Civil War Medicine

There are troves of books archiving Civil War medicine.  It is a subject of interest for me, so this short piece in the NYT today caught my eye.  In particular, it focuses more on the medical than surgical realm, so as internists the lessons should hit home.

As the war interfaced between periods–horse-and-buggy and industrial, accounts from soldiers of the day make for interesting reading and serve as a good comparison between then and now.  The battlefield and the treatment of our wounded currently is worlds apart, and the lessons learned not just from the Civil War, but all wars, is how our field advances.  Again, see WWII and Vietnam as illustrative examples.  This quote from the piece sums it up nicely:

The Union Surgeon General, William A. Hammond, famously claimed the Civil War “was fought at the end of the medical Middle Ages.”

The following are notable excerpts.  Of note, as other passages relay, other than quinine and opium, the pharmaceutical armamentarium was snake oil and herbal remedies.  EBM was n=1, a nod from mom, and handsome packaging.  Regardless, hope you learn a thing or two.

–Dysentery was the single greatest killer of Civil War soldiers.

Modest soldiers disliked using the open latrines and simply relieved themselves wherever they found a secluded place.

–Unlike today, medical training at the time of the Civil War varied greatly. Most of the older physicians had learned their profession through apprenticeship, much as skilled laborers did. Medical schools had become fairly common in the decade before the war, but most had only a two-year course of study, with the second year essentially a refresher course of the first.

–Syphilis and gonorrhea plagued both armies and became such a threat that generals were forced to start regulating prostitution. During the war, 8.2 percent of all Union soldiers contracted some sort of venereal disease

–Soldiers often complained that the treatment surgeons prescribed for diseases was worse than the disease itself…Other types of Civil War medical treatment seem almost like medieval torture. Incredibly, some surgeons cauterized the anus to treat dysentery and even the penis to treat venereal disease. Pneumonia patients were frequently bled or had heated mustard plasters placed on their chests to draw out fluid from the lungs. Surgeons treated one soldier’s stomach ailment by applying hot bricks to his feet and hot cloths to his stomach. The man wrote home, “Oh such hours of suffering, but the Lord was with me praise his name.”

–Most soldiers had little respect for surgeons because some became alcoholics from having easy access to medicinal liquor, and some were incompetent because of poor training. Postwar books and movies have only reinforced this stereotype, but it is historically inaccurate: the vast majority of them were dedicated and caring physicians who labored under almost unimaginable conditions.

–One way to judge the quality of Civil War medicine is to compare it with the care soldiers received in our other wars of the same time period. During the Civil War, at least 185,000 soldiers died in battle and 435,000 died from disease and other noncombat causes, for a ratio of about 1:2. The ratio was approximately 1:7 for the Mexican War and 1:5 for the Spanish-American War. Despite the primitive state of Civil War medicine, it appears the men received the best medical care of any American soldiers of the 19th century.

Brad Flansbaum

Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.

Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.

Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.

He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.

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