“The first battles of the Civil War [were] a wake-up call to the U.S. Medical Department,” said Kristen Pearlstein during a virtual science café presented by the National Museum of Health and Medicine. “Over the next three years, we see a number of innovations put into place that will permanently alter and improve the course of military medicine,” Pearlstein concluded.

Pearlstein, the museum’s Anatomical Collections manager, gave a brief history of the challenges military medicine faced at the onset of the American Civil War in April 1861, and how the military adapted and responded during the course of the war.

Initial challenges to military medicine stemmed from limited medical knowledge and lack of organization in the medical corps. With no established medical evacuation or military hospital system, the wounded could remain on the battlefield for days with little or no care. When men were finally removed from the field, they often received inadequate medical care as military surgeons had insufficient training and experience with combat injuries, most never having treated a gunshot wound.

Slower and less-damaging round musket balls from previous conflicts were used less frequently in favor of larger, heavier conical-shaped Minié balls that spun faster. This and other ‘advancements’ in weapons technology created more injuries, crushing bone and leaving large wounds.

Some of the biggest medical challenges stemmed from the lack of proper sanitation and sterilization. Germ theory had not been widely adopted, so medical environments were plagued with dirty hands, unsterile equipment, and overcrowded unhygienic camps where the spread of disease was hard to control.

By August 1862, things changed; an organized system of medical care and evacuation was established through the use of triage, ambulance support, field and general hospitals, and transportation via hospital trains and ships. Pearlstein noted by the end of the war, more than 1 million soldiers had received care in a federal military hospital.

Wound infections were prevalent and surgical interventions were increasingly used to address contamination, as military surgeons performed a large number of successful amputations and excisions (partial removal of a bone or joint). With advances in the administration of anesthesia, new types of surgery, like facial reconstruction surgery, were also developed. After the war, the large number of amputees led to improvements in prosthetics.

Perhaps one of the most significant responses to Civil War military medical challenges was the compilation of medical knowledge.

Founded in May 1862, the Army Medical Museum (known today as the National Museum of Health and Medicine, a division of the Defense Health Agency Research and Development Directorate) was established for collection purposes. Tasked with the gathering of reports, documents, artifacts, and specimens that showed examples of wartime injuries and diseases, the Army Medical Museum sought to understand and improve prognoses for soldiers. This culminated in development of the Medical and Surgical History of the War of the Rebellion, a six-volume account that documents lessons learned from the battlefield. According to Pearlstein, Medical and Surgical History is, to this day, one of the most extensive data collection efforts in the history of wartime medicine.

For more information on the museum’s collection of Civil War materials, visit the museum website.