Introduction
The development of medicine and medical care during the American civil war were significant due to its watershed impact on social and military evolution. The Civil War was the bloodiest war in the history of America, and had the war that had the most impact in the field of medicine. Civil war medical care providers such as surgeons had to learn fast and develop new techniques as the number of injured people were too high. The high number of the injured fighters included top officers and commanders in the military, which intensified and prompted the need for new developments. However, these developments have not been fully appreciated in the modern medical field probably due to the quality of modern medical as compared to the standards of the time.
The carnage caused by the Civil war during the world war forced the medical practitioners to develop new advances, which could have taken more than 25 years to develop if the war was not fought. The origin of numerous emergency medicine traces its origin in the battlefield of the civil war. It is approximated that more than six hundred thousand fighters were killed in the war, which could have been millions of people were it, not for the medical developments. The war experienced fighting with more advanced weaponry such as grooved barrels, which improved the firing power and precision of rifles and cannons. This prompted the medical field to explore new developments as the number of casualties of war increased. This paper seeks to explore the developments in the field of medicine, as a result, intensified fighting during the bloodiest war in the American history, the Civil war.
The development of more complex weaponry increased the number of casualties of war as small firearms wounding soldiers were more prevalent than the large, which could kill the attacked people. When the war began, the physicians had little knowledge of the cause, infections and prevention of diseases. Additionally, the medical practitioners accompanying the army into the war were ill-prepared and inexperienced as the majority was only used in dealing with small scale issues affecting the army. They also had little idea of logistical issues and dealing with large scale medical issues. Therefore, early in the war disease was the largest killer as soldiers died from common illnesses such as dysentery, malaria, typhoid. These common illnesses were common and were referred to as “camp and campaign” resulting from overcrowding and poor sanitation.
The battlefield casualties were the second largest killer in the war, and there logistical issues as the overwhelming number of wounded soldiers had to be moved from the battlefield. There were no ambulance corps, which prompted the Union General George. B McClellan to authorize the creation of trained ambulance corps to solve the logistical issues. The risks involved when conducting surgeries were numerous since there were no antiseptic, which resulted in increased post operation infections and a high death rate. The war was characterized by high brutality, which increased the complication among the wounded soldiers. Amputating wounded legs and arms were the most prevalent operations due the ammunitions used in the war. For example, the 58 caliber Minie ball ammunition with a conical shaped bullet distorted on its impact resulting in large gaping wounds characterized by shattered bones. Therefore, due to the large number of soldiers suffering from the attack surgeons conducted fast and easy amputation rather than attempts of removing the bullet to save the limb.
Accumulation of Patient’s Records and Data
The specific contributions and major accomplishments of the civil war in the field of medicine can be described as follows. For the first time in the field of medicine, practitioners were able to develop detailed and adequate accumulation of records and medical reports of the patient’s history. Although there were complex organizational challenges in the handling of the records, it marked a new practice in the field of medicine where the practitioners were able to understand the medical history of a patient. The practitioners developed a complex and extensive record keeping system, which handled massive data and accumulated records. The data kept in the record included transportation orders, quartermaster records as items that could provide insights into the lives of the soldiers. These items in the records, not only provided insights about the lives of the soldiers, but also an illustration of the sacrifices from all facets of the society and the costs of the war.
The accumulation of detailed reports and records was adopted for the first time enabling the compilation of a comprehensive military record. This practice facilitated the publication of the Medical and Surgical History of the War of Rebellion. This was identified in Europe as the most profound accomplishment, in the field of medicine, in the US. Although the initial practice of record keeping was characterized with complex systems, which hampered easy retrieval of information and data about patients, the practice has been modernized. The majority of the people does not appreciate the fact that practice of record keeping originated during the civil war. The practice is essential as it provides a detailed record and patient history, which is essential to the doctor's decision making. For example, it formed the basis whether the surgeons could amputate a wounded soldier or remove the stalled bullet. During the initial period when the war started, there were no medical records of the soldiers, and if a soldier was shot, the only option was amputation. The system of management of massive wounded soldiers was adopted during the world wars and also in the Korean war.
The Development of System for Managing Massive Casualties
When the battle started, and the Union went into the first battle referred to as the battle of Bull Run in mid 1861, they expected a small skirmish, but the rebels were ready for a war. Therefore, the medical practitioners were ill prepared about the magnitude of the problems and casualties that would arise from the war. This led to a high number of death rate as wounded soldiers lay for long hours without being tended. This caused the union soldier to retreat to Washington as the majority of the civilian drivers were cowards, untrained and low character. Jonathan Letterman who was the medical director of the army of the Potomac developed and implemented a brilliant system, which led to the evacuation and treatment of wounded soldiers in six weeks. The system is the basic model for the commonly known ambulance-to-ER system adopted in the modern medical care.
As the war intensified, the casualties equivalently increased. For example, the Battle of Antietam in 1862, left more than two thousand union soldiers dead injuring more than ten thousand. In response to the gross medical needs of the wounded soldiers and logistical needs of moving wounded soldiers, Letterman established caravans of fifty ambulances with trained drivers and two stretcher bearers. The facilitated the evacuation of wounded soldiers to hospitals where they received treatment. Additionally, the army also hired private wagons, which would carry medical supplies and circumvent the challenges of the enemy damaging the rails. He also introduced spring suspensions and added lock boxes under the driver’s seat for carriage of proteins, bed sacks and morphine, which were reserved for the wounded soldiers.
Changes in the Sanitation and Treatment
It is not disputable that, at the beginning of the war, the leading cause of death was preventable diseases such as typhoid, malaria, dysentery, diarrhea among others. This resulted from issues of overcrowding and poor ventilation in most facilities where the soldiers received medical care. As a result, there was a dire need of introducing new methods of dealing with the disease menace, which was eating the soldier’s population at an alarming rate. The start of the war was marked by ill preparation since the Union was not prepared for a real war. Therefore, as new soldiers were deployed in the war, issues of poor sanitation were prevalent and led to an increased number of ailing soldiers. Therefore, when the northern soldiers started occupying southern cities they introduced new methods of sanitation. For example, when the Northern troops occupied New Orleans in 1862, he developed a refuse disposal system and employed the newly discovered malaria drug quinine. As a result, there was a significant reduction in the cases of malaria and yellow fever in New Orleans.
The inclusion of medical doctors in the army not only improved the sanitation, but also led to better medical logistics systems. For example, in 1863, they constructed a hospital with more than 400,000 bed capacity, with specialized facilities for rehabilitation and surgery. Additionally, they developed inspectorate systems and programs, which would facilitate the maintenance of standards of care. As a result, the mortality rate reduced by more than 10 percent. There were also modifications of trains and horse drawn ambulances, which facilitated the movement of patients. By 1863, they had constructed vessels with full operating rooms and isolation wards, which were staffed by nurses and nautical doctors. The pavilion like general hospitals with good ventilation and maintenance of clean acted as a model for hospitals constructed thereafter for a period of more than seventy five years.
Hospital Organization and Introduction of Female Nurses into Hospital Care
Hospital organization and personnel were one of the major medical advancement during the civil war. At the period when the war began in 1861, the organization of medical practitioners was haphazard and organized on need basis. The number of staff was too small, and some health soldiers had to be left behind to help their wounded counterparts. People volunteered to work as nurses irrespective of their medical skills and hospitals were established on unsanitary buildings or positions of convenient. However, as the war advanced and by the end of the war organization of the medical field had significantly changed. This was characterized by permanent staff in the hospitals, which led to the introduction of the nursing corps in 1862, headed by Dorothea Dix. This marked the introduction of professional nursing where female nurses were introduced.
The female nursing corps was created by the US sanitary Commission, which was established in 1861, owing to the rising of preventable disease outbreaks. The basis of the commission was the promotion of clean water virtues, fresh air and good food. The commission also put pressure on the army medical department to facilitate improvement in sanitation and building of large ventilated hospitals. Additionally, it encouraged women to enroll into the newly created nursing corps. This marked the introduction of female nurses in the medical field commonly practiced by men. However, it was approximated that more than five hundred thousand soldiers of diseases during the war. The devastations of the Civil War led to the development of new medical practices referred to as models and the foundation of modern medical care.
Renaissance of Surgery and the Civil War
Prior to the war, the medical practice remained dormant, and most of the doctors were rural family practitioners without a medical license and board certification. The majority of the medical doctors was trained for only one year without didactic learning and formal residence. Hospitals were considered nonentity and even surgeons disregarded medical studies and books terming them as unnecessary. Therefore, medical dogma was based on the teachings of antiquity and surgery was rarely attempted. They did not consider the germ theory and when prepared and went to base camp for did not adopt any vaccination or sanitations.
The carnage that led to the increase in the number of casualties prompted the medical doctors to initiate better and efficient surgical methods. As a result, surgeons reformed and devised new chain devices, as well as refining operating rooms, instruments and scalpels. As the war continued and wounded soldiers continued to increase, the medical practices also improved. For example, the surgeons had developed sub-specialties of surgeries such as plastic surgery, orthopedic surgeries, abdominal, ocular, thoracic and neurological surgeries. Prosthetic parts were also created, and blood transfusion also ubiquitous facilitating the rising surgical operations.
The period also marked the use of anesthesia during surgeries contrary to the popular media. It was used and documented in more than 80,000 surgeries, which enabled surgeons to compare the effectiveness of different types of anesthesia. Therefore, by the end of the war, surgeons had gained unprecedented knowledge and experience in medicine and surgery. There was a generation of different treatment options based on the wide knowledge and experience of medical practitioners. The end of the war marked a new medical care system based on knowledge and experience rather than dogma and teachings of antiquity.
In conclusion, the beginning of the civil war was marked by an unprepared medical care system guided by dogma and teachings of antiquity. The Union was not prepared for war and approached the enemies casually like in a normal skirmish. However, as the war intensified, the number of ailing and wounded soldiers and increased prompting for the development of new approaches to deal with the menace. As a result, by the end of the war, there were newly built hospitals, wartime innovations such as ambulances and hospital trains, which have continually been developed. Additionally, medical professionals appreciated and continued to develop wartime education, and most of the modern practices can trace their origin to such knowledge and practices.
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