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Before the Civil War, medical care was typically practiced at home or in a doctor's individual office. Because of the massive numbers of diseased and injured in the war, hospitalization became a necessity. The two types of hospitals available for soldiers were the field hospital and the pavilion hospital. The field hospital was typically a barn or tent near the battlefield that was used for the wounded. The pavilion hospital resembled the city hospitals we have today, and they tended to those who needed long-term care for illness or injury.
The large volume of sick and injured made medical care a challenge; sanitation conditions were much less than adequate and surgeons had to choose which men to treat and which to leave alone.
Disease caused by infection and unsanitary conditions caused hundreds more deaths during the Civil War than cannonballs and firearms. Each camp was supposed to have a "sink" or large trench to substitute as a toilet. Each night, the men were supposed to pack six inches of dirt on top of the sink. However, some armies did not dig a sink and other men chose to go in open areas rather than expose themselves to the foul odors of the "sinks." Typhoid fever and malaria resulted from the flies and mosquitoes that gathered around the waste areas and transferred bacteria onto the food.
Diarrhea or dysentery were the most common illnesses at camp. In many cases they were symptoms of tuberculosis or malaria; however, food rations were scarce and often poorly cooked, so cases of food poisoning were common as well. Medical officers would often prescribe an astringent. Soldiers who were really sick were led to a cot in the hospital tent or sent to the pavilion hospital; those who were only slightly ill had to tend to the seriously sick or wounded and clean the bedpans and urinals.
The weather also affected many soldiers. Combined with an unbalanced diet, cold or rainy weather exposed men to viruses and bacteria. Men who contracted a cold often ended up with pneumonia, the third leading killer after typhoid and dysentery.
In the field hospital, the wounded were usually separated into three categories: mortally wounded, slightly wounded and surgical cases. After a battle, men with stretchers would go out to the field to take anyone who was wounded to the dressing station if they could not walk or had not been carried there by another soldier. There, the assistant surgeon would give the man a glass of liquor and sometimes rubbed morphine in the wound. The patient often had a dose of chloroform right before surgery or amputation.
The surgeon usually treated the surgical cases; the mortally and slightly wounded were left to their fates. Most of the surgical cases involved arm and leg wounds, which included the majority of wounds. Head, neck and chest wounds were typically fatal. Most of the extremity wounds were caused by the Minnie ball, which often tore off large pieces of flesh and crushed bones, so surgeons typically performed amputations.
Because of the filthy conditions and the lack of sanitation of instruments, many injured soldiers died of infection or gangrene. Usually pus would appear in about three to four days, a sign that Staphylococcus aureus had already set in the tissue. To treat the injured, the surgeon would remove the bullet or shell fragment from the wound before deciding to seal the wound or amputate the limb.
Sealing the wound usually enclosed bacteria in the body, so even though a patient would stop bleeding, a few days later he would begin running a high fever and be dead in about three days from blood poisoning. Doctors would seal the wound with collodion, usually without sterilizing it first. Later doctors discovered that if they painted iodine on the edges of the wound, infection was less likely.
Amputations were a more popular treatment for those whose limbs were more damaged. Two types of amputations were available: the "flap" or the "circular" operation. The flap enlarged the wound; the circular kept a small area open to infection. The sight at a field hospital was garish; one could hear an occasional scream, usually from the soldiers watching their comrades undergo amputations, and limbs were piled high beside the surgeon's table.
After the Civil War, several surgeons fought to establish guidelines for sanitation at hospitals, mainly as a result of their experience at the filthy field hospitals. Although surgeons had at their disposal antiseptics like iodine, carbolic acid, bichloride of mercury and others, many had to work to speedily to avail themselves of these. During surgery, surgeons would rarely clean instruments, due to the scarcity of water at the camps. Instruments that dropped to the floor would be rinsed in cold water or wiped on the surgeon's coat, which was covered in blood and pus. Doctors rarely washed their hands or instruments before working on a patient, and to locate a bullet or shell fragment, they would usually probe the wound with their fingers.
Wound dressings consisted of moist cotton and wet bandages. The typical reaction to the germs that the doctor passed to each patient was "surgical fever," or staphylococcus or streptococcus infections that released poisons into the bloodstream. Gangrene, which rotted away the flesh, was also common after surgery, the main reason why most doctors chose amputation over surgery.
Source: Shotgun's Home of the American Civil War