- Joshua Longmire
The Civil War led to numerous advancements in the field of orthopedics. Through extensive trial and error, and with limited understanding of germ theory, Civil War surgeons developed ideas and practices that still have a significant impact on how patients are cared for today. During the war, orthopedic treatment mainly consisted of conservative surgery, excisional surgery, or amputations. However, amputations were the most common method of treatment, with about 50% of extremity gunshot wounds that included fractures being treated with amputations, to best avoid further injury or death (Kuz). When it came to amputations, surgeons experimented with many different iterations; the anteroposterior flaps were found to be more useful than the circular or guillotine methods for retaining the most function while being the most effective (Kuz). As the war went on and surgeons gained more experience, they leaned more toward conservative surgeries and debridement rather than full amputation, unless secondary amputation was then deemed necessary. The most common conservative procedures were excision of the shoulder, elbow, and hip, with the hip being by far the least successful. After these excision surgeries, soldiers were commonly put into a splint and had passive motion started as soon as possible (Kuz).
Another advancement came with traction devices and splints, specifically Buck’s traction, which is used today with hip fractures, and plaster splints. Additionally, the first attempts at internal fixation of fractures were made during the Civil War. With only a couple of documented attempts, the main surgeon for this procedure was Dr. Benjamin Howard. He would “resect the comminuted ends of the fracture site, place the ends in opposition, and use a special drill and suture passer to hold the bone ends together using a wire” (Kuz). A development in orthopedic surgery and most surgeries in general during the Civil War was the best time after an injury to do surgery. While it was greatly debated amongst surgeons, the consensus seemed to be that primary surgery should be done within 48 hours of injury and secondary surgery should be done after 30 days. The time in between, the intermediate period, resulted in the most surgical deaths. An unlikely advancement in osteomyelitis and gangrene came when Confederate surgeons discovered that wounds with maggots became cured at much higher rates (Kuz). This became the primary form of treatment, with maggots being bred under sterile conditions.
With all the injuries and surgeries going on during the Civil War, there became a need for prosthetics. The Association for the Relief of Maimed Soldiers became the primary provider of prosthetics to soldiers with amputations, giving 769 prosthetics in total. The use of prosthetics also required that surgeons perform their amputations no more proximally than the distal ⅓ of the tibia and that they use anteroposterior flap amputations for the best outcomes. The more prosthetics that were made and the longer the war progressed, advancements in prosthetics included, “a single-axis ankle controlled by vulcanized rubber bumpers and a transfemoral prosthesis with a polycentric roller knee, multiarticulated foot, and endoskeletal construction” (Kuz).
The specialty of orthopedic surgery grew tremendously during the Civil War and shortly afterwards. The first orthopedics textbook is through to have been written about soldiers during the war by Louis Baur, the first orthopedic professorship was created in 1861 by Lewis Sayre, the first orthopedic residency was started in 1863 under James Knight, orthopedics was recognized as an especially by the first major hospital in 1872, and the American Orthopaedic Association was formed in 1887 as the first US orthopedic organization (Kuz). Orthopedic surgery started and grew from the heavy case load the surgeons were thrown into during the war, with many surgeons of the war using what they learned to treat patients and veterans after the war.
Looking at orthopedic surgery’s advancement and procedures today shows just how far the specialty and care for patients have come from what we saw in the beginning with the Civil War. Amputations during the Civil War resulted in a 26.3% mortality rate (Reilly). This is compared to current orthopedic surgery, where an above-the-knee amputation anywhere on the femur has the highest mortality rate at 7.22% (Ernst et al). What once was just a field solely defined by wound and trauma care has now grown into a specialty focused on many facets: preventative medicine, diagnosis and treatment of disorders and illnesses, and providing treatment, therapy, and recovery for musculoskeletal problems. Orthopedic surgeons now use a variety of tests, like X-rays, CT scans, MRIs, blood work, and physical exams, to be able to better determine the patient’s problem and best course of treatment (Liang et al). Once surgeons have their diagnosis, they now have a multitude of techniques and procedures they can use to best treat the patient. Orthopedic surgery uses arthroscopy, a surgical technique that is minimally invasive with the use of a camera, which allows surgeons to access and treat conditions in numerous joints with only a few small incisions. Another aspect of orthopedic surgery is joint replacement. Surgeons can remove diseased or injured joints and put in manufactured replacements to improve the use of the affected joints and the lives of their patients tremendously (Liang et al). Instead of simply amputating a limb or removing parts of joints like in the Civil War, surgeons now have the techniques and equipment to fix and replace affected body parts at a much higher frequency.
An area of orthopedic surgery that began during the Civil War was fracture repair. In addition to casting, external fixation, and internal fixation, which were done during the Civil War, surgeons can now do bone grafts and bone stimulation to replace bone and promote bone healing. Stemming from splints and traction devices in the Civil War, orthopedic surgeons today have many techniques for external fixation. Some of these techniques include the Ilizarov Technique, a set of wires and pins connected to a circular frame around the affected body part that corrects length discrepancies, and the Taylor Spatial Frame, a frame with struts and pins attached to the affected body part to also correct leg lengths or deformities (Liang et al). Orthopedic surgeons can also perform osteotomy procedures to help reshape and cut bones in patients that have certain conditions or deformities, as well as use bone fusion to relieve the pain and damage in joints to stabilize the patient. The field of orthopedic surgery has a much more expanded focus on soft tissue now, more than it did during the Civil War. Surgeons can use grafting techniques, percutaneous repair, arthroscopic repair, and open surgery to treat many other problems not related to bones (Liang et al).
Finally, orthopedic surgery now has aspects that could not have been thought of during the Civil War. The specialty is advancing toward the use of robotics in surgery, 3D printing of devices and implants, regenerative medicine, virtual reality, telemedicine, and artificial intelligence (Liang et al). Orthopedic surgery today can impact a much wider range of problems and offers more individualized diagnosis and treatments, many of which were developed and enhanced from the Civil War. Techniques like trauma management, amputations, Buck’s traction and plaster splints, open treatment of contaminated wounds, internal and external fixation, and resection and extraction of bone and fragments all stemmed from the Civil War and have led to the highly sophisticated orthopedic surgery field that we currently have today (Kuz).
References
1. Ernst, B. S., Kiritsis, N. R., Wyatt, P. B., Reiter, C. R., O’Neill, C. N., Satalich, J. R., & Vap, A. R. (2025). Ranking the Orthopedic Procedures With the Highest Morbidity and Mortality. Orthopedics, 48(1), e40–e44. https://doi.org/10.3928/01477447-20240913-02 (Original work published January 1, 2025)
2. Kuz J. E. (2004). The ABJS presidential lecture, June 2004: our orthopaedic heritage: the American Civil War. Clinical orthopaedics and related research, (429), 306–315.
3. Liang, W., Zhou, C., Bai, J., Zhang, H., Jiang, B., Wang, J., Fu, L., Long, H., Huang, X., Zhao, J., & Zhu, H. (2024). Current advancements in therapeutic approaches in orthopedic surgery: a review of recent trends. Frontiers in bioengineering and biotechnology, 12, 1328997. https://doi.org/10.3389/fbioe.2024.1328997
4. Reilly R. F. (2016). Medical and surgical care during the American Civil War, 1861-1865. Proceedings (Baylor University. Medical Center), 29(2), 138–142. https://doi.org/10.1080/08998280.2016.11929390
Saturday, September 20, 2025
Medical Education in the Civil War
- Ashley Isenberg
The Civil War not only transformed the political and social landscape of the United States but also fundamentally reshaped the medical profession, particularly in the South. While Northern physicians entered the conflict with stronger institutional ties to hospitals, more reliable access to cadavers, and a tradition of clinical instruction, Southern medical schools were often proprietary institutions with limited resources and inconsistent curricula.[1] When the war began, most Southern schools closed, leaving only the Medical College of Virginia open. In the postwar period, the South faced the challenge of rebuilding its devastated infrastructure while also modernizing its medical education. This essay explores how Southern schools adapted after the Civil War, emphasizing the reforms that gradually aligned them with Northern standards.
Before the war, Southern medical education was characterized by shorter lecture terms, limited emphasis on dissection, and minimal hospital training. Whereas Northern schools benefited from anatomy acts such as Massachusetts’ 1831 law and New York’s 1854 “Bone Bill,” which secured a legal cadaver supply, Southern students relied on grave robbing or personal appeals to governors for access to anatomical subjects.[2] Clinical instruction was similarly limited. At the University of Virginia in 1850, for example, candidates were required to complete two lecture courses in anatomy, medicine, and chemistry, but there was no mandatory hospital component. Charlottesville General Hospital did not even open until 1861, leaving graduates with little hands-on surgical experience.
The wartime consequences of this educational gap were Southern surgeons that were thrust into battlefield hospitals with minimal operative experience, often learning amputation techniques on wounded soldiers rather than in a controlled learning environment. In contrast, many Northern professors—including Samuel Gross of Jefferson Medical College and William Hammond of the University of Maryland—directly authored surgical manuals or led the Union’s Medical Department.[3] The South entered the war at a distinct disadvantage, both in training and institutional support.
Given the lack of prior training, the Confederacy was forced to improvise and learn on the spot. The Confederate Surgeon General, Samuel Preston Moore, commissioned new manuals tailored to resource-limited settings, the most notable being J.J. Chisolm’s Manual of Military Surgery (1861).[4] Southern surgeons turned to local herbal remedies when cut off from imported drugs like quinine and morphine, and many younger physicians gained surgical exposure only through battlefield necessity. While these adaptations revealed ingenuity, they underscored the lack of a standardized medical education system prior to the war.
Following the war, southern states rapidly responded to deficits in medical training highlighted by the war. By the 1870s, institutions such as Tulane, Vanderbilt, and the Medical College of Georgia began to re-emerge as important centers of medical education. These schools consciously modeled themselves on Northern universities, adopting graded multi-year curricula that replaced the traditional two terms of lectures. This shift was significant: students were now expected to progress through increasingly advanced coursework rather than repeat the same set of lectures twice.
Dissection also became more standardized in the postwar years. Although a uniform legal framework for cadaver donation would not arrive until the twentieth century with the Uniform Anatomical Gift Act (1968), Southern schools gradually secured more consistent access to anatomical material, bringing their training closer in line with national norms.[5]
Perhaps the most important reform in the South was the integration of hospitals into medical education. Prewar Southern schools were often located in smaller towns or rural settings without large patient populations, which severely limited clinical exposure. After the war, schools in urban centers such as New Orleans, Richmond, and Nashville developed partnerships with hospitals that allowed students to gain bedside experience. This mirrored the longstanding model of Northern institutions like the University of Pennsylvania, which had required attendance at Philadelphia Hospital or Pennsylvania Hospital as early as 1840.[6]
The new emphasis on hospital-based training in the South not only improved the quality of education but also aligned with broader national trends. By the late nineteenth century, the apprenticeship model was giving way to an institutional model in which hospitals, laboratories, and formal curricula defined the physician’s training.
The Civil War exposed the weaknesses of Southern medical education, but it also created an impetus for reform. Confederate alumni such as Joseph Jones of the Medical College of Georgia later became advocates for scientific rigor and clinical observation.[7] By joining the American Medical Association in greater numbers after the war, Southern schools linked themselves to national debates about standards, curricula, and licensing. Over time, these reforms helped Southern schools move away from the proprietary, profit-driven model that had dominated before the war.
Still, progress was uneven. Many institutions struggled financially, and it was not until the Flexner Report of 1910 that sweeping, nationwide reform would fully eliminate underperforming proprietary schools.[8] Nevertheless, the Civil War created a moment of reckoning for the South. By demonstrating the human cost of underprepared surgeons, the conflict forced Southern educators to invest in anatomy, hospital partnerships, and graded curricula that better prepared their graduates for the demands of modern medicine.
References
[1] Medical Lecture Tickets: Historical Narrative. University Archives and Records Center. Published March 29, 2018. Accessed September 19, 2025. https://archives.upenn.edu/exhibits/penn-history/medical-lecture-tickets/history/
[2] Anatomical Theatre at the University “Subjects” for Anatomy Class. Virginia.edu. Published 2023. https://exhibits.hsl.virginia.edu/anatomical-theatre/subjects-for-anatomy-class/index.html
[3] Hammond, William A. Circular. No. 2. Washington City: Surgeon General’s Office, 1862. Print.
[4] Chisolm’s Manual of Military Surgery, Civil Practice to Civil War: The Medical College of the State of South Carolina 1861-1865. Musc.edu. Published 2025. Accessed September 19, 2025. https://waring.library.musc.edu/exhibits/civilwar/ChisolmMMS.php?
[5] Sadler AM. The Uniform Anatomical Gift Act. JAMA. 1968;206(11):2501. doi:https://doi.org/10.1001/jama.1968.03150110049007
[6] I I. Accessed September 17, 2025. https://archives.upenn.edu/media/2017/10/catalogue-1840-41.pdf
[7] JOSEPH JONES: CONFEDERATE SURGEON - ProQuest. Proquest.com. Published 2025. Accessed September 19, 2025. https://www.proquest.com/docview/288310009?fromopenview=true&pq-origsite=gscholar&sourcetype=Dissertations%20&%20Theses
[8] February 2010 - Volume 85 - Issue 2 : Academic Medicine. Lww.com. Published 2025. Accessed September 19, 2025. https://journals.lww.com/academicmedicine/abstract/2010/02000/abraham_flexner_of_kentucky
The Civil War not only transformed the political and social landscape of the United States but also fundamentally reshaped the medical profession, particularly in the South. While Northern physicians entered the conflict with stronger institutional ties to hospitals, more reliable access to cadavers, and a tradition of clinical instruction, Southern medical schools were often proprietary institutions with limited resources and inconsistent curricula.[1] When the war began, most Southern schools closed, leaving only the Medical College of Virginia open. In the postwar period, the South faced the challenge of rebuilding its devastated infrastructure while also modernizing its medical education. This essay explores how Southern schools adapted after the Civil War, emphasizing the reforms that gradually aligned them with Northern standards.
Before the war, Southern medical education was characterized by shorter lecture terms, limited emphasis on dissection, and minimal hospital training. Whereas Northern schools benefited from anatomy acts such as Massachusetts’ 1831 law and New York’s 1854 “Bone Bill,” which secured a legal cadaver supply, Southern students relied on grave robbing or personal appeals to governors for access to anatomical subjects.[2] Clinical instruction was similarly limited. At the University of Virginia in 1850, for example, candidates were required to complete two lecture courses in anatomy, medicine, and chemistry, but there was no mandatory hospital component. Charlottesville General Hospital did not even open until 1861, leaving graduates with little hands-on surgical experience.
The wartime consequences of this educational gap were Southern surgeons that were thrust into battlefield hospitals with minimal operative experience, often learning amputation techniques on wounded soldiers rather than in a controlled learning environment. In contrast, many Northern professors—including Samuel Gross of Jefferson Medical College and William Hammond of the University of Maryland—directly authored surgical manuals or led the Union’s Medical Department.[3] The South entered the war at a distinct disadvantage, both in training and institutional support.
Given the lack of prior training, the Confederacy was forced to improvise and learn on the spot. The Confederate Surgeon General, Samuel Preston Moore, commissioned new manuals tailored to resource-limited settings, the most notable being J.J. Chisolm’s Manual of Military Surgery (1861).[4] Southern surgeons turned to local herbal remedies when cut off from imported drugs like quinine and morphine, and many younger physicians gained surgical exposure only through battlefield necessity. While these adaptations revealed ingenuity, they underscored the lack of a standardized medical education system prior to the war.
Following the war, southern states rapidly responded to deficits in medical training highlighted by the war. By the 1870s, institutions such as Tulane, Vanderbilt, and the Medical College of Georgia began to re-emerge as important centers of medical education. These schools consciously modeled themselves on Northern universities, adopting graded multi-year curricula that replaced the traditional two terms of lectures. This shift was significant: students were now expected to progress through increasingly advanced coursework rather than repeat the same set of lectures twice.
Dissection also became more standardized in the postwar years. Although a uniform legal framework for cadaver donation would not arrive until the twentieth century with the Uniform Anatomical Gift Act (1968), Southern schools gradually secured more consistent access to anatomical material, bringing their training closer in line with national norms.[5]
Perhaps the most important reform in the South was the integration of hospitals into medical education. Prewar Southern schools were often located in smaller towns or rural settings without large patient populations, which severely limited clinical exposure. After the war, schools in urban centers such as New Orleans, Richmond, and Nashville developed partnerships with hospitals that allowed students to gain bedside experience. This mirrored the longstanding model of Northern institutions like the University of Pennsylvania, which had required attendance at Philadelphia Hospital or Pennsylvania Hospital as early as 1840.[6]
The new emphasis on hospital-based training in the South not only improved the quality of education but also aligned with broader national trends. By the late nineteenth century, the apprenticeship model was giving way to an institutional model in which hospitals, laboratories, and formal curricula defined the physician’s training.
The Civil War exposed the weaknesses of Southern medical education, but it also created an impetus for reform. Confederate alumni such as Joseph Jones of the Medical College of Georgia later became advocates for scientific rigor and clinical observation.[7] By joining the American Medical Association in greater numbers after the war, Southern schools linked themselves to national debates about standards, curricula, and licensing. Over time, these reforms helped Southern schools move away from the proprietary, profit-driven model that had dominated before the war.
Still, progress was uneven. Many institutions struggled financially, and it was not until the Flexner Report of 1910 that sweeping, nationwide reform would fully eliminate underperforming proprietary schools.[8] Nevertheless, the Civil War created a moment of reckoning for the South. By demonstrating the human cost of underprepared surgeons, the conflict forced Southern educators to invest in anatomy, hospital partnerships, and graded curricula that better prepared their graduates for the demands of modern medicine.
References
[1] Medical Lecture Tickets: Historical Narrative. University Archives and Records Center. Published March 29, 2018. Accessed September 19, 2025. https://archives.upenn.edu/exhibits/penn-history/medical-lecture-tickets/history/
[2] Anatomical Theatre at the University “Subjects” for Anatomy Class. Virginia.edu. Published 2023. https://exhibits.hsl.virginia.edu/anatomical-theatre/subjects-for-anatomy-class/index.html
[3] Hammond, William A. Circular. No. 2. Washington City: Surgeon General’s Office, 1862. Print.
[4] Chisolm’s Manual of Military Surgery, Civil Practice to Civil War: The Medical College of the State of South Carolina 1861-1865. Musc.edu. Published 2025. Accessed September 19, 2025. https://waring.library.musc.edu/exhibits/civilwar/ChisolmMMS.php?
[5] Sadler AM. The Uniform Anatomical Gift Act. JAMA. 1968;206(11):2501. doi:https://doi.org/10.1001/jama.1968.03150110049007
[6] I I. Accessed September 17, 2025. https://archives.upenn.edu/media/2017/10/catalogue-1840-41.pdf
[7] JOSEPH JONES: CONFEDERATE SURGEON - ProQuest. Proquest.com. Published 2025. Accessed September 19, 2025. https://www.proquest.com/docview/288310009?fromopenview=true&pq-origsite=gscholar&sourcetype=Dissertations%20&%20Theses
[8] February 2010 - Volume 85 - Issue 2 : Academic Medicine. Lww.com. Published 2025. Accessed September 19, 2025. https://journals.lww.com/academicmedicine/abstract/2010/02000/abraham_flexner_of_kentucky
Anatomical Study Prior to the Civil War
- Jonathan Gagnon
In 1857, T.R. Roberts, medical student at the University of Virginia, pleaded to the governor of his state that “studying anatomy without subjects for demonstration is as fruitless as geometry without diagrams.” The sentiment behind Roberts’ words continues to ring true today, but they also raise a key issue in medical education prior to the Civil War: difficulties with acquiring cadavers for anatomical study. While the North had established legal precedence and organization for the collection of cadavers for medical education prior to the Civil War, the South relied on more clandestine and disorderly methods.
In the preparation of his letter to Governor Henry Wise, perhaps Roberts had heard horror stories from alums of his university, one of whom might have been A.F.E. Robertson who in 1834 was “shot in the back by an old fellow” while attempting a grave robbery to acquire a body for anatomical study. The legacy of grave robbing does not stop with Robertson, however, as Professor of Anatomy at the University of Virginia, Dr. Augustus Warner, devised a scheme to steal the university’s cart and horse to perform grave robbing at a larger scale. In this plan, Dr. Warner enlisted one of the university’s janitors to “break open the door to the stable, taking care, whilst so doing to commit the least possible injury to the property.” This clandestine operation was further developed in collaboration with “resurrectionists” who performed the body snatching themselves. Many times, however, the line between “resurrectionist” and “professor of anatomy” became one, as described in a letter by Medical College of Virginia Professor A.E. Peticolas: “to continue my lectures I was forced to play resurrectionist myself; by no means a pleasant profession, when the snow is 8 inches deep and the thermometer near zero.” In the absence of legal precedence, anatomy professors and students in the South formed “pseudo crime rings” to acquire bodies for anatomical study.
These records of grave robbing highlight that anatomical dissection did take place in the South, however the difficulties associated with acquiring bodies likely limited the supply of cadavers for study in southern medical schools. Therefore, medical students in the South had less exposure to primary dissections and likely learned anatomy in a more theoretical or academic sense. Given the lack of systemic documentation for health outcomes in the Confederacy during the Civil War, it is difficult to assess what role this diminished exposure to anatomy had on health outcomes, and how that might have contributed to the outcomes of the war itself. Nonetheless, the extensive nature of graverobbing operations by students and professors provide a strong contrast to the environment experienced by medical students in the North prior to the Civil War.
While not entirely immune to the practice of graverobbing, the North had a more cohesive system for delivering bodies to medical schools for anatomical study, established by the Massachusetts Anatomy Act of 1831 and the New York Bone Bill of 1854. The Massachusetts Act, titled “An act more effectually to protect the sepulchres of the dead, and to legalize the study of anatomy in certain cases” created a system that would deliver “unclaimed bodies” to physicians “within twenty-four hours from and after death.” This act, in conjunction with the New York Bone Bill, provided powerhouses in medical education such as Harvard Medical School and University Medical College of New York University with ample bodies for anatomical study. Going beyond advantages in legal backing, northern medical schools were located in more urban settings, compared to the rural environment of most southern medical schools. This disparity is highlighted in correspondence between Thomas Jefferson of the University of Virginia and Dr. Philip Physick of the University of Pennsylvania. In an 1824 letter responding to Jefferson’s request for advice on the development of an anatomy department, Physick mentions how “in our dissecting rooms every facility of dissecting and making preparations is afforded, the supply of subjects on moderate terms, being ample.” Given that this correspondence took place prior to any legal acts that provided a system for cadaver delivery to medical schools, it highlights that the dense population centers in the North likely provided greater access to cadavers.
Ultimately, the study of anatomy was troublesome for both northern and southern medical schools prior to the Civil War. Grave robbing was the predominate form of acquiring bodies for dissection in both regions, however legal acts allowed northern medical schools to develop a more sophisticated method of acquiring bodies for dissection. For southern medical schools, students and professors organized with resurrectionists to acquire bodies and would also perform the grave robbing themselves. Assessments of how discrepancies in the study of anatomy between the North and South impacted the war are difficult to make given less significant data collection in the South.
References:
1. Anatomical Theatre at the University “Subjects” for Anatomy Class. Virginia.edu. Published 2023. Accessed September 17, 2025. https://exhibits.hsl.virginia.edu/anatomical-theatre/subjects-for-anatomy-class/index.html
2. Report of the Select Committee of the House of Representatives on so much of the governor’s speech, at the June session, 1830, as relates to legalizing the study of anatomy - Digital Collections - National Library of Medicine. Nih.gov. Accessed September 17, 2025. http://resource.nlm.nih.gov/61111250R?_gl=1
3. Breeden JO. Body Snatchers and Anatomy Professors: Medical Education in Nineteenth Century Virginia. The Virginia Magazine of History and Biography. 1975;83(3):321-345. doi:https://doi.org/10.2307/4247966
4. NYU Langone Health History | The Lillian & Clarence de la Chapelle Medical Archives. Nyu.edu. Published 2019. https://archives.med.nyu.edu/about/nyu-langone-health-history
5. Gates E. Theatre of the Macabre. UVA Magazine. Accessed September 19, 2025. https://uvamagazine.org/articles/theatre_of_the_macabre
6. T.R. Roberts to Henry A. Wise, January 12, 1857. Governor Henry A. Wise Executive Papers, 1856-1859, Box 6: Folder 2. Accession #36710, January 14, 1857, The Library of Virginia, Richmond, Virginia.
In 1857, T.R. Roberts, medical student at the University of Virginia, pleaded to the governor of his state that “studying anatomy without subjects for demonstration is as fruitless as geometry without diagrams.” The sentiment behind Roberts’ words continues to ring true today, but they also raise a key issue in medical education prior to the Civil War: difficulties with acquiring cadavers for anatomical study. While the North had established legal precedence and organization for the collection of cadavers for medical education prior to the Civil War, the South relied on more clandestine and disorderly methods.
In the preparation of his letter to Governor Henry Wise, perhaps Roberts had heard horror stories from alums of his university, one of whom might have been A.F.E. Robertson who in 1834 was “shot in the back by an old fellow” while attempting a grave robbery to acquire a body for anatomical study. The legacy of grave robbing does not stop with Robertson, however, as Professor of Anatomy at the University of Virginia, Dr. Augustus Warner, devised a scheme to steal the university’s cart and horse to perform grave robbing at a larger scale. In this plan, Dr. Warner enlisted one of the university’s janitors to “break open the door to the stable, taking care, whilst so doing to commit the least possible injury to the property.” This clandestine operation was further developed in collaboration with “resurrectionists” who performed the body snatching themselves. Many times, however, the line between “resurrectionist” and “professor of anatomy” became one, as described in a letter by Medical College of Virginia Professor A.E. Peticolas: “to continue my lectures I was forced to play resurrectionist myself; by no means a pleasant profession, when the snow is 8 inches deep and the thermometer near zero.” In the absence of legal precedence, anatomy professors and students in the South formed “pseudo crime rings” to acquire bodies for anatomical study.
These records of grave robbing highlight that anatomical dissection did take place in the South, however the difficulties associated with acquiring bodies likely limited the supply of cadavers for study in southern medical schools. Therefore, medical students in the South had less exposure to primary dissections and likely learned anatomy in a more theoretical or academic sense. Given the lack of systemic documentation for health outcomes in the Confederacy during the Civil War, it is difficult to assess what role this diminished exposure to anatomy had on health outcomes, and how that might have contributed to the outcomes of the war itself. Nonetheless, the extensive nature of graverobbing operations by students and professors provide a strong contrast to the environment experienced by medical students in the North prior to the Civil War.
While not entirely immune to the practice of graverobbing, the North had a more cohesive system for delivering bodies to medical schools for anatomical study, established by the Massachusetts Anatomy Act of 1831 and the New York Bone Bill of 1854. The Massachusetts Act, titled “An act more effectually to protect the sepulchres of the dead, and to legalize the study of anatomy in certain cases” created a system that would deliver “unclaimed bodies” to physicians “within twenty-four hours from and after death.” This act, in conjunction with the New York Bone Bill, provided powerhouses in medical education such as Harvard Medical School and University Medical College of New York University with ample bodies for anatomical study. Going beyond advantages in legal backing, northern medical schools were located in more urban settings, compared to the rural environment of most southern medical schools. This disparity is highlighted in correspondence between Thomas Jefferson of the University of Virginia and Dr. Philip Physick of the University of Pennsylvania. In an 1824 letter responding to Jefferson’s request for advice on the development of an anatomy department, Physick mentions how “in our dissecting rooms every facility of dissecting and making preparations is afforded, the supply of subjects on moderate terms, being ample.” Given that this correspondence took place prior to any legal acts that provided a system for cadaver delivery to medical schools, it highlights that the dense population centers in the North likely provided greater access to cadavers.
Ultimately, the study of anatomy was troublesome for both northern and southern medical schools prior to the Civil War. Grave robbing was the predominate form of acquiring bodies for dissection in both regions, however legal acts allowed northern medical schools to develop a more sophisticated method of acquiring bodies for dissection. For southern medical schools, students and professors organized with resurrectionists to acquire bodies and would also perform the grave robbing themselves. Assessments of how discrepancies in the study of anatomy between the North and South impacted the war are difficult to make given less significant data collection in the South.
References:
1. Anatomical Theatre at the University “Subjects” for Anatomy Class. Virginia.edu. Published 2023. Accessed September 17, 2025. https://exhibits.hsl.virginia.edu/anatomical-theatre/subjects-for-anatomy-class/index.html
2. Report of the Select Committee of the House of Representatives on so much of the governor’s speech, at the June session, 1830, as relates to legalizing the study of anatomy - Digital Collections - National Library of Medicine. Nih.gov. Accessed September 17, 2025. http://resource.nlm.nih.gov/61111250R?_gl=1
3. Breeden JO. Body Snatchers and Anatomy Professors: Medical Education in Nineteenth Century Virginia. The Virginia Magazine of History and Biography. 1975;83(3):321-345. doi:https://doi.org/10.2307/4247966
4. NYU Langone Health History | The Lillian & Clarence de la Chapelle Medical Archives. Nyu.edu. Published 2019. https://archives.med.nyu.edu/about/nyu-langone-health-history
5. Gates E. Theatre of the Macabre. UVA Magazine. Accessed September 19, 2025. https://uvamagazine.org/articles/theatre_of_the_macabre
6. T.R. Roberts to Henry A. Wise, January 12, 1857. Governor Henry A. Wise Executive Papers, 1856-1859, Box 6: Folder 2. Accession #36710, January 14, 1857, The Library of Virginia, Richmond, Virginia.
Antiseptic and Hygienic Practices During the Civil War
- Jonathan Yu
The Civil War is considered to be one of the deadliest conflicts in American History (Digital History, n.d.). A significant reason for this was the rapid advancements in military technology, particularly the introduction of the Minié ball- a new type of lead bullet that had a shorter reload time, improved accuracy, greater range, and devastating power (HistoryNet, n.d.). Upon impact, the Minié ball splintered inside the body, causing catastrophic injuries. This led to a dramatic rise in amputations and, consequently, a surge in infections. Exacerbation resulted in a rise in infections. Exacerbated by unhygienic practices, disease and illness were responsible for over two-thirds of deaths during the Civil War.Septic practices during the war were still in their infancy. The vast majority of physicians and the public believed in the “Miasma” Theory, a theory centered around the belief that inhalation of air infected with corrupting matter was the root cause of disease (Halliday, 2001). This belief shaped the design of military camps, where latrines were often placed at the edge of camp to prevent the spread of “bad air”. However, because the latrines were so far away, some soldiers used the opportunity to desert. Guards were eventually stationed near latrines, but the distance and lack of privacy discouraged their use. As a result, many soldiers relieved themselves near their living quarters, contaminating food and water supplies (Civil War Monitor, n.d.).
Not all military camps were equally unsanitary. Dr. Mütter, a renowned surgeon and professor at Jefferson Medical College, was an early proponent of cleanliness. His student, Colonel Daniel Leasure, commanded a Union infantry regiment and instilled strict hygiene practices among his men during the Civil War and instilled the principles of hygiene within those that he commanded (Price, 2020). His remarkable success in limiting deaths by disease demonstrated the lifesaving importance of sanitation.
Disinfectants also began to see wilder use during this period, however, not precisely in the way that we conventionally think they are used today. In line with miasma theory, hospitals were kept smelling fresh to prevent the transmission of disease. When fresh air was unavailable, “disinfectants” such as lead nitrate, zinc chloride, charcoal, sulfate of lime, and carbolic acid were used to mask odors (Price, 2019). Still, despite the rise in disinfectant usage, people were predominantly using them to make the air smell better, rather than to disinfect tables and surgical tools.
Antiseptic practices also began to arise during the Civil War despite the lack of acceptance of Germ theory. In 1863, Dr. Goldsmith experimented with the use of bromine as an antiseptic to help treat hospital gangrene while serving the Army of the Cumberland. Goldsmith’s application of bromine reduced mortality from 46% to 3% (McIntire, 2023). Additionally, some surgeons began quarantining patients and ensuring that each had their own sponge, towel, and bedding. These small, but significant measures foreshadowed later advances in antiseptic technique.
The overall toll of disease on the Union Army was devastating. Pneumonia caused 1.7 million cases and 45,000 deaths; typhoid, 149,000 episodes and 35,000 deaths; diarrhea/dysentary, 360,0000 cases and 21,000 deaths; and malaria, 1,316,000 and 10,000 deaths (Sartin, 1993). These harrowing statistics highlight the devastating role of disease in the war.
One striking example occurred during General McClellan’s Peninsula Campaign in the Spring of 1862. He planned to land troops on the Virginia Peninsula and take over Richmond. However, diseases like malaria, typhoid, and dysentery ravaged his army, reducing his strength by more than one-third. There were nearly three disease episodes per soldier over 9 months. In the end, McClellan had to retreat after losing several battles to Robert E. Lee, likely prolonging the war by 1 to 2 years (Sartin, 1993).
American physicians also drew inspiration from Florence Nightingale’s reforms during the Crimean War, which emphasized ventilation and cleanliness. In 1861, Richmond, Virginia., saw the construction of the first pavilion-style hospital in the United States. These hospitals, designed to maximize airflow, helped patients recover more quickly and achieved mortality rates as low as 8% (Price, 2018). Their success led to rapid construction of similar styled hospitales throughout the war.
The creation of the United States Sanitary Commission in 1861 further advanced military medicine. The commission inspected soldiers and camps, advised on disease prevention, and lead relief efforts (Ullman, n.d.). It published a series of essays to guide physicians, many of whom had come from small towns with little experience treating battlefield injuries, in camp hygiene and appropraite care for the sick and wounded. These essays provided a much-needed standard of practice during the conflict.
Today, antiseptic and hygienic practices are vastly different. The acceptance of germ theory transformed medicine, allowing physicians to understand how disease spreads, and how to prevent it. Surgical instruments are now sterilized between each operations, and surgeons wear masks, gloves, and gowns to reduce infection risk. Sewage systems and modern toilets prevent contamination of water and food supplies. Building on the principles of pavilion-style hospitals, modern clinics are designed with private rooms and that there is adequate ventilation. The practices and techniques developed and understood during the Civil War serve as a critical foundation for modern medicine in the United States today.
Works Cited
Digital history. (n.d.). Retrieved September 19, 2025, from https://www.digitalhistory.uh.edu/disp_textbook.cfm?smtid=2&psid=3062#:~:text=The%20Civil%20War%20was%20the,and%20World%20War%20II%20combined.
Halliday S. (2001). Death and miasma in Victorian London: an obstinate belief. BMJ (Clinical research ed.), 323(7327), 1469–1471. https://doi.org/10.1136/bmj.323.7327.1469
Minie ball: The civil war bullet that changed history. (n.d.). HistoryNet. Retrieved September 19, 2025, from https://www.historynet.com/minie-ball/
McIntire, T. (2023, July 19). Hospital gangrene in the civil war. National Museum of Civil War Medicine. https://www.civilwarmed.org/hospital-gangrene-in-the-civil-war/
Price, D. (2018, February 20). The innovative design of civil war pavilion hospitals. National Museum of Civil War Medicine. https://www.civilwarmed.org/pavilion-hospitals/
Price, D. (2019, October 1). Fighting disease with smell: “Disinfection” during the civil war. National Museum of Civil War Medicine. https://www.civilwarmed.org/disinfection/
Price, D. (2020, June 29). Germ theory from antiquity to the antebellum period. National Museum of Civil War Medicine. https://www.civilwarmed.org/germ-theory-antebellum/
Reilly R. F. (2016). Medical and surgical care during the American Civil War, 1861-1865. Proceedings (Baylor University. Medical Center), 29(2), 138–142. https://doi.org/10.1080/08998280.2016.11929390
Sartin J. S. (1993). Infectious diseases during the Civil War: the triumph of the "Third Army". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 16(4), 580–584. https://doi.org/10.1093/clind/16.4.580
The enemy within. (n.d.). Civil War Monitor. Retrieved September 19, 2025, from https://www.civilwarmonitor.com/article/the-enemy-within/
Ullman, D. (n.d.). The united states sanitary commission. American Battlefield Trust. Retrieved September 19, 2025, from https://www.battlefields.org/learn/articles/united-states-sanitary-commission
Surgical anesthesia in the Civil War and the present day – whither ether?
- Harrison Smith-Jaoudi
The adoption of anesthesia as an integral part of major surgery in the Civil War owes much to publication efforts that provided military physicians, many with scant prior training or experience, practical guidance in the form of handbooks and manuals, the most widely distributed of which explained and advised surgical applications of inhalational anesthesia (https://pmc.ncbi.nlm.nih.gov/articles/PMC11191930/). The landmark Medical and Surgical History of the War of the Rebellion (MSHWR) records more than 80,000 instances of inhalational anesthesia, a “conservative figure” for the Union forces that includes 8,900 instances of use in “major operations” (https://pubmed.ncbi.nlm.nih.gov/20503754/). More than 160 years after the end of the war in 1865, it is of interest to see how essential aspects of the then-burgeoning practice of anesthesia appear in the present day. This post looks at one such aspect, the anesthetic agent ether, with an emphasis on merits recognized by Civil War physicians that contribute to its utility in present-day anesthesia.The earliest attempts to free patients from surgical pain are presumably lost to the historical record, but nerve compression, to take one example, seems to be attested at least from the third millennium BCE in ancient Egypt. From then on, there are anesthetic efforts, some similarly rooted in now-recognizable aspects of human physiology, scattered across time and space, including forms of “refrigeration anesthesia” via the application of ice or snow, as performed by Marco Severino in the 1600s, through various applications of opiates and ethanol, with commensurately various levels of plausibility and success, into the 19th century. Perhaps most intriguing is the soporific sponge, a device applied beneath the surgical patient’s nose from the 9th through 13th centuries. By boiling mandrake leaves, poppies, nightshade, and other herbal components, practitioners managed to infuse the soporific sponge with scopolamine and morphine, two agents that still see anesthetic and perianesthetic application as, respectively, antiemetic and analgesic (https://oce.ovid.com/book?SerialCode=02274621).
Ether, a volatile liquid whose vapors serve as an inhalational anesthetic, may have been known, and some of its potential anesthetic properties recognized, from as early as the 8th century, by the author or authors of the Jabirian corpus in the Islamic Golden Age. In Europe it was perhaps known to Raymond Lully in the 13th century and certainly known, as oleum vitrioli dulce, to Paracelsus and Valerius Cordus in the 16th. Its entrance into the medical limelight as an anesthetic, however, had to wait until the mid-19th century. Following then-unpublicized applications by William Clarke and Crawford Long in 1842, dentist William Morton executed the first public demonstration of ether for surgical anesthesia at the Massachusetts General Hospital, on 16 October, 1846, roughly 15 years before the Civil War began. Experimentation with ether for surgical anesthesia, along with greater interest in nitrous oxide and soon chloroform as alternative inhaled anesthetics, had spread worldwide by the end of the decade (https://oce.ovid.com/book?SerialCode=02274621).
In the Civil War itself, ether did not enjoy universal application, despite the broad uptake of anesthesia in surgical practice. Instead chloroform, the other dominant anesthetic agent of the 1860s, was the sole agent in 76.2% of cases the MSHWR records; by contrast, ether was the sole agent in 14.7% of cases. The two jointly applied in the remainder of cases, an intriguing early demonstration of medical interest in the power of anesthetic agents to complement or compensate one another’s strengths and deficiencies (https://doi.org/10.1177/0310057X0603401S01).
Chloroform’s primary merits were rapidity of induction and emergence, low volume requirements and hence ease of transportability and application in the field, lack of both objectionable odor and superficial respiratory irritation, and, perhaps crucially, lack of flammability – all by contrast with ether. Chloroform, however, posed serious respiratory and cardiac risks in the short term, risks whose principled scientific investigation and impact in ending chloroform anesthesia extended well into the 20th century, but which were clearly known by the time of the Civil War. The difference in perceived safety between the two agents is nicely illustrated by the section on anesthesia in Stephen Smith’s (Union) Hand-Book of Surgical Operations, preserved online (https://archive.org/details/handbooksurgica00smitgoog/page/n41/mode/2up?view=theater), where the instruction that ether should be applied “lavishly” contrasts with the admonishment that “great care must be exercised” in the administration of chloroform. Comments from physicians of the time who compared the two agents show informative parallels to the current day. Surgeon B.B. Breed, for example, wrote that despite chloroform’s widespread and largely successful use, he “employed ether in preference… preferring, both from personal experience and observation the delay and discomfort in its administration to the possible danger from the use of the latter” (https://pubmed.ncbi.nlm.nih.gov/20503754/).
What Breed indicates here, aside from the inductive sluggishness and subjective noxiousness of ether, is its remarkable safety profile, a major contributor to its continued worldwide use. In resource- and training-limited circumstances, in particular, ether is still invaluable, for reasons that largely held in the Civil War era too. For one of many modern enumerations of these reasons, readers can turn to Improvised Medicine: Providing Care in Extreme Environments (2nd ed., 2016); a selection follows. First, both diethyl ether (most common in the Civil War and still commonly used) and divinyl ether (most preferable today) are easy to produce, and in exigency can be repurposed from industrial to medical application. Second, it offers a (comparatively) vast safety margin, i.e., the dose required for satisfactory surgical anesthesia and the dose at which adverse events become likely are so far apart that it has been called “fool proof”, even in inexperienced hands. It supplies “intrinsic analgesia [and] neuromuscular relaxation, is a bronchodilator, rarely potentiates the dysrhythmic effect of sympathomimetic agents, causes little uterine relaxation, stimulates blood flow (helpful in shocky patients), and stimulates respiration” (https://accessmedicine.mhmedical.com/content.aspx?bookid=1728§ionid=115695659).
Of course there are myriad risks and caveats to be added. Certainly ether is no panacea, and the notion that any agent or procedure in medicine could be fool proof must be taken as hyperbolic. Still, ether is worth the attention not only of anesthesiologists and anesthetists, but of all practitioners with an interest in maintaining some of the advantages of surgical anesthesia when resources and training are limited. A celebration of ether anesthesia seems to be in order – just keep the matches and fireworks in another room.
Standardizing the Charts: Exploring the Civil War Legacy of William Hammond on Medical Recordkeeping
- Yousuf Latif
Prior to the Civil War, there were some efforts to compile records on sickness and mortality, however, there was little standardization and these statistics were not collected at regular intervals, or at a scale comparable with the Civil War. One such example from 1856 was The Statistical Report on the Sickness and Mortality in the Army of the United States, published by the office of the Surgeon General of the US Army. Although it was one of the earlier large reports, it was actually fairly involved, and included data on mortality as well as sickness by specific illness down to the regimen level (1). However, this was not a routine report – instead it covered a somewhat arbitrary sixteen year period – and the report acknowledges that its input data was at times lacking. Types of records varied by physician, there were no standard forms used, diagnoses were often vague or non-exhaustive, and often times data was either discarded or not collected. Civilian hospitals before the war also had little to no central reporting, as there was not national framework to guide them.
As Surgeon General, Hammond began to lay the foundations to correct some of these issues in data collection. In his role he directed for departmental surgeons to consolidate and send monthly reports of the sick, wounded, and killed in action to the Surgeon General’s office. His push for the collection of these reports, as well as bed cards and case histories allowed for the creation of the Medical and Surgical History of the War of the Rebellion report – an impressively detailed medical record of the war (2). Hammond also issued Circular No. 2, which in addition to establishing the Army Medical Museum also directed medical offers to “diligently collect and forward to the office of the Surgeon General all specimens of morbid anatomy, surgical or medical, which may be regarded as valuable; together with projectiles and foreign bodies removed; and such other matter as may prove of interest in the study of military medicine and surgery”(3). Hammond also required that physicians sent case histories with the samples they sent, in order for these records to better advance science and be able to be instructive to future army medical practitioners. (4). Other key reformers in the Civil War also helped to standardize the information that the healthcare system collected. Jonathan Letterman, the medical director of the Army of the Potomac, required that assistant-surgeons submitted reports of each case seen in the hospital, including the patient name, rank, company, hospital site, detail of the injury, the treatment given, and the eventual outcome. This data would be used to make tables detailing by unit the location of wounds, type of weapon that caused the injury, and treatment operation performed. Letterman also began to require that army medical directors made monthly reports to be delivered to the Office of the Surgeon General that noted issues faced and deficiencies that needed correcting, as well as to compile reports on hospital supply levels (4).
While the reforms and pushes for standardization in record keeping during this time were not always perfectly followed, they were a seminal moment towards the standardization of forms and the more regular recording of medical information. In the years that followed, army reporting became embedded in Army medical practice, and reporting of sickness and mortality became more standardized and regular through the eventual adoption of annual reports and standardized disease categories (5). While the story of Civil War medicine often focuses on battlefield amputations and early medical practices, an unsung part of its legacy is in the paperwork. Hammond and his department took the disorganized practice of notekeeping and set forth an expectation of uniform and detailed medical records. These were a turning point in American medical record keeping – this expectation never disappeared, and eventually made its way from military medicine to the civilian world. Hammond’s reforms ushered the way to our modern reporting standards that expect health data to be uniform, centralized, and used to guide policy.
References
1.
Coolidge, R. H. (n.d.). Statistical
Report on the Sickness and Mortality in the Army of the United States, Compiled
from the Records of the Surgeon General’s Office; A Period of Sixteen Years,
from January, 1839, to January, 1855.AMEDD
Center of History & Heritage.
https://achh.army.mil/history/book-mexicanwar-casualtystats-mexwarstats
2.
Love, A. G., Hamilton, E. L., & Hellman, I. L. (n.d.). Tabulating Equipment and Army Medical Statistics. AMEDD Center of History & Heritage.
https://achh.army.mil/history/book-misc-tabulatingequipandarmymedstats-chapter2
3.
Price, D. (2021, April 24). The Civil War and
the Army Medical Museum. National Museum
of Civil War Medicine. https://www.civilwarmed.org/army-medical-museum/
4.
Barr, G. (n.d.). Writing a Better
System into Place: How Record-keeping During the Civil War Transformed Military
Medicine in the United States. Galter
Health Sciences Library & Learning Center.
https://galter.northwestern.edu/news/writing-a-better-system-into-place-how-record-keeping-during-the-civil-war-transformed-military-medicine-in-the-united-states?category=75
5. Marble, S. (2025a, April 20). U.S. military medical surveillance: Two centuries of progress. MSMR. https://pmc.ncbi.nlm.nih.gov/articles/PMC12091953/
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