Civil War Medicine Lesson Plan | Civil War Trust

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Identifies facts and fictions about Civil War medicine.
MEDICAL 1 620,000 soldiers died during the Civil War. Two thirds died of disease, not wounds.

WHY? Poor Hygiene

Civil War soldiers didn’t get a daily shower. Also, they used the same few pots to cook food and to boil lice-infested clothing. Yummy!

Garbage in Camp

You couldn’t put the trash on the curb every week, could you?

Filth from Camp Sinks

Latrines were often dug too close to streams, which contaminated the water supply. Imagine drinking from the school toilets every day.

Overcrowding

Close contact with other people caused diseases to spread rapidly.

Exposure to all types of weather

Extreme hot and cold; rain, sleet, snow; dust and mud…. Exposure to the elements lowers your body’s ability to resist disease.

Improper and inadequate diet, spoiled food Staple foods were hardtack for Union soldiers and cornbread for Confederates. Fresh fruit and vegetables were rare. Soldiers received some meat, but, often, it spoiled or too full of preservatives to eat. More later. “Bugs”

Flies, mosquitoes, ticks, lice, maggots, and fleas were abundant and carried disease. Lack of medical knowledge People didn’t know about “germs” and how they were spread. Doctors didn’t wash their hands before operating, or clean tools after each patient.

Lack of surgeons

There were too few surgeons to handle the huge numbers of sick and wounded. Lack of immunity to diseases Many rural soldiers became sick because for the first time they were in a large group of people and had no immunity to diseases such as chickenpox, smallpox, scarlet fever, measles, mumps, and whooping cough. These epidemics ran rampant through many regiments.

Impure water

If a stream looked and smelled good, it was assumed that the water was good. Not always true!

From National Museum of Civil War Medicine Wood tick illustration from Hardtack and Coffee: The Unwritten Story of Army Life by John D. Billings. Illustrated by Charles W. Reed

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MEDICAL 2

What diseases did soldiers get?

✔SOME THINGS TO CONSIDER How many of these diseases have YOU had? Have you ever known anyone with any of these diseases? Why or why not?

Dysentery

Number one killer during the Civil War. Victims get severe diarrhea with passage of mucous and blood.

Typhoid fever

“Camp Fever” – Number two killer, at ¼ of disease deaths. This disease is caused by any of several bacteria. It is very severe, and causes a high fever, intense headache, intense rash, and delirium. Body lice transmit it.

Pediculus Vestimenti. Illustration from Hardtack and Coffee: The Unwritten Story of Army Life by John D. Billings. Illustrated by Charles W. Reed

Ague

Pronounced “AY-gyu”. A bad fever with a cycle of chills and sweating. Also, “swamp fever.”

Yellow Fever

Caused by a virus, this disease is carried by a specific mosquito and can be fatal.

Malaria

“Shakes” – spread by mosquitoes.

Scurvy

Disease caused by a lack of vitamin C. The gums get spongy; teeth become loose, and mucous membranes begin to bleed.

Pneumonia

Disease causing inflammation of the lungs.

Tuberculosis

A very contagious disease that is caused by a bacteria. It mainly affects the lungs.

Smallpox

An extremely dangerous, contagious disease caused by a specific virus. It causes a fever and “bumps” similar to chickenpox. Supposedly, in the 20th century, this disease was wiped out by global vaccinations. However, during the Cold War, both the United States and the former Soviet Union cultivated the smallpox virus for possible use in “germ warfare.”

Other

chicken pox, scarlet fever, measles, mumps, and whooping cough

The chart above doesn’t even count the infections and gangrene that were common with wounded soldiers!

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MEDICAL 3

Hospitals and Medical Knowledge Imagine you’re in gym class. You and your friend are running the 100-meter dash. Suddenly you both trip and skin your knees – badly. You roll around in the dirt, and then you don’t wash your wounds. Obviously, your knees get really, really infected and they start to ooze. Next day you both go to the school nurse. She determines that your oozing wounds aren’t that bad. In fact, she takes a cotton swab and transfers some of the “ooze” from your knee to your friend’s knee so it will get better faster. Wait a minute! Yuck! Why would she do that? During the Civil War, the experience and training of doctors wasn’t well regulated. The Union Army only had 98 doctors registered and the Confederacy had only 24 (Tenting Tonight, 79). Therefore, both armies were willing to take anyone who considered himself a physician. Most of these new doctors carried around a copy of a military surgery manual that had been written by Dr. Samuel Gress. Can you imagine being operated on by a man who had just read the directions? Infection was a huge problem. And, to make matters worse, doctors thought pus was a good sign (they called it laudable pus), and they transferred it from patients who had it to those who didn’t. So, they infected another patient (Tenting Tonight, 79).

Surgeons operating in a Federal hospital tent during the siege of Charleston, 1863. Massachusetts Commandery, Military Order of the Loyal Legion and the US army Military History Institute.

Doctors didn’t understand germs or how they were carried and spread. As a result, they violated nearly every rule of sterile technique that doctors use today. A doctor’s assistant wrote, It was common to see a doctor with his sleeves rolled up to his elbows, his bare arms as well as his linen apron smeared with blood and his knife…held between his teeth (Sabiston and Lyerly, 6). Infection and disease was so widespread that soldiers didn’t have much faith in doctors. Sometimes soldiers felt that limbs were amputated needlessly – or they simply didn’t want to have their arm or leg cut off (why not?). One such corporal drew his revolver on a doctor, saying, The man that puts a hand on me dies (Hardtack and Coffee, 310)!

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Amputation At the field or tent hospitals (which were close to battle lines and in range of bullets and shells) surgeons used their fingers to search for bullets and tried their best to control bleeding. And, believe it or not, three-fourths of a surgeon’s time was spent amputating limbs (Tenting Tonight, 33). Most wounds suffered by Civil War soldiers were to the arms and legs. An Army of Tennessee surgeon wrote that the shattering, splintering and splitting of a long bone by the impact of the Minie? or Enfield ball were, in many instances, both remarkable and frightful, and early experience taught surgeons that amputation was the only means of saving life (Tenting Tonight, 92). Amputation was the wounded soldier’s best chance of survival. Union soldiers suffered 174,000 extremity wounds (arms and legs). Of these, 30,000 resulted in amputations. (Tenting Tonight, 92) Three-fourths of the amputees survived (Tenting Tonight, 92). The sooner the amputation was performed, the better the chance of survival. If amputation was delayed more than 48 hours, blood poisoning, bone infection, or gangrene would set in, and the death rate would double (Tenting Tonight, 92). This was a very painful way to die. It was actually best to amputate within 24 hours (Museum of the Confederacy). Many doctors used anesthesia in the forms of chloroform and ether when they operated, especially near the end of the war. A patient’s chance of survival depended on how far the wound was from the trunk of the body.

Location Forearm Hip Joint

Fatality Rate 14% 88%

Museum of the Confederacy

When soldiers were wounded in battle, the Infirmary Corps carried the wounded to a forward aid station located within the lines of battle (Museum of the Confederacy). There, an assistant surgeon would give the soldier alcohol and painkillers and would try to stop the bleeding by packing the wound with lint and bandaging it. (Lint was obtained by scraping linen fabric. Think of the junk that collects on the filter of your clothes dryer.) If the bleeding would not stop, a tourniquet would be applied. This would stop the flow of blood to the limb, which meant that the limb would have to be amputated. Next, the wounded soldiers would be transported by ambulance to a field hospital, which was a short distance behind the lines.

Douglas Hospital, Washington D.C. with hospital tents outside to accommodate the overflow of the wounded. Massachusetts Commandery, Military Order of the Loyal Legion and the US army Military History Institute. 178

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MEDICAL 4 At the field hospital, the operating table was often a barn door supported by two barrels or similar objects. Doctors wore no masks or caps to tuck their hair under. There were no gowns – just an apron. The “operating table” was probably not cleaned after each patient – so it would be covered with blood and filth.

What was it like to have a limb amputated? T.D. Kingsley, a Union colonel: The surgeons used a large cotton press as their butchering room & when I was carried into the building and looked about I could not help compar- A nurse tending to two Union soldiers in a hospital in Nashville, TN. Massachusetts Commandery, Military Order of the Loyal Legion and the US ing the surgeons to fiends. It was army Military History Institute. dark & the building lighted partially with candles: all around on the ground lay the wounded men; some of them were shrieking, some cursing & swearing & some praying…(Tenting Tonight, 92). William Blackford of the 1st Virginia Cavalry: Tables about breast high had been erected upon which screaming victims were having legs and arms cut off…the surgeons and their assistants, stripped to the waist and bespattered with blood, stood around, some holding the poor fellows while others, armed with long, bloody knives and saws, cut and sawed away with frightful rapidity, throwing the mangled limbs on a pile nearby as soon as removed…his men were soon overwhelmed by the prayers, the curses, the screams, the blood, the flies, the sickening stench of this horrible little valley (Tenting Tonight, 94).

What happened after the amputation? The solider was moved, by ambulance, to a hospital further from the fighting. This was a bumpy ride, and the soldier was already in horrible pain. From this point, the soldier was often moved by rail. In the winter, the rail car was freezing cold. On the long, horrible trip, there was no water and nothing to kill the pain. Infection was the number one cause of death after surgery. It was caused by tetanus (lockjaw), erysipelas (intense swelling of tissues caused by bacteria), gangrene (death of soft tissue), and pyaemia (blood poisoning caused by bacteria). That’s one reason for the creation of field hospitals; some surgeons performed amputations on the field of battle to try to increase the chance of survival.

Two-Wheeled Ambulance. Illustration from Hardtack and Coffee: The Unwritten Story of Army Life by John D. Billings. Illustrated by Charles W. Reed.

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MEDICAL 5

Beat the Odds: Civil War Wounds Here are three different situations. Using what you know about chances of survival, rank the wounded soldiers from “best” to “worst”. How will each soldier be treated for his wounds?

1. Colonel Abner Morgan is a wounded Confederate cavalry officer. He was shot through the left leg, wounding his horse as well. The wounded leg was shot through the calf. He is bleeding very heavily.

2. Private Frank Weaver is from the 129th Pennsylvania. He was wounded with a bullet piercing his abdomen. It entered the left front and shot through to the back.

3. Private Clark Hannah is from the 87th Indiana. He was wounded in the right leg, in the thigh, just below the hip.

Wounded soldiers in a crowded hospital. Courtesy of the National Archives, NWDNS-111-B-286

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