The Blue, the Gray, and the Crimson: A Quick Examination of Civil War Medicine

When Christmas morning dawned in December of 1862, the sun rose over the battered town of Fredericksburg. Once a bustling colonial port, more recently a pleasant stop for travelers by coach and boat, on this day, the little town lay in ruins. And, if the brick and mortar firmaments suffered such catastrophic damage, what of the flesh and bone of the human armies that had battled there mere weeks before? What became of the wounded who survived the first days of battle?

At the beginning of the Civil War, plans were made on both sides for treating the wounded. But the overwhelming carnage and the perversity of nature complicated these best-laid plans. Could those who planned the war have foreseen the realities of the wrenching Mud March or the necessity of having untrained staff performing amputations, using a book of simple diagrams as a guide?

Wicked Weapons

The advent of the Minie ball (Minie bullet) brought a new dimension of horror to war wounds. Men could now fire as accurately as if they were using a rifle but reload as quickly as if they were using a musket. That meant the men started to be hit not at 50 yards but at 500 yards, increasing the slaughter immensely. Another peculiarity of this bullet was its design. The heavy lead bullet would pass cleanly through flesh but would flatten into a disc if it hit bone, causing enormous wounds while shattering the bone simultaneously.

Then there were the cannons. In the Civil War, exploding shell was routinely used in cannonades. Slivers of cast iron were thrown throughout the battlefield. As heavy armor was impractical on campaign, these weapons shredded troops clad in simple uniforms mercilessly, and the resulting wounds were difficult to treat.

The State of Medicine

Wounded soldiers under a tree near FredericksburgIn 1860, germ theory was unknown. Probably one of the most peculiar theories was that of laudable pus--which is to say that a wound that didn't develop swelling and drainage (a sign of bacterial infection) was a wound that probably should. Consider also that anesthetics were difficult to procure and that any serious wound on a limb was considered cause for amputation. Gangrene was particularly feared and resulted in many preemptive amputations.

In camp, dysentery often followed by typhus laid men low. These diseases were the all too natural result of large, lengthy encampments, when sanitary and water facilities would soon become contaminated. Many died of these simple causes but many were also furloughed to their homes, cutting the armies' effectiveness, particularly during critical summer campaigns.

The cause of debilitating and sometimes deadly malaria remained a mystery to Civil War doctors, but a preventative treatment in the form of quinine was just beginning to be used. At morning muster, doctors would administer the nasty-tasting doses, watching carefully to make sure they were swallowed.

Medical Facilities

On the Battlefield
Any large home, church, or public building might be converted to a hospital at need, and these places were usually spared the worst shelling by mutual agreement. Piles of discarded limbs might be hastily buried in nearby pastures as were unfortunate patients. There were simply too many wounded and dying for the makeshift facilities. Most lingered in the open, tended or not--perhaps living long enough to be sent to larger facilities. Field doctors practiced medicine quickly if not painlessly. Some troops deserted rather than face the surgeon's rapid knife. Medical artifacts of the period may be viewed at most Civil War museums, including Fredericksburg & Spotsylvania County Battlefields Memorial, NPS.

Behind the Lines
Large hospitals, such as Chimborazo Hospital in Richmond and Lincoln Hospital in Washington, were specially constructed for the purpose. Women on both sides volunteered for nursing duty. At first, doctors and male nurses were nonplussed by what they viewed as "petticoat rule," but in time the hard-working women came to be valued, and many wrote their memoirs after the war.

U.S. Sanitary Commission in Fredericksburg, May of 1864As the battles ground on, both Confederate and Union medical personnel became more efficient at caring for their wounded. In response to the Union's seemingly utter helplessness in the face of streaming casualties, the U.S. Sanitary Commission was founded to improve conditions. On the Southern side, the food and supply shortages made hospital recoveries more problematic as the years rolled on, but they, too, saw increases in efficiency.

And what happened to those wounded who were captured by their enemies? Horror stories are told of prisons on both sides. Again, the crippling dysentery and fevers raged. In the South, the army was starving, and Union prisoners fared worse. In Maryland, at Point Lookout, as many as 20,000 Confederate inmates lived in a facility designed for 10,000. Andersonville Prison in Georgia became infamous for its inhumane and unsanitary conditions. Again, gangrene, typhus, typhoid, and dysentery took their toll.


For decades after the war, veterans would gather at reunions. They were a scarred and bearded bunch. In many cases, the loss of limbs and/or health greatly impaired their ability to provide for their families. Pension application records often note the severity of these soldiers' disabilities. Wounds on both sides ran deep, both physically and psychologically and in many areas continue to this day. The library owns a number of books on Civil War medicine. Click here to view an annotated selection of our titles.

In addition, these Web sites offer materials for further study:

Andersonville: Part 7
Within this survivor's tale, a C.S.A. doctor is quoted at length as to the wretched conditions and subsequent mortality at the prison.
Civil War and 19th Century Medical Terminology
Odd terms to modern ears, such as Viper's Dance and Bad Blood, are given their modern names. Useful for making sense of old records.
Civil War Medical Care: Photographs from the United States Sanitary Commission Collection, 1861-1872
Over 200 photographs and drawings relating to the work, facilities and Civil War locales associated with the United States Sanitary Commission (USSC).
Civil War Medicine
Part of the Home of the American Civil War Web site. Links to many fascinating articles such as Drugs Availability in the Civil War and Transportation of the Wounded.
Civil War Medicine Cookbook
"PLEASE NOTE - These medicinal recipes are not intended for actual use! At best they'll make you go "yech". At worst, they'll kill you. We present them only to demonstrate what our ancestors went through. You have been warned."
A Manual of Military Surgery [Confederate States Army], 1863
Adobe Acrobat's free reader is required to browse this book. Includes detailed written descriptions of how to treat gunshot wounds and related diseases, as well as how to perform amputations-and it assumes no anesthetic is available.
National Museum of Civil War Medicine
Located in downtown Frederick, Maryland, the museum traces the history of Civil War medicine-from the education of its doctors to recruitment, field hospitals, and nursing, The Web site includes virtual tours (broadband connection required). NMCWM also hosts educational events throughout the year. Its site contains a bibliography and information on using its small research library.
The Society of Civil War Surgeons
"The specific goal of The Society of Civil War Surgeons is to promote, in both members as well as the general public, a deep and abiding appreciation for rich medical heritage of the American Civil War. To accomplish this, The Society will foster fellowship, provide a continuing forum for education and the exchange of information, and provide communications among people who have similar interests. The Society will also serve as a resource for those seeking authoritative information of Civil War medical and surgical practices." Includes reflective articles written by modern physicians.