One of the greatest myths told about Civil War medicine is that anesthetics weren’t used during surgeries or amputations. While it may be easy to believe, medicine was not quite that primitive during the era. A variety of sedatives were used during surgeries, including chloroform and whiskey. Chloroform negatively affects the central nervous system, liver, and kidneys, but despite this was used as an anesthetic during amputations, accompanied by “medical liquor”. Nowadays, we like to think that our anesthetic knowledge is a little bit more advanced. Today’s surgeons most typically use a local anesthetic called Bupivacaine when amputating extremities. This medicine fully sedates the amputee and blocks nerve impulses sending pain signals to the nervous system. Fortunately, whiskey is no longer needed. During the Civil War, disease was everywhere. The hospitals, battlefields, nd camps were filled with a plethora of deadly viruses.
Other than malaria, there were no medications or cures available for these common illnesses. Local streams were quickly contaminated, causing the growth and spread of most of these viruses, like dysentery, which killed almost one hundred thousand soldiers in total. Improper sanitation was another contributor. “Germ theory”, the theory that sicknesses and infections are caused by the invasion of the body by microorganisms (bacteria too small to be seen by the unaided eye), hadn’t yet been discovered. As soldiers came together in large groups, their bodies were contacted by pathogens that they had never before been exposed to. Cross contamination was caused as surgeons used the same tools to perform procedure after procedure. Germs spread like wildfire. Of the 620,000 soldiers who died during the Civil War, two thirds were killed by disease rather than enemy fire.
Their malnourished bodies, exhausted and worn from continuous battle as well as awful diet took an immense toll on their immune systems. It’s a misconception that the greatest danger was on the battlefield, when in fact the real enemy was visible only under a microscope. Because of advances made during this period, medical professionals now understand the risks associated with improper sterilization. Thorough detail is put into the cleansing and storing of each surgical apparatus. Equipment is first soaked in an enzymatic solution that eradicates contaminants, and then is cleaned in a high-powered washing machine. The machines whip around extremely hot water at speeds beating those of a carwash by tenfold, spraying the equipment with powerful cleaning solutions. Medicine has come a long way since the war. Emily Sohn of Discovery News states, “Injuries that resulted in amputations 150 years ago now lead to X-rays, the setting of bones, and a four- to six-week recovery period before returning to battle” (2011). Throughout the war, doctors made discoveries that drastically influenced modern medical technique, both on the battlefield and beyond.
For instance, the filthy conditions sparked a growing sense that sterilization lessened casualties. Then there was Letterman, who as medical director for the Union Army created a well-organized system of care during mass trauma situations, called a triage system. A triage system is the classification of someone’s injuries based on medical urgency, used for deciding the order of those to receive medical attention. As soldiers returned from the war, there grew a demand for efficient medical systems as there had been during battle. It was argued that, “If a wounded man could be picked up in the midst of the Battle of Gettysburg, after all, shouldn’t everyone be able to get rapid help after falling off a ladder on the street?” (Sohn, 2011) One of the major accomplishments during the Civil War was the establishment of an effective hospital system that threaded the wounded and diseased through a series of continuously improving treatments and rehabilitation.
In the decade before the war, American military action consisted of Native American skirmishes and the few wounded were treated at the various forts in small infirmaries. In cities, hospitals were for the indigent and working classes, and had a reputation as places to die. It would not be until the last decade of the nineteenth century that hospitals were looked upon as places of healing. Letterman’s ideas directly influenced the hospitals, emergency systems, and ambulance networks that we use today. Civil War surgeons were often unqualified for their jobs. Though they worked hard and did the best they could, minimal effort was put into their training. At this point, America was way behind Europe regarding medical academics. Only two years of schooling were required, the second year often being a repeat of the first. It is said that Harvard Medical School did not own a single stethoscope until after the war was over.
Many surgeons had never even seen a gunshot wound or performed surgery before they were thrown out into the thick of the war trauma. Medical boards admitted many ‘quacks,’ with little to no qualification. Yet, for the most part, the Civil War doctor (as understaffed, underqualified, and under-supplied as he was) did the best he could, muddling through the so-called ‘medical middle ages.’ Now, becoming a surgeon is a draining and lengthy process. Those wishing to begin this process have to be fully focused and committed to their studies in order to achieve their goals. Medical school admissions boards require all applicants to earn bachelor’s degrees from accredited colleges and universities. College juniors looking into a career in medicine will take an aptitude test to determine if they are fit for the program. The path to becoming a physician begins in medical school, which generally requires four years of full-time study beyond one’s undergraduate studies.
Curriculum is divided between classroom-based instruction in the sciences and clinical rotations where students develop applied skills in various areas of medicine. In order to practice medicine legally in the US, students must take and receive a passing score on the United States Medical Licensing Examination (USMLE), a three-part examination taken during and after medical school. Medical students must pass the first part of the examination, which covers basic medical principles, before entering their third year of studies. During their fourth year, students must pass the second part of the exam, which covers clinical diagnosis and disease development. During their final year of medical school, students start narrowing down their medical specialty options (e.g. pediatrics, anesthesiology). They submit an application for residency and are matched to open residency programs throughout the country. Newly-minted doctors transition from graduate school residency programs. These programs generally require at least three years to complete and provide in-depth training in students’ chosen specialties. The final step of the residency process is to complete Part III of USMLE.
This examination covers clinical management and assesses the doctor’s ability to practice medicine safely and effectively. Once their medical educations are complete, doctors may obtain certification in their chosen field. As you can tell, the process to becoming a surgeon is just a little bit more complicated than it was during the war. The process can take from eleven to twenty years to complete, but is never really finished. Even the most renowned surgeons still take classes and exams from time to time to ensure their performance is still at its best. From the Civil War, what they call the “Medical Middle Ages”, to the current medical technology, countless breakthroughs have been made. We’ve come long way since using chloroform as an anesthetic. We’ve come such a long way regarding medical sciences, and we’ll only be going forward from here.
