An Example of Civil War Medical Treatment

gem

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During the Civil War it wasn't understood what germs were or what role germs played in the transmission of disease. The role of germs wasn't understood till the 1880s and the first antibiotic penicillin, wasn't developed till the 1930s. At the time the "humoral theory" of medicine was prevalent with the belief that disease was caused by an imbalance in the bodies ' humours'. In this theory, humours existed as liquids within the body and were identified as blood, phlegm, black bile and yellow bile. Treating disease involved restoring the humoral balance. More aggressive ways of trying to restore the balance including things like having the body purged with laxatives and emetics, or the having the skin blistered or bloodletting.

Here is a case report of a soldier with pneumonia and the treatment rendered.

- https://www.essentialcivilwarcurriculum.com/civil-war-medicine.html


“A violent case in a dissipated subject. The patient stated that the day before he had a chill which was followed by fever and cough, with much pain in the side, so severe that he could scarcely breathe and did not sleep any during the night. He had violent cough with the characteristic rusty sputa [material brought up by coughing had the color of rust]; severe pain in the left side; great dyspnoea [difficulty breathing]; high fever; intense headache; pulse full, strong and frequent; skin hot and dry; face livid and anxious; respiration hurried; bowels constipated and urine scanty.

“1st day: Gave…mercurous chloride…and applied a blister over the seat of pain [an irritating substance placed on the skin caused a blister filled with fluid; the fluid thus produced was presumed to contain the noxious agent that caused the chest pain, drawing it out of the body]. 2d: Bowels well opened; the blister relieved the severe pain in the side; other symptoms unaltered. Gave brandy, eight ounces, morning, noon and night, with good nourishment. 3d: Very restless and sleepless during the night; symptoms unchanged. Gave twenty grains of sulphate of quinia [quinine, used here as a tonic, not for malaria], with half a grain of tartar emetic [antimony potassium tartrate, to induce vomiting], morning and evening; continued brandy and beef-tea. 4th: All the symptoms much improved; fever subsiding; pulse soft; skin moist; breathing easier; sputa mingled with less blood; secretion of urine copious. Diminished the quinia and tartar emetic by one-half; continued brandy and beef-tea. From this day complete convalescence was established and the patient soon recovered his strength—Surgeon Allen F. Peck, 1st N. M., Ft. Stanton, N.M., Dec. 31, 1862.”​
 
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“A violent case in a dissipated subject. The patient stated that the day before he had a chill which was followed by fever and cough, with much pain in the side, so severe that he could scarcely breathe and did not sleep any during the night. He had violent cough with the characteristic rusty sputa [material brought up by coughing had the color of rust]; severe pain in the left side; great dyspnoea [difficulty breathing]; high fever; intense headache; pulse full, strong and frequent; skin hot and dry; face livid and anxious; respiration hurried; bowels constipated and urine scanty."

Looking at the description of the soldier's symptoms a couple things are worth noting. The soldiers had acute onset 1 day duration symptoms of fever/chills and productive cough with rusty colored sputum. Already, this points to bronchitis or pneumonia. He also had symptoms of severe L sided chest pain, and dyspnea (shortness of breath) which indicate the infection was in the lung (pneumonia). The chest pain was caused by inflammation from the pneumonia , typically worse with deep breathing , and the medical term for that was pleurisy (term still used today). The shortness of breath was likely due to low oxygen levels due to the pneumonia interfering with oxygen exchange in the lung.

The other symptoms high fever, fast pulse, fast breathing and scanty urine (dehydration) support that he was quite sick.

Today, if he had those symptoms he would be admitted to the hospital and started on IV antibiotics, IV fluids, supplemental oxygen etc.

 
Mercury is a heavy metal and is now known to be toxic. Back then, however the use of mercury was an accepted treatment for 5 conditions - dysentery , typhoid fever, malaria, syphilis, and pneumonia.

"1st day: Gave…mercurous chloride…"

This is a short video 1:30 about the use of mercury during the civil war.

 
Interestingly, one of the ways the campsites of the Lewis and Clark expedition have been located is by detecting mercury in the soil as the expedition took a large quantity of blue mercury-laden pills with them. Mercury being a metal it's still detectible.

I often wonder how our current medical treatments will be viewed in 100 years.
 
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"and applied a blister over the seat of pain [an irritating substance placed on the skin caused a blister filled with fluid; the fluid thus produced was presumed to contain the noxious agent that caused the chest pain, drawing it out of the body]. 2d: Bowels well opened; the blister relieved the severe pain in the side; other symptoms unaltered. Gave brandy, eight ounces, morning, noon and night, with good nourishment. 3d: Very restless and sleepless during the night; symptoms unchanged. Gave twenty grains of sulphate of quinia [quinine, used here as a tonic, not for malaria], with half a grain of tartar emetic [antimony potassium tartrate, to induce vomiting], morning and evening; continued brandy and beef-tea. 4th: All the symptoms much improved; fever subsiding; pulse soft; skin moist; breathing easier; sputa mingled with less blood; secretion of urine copious. Diminished the quinia and tartar emetic by one-half; continued brandy and beef-tea. From this day complete convalescence was established and the patient soon recovered his strength—Surgeon Allen F. Peck, 1st N. M., Ft. Stanton, N.M., Dec. 31, 1862.”

a couple of other things worth pointing out are the chest pain was treating by blistering. This involved applying a noxious substance over the area of pain with the idea of creating a blister which would then burst and allow the noxious substances (bad humours) to leave the body.

He also makes a mention of 'Bowels well opened' and cathartics were often administered due to the belief that evacuating the bowels would purge the body of bad humours. Along the same lines 'half a grain of tartar emetic' [antimony potassium tartrate, to induce vomiting] was given along the same lines to purge the system.

Thus we can see that the treatments rendered thus far were actually harmful. Toxic mercury, as well as causing blistering which results in pain and could be prone to infection, adminstration of cathartics and medications to induce vomiting would only further contribute dehydration.

"Gave brandy, eight ounces, morning, noon and night" alcohol was often given as a sedative and pain killer.

Thus its easy to see that the advances in medicine since the civil war have been incredible. Lessons learned from the war itself also helped to spurn some of those advances.

During the war they were still operating under the humoral theory of medicine which dated all the way back to Hippocrates. Post war the understanding of germs and disease, antibiotics ,and vaccines have helped to revolutionize medicine is the 150+ years since the war.
 
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