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for America's CW fatalities is 620,000, as medical education consisted of 4 semesters
opposed to somewhat over 400,000 in WWII. in 2 years and still included outmoded
However, some would put the CW figure concepts of infectious diseases, attributing
as high as 850,000, a figure the Civil War them to bad air ("mal-aria"), miasmas, and
Trust foundation disagrees with. Perhaps a "maldistribution of the four humors" (black
more realistic figure, allowing for lost records bile, yellow bile, blood and lymph). Medical
(especially Confederate records and records advances (e.g., Holmes, Semmelweiss, Lister,
lost in combat situations) and more accurate Louis) were published, if at all, in obscure
population data, would be around 750,000. journals, often in German, Dutch or French,
Nevertheless, accepting the traditional figure and thus dissemination of new findings was
of 620,000 KIAs, a review of the
internet literature indicates that
most men did not die on the
battlefield; rather, over 400,000
died due to disease/infections,
and about one out of every four
combatants never made it home.
For any of our readers who
have served in the US military,
and are used to thinking of an
organized military Medical Corps,
Medical Service Corps, Nurse
Corps, MASH units, ambulances,
corpsmen, and helicopter transport and evacuation, etc., those
numbers should be shocking.
How could that be? Certainly,
many articles point the finger of
blame on incompetent doctors,
shoddy medical care standards,
unsanitary conditions, etc. Yet, the more really slow. Bleeding and blistering were
understanding authorities clearly indicate that, not uncommon. Most graduating doctors
given the primitive (by modern standards) had never seen or treated gunshot wounds.
status of Medicine in the 1860s, and in com- A toxic mercury compound (Calomel, or
paring it to today's medical care, we have to be "Blue Mass") was used to treat diarrhea and
aware of great differences, including the lack dysentery, typhoid, malaria, syphilis, and
of most of our modern medical organization, pneumonia.
training, pharmaceuticals, equipment and
Still, there were some advances accepted
support systems. Thus several authors admit and practiced. The US Sanitary Commission
that much of that period's wartime care was established early in the War and created
actually met, and sometimes exceeded, the the Camp Inspection Service which emphaera's standards of care. One also realizes that sized preventive measures. Although often
"medical support deficiencies...not discernible ignored or forgotten, the military required
in peacetime become deadly in war."
enlistees to be vaccinated ("variolation"),
Consider first, that the military's Medical generally with cowpox materials taken
Department at that time was a left-over from cows or clinical cases - sometimes
from the previous few decades, essentially using the dried scabs or pustule scrapings.
unchanged in organization, staffing, training Unfortunately, this sometimes succeeded
and equipment from the days of the Seminole in transmitting syphilis or hepatitis as well.
Wars and the War with Mexico. Then realize Quinine was used regularly to prevent/
that so-called "medical schools" of that period suppress malaria, even though the vector
were basically "diploma mills", and that etiology was unknown. When available,

antiscorbutics were used to prevent scurvy;
opiates were used not only to relieve pain
but for other purposes as well. Techniques
for arterial ligation were developed, as were
some rudimentary neurosurgical approaches.
Quarantine was used to interrupt yellow
fever transmission. The first plastic surgery
was performed. And the ambulance system
and hospitals were improved and enlarged
(see Letterman, below).
Wartime hospitals and ad
hoc treatment stations would
be set up as emergency facilities, usually in commandeered
homes, churches, or barns,
sometimes in tents or simply
treating the wounded lying
on the bare ground. The
wounded had to lie on the
battlefield for hours, some for
days, bleeding, with their open
wounds, compound fractures,
or shredded stumps exposed
to the offal, dirt, flies, and
baking in the sun. Not until
there was a lull in the battle
or a cease fire, could the litter
bearers carry, drag or put
them on carts and wagons
for evacuation. Many died
during that long wait.
The weapons of the day could, and did,
inflict some terrible wounds. Solid 20-pound
cannon balls could not only destroy walls and
fortifications, but rip a man apart if they hit
him directly. Other shells were explosives and
some were shrapnel containers. Among these
were the cannister (or 'grape shot') rounds
which contained several metal golf ball
sized smaller missives capable of death and
destruction. The standard issue bayonet was
17 inches long, capable of literally "running
through" the victim. The recently invented
hand cranked and hand fed Gatling guns
were capable of putting out 200 to over 400
rounds per minute. Standard muskets used
the standard .58 caliber rifled Minie' ball (less
often used was the larger, .69 caliber, version)
which could take a direct path through the
body, carrying pieces of clothing and dirt with
it, shattering bone and tendons, and exiting
the other side, leaving a compound fracture
continued on next page >

SUMMER 2019 | CHESTER COUNT Y Medicine 29


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