Tag: Civil War

War and Medicine

On November 12, 2024

The Evolution of the Army Medical Corps

The history of military medicine in the United States during the 18th and 19th centuries is essentially the history of the Army Medical Corps. There is no surprise that the Army Medical Corps played a significant role in advances in battlefield medicine. However, many people do not appreciate that the Army Medical Corps also played a significant role in the treatment of infectious diseases and improvements in general sanitation. For example, one of the first public health inoculation efforts was ordered by General George Washington in the Continental Army to protect troops against smallpox. Walter Reed led an Army Medical Corps team that proved that the transmission of yellow fever was by mosquitoes. The Army Medical Corps developed the first effective typhoid vaccine during the Spanish American War and in World War II the Army Medical Corps led research to develop anti-malarial drugs.

Revolutionary War and the Founding of the Army Medical Corps

The formal beginnings of military medical organization in the United States trace back to 1775, with the establishment of a Medical Department for the Continental Army. On July 27, 1775, the Continental Congress created the Army Medical Service to care for wounded soldiers. Dr. Benjamin Church was appointed as the first “Director General and Chief Physician” of the Medical Service, equivalent to today’s Surgeon General. However, Church’s tenure was brief and marred by scandal: he was proved to be a British spy, passing secrets to the enemy.

Church’s arrest in 1775 created a leadership vacuum, and the fledgling medical service had to reorganize quickly under Dr. John Morgan, who became the second Director General. Morgan sought to professionalize the medical corps, emphasizing proper record-keeping and standards of care. However, the Revolutionary War medical system struggled with limited resources, inadequate supplies, poor funding and an overworked staff. The lack of an effective supply chain for medicine, bandages, and surgical instruments was a significant issue throughout the conflict.

Early Challenges in Battlefield Medicine

During the Revolutionary War, military medical practices were rudimentary. Medical knowledge and understanding of disease processes had advanced little since the days of ancient Greece. Medical training was inconsistent and was principally by the apprentice method. In 1775 there were only two small medical schools in all of the 13 colonies. One of those closed with the onset of the revolution.

Field surgeons primarily treated gunshot wounds, fractures, and infections. Most treatments were painful and often involved amputation, as this was one of the few ways to prevent infections from spreading in an era without antibiotics. Battlefield medicine was further hampered by the fact that surgeons often had to work without proper sanitation or anesthesia.

One of the most significant health challenges faced by the Continental Army was disease, including smallpox, typhoid, dysentery, and typhus. In fact, more soldiers died from disease than from combat injuries. Recognizing the threat of smallpox, General George Washington made the controversial but strategic decision in 1777, to inoculate his troops against smallpox, significantly reducing mortality and helping to preserve the fighting force. At Valley Forge almost half of the continental troops were unfit for duty due to scabies infestation and approximately 1700 to 2000 soldiers died of the complications of typhoid and diarrhea.

It’s estimated that there were approximately 25,000 deaths among American soldiers both continental and militia in the American Revolution. An estimated 7000 died from battlefield wounds. An additional 17,000 to 18,000 died from disease and infection. This loss of soldiers to non-combat deaths has been one of the biggest challenges faced by the Army Medical Corps through much of its history.

Post-Revolution: Developing a Medical Framework (1783-1812)

After the Revolutionary War, the United States Army Medical Department went through a period of instability. There were ongoing debates about the structure and necessity of a standing army and medical service in peacetime. However, the need for an organized military medical service became apparent during the War of 1812. The war underscored the importance of medical organization, especially in terms of logistics and transportation of the wounded.

The Army Medical Department grew, and by 1818, the government established the position of Surgeon General. Joseph Lovell became the first to officially hold the title of Surgeon General of the United States Army. Lovell introduced improvements to record-keeping and hospital management and laid the groundwork for future medical advances, though the department remained small and under-resourced.

Advancements in Military Medicine: The Mexican-American War (1846-1848)

The Mexican-American War provided an opportunity for the Army Medical Corps to refine its practices. Field hospitals were more structured, and new surgical techniques were tested. However, disease continued to be a significant challenge, yellow fever and dysentery plagued American troops. The war also underscored the importance of sanitation in camps, though knowledge about disease transmission was still limited.

The aftermath of the Mexican-American War saw the construction of permanent military hospitals and better organization of medical personnel, setting the stage for the much larger and more complex demands of the Civil War.

Civil War: The Birth of Modern Battlefield Medicine (1861-1865)

The Civil War represented a turning point in military medicine, with significant advances in both battlefield care and medical logistics. By the start of the war, the Army Medical Corps was better organized than during previous conflicts, though it still faced many challenges. Jonathan Letterman, the Medical Director of the Army of the Potomac, revolutionized battlefield medicine by creating the Letterman System, which included:

Field Dressing Stations: Located near the front lines to provide immediate care.
Ambulance System: Trained ambulance drivers transported wounded soldiers from the battlefield to hospitals.
Field Hospitals and General Hospitals: These provided surgical care and longer-term treatment.

The Civil War saw the introduction of anesthesia (chloroform and ether), which reduced the suffering of wounded soldiers and made more complex surgeries possible. However, infection remained a major problem, as antiseptic techniques were not yet widely practiced and germ theory as a source for disease and infection was poorly understood. Surgeons worked in unsanitary conditions, often reusing instruments without sterilization and frequently doing little more than rinsing the blood off of their hands between patients.

Sanitation and Public Health Measures

One of the most critical lessons of the Civil War was the importance of camp sanitation and disease prevention. Dr. William Hammond, appointed Surgeon General in 1862, emphasized the need for hygiene and camp inspections. Under his leadership, new regulations improved the quality of food and water supplies. Though disease still claimed many lives, these efforts marked the beginning of a more systematic approach to military public health.

Additionally, the United States Sanitary Commission (USSC)was established in 1861. It was a civilian organization that was created to support the union army by promoting sanitary practices and improving medical care for soldiers with the objectives of improving camp sanitation, providing medical supplies, promoting hygiene and preventive care, supporting wounded soldiers and advocating for soldiers welfare.

Hammond also promoted the use of the Army Medical Museum to collect specimens and study diseases, fostering a more scientific approach to military medicine. Though he faced resistance from some military leaders, his reforms laid the foundation for modern military medical practices.

Conclusion

The evolution of the Army Medical Corps from the Revolutionary War to the Civil War reflects a gradual shift from rudimentary care to more organized, systematic medical practices. Early efforts were hindered by leadership issues, such as the betrayal by Benjamin Church, and by the challenges of disease and limited resources. However, over the decades, the Army Medical Department improved its structure, introduced innovations like inoculation and anesthesia, and laid the groundwork for advances in battlefield care. The Civil War, in particular, was pivotal in transforming military medicine, with lessons in logistics, sanitation, and surgical care that would shape the future of military and civilian medical systems.

For further reading, the following sources provide excellent insights:

Office of Medical History – U.S. Army
“Gangrene and Glory: Medical Care during the American Civil War” by Frank R. Freemon

Civil War Trivia

By John Turley

On August 26, 2023

In History

On January 12, 1864, President Lincoln went to Fort Stevens north of Washington, DC to observe military actions by the soldiers defending the capital against the Confederate cavalry of General Jubal Early. Lincoln became the only sitting United States President to come under direct fire from enemy troops. Reportedly, a young officer named Oliver Wendell Holmes (a future Supreme Court Justice) said to Lincoln “Get down you, damn fool”.

Ulysses S. Grant was the first army officer to hold the rank of Lieutenant General since George Washington.

One of General Grant’s ongoing problems was political generals. Because the army expanded so quickly, many people with little or no military experience were commissioned as officers because of political connections. Former senators, congressmen and governors frequently became generals. A number of these were placed in critical combat commands. Many of the early union setbacks can be partially attributed to the ineptitude of political generals who either were unable or unwilling to follow the orders of the professional army. (It must also be admitted that a few regular army generals were inept, but they were easier to set aside.) It wasn’t until late in the war that Grant finally had sufficient influence to be able to dismiss a number of these political generals.

Future Confederate General James Longstreet was a groomsman at the wedding of Ulysses and Julia Grant. He was a West Point friend of Grant’s and Julia’s cousin as well.

Lincoln first offered command of the Army of the Potomac to Robert E Lee. Lee refused, resigned his commission in the United States Army, and returned to Virginia where he swore allegiance to the Confederacy. The first official commander of the Army of the Potomac was General George B. McClellan. General Irwin McDowell commanded the union forces at the first battle of Bull Run, but those forces had not been designated as the Army of the Potomac at that time.

Lee was not the first choice for command of the army of Northern Virginia. The first commander of what would eventually become the army of Northern Virginia was General P. G. T. Beauregard. Interestingly, he also designed the Confederate battle flag which is today widely considered as the “Confederate flag”. It was designed because of the confusion between the Confederate national flag, the stars and bars, and the United States flag. General Beauregard relinquished command to General Joseph E. Johnston when his army was combined with Johnston’s larger army group. Lee did not become commander of the army of Northern Virginia until Johnston was wounded in battle and unable to continue.

The Civil War did not end with the surrender at Appomattox Courthouse on April 9, 1865. On April 26th, Joseph E. Johnston surrendered his larger army of 90,000 soldiers. On May 26th General Kirby Smith surrendered the Army of the Trans-Mississippi, the largest confederate force still operating on land. The last Confederate flag was lowered when the open ocean raider CSS Shenandoah surrendered to the British in Liverpool on November 6th. Interestingly, almost half of the Shenandoah ‘s victories over merchant ships occurred after the surrender at Appomattox.

The surrender at Appomattox Courthouse occurred in the home of Wilmer McLean. In one of those interesting coincidences of history, McLean originally lived near Manassas VA and his property was part of the battlefield of Bull Run. He moved to Appomattox Courthouse to try to get as far away from the fighting as he could.

At the beginning of the Civil War, Ulysses S. Grant was not even in the army. Initially, despite being a West Point graduate, he was refused a commission in the regular army and his first Civil War commission was in the militia.

Grant and wife were initially scheduled to be in the box with President and Mrs. Lincoln at Ford’s Theater on the night the President was assassinated. At the insistence of Julia, the Grants left Washington that afternoon. There’s been much speculation about why they did not attend the theater. Among the many reasons put forward are: Julia missed her children whom she had not seen for almost three months; Julia did not wish to spend time with Mrs. Lincoln whom she found disagreeable and with whom she had several contentious meetings; and one which seems most interesting, she was reported as being very worried about someone that she thought had been watching her all that day and she felt they needed to get away. The assassins did report that Grant had been one of their initial targets so this may be a true report.

Emancipation Proclamation only freed slaves in Confederate held territory. Slavery was not officially abolished in the entire United States until December 6, 1865, with the ratification of the 13th amendment.

Counting both northern and southern casualties, more Americans died in the Civil War than in all other American wars combined. The most recent estimate of the number of Civil War deaths on both sides is placed at about 750,000. Of that number, almost 2/3 died from disease.

At the end of the Civil War the United States had the largest army in the world. In 1860 the US Army had been about 16,000. At the end of the Civil War, it is estimated the army was slightly over one million. It is estimated that a total of about 2.6 million served in the US Army during the Civil War. There are no reliable estimates of the total number to have served in the Confederate Army.

Grant’s drinking was largely overstated. The stories of his dinking stem from a period, early in his career, when Grant was assigned to an isolated fort on the West Coast and his family remained on the East Coast. He suffered depression and loneliness. Throughout his life he had anxiety when separated from his family. While in the west, he began bouts of binge drinking. He missed his family to the point that he resigned from the army even though he had no job prospects at the time. There is very little report of any drinking by Grant’s following his return to the army during the Civil War, although rumors were plentiful. When given reports of supposed excessive drinking on Grant’s part, Lincoln is reported to have said “Find out what whiskey he drinks and send a case to all of my generals”.

Grant smoked up to 20 cigars a day and admirers from all over the country mailed him boxes of cigars. He eventually died of cancer of the throat and tongue.

The poet Walt Whitman worked as a volunteer in union hospitals.

Lew Wallace, author of Ben Hur, was a general in the Union Army. By most reports he was a better author than general.

The last verified Civil War veteran died in 1956. He was Albert Woolson who served in the Union Army as a drummer boy. There were three men who claimed to be Confederate veterans who lived longer than Woolson; however, one of those has been completely debunked and no confirmation of service of the other two has ever been found.