Civil War Medicine
by Janet King, RN, BSN, CCRN.I. In the Beginning: Vermont's Medical Team Goes to War
In the spring of 1861, as Governor Erastus Fairbanks responded to Lincoln's call for troops, the medical men of Vermont took stock of their situation. Theirs was a developing profession still having growing pains. No national laws or medical acts regulated the licensing or training of physicians. Medical training varied considerably but still consisted primarily of apprenticeships whereby a student "read" in a physician's office and acted as his assistant. Though most had some sort of "diploma," few could say they had any formal medical training. Entrance requirements to medical schools, such as the College of Physicians and Surgeons at the University of the State of New York, varied widely in their curriculum. The "standard" course was 2 years in length. The first year often consisted of 9 months of lecture and reading and 3 months of serving as an assistant to a physician. The second year was merely a repeat of the first. One program of the day had its aspiring physicians "taking care of the office, dispensing medications, and keeping a log of the weather!"
Medical theories of the 1860's were not very different from 100 years subsequent. Humoralism (sickness attributed to imbalance or corruption of the four basic humors: blood, black bile, yellow bile, and phlegm) and Solidism (sickness related to improper stimulation of nerves and blood vessels) were the two leading disease theories and dictated the therapies and "cures" of the day. Medical men were taught the art of blending "therapeutics" such as purgatives (to evacuate the bowel), diaphoretics (to induce sweating), and emetics (to induce vomiting). Bleeding (opening of a blood vessel with a sharp instrument) was often an initial treatment no matter what the patient's complaint or age. The only variances in this method were how the blood was obtained, how much was "let" (no control methods were used other than holding pressure over the vein when the doctor felt the patient had be bled enough), and the location from which the blood was drawn. Blistering was another method used to rid the body of its poison." This treatment included the application of some substance on the skin with the intention of creating a second degree burn that would then "suppurate" or produce pus thus drawing the "bad humors" away from the body.
One modicum of advise given to physicians of this era was "The sicker the patient the more drastic the therapy." Thus, it was not uncommon to see patients near death from the various modes of "medicinal therapeutics." The latest in medical advances and equipment were slow in coming to the United States. Although the stethoscope was invented in the 1830's, it was not until 1868 that medical schools such as Harvard used them, and microscopes were not used there until 1869. It was not until 1863 that the Army Medical Department obtained a microscope and thermometers were a rare item indeed (about 8 existed during the war). Hypodermic syringes were used by some physicians but the majority still "dusted" such drugs as opium and morphine into wounds or made them into pills.
The art of physical exam and the correlation of physical findings to diagnoses lagged behind European countries. Only the better trained American physicians practiced such skills as auscultation and percussion (listening and tapping over body parts to determine the presence of abnormal conditions, i.e. fluid, tumors, etc.) As for patients... many people were leery of medical men. Most people of the time tended to be cared for by loved ones, a midwife, or home-town healer in the comfort of their homes. Many people could say they had spent their entire lives without seeing a physician and hospitals were considered as a "last resort," as places of death and for those without friends or family.
Vermont physicians could look with pride on their achievements in promoting the growth and advancement of their profession. The Vermont State Medical Society, in 1825, had led attempts to raise the standards of medical schools, urging higher requirements for medical degrees and licenses. One of their number, Dr. Warren Stone, had traveled to Louisiana in 1834 to charter the Medical College of Louisiana.
Still, few physicians of the time could claim to be "surgeons." In the military they would be listed as "surgeons" or "assistant surgeons." Some had done little more than minor surgeries i.e. lancing a boil or sewing up a cut. Nothing prepared them for the massive casualties and horror of the Civil War and battlefield surgery. It is a tragic fact that after the war ended many of them could claim to be experienced and competent surgeons.
When Union regiments began to form and "surgeons" were selected, Vermont led the states in it's provision of qualified candidates. Vermont required the strictest exam and the scores of the exam determined the doctor's placement as a "surgeon" or "assistant surgeon." The newly commissioned volunteer physicians were subject to the rules and regulations of the Army Medical Department and they had a lot to learn about military ways! As was the case among the troops, the Medical Department was undergoing rapid restructuring and out of necessity, expanding rapidly. From a pre war force of 98 officers, the Medical Department would grow to over 11,000 doctors, organized into seven distinct corps and arranged in a military hierarchy from Surgeon-General to Assistant Surgeons with the rank of lieutenant.
Each regiment was allowed by regulation:
1 Surgeon 2 Assistant Surgeons 1 Hospital Steward 1 man detailed from the ranks to serve as orderly or nurse 1 man per 5 companies, from the ranks, to serve as hospital cook Litter bearers: To be taken from the regimental and company musicians during battle
The Army Medical Department consisted of Regular Army doctors and volunteers. Doctors were assigned to regiments;brigade and higher staffs; as medical inspectors and as staff of fixed hospitals. The physicians were joined by hospital stewards, who ranked as 1st Sgts and acted as apothecaries (pharmacists). Sometimes medical students were found in such a role. It was the steward's job to keep the records, assist with dressings, compound and dispense medications and give anesthesia when directed. At the time of battle, one of the regimental doctors and the steward would set up an "aid" station close behind the front lines. Here the wounded could be quickly treated and evacuated, the musicians playing a bigger part (as stretcher bearers) than they may have volunteered for! Aid stations would be marked with red flags for easy location by troops. The Surgeon of the regiment, along with other regimental surgeons would gather at a designated "Brigade Hospital" located farther back from the front lines. Here the actual surgery would take place - whether it be in a farmhouse, a barnyard or out in the open entirely. A yellow flag with a green "H" marked the location of this hospital.
But that was in battle. For now the newly commissioned captains and lieutenants had the huge task of examining new recruits and convincing regimental line officers that the medical concerns of a regiment were just as important to the men as were the elements of drill!
In perusing the Army Regulations, the new surgeon of the 1st VT Cavalry, George S. Gale, read that he was to: "examine the recruit stripped; observe that he has free use of all his limbs; chest ample, hearing, vision, speech perfect; no tumors or ulcerated or scarred legs; no rupture (hernia) or chronic cutaneous affection; no contusion or wound of the head that might impair his faculties; not subject to convulsions; no infectious disorder that may unfit him for military service". How, he wondered was he supposed to do all that "examining" on some 800 men? Many of his fellow surgeons did not spend much time worrying about regulations. Patriotic fervor, the need for recruits to fill quotas, time restraints, and limited medical examiners caused the regulations to go unheeded. This became a large problem in short order. Limited hospital beds were taken up by men who had pre existing problems, including chronic diseases such as syphilis, hernias and epilepsy. In some regiments the age requirements were overlooked and the only qualification was if you "looked strong and healthy" as you passed the regimental surgeon. 15 year old George Harriman of the 8th VT Infantry was worried about just that... "I shall never forget the anxiety with which I awaited the ordeal. The company was drawn up in line, and as each man's name was called, he had to step forward and march past the mustering officer equipped with all his outfit. If he showed the least signs of unfitness in his motions, he was rejected. You can imagine how I looked, a boy of fifteen loaded down with all my equipment. But I held myself straight as an arrow for that occasion and tried to walk past the officer with the air of a six footer. My accusing conscience caused me to expect to hear him ask my age, but he did not and I was in all right."
Regulations or not, the Vermont troops were assembled and their surgeons, assistant surgeons and stewards were now given their orders to do their "full duty" as soldiers in the United States Army.
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