Civil War and medicine

Civil War and medicineThis is a term paper for a history of medicine course. The paper should be 18 pages long in AMA style, with a minimum of 5 sources – books, journals, websites (books preferred). AMA is an American Medical Association citing style. Number references in order they appear in the text; not alphabetized.

In text, identify references with superscript arabic numerals and page numbers.I chose to write about the Civil War and its contributions to medicine. The idea is that although war is a terrible thing, it is this stress that is often the driving force for much research and technological advancements in the field of medicine. This can include surgical, pharmaceutical, etc developments that were made to deal with the diseases and injuries that arose as a result of the war or prior to the war.

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It can also include a history of the medical aspect of the Civil War in general such as the issue of sanitation, diet and how it was dealt with. A good website I found about the development of the medical field during the war is here

htm1.War, medicine and modernity / edited by Roger Cooter, Mark Harrison and Steve Sturdy.2.

Bleeding blue and gray : Civil War surgery and the evolution of American medicine / Ira M. Rutkow. AUTHOR Rutkow, Ira M.3.AUTHOR Wilbur, C. Keith, 1923- TITLE Civil War medicine, 1861-1865 / by C. Keith Wilbur.4.

AUTHOR Denney, Robert E. TITLE Civil War medicine : care & comfort of the wounded / Robert E. Denney.

5. AUTHOR Flannery, Michael A., 1953- TITLE Civil War pharmacy : a history of drugs, drug supply andprovision, and therapeutics for the Union and Confederacy / Michael A.

Flannery.6. AUTHOR Freemon, Frank R., 1938-TITLE Gangrene and glory : medical care during the American Civil War / Frank R. Freemon.7.

TITLE In hospital and camp : the Civil War through the eyes of its doctors and nurses / compiled by Harold Elk Straubing.8. AUTHOR Welsh, Jack D., 1928- TITLE Medical histories of Union generals / by Jack D. Welsh.

            During the American Civil War, medicine was still in its infancy stages.  The war had begun only when a bit was known about the way in which germs cause disease.  However, antibiotic were still not discovered, which could be utilized to treat infectious.  The persons who provided medical care were under-qualified and inexperienced.  Frequently, medical care was provided to society by quacks that did not treat disease but instead offered immediate disappearance of the symptoms through some magical means or consuming certain secret agents.  They did not even know that good sanitation and hygiene was required to prevent diseases.  Although, many soldiers died of injuries, the number one killer in the War was disease.  This was a really not anticipated before the war could start.

  The war actually began over a small conflict and was supposed to last only for a short period.  However, due to several factors, it went for several years, and left thousands of men dead, wounded and disabled.  The casualties suffered were almost equal on both sides (Bollet, AJ, 2002).  The Northern Army which had more men suffered more losses than the Southern Army.  Some of the causes for the large number of diseases includes:-1.      low number of physicians2.

      ignorance on the part of the army personnel3.      many of the army personnel were illiterate4.      the army personnel did not know the importance of hygiene5.

      the food and water supply was very poor6.      the army personnel did not even have proper clothing7.      the presence of insects in the campsDuring the war, soldiers originating from rural areas were mixed with those belonging to urban areas.  Thus diseases and infections also spread.

  The men in the army had a very poor sense of personal hygiene.  They often did not maintain hygiene at the camps and hence disease spread.  Poor hygiene not only acted as a breeding ground for germs but also worsened the outcome of several other conditions.

  The diet consumed by the army personnel mainly consisted of proteins and calories but very poor amounts of minerals and vitamins.  Thus the soldiers were likely to suffer from nutritional diseases (Bollet, AJ, 2002).During the ancient times, the role of military surgeons was recorded.  However, their role became more important when firearms and gun powder was introduced into warfare.  Special treaties with the opponents and setting up of hospitals were taken up in order to improve the art and practice of military surgery.

  Heinrich von Pfolspeundt (1460) a soldier belonging to the Bavarian army was the first to give a clear description of gunshots injuries and the way in which it was handled.  His book was only published in the 19th century, and by that time, much was known about gunshot wounds.  Hieronmyous Brunschwig was the first to release a noteworthy book known as the Book of Wound Surgery related to treatment of wound that occurred during war (1497).  Brunschwig felt that following gunshot wounds, the individual had high chances of sustaining ill-effects from the gunpowder utilized in the war weapons and hence suggested use a seton (device that contains a silk thread to remove the gun powder).  During the 18th century there were a few advancements in the field of medicine.  In the late portion of the 18th century a Belgian astronomer by name LAJ Quetelet demonstrated the importance of vital statistics.  However, vital statistics were usually not available for the common man, but the army and Navy personnel had a detailed mention of the vital statistics, and record of health and disease status.

  This actually meant the introduction of preventive medicine.  Several countries including Great Britain and United States were maintaining detailed records of their soldiers (Singer C., 1962).  In the 16th century Hans von Gerdorrff wrote a book by name Field Book of Wound Surgery.  He suggested use of warm water, oil and use of skin and muscle flap to close amputation wounds.  Giovanni da Vigo published his book A Compendious practice of the art of surgery in 1514 to suggest methods of cauterizing wounds using chemicals and hot water.

  During the American Civil War period, Silas Wier Mitchell wrote a book on gun-shot wounds that affected nerves.  He worked in the American Army as a neurologist.  He was one of the greatest American neurologists during that time, and was known for his publications in clinical trials.  Mitchell has worked in associations Williams Williams Keen.  William Williams Keen was known had developed a system of treating nerve disorders (Singer C., 1962).The number of medical personnel who served during the American civil war was very less suggesting that the medical system prevailing during that time was just beginning to develop.

  The surgery team of the Northerners consisted of the Surgeon General, about 30 surgeons and 83 assistants.  About 27 personnel team were dropped out (some joined the Southerners), which was left with just about 87.  Many soldiers acted as assistants, and many individuals were taken on a contract basis.  These individuals were usually had to work in make-shift hospitals and not on the military front.  Later during the Civil war, each state had a surgeon and an assistant surgeon (Adams GW, 2004).   Dr.  Moore of the Southern Army made the first attempts to improve the quality of surgeons during the war times by ensuring that the recruited surgeons pass an examination board.  He also improved the standards of care in the hospital.

  At that time, the Congress and the President understood the ideas of Dr. Moore and ensured that hospitals were created.  Dr. Moore was very instrumental in ensuring that the healthcare system prevailing at that time was further improved.  He was working as a military surgeon in the US Army, but left his post and joined the Southerners as a Surgeon-General.  He was very instrumental in changing the status of medical care delivery system in the Army by bringing about a revolution in the system.

  He was responsible for designing hospitals which was utilized for several decades later.  He ensured that hospitals provide care for at least 80 to 100 people at one time.  He wanted hospitals to have adequate ventilation.  He ensured that Medical and Surgical Journals were written to distribute medical knowledge.

  Though his efforts, he was able to save thousands of lives during the War.  He set up manufacturing units for several drugs and medicines, and in cases where a shortage still existed; he imported them from other areas of the world such as Europe (Purcell PN, 1992).  Clement Finley joined the Union army as a Surgeon General replacing General Thomas Lawson.  He began to further expand the army.

  When the War began several humanitarian organizations offered to help to treat the soldiers.  The Government wanted to create a Sanitary Commission and elected Henry Bellows as the President and Frederick Olmsted and the Executive Secretary.  The Commission helped in advising and assisting the defense department during the war period.

  Initially, about 12 members were present in the Sanitary Commission and it soon expanded to include the other parts of the US.  During the war the womenfolk made dressings, medicines and cooked packed food for the soldiers.  Even medical education prevailed during the war.  Doctors wrote articles and pamphlets about disease thus trying to create awareness (Adams GW, 2004).

During the Civil war one in every four men had lost their lives.  They were usually provided care by people who were not qualified, not experienced and who had not used proper techniques, medicines and equipment.  However, the civil war helped the US to build a proper a medical care system.  Techniques of providing medical care were improved.

  Hospitals that were actually non-existent in the US before the War, slowly began to be constructed.  A basic idea of providing medical care and improving the outcome of several conditions was also obtained.  Before the War, Europe had a better system of medical education compared to the US.

  Medical students trained for 4 years in Europe, but in the US it was only 2 years.  Students in Europe received good clinical and laboratory exposure, but in the US such exposure was minimal.  Many medical personnel found it very difficult to handle cases during the war because of limited education.  Some of the major universities that imparted medical education during the war period did not even have basic medical equipment.  About 98 medical officers were present in the Federal army and 24 were appointed in the Confederacy army.  About 13, 000 served in the Federal Army and about 4, 000 doctors served in the Confederacy Army in various hospitals.  More than 10 million cases were treated by doctors and surgeons within a 2 year period.

  In total about 600, 000 men (360, 000 from the North and 260, 000 from the South) lost their lives during the American Civil War.  About 110, 000 from the North and 94, 000 from the South lost their lives due to injuries sustained at the battlefield (Civil War Home, 2002).The Southern Army was slightly backwards compared to the Northern Army.  They did not arrange for a Sanitary Commission and the doctors did not have a system in place to ask for their logistics of medicines. The camps were not maintained hygienically.  During the war many soldiers complained of diarrhea.

  In fact about 50 % of all mortalities arose from diarrhea, intestinal diseases and dysentery (Civil War Home, 2002).  More than 50, 000 soldiers lost their lives as a result of gastro-intestinal diseases during the war.  In fact every soldier developed some form of diarrhea during their service in the army during the Civil War period.  The main cause for this was that a proper toilet containing of a sink was not maintained, and the fecal matter often contaminated food.  The camps where soldiers stayed were not kept clean.  Manure, garbage, decomposing substances, dust, even human refuse, etc, was present, which was a haven for bacteria and viruses to multiply.  The soldiers developed diarrhea, and the doctors considered that this usually occurred as a result of consuming poorly cooked food.

  An astringent was usually prescribed to help the soldiers cope up with the symptoms.  Although most soldiers had symptoms of diarrhea or dysentery, some soldiers had symptoms of tuberculosis or malaria, whereas some from the south developed amoebic or bacillic dysentery.  This was mainly spread from the slaves.

  (Adams GW, 2004).  Some of the soldiers even died from pneumonia (which was the third largest killer after diarrheal diseases and typhoid) and tuberculosis.  Several other illnesses such as chicken pox, mumps, measles, whooping cough, small pox, etc, were also occurring as outbreaks in the army camps, causing fever and illness.  These diseases were not prevented because at that time no vaccine was available.  In the Southern troops, typhoid was a great problem, as it spread through the consumption of contaminated water and food.

  Malaria mainly spread through the anopheles mosquito from swamps and stagnant water.  About 25 % of all soldiers were in fact infected with malaria at some point during their service in the army.  To some extent malaria was controllable due to the presence of quinine (Civil War Home, 2002).The soldiers consumed diet rich in energy only but low in vitamins.  They were given fresh or preserved beef, salted pork, military crackers, etc.

  Frequently, the food was stale and infested with insects.  The health of many soldiers deteriorated because of the food prepared during the war.  They were not given a nutritionally balanced diet (Adams GW, 2004).

During the war, several makeshift hospitals were made, where the wounded and the sick were admitted.  The hospitals were usually located at a mile away from the frontline.  Schools, churches, houses and barns were utilized as makeshift hospitals.

  A hospital could be recognized by a yellow flag with H written in green (Goellnitz, J, 2002).  The most common wound that were fatal, were those that originated from the Minnie ball or the Enfield ball.  When the ball struck the head, chest or abdomen, it was most likely that the soldier would die or would live for a very short time.  The conical ball when struck the abdomen almost always had a fatal outcome.  The individual had high chances of perforating the intestines.  Rarely, the ball did not strike the intestines and were rather pushed towards one side.

  The ball also created a large entry and exist wound in the chest (Roberts, DJ, 2002).  When it stuck a limb, there was a chance that the bone would get broken off, frequently requiring amputations.  More than 175, 000 injuries to the limbs were reported during the Civil war, out of which more than 30, 000 amputations were performed (Civil War Home, 2002).   The Minnie balls carried a very low velocity and produced shattering, comminution and significant bone destruction.  Many surgeons at that time were so scared on looking at the appearance of the injury, that they felt the most beneficial form of treatment would be to amputee the injured limb.  Some surgeons who had good experience in treating fractures, reduced the disjoint bones in such a way that healing could be enabled and the soldier could get back to normal within a short period of time.  Usually, amputation of the upper limbs had a better outcome than amputation of the lower limbs, as the blood and nerve supply was better in the upper limb.  The Surgeons of the South frequently practiced saving the limb by doing only conservative surgery.

  However, many soldiers had lost their lives, as the chances of complications and serious infection developing was very high (Roberts, DJ, 2002).  The people who were less sick were admitted with those who were severely help, to help them in getting well and assisting the doctors.  This practice of combining the seriously ill without the chances of survival with those who were only mildly ill is even practice today in several of the military regiments.  Dressing stations were frequently established at the forefront.  During a war, the assistant surgeon and a few soldiers would move towards the frontline line to maintain a dressing station.  They carried bandages, morphine, opium, whisky, and brandy.  Small dressing stations were formed from where the wounded soldiers were moved to be treated.

  When the soldiers received a wound, they were given alcohol (to prevent shock) or an opium pill (to reduce the severe pain).  Morphine powder was frequently applied over the lesion.  Lint was applied and a bandage was placed.  Some soldiers had to then move by walk to the nearby hospital for further treatment.  During this period, the surgeons felt that some of the drugs when injected could provide a much faster and better effect.  From this the use of the syringe arose.

  The subcutaneous method of injection was founded by Rynd in 1845, but his technique was still not utilized widely (Cumston CG, 1926).  Some of those soldiers who were severely ill, had to go to the hospital by ambulances (Adams GW, 2004).The early ambulances utilized were rather inconvenient and unreliable.  They were basically two-wheeled carts or four-wheeled wagons (Civil War Home, 2002).

  Initially during the war, some of the states utilized spring vehicles as ambulances.  However, due to the bad condition of the roads, and excessive usage, they were replaced with mule-drawn wagons.  The name of the regiment along with the division was painted on the side of the vehicle.  Each surgeon was given a chest containing medicines, surgical instruments and amputation instruments.  They were also given certain amount of rations (Roberts, DJ, 2002).

  Usually, the hospitals were located more than five miles from the frontline.  The soldiers were left in a queue to be operated.  Before the operation, they were given opiates and liquor to help reduce the pain during the surgery.  Usually chloroform was utilized, and ether was avoided, as it was explosive.  An ample of chloroform was given to the patient before he was treated for amputation.  Chloroform was utilized as an anesthetic agent in about 75 % of all cases.  The lower incidences of side-effects attributed to the use of chloroform was remarkable.

  Out of the 9000 cases in which chloroform was used as an anesthetic, only about 43 soldiers died (0.4 %).  Usually, the anesthesia was administered by the open-drop method and given in doses lower than that of normal.  It was applied on a cloth and this was held near the patient’s nose.  After sometime the patient became unconscious, and then the surgeon continued to work on the patient (Goellnitz, J., 2002).  The surgeons and the assistant-surgeons worked one by one on these soldiers in suturing wounds and amputing severely damaged limbs (Adams GW, 2004).

  The tables that were utilized were about chest high (Civil War Home, 2004).  It took about 10 minutes for the surgeons to complete an amputation with the process of sawing and cutting.  They also applied ligatures to the severely bleeding arteries.  Usually, those who received wounds on their limbs were treated first as they had a better chance of survival.

  They were usually treated for amputating the affected limb.  Following the surgery, there were chances that infection of the wound may occur, and sepsis may develop (Civil War Home, 2004).  The surgeons worked throughout the night and usually did not wash their hands or instruments after each case due to the lack of water (Goellnitz, J., 2002).  Those individuals who had received very slight injuries, or those who had received injuries to their head, neck face, chest and abdomen were delayed.  Injuries to the head, neck, chest, etc were delayed in treatment as they had a very poor chance of survival.

  Supportive treatment was maintained by giving them doses of alcohol and opium to reduce the effects of the wound.  Some hospitals were also forms of hospices to help the severely injured to die with a lower amount of sufferings.  At that time, the principles of sterilization, disinfection and asepsis were usually not followed properly.  Surgeon worked in an environment having germs present.  The surgeons understood that germs could infect the wounds and worsen the outcome (Adams GW, 2004).  They were aware that wounds once infected had a poorer prognosis.  They even understood that cleaning the instruments could reduce the germs levels and improve the outcome of the disease.

  They simple cleansed and reused the instruments.  They did not known how the instruments could be sterilized or disinfected.  Some surgeons did not was their hands and other parts of the body during the surgery, and passed on infections from one individual to another (Civil War Home, 2004).  Most wounds contained pus due to the transmission of infection.  Only in rare cases, the wound healed without pus formation, and the surgeons considered to be healing with primary intention.  Usually all soldiers with wounds, developed a very high fever after a few days due to sepsis, and later died.  Sepsis often claimed the life of 40 % soldiers who developed severe injuries.

  These fevers were known as ‘Surgical fevers’ and were caused by Staphylococcus aureus and Streptococcus pyogenes.  The bacteria, entered through the wound, multiplied, entered into the blood, released toxic substances, and spread to various parts of the body.  In the wounds, they destroyed tissues causing gangrene.  About one out of every four soldiers who were amputated suffered from infection of the wound (Civil War Home, 2004).  Soon the surgeons and the health officials began to release the importance of maintaining an aseptic environment during wound management.  Iodine, carbolic acid, alcohol, mercury compounds and sodium hypochlorite were frequently utilized to dress wounds (Adams GW, 2004).

Many soldiers during the War considered that bullets and missiles to be the biggest killer.  However, this was not true, and rather disease and infection was the biggest killer.  Three out of every five soldiers in the Northern Army, and two out of every three soldiers in the Southern Army died of diseases.  Many of those who joined the army during the Civil War period were either too young or too old to handle the difficulties in war.  The army recruited men between the ages of 18 to 45 years.  They even considered recruiting men who were incapable of fighting the war.  Such men usually fell ill during the war, and had not survived (Civil War Home, 2004).

Slowly the quality of care provided in the hospitals began to improve.  Hospitals at various levels in division, corps and brigade, began to be set up according to their size.  The Letterman Ambulance plan was also setup which was a more organized way of transferring injured men.  The team consisted of a sergeant, stretcher bearers and a driver.  In areas where the war was fought near river banks, boats were utilized to transfer the injured soldiers.  In some areas, rail cars were utilized to transfer the injured patients from the field hospitals to the general hospitals.  They used freight cars more often than passenger cars.  The first hospital train was set up running from Chattanooga to Louisville following the Chattanooga Battle.

  The train had several amenities such as a food pantry and a supply store.  Many of the military commanders were afraid that once the injured soldieries were released, they would not return to the battlefield.  The concern was even greater in the South, as they had fewer men compared to the North (Adams GW, 2004).In 1862, Edwin A. Stanton, realized that certain amount of development was required in the army to help the soldiers with medical care.  Medical inspectors were being recruited on a merit basis, and churches, schools and hotels were converted into makeshift hospitals.  Hammond, a Professor at the University Of Maryland Medical School wrote a book on military hygiene by name The Hospital’s Stewarts Manual (Adams GW, 2004).

During the initially stages of the war, male soldiers also worked as nurses, providing care to their injured counterparts.  The work of Florence Nightingale during the Crimean War was widely noted, and Dorothea Dix who brought about reforms in jails and mental hospitals, was appointed as a Superintendent of a corps of female nurses.  Florence Nightingale was closely associated with the Sanitary Commission.  She was associated with Nursing since 1844.  She received some training in Kaiserswerth for about 3 months.

  She was appointed a Superintendent of a women’s unit in the Hospital in 1853.  She was more interested in training nurses.  She soon became the Superintendent at the King’s College Hospital of Nursing.  The outbreak of the Crimean war prevented her from further working as a Superintendent and instead she was more interested in serving the soldier and the wounded (in 1854).  The Situation existing in the British military hospitals were similar to that existing during the American Civil War.  The British did not use women to serve as nurses, whereas, the French nurses served as nurses.  Florence Nightingale was appointed by the Secretary of war to take care of nursing of the wounded British soldiers during the War, and she personally selected her team consisting 38 nurses belonging to various religious orders.

  By the end of the war, about 128 nurses were serving under the Florence Nightingale cadre.  She ensured that the soldiers received personal care during their stay in the hospital.  This helped to hasten the recover of soldiers.

  She was known for monitoring the hospital beds frequently even during the night, and hence she was known as the “Lady with the Lamp” (Singer C., 1962).  Dorothea Dix derived a lot of motivation from Florence Nightingale and she tried to produce similar kind of results through her work.

  However, the nurses were not liked by most of the surgeons as they frequently tried to command them.  Many of the surgeons even send back a few nurses.  However, Dorothea Dix sent replacements for these nurses, as per the army rules.  The nurses did not receive any formal training, but were very much liked by the patients.  The nurses cared and nursed the patients.  The condition of many soldiers improved dramatically following proper nursing care.

  Nuns belonging to various groups including the Sisters of Charity helped to bred discipline and care in nursing.  Many women’s groups helped to improve sanitation and the quality of food in the hospitals.  Clara Barton and Mary Ann Bickerdyke also functioned in improving the care of soldiers during the war.

  However, the South was not using women much in their military hospitals.  Black women were being utilized as cooks and washerwomen.  The Richmond hospital was one of the only hospitals in the South to have women appointed as nurses.  (Adams GW, 2004).

In the US, during the 19th century most of the drugs were imported from other countries especially the European Countries.  When the War began, the North was able to continue procuring the drugs from the European nations, but the Southerners were able to do so because of the Union blockade.  They were forced to perform several acts such as smuggling, capturing enemy logistics, and using herbal and local remedies.  Pharmacists and the physicians (purveyors) purchased the medical logistics from the suppliers.

  Both the sides also began manufacturing laboratories that bought raw materials, manufactured new drugs and packaged the medicines for use in the Army.  The Southerners frequently utilized locally available material to manufacture the drugs due to the trade blockade.  Pharmacists frequently received, stocked and dispensed medical logistics to the army as per their requirements.  Several temporary staff were appointed as hospital Stewarts to help dispense the drugs administered by the physicians in the military.  Some of these Stewarts were physicians or pharmacists, and others were just ordinary men with no previous training or experience.

  Most of process involving the drugs had the pharmacists involved (Hasegawa GR, 2000).During the war people who knew about plants and the use of their extracts were also in demand.  Quinine was required in large quantities by the military to treat malaria.

  Malaria was a big problem in the army camps.  The red-oak bark extract was frequently utilized in wounds to reduce sepsis and encourage faster wound healing.  The elm and wahoo root bark was utilized as an emollient.  Poppy seeds, stramonium and nightshade was utilized for its analgesic properties.  Boneset tea was used to treat individuals who had intermittent vomiting.  Some soldiers who were allergic to quinine were given tea of the butterfly root extract or pleurisy root extract to treat malaria.  It helped to reduce the course of the febrile stage.

  Mandrake tea, Virginia snake-root and yellow root were also used to treat fevers.  Stramonium leaves, mustard seeds, pepper and hickory leaves were applied for pneumonia and pleurisy.  A mixture containing raspberry leaves or whortleberry leaves were utilized to treat cases of diarrhea.  Peach leaves were utilized to treat cases of nausea and vomiting.  The roots of blackberry were also utilized to treat diarrhea.

  Sweet gum, mutton suet, balsam cucumber and balm of Gilead were utilized in cuts and sores.  The bark of the China berry plant was utilized as a de-worming agent.  The Blackberry syrup was used as a vehicle for carrying many medicines.  Individuals who were suffering from hemorrhages and diarrhea were given the extract of cocklebur (Va, R, 1905). Scurvy was treated by administering green vegetables for the soldiers.  Loose bowels were treated by administering an opium plug.  Opium, quinine and muster plasters were utilized to treat pneumonia and bronchitis.  Alcohols were often applied to wounds to remove any germs that could be causing infection (Goellnitz J, 2002).

  The Southerners were using the herbal and local remedies more frequently, as they found it difficult to import the regularly administered medications (Goellnitz J, 2002).Chimborazo was one of the largest hospitals in the US, serving about 8000 soldiers at a time.  The hospital also had very big kitchens and dinning rooms.  The hospital itself had a farm and a poultry house.

  The Jackson Hospital housed about 6000 patients at a time.  In the year 1864, about 154 hospitals were existent in the US, which were mostly located near the Atlantic Coast.  During the mid-war period, the US had about 589 good hospitals and about 300 hospitals offered poor services (Commager HS, 2002).  In 1861, Washington had about 2000 hospital beds.  In the year 1862, more than 50, 000 patients were treated in the City of Washington itself.  About 16 hospitals were present in Washington by the year 1864.  In the Western portion of the US, the Jefferson Hospital at Jeffersonville was one of the best.  It housed about 2000 patients in 1863-64, later expanded to 2600 and by the end of the war it housed about 5000 patients.

  By the end of the war (1865) there are about 204 hospitals in the US that could house more than 130, 000 patients at a time.  However, most of these hospitals began to close down during the post-war period.  The hospital staff members who served during the war period were left unemployed.  During the Civil war about 600, 000 men lost their lives and many more were left permanently disabled (Adams GW, 2004).In one of the Hospitals at Andersonville, Georgia, about 17, 000 patients were admitted in the hospital in 1864, out of which 458 were for wounds, 7000 were for diarrheal diseases and 5000 were for Scurvy.  THE percentage of fatal cases was high for diarrheal and dysenteric diseases (Civil War Home, 2006).

   Although, the standards of medical care were poor during the US Civil War, attempts were made both by the Northerners and the Southerners to improve the level of medical care.  We may not appreciate the level of care provided during the Civil war period, as we would consider it very poor when compared to the standards existing nowadays (Blaisdell FW, 1988).  The improvements of medical care have been gradual over the centuries.  However, during the Civil War the development made was very drastic, such that the medical personnel were desperate to find an immediate solution to several medical problems in order to save lives and improve the outcome of disease or injuries.  Their efforts in fact were later used as a baseline to develop an effective healthcare system in the US.  Many thousands of lives were lost during the US Civil War due to disease, injuries and infection.

  The medical personnel of both sides made an attempt to provide at least a rudimentary medical care and improve the survival rates to a very slight extent for several injuries and diseases.  During the war, several innovations were developed which are still being utilized in medicine today.  The standards of medical care provided during the American Civil were although not up to the mark, as much better standards were provided in several of the European Wars.  Many other wars following the Civil War tried to adopt some of the principles employed to improve the outcome of injuries and diseases.  The Civil War was a real eye opener to the US Government of the potential hazards medical problems could pose.  Before the War, the Harvard Medical School did have a stethoscope or a microscope.  The medical recording process was improved during the Civil war, and this kind of data recording was utilized for civilians later (Bollet AJ, 2002).  The Civil War was a lesson to be learnt for the new candidates aspiring roles of physicians in the future.

  This helped to improve the standards of care prevailing.  Several new concepts such as preventive techniques, management of infectious diseases, use of anesthetic agents, surgical management, etc was introduced (Blaisdell FW, 1988).  A complete process of recording the history and managing the case was brought about during the Civil War which was later developed further and is still being utilized nowadays.  A Book was later published known as The Medical and Surgical History of the War of the Rebellion which was well-known in Europe.

  The Europeans soon began to look into the American system for providing medical information.  Some of the areas where an improvement was made in the medical systems following the Civil War include development of antibiotics, ambulances corps development, sterilization and disinfection, improving cleanliness and hygiene in the hospitals, wound management, disaster management, improving nursing care and development of the nursing corps, surgery techniques, anesthesia administration, arrangement of a hospital system, organizing military hospitals, etc.  The War helped to build and identify a system by which all causalities could be transported immediately to the hospital for emergency management.

  Several units such as the aid stations, field hospitals and general hospitals formed a circle which helps provide emergency medical care to the patients.  This system was later used in the World Wars and the Korean War.  A new architectural system for construction of hospitals was identified in the Civil War.  Hospitals which were earlier small and located in unhygienic areas were now large, and having a good ventilation system with big windows (Blaisdell FW, 1988).  The hygiene and the cleanliness in the hospitals were improved.

  Such a design for hospitals which was followed during the Civil War period was used over the next 75 years (Blaisdell FW, 1988).  Surgeons who were routinely performing amputations developed new techniques and processes in order to improve the outcomes of the surgery.  The hospitals performing amputations became more efficient in the surgery.  They usually ensured that the amputation was preformed during the first 24 hours following the injury in order to improve the outcome of the condition (Blaisdell FW, 1988).  The medical faculty also began to understand the importance of hygiene, cleanliness, disinfection and sterilization in improving the outcome of several conditions.

  The Church also began to realize of the role it could play during wars.  Several of the nursing orders that played a role during the Civil War were based from Catholic Organizations.  Following the civil war, nursing care was improved in the US.  The sanitary Commission which was formed during the Civil War enabled the public to help the soldiers.  This was the forerunner to the American Red Cross (Blaisdell FW, 1988).References:Bollet AJ.

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Samuel Preston Moore: Surgeon-General of the Confederacy. Am J Surg. 1992; 164(4):361-365.   http://www.ncbi. Civil War Society. – Civil War Home. Medical Care, Battle Wounds, and Disease Available at http://www.civilwarhome.

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