A TIME OF LITTLE KNOWLEDGE: THE IMPACT OF DISEASE AND MEDICINE

DURING THE AMERICAN CIVIL WAR

Jennye Bekker

HIST 444W: Civil War & Reconstruction

April 11, 2020

1

The American Civil War was a war like no other. Brothers fought against brothers,

fathers fought against sons, and ex-slaves fought against masters. When the Southern states

declared secession and the war began, no one expected it to be the long, brutal, four-year war

that occurred and is studied today. Union men fought and died to preserve the unity of the nation

while Confederate men rebelled and aimed for independence. Though war is a horrific event that

results in casualties, it forces and drives the advancement of new technologies. Seeing all of the

death and disease surrounding the soldiers, the medical community was pressured to quickly

adapt to the new war-time technologies and present diseases. The Civil War presented thousands

of deaths, casualties, and diseases that surgeons and medical practitioners had to combat with.

This was a time period where some of the greatest medical advances emerged because of the

ongoing demands of the war. The medical community of the Antebellum Era was completely

different than what was seen during the war. The American Civil War presented an opportunity

for the entire medical community to advance and create new treatments and methods that could

challenge the common wartime diseases and weaponry.

The American Civil War resulted in the deaths of thousands of men; however, most of

the deaths were not a result of a bullet wound, but disease. Unlike wars in the present day,

disease was a soldier’s greatest enemy. It was not until World War I where more soldiers were

killed by weapon wounds than disease.1 This means that the Civil War was no exception, and 2/3

of all the Civil War deaths were a result of disease. Disease was popular during wartime

especially because of overcrowded camps, unsanitary hospitals, and poor living conditions.

Additionally, the camp surgeons and medical practitioners dealt with so many wounded soldiers

that it was impossible to keep infections out. Also, during this time new wartime technologies

1
Adams, George Worthington, Doctors in Blue the Medical History of the Union Army in the Civil War (New York:
Henry Schuman, Inc. 1952), pp. 194
2

were introduced, and the preferred weapon of choice was the musket. Muskets were loaded with

minié balls which were dangerous as they almost always left the victim with an infection.2 These

minié balls were made of a soft yet heavy lead that traveled at a low velocity. When hitting

impact, they often would lose their shape, create a large wound, and had enough force to shatter

bone. Soldiers would end up with a gaping hole where the ball entered which would bleed

tremendously. The main issue with these weapons was the infections that set in after being hit.

Because of their slow speed, as the ball entered the body it would bring in particles of clothing

and dirt to fester in the wound.3 Though unknown during the time, the bacteria that attached to

the soldier’s clothing or that was hanging onto the ball caused infections that could easily be

spread to other soldiers. Most of the time, it was not the actual wound that killed a soldier, but

the secondary infection that set in either during impact or while being treated at a hospital. The

typical occurrence was that a soldier would be hit with a minié ball that would rupture the skin

and shatter some bone, develop a secondary infection, and then be discharged with either a

useless or amputated limb. This was a common routine as the majority of Civil War weapons

that caused injury were firearms. Even though some bayonets were used, they often immediately

killed their victim from hemorrhaging rather than sending them to a hospital. The novel wartime

technology used during the Civil War surrounded medical surgeons and practitioners with

secondary infections that were difficult to treat as well as prevent from spreading across camp.

During the Antebellum Era before the Civil War, practicing medicine was completely

different than what is seen today. This was a time where any man could become a doctor as long

as they had the funds to pay for medical school.4 There were no standardized tests or prerequired

2
Adams, Doctors in Blue, p. 114
3
Adams, Doctors in Blue, p. 114
4
Peyton, Westmore, “Tender Loving Care: A Study of the Doctors, Their Medicines, and Medical Treatment During
the American Civil War Era,” Lincoln Herald Vol. 84: No. 2, p. 106
3

courses and thus becoming a doctor was reserved for wealthy individuals regardless of previous

education. The curriculum consisted of general anatomy and physiology, but rarely contained

any laboratory or clinical experience. Dissections were rare and so many aspiring doctors

traveled to Europe for higher training. Most of the doctors graduating in America did not have

proper medical training yet opened practices and were welcomed during the Civil War. Medicine

during this time was variable and consisted of traditional medical treatments as well as

quackery.5 People in medicine were known for doing more harm than good to the body, and thus

homeotic and other practices emerged to offer other methods of treatment to patients. This often

resulted in less damage but was just as ineffective at curing medical ailments. Common practices

were bloodletting and medicines of horrid taste and aroma. The previous practice and knowledge

of medicine were not going to be enough to help all of the diseased and wounded soldiers.

Surgeon General William Hammond created Circular No. 2 in 1862 to teach future medical

physicians the “basic principles of military medicine.”6 This Circular established the Army

Medical Museum which preserved medical evidence from the Civil War to be later studied by

researchers. All medical officers had to document any wound or disease they encountered on the

field and record information regarding treatments and survival. This information was kept so that

both during the war and after, scientists could examine each specimen to investigate the cause of

disease and search for effective treatments. This showed how Hammond was thinking ahead to

the conclusion of the Civil War to prevent the issues that they were encountering from occurring

in future wars. Many of the diseases seen in the Civil War were hardly present in WWI which

was because of the immense data collection and medical research done following the war. Civil

5
Brumback, Roger A. “Fragmentation of Medicine in the United States: Remnants of the 19th Century and the
American Civil War” Journal of Evidence-Based Complementary & Alternative Medicine Vol. 17 No. 1  (2012) p. 9
6
Devine, Shauna. Learning from the Wounded The Civil War and the Rise of American Medical Science. (Chapel
Hill: The University of North Carolina Press, 2017) p. 22
4

War medical advancements completely changed how medicine was previously practiced during

the Antebellum Era and was looking towards future research to prevent the same diseases from

occurring once more.

One large challenge that medical practitioners had to overcome was the disorganization

of finding the wounded soldiers. Neither the North or South was experienced or had a strong

military setup prior to the start of the war. One of the main examples of this challenge was

during the Battle of Bull Run. This was a case where there were no military ambulances and

wounded soldiers “remained on the battlefield for days.”7 All of the ambulances were driven by

civilians who fled as soon as the battle started. If an ambulance was accidentally left behind,

healthy soldiers stole them to flee the site. There was no efficient way to gather up the wounded

and take them to receive medical attention. The disorganization was quickly realized, and thus

medical director Jonathan Letterman created an ambulance corps “under medical direction.”8

This establishment organized two trained ambulance staff to go into battle and scout out

wounded soldiers. These staff had the sole purpose of escorting wounded soldiers to the tent

hospitals a short distance away. By doing so, other soldiers could focus on firing at the enemy

while knowing that their fallen ally would be taken away for care. The ambulances were initially

two-wheeled wagons containing stretchers that were constantly wheeled between the battlefield

and hospital.9 The corps consisted of stretcher-bearers under the command of nonphysician

leaders such as commanders and lieutenants. When not in use, the wagons often carried supplies

necessary for the field hospitals. Letterman established a stocking system to ensure that surgical

7
Reilley, Robert F. “Medical and Surgical Care During the American Civil War, 1861-1865” Baylor University
Medical Center Proceedings Vol. 29 No. 2 (April 2016) p. 139
8
Smith, Dale C. “Military Medical History: The American Civil War” OAH Magazine of History Vol. 19 No. 5
(September 2005) p. 18
9
Place, Ronald J. “The Strategic Genius of Jonathan Letterman: The Relevancy of the American Civil War to
Current Health Care Policy Makers” Military Medicine Vol. 180 No. 3 (2015) p. 260
5

equipment and dressings were available to each soldier and these items were transported from

location to location via the ambulances and ambulance corps. The establishment of the

ambulance corps was an effective method for retrieving wounded soldiers off the battlefield to

receive medical care.

One of the main reasons that disease was so common during the Civil War was because

of the prevailing views on medicine. The original theories of how diseases were spread led to the

methods of treatments prescribed by doctors. One of the principal disease theories during this

time was the miasmatic theory stating that diseases were a result of the atmosphere.10 With this

theory, contaminated air, water, and plant matter were contenders for the causes of diseases such

as gangrene and erysipelas. Many advocates claimed that places with “bad air,” filth, or decaying

matter lead to a heightened chance of contracting a disease. Because of this, many treatments

hoped to expose patients to places of a cleaner environment; however, this was not possible with

the dirty and overcrowded camp conditions. Another common (but incorrect) theory related to

the passage of contaminated material from a diseased person.11 Supporters of this theory believed

that diseases were created in sick people and were then passed onto healthy people through

exhalations in the air. The idea that the air contained diseased material remained prevalent but

was incorrect as it did not target the presence of microorganisms. It was not until after the Civil

War where germ theory was created and accepted, but up until that point, the miasmatic theory

was thoroughly questioned and challenged as researchers analyzed gangrenous limbs. The

prevailing theories of the Antebellum Era continued to take precedence during the Civil War that

Devine, Learning from the Wounded, p. 99

10

11
Devine, Shauna. “‘To Make Something Out of the Dying in This War’: The Civil War and the Rise of American
Medical Science,” Journal of the Civil War Era, Vol. 6, No. 2 (June 2016) p. 154
6

even though microorganisms were viewed, they were not accepted as the cause of disease, and

thus medical treatments were not efficient in helping wounded soldiers.

The American Civil War is known for its high amputation rate. When wounded soldiers

entered the field hospital, the most common procedure was the amputation of a limb. It was

noted that three out of four operations surgeons performed were amputations.12 This was quite

common because the wounds created by the minié balls were so damaging and destructive to the

body. Additionally, the high rate of wounded soldiers each day meant that surgeons had to devise

a quick and easy way to treat their wounds. Because of this, the removal of an entire limb was a

quick way to get rid of the wound and minimize any initial infection. Amputations took about 2

to 10 minutes per limb and were done quickly to keep up with the constant demand of wounds.13

Surgeons were constantly loaded with soldiers needing to be amputated and often had a giant

pile of limbs lying next to them at the end of the day. Amputation provided the soldier with a

higher chance of survival especially if the part that was removed was away from the torso.

Observed in the South, amputations near the lower portions of the thigh more commonly resulted

in death compared to farther extremities. The main complications were because of hemorrhaging

in which blood vessels were not correctly tied. This often happened because of the fast pace

necessary for each procedure. Dr. James Fulton was a medical surgeon in the Civil War and

wrote in his diary evidence of amputations. He remembered when they had waited to perform an

amputation on a wounded soldier in hopes of saving his leg, but even after the amputation, the

soldier had died.14 Soldiers with the worst wounds were treated first while others waited to be

operated on. The main issue was that as the ball hit the skin, it brought in dirt and bacteria to the

12
Westmore, “Tender Loving Care,” p. 110
13
Reilly, “Medical and Surgical Care,” p. 140
14
Hicks, Robert D. Civil War Medicine A Surgeon’s Diary. ( Bloomington, Indiana: Indiana University Press. 2019)
p. 73
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body. As many soldiers patiently waited to see a surgeon, infection started festering in the wound

and reduced their chances of survival. Because of this, surgeons tried to complete as many

amputations as possible to reduce the chances of initial infection; however, because of the fast-

paced environment, there were tremendous risks of hemorrhaging as well as developing a

secondary infection.

Amputation was popular for both the Union and the Confederacy; however, was much

more dangerous with the limited resources of the South. The main difference between the North

and South was the shortage of doctors and medical equipment. Southern doctors did not have the

necessary medical training and were often learning on the battlefield. Additionally, the South did

not have the necessary supplies and was often short on chloroform.15 While performing

amputations, both the North and South had many surgeons in favor of chloroform. This chemical

was an anesthetic and had the power to put a patient under while performing the amputation so

that he was unaware of any pain or loss of blood (ether was another common anesthetic but was

not nearly as popular as chloroform). Many Confederate surgeons wanted to use chloroform for

every amputation; however, it was in such short supply that surgeries were often performed

without. Because of this common occurrence, Confederate surgeons were viewed as butchers

chopping off the limbs of wounded soldiers. When applicable, chloroform was administered with

a cloth as a patient breathed in.16 There were many dangers with this method including the

dispersion of chloroform in the air. If the vapors did not go directly to the patient, then

occasionally the surgeon could be affected. Additionally, an overdose of chloroform could

paralyze the heart and thus kill the patient. Because of this, not all surgeons accepted the use of

chloroform. When chloroform was not available or was decided against, the patient was operated
15
Miller, Brian Craig. Empty Sleeves: Amputation in the Civil War South. Athens: (University of Georgia Press,
2015). p. 30
16
Miller, Empty Sleeves, p. 31
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while he was still in shock.17 Commonly in the South, the patient was tied down and restrained

by assistants and then given something to bite down upon. Because of the lack of resources,

Confederate surgeons were forced to perform amputations with whatever sharp objects they had

which ranged from pocketknives to large saws. Without the ample supply of anesthetics or

medicines, many Southern soldiers were forced to face the wrath of the surgeon’s knife while

still awake which was painful, extremely dangerous, and often led to secondary infections.

One of the biggest complications of both minié ball wounds and amputations was the

development of gangrene. This disease is commonly known as hospital gangrene because it was

popular among hospitals before the Civil War. One of the main beliefs during this time was that

all wounds were “healing” if they developed a cream-colored discharge following the initial

treatment.18 Doctors looked for pus all over a wound, and in the occurrence that there was not

any present, they viewed it as a complete oddity and that it was not healing properly. Contrarily,

the formation of pus was a secondary infection developing; however, medical practitioners did

not attribute the pus infection to the deteriorating health of the patient. During the Civil War

surgeons and medical practitioners did not just see a small amount of discharge, but the foul-

smelling and fast-spreading disease of gangrene. Confederate doctor Joseph Jones noted the

“rampage” of the disease that even after the removal of a gangrenous limb, the disease often

reappeared and resulted in death.19 Gangrene was common in field hospitals and even if a soldier

did not initially have the infection, he often contracted because of the unsanitary conditions.

Surgeons would use unsterilized equipment that would harbor disease and get passed on from

soldier to soldier. Because of this, gangrene was quickly passed throughout a camp and even to
17
Westmore, Tender Loving Care, p. 109
18
Trombold, John M. “Gangrene Therapy and Antisepsis Before Lister: The Civil War Contributions of Middleton
Goldsmith of Louisville” The American Surgeon Vol. 77 No. 9 (September 2011), p. 1138
19
Breeden, James O., Joseph Jones, M.D.: Scientist of the Old South (The University Press of Kentucky, 1975), p.
160
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surgeons, nurses, and other medical volunteers. Since many soldiers had gangrenous wounds and

Hammond’s Circular No. 2 demanded that all cases were thoroughly documented, there was

plenty of evidence for medical practitioners to begin experiments for a cure. One of the notable

cures was developed by assistant surgeon Frank Hinkle who emphasized the potential of

permanganate of potassa.20 Previous data suggested that permanganate of potassa could be used

as a deodorizer for certain ulcers and thus prompted Hinkle to conduct experiments of applying

the chemical to gangrenous wounds. When doing so, patients had the solution applied to the

wound every few hours following cleansing the area with soap and water. The improved

sanitation as well as the effective treatment both stopped the spread of gangrene as well as

helped prevent the infection from taking hold of a new wound. Even though it was effective,

surgeons did not often have permanganate of potassa on hand. Assistant Medical Director

Middleton Goldsmith noticed that gangrenous patients around bromine vapor recovered more

often than others.21 Bromine was a volatile compound that was commonly around camp hospitals

and was thus used to treat gangrene. Similar to treatments of permanganate of potassa, the

wounds were cleansed and also the gangrenous tissue was removed. When conducting an

experiment, Goldsmith concluded that pure bromine was the more effective treatment that

increased survival rate and cured the disease quicker. Without the emphasis of documentation

enforced by Circular No. 2, many of the treatment experiments would not have been successful

or as widespread as they ended up being. Even though gangrene was a highly contagious disease

that quickly spread among soldiers, experiments discovered that bromine vapor could help heal

the wound quickly.

20
Devine, Learning from the Wounded, p. 115
21
Trombold, “Gangrene Therapy,” p. 1141
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The living conditions of war presented additional problems to soldiers in terms of

deficiency diseases. Microorganisms caused most of the deadly diseases; however, diseases

involving deficiencies in essential nutrients caused issues and troubles during battle. One

common disease was scurvy. This is because the food given to the soldiers lacked enough

Vitamin C to prevent the disease.22 Scurvy had been known and been effectively treated since the

late 19th century, but the war presented a shortage of fresh fruits and vegetables. Soldier rations

consisted of highly salted meat and many grains. Fruits were attempted to be given to the

soldiers yet were often unripe and inedible. To combat the sickness, soldiers would scavenge for

food including hunting for fresh meat from livestock and gathering any fruits or berries from the

environment. This was an issue because resources were quickly picked over and could not

supply an entire regiment. With scurvy, common treatments were lemon juice as well as fresh

fruit or vegetables. This often helped lessen the symptoms and was effective at getting a soldier

back on the field. Medical practitioners also administered lemonade to the sick soldiers;

however, they would often relapse because of a continuous deprivation of Vitamin C. Scurvy

threatened soldiers (particularly those who were Confederates) and often had horrific side

effects. In addition to the bleeding gums and tender teeth, it often led to chronic diarrhea which

was painful and deadly.23 Gastrointestinal abnormalities such as diarrhea and dysentery were the

most common complications for soldiers. They were often so deadly because of how quickly

they could dehydrate a person. The best treatment was the consumption of wild blackberries.

Soldiers enjoyed the taste for the berry as well as it had a high medicinal value. The danger of

scurvy, diarrhea, and dysentery was their ability to worsen any infection or wound.24 These

22
Reilly, “Medical and Surgical Care,” p. 141
23
Bollet, Alfred Jay, “Scurvy and Chronic Diarrhea in Civil War Troops: Were They Both Nutritional Deficiency
Syndromes?” Journal of the History of Medicine and Allied Sciences, Vol. 47, (1992), p. 58
24
Breeden, Joseph Jones, M.D., p. 191
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diseases drained the strength of any soldier and their ability to fight off diseases. They weakened

the immune system and caused complications when fighting other diseases. Also, prisoners

captured by the enemy were often the ones who suffered the most from these deficiency diseases.

They were forced to resort to eating rats and were given whatever food was leftover. Once

prisoners of war were released, they were often always brought back with a deficiency of some

sort. While scurvy was not one of the biggest diseases during the Civil War, it led to

complications when combined with other ailments and could result in chronic diarrhea which

was a common killer.

The warm environment of the South brought new vectors of diseases: mesquites. Though

diseases such as malaria and yellow fever were found in the North, they festered in the deep

South and could quickly instill fear in an army. Yellow fever was known as the “strangers’

disease” particularly because it always affected those without immunity and thus had

psychological impacts among northern soldiers.25 Some soldiers were more afraid of contracting

yellow fever than facing battle. The disease was particularly worrisome because no one

understood how it was spread until the onset of the war. Prevailing beliefs stated that it was

caused by unsanitary conditions and bad air (reverting back to miasmatic theories). Because of

the psychological fear among soldiers, Major General Benjamin Butler ordered increased

sanitation efforts to remove standing water and waste products. These effects quickly controlled

the disease and diminished any fears associated with it. Additionally, quarantine systems were

put in place to prevent susceptible soldiers from contracting the disease. The success of

quarantine systems was a huge medical advance during the time as it eliminated yellow fever in

New Orleans until 1864. This was a disease where medical professionals could not do much

25
Graham, Barry F. “The Battle of Yellow Jack: A Comparative Look at Preventive Medicine During the American
Civil War” The Army Medical Department Journal (April 2013) p. 103
12

other than treat the direct symptoms of the disease; however, the improved sanitation conditions

greatly diminished the number of cases. Another common mosquito disease was malaria. During

the war, one in three Union soldiers had the disease at least once.26 Many Southerners hoped that

the swampy lands of the South would quicken the spread of the disease and kill thousands of

soldiers. They failed to consider was that previous medical recorders discovered that quinine was

an effective drug to combat most malaria cases. When a soldier came down in a malaria fever,

field doctors would dissolve the drug in whiskey and administer it to the patient. This was

possible for the Union because they had access to ample supplies of quinine, but the Confederacy

had a shortage. Blockades prevented the South from obtaining imports of quinine and other

necessary drugs. Because of this, the Carolinas were notorious for a high mortality of malaria.27

Even though the South thought that the North would suffer more from insect-carrier diseases, the

lack of medical supplies and treatments greatly hindered the South and accompanied the high

mortality.

One last large disease army practitioners had to grapple with was cholera and the

gastrointestinal problems it brought. Cholera was a disease that would appear in large numbers

all at once rather than spread like a contagion. This disease killed within 48 hours by immensely

dehydrating its victim.28 It had effects such as vomiting, diarrhea, and horrific rice-water stools.

Because so many people were worried about the disease, any physician that treated a cholera

patient was compensated for putting themselves in danger. The disease had affected both soldiers

and citizens on both sides and most deaths were well documented. With this knowledge,

physicians could pinpoint specific locations and times of outbreaks to try to dissect how the

26
Humphreys, Marget, “This Place of Death: Environment as Weapon in the American Civil War,” The Southern
Quarterly, Vol. 53, No. 3/4 (Spring/Summer 2016), p. 21
27
Humphreys, “This Place of Death,” p. 22
28
Devine, Learning from the Wounded, p. 216
13

disease was spreading. To prevent cholera, camps were placed in well-ventilated areas that were

elevated for improved sanitary conditions.29 All sick soldiers and prisoners were kept away from

the others and all tools were sanitized. Previous theories presented by John Snow suggested that

cholera was caused by contaminated water. In response to this, Physician T. A. McParlin ordered

only rainwater or distilled water to be distributed to troops. Once set in place, cholera cases

started diminishing immediately. Support for Snow’s theory appeared when soldiers would run

out of pure water and would instead drink river water. After doing this, cases of cholera

developed and thus supported Snow’s theory. McParlin’s experiment was replicated many times

and was successful at reducing cholera epidemics throughout camps. Finally, this medical

milestone led to inspections for new recruits when entering soldier camps.30 All new soldiers

arriving at camp had to go through strict inspections to ensure that they were not carriers of

disease. This was a big change because previously only symptomatic men were questioned and

inspected. The responses to cholera including new sanitation precautions and inspection

requirements were implemented to decrease the spread of diseases and improve the living

conditions of camp life.

The Civil War presented opportunities for women in medicine. Typically, women were

only midwives and would assist during pregnancy and delivery; however, the war led many

women into the field of nursing. Because they could not fight in the war, women did whatever

they could within the “women’s sphere” to support the soldiers.31 They viewed nursing as an

extension to their sphere because they previously cared for children, family members, and

babies. Once war broke out, women found themselves substituting for men in traditionally male

29
Devine, Learning from the Wounded, p. 223
30
Devine, Learning from the Wounded, p. 236
31
Lesniak, Rhonda Goodman. “Expanding the Role of Women as Nurses During the American Civil War,”
Advances in Nursing Science, Vol. 32, No. 1. (2009) p. 34
14

positions and began entering camp hospitals. The nurses traditionally assisted the surgeons,

dispensed treatment, and helped mentally support the wounded. Similar to many surgeons and

physicians, nurses had not had any previous training and instead learned on the field through

experience.32 Wounded soldiers were often passed to nurses after being seen by the head

surgeon. After this, the women nurses would administer any necessary treatment, dress wounds,

and be an ear for dying patients. Because of the grotesque wounds seen during battle, many

nurses were not mentally up to the challenge. Some women would turn away and faint at the

sights and smells of amputations and war. Women had to overcome their fears in order to

continue practicing medicine.33 Many nurses were unhappy that surgeons often resorted to

amputations. They saw mangled limbs, disease deformities, and gangrene of hundreds of men

each day. Nurses had to mentally remove themselves from the situation to care for the thousands

of soldiers demanding help. Finally, the Civil War erased all traditional funeral practices and so

soldiers were dying far away from friends and family. To combat this issue, many nurses would

listen to soldiers as they said their last words and would help write back to loved ones to notify

about a death. This helped soldiers who were wishing for their families as they laid dying in the

hospital. Civil War nursing was a big leap for women because it proved that they could step in

and be useful in essential roles that were previously reserved for men.

The Civil War led to many medical advances; however, the consequences of the war

were present during the post-war period. Many of the volunteer surgeons and physicians

continued to practice medicine after the conclusion of the war. During the war, specialization

was common and injured soldiers would be sent to specific hospitals.34 There they would receive

32
Hsu, David. “Walt Whitman: An American Civil War Nurse Who Witnessed the Advent of Modern American
Medicine,” Archives of Environmental & Occupational Health, Vol. 65, No. 4 (2010), pp 238
33
Breeden, Joseph Jones, M.D., p. 95
34
Devine, Learning from the Wounded, p. 136
15

specific treatments from physicians that were trained immensely on that topic. Prior to the war

specialization was frowned upon primarily because of the overwhelming thought that doctors

needed to know everything about the entire body. When the war started introducing complicated

wounds, doctors often tried to focus specifically on one body part and learn as much as they

possibly could. They became experts in their field and continued to open up their own practices

following the war. Some specialist topics included researching the onset of paralysis from

wounds, the effect of nerves on nervous diseases, and reconstructive surgery. The Civil War

created reconstruction specialists who helped to reconstruct facial deformities.35 Many veterans

came out of the war missing limbs because of amputations and were viewed as heroes. The

public symbolized the missing limb as a sacrifice given during the war. Additionally, some

veterans were unfortunate and came out of the war with facial deformities. Rather than regarded

with valor, those with facial deformities were looked down upon and were outcasts in society.

Because of this, many soldiers hoped for facial reconstruction to help with daily activities such

as eating as well as to somewhat normalize their appearance. This branch of specialization was

used mainly to partially reconstruct the face so that the patient could eat or speak and was less

focused on appearance. Following WWI, the specialization took off as more soldiers needed

facial reconstruction and it focused on reverting the appearance back to how it was. The Civil

War influenced medical practitioners to continue their studies and practice specialization on

soldiers post-war.

In addition to medical practitioners, veterans returning from war needed to readjust to

normal life. Many amputees returned home and struggled to return to work because of their

handicap.36 When Confederate men returned home, they could not find jobs and thus could not

35
Devine, Learning from the Wounded, p. 165
36
Miller, Empty Sleeves, p. 118
16

be providers for their family. Instead, they turned to organizations for help finding employment

and pay. As time passed, many older veterans ended up being completely dependent on the state

government for their financial needs. To help return to normal life, some amputees sought out

prosthetic limbs such as peg legs. Some soldiers were left with amputated stumps that were too

painful for a prosthetic to be added, but others functioned in public with wooden legs.37 These

prosthetics were painful to wear for long periods of time and were only worn when necessary.

Chronic pain was the new normal for amputee victims and many had to continue with morphine

therapy. Additionally, some amputees reported feelings from an amputated limb as if it was still

present. This phantom limb often caused emotional pain for the idea of now being a “cripple”.

Southern soldiers struggled to take care of themselves and had to grapple with the defeat of the

war and loss of normalcy. Many soldiers exhibited neurological military injuries and had

symptoms that would today be categorized as PTSD.38 Loved ones noticed that those who

returned from war were angrier, emotionally distant, drank often, and would get startled by

sounds of war. War veterans such as Walt Whitman documented how he suffered constantly

because of his memories of war, yet there were no treatments for psychological diseases. Even

though psychology was not created until the late 19th century, both veterans and nurses often re-

experienced the traumatic events of war and were in distress. While home from the war, their

minds could not return to normal and certain triggers would always arouse them to remember

their time during battle. There was nothing that could have been done to treat the PTSD victims

and they remained emotionally damaged for the rest of their lives. Overall, soldiers who survived

the Civil War (especially in the South) were left with nothing and had to learn how to adapt to

the changes post-war.

37
Miller, Empty Sleeves, p. 119
38
Hsu, “Walt Whitman,” p. 238
17

The American Civil War was a tragedy and resulted in the loss of hundreds of thousands

of men primarily to disease. The constant demands of war drove the advancement of the medical

community to combat the ongoing diseases of the time. During the Antebellum Era, not much

was taught in medical schools and so all war volunteers had to learn through experience on the

field. When they got there, they were met with a combination of horrific diseases from the

unsanitary conditions and grotesque wounds from the new rifle technology. Medical

advancements such as the enforcement of Circular No. 2 helped physicians research new

methods of treatment for old diseases. Throughout the war, surgeons and nurses worked side-by-

side to help provide care for all soldiers. Since the war was known for the enormous amount of

amputations, during the postwar era many amputees struggled to adjust to the new daily life.

They suffered from a lack of jobs because of their handicap as well as carrying trauma from their

war experience. The war resulted in higher sanitation practices, effective methods for

transporting the wounded, and quarantining those who displayed disease symptoms. The

advanced efforts and medical knowledge were carried into upcoming wars such that WWI had

fewer deaths by disease compared to weapons. Many of the diseases that were fatal to soldiers

during the Civil War was less threatening during WWI. The Civil War was a wake-up call for the

medical community, and they had to create effective treatments in response to all of the suffering

around them.
 18

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