Deadly Civil War also brought life-saving medical advancements

As a young lawyer in Illinois, Abraham Lincoln suffered from melancholy – what we now call depression. At the time, doctors attributed the condition to a buildup of black bile in the liver and recommended taking pills called Blue Mass, which contained mercury.

“They would prescribe this for just about anything, including tuberculosis, syphilis, constipation, toothaches, parasitic infections – you name it. This was the miracle drug,” said Ashleigh Meyer, a historian with Old City Cemetery Museums & Arboretum in Lynchburg, Va.

While taking two or three Blue Mass pills a day, Lincoln experienced insomnia, tremors, rage attacks, forgetfulness and fits of delirium, Meyer said. “What we know now is that he was suffering from mercury poisoning” – daily consuming more than 9,000 times the chemical’s safe amount.

“He stopped taking these pills about five months into his presidency, as he was starting to recognize that they were having some adverse effects,” Meyer said. “Had he continued to take this medication, the entire course of American history could be very, very different if he was in a different state of mind when the Civil War broke out.”

During a recent webinar hosted by AARP Virginia, Meyer explained that the Civil War represented a dividing line in medical history.

At the start of the war, which lasted from April 1861 to April 1865, medical thinking bordered on the medieval. Many doctors believed in superstitions: that a person’s health, for example, depended on a balance among four “humors” or bodily fluids – blood, phlegm, yellow bile and black bile.

Treatment included bloodletting – piercing a vein in a particular part of the body. For instance, “you might have been bled from behind the ears if you were suffering from vertigo or headaches,” Meyer said. “The general theory was that the sicker you were, the more blood you needed to lose. Of course, now we recognize that that is a very dangerous idea, and unfortunately many people did die from bloodletting.”

As an alternative to bloodletting, Meyer said, doctors treating wealthy patients sometimes used blood-sucking leeches – another dubious practice. And she said medicines in the early 19th century often contained dangerous and addictive substances including opium, cocaine and arsenic.

People didn’t need a prescription to buy such products. “You could ask for those over the pharmacy counter, and they would be handed to you,” Meyer said.

But by the end of the Victorian era in 1901, health-care knowledge, technology and professions had advanced significantly, she said. Meyer said the Civil War exposed the shortcomings of existing medical practices and served as a “major catalyst” for improvements.

As America’s greatest mass casualty event, the war provided both the opportunity and the necessity to try new approaches in medicine. “We had to learn and adapt very quickly on both sides of the conflict,” Meyer said.

Historians say about 620,000 soldiers died in the Civil War – more than in World War I and World War II combined. “It’s estimated that one in three Southern households lost at least one family member,” Meyer said. Another half-million soldiers in the Civil War lost limbs or suffered other injuries.

Casualties were high for several reasons. For one thing, both Union and Confederate armies used rifle-muskets and an especially devastating type of bullet called the Minié ball, which shattered bones and ripped tissue.

Soldiers who survived being shot by the conical, soft-lead bullets often required amputations. In many cases, the men contracted tetanus, gangrene and other infections.

During the Civil War, Meyer said, disease – including cholera, typhoid and smallpox – killed far more soldiers than did bullets and bayonets. “It wasn’t the battlefield wound that killed you; it was the disease that you contracted afterwards,” she said.

In response, doctors adopted methods such as sterilizing equipment – and they worked. At the start of the war, hospitals treating soldiers had a mortality rate from infections of 60%, Meyer said. By the end of the war, the mortality rate was just 3%.

Meyer said the Civil War prompted physicians to follow scientific theories developed by experts in Europe, including:

● Dr. John Snow, considered the father of epidemiology. During a cholera epidemic in London in 1854, Snow plotted deaths on a map and proved that the outbreak was caused by contaminated water from a city pump – not by stinky air, as the “miasma theory” erroneously held at the time.

● Louis Pasteur, a French chemist and a pioneer in microbiology and immunology. In 1861, he published research showing that certain germs caused diseases and that heat could kill microbes that make people sick. Pasteur also developed vaccines.

Such ideas “did not just spread overnight,” Meyer said. “There were still a lot of people very skeptical about this information. First of all, the idea of tiny invisible organisms being the cause of their illness was hard to believe in many cases and, in some cases, heretical.”

But the medical challenges posed by the Civil War pushed physicians to apply that knowledge and include it in educating doctors, she said.

Also during the war, Meyer said, surgeons made more widespread use of anesthesia, such as chloroform or ether, which had been developed in 1846 by William Thomas Green Morton, a Boston dentist.

Moreover, the Civil War fostered advancements in trauma care.

At the start of the conflict, wounded soldiers were left on the battlefield until the fighting had stopped – often days later.

“Then, if they were still alive, they would be carried off to a field hospital, where an exhausted surgeon waited for them,” Meyer said. Doctors typically used “the same unsterilized tools that they had used on the patient before” – at best, dunking them in a bucket of warm water.

But midway through the war, each army established a dedicated ambulance corps that tried to retrieve and treat soldiers as soon as they had been injured, Meyer said.

“That’s actually what led to what we now know as our modern emergency medicine” – networks of ambulances and paramedics.

The Union Army had 13,000 surgeons and other doctors, while the Confederate Army had fewer than 3,300, Meyer said. She said the North’s advantage in medical resources “beyond a shadow of a doubt contributed to the outcome of the Civil War.”

Under Surgeon General William Hammond and Dr. Jonathan Letterman, medical director of the Army of the Potomac, the North established a triage system – a process to categorize soldiers’ injuries and prioritize their care.

Hammond and Letterman emphasized sanitation, hygiene, the standardization of medical supplies and treatments based on scientific evidence. For instance, Hammond, an expert on the nervous system, banned mercury pills.

In addition, Hammond “opened a specialty hospital for unique and unusual wounds,” Meyer said. “This was the first time that we had ever seen a specialty hospital, and it led to the modern development of medical specializations.”

The South also improved its hospitals – opening Chimborazo Hospital in Richmond and converting 19 tobacco warehouses in Lynchburg to “emergency hospitals for Civil War soldiers,” Meyer said.

During the online presentation, she displayed tools such as surgical knives and a bone saw used in amputations.

“A skilled surgeon could actually remove a limb in under six minutes,” she said. Antibiotics weren’t developed until the 20th century. During the Civil War, amputating a soldier’s infected arm or leg “gave these men a fighting chance at survival,” Meyer said.

One out of 13 soldiers lost at least one limb, she said. Because of the prevalence of amputations, the war triggered innovations in prosthetics, facial reconstruction and other cosmetic surgery.

Other advances in medicine during the war include the use of quinine to prevent malaria and quarantines to control pandemics, Meyer said. “Additionally, Congress developed the pension system for the permanent care of veterans, which, of course, we still have to date.”

The Civil War also marked the beginning of formalized nursing in the United States. Women – from Dorothea Dix (with the Union Army) to Sally Louisa Tompkins (with the Confederacy) – played key roles in caring for wounded soldiers. The war’s most famous nurse, Clara Barton, went on to establish the American Red Cross.

Furthermore, the Civil War brought advances in medical education, Meyer said.

“The sudden availability of cadavers meant the opportunity to study and examine human anatomy and to learn more about the physical form and the human body and how things actually worked,” she said.

“A lot of theoretical understanding of how the human body was put together was resolved and brought to light as a result of the widely available number of cadavers that unfortunately resulted from the Civil War.”

 So despite being America’s bloodiest conflict, Meyer said, “There were a lot of really fascinating and critical developments that came out of the Civil War and that not only became lifesaving tools at the time but were also used to push the United States further as an active ground for medical science and advancement.”

Visiting Old City Cemetery and its museums

Old City Cemetery Museums & Arboretum are located at the corner of Fourth and Taylor streets in downtown Lynchburg.

The location includes five small museums:

● The Victorian Mourning Museum, with exhibits on funeral etiquette, coffins and embalming

● The Pest House and Medical Museum, where Civil War soldiers were treated and people with contagious diseases were quarantined in the 19th century

● The Hearse House and Caretakers’ Museum, featuring a turn-of-the-century hearse

● The Station House Museum, a reconstructed railway depot

● The Chapel and Columbarium.

The cemetery grounds are open daily free of charge. Visitors may take self-guided tours of the exterior of the buildings, using brochures and audio recordings. Guided tours are available by appointment and special request. For information, call 434-847-1465.