Confederate Medical Facts
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Most wounds were caused by an elongated bullet made of soft lead, about an inch long, pointed at one end and hollowed out at the base, and called a "minie" ball, having been invented by Capt. Minié of the French army. Many doctors who saw service in the Civil War had never been to medical school, but had served an apprenticeship in the office of an established practitioner.
Surgeons could either be commissioned officers of the Union or Confederate Army or volunteer officers in State service. Contract surgeons were civilian doctors hired by the army, yet held no commissions and wore no uniforms or insignia of rank. In 1861, there was no military review board for volunteer or contract surgeons. Appointments were often based on nepotism, personal friendships and political patronage, with professional qualifications not the primary consideration.
Most surgeons received their training by the apprentice system, training with an older, more experienced doctor, and thus learning out-of-date medical techniques. Younger doctors attended medical schools, but this caused many an old soldier to hold the opinion that they were only in the field to get more practice, not to save lives. In wartime, quality control standards were frequently ignored, so some doctors were outright "quacks" with forged credentials.
Many surgeons returned to private pratice after the war, but some were addicted to pain-killers like opium, laudanum and alcohol like their patients.
The Headquarters of the Army Medical Department acquired its first achromatic microscope in 1863. Civil War era physicians were up-to-date in their knowledge of traumatic diseases of the eye.
Specialty hospitals devoted to eye and ear diseases had begun to develop in the U.S. before the Civil War. During the war, the Union Army established such a specialty hospital. On Aug. 23, 1864, it was moved from Washington, D.C. to Chicago where it was named the Desmarres Hospital. It had 150 beds and Surgeon J.H. Hildreth, U.S.Volunteers, was in charge.
Near the end of the war, an Ophthalmic Hospital also was opened by the Confederate army in Athens, Georgia. It apparently was under the command of Surgeon Bolling A. Pope.
Although Civil War surgeons were using the primitive version of the ophthalmoscope of Civil War times, they were up to international standards in the treatment of eye injuries and even specialized in it.
Civil War physicians were up to international standards in their knowledge of the medical science of the time, and during the war quickly forged into leadership in military medicine.
More soldiers died from diarrhea than were killed in battle. The soldiers lived in unhealthy conditions. They were often poorly fed and crowded together in unsanitary camps. Epidemics would sweep through encampments and take more fearful tolls than the worst battle. Most diseases were little understood and quite often the treatment administered to the sick soldier did more harm than good.
Venereal disease was not only prevalent but largely uncontrolled.
Diarrhea was the deadliest ailment of all soldiers in the war. The soldiers would call it "Tennessee trots", "Virginia quick steps", or "the bowel complaint". Doctors labeled it "debilitis", "dysentery", or "diarrhea". Treatments for diarrhea varied according to the doctors' whims and the available medications. Many soldiers regarded admission to a hospital as a death sentence and would endure a great deal of suffering before resorting to that alternative.
A medication commonly administered was a mercury-and-chalk compound called blue mass. Supposedly good for ailments ranging from toothache to constipation, it was a staple of all doctors' medicine chests.
Quinine was one the most valuable of the Civil War era medicines. Known to be effective as a treatment for malaria, it was also prescribed for a dozen other complaints and even used as a dentifrice. But the most commonly prescribed medication, and one thought to be beneficial for the widest variety of ailments, was alcohol, usually in the forms of whiskey and brandy.
The lowest ranking member of the Medical Departments during the war was usually the hospital stewards- noncommissioned officers who received the pay and allowance of a sergeant major. Each regiment was authorized to have one hospital steward, who was often chosen by the regimental surgeon from the enlisted men in the unit. Hospital stewards were also assigned to permanent military hospitals.
Army regulations specified that men selected as hospital stewards had to be of good character: "temperate, honest, and in every way reliable, as well as sufficiently intelligent, and skilled in pharmacy." Temperance was an important quality since one responsibility of the hospital steward was controlling and dispensing medicinal whiskey. As he was responsible for keeping many medical records, the steward also needed to be literate and intelligent.
His other duties included assisting the field surgeon in operations, supervising hospital cooks and nurses, and even prescribing drugs and performing minor operations during emergencies. Army doctors relied heavily on hospital stewards for the day-to-day management of their department.
MEDICAL DEPARTMENT:
The organization of the Confederate Medical Department was identical with that of the Union Army at the start of the war, and the army regulations under which rank and discipline were maintained were those of the United States, the only copies which came under the writer's observation being those printed prior to the war.
The medical staff of the Confederacy Army embraced only 3 grades of rank:
1) One Surgeon-General with rank, emoluments, and allowances of a brigadier-general cavalry officer
2) About 1,000 surgeons with rank, allowances, and emoluments of a major cavalry officer
3) About 2,000 assistant-surgeons, with the rank of a captain cavalry officer
Among the latter were a number of contract surgeons or acting assistant-surgeons, with the pay of a 2nd lieutenant infantry officer, who were temporarily employed. Nearly all of these, however, at some period subsequent to their employment as contract surgeons were examined by an army board of medical examiners and were commissioned as surgeons or assistant surgeons, or dropped from the army rolls.
Each infantry or cavalry regiment was assigned a surgeon and an assistant surgeon; to a battalion of either, and sometimes to a company of artillery, an assistant surgeon. Whenever regiments and battalions were combined into brigades, the surgeon whose commission bore the oldest date became the senior surgeon of brigade, and although a member of the staff of the brigade commander, was not relieved of his regimental duties.
Sometimes, however, he was allowed an additional assistant surgeon, who was carried as a supernumerary on the brigade roster. To the senior surgeon of brigade, the regimental and battalion medical officers made their daily morning, weekly, monthly, and quarterly reports, and reports of killed and wounded after engagements, which by him were consolidated and forwarded to the chief surgeon of the division to which the brigade was attached.
Regiments and brigades acting in an independent capacity forwarded their reports to the medical director of the army or department, or to the Surgeon General. Requisitions for regimental and battalion medical, surgical, and hospital supplies, as well as applications for furlough or leave of absence, discharge, resignation, or assignment to post duty, on account of disability, were first approved by the regimental or battalion medical officer, after giving his reasons for approval and the nature of the disability in the latter instances, and forwarded by him to the senior surgeon of brigade, and by him to the chief surgeon of division and the other ranking officers in the corps and army for their approval. Independent commands reported to the medical director of the department or army, or the Surgeon-General.
Medical purveyors nearest to the army, as promptly as possible, forwarded all needed medical, surgical and hospital supplies, on approved requisitions.
Chief Surgeon of Division: Assignments were sometimes made in accordance with seniority of rank of the senior surgeons of brigades, in other instances on application of the general commanding the division. His duties, in addition to approving reports coining from the senior surgeons of brigades, were to advise with the division commander in all matters pertaining to the medical care and hygiene of his command, and to have personal care of the attaches of the division staff and headquarters, and to advise and consult with his medical subordinates.
Each corps was assigned a medical director, a commissioned surgeon, his permanent assignment being made on personal application of the lieutenant-general commanding the corps; temporarily and when emergency demanded, his duties, which were similar to those of the chief surgeon of division as pertaining to the corps, devolved upon the chief surgeon of division whose commission bore priority of date; he, in turn, being succeeded by the ranking senior surgeon of brigade.
A medical director was assigned to the staff of each general commanding a department, or an army in a department, his selection usually being in deference to the general on whose staff he served and to whom was submitted for approval all reports and papers, from the various army corps, independent divisions, brigades, or smaller detachments. He also bad charge of the staff and attaches of the department or army headquarters.
The non-commissioned medical staff consisted of a hospital steward for each regiment or battalion, with the rank and emoluments of an orderly sergeant, his selection as a rule being made by the ranking medical officer of the command, usually a graduate or undergraduate in medicine, or one having had previous experience in handling drugs; and his duties were to have charge of the medical, surgical, and hospital supplies under direction of the regimental or battalion medical officer, caring for and dispensing the same, seeing that the directions of his superior as to diet and medicines were carried out, or reporting their neglect or failure.
The regimental band constituted the infirmary detail to aid in caring for the sick in camp and to carry the wounded from the field of battle, and when so occupied were under the surgeon or assistant surgeon. When necessary, additional detail was made from the enlisted men to serve temporarily or permanently on the infirmary corps. In some instances, an enlisted man was detailed as hospital clerk, and with the hospital steward was required to be present at sick-call each morning; these soldiers, with the infirmary detail, were relieved from all other regimental duty, such as guard duty and police detail.
Assistant Surgeon: Duties were to assist or relieve the surgeon in caring for the sick and wounded in camp or on the march. On the field of battle he was expected to be close up in the immediate rear of the center of his regiment, accompanied by the infirmary detail, and to give primary attention, first aid to the wounded-this consisting in temporary control of hemorrhage by ligature, tourniquet, or bandage and compress, adjusting and temporarily fixing fractured limbs, administering water, anodynes, or stimulants, if needed, and seeing that the wounded were promptly carried to the field-hospital in the rear by the infirmary detail or ambulance.
Surgeons: Duties, in addition to caring for the sick in camp and on the march, were to establish a field-hospital, as soon as they could learn that the command to which they were attached was going under fire, at some convenient and, if possible, sheltered spot behind a bill or in a ravine, about one-half to one mile in rear of the line of battle, which was done under direction of a brigade or division surgeon.
Here, the combined medical staff of a brigade or division aided one another in the performance of such operations as were deemed necessary, as the wounded were brought from the front by the infirmary detail on stretchers or in the ambulance. Amputations, resections of bone, ligatures of arteries, removals of foreign bodies, adjusting and permanently fixing fractures, and all minor and major operations and dressings were made when deemed best for the comfort and welfare of the wounded men.
As soon as possible, after the permanent dressings were made at the field-hospital, and even in some instances while the troops were still engaged, the wounded were carried to the railroad and transported to the more permanent hospitals in the villages, towns, and cities, some miles distant.
| CASUALTIES (estimates) | |
| Army | |
| Died in combat | 94,000 |
| Died of disease | 164,000 |
| Died as prisoners | 25,976 |
| Wounded in action | 194,026 |
| TOTAL | 478,002 |
| Navy: No statistics available | |
Of every 1,000 troops in a battle: 150 were hit
Mortality-rates were greater among the Confederate wounded, because of their inferior medical service
Battlefield Wounds:
- Bayonets caused less than .5% of wounds
- Artillery fire caused 5.5% of wounds
- Bullets caused more than 94% of wounds
Both Armies:
- 15% of the wounded men in the war died
- 80% of the wounds were in the extremities
- Diseases most prevalent: dysentery, typhoid fever, malaria, pneumonia, arthritis, and acute childhood diseases; measles, mumps, and malnutrition
- Sickness/Diseases: accounted for 1/3 of all casualties
The first organized ambulance corps were used in the Peninsular campaign and at Antietam.
In each regiment, there were officers whose duties did not require that they should go into action-- the Chaplain, the Quartermaster, and the Surgeons. Although they had no tactical position in the line of battle, there was a loss of life among their number which entitles them to some other place in the records of the war than that of mere non-combatants. Many of them waived their exemption from danger, and gallantly volunteered for service in the field; while others (the surgeons, for instance) attended calmly to the performance of their duties amid perils.
Though the surgeons seldom took an active part in a battle, they were required to be near, and much of the time were under fire. Some of them went on the field with their regiments in order to render timely aid; others were stationed near by at some field hospital, where they often found themselves exposed to serious danger. During the war, 40 Surgeons were killed and 73 wounded while bravely attending to their duties on the battle field. Many surgeons died from disease while in the service.
There were a number of Chaplains killed in battle. These gallant members of the Church Militant were wont to take a more active part in the fighting than has been generally credited to them. They were frequently seen in the thickest of the fight, some of them handling a rifle, while others, unarmed, would move about among their men encouraging them to do their best.
Many of the Chaplains had served in the ranks as enlisted men prior to their appointment. They were regularly ordained clergymen, whose patriotic zeal had impelled them to exchange their pulpits for the camp; so, when a vacancy occurred in the chaplaincy of a regiment to which any such belonged, the Colonel was very apt to recommend the clerical musket-bearer, whose gallantry perhaps had already attracted his attention.
Many clergymen who left their pastoral duties to accept commissions in the army, some of whom held regimental or brigade commands.
The musicians formed a numerous class among the non- combatants. Although their legitimate duty in time of battle was confined to that of stretcher-bearers, they often participated in the fighting.
The frequent loss of life among the stretcher-bearers attests the faithful work of the men employed in that duty, most of whom were musicians. It was not an uncommon experience for many of them to be killed in battle.
GENERAL OFFICERS KILLED/MORTALLY WOUNDED IN BATTLE:
Army Commanders
Gen. Albert Sidney Johnston.........Shiloh
Corps Commanders
Lt. Gen. Thomas J. Jackson.........Chancellorsville
Lt. Gen. Leonidas Polk...................Pine Mountain
Lt. Gen. Ambrose P. Hill.................Petersburg
Division Commanders
Maj. Gen. William D. Pender.........Gettysburg
Maj. Gen. J.E.B. Stuart....................Yellow Tavern
Maj. Gen. William H. Walker..........Atlanta
Maj. Gen. Robert E. Rodes............Opequon (1864)
Maj. Gen.Patrick R. Cleburne........Franklin
Brig. Gen. John Pegram................Hatcher's Run
Brigade Commanders
62 Brigade commanders (Brig. Gens. and Cols.)
AMPUTATIONS:
The trademark of Civil War surgery, amputations accounted for 75% of all operations performed by Civil War doctors. More arms and legs were chopped off in this war than in any other fought by this country. 3 out of every 4 wounded soldiers were hit in the extremities, and at that time, amputation was the only proper medical treatment for a compound fracture or severe laceration of a limb.
Surgery had not yet progressed to an understanding of antiseptic conditions. A doctor would use the same knife and saw all day, wiping his hands and instruments on his apron when they became too slimy. Most surgery was performed outside on operating tables made of doors laid upon boxes, with tubs underneath to catch the blood. An experienced surgeon could remove a limb in a few minutes.
Ether and chloroform were commonly used as anesthetics, but supplies could not keep up with demand. Surgery was but a prelude to the horrors a soldier would face. Gangrene and other little-understood infections swept through hospitals with deadly results. Surgical fevers (infections), routinely treated with yeast poultices and charcoal dressings, were responsible for most of the deaths of amputees. Primitive as the conditions were, it is likely that the majority of amputees were saved by the saw. Amputations performed within 48 hours of a wound were twice as likely to be successful as those performed after that length of time.
The average amputation could be finished in 10-15 minutes, partly due to the fact that the surgeon had to treat many patients and had to work as quickly as he could. Several different painkillers were available, including morphine and opium.
Gunshot Wounds:
Along with amputations, the treatment of gunshot wounds was one of the most common medical procedures of the war. The bullet, if located, was to be extracted or removed from the wound, the blood vessels sutured and the wound packed with medicinal lint (scraped from bed spreads by patriotic ladies at home) and bandaged. The introduction of the Minie Ball, a conical projectile, greatly increased the severity of gunshot wounds during the Civil War. Round musket balls used in smoothbore weapons tended to bounce off or bruise tissue, with less damage below the surface. The large, low-velocity, high-impact Minie Ball would bore and "keyhole" through the tissue, leaving a large gaping wound, shattering bone and bringing in foreign objects like grass, dirt, and pieces of clothing that would greatly increase the chance of blood poisoning or septicemia.
Medical Corps uniforms: They were similar to that of the rank and file with only a slight difference. While the cloth and cut were the same, the facings of the coat collar and cuffs and the stripe down the sides of the trousers were black, while those of the infantry were light blue, the artillery, scarlet, and cavalry, buff; on the front of the cap or hat were the letters " M. S." embroidered in gold, embraced in 2 olive branches.
On the coat sleeve of the Assistant-Surgeon were 2 rows of gold braid, with 3 gold bars on the ends of the coat collar extending back about 1.5 inches; while the surgeon had 3 rows of braid on the coat sleeves, and a single star on each side of the coat collar. The chevrons on the coat sleeves and the stripe down the trousers of the hospital steward were black.
Surgeon-General of Confederate Army: S.P. Moore
MEDICAL DIRECTORS IN THE FIELD:
SURGEON.............AREA
L. Guild..................Army of Northern Virginia
H. McGuire............ANV, Ewell's Corps
J.S.D. Cullen........ANV, Longstreet's Corps
J.W. Powell...........ANV, Hill's Corps
J.B. Fontaine........ANV, Cavalry Corps
John A. Hunter.....ANV, Breckinridge's Command
R.L. Brodie...........ANV, Beauregard's Command
T.L. Ozier...............Charleston, S.C.
A.J. Foard..............Army of Tennessee
J.H. Erkskine........AT, Hindman's Corps
A.L. Breysacker....AT, Hardee's Corps
P.B. Scott...............Meridian, Miss.
F.A. Stanford.........Wheeler's Cavalry Corps
J.F. Heustis..........Mobile, Al.
John. M. Haden....Marshall, Tx.
J.H. Berrien...........Houston, Tx.
J.T. Darby...............Stewart's Corps
W. Jennings..........Morgan's Command
MEDICAL DIRECTORS OF HOSPITALS:
SURGEON...............AREA
W.A. Carrington...........Richmond, Va.
F.A. Ramsey.................Bristol, Tenn.
P.E. Hines....................Raleigh, N.C.
N.S. Crowell.................Charleston, S.C.
S.H. Stout......................Macon, Ga.
S.A. Smith.....................Alexandria, La.
J.F. Heustis..................Mobile, Al.
P.B. Scott.......................Meridian, Miss.
MEDICAL INSPECTORS IN THE FIELD:
SURGEON...............AREA
W.D. Tucker............Dept. of Ala., Miss., and La.
S. Choppin..............Dept. of N.C. and South Va.
R.J. Breckinridge....Dept. of Army of Northern Virginia
J.W. Breedlove........Western Virginia
E.N. covey................Va., Tenn., and Ga.; Superintendent of Vaccination of Armies in these States
W.W. Anderson.......N.C., S.C., Ala., Fla., La., and Miss.; Superintendent of Vaccination of Armies in these States
MEDICAL INSPECTORS OF HOSPITALS:
SURGEON...............AREA
T.C. Madison................Petersburg, Va.
F. Sorrel.........................Richmond, Va.
E.S. Gailland.................Box 1150 Richmond, Va.
R.A. Kinloch...................Charleston, S.C.
W.M. Brown....................Morton, Miss.
E.A. Flewellen................Army of Tennessee
J.H. Morton.....................Abingdon, Va.
ARMY MEDICAL BOARDS:
A.N. Talley.....President of Board...Richmond, Va.
E. Geddings...President of Board...Charleston, S.C.
W.M. Brown....President of Board....Lt. Gen. John B. Hood's Headquarters
J.J. Gaenslen...President of Board...Maj. Gen. E.K. Smith's Headquarters
?? Hooper.....President of Board....Trans-Miss. Department
