Medicine in the American Civil War

The state of medical knowledge at the time of the Civil War was quite limited by 21st century standards. Doctors did not understand germs and did little to prevent infection. It was a time before antiseptics, and a time when there was no attempt to maintain sterility during surgery. No antibiotics were available, and minor wounds could easily become infected, and hence fatal. While the typical soldier was at risk of being hit by rifle or artillery fire, he faced an even greater risk of dying from disease.

Unidentified officer in the Confederate Medical Corps. From the Library of Congress Prints and Photographs division, Liljenquist Family Collection of Civil War Photographs

## Background

[edit]

French doctor Dominique Larrey made advances in military medicine during the 1789-1799 French Revolution and the 1800-1815 Napoleonic Wars. Conditions at military hospitals during the 1853-1856 Crimean War were improved by the British civilian volunteers led by Florence Nightingale and the British military doctor James Barry. Yet reforms in the care of wounded soldiers came slowly. A historical comparison gives some idea of the scale of casualties.

## Union

[edit]

Main article: Union (American Civil War) § Medical conditions

The hygiene of the camps was poor, especially at the beginning of the war when men who had seldom been far from home were brought together for training with thousands of strangers. First came epidemics of the childhood diseases of chicken pox, mumps, whooping cough, and, especially, measles. Operations in the South meant a dangerous and new disease environment, bringing diarrhea, dysentery, typhoid fever, and malaria. There were no antibiotics, so the surgeons prescribed coffee, whiskey, and quinine. Harsh weather, bad water, inadequate shelter in winter quarters, poor policing of camps and dirty camp hospitals took their toll.[1] This was a common scenario in wars from time immemorial, and conditions faced by the Confederate army were even worse.

When the war began, there were no plans in place to treat wounded or sick Union soldiers. After the Battle of Bull Run, the United States government took possession of several private hospitals in Washington, D.C., Alexandria, Virginia, and surrounding towns.[2] Union commanders believed the war would be short and there would be no need to create a long-standing source of care for the army's medical needs. This view changed after the appointment of General George B. McClellan and the organization of the Army of the Potomac. McClellan appointed the first medical director of the army, surgeon Charles S. Tripler, on August 12, 1861. Tripler created plans to enlist regimental surgeons to travel with armies in the field, and the creation of general hospitals for the badly wounded to be taken to for recovery and further treatment.[3] To implement the plan, orders were issued on May 25 that each regiment must recruit one surgeon and one assistant surgeon to serve before they could be deployed for duty. These men served in the initial makeshift regimental hospitals. In 1862 William A. Hammond became surgeon general and launched a series of reforms.[4] He founded the Army Medical Museum,[5] and had plans for a hospital and a medical school in Washington; a central laboratory for chemical and pharmaceutical preparations was created; much more extensive recording was required from the hospitals and the surgeons. Hammond raised the requirements for admission into the Army Medical Corps. The number of hospitals was greatly increased, and he paid close attention to aeration.[6] New surgeons were promoted to serving at the brigade level with the rank of major. The surgeon majors were assigned staffs and were charged with overseeing a new brigade-level hospital that could serve as an intermediary level between the regimental and general hospitals. Surgeon majors were also charged with ensuring that regimental surgeons were in compliance with the orders issued by the medical director of the army.[7]

In the Union skilled, well-funded medical organizers took proactive action, especially in the much enlarged United States Army Medical Department,[8] and the United States Sanitary Commission, a new private agency.[9] Numerous other new agencies also targeted the medical and morale needs of soldiers, including the United States Christian Commission as well as smaller private agencies such as the Women's Central Association of Relief for Sick and Wounded in the army (WCAR) founded in 1861 by Henry Whitney Bellows, and Dorothea Dix. Systematic funding appeals raised public consciousness, as well as millions of dollars. Many thousands of volunteers worked in the hospitals and rest homes, most famously poet Walt Whitman. Frederick Law Olmsted, a famous landscape architect, was the highly efficient executive director of the Sanitary Commission.[10]

Field hospital of the 3rd Division, 2nd Corps in Brandy Station, VA in 1864

States could use their own tax money to support their troops as Ohio did. Following the unexpected carnage at the battle of Shiloh in April 1862, the Ohio state government sent three steamboats to the scene as floating hospitals with doctors, nurses and medical supplies. The state fleet expanded to eleven hospital ships. The state also set up 12 local offices in main transportation nodes to help Ohio soldiers moving back and forth.[11]

Field hospitals were initially in the open air, with tent hospitals that could hold only six patients first being used in 1862; after many major battles the injured had to receive their care in the open. As the war progressed, nurses were enlisted, generally two per regiment. In the general hospitals one nurse was employed for about every ten patients.[12] The first permanent general hospitals were ordered constructed during December 1861 in the major hubs of military activity in the eastern and western United States.[13] An elaborate system of ferrying wounded and sick soldiers from the brigade hospitals to the general hospitals was set up. At first the system proved to be insufficient, and many soldiers were dying in mobile hospitals at the front and could not be transported to the general hospitals for needed care. The situation became apparent to military leaders in the Peninsular Campaign in June 1862 when several thousand soldiers died for lack of medical treatment.[14] Dr. Jonathan Letterman was appointed to succeed Tripler as the second medical director of the army in 1862 and completed the process of putting together a new ambulance corps. Each regiment was assigned two wagons, one carrying medical supplies, and a second to serve as a transport for wounded soldiers. The ambulance corps was placed under the command of Surgeon Majors of the various brigades. In August 1863 the number of transport wagons was increased to three per regiment.[15]

Patients in Ward K of Armory Square Hospital in Washington, DC in 1865

Union medical care improved dramatically during 1862. By the end of the year each regiment was being regularly supplied with a standard set of medical supplies included medical books, supplies of medicine, small hospital furniture like bedpans, containers for mixing medicines, spoons, vials, bedding, lanterns, and numerous other implements.[15] A new layer of medical treatment was added in January 1863. A division level hospital was established under the command of a Surgeon-in-Chief. The new divisional hospitals took over the role of the brigade hospitals as a rendezvous point for transports to the general hospitals. The wagons transported the wounded to nearby railroad depots where they could be quickly transported to the general hospitals at the military supply hubs. The divisional hospitals were given large staffs, nurses, cooks, several doctors, and large tents to accommodate up to one hundred soldiers each. The new division hospitals began keeping detailed medical records of patients. The divisional hospitals were established at a safe distance from battlefields where patients could be safely helped after transport from the regimental or brigade hospitals.[16]

Although the divisional hospitals were placed in safe locations, because of their size they could not be quickly packed in the event of a retreat. Several divisional hospitals were lost to Confederates during the war, but in almost all occasions their patients and doctors were immediately paroled if they would swear to no longer bear arms in the conflict. On a few occasions, the hospitals and patients were held several days and exchanged for Confederate prisoners of war.[17]

Both armies learned many lessons during the war. In 1886, the U.S. established the United States Army Hospital Corps. The Sanitary Commission collected enormous amounts of statistical data and improved the means of storing and accessing information for research.[18]

## Confederacy

[edit]

Captain in Confederate uniform with black cuffs indicating surgeon. From the Library of Congress Prints and Photographs division, Liljenquist Family Collection of Civil War Photographs Confederate Chimborazo Hospital in April, 1865 in Richmond, VA Dr. Edmund Lewis Massie of Trans-Mississippi Department, Medical Staff Confederate States Infantry Regiment

The Confederacy was quicker to authorize the establishment of a medical corps than the Union, but the Confederate medical corp was at a considerable disadvantage throughout the war primarily due to the lesser resources of the Confederate government. A Medical Department was created with the initial army structure by the provisional Confederate government on February 26, 1861. President Jefferson Davis appointed David C. DeLeon Surgeon General. Although a leadership for a medical corp was created, an error by the copyist in the creation of the military regulations of the Confederacy omitted the section for medical officers, and none were mustered into their initial regiments. Many physicians enlisted in the army as privates, and when the error was discovered in April, many of the physicians were pressed into serving as regimental surgeons.[19]

DeLeon had little experience with military medicine, and he and his staff of twenty-five began creating plans to implement army-wide medical standards.[20] The Confederate government appropriated money to purchase hospitals to serve the army, and the development of field services began after the First Battle of Manassas.[21] The early hospitals were quickly overrun by wounded, and hundreds had to be sent by train to other southern cities for care following the battle.[22] As a result of the poor planning, Davis demoted DeLeon and replaced him with Samuel Preston Moore. Moore had more experience than DeLeon and quickly moved to speed the implementation of medical standards. Because many of the surgeons in the regiments had been pressed into service, some were not qualified to be surgeons. Moore began reviewing the surgeons and replacing those found to be inadequate for their duties.[23]

Initially the Confederacy employed a policy of furloughing wounded soldiers to return home for recovery. This was a result of their lack of field hospitals and limited capacity in their general hospitals. In August 1861, the army began the construction of new larger hospitals in several southern cities, and the furloughing policy was gradually halted.[24] The earliest recruits for surgeons were required to bring their own supplies, a practice that was ended during 1862. The government began providing each regiment with a pack with medical supplies including medicines and surgical instruments.[25] The Confederacy, however, had limited access to medicinal supplies and relied on their blockade-running ships to import needed medicines from Europe, supplies captured from the North or traded with the North through Memphis. Anesthetics were not in as short supply as medical instruments, something highly prized. Field hospitals were set up at the regimental level and located in an open area behind the lines of battle and staffed by two surgeons, one being senior.[26] It was the responsibility of the regimental surgeons to determine which soldiers could return to duty and which should be sent to the general hospitals. There were no intermediary hospitals, and each regiment was responsible for transporting its wounded to the nearest rail depot, where the injured were transported to the general hospitals for longer-term care.[27] In some of the lengthier battles, buildings were seized to serve as a temporary secondary hospital at a divisional level where the severely wounded could be held. The secondary facilities were staffed by the regimental surgeons, who pooled their resources to care for the wounded and were oversaw by a divisional surgeon.[28]

## Ambulance system

[edit]

Ambulance drill being demonstrated at Headquarters Army of Potomac after the Battle of Antietam and the formation of the ambulance corps. (March 1864)

Before the formation of any organized ambulance system, a significant number of Union and Confederate soldiers lost their lives on the battlefield in wait for medical aid. Even if an army were able to overcome the shortage of ambulances, it was really the lack of organization that made it difficult to recover the wounded on the battlefield.[29] In some cases, those who manned the ambulances were corrupt and sought to steal from the ambulance wagon and the wounded passengers while in some situations they even refused to gather hurt soldiers.[30] With an insufficient number of ambulances performing assigned tasks, the wounded looked to their comrades to carry them to safety and in essence this removed many soldiers from the battlefield.[31] Owing to the overall lightness of the ambulance the ride was very uncomfortable for wounded soldiers, with the terrain being torn up by shells and explosions the ambulance at times would overturn further harming its passengers.[32] It was obvious that the ambulance system needed work for both the Union and the Confederate armies, yet only the Union would fully prosper in this area with the help of Dr. Jonathan Letterman and the beginning stages of the ambulance corps.

Letterman's revolutionary ideas dramatically improved both the ambulance and the ambulance system. With new designs the common Union ambulance was now composed of a 750 lb wagon that was powered by 2–4 horses and was made to carry 2–6 wounded soldiers. Other accessories that were standard for the improved ambulances included compartments to store medical supplies, stretchers, water, and even removable benches and seats to adapt to the number of passengers.[33] Letterman's ideas improved the ambulance system dramatically by setting standards to train the ambulance crew, by having routine ambulance inspections, and also by developing strategical evacuation plans to most efficiently save and transport fallen soldiers.[34] Letterman's system was so efficient that all wounded soldiers at The Battle of Antietam were removed from the battlefield and sent to care within one day so this new system saved thousands of Union lives.[35] Soon after The Battle of Antietam began the formation of the ambulance corps and while the Confederates were also working out a similar system their constant shortage of ambulances was not adequate enough to summon such an effective force as even some their ambulances came by capturing Union ambulances.[36]

## Soldiers

[edit]

Period painting of an American Civil War soldier, wounded by a Minié ball, lies in bed with a gangrenous amputated arm.

The most common battlefield injury was being wounded by enemy fire. Unless the wounds were minor, this often led to amputation of limbs to prevent infection from setting in, as antibiotics had not yet been discovered. Amputations had to be made at the point above where the wound occurred, often leaving men with stub limbs. A flap of skin was saved and stitched to the stump to cover the wound.[37] There were two types of amputations, primary and secondary. The primary amputation was done between 24 and 48 hours after the injury. The secondary amputation was done after a longer period of time, often because of infection.[38] During this time, there were two main methods of amputation, the flap method and circular method. The flap method was typically used when an amputation had to be done quickly. The bone was cut above flaps of skin and muscle, which were pulled together to close the wound. The circular method was a circular cut that only allowed a flap of surface skin to cover the wound. The flap method was more likely than the circular method to lead to gangrene, as the deep muscle tissue suffered from lack of circulation.[39] Approximately 30,000 amputations were performed during the Civil War.[40]

Patients were generally sedated prior to a surgical operation. The use of ether as general anesthesia started in 1846 and the use of chloroform in 1847.[41] Contrary to popular belief, few soldiers experienced amputation without any anesthetic. A post-war review by the U.S. Army Medical Department found that over 99.6% of surgeries performed by their staff were conducted under some form of general anesthesia. Surgeons preferred chloroform in field hospitals, while ether was more common relegated to general hospitals well beyond the range of fighting due to its explosive nature.[42] The most popular anesthetic agent was chloroform, accounting for more than 70% of all surgeries in the North according to a study in the Medical and Surgical History of the War of the Rebellion. Ether was more commonly used behind the lines because it required a heavier dosage, took longer to induce insensibility, and was highly flammable. In some cases, a blend of ether and chloroform was used to sedate patients.[43] When properly done, the patient would feel no pain during their surgery, but there was no structured system like the modern phases of anesthesia for gauging the proper dosage and depth of a patient's amnesia, analgesia, and muscle relaxation. In some cases, patients were insensible to pain, but did not experience amnesia. Stonewall Jackson, for example, recalled the sound of the saw cutting through the bone of his arm, but recalled no pain.[44]

Infection was the most common cause of death of injured soldiers.[45][46] Infection occurred for a variety of reasons. Surgeons would typically go from surgery to surgery without cleaning their equipment or their hands; surgeons would use sponges that they only rinsed in water on multiple patients. These practices caused bacteria to spread from patient to patient, from all surgical surfaces, and from the environment, which caused infections in many.[47]

The American Civil War was the first "modern war" in terms of technology and lethality of weapons.[48] "It was a conflict that prefigured our own time in its unanticipated scale and scope, in its incorporation of rapidly advancing technologies of firepower, transportation, and communication."[49] However it was simultaneously fought "at the very end of the medical 'Middle Ages.'"[50] Very little was known about the causes of disease, and so a minor wound could easily become infected and take a life. Battlefield surgeons were underqualified, and hospitals were generally poorly supplied and staffed. In fact, there were so many wounded and not enough doctors, so doctors were forced to spend only a little time with each patient. They became proficient at quick care. Some surgeons spent as little as 10 minutes on amputating a limb.[51] The most common battlefield operation was amputation. If a soldier was badly wounded in the arm or leg, amputation was usually the only solution.[citation needed] About 75% of amputees survived the operation.[citation needed]

A 2016 research paper found that Civil War surgery was effective at improving patient health outcomes.[52] The study finds that "in many cases [surgery] amounted to a doubling of the odds of survival".[52]

If a wound produced pus, it was thought that it meant the wound was healing, when in fact it meant the injury was infected. Specifically, if the pus was white and thick, the doctors thought it was a good sign. Roughly three in five Union casualties and two in three Confederate casualties died of disease.[citation needed]

## Women as nurses

[edit]

North and South, over 20,000 women volunteered to work in hospitals, usually in nursing care.[53] They assisted surgeons during procedures, gave medicines, supervised the feedings and cleaned the bedding and clothes. They gave a good cheer, wrote letters the men dictated, and comforted the dying.[54]

The Sanitary Commission handled most of the nursing care of the Union armies, together with the necessary acquisition and transportation of medical supplies. Dorothea Dix, serving as the commission's Superintendent, was able to convince the medical corps of the value of women working in 350 Commission or army hospitals.[55] A representative nurse was Helen L. Gilson (1835–68) of Chelsea, Massachusetts, who served in the Sanitary Commission. She supervised supplies, dressed wounds, and cook special foods for patients on a limited diet. She worked in hospitals after Antietam, Fredericksburg, Chancellorsville, and Gettysburg battles. She was a successful administrator, especially at the hospital for black soldiers at City Point, Virginia.[56] The middle-class women North and South who volunteered provided vitally needed nursing services and were rewarded with a sense of patriotism and civic duty in addition to the opportunity to demonstrate their skills and gain new ones, while receiving wages and sharing the hardships of the men.[57]

Mary Livermore,[58] Mary Ann Bickerdyke, and Annie Wittenmeyer played leadership roles.[59] After the war some nurses wrote memoirs of their experiences; examples include Dix, Livermore, Sarah Palmer Young, and Sarah Emma Edmonds.[60]

Several thousand women were just as active in nursing in the Confederacy but were less well organized and faced severe shortages of supplies and a much weaker system of 150 hospitals. Nursing and vital support services were provided not only by matrons and nurses, but also by local volunteers, slaves, free blacks, and prisoners of war.[61][62][63]

## Hospital Stewards

[edit]

Union hospital steward in uniform. Hospital stewards and surgeons in uniform at Harewood Hospital.

During the civil war the role of hospital stewards was integral to medicine in the civil war and the operation of hospitals. First becoming a role in the military medical field in the late 1700's to early 1800's, they were assigned very important tasks, taking the role of a pharmacists in the army, a term used and adopted later, and to generally act as hospital administrators. In addition to having to fill out the prescriptions for the people in the hospitals, they were also in charge of mixing and creating the drugs and medicine for the patients themselves.[64] As part of administrative duties they also had to keep inventory of the supplies and keep and make the medical records of the hospital.[64] Despite being such a necessary and vital part to hospitals, the numerous standards and requirements set for someone to be hired in this position were so high only a select few could become a steward. These included things such as being well educated in pharmaceutical practices, minor education in surgical procedures, be able to cook, the application of bandages, cups, and leeches.[64] These requirements went even further recommending that stewards be younger, intelligent and healthy men with good natures.[64] To ensure that candidates met their desired standards they gave potential candidates exams and checked for any previous experience in medical or medicinal fields. Ultimately, the selected candidates were men who scored the highest on the exams and had the experience working in the field before.[64] Because of this process to select the best candidates, hospitals would only ever have one or two stewards assigned to the entire building, leading to them being heavily overworked with their duties.

## Freed slaves and civilians

[edit]

Historian Leon Litwack has noted, "Neither white nor black Southerners were unaffected by the physical and emotional demands of the war. Scarcities of food and clothing, for example, imposed hardships on both races." Conditions were worse for blacks.[65] Late in the war and soon after large numbers of blacks moved away from the plantation. The Freedmen's Bureau refugee camps saw infectious disease such as smallpox reach epidemic proportions. Jim Downs states:

Disease and sickness had more devastating and fatal effects on emancipated slaves than on soldiers, since ex-slaves often lacked the basic necessities to survive. Emancipation liberated bondspeople from slavery, but they often lacked clean clothing, adequate shelter, proper food, and access to medicine in their escape toward Union lines. Many free slaves died once they secured refuge behind union camps[66][67]

## New Practices Adopted During the War

[edit]

Ignaz Semmelweis

Many new medicinal and medical practices were adopted during the civil war. One of such practices was the sterilization to clean and sanitize tools between medical procedures. Ignaz Semmelweis, a physician from Vienna, made the realization in 1847 that diseases were being transferred between patients through contaminated materials.[68] While this was initially ignored by the medical community, medical professionals came to realize its importance and started to implement preventions in their practices. This led to Joseph Lister, a British surgeon, developing a method of sterilization to clean tools in the 1860s by soaking the medical tools in carbolic acid.[68] Many physicians in Britain were slow to using this practice however it became more widely used in practice by medical professionals in America.[68]

Joseph Lister

Additional modern medicinal practices were also starting to be utilized such as the analysis of cells under a microscope. In 1863 in an attempt to treat a soldier's wounds, physicians decided to utilize a microscope to see if they could learn anything more about the infection and status of the wound. Through this they saw what they called "diseased cells" and "infusorial animalcules".[68] Through further tests and analysis under the microscope they found a remedy that seemed to help kill the infection and were able to treat the soldier's wounds. As a result of this, the patients' case was recorded and created an example of how microscopes could be properly utilized.[68] This was one of the many cases that eventually would lead microscopes being used in modern medicinal practices for their ability to see the more detailed impact of their treatments on patients.

Medical research also became more pronounced in this time as states began passing laws that allowed for medical schools to use the bodies that were not claimed by anyone for research purposes.[68] This coupled with the injuries brought on by the war allowed for doctors to develop better understandings of the nature of the injuries and diseases. As a result of this the view that medicine and medical professionals went about practicing and researching changed, shifting focus from just the physical aspects of diseases and medical research to a more inqusitive style of figuring out its nature as well.[68]

## Aftermath

[edit]

Based on their experiences in the war, many veterans went on to develop high standards for medical care and new medicines. The medical profession had grown significantly to number thousands of medical professionals across the nation[69] as the modern pharmaceutical industry began developing in the decades after the war. Colonel Eli Lilly had been a pharmacist; he built a pharmaceutical empire after the war.[70] Clara Barton founded the American Red Cross to provide civilian nursing services in wartime.[71]

## See also

[edit]

* American Civil War portal
* Medicine portal

* Bibliography of the American Civil War#Medical
* History of nursing in the United States
* National Museum of Civil War Medicine
* Military medicine
* Union (American Civil War)#Medical conditions

## References

[edit]

1. ^ Kenneth Link, "Potomac Fever: The Hazards of Camp Life," Vermont History, (1983) 51#2 pp 69-88
2. ^ Billings, p. 298.
3. ^ Billings, p. 299.
4. ^ U.S. Army Medical Department, The Evolution of Preventive Medicine in the United States Army, 1607-1939, chapter 6, p. 104 Archived February 8, 2008, at the Wayback Machine
5. ^ Now the National Museum of Health and Medicine.
6. ^ Freemon (2001), p. 89, p. 89, at Google Books; also p. 38
7. ^ Billings, p. 300.
8. ^ Mary C. Gillett, The Army Medical Department, 1818–1865 (1987)
9. ^ William Quentin Maxwell, Lincoln's Fifth Wheel: The Political History of the U.S. Sanitary Commission (1956)
10. ^ Justin Martin, Genius of Place: The Life of Frederick Law Olmsted (2011) pp 178-230
11. ^ Eugene E. Roseboom, The Civil War Era, 1850–1873 (1944) p 396
12. ^ Billings, p. 301.
13. ^ Billings, p. 302.
14. ^ Billings, p. 303.
15. ^ a b Billings, p. 304.
16. ^ Billings, p. 305.
17. ^ Billings, p. 306.
18. ^ James H. Cassedy, "Numbering the North's Medical Events: Humanitarianism and Science in Civil War Statistics," Bulletin of the History of Medicine, Summer 1992, Vol. 66 Issue 2, pp 210-233
19. ^ Freemon, p. 28
20. ^ Freemon, p. 29
21. ^ Freemon, p. 30
22. ^ Freemon, p. 31
23. ^ Freemon, p. 32
24. ^ Freemon, p. 34
25. ^ Freemon, p. 41
26. ^ Freemon, p. 43
27. ^ Freemon, p. 45
28. ^ Freemon, p. 46
29. ^ Cunningham, Horace Herndon (1960). Doctors in Gray: The Confederate Medical Service. Baton Rouge: Louisiana State University Press. p. 119.
30. ^ McGaugh, Scott (2013). Surgeon in Blue: Jonathan Letterman, The Civil War Doctor Who Pioneered Battlefield Care. New York: Arcade Publishing. p. 94.
31. ^ Schroeder-Lein, Glenna R. (2015). The Encyclopedia of Civil War Medicine. p. 12.
32. ^ Adams, George Worthington (1952). Doctors in Blue: The Medical History of the Union Army in the Civil War. New York: Henry Schuman. p. 63.
33. ^ McGaugh, p.67
34. ^ McGaugh, p.88
35. ^ McGaugh, p.106
36. ^ Schroeder-Lein, p.13
37. ^ Freemon, p. 49
38. ^ "Surgery in the Civil War | Behind the Lens: A History in Pictures | Essays and Photos Courtesy of The Burns Archive | Mercy Street | PBS". Surgery in the Civil War | Behind the Lens: A History in Pictures | Essays and Photos Courtesy of The Burns Archive | Mercy Street | PBS. Retrieved 2017-05-25.
39. ^ Chisolm, Julian John; Confederate States of America. War Dept (1861). A manual of military surgery, for the use of surgeons in the Confederate army; with an appendix of the rules and regulations of the medical department of the Confederate army. Richmond, Va., West & Johnston.
40. ^ "The Truth About Civil War Surgery". www.historynet.com. 12 June 2006. Retrieved 2017-05-25.
41. ^ "Surgery in the Civil War | Behind the Lens: A History in Pictures | Essays and Photos Courtesy of The Burns Archive | Mercy Street | PBS". Surgery in the Civil War | Behind the Lens: A History in Pictures | Essays and Photos Courtesy of The Burns Archive | Mercy Street | PBS. Retrieved 2017-05-25.
42. ^ "An Infinite Blessing: Anesthesia and the Civil War, Part 1". National Museum of Civil War Medicine. 2020-06-02. Retrieved 2020-07-13.
43. ^ Albin, Maurice S. (2000). "The Use of Anesthetics during the Civil War, 1861-1865". Pharmacy in History. 42 (3/4): 99–114\. ISSN 0031-7047. JSTOR 41112682.
44. ^ "Confederate Use of Anesthesia in the Civil War". National Museum of Civil War Medicine. 2020-06-08. Retrieved 2020-07-13.
45. ^ Billings, p. 314
46. ^ Freemon, p. 48
47. ^ "Civil War Battlefield Surgery | eHISTORY". ehistory.osu.edu. Retrieved 2017-05-25.
48. ^ A. D. Harvey, "Was the American Civil War the First Modern War?" History 97.2 (2012): 272-280 online.
49. ^ Drew Gilpin Faust, " 'Numbers on Top of Numbers': Counting the Civil War Dead" Journal of Military History 70#4 (2006), pp. 995-1009 at p 997. online
50. ^ Adams, Doctors in Blue p 260.
51. ^ "Civil War Virtual Museum | Field Medicine | Amputation Kit". www.civilwarvirtualmuseum.org. Retrieved 2017-05-25.
52. ^ a b Baker, Matthew (2016-11-02). "Was Civil War Surgery Effective?". Hunter College Department of Economics. `{{cite journal}}`: Cite journal requires `|journal=` (help)
53. ^ Jane E. Schultz, "The Inhospitable Hospital: Gender and Professionalism in Civil War Medicine," Signs (1992) 17#2 pp. 363-392 in JSTOR
54. ^ Ann Douglas Wood, "The War within a War: Women Nurses in the Union Army," Civil War History (1972) 18#3
55. ^ Thomas J. Brown, Dorothea Dix: New England Reformer (Harvard U.P. 1998)
56. ^ Edward A. Miller, "Angel of light: Helen L. Gilson, army nurse," Civil War History (1997) 43#1 pp 17-37
57. ^ Elizabeth D. Leonard, "Civil war nurse, civil war nursing: Rebecca Usher of Maine," Civil War History (1995) 41#3 pp 190-207
58. ^ Wendy Hamand Venet, A Strong-minded Woman: The Life of Mary Livermore (2005)
59. ^ Elizabeth D. Leonard. "Civil War Nurse, Civil War Nursing: Rebecca Usher of Maine," Civil War History (1995): 41#3 190-207. in Project MUSE
60. ^ Mary Gardner Holland, ed. Our Army Nurses: Stories from Women in the Civil War (1895) excerpts
61. ^ Libra R. Hilde, Worth a Dozen Men: Women and Nursing in the Civil War South  (2012) excerpt
62. ^ for letters from a Catholic nun who was in charge of a Confederate hospital see E. Moore Quinn, "'I have been trying very hard to be powerful "nice"': the correspondence of Sister M. De Sales (Brennan) during the American Civil War," Irish Studies Review (2010) 18#2 pp 213-233.
63. ^ Cheryl A. Wells, "Battle Time: Gender, Modernity, and Confederate Hospitals," Journal of Social History (2001) 35#2 pp. 409-428 in JSTOR
64. ^ a b c d e Campbell, William T. (2018). "Overworked, Undermanned and Indispensable: HOSPITAL STEWARDS IN THE CIVIL WAR". Military Images. 36 (4).
65. ^ Leon Litwack, Been in the Storm So Long: The Aftermath of Slavery (1979) p. 5.
66. ^ Jim Downs, Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction (Oxford University Press, 2015), pp. 5, 212. excerpt
67. ^ Gretchen Long, Doctoring Freedom: The Politics of African American Medical Care in Slavery and Emancipation (2012).
68. ^ a b c d e f g Devine, Shauna (June 2016). ""To Make Something Out of the Dying in This War": The Civil War and the Rise of American Medical Science". Journal of the Civil War Era. 6 (2): 157.
69. ^ Devine, Shauna (June 2016). ""To Make Something Out of the Dying in This War": The Civil War and the Rise of American Medical Science". Journal of the Civil War Era. 6 (2): 157.
70. ^ Ann T. Keene. "Lilly, Eli", American National Biography Online, 2001 Archived July 1, 2001, at the Wayback Machine
71. ^ Elizabeth Brown Pryor, Clara Barton: Professional Angel (University of Pennsylvania Press, 1987)

## Further reading

[edit]

* Adams, George Worthington (1952). Doctors in blue: the medical history of the Union Army in the Civil War. New York: Schumann. online
* Billings, John D. (2005). Hard Tack and Coffee: Soldiers' life in the Civil War. Konecky & Konecky. ISBN 1-56852-443-9.

* Bollet, Alfred Jay. (2002) Civil War Medicine: Challenges and Triumphs ; a revisionist scholarly study.
* Cassedy, James H. "Numbering the North's Medical Events: Humanitarianism and Science in Civil War Statistics," Bulletin of the History of Medicine, (1992) 66#2 pp 210–233
* Cunningham, H.H. (1993) Doctors in Gray: The Confederate Medical Service online; a major scholarly survey
* Dammann, Gordon E., and Alfred Jay Bollet. (2007) Images of Civil War Medicine: A Photographic History (2007)
* Devine, Shauna. Learning from the Wounded: The Civil War and the Rise of American Medical Science. Chapel Hill, NC: University of North Carolina Press, 2014.
* Downs, John. Sick From Freedom: African-American Illness and Suffering During the Civil War and Reconstruction  (Oxford UP, 2012) excerpt
* Fett, Sharla M. "Middle passages and forced migrations: Liberated Africans in nineteenth-century U.S. camps and ships." Slavery and Abolition 31.1 (2010): 75–98.
* Freemon, Frank R. (2001). Gangrene and Glory: Medical Care During the American Civil War. University of Illinois Press. ISBN 0-252-07010-0. Preview at Google Books
* Gillett, Mary C. The Army Medical Department, 1818–1865 (1987) online
* Hasegawa, Guy R. (2024). The Confederate Navy Medical Corps: Organization, Personnel and Actions. McFarland.
* Humphreys, Margaret. (2013 Marrow of Tragedy: The Health Crisis of the American Civil War (Johns Hopkins University Press, 2013) a major scholarly survey. online

* Martin, Justin. Genius of Place: The Life of Frederick Law Olmsted (2011) pp 178–230 on the U.S. Sanitary Commission
* Maxwell, William Quentin. Lincoln's Fifth Wheel: The Political History of the U.S. Sanitary Commission (1956)
* Miller, Brian Craig. Empty Sleeves: Amputation in the Civil War South (University of Georgia Press, 2015). xviii, 257 pp.
* Rutkow, Ira M. Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine (2005) 394 pp.
* Schroeder-Lein, Glenna R. The Encyclopedia of Civil War Medicine (2012) a major scholarly compendium. 450pp.
* Schroeder-Lein, Glenna R. Confederate Hospitals on the Move (1994)
* Schultz, Jane E. "The Inhospitable Hospital: Gender and Professionalism in Civil War Medicine," Signs (1992) 17#2 pp. 363–392 in JSTOR
* Shryock, Richard H. "A Medical Perspective on the Civil War," American Quarterly (1962) 14: 161–73. in JSTOR
* Waitt, Robert W. (1964) Confederate Military Hospitals in Richmond. VCU Libraries Digital Collections
* Weicksel, Sarah Jones. "The Dress of the Enemy: Clothing and Disease in the Civil War Era" Civil War History (2017) 63#2 133-150 online

### Historiography

[edit]

* Flannery, Michael A. "Medicine and Health Care" in A Companion to the U.S. Civil War ed. by Aaron Sheehan-Dean (Wiley, 2014) pp.592-607 online.

### Primary sources

[edit]

* Joseph H. Barnes et al., eds. The Medical and Surgical History of the War of the Rebellion, 1861–1865, 6 vols. (Washington: U.S. Government Printing Office, 1870–88).
* Gemrig's illustrated catalogue of surgical instruments, ca 1868
* Robertson Hospital Register, Statistical data on 1,329 patients. VCU Libraries Digital Collections.
* Sanger Historical Files (1859–1865), Excerpts, Includes letters, reports, and hospital records of the Medical College of Virginia during the American Civil War. VCU Libraries Digital Collections.
* Welsh, Jack D. Two Confederate Hospitals and Their Patients, Atlanta to Opelika (Mercer University Press, 2005) 183 pp. and CDROM; statistical data on 18,000 patients

* v
* t
* e

American Civil War

Origins

* Origins

* Timeline leading to the War
* Bleeding Kansas
* Border states
* Compromise of 1850
* John Brown's raid on Harpers Ferry
* Kansas-Nebraska Act
* Lincoln–Douglas debates
* Missouri Compromise
* Nullification crisis
* Origins of the American Civil War
* Panic of 1857
* Popular sovereignty
* Secession
* South Carolina Declaration of Secession
* States' rights
* Proclamation 80

|

Slavery|

* African Americans
* Cornerstone Speech
* Crittenden Compromise
* Dred Scott v. Sandford
* Emancipation Proclamation
* Fire-Eaters
* Fugitive slave laws
* Plantations in the American South
* Positive good
* Slave Power
* Slavery in the United States
* Treatment of slaves in the United States
* Uncle Tom's Cabin

Abolitionism|

* Abolitionism in the United States
* Susan B. Anthony
* James G. Birney
* John Brown
* Frederick Douglass
* William Lloyd Garrison
* Lane Debates on Slavery
* Elijah Parish Lovejoy
* J. Sella Martin
* Lysander Spooner
* George Luther Stearns
* Thaddeus Stevens
* Charles Sumner
* Caning
* Harriet Tubman
* Underground Railroad

* Combatants
* Theaters
* Campaigns
* Battles
* States

| Combatants|

| Union|

* Army
* Navy
* Marine Corps
* Revenue Cutter Service

|

Confederacy|

* Army
* Navy
* Marine Corps

Theaters|

* Eastern
* Western
* Lower Seaboard
* Trans-Mississippi
* Pacific Coast
* Union naval blockade

Major campaigns|

* Anaconda Plan
* Blockade runners
* New Mexico
* Jackson's Valley
* Peninsula
* Northern Virginia
* Maryland
* Stones River
* Vicksburg
* Tullahoma
* Gettysburg
* Morgan's Raid
* Bristoe
* Knoxville
* Red River
* Overland
* Atlanta
* Valley 1864
* Bermuda Hundred
* Richmond-Petersburg
* Franklin–Nashville
* Price's Missouri Expedition
* Sherman's March
* Carolinas
* Mobile
* Appomattox

Major battles|

* Fort Sumter
* 1st Bull Run
* Wilson's Creek
* Fort Donelson
* Pea Ridge
* Hampton Roads
* Shiloh
* New Orleans
* Corinth
* Seven Pines
* Seven Days
* 2nd Bull Run
* Antietam
* Perryville
* Fredericksburg
* Stones River
* Chancellorsville
* Gettysburg
* Vicksburg
* Chickamauga
* Chattanooga
* Wilderness
* Fort Pillow
* Spotsylvania
* Cold Harbor
* Atlanta
* Crater
* Mobile Bay
* Franklin
* Nashville
* Five Forks

Involvement|

| States and
territories|

* Alabama
* Arkansas
* Arizona
* California
* Colorado
* Connecticut
* Dakota Territory
* District of Columbia
* Delaware
* Florida
* Georgia
* Hawaii
* Idaho
* Illinois
* Indian Territory
* Indiana
* Iowa
* Kansas
* Kentucky
* Louisiana
* Maine
* Maryland
* Massachusetts
* Michigan
* Minnesota
* Mississippi
* Missouri
* Montana
* Nebraska
* Nevada
* New Hampshire
* New Jersey
* New Mexico
* New York
* North Carolina
* Ohio
* Oregon
* Pennsylvania
* Rhode Island
* South Carolina
* Tennessee
* Texas
* Utah
* Vermont
* Virginia
* Washington
* West Virginia
* Wisconsin

|

Cities|

* Atlanta
* Charleston
* Chattanooga
* New Orleans
* Richmond
* Washington, D.C.
* Winchester

Leaders

| Confederate|

| Military|

* R. H. Anderson
* Beauregard
* Bragg
* Buchanan
* Cooper
* Early
* Ewell
* Forrest
* Gorgas
* Hill
* Hood
* Jackson
* A. S. Johnston
* J. E. Johnston
* Lee
* Longstreet
* Morgan
* Mosby
* Polk
* Price
* Semmes
* E. K. Smith
* Stuart
* Taylor
* Wheeler

|

Civilian|

* Benjamin
* Bocock
* Breckinridge
* Davis
* Hunter
* Mallory
* Memminger
* Seddon
* Stephens

Union|

| Military|

* Anderson
* Buell
* Burnside
* Butler
* Du Pont
* Farragut
* Foote
* Frémont
* Grant
* Halleck
* Hooker
* Hunt
* McClellan
* McDowell
* Meade
* Meigs
* Ord
* Pope
* D. D. Porter
* Rosecrans
* Scott
* Sheridan
* Sherman
* Thomas

|

Civilian|

* Adams
* Chase
* Ericsson
* Hamlin
* Lincoln
* Pinkerton
* Seward
* Stanton
* Stevens
* Wade
* Welles

Aftermath

| Constitution|

* Reconstruction Amendments
* 13th Amendment
* 14th Amendment
* 15th Amendment

|

Reconstruction|

* Alabama Claims
* Brooks–Baxter War
* Carpetbaggers
* Colfax riot of 1873
* Compromise of 1877
* Confederate refugees
* Confederados
* Eufaula riot of 1874
* Freedmen's Bureau
* Freedman's Savings Bank
* Homestead Acts
* Southern Homestead Act of 1866
* Timber Culture Act of 1873
* Impeachment of Andrew Johnson
* trial
* efforts
* timeline
* first inquiry
* second inquiry
* impeachment managers investigation
* Kirk–Holden war
* Knights of the White Camelia
* Ku Klux Klan
* Ethnic violence
* Memphis riots of 1866
* Meridian riot of 1871
* New Orleans riot of 1866
* Pulaski (Tennessee) riot of 1867
* South Carolina riots of 1876
* Reconstruction acts
* Habeas Corpus Act of 1867
* Enforcement Act of 1870
* Enforcement Act of February 1871
* Enforcement Act of April 1871
* Reconstruction era
* Reconstruction military districts
* Reconstruction Treaties
* Indian Council at Fort Smith
* Red Shirts
* Redeemers
* Scalawags
* South Carolina riots of 1876
* Southern Claims Commission
* White League

Post-
Reconstruction|

* Commemoration
* Centennial
* Civil War Discovery Trail
* Civil War Roundtables
* Civil War Trails Program
* Civil War Trust
* Confederate History Month
* Confederate Memorial Day
* Decoration Day
* Historical reenactment
* Robert E. Lee Day
* Confederate Memorial Hall
* Disenfranchisement
* Black Codes
* Jim Crow
* Historiographic issues
* Lost Cause mythology
* Modern display of the Confederate flag
* Red Shirts
* Sons of Confederate Veterans
* Sons of Union Veterans of the Civil War
* Daughters of Union Veterans of the Civil War
* National Society Daughters of the Union 1861-1865
* Southern Historical Society
* United Confederate Veterans
* United Daughters of the Confederacy
* Children of the Confederacy
* Wilmington insurrection of 1898

Monuments
and memorials|

| Union|

* List
* Grand Army of the Republic
* memorials to Lincoln

|

Confederate|

* List
* artworks in Capitol
* memorials to Davis
* memorials to Lee
* Removal

Cemeteries|

* Ladies' Memorial Associations
* U.S. national cemeteries

Veterans|

* 1913 Gettysburg reunion
* 1938 Gettysburg reunion
* Confederate Memorial Hall
* Confederate Veteran
* Grand Army of the Republic
* Military Order of the Loyal Legion of the U.S.
* Old soldiers' homes
* Southern Cross of Honor
* United Confederate Veterans

* Related topics

| Military|

* Arms
* Armies
* Campaign Medal
* Cavalry
* Confederate Home Guard
* Confederate railroads
* Confederate revolving cannon
* Field artillery
* Infantry
* Medal of Honor recipients
* Medicine
* Naval battles
* Official Records
* Partisan rangers
* POW camps
* Rations
* Signal Corps
* Turning point
* Union corps badges
* U.S. Balloon Corps
* U.S. Home Guard
* U.S. Military Railroad

|

Political|

* Committee on the Conduct of the War
* Confederate States presidential election of 1861
* Confiscation Act of 1861
* Confiscation Act of 1862
* Copperheads
* Diplomacy
* Emancipation Proclamation
* Habeas Corpus Act of 1863
* Hampton Roads Conference
* National Union Party
* Politicians killed
* Radical Republicans
* Trent Affair
* Union Leagues
* U.S. Presidential Election of 1864
* War Democrats

Music|

* Battle Hymn of the Republic
* Dixie
* John Brown's Body
* A Lincoln Portrait
* Marching Through Georgia
* Maryland, My Maryland
* Names from the War
* When Johnny Comes Marching Home
* Daar kom die Alibama

By ethnicity|

* African Americans
* German Americans
* Irish Americans
* Italian Americans
* Native Americans
* Catawba
* Cherokee
* Choctaw
* Seminole

Other topics|

* Baltimore riot of 1861
* Battlefield preservation
* Bibliography
* Confederate war finance
* Confederate States dollar
* Espionage
* Confederate Secret Service
* Great Hanging at Gainesville
* Great Revival of 1863
* Gender issues
* Juneteenth
* Naming the war
* New York City Gold Hoax of 1864
* New York City riots of 1863
* Photographers
* Richmond riots of 1863
* Salt
* Supreme Court cases
* Tokens
* U.S. Sanitary Commission
* Women soldiers

Related|

* List of films and television shows about the American Civil War

* Category
* Portal

Authority control databases: National |

* United States
* Israel

|

*[v]: View this template
*[t]: Discuss this template
*[e]: Edit this template