Health and Medicine Overview

Twenty-first-century Americans are likely to react with horror when reading about or—worse still—seeing graphic depictions of medicine as it was practiced during the Civil War. For those who have grown up taking for granted the best medical care history has yet known, the standards of care and the level of ignorance of Civil War medical men are indeed a shocking contrast. Yet the physicians of the mid-nineteenth century were not fools, and the surgeons of the Civil War armies were not—for the most part, at least—uncaring and incompetent quacks. During the war years, dedicated medical personnel applied themselves diligently to repairing the damage war had wrought and made real progress in that direction. On the civilian front, throughout the nineteenth century the medical profession made steady progress in combating the many ills to which human flesh is heir, and a measure of its success can be seen in steadily rising average life expectancies.

For the average modern student of the war the limitations of Civil War medicine are perhaps most vividly pictured by the typical army surgeon's medical instrument kit, in which the most prominent object was a large bone saw. Surgeons of the day plied such saws actively in cutting through bones as part of the operation of amputating a limb. Amputations were appallingly common during the war, and numerous accounts of major battles tell of steadily growing piles of severed limbs outside the field hospitals where the surgeons were hard at work. Adding to the horror of the scene, supplies of anesthesia might well run out before the midway point of a major battle, and subsequent amputations were performed with the aid of several burly male nurses pinioning the screaming patient to the operating table.

The prevalence of amputation was not, however, entirely a factor of medical incompetence. Civil War rifles fired large slugs, usually about 0.58 of an inch in diameter, made of soft lead. Traveling at low velocity, such a slug would carry bits of soiled clothing with it into the body, starting the process of infection at the moment of wounding. Upon striking a bone, the slug would flatten and shatter the bone rather than pierce it cleanly. The resulting mass of splintered bone and mangled flesh would present severe challenges even to modern surgeons trying to save a limb. Even if the bone could be set, the infection that often followed such a wound often proved fatal to the patient, and the only way to be sure of removing all of the infection was to remove the area of damage. Numerous accounts tell of wounded soldiers who steadfastly refused amputation only to die of gangrene or blood poisoning several weeks later. Generally for a shattered limb, amputation was the only reasonable treatment and proved to be a life-saving one in many cases.

That amputation was not more effective than it was in saving life was due to what was probably the greatest shortcoming of the Civil War medical profession: an all but complete ignorance of germs and of antiseptic practices. Surgeons did not realize that they were spreading infection by using unsterilized instruments in one operation after another. Often during a major battle, Civil War surgeons came to look more like butchers than physicians, wiping their bone saws on their aprons before starting the next amputation. Infection of the stump could often follow and sometimes proved fatal. Still, odds of survival were better for amputees than for those with shattered limbs who refused the procedure.

Civilians, of course, rarely had to face the horrors of amputation. Yet disease could and frequently did carry off Americans of any age group living in any part of the country, and medical care could be as inadequate on the home front as it was on the battle fronts. Cholera and typhoid were common and deadly diseases throughout the United States during this period. It was typhoid that took the life of Lincoln's favorite son, Willie, in February 1862. Small pox was not yet extinct and still took many lives, as did a host of other maladies. Doctors did what they could, but the medicines of the day could be as bad as—or worse than—the diseases they were supposed to cure. Many mid-nineteenth-century medicines were purgatives, since the medical wisdom of the day held that sickness might be cured by purging impurities from the system. Among the worst was mercury calomel, which was not only a diuretic but also a poison. Mid-nineteenth-century medical men were not oblivious to the fact that the calomel they prescribed did not necessarily produce the desired results in many of their patients, so they took the logical step and began prescribing much larger doses.

The Conquest of Pain

One of the most noteworthy medical advances of the nineteenth century—the discovery and use of reliable general anesthetics—took place in the 1840s, less than two decades before the Civil War. Prior to the introduction of ether and chloroform, surgery (including dental extractions) and childbirth were dreaded ordeals.

Chloroform, also known as methyl trichloride, was discovered in 1831 by Samuel Guthrie (1782-1848), an American physician, and rediscovered independently in 1832 by Eugene Soubiran, a French chemist, and Justus von Liebig, a German professor. Guthrie's method of synthesizing chloroform was relatively simple; it involved mixing chlorinated lime with whiskey. The compound was known locally as "Guthrie's sweet whiskey." Diethyl ether, first synthesized by the German Valerius Cordus in 1540, was known to have anesthetic properties but was not used in surgery until 1842. In March of that year, Crawford Long (1815-1878), a physician practicing in Georgia, used ether to anesthetize a patient in order to remove a cancerous tumor from his neck. Ether was also used in the mid-1840s for dental surgery.

The most important use of both anesthetics from the standpoint of the civilian population in those last years before the Civil War, however, was the relief of pain in childbirth. Dr. Long began to use ether to help women in childbirth shortly after his successful 1842 operation; in fact, when he died in 1878, he was on his way home after delivering a baby.

The use of either anesthetic to ease the pain of delivery was controversial in the 1840s, however. Dr. Long was accused of witchcraft by some Southerners and of disturbing the natural order by others. Many people interpreted Genesis 3:16 as implying that easing the pain of childbirth by administering anesthesia is contrary to God's will. When the Scottish obstetrician James Young Simpson (1811-1870) first administered chloroform to a woman in childbirth, he was criticized by some conservative clergy. The debate over the moral legitimacy of obstetrical anesthesia, however, was effectively ended in 1853, when Dr. John Snow (1813-1858)—a devout churchgoer—administered chloroform to Queen Victoria for the birth of her youngest son, Prince Leopold. Thereafter, women on both sides of the Atlantic were able to benefit from the use of anesthesia during delivery.

Neither drug was ideal, however. Ether is highly flammable and is easily ignited by an open flame, a spark, or even a hot metal surface. It also frequently causes nausea and vomiting when the patient recovers consciousness. Its chief advantage over chloroform is that it has a higher margin of safety (that is, the difference between a therapeutic and a toxic dose is greater). Chloroform, while nonflammable, requires a skilled anesthesiologist, as it is relatively easy to give a patient an overdose. In addition, chloroform has been known to cause liver damage and abnormal heart rhythms leading to death. Both compounds have been largely replaced by halothane, sevoflurane, and other modern inhaled anesthetics; nevertheless, for civilians and soldiers alike during the Civil War, these first general anesthetics were truly "wonder drugs."

rebecca j. frey

BIBLIOGRAPHY

Keys, Thomas E. The History of Surgical Anesthesia. Rev. ed. New York: Dover Press, 1963.

Radford, Ruby L. Prelude to Fame: Crawford Long's Discovery of Anaesthesia. Los Altos, CA: Geron-X, 1969.

Not all of the doctors' ministrations were harmful though. Quinine is an example of a Civil War era medicine that was actually somewhat effective against malaria, although doctors prescribed it fairly freely for many sorts of diseases against which it had no discernable effect. Medical authorities also strove to design and build hospitals that were both comfortable and healthy for the sick and wounded soldiers and made great advances in the quality of hospital care. The giant Chimborazo Hospital in Richmond was the largest and most dramatic example, but a number of northern hospitals established during the war were at least equally good. Most physicians took their duties very seriously and worked steadily throughout the war years to improve the quality of their care. The experience gained by surgeons during the Civil War brought important improvements to both military and civilian medicine in the years that followed. Nevertheless, medical care presents one of the most striking contrasts between the everyday life of the mid-nineteenth century and that of the early twenty-first.

Steven E. Woodworth