- Maiko Sho
The Civil War was a turbulent time in American history where advancements in warfare technology enabled bloodier battles among thousands of young men who fought valiantly for their country, in a time when the medical profession was not yet equipped to handle such mass destruction. The Civil War occurred between April 12, 1861 and April 9, 1865, and during this time there was a total of 620,000 soldier deaths reported. Of these, 2/3 died of disease, as the germ theory was not yet widely accepted and antiseptics did not yet exist. Furthermore, a total of 80,000 surgeries were performed over these 4 years, and over ¾ of all surgeries, over 60,000 cases, consisted of amputations.
In contrast to today’s amputations, which are often required for patients suffering from end-stage complications of peripheral vascular diseases such as diabetes and other causes of gangrenous infections, amputations during the Civil War were performed on otherwise healthy young soldiers, with the average Union soldier being only 25.8 years old.
What made the Civil War a particularly bloody and destructive war was the birth of destructive new technology, including new rifled muskets and artillery that increased the accuracy and distance that bullets could travel, and most notably the Minié ball. The Minié ball was invented in 1849 by French captains Claude Etienne Minié and Henri-Gustave Dolvigue. In contrast to the traditional round musket ball, the Minié ball had a conical shape with a hollow base at the bottom, allowing for gas to expand when the rifle was fired such that it would shoot out of the barrel rotating at high speed, resulting in greater accuracy. Made of 0.58 or 0.69 caliber lead, the Minié ball was larger than most bullets used today. To quote William Todd Helmuth, he said of the Minié ball,
None but those who have had occasion to witness the effects produced upon the body by these missiles, projected from the appropriate gun, can have any idea of the horrible laceration that ensues. The wound is often from four to eight times as large as the diameter of the base of the ball, and the laceration so terrible that mortification [gangrene] almost inevitably results. […] The effects are truly terrible; bones are ground almost to powder, muscles, ligaments, and tendons torn away, and the parts otherwise so mutilated, that loss of life, certainly of limb, is almost an inevitable consequence.
In contrast to the improved technology of warfare, military tactics remain unchanged. Soldiers charged head-on in tight linear formation toward enemy lines, only to be met by newly developed ammunition with increased firepower, accuracy and certain bloodbath. Unfortunately, these ruthless battle tactics continued long after the Civil War, until the end of the First World War.
Unfortunately for soldiers of the Civil War Era, the technology of warfare far surpassed the technology of medicine. At the beginning of the Civil War, most states’ medical licensing laws had been repealed, such that there was no official licensing system in place for one to be called a physician. It is interesting to take a look back in time to see the development of physician training. Before 1800, medical training was mostly an apprenticeship. Students paid a fee of roughly $100/year to live with a practicing physician and learn the trade by observation and apprenticeship. At the turn of the 19th century, while a few medical schools opened their doors, mistrust grew due to practices such as grave robbing and few entrance requirements. Furthermore, although examination boards for licensing physicians began at this time, they were for profit and more than willing to allow any examinee to take the exam without regulation for completion of necessary prior coursework. The wave of egalitarianism that overtook American culture around the 1830’s further dysregulated the formal institution of medical education and effectively shut down any institutionalization of medical practice, undoing the work of the past several decades. People believed that anyone who desired to be a physician should be able to do so, and that patients should also be allowed to freely choose who they wanted their physician to be.
Therefore, by the time the Civil War was in full force and countless badly maimed soldiers were in desperate need of a physician, those available were mostly young doctors, many without licenses, serving to meet the rapidly growing need for medical practitioners. Prior to the war, they had barely any experience of surgical procedures and those who had had mostly experienced “occasional trauma, lancing boils, and pulling teeth.” Overwhelmed by the immense number of casualties and limited by time and tools, surgeons did not have the luxury of performing detailed reconstructive operations and instead, often operated under frenzied conditions. Nevertheless, surgical amputations were the mainstay of treatment, improving mortality rate from 75% in untreated patients to 25% in amputated patients.
The carnage and bloodbath that ensued on the Civil War battlegrounds was something that no physician of the era was prepared for, and yet many young physicians and nurses stepped up to meet the need of caring for the wounded. These years brutally uncovered the truth, laying bare the paucity of knowledge and utter systematic disorganization of medical care that existed at the time, but also highlighted the talents of brave individuals who served the country in a time of great need. Ultimately, these years of struggle reinforced the great need for improvement and set the stage for the birth of modern medical education, innovation, and practices that were to come in the following decades.
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