Improvisation, adaptation and innovation: the handling of wounded in the Civil War

[摘要] Critics of Civil War medical practices tend to isolate them from all other aspects of the war and evaluate them against twentieth century standards. This results in a distorted picture of successes and failures. Only when viewed in proper historical perspective and evaluated as components of vastly different logistics systems can the Confederate and Union Medical Departments be judged properly. Efforts by the Confederacy to support its army were hampered by shortages of capital, labor, food, supplies and transportation. These shortages kept its logistics system in the embryonic stages of development throughout the war. The Union, on the other hand, was able to support its army for exactly the opposite reasons. An abundance of capital, labor and raw materials combined with an excellent transportation network and a strong industrial base to insure the success of Union logistics and, in a war of attrition, to guarantee victory. Reflecting the poverty of its logistics system, the Confederate Medical Department, under the strong leadership of Samuel Preston Moore, managed not only to survive four years, but to acquit itself admirably on many battlefields. To care for the wounded, surgeons relied on their abilities to improvise and adapt. Such skills, early learned and often used, carried them through periods of total logistical failure. There were never established in the South medical supply, ambulance and field hospital systems with a statutory basis. Only in its system of general hospitals did the Medical Department achieve any degree of standardization and efficiency. Beyond that, its accomplishments fit in well with the overall accomplishment of the Confederacy -- that of conducting an improvised war throughout. In stark contrast to the struggles of Confederate surgeons was the ease with which Union surgeons handled their wounded. Under innovative men like William A. Hammond and Jonathan Letterman, medical supply, ambulance and field and general hospital systems were established and standardized within the Union Army. Medical officers in the North were also capable of improvising and adapting to a countless variety of situations, but after 1863 there was little need for improvisation. More time could be spent refining a medical system already receiving world acclaim. Under the aegis of a sound logistics system, Union surgeons saw innovation become routine. No one will deny that the wounded on both sides suffered terribly. Despite the primitive state of the art, practices, which by today's standards seem barbaric, were saving men's lives. The mortality rate of wounded soldiers was less than that of any previous conflict. Had aseptic and antiseptic procedures been known to Civil War surgeons, countless more lives could have been saved. Discovery of those techniques, however, would belong to the post-war generation. Still, the medical triumphs of the Civil War should not be overlooked. For the first time in a war medical and surgical activities were systematically reported and analyzed. Major advances were made in dentistry, nursing and pharmacy. Military health lessons learned during the war gave impetus to the public health movement, and innovations in hospital design and construction were also introduced. Surgeons took the lifesaving surgical skills learned in battle into civil practice where,as leaders in the medical field, they, made major contributions to American medicine for the next half century. From a military standpoint, Civil War medical contributions had far-reaching effects. Letterman's field hospital and ambulance systems led to improved methods in caring for the sick and wounded in armies throughout the world and remained basically unchanged in the United States Army until after World War II.

[发布机构] Rice University