Are You Ready to Serve as a US Civil War Doctor? Quiz

Answer: reject; fits/epilepsy excluded a man from service

All the various rules for examining recruits agreed that fits or epilepsy was a symptom to fail a recruit, regardless how healthy he seemed otherwise. There was simply no way to control seizures in the 1860s.

No such thing as probationary acceptance existed. Some surgeons were lax, letting all sorts of recruits through, even females, using all sorts of cursory exams. But there were rules they should have been following, which is why I specified "by the book," because practices varied, but books generally agreed. For example, "Manual of the Medical Officer of the Army of the United States," written by Dr. Charles Trippler, 1858, said: "Epilepsy. Rejection is absolute in all cases of Epilepsy."

If the condition was acquired during service, it also disqualified a man from reduced service in the invalid corps. The following is from "The Army Surgeon's Manual," 1864, on such disqualifications: "Great injuries or diseases of the skull... epilepsy, or other serious nervous or spasmodic symptoms."

Answer: vaccinating your men

Smallpox was the first disease for which a vaccination had been developed, by Edward Jenner in the very late 1700s. Though vaccination sometimes caused side effects due to a lack of sterility when the vaccine matter was inserted, the disease protection worked and there was no reason for the average surgeon to avoid it.

According to the Revised Regulations for the [U.S.] Army, approved August 10, 1861, "Good vaccine matter will be kept on hand by timely requisition on the Surgeon-General." Confederate hospitals requested it where they seemed most apt to receive it. A doctor in Dalton, Ga, wrote Georgia Governor Joseph Brown on Aug. 26, 1862 asking him to "send vaccine matter to Dalton [Confederate military hospitals] as there was none to be had in the county. There is smallpox in Georgia and our people are greatly alarmed for fear of the spread of the disease!"

Answer: diaphoretics, mild purgatives, stimulants, then treat complications as they occur

You thought being a military surgeon would be about battlefield surgery, so what's with all these questions about illnesses? Unfortunately, it's typical; more men died of disease than wounds.

Concerning the wrong answers: The humoral theory and heroic medicine were from about 20 years earlier. Homeopaths were rarely accepted into the medical service. Medicines made from herbs were common, but even Confederate soldiers could get them through the military supply table.

"Outlines of the Chief Camp Diseases of the United States Armies" by Dr. Joseph Woodward, 1863, said: "One of the most characteristic diseases of the present war has been epidemic measles, from which few of the new regiments have entirely escaped." Woodward said the disease was self-limiting, but the complications needed watched: "Intense cerebral symptoms, as stupor and coma, are to be met by cold to the head, dry cups [raising a blister] to the nape of the neck, hot pediluvia [foot baths], and sinapisms [mustard plasters] to the extremities... Even should there be, however, unmistakable evidence of meningeal inflammation, bleeding and mercurials must not be resorted to. Congestion of the lungs is to be treated by the warm bath, by dry cups over the posterior surface of the chest, by hot pediluvia and sinapisms to the wrists and ankles."

Answer: supervise transporting the wounded in ambulances to a field hospital up to 1-2 miles back

You might treat patients on the field after the battle with a private following along, carrying a medical pannier of supplies. Then you would fall back to an aid station or dressing station to give further treatment, then arrange ambulance transportation back to a field hospital in the nearest barn, church or large home, at a safe enough distance to perform surgeries if necessary.

All these steps required careful thought about where the enemy might move; hospitals were sometimes overrun despite the best planning. A field hospital needed located in a safe place, perhaps a mile or more from the enemy lines, far back from the battlefield. The final step was transportation to a general hospital in a large, secluded city. Hospital ships were another safe option.

There are many good overviews of Civil War medical treatment online, such as http://www.civilwar.org/education/history/civil-war-medicine/civil-war-medicine.html

Answer: extremely high in the North, almost as high in the South

There has been a persistent myth that soldiers in the Civil War endured operations while held down and screaming. Analysis of cases reported in the US "Medical and Surgical History of the War" and of Confederate supply records show that anesthesia was used for most procedures requiring it. Confederate surgeon Dr. J. J. Chisholm of Charleston, South Carolina invented a chloroform inhaler to make the use of the drug more efficient and stretch southern supplies further.

One explanation is that soldiers went through a period of agitation while being anesthetized and observers saw this, assumed they were seeing the surgery itself, wrote about it, and started the stories. There's also the truth that less than 20 years before, in the Mexican War, and of course in the War of 1812 and Revolutionary War, soldiers did endure amputations without anesthesia, before it was discovered, and surgeons could only offer alcohol and opiates and try to finish quickly, but by the Civil War, things had changed. Here's an article from the Museum of Civil War Medicine in Maryland: http://www.civilwarmed.org/surgeons-call/anesthesia1/

Answer: tying or ligating with silk thread

The cautery was used sometimes, but there's a persistent belief that it was used as the standard treatment of arteries after an amputation. Ambrose Pare, a French surgeon, had shown that ligation was a superior treatment to the arteries after amputation, as far back as the 16th century, and surgery manuals of the 1860s also recommended ligation.

Answer: opiates and derivatives: morphine, laudanum

Morphine was a refined form of opium, and worked best when rubbed on the open surfaces of the wound to be absorbed directly, or injected by the newly invented hollow hypodermic needle. Laudanum was an old, well-known tincture of opium (dissolved in alcohol). Opium pills and other formats all used opium as the basis of the medication.

Cocaine-based medicines that were best for topical or local anesthesia were not developed for regular use yet. Chloroform and ether had their main uses in inducing "surgical sleep," safely wearing off in a quarter hour or so. A few medicines such as hyoscyamus (henbane, full strength, not homeopathic), given for nervous headache, were too dangerous and useless for battlefield treatments.

Ironically, similar battlefield injuries are treated with similar opiate derivatives today. Though they may be improved with longer action, less stomach upset, intravenous use, etc., the opium poppy is still at the heart of the best medicines, with cocaine medicines added for topical numbing.

Answer: trephine or otherwise make access to raise the skull and reduce the pressure

Making a hole in the skull to elevate the depressed bone was the goal, achieved by trephining or trepanning. The 1863 "Principles and Practice of Surgery" by Henry Hollingsworth Smith, says: "When, from a depressed fracture or effusion of blood outside the dura mater, the brain is compressed, and the surgeon is satisfied that the removal of the compression will probably enable the brain to recover its functions, he may prepare for the [trephining] operation as hereafter directed..."

Some military surgeons argued the outcome was not as good in military as in civilian life, but that was true of many things, since civilian nursing care was so much better among a patient's family. There was no alternative treatment other than to do nothing except try to control symptoms, so a doctor might try trephining anyway.

Answer: they felt Hammond was insulting their judgment, and he should be removed

In May 1863, Surgeon General William Hammond claimed "calomel had been pushed to excess by military surgeons," causing "innumerable cases of profuse salivation" and "the not infrequent occurrence of mercurial gangrene," according to an article by Major James Pilcher in the 1904 "Journal of the Association of Military Surgeons of the United States." The situation didn't last long. Upset doctors, believing Hammond implied they didn't know how to do their jobs, soon found trumped up charges to bring against him and before the end of the year he was effectively removed from office.

Answer: quinine, or dogwood bark as a substitute

In the swampy areas of the south, malaria was a common disease, and doctors didn't know it was spread by mosquitoes. Quinine was given to prevent it, but as an imported drug, it soon became of short supply in the blockaded South, when other medicines took priority to smuggle. One of the major experts on indigenous southern remedies, Francis Peyre Porcher looked for substitutes, suggesting holly, knotgrass, alder, yellow poplar bark or tulip tree bark.

He also mentioned boneset and dogwood, the latter "employed with great advantage" especially taking the place of cinchona, the imported bark that produced quinine.