Shortages of vital medical supplies plagued the South until the end, including shortages of quinine and anesthetics. Paradoxically, these shortages sometimes produced beneficial if unexpected results. It had been the common practice on both sides to cleanse wounds with sea sponges kept in buckets of water next to the operating table. Squeezed in dirty water and used repeatedly, these sponges became major sources of infection transmission. The shortage of sponges in the South as a result of the Union blockade forced Confederate surgeons to use cotton rags instead. Since the rags were used only once, disease transmission was reduced considerably.
The used rags were recycled, a process that required them to be washed, boiled, and ironed, and thus made sterile. Bandages, too, were better in the South since they were made of cotton that had first to be baked to be made useable. It had been common practice to use harness-maker’s silk for ligatures and sutures. With no silk available, Southern surgeons used horsehair instead. To make horsehair pliable enough for suturing, it first had to be boiled. Boiling made the suture material sterile.
The South recognized dentistry as an important medical specialty. As secretary of war before hostilities broke out, Jefferson Davis had tried to convince the army to establish a separate dental corps, but had failed to do so. The South had a more comprehensive dental care program than the North, which contented itself with transferring to the artillery any toothless soldiers who could not bite off the ends of their cartridge packets.
Medical Personnel Become Noncombatants
The Confederacy’s general hospital system was perhaps the only element of the military medical service that was somewhat equivalent to the system in the North. The largest hospital on either side was the 8,000-bed Chimborazo Hospital outside of Richmond. With 150 single-story pavilions organized into five divisions, each with 40 to 50 surgeons and assistant surgeons per division, it was the largest military hospital ever built in the Western world. The pavilion-style hospital proved to be the best design for reducing infection by improving ventilation and isolation. These hospitals consisted of a series of long, single-story buildings isolated from each other. High ceilings with vents at the top and sufficient windows provided ventilation. Usually connected to a central semicircular corridor, these 60-patient buildings were sometimes unconnected, providing excellent isolation for disease wards. The pavilion-style hospital is generally credited to Dr. Samuel Moore, the Confederate surgeon general, who supposedly got the idea from British hospitals used in the Crimea. In fact, the design is actually much older and reflects the design of legion camp hospitals used by the Roman medical service.
One of the more significant military medical contributions of the South is attributed to Lt. Gen. Thomas “Stonewall” Jackson. In 1862, Jackson ordered all Union medical officers held by his command to be released and henceforth treated as noncombatants. By June of that year, both Lee and McClellan agreed to a similar practice. Medical personnel were no longer to be subject to capture. If taken, they were to be allowed to treat their wounded and immediately released. All medical personnel held in Union and Confederate prison camps were freed in 1862, and exchanges of captured medical personnel continued until the end of the war. Jackson had instinctively anticipated the regulations dealing with medical personnel that were adopted by the First Geneva Convention a few years later.
Medical Advances of the Civil War
A number of advances in military medicine resulted from the Civil War. Hammond created the Army Medical Museum to collect and study artifacts and information relevant to military medical care. John Shaw Billings began the Library of the Surgeon General’s office which remains the largest military medical library in the world. Congress established a pension system for disabled soldiers far more generous and comprehensive than anything seen in Europe at the time. The pension system was chosen over the asylum system of permanent care because it provided the disabled soldier with more freedom and mobility. For the first time an accurate medical records system was created that made it possible to track casualty records for every soldier. One consequence was the publication of the massive Medical and Surgical History of the War of the Rebellion, which remains the standard against which all such works are judged.
The Civil War saw the development of the first effective military medical system for dealing with mass casualties, including aid stations, field and general hospitals, ambulance and theater-level casualty transport, along with an effective staff to coordinate it. For its time it was the best military medical system ever deployed, and it remained a model for other countries for decades. The introduction of the pavilion-style hospital was so effective in reducing disease mortality that it became the standard design for both military and civilian hospitals for the next 75 years. Wide use of anesthesia, primary amputation, the splint, and debridement (cutting away dead tissue) were the first effective methods of wound management in the modern age. These techniques, taught to thousands of physicians through hard experience, were carried back to civilian life, elevating the general level of medical care available to the nation as a whole.
The prevalence of facial injuries encountered during the war stimulated the development of the new medical specialty of plastic surgery. Civil War surgeons performed six reconstructions of the eyelid, five of the nose, three of the cheek, and 14 of the lip, palate and other parts of the mouth. Dr. Gordon Buck performed the first total face reconstruction in history. Joseph Woodward, another war surgeon, became the first person to link the new technology of the camera to the microscope, and he published the first microphotographs of disease bacteria. He is also credited with the technique of using analine dyes to stain tissues for microscopic analysis. The advent of microphotography served to make the American military medical establishment receptive to the germ-fighting discoveries of Pasteur and Lister when they came along a few years later.
Despite the terrible slaughter and suffering that it caused, the Civil War ironically marked one of the most progressive periods in the history of military medicine. That it came at a cost of hundreds of thousands of ruined lives and shattered families goes without saying.
This article by Richard A. Gabriel first appeared in the Warfare History Network on September 22, 2016.
Image: Civil war doctor. June 8, 2008. Flickr/Rennett Stowe. Creative Commons Attribution 2.0 Generic (CC BY 2.0)