The Civil War was the bloodiest war in United States history; it was a long four years in which roughly 600,000 people died, which was two percent of the population. More people died during this war than in all the following wars combined: the American Revolution, the War of 1812, the Mexican War, the Spanish-American War, World Wars I and II, the Korean War, Vietnam, and the Persian Gulf War. The soldiers had to train long and hard to prepare for this exhausting combat. One soldier from Connecticut, Philip W Hudson, wrote a letter articulating all the endless drills he had to do, the first one at 4:45 a.m., to lights out at 9:45 p.m. (Hudson B1). He explains how “they are kept very strict and constantly drilling”. The intended audience of this letter is Philip’s father which is clearly shown in the address of the letter. The reason this is significant is because it shows the strong relationship between soldiers and their families back home. Hudson told his father about his daily life and reassured his father of his well-doing. Unfortunately, after all this preparation, the soldiers fighting in the war had a one-in-four chance of dying. Oddly enough, “twice as many soldiers died from disease than in combat” (Reilly H1). Thus, there was a strong desire to support the troopers and help them stay as healthy as possible. It was obvious that something needed to be done about the continuous casualties. So, both sides, the North and South, worked on improving their medical care, but there were not too many knowledgeable people on that matter. This period is commonly referred to as the Middle Ages of American medicine. The few people who started off the war as surgeons did not have formal training in medicine; many did not know about bacteria and the causes of diseases. Every year, the understanding of medicine improved because of the increased ambition to lessen the number of deaths caused by illnesses. The term, medicine, is not what the general person may think of when first hearing it; there are many elements to consider to help determine who had the dominance. A few of those aspects consist of anesthesia, physical exams, transportation of infected soldiers, hospitals, sanitation, and treatment. Some may argue that neither side had an advantage over the other when it came to medicine, but there were many factors proving the North had a slight advantage: their performance of anesthesia, their easy-access medical supplies, and their superior treatment.
It must be conceded that the North and the South had no distinct differences when comparing the practices between them. To begin, the performance of physical exams was generally alike. At the beginning of the war, because of the desire to have a large number of soldiers fighting, there was not a structured exam to neglect the infectious soldiers from the healthy ones. After both sides faced numerous deaths from diseases, they had to be more strict on who was allowed to fight. Luckily, there were two manuals written, A Manual of Instructions for Enlisting and Discharging Soldiers by Roberts Bartholow and Manual of Instructions for Military Surgeons on the Examination of Recruits and Discharge of Soldiers by John Ordronaux. The purpose of these manuals was to provide guidelines in their examination of recruits. Ordronaux says, “Age, temperature, and occupation are all data which must be weighed and considered in every instance before he can correctly form an opinion” (Ordronaux 19). Basically, it was important to know the full story before making a judgment. Bartholow agreed when he said, “The principal object of the surgeon is to reject what is absolutely unfit” (Bartholow K1). He thought the examiner needed to be able to determine what did not match the standards without any questions. He believed the most important category the enlisting surgeon should look at was “feebleness of constitution”. This meant if men seemed too small, sickly, or had a sunken or narrow chest, they were considered unfit. The steps to physical exams consisted of one surgeon making sure the applicants were in the prescribed age range, then ordering them to take off their clothes for an examination of general anatomical features, conformation, and range of motion. Then finally there was a detailed exam of each body part; head, ears, eyes, teeth, neck, chest, abdomen, arms, legs, hands, and feet. There were of course minimum and maximum heights and weights. The minimum age was 18 years and the maximum was 35 years, but was raised to 45 by the Enrollment Act if 1863. The minimum weight was 115 to 120 lbs for someone who was 5’7”, while someone who was 6’7” had a minimum weight requirement of 195 lbs. Furthermore, there were not any clear-cut differences splitting up the operation of a physical exam in the North and the South.
Sanitation was another factor with similar aspects on both sides of the Civil War. The army camps were “filthy, fetid places and breeding grounds for disease” (Woodworth C2). One soldier said that a military camp in wartime was more often than not “a city without sewerage”(Woodworth C2). Now it is only imaginable to picture what that must have looked like. Many factors had a role in causing the campsites to look like this such as an “indifference to basic hygiene, careless disposal of human and animal waste, limited access to clean water, close quarters, and complete ignorance of the ways in which disease-carrying bacteria could move from soldier to soldier” (Woodworth C2). An inspector who visited the camps of one Federal Army found they were “littered with refuge, food, and other rubbish”(Goellnite I3). On top of the army camps being unsanitary, so were the hospitals, the place where the soldiers were supposed to go to fight off the diseases, not pick up more. The Union and Confederates claim that the hospitals were overall unsanitary. Not only did a large number of ill soldiers deem the hospitals unsanitary, but so did the surgeons who spent every day in this work environment. One Surgeon, William Williams Keen, the United States’ first brain surgeon, says the surgeons operated in “old blood-stained and often pus-stained coats. [They] operated with clean hands in the social sense, but they were undisinfected hands…[They] used undisinfected instruments from undisinfected plush-lined cases...If a sponge or instrument fell on the floor it was washed and squeezed in a basin of tap water and used as if it were cleaned” (Colihan 65). Keen was a surgeon who operated for the Union Army. A surgeon from the Confederate army described the hospitals with having its operating table from which “a steady stream of blood flowed into a tub on the floor that caught the arms and legs. The floor became littered with piles of dirty rags, blood, and water. . . .'(Social Welfare?). Hence, both surgeons from both sides of the war seemed to generalize the hospitals as being unsanitary. Despite the horrendous conditions of both sides of the army, the civilians knew something needed to be done which is where a slight advantage of the North comes into play; The U.S. Sanitary Commission was created.
The Sanitary Commission originated on June 18, 1861. It was designed to help the Union soldiers, although it was applicable to wounded Confederate soldiers who had been captured. Mary A. Livermore, a nurse, believes the commission was designed to “do what the government could not” by having its methods “arranged to meet every emergency” (Goellnite I3). Its purpose was to promote clean and healthy conditions in the U.S. Army Camps. The Sanitary Commission “staffed field hospitals, raised money, provided supplies, and worked to educate the military and government on matters of health and sanitation”(Tripler M2). One month later the commission published a report containing its “Rules for Preserving the Health of the Soldier”. It was written by Van Buren, M.D., signed by twelve other members of the commission, and then reprinted and published in Harper’s Weekly Rules for Food. This newspaper consisted of many rules beneficial to the Union soldiers. These rules included “water must always be drank in moderation, bread must be thoroughly baked and not eaten until its cold, every officer and soldier should be carefully vaccinated with fresh vaccine matter, men should not be overdrilled, bathe feet every night before sleeping, and select a shoe of stout, soft leather, with a broad sole and low heel” (Weekly 542). The inheritance of these rules would seat the Union soldiers above the Confederate on the sanitation scale. Dr. Hall created a “Military Handbook and Soldiers Manuel” containing concentrated advice for the Union troops. One small but effective piece of advice was telling them to grow out their beards but no longer than three inches. This would “protect the lungs against dust and the throat against winds and colds in the winter, while in the summer the throat is less feverish, thirsty, and dry” (Wilbur A24). Another instruction he told the soldiers to follow was when using water from streams or ponds to “boil it well, and when cool, shake it or stir it so enough oxygen can get into it for improved drinking” (Wilbur A25). This may seem obvious now, but in this time there was little information on sanitation so that piece of guidance made him sound like a genius to some, especially since it tended to prevent cholera and all bowel diseases. There were many more rules and advice given, but by looking at just a few, it is easy to tell that the Union having the commission, already placed them with an advantage over the Confederates.
During the war, the North and the South had similar forms of transportation, but there were always those few aspects benefitting the North rather than the South. Transportation was important under the topic of medicine because it is how wounded soldiers would get to hospitals and how supplies would be delivered to the soldiers and hospitals. The soldiers and supplies were transported by foot, trains, John Letterman’s Ambulance Corps, steamboats, horses, and mules. Marching was the main way soldiers went from one place to the next. On an average day, soldiers might walk 15 miles, while on a day when they are ordered to march they may walk 30 miles. For the soldiers to not get dirty while walking, there would be logs across the muddy or low areas, called corduroy roads (Albert 1). The Union soldiers did have to carry 15-20 more pounds worth of supplies on their backs which was a pain for traveling, but in the long run, it was worth it because it helped them with better first aid and other necessities to win the fight.