Health and Medicine During the Civil War

The Statistics of the War
Union Soldiers
Of every 1,000 soldiers, 112 were wounded
Soldier had 1 in 8 chance of dying from illness
Soldier had 1 in 18 chance of dying in battle
360,000 soldiers died-110,000 in battle and 250,000 from disease
Confederate Soldiers
Of every 1,000 soldiers, 150 were wounded
Soldier had 1 in 5 chance of dying from illness
Soldier had 1 in 8 chance of dying in battle
258,000 soldiers died-94,000 in battle and 164,000 of disease
56,000 soldiers died in prison camps-9% of all deaths

In 1865, when the Civil War was over, 620,000 soldiers had died. At this time that number was 2% of the United States population.

In 2021, if we lost 2% of the United States population, the number of dead would be 6,140,000!

6,140,000 is twice the population of Chicago.

Disease: The Number One Killer
1 in 4 soldiers who enlisted in the army died
67% of all soldiers who died did so because of disease
Dysentery: 95,000 deaths | 287,000 cases
Typhoid Fever: 29,000 deaths | 79,000 cases
Lung Inflammation: 20,000 deaths | 77,000 cases
Childhood Diseases (diphtheria, measles, scarlet fever, mumps): 7,000 deaths | 200,000 cases
Causes of Disease during the Civil War

Unfortunately doctors and nurses during the Civil War just did not know that hygiene [the practice of keeping clean to stay healthy and prevent disease] was important for health. Most of the medical people cared for the sick and dying and often risked their own lives in do so, they just did not know any better at that time in history.

The reason diseases killed so many soldiers during the Civil War was the lack of basic sanitary and hygiene practices. For example, surgeons would not clean their equipment between patients often leaving the blood from the previous patient on their tools when moving on to the next patient.

Doctors at that time had no knowledge of cross contamination, which is the passage of microorganisms that can cause disease from one object to another. Medical tools, doctors, and nurses’ hands were usually not cleaned between the treatments of different patients.

The drinking of contaminated water led to the spread of waterborne diseases and was a major problem at Civil War camps. Contaminated water can cause numerous diseases including dysentery and typhoid fever; two big killers of Civil War soldiers. Often water sources for army camps were dirty and filled with all kinds of bacteria. Quite often little thought was given to the location of the camps latrine [a toilet for use by many, with or without plumbing, as in a camp or a military barracks or bivouac] which may have been upstream from where soldiers got water for their canteens.

Army hospitals, especially at the beginning of the war, were overcrowded and poorly ventilated; conditions which allowed airborne diseases to spread rapidly. Patients would sneeze and cough into the air releasing small droplets filled with viruses or bacteria into the air; other patients who inhaled these water droplets could get tuberculosis or other infectious diseases. As the war progressed hospitals with better ventilation were constructed, especially in the North.

Army camps were almost always overcrowded (sometimes 3-6 soldiers would share one dog tent) and airborne diseases would spread quickly among the soldiers.

A Civil War Dog Tent

Early Civil War Hospital

Early photograph showing the crowded conditions in a hospital

“I had charge of a burial squad the next day and put 728 men in one grave. The trench was 6 ½ feet wide and 500 feet long and we put the men three deep. They had all been killed on less than ten acres of ground, and you could almost walk over the field on dead men. But Sherman flanked us out of this position as he had been doing all spring.”
-Captain James Madison Hudson

Did You Know?

More than 1.5 million horses and mules were killed during the Civil War.

Did You Know?

During the Battle of Gettysburg between 4,000 and 5,000 horses and mules died.

Did You Know?

Union Major General Phil Sheridan had a big and black horse named Rienzi that he rode while involved in the Civil War. Rienzi and Sheridan were together for the last 3 years of the war, through 45 battles, two cavalry raids, and 19 smaller battles. Rienzi was wounded several times, but recovered.

Did You Know?

Prior to 1861 there were approximately 3.4 million horses in the Northern states, 1.7 million in the Confederate states, and about 800,000 in the border states of Missouri and Kentucky.

Main Diseases of the Civil War
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Dysentery
Dysentery was the worst disease of the Civil War, and the overall main killer of soldiers during the war. This disease, called ``the quickstep`` by soldiers, involved inflammation of the intestines causing stomach pain and diarrhea containing blood, and may also involve a fever.
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Typhoid
The disease is caused by eating or drinking food or water that has been contaminated with the feces of a person with the disease. People infected with this disease get fevers, headaches, constipation, chills, and some people develop a skin rash. If you contracted this disease during the Civil War you had a 1 out of 3 chance of dying.
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Pneumonia
The third most deadly disease during the American Civil War was pneumonia. Pneumonia, which is a lung inflammation caused by a bacterial or viral infection, killed over 35,000 soldiers during the war. This disease causes coughing, chills, fever, and makes breathing extremely difficult.
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Measles
Measles, also known as rubeola, killed many soldiers during the war. Measles is a very contagious (able to be passed from one individual to another through contact) disease that is spread through the air from the coughing and sneezing of infected people. The virus can survive for several hours on objects it lands on.
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Malaria
Malaria is an infectious disease spread by mosquitos. The symptoms of this disease can include fever, vomiting, fatigue, and headaches. In severe cases it can cause death. It is estimated around 30,000 soldiers died from this disease. This number would have been much worse had it not been for quinine, a medicine used to prevent and treat Malaria.
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Tuberculosis
Tuberculosis (or 'TB') is a dangerous infectious disease that affects human lungs. Tuberculosis is spread from one person to another through the air via coughs and sneezes. It is estimated that 14,000 soldiers died from TB during the Civil War. During the era of the Civil War Tuberculosis was known by the name, 'Consumption.'
Amputations During the Civil War
A Minnie ball after it struck something

Over the course of the Civil War, an estimated 476,000 soldiers were wounded by bullets, artillery shrapnel (small metal pieces that scatter outwards from an exploding bomb or shell), or swords and bayonets. The most common wounds suffered by Civil War soldiers were from the bullets fired by muskets. The typical bullet used was called a Minnie ball, a conical bullet with hollowed groves (see picture at left). Weighing 1.5 ounces the large bullets traveled very slowly after being fired (unlike today’s bullets). When the bullet struck a human, the Minnie ball caused considerable damage, often flattening upon impact. These bullets splintered bones, damaged muscle, and drove dirt, clothing, and other debris into the wounds. As a result of the immense damage inflicted by Minnie balls, amputations were common during the Civil War.

An amputation is a surgical procedure that removes a piece of the body because of trauma or infection. Over the course of the Civil War, three out of four surgeries (or approximately 60,000 operations) were amputations. This number of amputations earned surgeons throughout the armies a reputation of being “butchers” when, in fact, amputations were one of the quickest, most effective ways for surgeons (in the Civil War) to treat as many patients as possible in a short amount of time. The medical director of the Union Army, Dr. Jonathan Letterman, was well aware of the criticisms of surgeons in the field and wrote in his report after the Battle of Antietam:

The surgery of these battlefields 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 attacks 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.

There were several types of wounds that required an amputation according to medical military manuals, including “…when an entire limb is carried off by a cannon-ball leaving a ragged stump; also if the principle vessels and nerves are extensively torn even without injury to the bone; or if the soft parts (muscles) are much lacerated; or in cases of extensive destruction of the skin.” However, when amputation was necessary, the limb was not simply ‘chopped off’ as commonly believed. The procedure was practical, and like most surgical procedures over the course of the war, were conducted with patients under anesthesia (is a substance that stops pain. It makes people either stop hurting, or go completely to sleep during surgery) in the form of either chloroform or ether.

Before undergoing an amputation, a tourniquet (pronounced: tur·nuh·kut) was tightened around the limb in order to reduce bleeding when the damaged limb was removed. The surgeon began with either a circular or flap amputation procedure. A circular amputation cut through the skin, muscle, and bone all at the same point on the limb creating an open wound at the stump that healed on its own. It proved the simplest and fastest method of amputation, but it took longer for the limb to heal. The flap method used skin from the amputation limb to cover the stump, closing the wound. This surgery took longer but healed faster and was less prone to infection. Whenever possible surgeons opted for the flap method.

The chances of survival for an amputation depended on where the amputation was performed and how fast medical treatment was administered after the wounding. Many amputations over the Civil War occurred at the fingers, wrist, thigh, lower leg, or upper arm. The closer the amputation was to the chest and torso, the lower the chances were of survival as the result of blood loss or other complications. Many surgeons preferred to perform primary amputations, which were completed within 48 hours of the injury. They had a higher chance of survival rather than intermediary amputations which took place between 3 and 30 days. Poor nutrition, blood loss, and infection all contributed to the lower survival rates of intermediary amputations after 48 hours.

An illustration from a Civil War medical textbook showing how to perform an arm amputation

 

This is a Civil War-era tourniquet
Walt Whitman
Uncovering a limb-pit where amputated limbs were buried. This is at the Manassas Battlefield.

After completing numerous amputations after a battle, medical personnel were left with another problem-what to do with the piles of discarded limbs. The sight of a pile of amputated limbs frightened many, contributing to the soldiers’ views that surgeons were more butchers than actual doctors.

After the Battle of Fredericksburg, the poet Walt Whitman [click here] described the scene at a Union hospital at Chatham, near Fredericksburg, Virginia:

…it was used as a hospital since the battle, and seems to have received only the worst cases. Outdoors, at the foot of a tree, within 10 yards of the front of the house, I noticed a heap of amputated feet, legs, arms, hands, etc…about a load for a one-horse cart. Several dead bodies lie near, each covered with its own brown woolen blanket. In the doorway, toward the river, are fresh graves, mostly of officers, their names on pieces of scrap wood or broken boards, stuck in the dirt.

What were surgeons to do with these amputated limbs? Unfortunately, there is not a clear answer for little was written about the subject since it was a shocking and sickening sight. From research it appears that many amputated limbs were buried in mass graves or less likely burned.

Soldiers After the War

For soldiers who survived amputations, mental and physical struggles followed them home. In the 1800s, one of the many signs of manhood was the ability to support one’s family. Having a disability meant that once handicap soldiers returned home they were no longer the prominent member of their families, but instead had to rely on others. In the 1800s, men who were not the primary supporters of their household were looked upon unfavorably by society, and many handicap soldiers were seen as a curse on society. In fact, the slang term ‘invalid’ in the 1800s meant a person wasn’t considered a valid member of society. Once handicap soldiers returned home most of them struggled with depression, shamefulness, and finding a meaningful role in society again. This created a mounting need for pensions [an amount of money paid to soldiers from the U.S. government] and prosthetics [‘Pro-sted-dics] a device made to replace a missing human body part] for wounded soldiers.

A Civil War era artificial leg
A Civil War era artificial arm

A federal pension system was created in 1862 to assist wounded Union veterans. However, the system to apply for a pension was very black and white: either a veteran had the physical ability to work, or they did not. According to the United States Pension Office, disability was defined as the inability to perform manual labor meaning that in order to get what many soldiers believed was a fair payment, they had to swear that they could no longer work at all. For many veterans, this was a huge step to take because it took away their manliness because they had to rely on the government for money to live and support their families. If a disabled soldier decided to apply for a pension, the amount they received on a monthly basis depended on their rank and the severity of their injury.

For example, a disabled private received just $8 per month (about $205 a month in 2020) from the first pension system. Dependents, such as widows and children, of soldiers who were killed on duty, were also eligible. Because of the negative views of the 1800s around receiving a pension (or government aid), many veterans did all they could to try and prove that they were able to work.

Many veterans wanted to continue to work after recovering from their wartime injuries, but as a disabled veteran, they were often discriminated against [discrimination is unfair treatment of one particular person or group of people] for it was often assumed they could not perform a job as well as an able-bodied employee. As a result, some veterans went to extreme lengths to prove they could work, including learning to write with their left hands for clerical work, as well as relying on prosthetics. Prior to the Civil War, there were few choices for artificial limbs for soldiers that needed them. The limbs that were available  were uncomfortable and not really functional. As early as 1861, amputees began developing their own improved prosthetics allowing for greater movement and allowing them to reenter their communities. One of the first soldiers to undergo an amputation during the Civil War was Private James Hanger of Churchville, Virginia, who lost his leg during the Battle of Philippi on June 3, 1861.

Over the course of the war, he began distributing his new “Hanger Limb” to other soldiers in need and after the war ended, he began his own company-the J.E. Hanger Company. Today, Hanger Incorporated is one of the leading artificial limb companies today. Check out www.hanger.com

J.E. Hanger, maker of artificial limbs. The company is still in business.

The Civil War created thousands of ‘maimed men’ who returned home with empty sleeves and had to readjust to life without limbs that many take for granted. These men not only had to deal with uncomfortable and painful prosthetics, they also had to come to terms with how they were treated by their family and local community. Like many aspects of Civil War medicine, because there were so many cases of amputations, the procedures, recovery methods, quality of prosthetics, and an increased awareness for mental health were all to develop and mature into the modern medicine that many of us take for granted today.

Resources Used:

Paige Gibbons Backus, “Amputations and the Civil War,” March 25, 2021, https://www.battlefields.org/learn/articles/amputations-and-civil-war.

Groeling, Meg. The Aftermath of Battle: the Burial of the Civil War Dead. El Dorado Hills, CA: Savas Beatie, 2015.