A Transnational View of Medicine and Medical Practices during the Civil War

Interest in the medical history of the Civil War has increased in recent years, not in small part due to Shauna Devine’s Tom Watson Brown Award-winning work, Learning from the Wounded.[1] Tens of thousands of U.S. and Confederate soldiers suffered some form of injury in the course of the Civil War. The war, as is often the case, provided an opportunity for medical professionals to experiment with better treatments, more rapid removal of soldiers from the battlefield, and the recovery of wounded men. While the Civil War is often told as an exceptional domestic story, the history of mid-nineteenth-century nursing and medical advances should not start on the wounded-covered banks of Bull Run, but in the filthy and vermin-covered barracks of the other major mid-century war, the Crimean War (1853-1856).

By the time the Ottoman and Russian empires started the next installment of their long ongoing conflict over Black Sea and Mediterranean dominance in 1853, military technology had changed dramatically. The minié ball, a lead-based projectile, caused significant wounds, often leaving parts of the fabric and the bullet itself in the body of the wounded, causing infection. Like in every war, soldiers suffered from cholera, dysentery, and gangrene.[2] However, the emergence of the telegraph and popularity of newspapers allowed the first war correspondent, William Howard Russell, to report on the dismal state of the field hospitals, forcing a change in thinking among both medical professionals and the public.

The British military hospital at Scutari, on the outskirts of Istanbul, was filthy, damp, and infested. Worse, the Inspector General of Hospitals, John Hall, urged his officers against chloroform, writing: “the smart knife is a powerful stimulant; and it is better to hear a man bawl lustily, than to see him sink silently into the grave.”[3] With the French sending a group of fifty charity sisters, the British asked Florence Nightingale, a former director of a sanatorium in London, to recruit a group of British nurses for Crimea. She arrived with twenty-four women in November 1854 and immediately requested “a thousand mops, fifty quart bottles of disinfectant, three thousand tin plates and thousand yards of toweling.”[4] By the end of the war, her work reduced the number of British deaths from sickness. Whereas the French lost 21,191 soldiers to disease, the British only lost 606. The British had made significant advances in the treatment of wounded soldiers; however, these lessons were soon lost to contemporaries. As a result, the majority of Civil War soldiers still suffered horrendously from wounds sustained.

Nightingale laid the foundation for the modern nursing profession in both Europe and the United States. She wanted her nurses to be “sober, honest, truthful, trustworthy, punctual, quiet and orderly, cleanly and neat.” She reserved the profession for respectable women. She had no time for “excellent gentlewomen more fit for Heaven than a hospital.” She called for a dramatic revision of the medical service within the army.[5] However, her lessons and work, just like that of the soldiers in the trenches of Sevastopol, were quickly forgotten by contemporary military officials and politicians.

If the Crimean War tried to alter the medical world pre-American Civil War, so did the Wars of Italian Unification (the Second War of Independence in 1859 and Third War of Independence in 1866). Just like the events in Fredericksburg, Vicksburg, or Cold Harbor, many wounded soldiers in Italy remained untreated on the battlefield for days after the fighting ceased. During the Battle of Solferino, Franco-Italian forces assaulted the Austrian army. A bloodletting ensued and many soldiers remained on the field for hours, at times days. On June 27, having tried his best to help, Genevan businessman Henri Jean Dunant departed the region in disgust.

Dunant recollected, “The stillness of the night was broken by groans, by stifled sighs of anguish and suffering . . . Heart-rending voices kept calling for help. Who could ever describe the agonies of that fearful night.” The medical services were incompetent; the French army only had one doctor for every one thousand soldiers and no medical equipment. Dunant observed, “The poor wounded men . . . were ghostly pale and exhausted. Some, who had been the most badly hurt, had a stupefied look. . . . Others were anxious and excited by nervous strain and shaken by spasmodic trembling. Some, who had gaping wounds already beginning to show infection, were almost crazed with suffering. They begged to be put out of their misery; and writhed with faces distorted in the grip of the grip of the death struggle. . . . Many were disfigured . . . their limbs stiffened, their bodies blotched with ghastly spots, their hands clawing at the ground, their eyes starting wildly, their moustaches bristling.”[6]

In October 1862, Dunant’s Memory of Solferino was published and Guillaume-Henri Dufour, a veteran of the Napoleonic Wars and commanding general of the Swiss Confederation forces in the recent Sonderbundskrieg (a civil war that tore the Swiss Confederation apart for a month in 1847) reached out to Dufour to humanize the face of war for wounded soldiers. Dunant, Dufour, and a few others decided to take their idea for an international relief organization to the International Charity Congress in Berlin in October 1863. To lend weight to their project, they established the International Committee for Relief to the Wounded. Questions immediately arose about military doctors in uniforms being indistinguishable from fighting men and thus unprotected from enemy bullets or the treatment of wounded regardless of affiliation. In Berlin, Dunant invited interested parties for another meeting in Geneva.[7]

On October 23, 1863, representatives of sixteen countries were in Geneva. For four days, the delegations debated a list of ten articles which called for the creation of committees in the individual countries, advice to army medical services, preparation to enlist volunteer medical personnel on the battlefields (wearing armbands with a red cross distinguishing them as noncombatants), and the coordination of committees by the central body in Geneva. Out of this conference was born the International Committee of the Red Cross, ICRC. While these notions and opportunities did not reach the Civil War in time, the ICRC immediately found an opportunity to test their new accomplishments during the Dano-German War of 1864. Unfortunately, many on the ICRC’s accomplishments were neither new nor productive, leaving Nightingale worried that the ICRC would negate many of the changes in medical treatment and care she had pushed for during the past decade.[8]

The Dano-German War was almost over when on August 8, 1864, sixteen nations assembled in Geneva to ensure that hospitals, field stations, and medical personnel were considered neutral. There was disagreement regarding whether nurses were included in this neutrality. The United States had two unofficial representatives from the U.S. Sanitary Commission present, who faced much ignorance about their work and the advances in medicine during the Civil War. On August 22, 1864, those present, except for the United States and Great Britain, the two countries with the most experience in military medicine, signed the Convention for the Amelioration of the Condition of the Wounded in Armies in the Field, which institutionalized many of the already agreed upon stipulations. The conference also adopted the inversed Swiss flag as its symbol, which meant the organization was increasingly called the Red Cross.[9]

Charles Bowles, the representative of the U.S. Sanitary Commission to the conference, wrote, “The result of the Congress is a treaty which, althou’ less than perfect, is far more than was really to have been expected. . . . Its grand test, future practicability, remains to be applied. To reconcile humanity with the exigencies of war, or inhumanity under another name, is a task of almost insurmountable difficulty. Its influence will be felt, and the justice of its principles acknowledged, and those who violate it will at least be morally accountable . . . It will be marked by the future historian as a forward step in the civilization of the nineteenth century.”[10]

Only after the Civil War did the Red Cross get an opportunity to test its operation and principles in wartime, during the Austro-Prussian War of 1866. The one major battle at Königgrätz caused 30,000 Austrian casualties, versus 10,000 Prussian casualties. Prussia was entirely responsible for the care of all the wounded. Prussian stretcher-bearers wore the Red Cross as they carried wounded off the field. Chloroform was used during operations. The railroads carried the wounded back to hospitals in Prussia with local committees along the railroad providing the wounded on the trains with refreshments. In contrast, Austria was unprepared; five days after the battle Prussian volunteers found a primitive field hospital with 300 badly wounded and barely alive soldiers. There were 800 men already dead for lack of treatment.[11]

The many wars of the mid-nineteenth century dramatically highlighted the suffering among wounded soldiers on the battlefield. As a result, states and private individuals sought to improve the fate of the wounded. The Atlantic was more barrier then highway of information during the Civil War era. In the end, the emergence of nursing, the professionalization of medicine, and the creation of the Red Cross dramatically improved the suffering of soldiers wounded during battle. The battles of the mid-nineteenth century, including the American Civil War, forced this rethinking, but many of these advances came too late for over half a million U.S. residents killed by insufficient medical care in the war.

 

[1] Shauna Devine, Learning from the Wounded: The Civil War and the Rise of American Medical Science (Chapel Hill: University of North Carolina Press, 2014)

[2] Frank R. Freemon, Gangrene and Glory: Medical Care During the American Civil War (Urbana: University of Illinois Press, 2001), 48-49

[3] Caroline Moorehead, Dunant’s Dream: War, Switzerland and the History of the Red Cross (London: HarperCollins, 1998), 30-32.

[4] Florence Nightingale to Sidney Herbert, December 21, 1854, in Florence Nightingale: Collected Works of Florence Nightingale, ed. Lynn McDonald (Waterloo: Wilfrid Laurier University Press, 2010): 14:85-86.

[5] Moorehead, Dunant’s Dream, 32.

[6] Henry Dunant, A Memory of Solferino (Geneva, Switzerland: ICRC, 2011), 41, 44.

[7] Moorehead, Dunant’s Dream, 13-19.

[8] Ibid., 20-21, 30.

[9] Ibid., 43-45.

[10] Charles S. P. Bowles, Report of Charles S. P. Bowles: Foreign Agent of the United States Sanitary Commission, Upon the International Congress of Geneva, for the Amelioration of the Condition of the Sick and Wounded Soldiers of Armies in the Field, Convened at Geneva, 8th August, 1864 (London, UK: R. Clay and Taylor, 1969), 15.

[11] Moorehead, Dunant’s Dream, 53-55.