Civil War Medicine

By Peter Galvin, MD

Last week, I gave a presentation on this topic to the Breezy Point Civil War club. My PowerPoint presentation is way longer than the 550 words per week I’m limited to, so I pared it down so it would fit into two articles. From a medical perspective, the Civil War was fought in the late Middle Ages. That’s because bacteria and viruses had not been discovered yet. Back then, medical experts still believed in the “miasma” (which means “bad air”) theory, first proposed by Hippocrates and Galen in the 4th century BC. The theory was that infections and diseases arose from the odors given off by decomposing organic matter. They thought that maggots came from spontaneous generation. Today, of course, we know that maggots are eggs/larvae laid by flies. This was even though, in 1796, Edward Jenner discovered the smallpox vaccine. He found that giving someone the weaker cowpox disease conferred immunity against smallpox. It wasn’t until the mid-1860s that Joseph Lister discovered that sterilizing his surgical instruments with carbolic acid reduced the number of surgical infections. He published his findings and his theory about germs and sterilization in “Lancet,” a still-prestigious British medical journal. The editors ridiculed him and his theories. Incidentally, Listerine is named in his honor.

The nature of gunshot wounds changed drastically just before the war with the invention, in 1847, of the minie ball by Claude Etienne Minie. Prior to that, ammunition consisted of round lead balls fired by smooth-bore muskets. The weapons were very inaccurate at more than a few yards. Low energy lead balls would pierce the skin and then follow a meandering path under the skin. Minie balls, fired by the Minie rifle, which had a rifled barrel (a spiral groove is cut into the barrel causing the round to spin upon exiting the barrel) were much more accurate and were high-energy projectiles that would smash through anything they encountered, including bones, causing devastating injuries. The minie ball weighed 32 grams. For comparison, a 9mm round (just the projectile, not the casing) weighs 7 grams, and a .44 Magnum weighs 16 grams.

The Civil War was the first modern war. Before then, wars were fought by small armies because everything and everyone had to travel on foot or by horse. But the advent of railroads, along with canned food and industrial production, changed that dynamic. Never before had armies of 100,000 or more men opposed each other, and, of course, the scale of the resulting carnage shocked the world. Also, the telegraph allowed government leaders to get up to the minute reports from the battlefield. Lincoln practically lived in the telegraph office during the war. Neither side was prepared for war, especially war on that scale. Army hospitals didn’t exist. Most soldiers came from rural areas and had never experienced crowded situations before, so many diseases, especially childhood diseases like measles, chicken pox, mumps, and whooping cough, were rampant. Early in the war, a North Carolina infantry regiment had 800 of its 1,200 soldiers sick with measles. Robert E. Lee once commented that he could make a whole new army from the sick list.

Next week, we’ll look at injuries and diseases of the war.

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