Civil War Medicine with a Focus on Missouri
Civil War Amputation Kit Image courtesy of the Civil War Museum at Wilson’s Creek National Battlefield
The medical establishments within the U.S. Army and the nascent Confederate Army were almost totally unprepared for either the scope or duration of the American Civil War. The peacetime U.S. Army had only 113 physicians to care for more than 16,000 personnel scattered across the country. The Army’s Surgeon General, Dr. Thomas Lawson, was unable to think beyond the needs of small, frontier post hospitals. Fortunately for the Union, the Medical Department entered a new era under a relatively junior physician, Dr. William A. Hammond, on April 25, 1862. The Confederate Medical department had to begin from scratch.
Contrary to popular belief, nineteenth century 1) ___ was not always crude and ineffective. Lack of preparedness was the foremost problem, and it was responsible for much otherwise unnecessary suffering. The Civil War brought important advances in both organization and technique. While shortages often crippled the Confederacy’s efforts, by the end of the conflict the medical treatment available to Union soldiers was probably the best in the world. It gave sick and injured 2) ___ a greater opportunity of recovery than in any previous war.
With the outbreak of war civilian doctors entered the ranks of the Northern and Southern forces in large numbers. While some had served only an apprenticeship with an experienced practicing physician, formal medical education was becoming common. Diploma mills existed, but so did an increasing number of respected medical 3) ___, such as the McDowell Medical College in St. Louis. By modern standards the curriculum in even the best schools was surprisingly brief lasting two years, with the second year being merely a repeat of the first. Not surprisingly, the quality of military surgeons differed considerably. Late in 1861 the U.S. Army Medical Department began giving examinations to weed out unqualified physicians. The Confederacy soon took similar and perhaps even more rigorous steps.
Education and peacetime practice did little to prepare 4) ___ to treat the mass casualties of war.
Missouri, being a divided state, had two governments during the Civil War.
The border troubles labeled “Bleeding Kansas” in the Eastern press gave Missouri a reputation for violence, yet prior to the Civil War relatively few physician within the state ever treated a gunshot wound or performed more than minor surgery, much less attempted the amputation of a limb. The same was true elsewhere. Moreover, once in uniform, few military surgeons considered it to be their duty to address the basic requirements to keep the men healthy to fight, such as proper sanitation, food, and shelter. Civilian organizations, often labeled “sanitary commissions,” sprang up to address these needs, but in Missouri the dynamics of the conflict limited these to the Union side. St. Louis became the center of the regional Western Sanitary Commission, as well as the local St. Louis Ladies Union Aid Society and parallel Colored Ladies Union Aid Society.
In Union and Confederate volunteer service, and in the Missouri State Guard, regulations authorized each regiment a surgeon, an assistant surgeon, a hospital steward with the rank of sergeant major, and several enlisted men serving as orderlies. Each morning at “sick call,” the surgeons listened to soldiers’ complaints and provided treatment. The steward was responsible for supplies and medicine chests. Orderlies were jacks-of-all-trades, men who showed an interest and aptitude in 5) ___ and were appointed by the surgeon. During combat the medical team set up a field hospital close to the action. The assistant surgeon usually manned an aid station treating wounded at the edge of the battlefield until they could be removed to the surgeon’s care at the field hospital. Near the end of 1861 the Union army began consolidating regimental hospitals into division and corps hospitals to handle larger bodies of troops more efficiently, but an Ambulance Corp was not formed until well into 1862. Prior to that wounded were brought from the field either by comrades or by musicians from the regiment’s band, if it had one.
Gunshots accounted for 94% of the recorded battle 6) ___. Injuries from artillery projectiles were less common, while bayonet and sword wounds were quite rare. The most common wounds were to the extremities, with almost equal involvement of the arms and legs. In combat involving muzzle-loading weapons, limbs often remained vulnerable even when a soldier fired from a protected position. Non-extremity wounds almost always resulted in death on the battlefield. Penetrating gunshots to the abdomen or head were about 90% fatal, those to the chest about 60%.
Contrary to myth, Civil War doctors did not perform excessive numbers of 7) ___ because they were ignorant of, or unwilling to consider, alternatives. Doctors usually performed amputations in cases involving the penetration of a joint, a compound fracture, substantial tissue or bone destruction, or evidence of infection (gangrene). They had to consider the fact that survival rates were much greater when amputations were performed within the first twenty-four hours of injury. This was called primary amputation. Secondary amputations were performed after the 24 hour period and resulted in higher mortality and morbidity caused by bacteria having more time to enter the open wound. Surgeons were aware that the presence of foreign material such as wadding, clothing fragments, or dirt in wounds increased the likelihood complications. Tragically, it was not until just after the war ended that European physician Joseph Lister, using the work of Louis Pasteur, demonstrated the role that 8) ___ played in wound infection, too late to save the lives of tens of thousands of men in uniform.
One of the war’s most important advances was the popularization of anesthesia. Military surgeons employed ether and chloroform, which had first come into use at the time of the Mexican War, 1846-1848. Both drugs had drawbacks. Highly flammable ether, which took sixteen minutes to take effect, posed a danger when operations were performed by candle or lantern light. Chloroform was nonflammable and worked in about nine minutes, but improper application could result in death. During those nine minutes the patient passed through an excitable stage and might need to be restrained. The process was poorly understood by laymen observers and led to the myth that many operations were performed without any anesthetic at all, which was rarely the case. Recovering patients received either morphine or opium, which were effective painkillers but 9) ___.
Although more than a thousand military engagements occurred in Missouri, disease killed over twice as many men as bullets. Infections spread rapidly in overcrowded camps. Measles, mumps, rubella, and chicken pox ran rampant, particularly among newly-enlisted soldiers from rural areas who lacked immunities from prior exposure. But even more fatalities resulted from dysentery and diarrhea contracted due to unsanitary conditions. The Western Sanitary Commission worked tirelessly throughout the war to improve conditions in camps, hospitals, and prisons. Science largely ignorant of the cause of diseases and most medications were ineffective. Malaria was the only major disease combated successfully, being treated with 10) ___, a drug made from the bark of the Peruvian Cinchona tree.
Physician, Major Martin R. Delany
“Once let the black man get upon his person the brass letter, U.S., let him get an eagle on his button, and a musket on his shoulder and bullets in his pocket, there is no power on earth that can deny that he has earned the right to citizenship.” – Frederick Douglass
Missouri was the first State to see Colored Troops in combat. Only men ages 18 to 45, of good health and physical condition could enlist in the U.S. Colored Troops. Before December 1863, Missouri slaves of loyal masters needed consent before enrolling. The first colored regiment organized in the State of Missouri was the 3rd Arkansas Infantry (African Descent). It was composed of primarily Missourians but because of prejudice the State did not want to claim them as their own. The unit was composed of freemen and slaves of masters loyal to the Union. They began recruitment on shortly after May 22, 1863 and were organized Aug 12, 1863 at Schofield Barracks, St. Louis, Mo. They were re-designated the 56th U.S. Colored Troops on March 11, 1864. Most of their service was garrison duty at Helena, Arkansas but they did go on two nearby expeditions. The regiment lost a whopping 674 men; 25 killed; 649 died of disease. It remained on duty at Helena till mustered out, Sept. 15, 1866. “Nearly 40,000 black soldiers died over the course of the war – 30,000 of 11) ___ or disease.”
In June 1864 Congress granted equal pay to the U.S. Colored Troops and made the action retroactive. Black soldiers received the same rations and supplies. In addition, they received comparable 12) ___ care. Colored Troops had separate hospital wards at Benton Barracks. Nurses were staffed by the Colored Ladies Union Aid Society.
Not all the troops at Benton Barracks experienced good treatment from the government. Lt. Col. William F. Fox, U.S.V. reported that for the 2nd Missouri Colored Infantry, “Over 100 men died at [Benton] Barracks before the regiment took the field, the men having been enlisted by the Provost-Marshals throughout the State and forwarded to this Post during an inclement season,– thinly clad, and many of them hatless, shoeless, and without food. Many suffered amputation of frozen feet or hands, and the 13) ___ engendered by this exposure resulted in a terrible and unprecedented mortality.” In wartime Missouri, no matter what Congress says, there were no guarantees for former slaves.
The highest ranking black was Martin R. Delany, commissioned a Major and “graduate of the Harvard Medical School and the first Negro field officer to serve in the Civil War.” He served in the 104th Regiment U.S. Colored Troops. [The New York Times, Mar.1, 1865]
Lincoln University of Missouri (Jefferson City) was founded in 1866 by officers and men of the 62nd and 65th U.S. Colored Troops.
ANSWERS: 1) military; 2) soldiers; 3) schools; 4) physicians; 5) nursing; 6) wounds; 7) amputations; 8) bacteria; 9) addictive; 10) quinine; 11) infection; 12) medical; 13) diseases
Physician, Major Martin R. Delany