620,000 soldiers died during the Civil War.
Two thirds died of disease, not wounds.
Poor Hygiene Civil War soldiers didn’t get a daily shower.
Also, they used the same few pots to cook
food and to boil lice-infested clothing.
Garbage in Camp You couldn’t put the trash on the curb every
week, could you?
Filth from Camp Sinks Latrines were often dug too close to
streams, which contaminated the water sup-
ply. Imagine drinking from the school toi-
lets every day.
Overcrowding Close contact with other people caused dis-
eases to spread rapidly.
Exposure to all types of weather Extreme hot and cold; rain, sleet, snow;
dust and mud…. Exposure to the elements
lowers your body’s ability to resist disease.
Improper and inadequate diet, spoiled food Staple foods were hardtack for Union sol-
diers and cornbread for Confederates. Fresh
fruit and vegetables were rare. Soldiers
received some meat, but, often, it spoiled or
too full of preservatives to eat. More later.
“Bugs” Flies, mosquitoes, ticks, lice, maggots, and
fleas were abundant and carried disease.
Lack of medical knowledge People didn’t
know about “germs” and how they were
spread. Doctors didn’t wash their hands
before operating, or clean tools after each
Lack of surgeons There were too few surgeons to handle the
huge numbers of sick and wounded. Lack of
immunity to diseases Many rural soldiers
became sick because for the first time they
were in a large group of people and had no From National Museum of
immunity to diseases such as chickenpox, Civil War Medicine
smallpox, scarlet fever, measles, mumps, and Wood tick illustration from
whooping cough. These epidemics ran ram- Hardtack and Coffee: The
pant through many regiments. Unwritten Story of Army
Impure water If a stream looked and smelled good, it was by John D. Billings.
Illustrated by Charles W.
assumed that the water was good. Not
C I V I L WA R P R E S E RVAT I O N T R U S T 175
What diseases did soldiers get?
Dysentery Number one killer during the Civil War.
Victims get severe diarrhea with passage of
mucous and blood.
Typhoid fever “Camp Fever” – Number two killer, at ¼ of
disease deaths. This disease is caused by any
✔SOME THINGS Pediculus Vestimenti. of several bacteria. It is very severe, and
Illustration from Hardtack and
TO CONSIDER Coffee: The Unwritten Story of
causes a high fever, intense headache,
Army Life by John D. Billings. intense rash, and delirium. Body lice trans-
How many of
Illustrated by Charles W. Reed mit it.
have YOU had?
Ague Pronounced “AY-gyu”. A bad fever with a
cycle of chills and sweating. Also, “swamp
Have you ever
with any of these
Yellow Fever Caused by a virus, this disease is carried by a
diseases? Why or
specific mosquito and can be fatal.
Malaria “Shakes” – spread by mosquitoes.
Scurvy Disease caused by a lack of vitamin C. The
gums get spongy; teeth become loose, and
mucous membranes begin to bleed.
Pneumonia Disease causing inflammation of the lungs.
Tuberculosis A very contagious disease that is caused by a
bacteria. It mainly affects the lungs.
Smallpox An extremely dangerous, contagious disease
caused by a specific virus. It causes a fever
and “bumps” similar to chickenpox.
Supposedly, in the 20th century, this disease
was wiped out by global vaccinations.
However, during the Cold War, both the
United States and the former Soviet Union
cultivated the smallpox virus for possible use
in “germ warfare.”
Other chicken pox, scarlet fever, measles, mumps,
and whooping cough
The chart above doesn’t even count the infections and gangrene that
were common with wounded soldiers!
176 TWO WEEK CURRICULUM FOR TEACHING THE CIVIL WAR
Hospitals and Medical Knowledge
Imagine you’re in gym class. You and your friend are running the 100-meter dash. Suddenly
you both trip and skin your knees – badly. You roll around in the dirt, and then you don’t
wash your wounds. Obviously, your knees get really, really infected and they start to ooze.
Next day you both go to the school nurse. She determines that your oozing wounds aren’t
that bad. In fact, she takes a cotton swab and transfers some of the “ooze” from your knee to
your friend’s knee so it will get better faster.
Wait a minute! Yuck! Why would she do that?
During the Civil War, the experience and training of
doctors wasn’t well regulated. The Union Army only
had 98 doctors registered and the Confederacy had
only 24 (Tenting Tonight, 79). Therefore, both armies
were willing to take anyone who considered himself a
physician. Most of these new doctors carried around a
copy of a military surgery manual that had been written
by Dr. Samuel Gress. Can you imagine being operated
on by a man who had just read the directions?
Infection was a huge problem. And, to make matters
Surgeons operating in a Federal hospital tent
worse, doctors thought pus was a good sign (they called during the siege of Charleston, 1863.
it laudable pus), and they transferred it from patients Massachusetts Commandery, Military Order
who had it to those who didn’t. So, they infected anoth- of the Loyal Legion and the US army
Military History Institute.
er patient (Tenting Tonight, 79).
Doctors didn’t understand germs or how they were carried and spread. As a result, they vio-
lated nearly every rule of sterile technique that doctors use today. A doctor’s assistant wrote,
It was common to see a doctor with his sleeves rolled up to his elbows, his bare arms as well as his
linen apron smeared with blood and his knife…held between his teeth (Sabiston and Lyerly, 6).
Infection and disease was so widespread that soldiers didn’t have much faith in doctors.
Sometimes soldiers felt that limbs were amputated needlessly – or they simply didn’t want to
have their arm or leg cut off (why not?). One such corporal drew his revolver on a doctor,
saying, The man that puts a hand on me dies (Hardtack and Coffee, 310)!
C I V I L WA R P R E S E RVAT I O N T R U S T 177
At the field or tent hospitals (which were close to battle lines and in range of bullets and
shells) surgeons used their fingers to search for bullets and tried their best to control bleed-
ing. And, believe it or not, three-fourths of a surgeon’s time was spent amputating limbs
(Tenting Tonight, 33). Most wounds suffered by Civil War soldiers were to the arms and legs.
An Army of Tennessee surgeon wrote that the shattering, splintering and splitting of a long bone
by the impact of the Minie? or Enfield ball were, in many instances, both remarkable and frightful,
and early experience taught surgeons that amputation was the only means of saving life (Tenting
Amputation was the wounded soldier’s best chance of survival. Union soldiers suffered
174,000 extremity wounds (arms and legs). Of these, 30,000 resulted in amputations.
(Tenting Tonight, 92) Three-fourths of the amputees survived (Tenting Tonight, 92). The soon-
er the amputation was performed, the better the chance of survival. If amputation was
delayed more than 48 hours, blood poisoning, bone infection, or gangrene would set in, and
the death rate would double (Tenting Tonight, 92). This was a very painful way to die. It was
actually best to amputate within 24 hours (Museum of the Confederacy). Many doctors used
anesthesia in the forms of chloroform and ether when they operated, especially near the end
of the war.
A patient’s chance of survival depended on Location Fatality Rate
how far the wound was from the trunk of Forearm 14%
the body. Hip Joint 88%
Museum of the Confederacy
When soldiers were wounded in battle, the Infirmary Corps carried the wounded to a for-
ward aid station located within the lines of battle (Museum of the Confederacy). There, an
assistant surgeon would give the soldier alcohol and painkillers and would try to stop the
bleeding by packing the wound with lint and bandaging it. (Lint was obtained by scraping
linen fabric. Think of the junk that collects on the filter of your clothes dryer.) If the bleed-
ing would not stop, a tourniquet would be applied. This would stop the flow of blood to the
limb, which meant that the limb would have to be amputated. Next, the wounded soldiers
would be transported by ambulance to a field hospital, which was a short distance behind the
Washington D.C. with
hospital tents outside to
accommodate the over-
flow of the wounded.
Order of the Loyal
Legion and the US army
178 TWO WEEK CURRICULUM FOR TEACHING THE CIVIL WAR
At the field hospital, the operating
table was often a barn door sup-
ported by two barrels or similar
objects. Doctors wore no masks
or caps to tuck their hair under.
There were no gowns – just an
apron. The “operating table” was
probably not cleaned after each
patient – so it would be covered
with blood and filth.
What was it like to have
a limb amputated?
T.D. Kingsley, a Union colonel:
The surgeons used a large cotton press
as their butchering room & when I
was carried into the building and
looked about I could not help compar- A nurse tending to two Union soldiers in a hospital in Nashville, TN.
ing the surgeons to fiends. It was Massachusetts Commandery, Military Order of the Loyal Legion and the US
army Military History Institute.
dark & the building lighted partially
with candles: all around on the
ground lay the wounded men; some of them were shrieking, some cursing & swearing & some pray-
ing…(Tenting Tonight, 92).
William Blackford of the 1st Virginia Cavalry: Tables about breast high had been erected upon
which 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, throw-
ing the mangled limbs on a pile nearby as soon as removed…his men were soon overwhelmed by the
prayers, the curses, the screams, the blood, the flies, the sickening stench of this horrible little valley
(Tenting Tonight, 94).
What happened after the amputation?
The solider was moved, by ambulance, to a hospital further from
the fighting. This was a bumpy ride, and the soldier was already in
horrible pain. From this point, the soldier was often moved by rail.
In the winter, the rail car was freezing cold. On the long, horrible
trip, there was no water and nothing to kill the pain.
Infection was the number one cause of death after surgery. It was caused by tetanus (lock- Ambulance.
jaw), erysipelas (intense swelling of tissues caused by bacteria), gangrene (death of soft tis- Illustration from
Hardtack and Coffee:
sue), and pyaemia (blood poisoning caused by bacteria). That’s one reason for the creation of The Unwritten Story of
field hospitals; some surgeons performed amputations on the field of battle to try to increase Army Life
the chance of survival. by John D. Billings.
Illustrated by Charles
C I V I L WA R P R E S E RVAT I O N T R U S T 179
Beat the Odds: Civil War Wounds
Here are three different situations. Using what you know about chances of survival, rank the
wounded soldiers from “best” to “worst”. How will each soldier be treated for his wounds?
1. Colonel Abner Morgan is a wounded Confederate cavalry officer. He was shot
through the left leg, wounding his horse as well. The wounded leg was shot through
the calf. He is bleeding very heavily.
2. Private Frank Weaver is from the 129th Pennsylvania. He was wounded with a
bullet piercing his abdomen. It entered the left front and shot through to the back.
3. Private Clark Hannah is from the 87th Indiana. He was wounded in the right leg,
in the thigh, just below the hip.
Wounded soldiers in a crowd-
ed hospital. Courtesy of the
180 TWO WEEK CURRICULUM FOR TEACHING THE CIVIL WAR