Union Medical Civil War Facts
MEDICAL CASUALTIES/HEALTH
Venereal disease was not only prevalent but largely uncontrolled. 8% of soldiers were treated during the war.
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 U.S. or C.S. 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received their training by the apprentice system, training with an older, more experienced doctor, and thus learning out-of-date medical techniques.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 first organized ambulance corps were used in the Peninsular Campaign and at Antietam.
The first U. S. Naval hospital ship, the U.S.S. Red Rover, was used on the inland waters during the Vicksburg campaign.
More soldiers died from diarrhea than were killed in battle. Indeed, more than twice as many soldiers died from various illnesses than were killed as a result of 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.
The universal ailment of all soldiers, and the deadliest, had many names. 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 to soldiers 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: 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.
Alcohol: 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.
Hospital Stewards:
The lowest ranking member of the Medical Departments during the Civil War were usually 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.
Regulations called for Union hospital stewards to wear the red-trimmed uniform of artillerymen. Their uniform insignia consisted of an emerald green, yellow-edged, half-chevron that bore a two-inch-long yellow caduceus (staff with two entwined snakes and two wings at the top). Hospital stewards of volunteer regiments, however, were known to wear a variety of different uniforms and insignia. Confederate hospital stewards' uniforms and insignias were not officially regulated, but one surgeon recalled that on the uniform many wore, "the chevrons on the coat sleeves and the stripe down the trousers... were similar to those worn by an orderly or first sergeant, but were black in color."
Ambulance Corps:
How to collect and transport the wounded was a major problem during the first part of the Civil War. The failure of the medical services to provide for moving the wounded to hospitals set up in the rear of the battlefields caused unnecessary suffering and death.
After 1st Manassas/Bull Run, Surgeon General Charles S. Tripler, commanding the Army of the Potomac Medical Department, began a series of reforms to remove casualties from the battlefield more safely and efficiently. After his efforts failed to ease needless suffering, Tripler was replaced by Dr, Jonathan Letterman on July 4, 1862.
Letterman organized ambulance service into corps and division units, staffed by soldiers chosen by Medical Department officers. Drills were intensified and done more frequently.
After several attempts, the Ambulance Corps Act was finally passed on March 11, 1864. It established the corps as a regular army unit and gave the Medical Department the right to train and examine men for duty. Corps members wore an inverted green chevron.
The Union Medical Department received much support in its upgrading of the ambulance corps from the U.S. Sanitary Commission. The situation in the Confederacy was much worse. With no equivalent to the Sanitary Commission, the Confederate doctors relied for help on local soldiers' relief societies and ambulance committees.
The situation was grim in the beginning of the Civil War, but by the end, the ambulance organization developed by the Union had become the model most armies of the world.
U.S. Sanitary Commision:
President Abraham Lincoln's first call for troops to put down the Southern rebellion evoked an unsolicited outpouring of food, clothing, medical supplies, and money from individual citizens for the care and comfort of the Union soldiers. Some individuals banded together in aid societies to care for the units formed from their locality, but the mostly uncoordinated flood of material resulted in a chaos of rotting food-stuffs and undelivered but badly needed supplies.
In April 1861, Rev. Henry Bellows of New York organized a number of separate women's aid organizations into the Women's Central Association of Relief. On May 18, Bellows and three eminent medical men, seeing the great need for organization and coordination of the benevolent activities as well as improvement in cleanliness of the soldiers' camps, proposed to the secretary of war that a commission of civilians, medical men, and military officers be organized to regulate and develop the country's soldiers' aid activities. On June 7, the administration reluctantly agreed to the naming of a "Commission of Inquiry and Advice in Respect of the Sanitary Interests of the United States Forces", which became known as the U.S. Sanitary Commission, the forerunner of the American Red Cross.
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.
| UNION ARMY | Ratio: Officers to Enlisted | |
| Died in combat* | 110,100 | 1 to 16.2 |
| Died of disease | 224,580 | 1 to 72.6 |
| Died as prisoners | 30,128 | 1 to 298.6 |
| Non-battle deaths** | 24,881 | 1 to ?? |
| Wounded | 275,175 | 1 to ?? |
| TOTAL | 664,864 | 1 to ?? |
* KILLED in action (67,088) MORTALLY wounded (43,012)
**OTHER causes:
Cause not known.............12,121
Drowning............................4,944
Accidents............................4,114
Miscellaneous...................2,034
Murdered.............................520
Suicide................................391
Sunstroke...........................313
Military executions.............267
Killed after capture............104
Executed by Enemy...........64
UNION NAVY (from the above figures)
Died in combat............................1,804
Died of disease or accident......3,000
Wounded in action......................2,226
CASAULTY % FOR TROOPS ENGAGED IN COMBAT:
1 out of every 42.7 men would be killed
1 out of every 38.1 men would die of wounds
1 out of every 10.2 men would be captured
1 out of every 6.7 men would be wounded
Of every 1,000 troops in a battle: 112 were wounded.
There were 6,000,000 cases of disease in the army.
On average, every man was sick at least twice.
Of every 1,000 troops, 995 eventually contracted chronic diarrhea or dysentery.
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
Battlefield Wounds:
Bayonets caused less than 4% of wounds
Artillery fire caused 5% of wounds
Bullets caused more than 90% of wounds
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.
Several lives were also lost among the Quartermasters, some of them having been killed while serving as volunteer aids, while others fell while attending to the duties of their position when under fire. Among the first to scale the heights of Missionary Ridge was a Quartermaster-Sergeant of a Michigan regiment, who had borrowed a gun and volunteered for the fight.
It will, doubtless, be a surprise to many to note the 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.
In this connection, mention should also be made of the 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
- Maj. Gen. James B. McPherson......Atlanta
Corps Commanders
Maj. Gen. Joseph K. Mansfield.......Antietam
Maj. Gen. John F. Reynolds............Gettysburg
Maj. Gen. John Sedgwick................Spotsylvania
Division Commanders
- Maj. Gen. Issac I. Stevens................Chantilly
- Maj. Gen. Philip Kearny.....................Chantilly
- Maj. Gen. jesse L. Reno...................South Mountain
- Maj. Gen. Isreal B. Richardson........Antietam
- Maj. Gen. Amiel W. Whipple............Chancellorsville
- Maj. Gen. Hiram G. Berry..................Chancellorsville
- Maj. Gen. James S. Wadsworth......Wilderness
- Maj. Gen. David A. Russell..............Opequen (1864)
- Brig. Gen. William H. Wallace.........Shiloh
- Brig. Gen. Thomas Williams...........Baton Rouge
- Brig. Gen. James S. Jackson..........Chaplin Hills
- Brig. Gen. Issac P. Rodman............Antietam
- Brig. Gen. Thomas G. Stevenson...Spotsylvania
- Brig. Gen. James A. Mulligan..........Winchester (1863)
Brigade Commanders: 32 Brig. Gens., 35 Cols. serving as brigade commanders
Chaplains: 11 killed in action while with their front-line units
Top 7 Infantry Regiments with highest combat Death Rate:
- 5th New Hampshire
- 83rd Pennsylvania
- 7th Wisconsin
- 5th Michigan
- 20th Massachussetts
- 69th New York
- 28th Massachussetts
- 23 Regiments had 15% or more combat death rates
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.
AMPUTATION CASES
Body Part........Cases........Deaths........ % Fatal
Fingers............ 7,902........... 198............... 2.5
Forearms........ 1,761........... 245...............13.9
Upper Arms.... 5,540............1,273........... 23.0
Toes................. 1,519........... 81................. 5.3
Shins................ 5,523.......... 1,790............ 32.4
Thighs.............. 6,369.......... 3,411............ 53.6
Knee Joints..... 195............. 111................ 56.9
Hip Joints......... 66............... 55.................. 83.3
Ankle Joints..... 161............. 119................ 73.9
AMPUTATION (STEP-BY-STEP)
- 1st Step: The wounded soldier would be brought to the operating table, which was in some cases nothing more than a door on 2 saw horses, a table church pews, or anything that would support the weight of a man and was available to the surgeon in the field. The wound would require examination to determine severity. If amputation was deemed necessary due to any of the reasons mentioned above, the surgeon would proceed.
- 2nd Step: Use of a general anesthetic to put the patient to sleep. Chloroform and ether were the 2 anesthetics available to surgeons during the war. In fact, contrary to popular belief, anesthesia had been widely used by American physicians since the 1840s.
- 3rd Step: As soon as the patient was unconscious, tourniquets or the hands of a competent assistant would be used to stop the flow of blood to the surgical site.
- 4th Step: The skin would be incised or cut with an amputating knife, then retracted or pulled back, and the muscle would be incised. The bone would be exposed and a surgical or capital saw used to sever the limb from the body.
- 5th Step: The surgeon would then ligate, or tie off the major blood vessels with surgical silk thread, using an instrument called a tenaculum to grasp the arteries. Ligatures were often left dangling from the stump to allow for their removal later. (This later removal could lead to secondary hemorrhaging, as surgeons were unable to quickly stop the flow of blood when the ligatures were pulled).
- 6th Step: After the major bleeding was stopped, gnawing forceps and a bone file would be used to smooth the rough edges of the stump of the bone and aid in the healing process.
- 7th Step:The wound was then closed with curved needles and silk thread. After the operation, the patient would then be removed from the table for post-operative care.
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.
