Civil War Battlefield Medicine

Compiled by Jenny Goellnitz

An Introduction to Civil War Medicine

During the 1860s, doctors had yet to develop bacteriology and were generally ignorant of the causes of disease. Generally, Civil War doctors underwent two years of medical school, though some pursued more education. Medicine in the United States was woefully behind Europe. Harvard Medical School did not even own a single stethoscope or microscope until after the war. Most Civil War surgeons had never treated a gun shot wound and many had never performed surgery. Medical boards admitted many “quacks,” with little to no qualification. Yet, for the most part, the Civil War doctor (as understaffed, underqualified, and under-supplied as he was) did the best he could, muddling through the so-called “medical middle ages.” Some 10,000 surgeons served in the Union army and about 4,000 served in the Confederate. Medince made significant gains during the course of the war. However, it was the tragedy of the era that medical knowledge of the 1860s had not yet encompassed the use of sterile dressings, antiseptic surgery, and the recognition of the importance of sanitation and hygiene. As a result, thousands died from diseases such as typhoid or dysentery.

The deadliest thing that faced the Civil War soldier was disease. For every soldier who died in battle, two died of disease. In particular, intestinal complaints such as dysentery and diarrhea claimed many lives. In fact, diarrhea and dysentery alone claimed more men than did battle wounds. The Civil War soldier also faced outbreaks of measles, small pox, malaria, pneumonia, or camp itch. Soldiers were exposed to malaria when camping in damp areas which were conductive to breeding mosquitos, while camp itch was caused by insects or a skin disease. In brief, the high incidence of disease was caused by a) inadequate physical examination of recruits; b) ignorance; c) the rural origin of my soldiers; d) neglect of camp hygiene; e) insects and vermin; f) exposure; g) lack of clothing and shoes; h) poor food and water. Many unqualified recruits entered the Army and diseases cruelly weeded out those who should have been excluded by physcial exams. There was no knowledge of the causes of disease, no Koch’s postulates. Troops from rural areas were crowded together for the first time with large numbers of other individuals and got diseases they had no immunity to. Neglect of camp hygeine was a common problem as well. Ignorance of camp sanitation and scanty knowledge about how disease was carried led to a sort of “trial and error” system.You can read Surgeon Charles Tripler’s report on sanitation that is included in this web site for a contemporary view of camp hygeine. An inspector who visited the camps of one Federal Army found that they were, “littered with refuse, food, and other rubbish, sometimes in an offensive state of decomposition; slops deposited in pits within the camp limits or thrown out of broadcast; heaps of manure and offal close to the camp.” The Federal government even founded a Sanitary Commission to deal with the health problems in army camps. Mary Livermore, a nurse, wrote that… “The object of the Sanitary Commission was to do what the Government could not. The Government undertook, of course, to provide all that was necessary for the soldier, . . . but, from the very nature of things, this was not possible. . . . The methods of the commission were so elastic, and so arranged to meet every emergency, that it was able to make provision for any need, seeking always to supplement, and never to supplant, the Government.”  Both Armies faced problems with mosquitos and lice. Exposure turned many a cold into a case of pneumonia, and complicated other ailments. Pneumonia was the third leading killer disease of the war, after typhoid and dysentery. Lack of shoes and proper clothing further complicated the problem, especially in the Confederacy. The diet of the Civil War soldier was somewhere between barely paltable to absoultely awful. It was a wonder they did not all die of acute indigestion! It was estimated that 995 of 1000 Union troops eventually contracted chronic diarrhea or dysentery; their Confederate counterparts suffered similarly. Disease was particularly rampant in the prisoner-of-war camps, whose conditions were generally worse than the army camps.

To halt disease, doctors used many cures. For bowel complaints, open bowels were treated with a plug of opium. Closed bowels were treated with the infamous “blue mass”… a mixture of mercury and chalk. For scurvy, doctors prescribed green vegetables. Respiratory problems, such as pneumonia and bronchitis were treated with dosing of opium or sometimes quinine and muster plasters. Sometimes bleeding was also used. Malaria could be treated with quinine, or sometimes even turpentine if quinine was not available. Camp itch could be treated by ridding the body of the pests or with poke-root solution. Whiskey and other forms of alcohol also were used to treat wounds and disease … though of questionable medical value, whiskey did relieve some pain. Most medinces were manufactured in the north; southerners had to run the Union blockade in order to gain access to them. On occasion, vital medicines were smuggled into the South, sewn into the petticoats of ladies sympathetic to the Southern cause. The South also had some manufacturing capabilites and worked with herbal remedies. However, many of the Southern medical supplies came from captured Union stores. Dr. Hunter McGuire, the medical director of Jackson’s corps, commented after the War on the safeness of anethesia, saying that in part the Confederacy’s good record was due in part from the supplies requisitoned from the North.

Battlefield surgery (see separate web page describing an amputation) was also at best archaic. Doctors often took over houses, churches, schools, even barns for hospitals. The field hospital was located near the front lines — sometimes only a mile behind the lines — and was marked with (in the Federal Army from 1862 on) with a yellow flag with a green “H”. Anesthesia’s first recorded use was in 1846 and was commonly in use during the Civil War. In fact, there are 800,000 recorded cases of its use. Chloroform was the most common anesthetic, used in 75% of operations. In a sample of 8,900 uses of anesthesia, only 43 deaths were attributed to the anethestic, a remarkable mortality rate of 0.4%. Anesthesia was usually administered by the open-drop technique. The anethestic was applied to a cloth held over the patient’s mouth and nose and was withdrawn after the patient was unconscious. A capable surgeon could amputate a limb in 10 minutes. Surgeons worked all night, with piles of limbs reaching four or five feet. Lack of water and time meant they did not wash off hands or instruments

Bloody fingers often were used as probes. Bloody knives were used as scalpels. Doctors operated in pus stained coats. Everything about Civil War surgery was septic. The antiseptic era and Lister’s pioneering works in medicine were in the future. Blood poisoning, sepsis or Pyemia (Pyemia meaning literally pus in the blood) was common and often very deadly. Surgical fevers and gangrene were constant threats. One witness described surgery as such: “Tables about breast high had been erected upon which the screaming victims were having legs and arms cut off. The surgeons and their assistants, stripped to the waist and bespattered with blood, stood around, some holding the poor fellows while others, armed with long, bloody knives and saws, cut and sawed away with frightful rapidity, throwing the mangled limbs on a pile nearby as soon as removed.” If a soldier survived the table, he faced the awful surgical fevers. However, about 75% of amputees did survive.

The numbers killed and wounded in the Civil War were far greater than any previous American war. As the lists of the maimed grew, both North and South built “general” military hospitals. These hospitals were usually located in big cities. They were usually single storied, of wood construction, and well-ventilated and heated. The largest of these hospitals was Chimbarazo in Richmond, Virginia. By the end of the War, Chimbarazo had 150 wards and was capable of housing a total of 4,500 patients. Some 76,000 soldiers were treated at this hospital.

There were some advances, mainly in the field of military medicine. Jonathan Letterman, revolutionized the Ambulance Corps system. With the use of anethesia, more complicated surgeries could be performed. Better and more complete records were kept during this period than they had been before. The Union even set up a medical museum where visitors can still see the shattered leg of flamboyant General Daniel Sickles who lost his leg at the Trostle Farm at the battle of Gettysburg when a cannon ball litterally left it hanging by shreds of flesh.

The Civil War “sawbones” was doing the best he could. Sadly when American decided to kill American from 1861 to 1865, the medical field was not yet capable of dealing with the disease and the massive injuries caused by industrial warfare.

Civil War Medical Terms

  • ague: Fever, or other recurrent symptom resulting from malaria also known as a chill. It was a common synonym for intermittent fever.
  • amputation: Removal of an appendage of the body, usually a limb. circular: Using a single flap and by making a circular cut at a 90 degree angle to the long axis of the appendage.

    primary: surgery done following the period of shock and before inflammation sets in. Most amputations were done within the first 24 hours.

    secondary: usually performed to improve an earlier amputation.

  • anodynes: medicine that relieves pain
  • apoplexy: stroke; sudden impairment due to a cranial hemorrhage. It could also refer to extravasation of blood in any organ.
  • asthenia: weakness
  • bilious attack: certain diseases such as malaria or typhoid was sometimes designated as bilious fever. Applied to group of symptoms consisting of headache, abdominal pain, and constipation. Commonly name given to migraines or acute dyspepsia.
  • blue mass: also known as blue pill. It was a mercury mass used for many conditions.
  • Bright’s disease: general term for kidney diseases.
  • Camp, state: made up of various symptoms such as fever or diarrhea which happened when troops were crowded together.
  • catarrhus: inflammation of the mucus membranes.
  • cholera: acute infectious disease characterized by severe diarrhea with extreme fluid losses, the resulting dehydration and electrolyte loss often leading to death. Different types included Asiatic and morbus.
  • colica: acute abdominal pain
  • consumption: wasting away of the body. Generally applied to tuberculosis.
  • debility: lack or loss of strength. Debility is generally considered to be lasting.
  • dementia: insanity. Organic loss of intellectual function.
  • dengue: also known as ‘break bone fever’. An infectious disease which is characterized by severe pains in the eyes, head, and extremities and accompanied by catarrhal symptoms. Transmitted by the bite of a mosquito.
  • dysentery: inflammation of the intestines. The cause could be a chemical irritant, bacteria, or parasites.
  • dyspepsia: term used to describe epigastric discomfort after meals. It refers to a state in the stomach in which functions are disturbed.
  • dyspena: difficulty in breathing.
  • erysipelas: a very contagious skin disease due to areas being infected with a strep germ. It is characterized by redness and swelling of the affected areas. It generally lasted between 10 and 14 days. Most infections of wounds were more likely not this disease and actually cellulitis.
  • excision: removal by cutting. Done usually instead of performing an amputation.
  • fevers: elevation of body temperature above normal.

    Camp: included typhoid and many other diseases; a catch-all phrase.
    intermittent: recurring fevers; usually malaria was the cause.
    remittent: usually used to refer to malaria
    typhoid: a disease characterized by chills, fever, abdominal distention, and an enlarged spleen.
    yellow: acute infectious disease transmitted by mosquitoes in which the symptoms are jaundice, fever, and protein. Has two stages in which delirium and coma could be the results of the second one.

  • grippe: also known as influenza. Acute viral infection of the respiratory tract.
  • malaria: disease caused by a protozoa. It is parasitic of red blood cells and is transmitted by mosquitoes. Symptoms included chills, fever, and sweating. Often chronic and recurring.
  • morbi: diseased or unhealthy.
  • mortification: death.
  • osteomytelitis: inflammation of bone. A common surgical fever.
  • peritonitis: often the cause of death in abdominal wounds. Inflammation of the internal membrane lining the abdomen and pelvic walls.
  • pneumonia: inflammation of the lungs. Different types included hypostatic, senile, and typhoid.
  • prostration: extreme exhaustion.
  • pyemia: refereed to pus in blood, literally. Used during the Civil War to denote all types of blood poisoning. It was very often fatal.
  • pyrosis: heartburn.
  • quinine: drug principally used to treat malaria and fevers including typhoid.
  • resection: same as excision. It was a recommended treatment for some types of fracture instead of amputation.
  • rheumatism: inflammation of the joints, muscles, and bursae.

    inflammatory: rheumatic fever. Could be fatal.

  • sloughing bone: necrotic bone that seperates from portions that are viable.
  • suppuration: formation of pus. Looked on as a good sign during the 1860’s.

Civil War Dentistry

The dental profession had gained some standing during the two decades that preceded the Civil War. In the Confederate states, there were about 500 dentists. Jefferson Davis, while serving as Secretary of War under Pierce, was an advocate for a dentistry corps. Perhaps this is why the Confederate Army had a dental program, while a similar idea in the Union Army was rejected by the War department. Confederate Surgeon General Moore was also quite supportive of the idea of Army dentists, leading to the comment that the dentists owed more to Moore “than to any man of modern times”.

Soldiers tended to neglect basic care of their teeth. Toothbrushes were scarce and their diet was inadequate. Also, Dental operations usually cost more than the common private soldier could afford… particularly in the Confederacy when inflation set in. Despite poor dental care, a soldier’s teeth were important on the battlefield. Many recruits were turned down if they lacked six opposing upper and lower front teeth, considered necessary to bite off the end of the powder cartridges used with the muzzle loading rifles of the times.

Dentists were usually accorded the rank of hospital steward, though according to one source, they also could be full surgeons with all the pay and benefits of a surgeon. Medical director William A. Carrington, CSA, commented that dentists “plugged, cleaned, and extracted teeth”, in addition to “adjusting fractures of the jaw and operating on the mouth”. Another, Richmond dentist Dr. W. Leigh Burton, commented that his days were filled of “twenty to thirty fillings, the preparation of cavaties included, the extraction of 15 or 20 teeth, and the removal of tartar ad libitum!”

Dentist Dr. James B. Bean of Atlanta made significant contributions to the treatment of fractured maxillary bones. Bean used an interdental splint made of vulcanized india rubber that had cup shaped indentations for the teeth. Bean’s splint was a great success and he was sent to Richmond where his splint was used for treatment at a ward of the Recieving and Way Hospital.

The Confederacy in particular should be praised for it’s Dental Corps. The act of conscripting dentists in January 1864, gave the Confederate soldier at least that small advantage over his Union counterpart. As before stated, all attempts at the Union Dentistry corps were turned down.

Medical Information on Some Generals

Lieutenant General Ambrose Powell Hill

For years, writers cited the Commander of the Third Corps, Army of Northern Virginia (ANV) as having some type of psycosymptomatic disorder. It always seemed to them that when the action was getting hot or stressful, down went A.P. Hill. In his book A.P. Hill: The Story of a Confederate Warrior, James I. Robertson challanges this idea saying that General Hill suffered cruelly from prostatis, brought on by his “youthful indiscretion” while on furlough from West Point. We can not say for certainty if this was indeed what was wrong with Hill. Some say that the General was suffering from malaria. A.P. Hill was born November 9, 1825 in Culpepper, Virginia. While he was a cadet at West Point in the summer of 1844 he contracted gonorrhea. The disease was so bad that he graduated a year behind, in the class of 1847. He suffered from typhoid fever in Mexico and from yellow fever later. Hill was wounded at Chancellorsville through the calves of his legs. At Gettysburg on July 1, he was ill. Between 1864 and 1865 he suffered from occasional illness. The suggestion of Robertson was that he was suffering from prostatis and a stricture, resulting in chronic infection, impaired kidney function, and uremia. This is, however, only speculation. Hill was killed by a bullet through the heart on April 2, 1865 at Petersburg. (Read a profile of General Hill.)

Major General James Ewell Brown Stuart

JEB Stuart was commander of the ANV’s cavalry and was mortally wounded at the battle of Yellow Tavern in May of 1864. Stuart was born Feb. 6, 1833 in Patrick County, Virginia and graduated from West Point in 1854. He was wounded in the chest on July 29, 1857 in Kansas by a pistol shot. On May 11, 1864, Stuart was shot by a dismounted trooper at a distance of only 10 to 15 yards. The bullet had a speed of 700 feet per second. The bullet entered on the right side below the ribs. It passed into the peritoneal cavity. Stuart’s intestines were perforated in at least a few places. He also suffered from damaged blood vessels. There was speculation that the bullet had ranged up and passed into his liver. It took him 27 hours to die. Stuart died from a combination of peritonitis and internal hemoraging at about 7:30 in the evening of May 12, 1864. (Read a profile of James Ewell Brown Stuart.)

Major General Winfield Scott Hancock

A wound suffered at Gettysburg hindered the rest of famed Second Corps General Hancock’s Civil War career. Born on Valentine’s Day, 1824, Hancock graduated from West Point in 1844 and served in the Mexican War. He was wounded slightly in the knee at Churubusco and was suffering from chills and fever during the battle of Chapultepec. Hancock was wounded while sitting on his horse on July 3 at Gettysburg. The bullet entered his right thigh and lodged, carrying in some foreign material. An improvised tourniquet staunched the bleeding. The wound remained a constant problem for Hancock until a surgeon, Dr. Louis Read, was able to find the bullet and remove it. In June of 1864, the wound reopened and bone fragments extruded from it. Hancock gave up command on June 17, but returned to command on the 27th. He gave up command of the Second Corps in November 1864. Hancock died on Feb. 9, 1886 in New York. The book Hancock at Gettysburg by A.M. Gambone gives much detail about General Hancock’s wounding.

John Fulton Reynolds

General John F. Reynolds fell defending his native state of Pennsylvania in command of the Left Wing of the Army of the Potomac. Reynolds was born on September 20, 1820 in Lancaster, Pennsylvania and graduated from West Point in 1841. Before the War, he suffered from at various times bilious fever, yellow fever, and malaria. On the morning of July 1, Reynolds was shot through the back of the head by a rifle ball. The bullet entered behind the right ear and passed through the brain. He fell face down from his horse. No obivious bleeding was present. When his aides turned him onto his back, he smiled, gasped once, and apparently died. He apparently died within a minute or two of being shot.

Brevet Major General Joshua L. Chamberlain

A terrible wound taken at the battle of Petersburg was declared by surgeons to be mortal, but it would be fifty years before General Chamberlain succumbed to the wound. Born Sept. 8, 1828, Chamberlain saw action with the Fifth Corps Army of the Potomac from Antietam to Appomattox. He was scratched on the face at Fredericksburg in Dec. 1862. In June 1863, he suffered sunstroke. At Gettysburg on July 2, he was wounded twice in the foot and hip. Both wounds were minor. From August on, he suffered from malaria. On June 18, 1864, he was shot, the bullet passing through his hips and body. The bullet severed arteries, nicked the bladder, and broke the pelvic bones. Expected to die, Chamberlain survived. Returning to the Army, he was wounded at Quaker Road on March 29, 1865. The bullet passed through the neck of his horse, hit his arm, and struck him in the chest where it was deflected. Chamberlain suffered for the rest of his life with the wounds he took at Petersburg though he had a distingushed post war career. Eventually, the infection caused his death on Feb. 24, 1914. (Read a profile of Joshua Lawrence Chamberlain.)

Civil War Surgery and Amputations

The most common Civil War surgery was the amputation. A few words about why there were so many amputations may be appropriate here. Many people have construed the Civil War surgeon to be a heartless indivdual or someone who was somehow incompetent and that was the reason for the great number of amputations performed. This is false. The medical director of the Army of the Potomac, Dr. Jonathan Letterman, wrote in his report after the battle of Antietam:

The surgery of these battle-fields has been pronounced butchery. Gross misrepresentations of the conduct of medical officers have been made and scattered broadcast over the country, causing deep and heart-rending anxiety to those who had friends or relatives in the army, who might at any moment require the services of a surgeon. It is not to be supposed that there were no incompetent surgeons in the army. It is certainly true that there were; but these sweeping denunciations against a class of men who will favorably compare with the military surgeons of any country, because of the incompetency and short-comings of a few, are wrong, and do injustice to a body of men who have labored faithfully and well. It is easy to magnify an existing evil until it is beyond the bounds of truth. It is equally easy to pass by the good that has been done on the other side. Some medical officers lost their lives in their devotion to duty in the battle of Antietam, and others sickened from excessive labor which they conscientiously and skillfully performed. If any objection could be urged against the surgery of those fields, it would be the efforts on the part of surgeons to practice “conservative surgery” to too great an extent.

Still the Civil War surgeon suffers from being called a butcher or some other derisive term.

The slow-moving Minie bullet used during the American Civil War caused catastophic injuries. The two minie bullets, for example, that struck John Bell Hood’s leg at Chickamauga destroyed 5 inches of his upper thigh bone. This left surgeons no choice but to amputate shattered limbs. Hood’s leg was removed only 4 and 1/2 inches away from his body. Hip amputations, like Hood’s, had mortality rates of around 83%. The closer to the body the amputation was done, the more the increase in the wound being mortal. An upper arm amputation, as was done on Stonewall Jackson or General Oliver O. Howard (who lost his arm at Fair Oaks in 1862) had a mortality rate of about 24%.

Following is a description of a common battlefield amputation. Missing arms and legs were permanent, very visible reminders of the War. Amputees ranged from the highest ranking officers, like John B. Hood, Stonewall Jackson, and Oliver O. Howard, all the way down to the enlisted men, such as Corproal C.N. Lapham of the 1st Vermont Cavalry who lost both of his legs to a cannon ball. Hood, Jackson, Howard, and Lapham were certainly not alone in their loss, as 3 out of 4 wounds were to the extremities…in the Federal Army this led to 30,000 amputations.

The wait for treatment could be a day, maybe two and that was not out of the ordinary. When treatment was finally done on the poor soldier, it was not done antiseptically. It would only be in 1865 that Joseph Lister embarked upon the era of antiseptic surgery. Surgeons did not even perform careful handwashing before operating. The doctors wore blood splattered clothes. When something was dropped, it was simply rinsed in cool, often bloody water. They used sponges that had been used in previous cases and simply dipped in cold water before using them again on the next person.

A surgeon recalled: “We operated in old blood-stained and often pus-stained coats, we used undisinfected instruments from undisinfected plush lined cases. If a sponge (if they had sponges) or instrument fell on the floor it was washed and squeezed in a basin of water and used as if it was clean”

The injuries to be dealt with were dreadful and the fault of the soft lead Minie Ball. With the capability to kill at over 1,000 yards, this soft lead bullet caused large, gaping holes, splintered bones, and destroyed muscles, arteries and tissues beyond any possible repair. Those shot with them through the body, or the head, would not be expected to live. Almost all wounds were caused by the bullet, with canister, cannonballs, shells, and edged weapons next on the list.

Confederate soldiers killed near the Wheatfield at Gettysburg / Library of Congress

The weapons (particularly the rifle) of the 1860s were far ahead of the tactics; i.e. the generals still thought to take a position you needed to go at it with the bayonet. The cynlidrical lead bullet, the Minie ball, was rather large and heavy (.58 caliber usually). When it hit bone, it tended to expand. When it hit “guts” (i.e. the intestines) it tended to tear them in ways the old smoothbore musket ball did not. Since they crushed and smashed bone so badly, the doctors did not have much choice but to amputate a limb. Wounds to the stomach were almost always a death sentence.

Civil War doctors were woefully ill-prepared; of 11,000 Northern physicans, 500 had performed surgery. In the Confederacy, of 3,000, only 27. Many docs got their first introduction to surgery on the battlefield. Doctors usually did not specialize. Medical school, for many, was just 2 years (some less, few more). Surgeons reacted by adapting. They learned surgery on the job. And people died, of course, until they learned and became better… Many doctorss were political appointments; there were no licensing boards in the 1860s… Army exam boards often even let in quacks.

This barn at Sharpsburg served as a hospital for the wounded. Barns were often taken over by surgeons for use. / Library of Congress

Of the wounds recorded in the Civil War, 70%+ were to the extremities. And so, the amputation was the common operation of the Civil War surgeon.

The field hospital was hell on earth. The surgeon would stand over the operating table for hours without a let up. Men screamed in delirium, calling for loved ones, while others laid pale and quiet with the effect of shock. Only the division’s best surgeons did the operating and they were called “operators”. Already, they were performing a crude system of triage. The ones wounded through the head, belly, or chest were left to one side because they would most likely die. This may sound somewhat cruel or heartless, but it allowed the doctors to save precious time and to operate on those that could be saved with prompt attention.

The surgeon would wash out the wound with a cloth (in the Southern Army sponges were long exhausted) and probe the wound with his finger or a probe, looking for bits of cloth, bone, or the bullet. If the bone was broken or a major blood vessel torn, he would often decide on amputation. Later in the War, surgeons would sometimes experiment with resection, but amputation was far more common.

Deciding upon an amputation, the surgeon would adminster chloroform to the patient. Hollywood’s portrayal of battlefield surgery is dramatized and largely false; anesthesia was in common and widespread use during the war…. it would make more complicated and longer operations possible as the era of antiseptic surgery began in 1865 (too late for the poor Civil War soldier). With the patient insensible, the surgeon would take his scalpel and make an incision through the muscle and skin down to the bone. He would make incisions both above and below, leaving a flap of skin on one side.

Taking his bonesaw (hence Civil War slang for a doctor is a “Sawbones”) he would saw through the bone until it was severed. He would then toss it into the growing pile of limbs. The operator would then tie off the arteries with either horsehair, silk, or cotton threads. The surgeon would scrape the end and edges of the bone smooth, so that they would not work back through the skin. The flap of skin left by the surgeon would be pulled across and sewed close, leaving a drainage hole. The stump would be covered perhaps with isinglass plaster, and bandaged, and the soldier set aside where he would wake up thirsty and in pain, the “Sawbones” already well onto his next case.
15 years after the War, surgeon George Otis cited the five principal advances of Civil War surgery: the surgeons had learned “something” about head injuries, how to deal with awful “ghastly wounds” without dismay, they had learned how to litigate arteries, information on injuries to spine and vertebrate had been “augumented,” and “theory and practice” in chest wounds had been forwarded.A good surgeon could amputate a limb in under 10 minutes. If the soldier was lucky, he would recover without one of the horrible so-called “Surgical Fevers”, i.e. deadly pyemia or gangrene.

A little about the “Surgical Fevers”. These were infections arising from the septic state of Civil War surgery. As you should have been able to see, the Civil War surgeon was interested not so much in cleanliness, but speed. As such, and not knowing anything about antiseptic surgery, fevers arose. Of these, the most deadly was probably pyemia. Pyemia means, literally, pus in the blood. It is a form of blood poisioning. Nothing seemed to halt pyemia, and it had a mortality rate of over 90%. Other surgical diseases included tetanus (with a mortality rate of 87%), erysepilas, which struck John B. Gordon’s arm after he was wounded at Antietam, and osteomyelitis which is an inflammation of the bone. Also, there was something called “Hospital Gangrene”. A black spot, about the size of a dime or so, would appear on the wound. Before long, it would spread through, leaving the wound an evil smelling awful mess. The Hospital Gangrene of the Civil War is an extinct disease now.

Primary amputation mortality rate: 28%
Secondary amputation mortality rate: 52%

Opinion of the Civil War Surgeon

“The surgery of these battle-fields has been pronounced butchery. Gross misrepresentations of the conduct of medical officers have been made and scattered broadcast over the country, causing deep and heart-rending anxiety to those who had friends or relatives in the army, who might at any moment require the services of a surgeon. It is not to be supposed that there were no incompetent surgeons in the army. It is certainly true that there were; but these sweeping denunciations against a class of men who will favorably compare with the military surgeons of any country, because of the incompetency and short-comings of a few, are wrong, and do injustice to a body of men who have labored faithfully and well. It is easy to magnify an existing evil until it is beyond the bounds of truth. It is equally easy to pass by the good that has been done on the other side. Some medical officers lost their lives in their devotion to duty in the battle of Antietam, and others sickened from excessive labor which they conscientiously and skillfully performed. If any objection could be urged against the surgery of those fields, it would be the efforts on the part of surgeons to practice “conservative surgery” to too great an extent.”—Dr. Jonathan Letterman

Obviously, even at the time of the Civil War, the surgeon was coming under attack for his actions.

The Civil War surgeon worked in conditions that today would be completely unthinkable. Doors were often used as operating tables. There was a lack of water, basic supplies, drugs, and most of all: time. Take as an example the best-known battle of the Civil War, Gettysburg. There were approximately 50,000 casualties at Gettysburg in three days of savage fighting. All of this descended down on the heads of the medical men. For the most part, they measured up admirably. Many of them worked until they dropped. With a lack of time, knowledge, and basic supplies, the best bet for saving life was usually an amputation as soon as possible. Thus, Letterman said if any complaint could be lodged against his surgeons after Antietam, it was that they had been too conservative in cutting off limbs.

The Civil War doctor was not a quack, he does not deserve to be labeled a “butcher” or a “barber” or some other equally derisive term. The Civil War surgeon was the most part a hard working, competent, and compassionate individual. Though obviously hardened by the sights, sounds, and smells of War, they still did what they thought best. Really, given the medical knowledge of the time and the hideous destructive powers of the Minie ball, they had no chance but to amputate in most cases.

While modern operating rooms are sterilized and clean, with efficient lighting, gloves, many complicated and specialized instruments, the Civil War surgeon had little to work with. Lighting, even for general officers, was often a held lantern. Farms, school houses, homes, churches were the operating rooms. The operating table could be a door, sometimes a kitchen table. At the basics, the Civil War surgeon’s kit consisted of two surgical saws, a curved probe, retractor, cutting pliers, clamps, brush, and trepanning instruments carried in a plush lined wooden chest.

The Civil War surgeon could often be wounded or even killed. Hospitals sites were chosen close to the line and where water was available. Improvisation, particularly for the Confederate surgeon, was the name of the game. Hunter McGuire on the adaptability of the Confederate surgeon:

The pliant bark of a tree made for him a good tourniquet; the juice of the green persimmon, a styptic; a knitting needle, with its point sharply bent a tenaculum; and a pen knife, in his hand, a scalpel and bistoury. I have seen him break off one prong of a common table fork, bend the point of the other prong and with it elevate the bone in a depressed fracture of the skull and save life

The Civil War came at the end of the medical middle ages. Little was known of bacteriology for example. Surgery was septic. Yet, to label the Civil War surgeon in derisive terms does him a great injustice. Forty Union doctors lost their lives in battle. Dr. J.B. Fontaine, of the cavalry corps of the ANV, was killed in the line of treating a wounded soldier, Dr. E.S. Galliard had to have his arm amputated after being wounded treating Joe Johnston. Many medical officers, including Jonathan Letterman, died young. The Civil War surgeon often sacrificed his health to do what he could to save life.

Doctor Hunter Holmes McGuire

Dr. Hunter Holmes McGuire, M.D., CSA (1835-1900)

John W. Schildt in his biography of Hunter McGuire summed up the doctor as such: “When people needed to talk, he listened. Those who knew him said Dr. Hunter McGuire made you feel that you were the most important person in the world.” Another quote that describes the Winchester physican is “Make not patients of your friends -but friends of your patients.”

Such a man was Hunter Holmes McGuire, a native of Winchester, Virginia in the Northern end of the Shenandoah Valley. Born on October 11, 1835, at age 22 he was already a professor and full doctor. An impressive man, tall — almost 6’4″ — thin, and handsome with black hair and blue eyes, Dr. McGuire was a believer in State’s Rights and Virginia and thus embarked on a career as a Confederate Medical Officer in 1861.

At first, he signed up to fight as a private in the Winchester Rifles (Co. F of the 2nd Virginia which fought in the Stonewall Brigade), but McGuire was too valuable to serve as a foot soldier when the Confederacy needed trained doctors. McGuire served under many different commanders; among them were Thomas J. “Stonewall” Jackson, Richard Ewell, and Jubal Early. It is, however, as Jackson’s surgeon that Dr. McGuire is remembered. McGuire would later say: “The noblest heritage I shall hand down to my children is the fact that Stonewall Jackson condescended to hold me and treat me as his friend.”

McGuire served in all the major battles of the Army of Northern Virginia as the medical director of the famed Second Corps. In May of 1863, Jackson was wounded in the arm by friendly fire at the battle of Chancellorsville. After a week long battle with pneumonia, Jackson died of the pneumonia. (note: modern physicans think Jackson probably died of a pulmonary embolism, not pneumonia as McGuire thought) A picture of McGuire taken in mid-May shows him looking gaunt and exhausted, both indicative of the tireless efforts he put forth in an attempt to save his friend and patient. In fact, Dr. McGuire attempted to give his patient and friend round the clock care.

McGuire saw many tragedies in his career as a medical officer for the dying Confederacy. His good friend and commander Jackson died. His tent-mate Sandie Pendelton was mortally wounded in the Valley in 1864. McGuire’s own brother Hugh was mortally wounded in 1865. His beloved home the Shenandoah Valley was in flames. And McGuire himself was captured at Waynesboro on March 2nd. Paroled by General Sheridan for his policy of not keeping Union Surgeons, McGuire was with the Army of Northern Virginia and tasted the bitter defeat of surrender at Appomattox Court House.

McGuire after the War went to Richmond where he built a hospital of his own and had a career that was varied and productive, and often included helping one who had worn the gray during the Civil War. Especially at first, but later as well, he would work without pay. He forever remained a staunch supporter of Jackson’s reputation and image, writing several biographical sketches and giving speeches about his former commander. McGuire served also as a professor after the War, was president of numerous medical organizations and societys including the American Medical Assocaiation. In addition, he married and fathered 10 children, some of whom followed in his footsteps in pursuing medical careers. He died of complications of a cerberal embolism on September 19, 1900. He is buried amongst many Confederate notables in Richmond’s Hollywood Cemetery. A statue stands on the Virginia State House grounds to the Winchester physican.

Hunter McGuire was a truly gifted individual. He was a deft surgeon, a highly gifted and competent doctor, a superb teacher, an outstanding orator, a brilliant administrator, and a prolific writer and author. One person remembered the physican in consulting with his patients was “like a husband pondering the problems of the sick wife; the father looking down on the afflicted child.” His contributions to Virginia, the Confederacy, the United States, and medicine as a whole can not be overlooked.

For more information read: “Doctor in Gray” by John Schildt, “Hunter McGuire: Stonewall’s Surgeon” by Maurice Shaw, or “Stonewall Jackson” by James Robertson.

Tribute to Dr. McGuire that appeared in the Sept. 19, 1900 Richmond News:

None more striking has been known to this generation of Virginians. Few men have seen in these parts whose opinions, professional or other, carried as much weight. It may be doubted whether anybody has lived in Virginia since Lee and Jackson died who was loved by more people.

In character, he was all that men mean by “strong”, “decided”, “vigorous” or any similar term. Nevertheless, he was strikingly simple, straight-forward and unaffected, modest, even to reserve; yet throughout his life, a warrior waging sternest battle for reality and truth, of whom a friend could get real help when counsel was needed, because he had not the coward’s gift for tempering opinions to suit the changing expression of his auditor’s eye. A brave and true man, in whose sincerity and strength great Jackson could entirely confide; whose force General Lee upon occasion markedly acknowledged.

Inscription on Hunter McGuire’s Monument in Richmond:

Hunter Holmes McGuire, M.D., L.L.D. President of the American Medical and of the American Surgical Associations; Founder of the University College of Medicine Medical Director, Jackson’s Corps, Army of Northern Virginia. An Eminent Civil and Military Surgeon and Beloved Physician. An Able Teacher and Vigorous Writer; A Useful Citizen and Broad Humanitarian, Gifted in Mind and Generous in Heart, This Monument is Erected by his Many Friends.


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Originally published by eHistory at The Ohio State University under a Creative Commons license.