Battlefield Medical Care

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One of my passions is the study of history, more specifically Civil War history, and the history of medicine. Medicine and the Civil War are intertwined in many ways. Following the Battle of Gettysburg, Union surgeon Bushrod James wrote “No written nor expressed language could ever picture the field of Gettysburg! Blood! Blood! And tattered flesh! Shattered bones amid mangled forms almost without the semblance of human beings! Faces torn and bruised and lacerated.” In total, that one battle saw upwards of 51,000 casualties and 7,000 dead. The carnage was so massive in part because of technological advances in weaponry. Prior to the Civil War, opposing sides had to be very close to each other in order to inflict damage on the other side. Guns were smooth bore muskets that fired round lead balls. They were very inaccurate at more than 10 or 15 yards. Napoleonic battlefield tactics consisted of opposing lines of men who fired two volleys at each other, followed by a bayonet charge. Thus, wounds were mostly of a stabbing and slashing nature. The Minie ball changed all that. Designed in 1849 by French Army Captain Claude-Etienne Minie, it was conical with a concave bottom. It increased both the accuracy and distance of a musket. Its wounds were devastating. The lead minie ball would flatten on impact, smashing through tissue and splintering bone. As a result, Civil War wounds consisted of only 5% stabs and slashes, 85% minie ball wounds, and 10% artillery wounds, which, due to the use of grape and canister shot at close range, were devastating.

Battlefield casualty care made great advances during the Civil War, especially on the Union side. In 1862 at the Battle of Fort Donelson, Union General U.S. Grant had his chief surgeon, Henry Hewitt, move regimental surgeons and their stations up to the front, at times only yards away from the fighting. Another of Grant’s surgeons, Bernard John Dowling Irwin, realized that too many wounded men were dying on their trip north to hospitals. He established the first true field hospital, using captured rebel tents and organizing them into treatment, surgery, and recovery areas. This allowed the wounded to recover sufficiently before their trip to a hospital. Survival rates soared. Union Major Jonathan Letterman took lessons learned from Hewitt and Irwin and established the first integrated battlefield medical evacuation system. At Gettysburg, the Union Army had more than 650 medical officers and over 1,000 ambulances. Letterman had each division contain a medical director who ensured that every division had at least one fully staffed field hospital with aid stations based as close to the battle as possible.

Unfortunately, the actual medical care the soldiers received was very poor (by our standards) because modern surgical and infection control procedures had yet to be discovered. Any limb wound was treated by amputation with the surgeon using the same instruments from patient to patient. Often, in order to save time, the surgeon held the bone saw in his teeth. Gangrene and sepsis were common. Ether and chloroform were both available and widely used, at least on the Union side. Pain control used morphine, opium, and whiskey.

For more information you can visit the National Museum of Civil War Medicine in Fredrick, Maryland. www.civilwarmed.org 

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 By Peter Galvin, MG

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