Author:Matthew Croson, Hamilton Middle School, Baltimore City Public School System
Grade Level:Middle
Duration:1 period
Overview:
Like many modern wars, a good deal of the carnage during the American Civil War came from the fact that weapon technology outpaced the opposing side's ability to cope with and defend against it. This lesson focuses on what happened when the deadly "minie" ball replaced round bullets in American soldiers' rifles. The new ball tore through flesh and shattered bones at a much greater distance than older ammunition, and because of the unsanitary and sometimes crude field hospital practices, hundreds of thousands of soldiers died off of the battlefield. Students will engage with the dilemmas of Civil War doctors and nurses, and learn about new medical technologies of the period that did help soldiers survive the long struggle.
Content Standards:
Era 5: Civil War and Reconstruction (1850 - 1877)
Standard 2: The course and character of the Civil War and its effects on the American people.
Historical Thinking Standards:
Standard 2: Historical Comprehension
G. Draw upon visual, literary, and musical sources.
Standard 5: Historical Issues-Analysis and Decision-Making
A. Identify issues and problems in the past.
B. Marshal evidence of antecedent circumstances and contemporary factors contributing to problems and alternative courses of action.
F. Formulate a position or course of action on an issue.
Students will be able to identify the problems with battlefield surgery and factors in successful operations.
- Students will be able to evaluate the methods of field surgery concerning
communicable diseases and infections that have changed over the past 200 years.
- Students will analyze period photographs to reach independent
conclusions concerning appropriate battlefield medical practices.
The American Civil War was an era of technological advancement in many
industries. While new industries emerged, established industries developed after the
outbreak of the war, specifically in northern states. (Paludan 144). Arms and other
"offensive" technology were no different as the demand for such items swiftly
escalated. Unfortunately, sometimes the new arms technology wounded soldiers in
ways that the current state of medical technology was unprepared to treat.
Specifically in the case of the American Civil War, a new rifled projectile with
much improved accuracy and range called the "lead minie ball" preceded the
professional medical understanding of communicable and transmittable infection
and the practice of sterilizing instruments and prevention of wound contamination.
This "technological mismatch" resulted in incredibly high mortality rates. Servicemen
who were wounded, often died some time later due to complications and infections
related to well meaning but ineffective surgical procedures such as amputation. Once
wounded, a Civil War soldier died at a rate eight times greater than his later World
War I counterpart. Of the 620,000 casualties in the American Civil War, two thirds of
these deaths were from disease or infection, not battle. (Wagner et al. 623) While
many different types of military technology developed during the American Civil War,
this discussion targets the specific technological mismatch of the lead minie ball and
corresponding treatment of associated bodily damage.
The lead minie ball is not a "ball" at all but rather a bullet shaped projectile
made of lead with two or three grooves or rings etched at the base of the bullet. It was
invented in 1848 by French Army Captain Claude F. Minie and by 1855 was adapted
for military use in the United States by Harpers Ferry armory worker James H. Burton
who was able to demonstrate that the ball would be cost effective. This combination
of cost effective manufacturing plus unbeatable accuracy and range made the lead
minie ball an "industry favorite" for the U.S. Army. (Freemon 12) When fired, this cone
shaped ball would expand inside the rifled barrel of the gun to barrel and produce a
projective with a greater range and accuracy than the previous "round" shaped musket
ball. The term "rifle" itself refers to the "rifling" or cut grooves inside the weapon barrel
that creates the accurate and destructive spinning projectile. The musket balls, while
still creating dangerous and often deadly wounds, were rarely very accurate. When
they did find their marks, they often bounced off of bone or exited out of muscle and
flesh. Since the lead minie ball had significantly more power and velocity than other
ammunition, it shattered and broke bones as it fragmented inside the body, leaving a
ragged, complex, and difficult to treat wound. Wounds caused by the lead minie ball
may have even been more prone to infection than any other type of puncture wound as
the action of a lead minie ball tearing through skin would introduce dirt and clothing
into the wound. A young solider wrote:
"Shepard extracts from my wound several pieces of my pantaloons that
have been carried into my leg by the bullet and which worked
themselves back the surface today, taking twenty-two days to go a
distance of about 2 inches." (Murphy 89)
Unfortunately, as the lead minie ball proliferated on both sides of the conflict,
the corresponding medical technology did not. As 21st century people, we take some
concepts of medical technology for granted. The idea that infections can be limited or
even avoided by properly sterilizing surgical equipment and maintaining a
scrupulously clean surgical environment is not new to 21st century minds. In cases
where our 21st century medical technology fails and wounds become infected or
otherwise compromised, a battery of antibiotics may quickly and easily resolve the
problem. Additionally, our modern 21st century medical technology is instrumental in
identifying the wound, including systems as complex as CAT scans and as simple as
x-ray-imaging.
Now, imagine the situation as it was in the last quarter of the 19th century, a
mere 150 or so years ago. Infections were common and hard to treat. The concept of
blood based or other fluid based pathogens was not fully accepted, but limited to the
idea that a clean surgical space resulted in fewer complications. A bullet wound in the
21st century might be first be "imaged" using any manner of modern imaging tools so
that extraction of shattered projectile or bone would be most efficient and least
traumatic. In 1860, "good" medical care might involve digging the bullet out with dirty
fingers and soiled instruments. Medical school education for Civil War doctors might
have consisted of a basic apprenticeship with an existing (and likewise poorly trained)
physician or two six month terms of lectures at any one of nearly 40 American medical
schools where a philosophy of bringing a balance to the humors of the body
prevailed. Regardless of where or how a period medical education was earned,
medical practitioners had no knowledge of germ theory or antiseptic practices.
(Museum)
Rampant infection or not, it was fortunate that wide spread use of anesthesia
predated the American Civil War by several years and was probably generally
available to battle field wounded, despite the dramatic portrayal of non-anesthesia
amputations by popular media such as the movie and book Gone With the Wind.
Unfortunately, most of the pain killer drugs of the time were straight morphine or
chloroform and doubtlessly lead to a significant number of addicted veterans. While
morphine and chloroform were used to deal with pain, when those ran short, whiskey
and bourbon had to do. (Murphy 86)
The same hampering lack of knowledge about the spread of infection and
disease in Civil War surgical environments also hampered the reduction of
communicable diseases such as diarrhea, dysentery, Typhoid fever, Malaria,
smallpox, tuberculosis, and pneumonia that ripped through war time camps of
soldiers and prisoners alike and left thousands dead in their wake. (Bollet 213)
Ironically, the American Civil War was over just a few short years before Louis Pasteur
discovered the role of germs in infection. With no knowledge of how infection was
transmitted, control was impossible except by accident.
Surgeons, limited by available light, often performed operations outside during
the day. The need for bright light is understandable, and since the availability of
artificial light was expensive, it had to be created using candles or oil lamps, which
were usually dim, fluxuating and hot. Most of the photographs of this time are exterior
photographs for the same simple reason that making artificial light was hard, and the
sun did a much better job. Additionally, the mess and considerable gore of a 19th
century surgery and the sheer volume of battle related amputations would strongly
encourage an outside operating theater.
The surgical operations themselves were limited by medical technology.
Amputations were extremely common and medically necessary but they were rather
gruesome and simple in their execution. A surgeon would build a make shift
operating table and administer available painkiller to the patient. The surgeon would
employ tourniquets to stop the flow of blood in the extremity above the damage, and
then, perhaps with the help of a strong armed friend, use a stiff serrated saw to
separate flesh, muscle and bone from the lucky patient. By the time the patient (or
victim) regained his senses, the surgeon had not only added the removed limb to an
ever growing heap, but probably the recently severed limbs of a dozen others. One
soldier tells the tale as follows:
"We moved on to the East side of town where they were fetching the
wounded&they had tents for those that were the worst off, and where they
were amputating arms and legs&the legs had the shoes and stockings
still on them" (Murphy 86)
While this may seem a bit barbaric, the soldier was lucky that he had been hit
in an extremity. Soldiers wounded in the chest, head or abdomen were often times left
to die on the battlefield. (Bollet 99). The chances of death after amputation increased
with the proximity of the amputation to the trunk of the body. Amputations of the hand
or the fingers resulted in only 2.9% percent of deaths. A wound in the thigh had a
death rate of 54.2% and a hip joint wound nearly insured death at a rate of 83.3%.
(Wagner et al. 634)
While the state of 19th century medical technology seems barbaric, some
innovations refined during this time period are still used today with positive results.
For example, the hypodermic syringe was first used in the American Civil War
(Freemon 69) and the idea of an ambulance was developed and refined during this
time period as well. (Bollett 103). A more complex system of field hospitals and
mobile surgical units was developed during this time as was the professional
advancement and role development of nurses and the founding of organizations like
city sanitary commissions and participation of Catholic Sisters in care giving roles.
(Maher 82)
The U.S. Sanitary Commission was first approved by the federal government in
1861 in order to provide medical care to Union soldiers when the U.S. government
could not. The Commission sent food and clothing to soldiers in the field as well as
assisting the wounded in some of the battles. While the Sanitary Commission was a
national organization with male head figures, the city branches of the Commission
were mostly run and staffed by women who cared for the wounded, sent care
packages to troops in service, and raised huge amounts of money to support their
efforts. (PBS Livermore) When viewing disturbing pictures of period battle field
hospitals, it is important to remember, that although gruesome, the point of medical
treatment in general and amputations in particular were honest attempts to heal
wounded people. Even the doctors themselves believed in the necessity of
amputation in prevention of infection as can be seen in the words of an imprisoned
southern soldier upon meeting a Union doctor:
He is a very fine looking man an has his hand in sling&when operating
on upon a gangrened wound, the knife with which he was operating cut
his finger slightly; and fearing infection he sensibly had his own finger
immediately amputated. (Murphy 86)
Bibliography
Bollet, Alfred Jay, M.D. Civil War Medicine; Challenges and Triumphs. Tucson: Galen Pres, Ltd., 2002.
Freemon, Frank R. Microbes and Lead Minie Balls: An Annotated Bibliography of Civil War Medicine. London: Associated University Presses, 1993.
Maher, Sister Mary Denis. To Bind up the Wound:; Catholic Sister Nurses in the U.S. Civil War. Westport: Greenwood Press, 1989.
Murphy, Jim. The Boys - War: Confederate and Union Soldiers Talk About the Civil War. New York: Clarion Books, 1991.
"Museum Exhibits" From the web page of the National Museum of Civil War Medicine. http://www.civilwarmed.org/exhibits.cfm, Accessed August 14th 2004.
Paludan, Phillip Shaw. A Peoples Contest: the Union & the Civil War 1861-1865. Lawrence: University Press of Kansas, 1998.
People & Events: Mary Livermore (1820-1905) and the U.S. Sanitary Commission http://www.pbs.org/wgbh/amex/grant/peopleevents/p_livermore.html Accessed August 14th 2004.
Wagner, Margaret E., Garry W Gallagher. and Paul Finkelman. The Library of Congress Civil War Desk Reference. New York: Simon and Schuster Press, 2002.
Amputation: The surgical removal of a limb or portion of a limb. Amputation
may be done above the knee, below the knee, or part of the foot.
This process was frequently used during the Revolutionary and
Civil Wars.
Anesthesia: A chemical or drug used to numb the feeling of pain or to
alter consciousness of a patient while they undergo a
medical procedure.
Antiseptic: A medical device or function designed to prevent communicable diseases from spreading by killing the
communicable agents. Hydrogen peroxide or tincture of
iodine were used as antiseptics because they could be
applied directly to wounds and killed many communicable
agents.
Communicable: Capable of being transmitted by infection. Some
communicable diseases are transmitted through saliva or
blood, while others are transmitted in the air.
Minie Ball: A specific type of bullet fired from a rifle that was used during
and after the American Civil War. It was particularly
destructive and caused difficulties in treating wounds. It was
named for its inventor, Claude Minie and was roughly about
the size of a U.S. quarter.
Surgeon: A medical specialist who deals with issues of cutting into a
patients flesh in order to repair a wound.
Photograph of an 1863 Civil War Era Operating Theater Photograph of an 1863
Photograph of an 1863 outdoor amputation showing with an all male surgical group: to
be used to compare operating theaters from a pre-germ theory and post germ theory
world.
"Amputation scene at a general hospital" Attributed to Charles J. and Isaac C. Tyson.
Tipton Collection., 1863
Item from Record Group 79: Records of the National Park Service, 1785 - 1990
Location: Still Picture Records LICON, Special Media Archives Services Division
(NWCS-S), National Archives at College Park, 8601 Adelphi Road, College Park, MD
20740-6001 PHONE: 301-837-3530, FAX: 301-837-3621, EMAIL: stillpix@nara.gov
Photograph of 1940s Era Operating Theater
Photograph of a 1940s era operating room with a large light, clean dressings, nurse and
stainless steel operating fixtures: to be used to compare operating theaters from a pre-
germ theory and post germ theory world.
“Operating room in a company owned hospital” U.S. Coal &
Coke Company, U.S. #30 & 31 Mines, Lynch, Harlan County, Kentucky, 09/19/1946
Location: Still Picture Records LICON, Special Media Archives Services Division
(NWCS-S), National Archives at College Park, 8601 Adelphi Road, College Park, MD
20740-6001 PHONE: 301-837-3530, FAX: 301-837-3621, EMAIL: stillpix@nara.gov
Photograph of 1970s Era Operating Theater
Photograph of a 1970s era hospital room showing masked attendants and surgical
drapes: to be used to compare operating theaters from a pre-germ theory and post
germ theory world.
Item from Record Group 412: Records of the Environmental Protection Agency, 1944 -
1989
Location: Still Picture Records LICON, Special Media Archives Services Division
(NWCS-S), National Archives at College Park, 8601 Adelphi Road, College Park, MD
20740-6001 PHONE: 301-837-3530, FAX: 301-837-3621, EMAIL: stillpix@nara.gov
The Boy’s War
First-hand accounts that include diary entries and personal letters describe the
experiences of boys, sixteen years old or younger, who fought in the Civil War: to be
used to highlight medical technology and prisoner of war camp conditions.
Murphy, Jim. The Boys’ War; Confederate and Union Soldiers Talk About the Civil War.
New York: Clarion Books, 1990.
