Some of the women who volunteered to serve as nurses actually were nuns, including 300 Daughters of Charity of St. Vincent de Paul (1/3 of the order’s total membership at the time).

XII. Employment Status of Female Nurses

By war’s end, at least 5,000 women had volunteered to serve as nurses in Union Army hospitals. Nurses served in one of these ways:

1. As paid volunteers arranged on the local level.
2. As unpaid volunteers arranged on the local level.
3. Wives and daughters of medical personnel sometimes served as nurses, without pay but drawing daily rations from the Union Army.
4. Female relatives of wounded men sometimes stayed on after their relative recovered or passed on, having no formal assignment but helping out as needed.
5. As employees of State agencies or aid societies like the U.S. Sanitary Commission.
6. As nurses specifically assigned to a hospital by the Superintendent of Female Nurses.

XIII. Famous Civil War Nurses

Two of the most famous Civil War nurses, Clara Barton and Mary “Mother” Bickerdyke, began their service as volunteer nurses without official government appointments. When someone asked Mother Bickerdyke by whose authority she served, she replied that she had “received my commission from Almighty God.” Since nobody chose to question His authority, she was allowed to continue her work. During the war she was formally commended by General Sherman for her tireless efforts to aid injured soldiers. Miss Barton became famous for her post-war efforts to help people find missing soldiers.

XIV. Civil War Nurses- Postwar Experiences

Much is made of the liberating effect employment in World War II industries had on American women, but little is made of the liberating effect that employment as Civil War nurses had on women North and South. Women who worked as nurses experienced freedoms and responsibilities many had never encountered in their pre-war occupations. Once the war ended, their brushes with the outside world were not easily forgotten. Many such women later played important parts in the women’s suffrage movement.

Tom Pearson, Reference Librarian
Special Collections Department
St. Louis Public Library
1301 Olive Street
St. Louis, MO 63103

Copyright © 2009 by St. Louis Public Library.

KILLED BY THE CURE: CIVIL WAR MEDICINE, PT. III

Copyright © 2009 by St. Louis Public Library.

VIII. Civil War Nurses

Female nurses were a most uncommon sight in American medicine prior to the Civil War. Men performed most of the duties we commonly associate with nurses. Florence Nightingale and her Corps of Female Nurses, who were employed by the British during the Crimean War in the 1850s, had fired the imaginations of American women, however, many of whom eagerly volunteered their services to the Union Army Medical Corps.

IX. Dorothea Dix

A flood of applications by women to work as volunteer nurses in Union Army hospitals brought about the appointment of Miss Dorothea Dix, who was already well-known for her pre-war work in the reform of insane asylums, as Superintendent of Female Nurses by the Director of the Union Army Medical Corps in 1861.

Miss Dix decreed that volunteer female nurses should be “plain-looking, mature” women who had to dress in simple brown or black dresses. They were not to wear bows or jewelry, have curls in their hair, or wear hoops in their skirts.

X. Appearance of Female Nurses

Most women greatly disliked Miss Dix’s strictures on age, appearance, and dress, and many violations of her rules occurred. One volunteer female nurse noted that “never before have so many American women attempted to appear older than their natural years.” Attractive women did what they could to disguise their looks until appointed, then reverted to their normal appearances.

Many women “felt naked” without the hoop skirts then in fashion, and wore them in spite of Miss Dix’s prohibition. In at least one documented case, a hoop skirt caught in a soldier’s surgical dressing and opened the wound, causing his death due to hemorraging.

Tom Pearson, Reference Librarian
Special Collections Department
St. Louis Public Library
1301 Olive Street
St. Louis, MO 63103

KILLED BY THE CURE: CIVIL WAR MEDICINE, PT. II

Copyright © 2009 by St. Louis Public Library. This publication may not be reproduced or republished without prior written permission of the St. Louis Public Library.

V. Civil War Medical Personnel

Civil War medical personnel included:

Military: Surgeons, Assistant Surgeons, & soldiers detailed as Hospital Stewards and Orderlies (during battles, Musicians served as stretcher-bearers)

Civilian: Contract surgeons, nurses, hospital stewards, druggists, matrons, cooks, laundresses, and manual laborers (both sides employed some black persons as cooks, laundresses, and manual laborers)

VI. Training of Doctors at the Time of the Civil War

Doctors of that era trained in one of two ways:

1. By apprenticing themselves to a practicing doctor. Doctors trained in this way could only be as good as the doctor who trained them, as there were no licensing boards to guarantee their medical knowledge and surgical skills.

2. Attend a medical school. This involved two years of schooling. Each year consisted of a six-month course of study- the second year was an exact repeat of the first year’s coursework! Prospective new doctors generally had no surgical experience, beyond observation of operations.

VII. Doctors in the Armies of the U. S. A. and the C. S. A.

When the Civil War began, there were 115 doctors in the regular army who took care of the army’s 15,000 soldiers. 27 of these men resigned their commissions toenter the Army of the C.S.A. Thus, both the U.S.A. and the C.S.A. began the war with fewer than 100 doctors to care for their armies.

By war’s end, the U.S. Army had more than 13,000 doctors in the field and in its general hospitals; the Army of the C.S.A. at its height had approximately 3,300 doctors serving its cause in the field and in general hospitals like Chimborazo in Richmond, Virginia.

Tom Pearson, Reference Librarian
Special Collections Department
St. Louis Public Library
1301 Olive Street
St. Louis, MO 63103

KILLED BY THE CURE: CIVIL WAR MEDICINE, PT. I

Copyright © 2009 by St. Louis Public Library. All rights reserved.

I. Civil War Military Hospitals

When the Civil War broke out, there were no official United States military hospitals. Each Army regiment had its own hospital, which was staffed with a surgeon, and two assistant surgeons. Equipment consisted of medical supplies, at least one ambulance, and a number of tents. If a regiment found itself with more sick and wounded men than it had beds for, nearby civilian buildings were temporarily used for that purpose.

It quickly became apparent that larger, more permanent hospitals would be necessary. They were called general hospitals because they could admit men from any regiment in its service region.

II. Hospitals in the North

Once the war began in earnest, both sides had to quickly acquire or build hospitals for the sick and wounded. By 1863, there were 151 general hospitals for soldiers in the North; by 1865 there were 204, which provided beds for 137,000 sick and wounded soldiers. The largest capacity Northern military hospital was Satterlee Hospital in Philadelphia, with a 3,519 bed capacity. Following close on its heels was the hospital at Fort Monroe, Virginia, which had a 3,497 bed capacity.

III. Hospitals in the South

The South also had to rapidly acquire places to put its sick and wounded men. By 1865, the South had 150 general hospitals for soldiers in operation. The largest by far was Chimborazo Hospital in Richmond, Virginia (so-called because of its location on Chimborazo Heights). This sprawling hospital complex had an 8,000 bed capacity, making it the largest military hospital by far in the North or the South.

IV. Hospital Acquisition

The need for more hospital beds was filled in one of four ways:

1. Use of army barracks as hospitals (layout and poor ventilation made most of them unsuitable for long-term use as hospitals).
2. Conversion of existing buildings in the civilian sector into hospitals (layout and poor ventilation also made many of these unsuitable for long-term medical use).
3. Tents could be pitched around hospitals to provide additional temporary bed space.
4. Construction of new buildings designed specifically as military hospitals

Tom Pearson, Reference Librarian
Special Collections Department
St. Louis Public Library
1301 Olive Street
St. Louis, MO 63103