Medical Improvements in the Civil War and Their Affect on Modern Military Medicine
Originally published in Spring/Summer 2010 in the Surgeon’s Call
Most of the major medical advances of the Civil War were in organization and technique, rather than medical breakthroughs. In August of 1862, Jonathan Letterman, the Medical Director of the Army of the Potomac, created a highly-organized system of ambulances and trained stretcher bearers designed to evacuate the wounded as quickly as possible. A similar plan was adopted by the Confederate Army. This system was a great improvement on previous methods. He established a trained ambulance corps, consolidated all of the ambulances of a Brigade, and created a system of layered levels of care for the wounded on the battlefield. The levels of care were small field dressing stations (usually directly on the battlefield), field hospitals (located in a safer place just beyond the battlefield), and a system of general hospitals in most large cities. Transporting the wounded men from one hospital to another was also coordinated. The Letterman plan remains the basis for present military evacuation systems.
A system of triage was established that is still used today. The sheer number of wounded at some of the battles made triage necessary. In general, the wounded soldiers were divided into three groups: the slightly wounded, those “beyond hope”, and surgical cases. The surgical cases were dealt with first since they would be the most likely to benefit from immediate care. These included many of the men wounded in the extremities and some with head wounds that were considered treatable. The slightly wounded would be tended to next, their wounds were not considered life-threatening so they could wait until the first group was treated. Those beyond hope included most wounds to the trunk of the body and serious head wounds. The men would have been given morphine for pain and made as comfortable as possible. After all others were treated, the surgeons would attempt to treat any of these hopeless cases that were still alive. Many did indeed survive. Remember, these were the days before antibiotics or the knowledge of germ theory, so abdominal surgery was rarely attempted since there were almost always fatal complications.
Hospitals became places of healing rather than places to go to die, as they were widely considered before the war. The large-scale hospitals set up by the medical departments had an astounding average death rate of only 9%. Large hospitals became much more accepted by the public after the war. Also, the introduction of women into the nursing profession had a great impact on medical care. Women nurses were first truly accepted during the war, mainly out of necessity. Although there was a great deal of prejudice against them, especially early on, surgeons came to see that their contributions went a long way in aiding the patients. Once they had an established place in medical care they would not give it up. Nursing as a profession was born.
Due to the sheer number of wounded patients the surgeons had to care for, surgical techniques and the management of traumatic wounds improved dramatically. Specialization became more commonplace during the war, and great strides were made in orthopedic medicine, plastic surgery, neurosurgery and prosthetics. Specialized hospitals were established, the most famous of which was set up in Atlanta, Georgia, by Dr. James Baxter Bean for treating maxillofacial injuries. General anesthesia was widely used in the war, helping it become acceptable to the public. Embalming the dead also became commonplace.
Medical technology and scientific knowledge have changed dramatically since the Civil War, but the basic principles of military health care remain the same. Location of medical personnel near the action, rapid evacuation of the wounded, and providing adequate supplies of medicines and equipment continue to be crucial in the goal of saving soldiers’ lives.
As has been the case throughout the history of military medicine, the lessons learned and the technical developments made by the military rapidly find their way into civilian applications. To this end, these medical breakthroughs eventually benefit all of society.
About the Author
Terry Reimer is presently the Director of Research the National Museum of Civil War Medicine in Frederick, Maryland. Previous work includes over twenty years of experience in historical archaeology and research, specializing in 17th, 18th and 19th century American sites. She holds a B.A. in Anthropology from the University of Maryland and did graduate work in anthropology and folklore studies at George Washington University. She is the author of two books, One Vast Hospital: the Civil War Hospital Sites in Frederick, Maryland after Antietam and Divided by Conflict, United by Compassion: The National Museum of Civil War Medicine, and the co-author of two other books, Bad Doctors: Military Justice Proceedings Against 622 Civil War Surgeons and Caleb Dorsey Baer: Frederick, Maryland’s Confederate Surgeon.