A Really Bad War to be Wounded in
Categories: History , Nonfiction , Health & Nutrition
My alternate title for this entry was "It's A Wonder Anyone's Alive at All."
The total casualty rate during World War I was far higher than the American Civil War's. However, huge medical advances occurred between the 1860s and 1914. You may ask yourself which would be worse--to be wounded in the Civil War or in World War I.
I have to say that being wounded in the Civil War in most situations, especially early on, would be much worse. Ira M. Rutkow's Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine is a sobering reminder of how awful medicine was before the development of asepsis and antiseptics. It's also the story of how personality conflicts and inter-agency political battles can get in the way of what everyone agrees is a good thing--in this case, proper care for the war's wounded soldiers.
Most of the Confederate Army's medical records were destroyed, so Bleeding Blue and Gray concentrates on Union Army policies. At first there were none. The surgeon general at the time believed, for example, that army hospitals were unnecessary in South Carolina because of its warm climate--even after four wounded soldiers froze to death. Little could be said about the efficacy of American medical schools in turning out physicians. In fact, you could avoid med school completely and still call yourself a doctor, even if your personal theories about medicine were worse than the accepted ones.
In fact, you'd have to be pretty eccentric to have medical theories worse than the accepted ones. The physician with the strongest following in the United States at the time was Benjamin Rush. His belief was that human sickness was caused by "excess activity in blood vessels." Thus, removing excess body fluids--including blood and the contents of the digestive system through bleeding, purging, and the blistering of the skin--was the best possible way to deal with disease.
As in World War I, amputation was the primary surgical procedure; amputation fatalities, percentage-wise, during the Civil War, were higher because of the lack of clean facilities and surgical instruments. While anesthetics like ether were theoretically available, they did not always make it to the operating field (and I use the word "field" literally), and the surgeon's duty was to complete the process as quickly as possible to lessen the pain of the procedure, assisted by aides holding the hapless patient down.
Some doctors and indeed untrained random enthusiasts abandoned their assigned roles of treating the sick or dressing wounds and rushed off to the amputation fields just for the joy of the experience. Except for the mad amputators, though, the doctors were for the most part doing the best they could.
There are several heroes in Bleeding Blue and Gray, and the first one is Frederick Law Olmsted--yes, the designer of New York's Central Park--who became executive secretary of the United States Sanitary Commission, the precurser of the Red Cross. The civilians on the Sanitary Commission were finally successful in establishing an independent ambulance service and in making sure some basic sanitary conditions were established--that hospital kitchens were not drawing their water from the latrines, for example.
Surgery was performed only by doctors who had passed rigorous exams. Female nurses of various levels of competency were allowed to treat the soldiers. Hospital ships were established. A new surgeon general, William Hammond, declared the medications that caused the most violent digestive-system reactions would no longer be SOP in the Union Army. Standard designs for army hospitals assured that the convalescing wounded would not have to look out the windows at the dead. Ventilation was somewhat helpful.
By the end of the war, most ciivilians had developed a new, more positive view of hospitals than they had previously held; while surgery was still performed under what we would consider bad conditions, patients could in general at least count on better care than they might have received at home.
Things were still bad in World War I, by the way, but more because of the overwhelming number of casualties in the badly planned battles and the perhaps inevitable filth, vermin, and mud of the trenches than because of lack of basic knowledge of sanitation, although a certain number of medical facts (e.g., gangrene isn't going to go away on its own) seemed to have needed to be relearned. The heavily fertilized soils of France caused infections that could often not be treated with antispectic-laden bandages packed into the soldiers' wounds. However, motorized ambulances, a more adequate number of medical personnel after the first appalling battles, and, of course, increases in medical knowledge, probably made conditions for the wounded at least less horrible than they would have been under the same circumstances in the 1860s. Poet Walt Whitman served as a nurse for the Union Army, by the way, and recorded his experiences in the very moving Specimen Days.
