Civil War Surgeons

by William J. Miller

History has not been kind to Civil War doctors. For generations, the failures and inadequacies of these men, and a very few women, have received far more attention than their successes and accomplishments. Historians will praise the surgeons of the 1860’s for their dedication and selflessness, but in the next breath tell us horror stories about mass amputation (much of it unnecessary) and about how doctors encouraged the infection of wounds in the belief that the discharge of a “laudable pus” helped promote healing. Invariably, these writers then quoted grim statistics of more than 600,000 dead in the War, only one third of them on battlefields. Disease killed twice as many as combat. The most common portrait of Civil War surgeons, then, is of hard-working, well-meaning but tragically ineffective men who really hadn’t any idea what they were doing. We view them with a sort of benign condescension.

There is a danger in such smugness. To view Civil War physicians as incompetent is to commit the history student’s greatest error: Judging one generation by a later generation’s standards.

By the standards of their day, Civil War doctors were remarkably successful. Considering how little they knew (the existence and significance of bacteria was still theoretical) it is a wonder they saved any patients at all. But not only did they save lives, they did so in unhoped-for numbers. For most American military doctors, the Army’s experience in the Mexican War served as the standard by which they could measure effectiveness. In that war, 10 men died of disease for every one man killed in battle. Doctors in the Civil War reduced that ratio from ten-to-one to two-to-one. Administrators made tremendous strides in medical organization, in creating an ambulance corps and modern field hospitals. And surgeons developed several concepts that would become pillars of modern medicine: the extensive use of female nurses, the necessity of well-ventilated operating areas, and the importance of bolstering a patient’s morale in recovery.

In the face of this evidence, it is easier to see the maligned Civil War surgeon not as hapless but as heroic — achieving significant success despite a dearth of knowledge and materials.