Comparing Northern to Southern Medical Care
THE PREVIOUS CHAPTER REVIEWED THE BIOLOGIcal changes produced by the American Civil War. This chapter analyzes the human efforts to counter these biological effects and evaluates the overall effectiveness of the medical departments of the Union and the Confederate armies.
A major function of the medical department involved the treatment of those soldiers wounded on the battlefield. Many soldiers bled to death before they could be evacuated; they never came under the control of the medical department and were classified as killed in battle. A few wounded patients died of hemorrhage days to weeks after wounding; their infected wounds slowly ate away surrounding tissue, including blood vessels. The majority of individuals who died from wounds, however, did not perish because of bleeding, but developed a direct infectious complication. Erysipelas or hospital gangrene worsened until it became pyemia and the patient, febrile, delirious, and prostrate, died.
Civil War era physicians knew that something, some “morbific principle,” could spread from one wound to another. It is amazing how close some of them came to the basic principles of bacteriology. For example, Edmund Andrews, a graduate of the University of Michigan, surgeon of the 1st Illinois Light Artillery, submitted an official report on hospital gangrene. He recommended that “no probes or other instruments which have been used in a case of this disease should ever be used on another patient, until they have been thoroughly cleaned by washing, and then dipped in boiling water.” He further argued that no doctor should use a sponge on two different wounds.1 As related in chapter 12, the Union physicians at Decamp General Hospital on David's Island in New York harbor were able to stop an epidemic of hospital gangrene by restricting the use of sponges, one for each patient.
In his surgical manual, John H. Packard included a chapter entitled “Disinfectants.” He argued that certain diseases, such as gangrene and dysentery, travel from person to person by infective particles that he called fomites. Heat could stop this transmission; Packard recommended that clothing and bedding should be heated or boiled in water before reuse. Wound-to-wound transmission could be stopped by painting certain chemicals upon either wound.2 During the War, several different chemicals were recommended to stop the progression of hospital gangrene; the surgeon of the 11th Iowa had great success with iodine.3 Many people still place iodine on a fresh abrasion today.4
To intercept the fomite or morbific principle that traveled from a sick person to a healthy one, medical authorities devoted most of their energy to the concept of ventilation. They hoped that the agent that transmitted the infection would be blown out the window. This desire for good ventilation in hospitals became a medical fetish. Hammond's directive of 24 November 1862 required twelve hundred cubic feet of space per hospital bed.5 The special committee on military hygiene of the American Medical Association calculated that a hospital ward with fifty patients needed 1.175 million cubic feet of air each twenty-four