Between Flesh and Steel (30 page)

The French Society for the Aid to Wounded Soldiers obtained its first experience in providing ambulance and medical personnel to troops in battle with some considerable success. By the end of the war with Germany in 1870, however, many commonly recognized that the French medical service needed reform. In 1878, the International Congress of Military Medicine held in Paris passed a resolution calling for the creation of an autonomous medical service to guarantee better control over medical assets in wartime. A governmental commission was appointed to study the problem but adjourned a year later with no results. It required ten years' worth of coverage in newspapers and journals to convince the French legislature finally to vote, in 1882, to create a semiautonomous military medical service. In 1889, the French became the last major Western power to adopt an autonomous military medical service for its armies. They created a new medical school to train military
physicians, and they improved and organized recruitment. At last the medical personnel had control over their own resources, but they were still greatly restricted in their control and authority over the support resources needed to make the medical service perform adequately. This state of affairs continued until 1914 where, once again, the French entered another major war with a less than adequate medical service to treat its casualties.

If the medical care provided to the armies of France and England was poor, it was poorer still in the Russian Army. The Russian military medical corps entered the nineteenth century considerably behind the medical services of Europe because the medical profession in Russia was chronically underdeveloped. The country had only a few facilities for training physicians and surgeons, and their graduates were not attracted to a normal military career, which required twenty-five years of service. Consequently, the czarist armies relied heavily on barber-surgeons. Although the service made some efforts to train these feldshers, most of the medics assigned to military units were only marginally competent. In 1805, the Russian Army had only 74 feldshers assigned to the army and 388 to the navy.
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The official army title for them was
tsiriulnik
(barber), a title that reflected their low status.

At the outbreak of the Crimean War, however, Russia was able to produce sufficient numbers of barber-surgeons to fill out most field units. Indeed, as noted earlier, the Russian Army had the largest ratio of medical men to force, with 1,608 officers and more than 3,759 feldshers serving in the Crimean War.
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Despite these numbers and Russia's internal lines of communication in the theater of operations, the quality of medical support provided to the Russian Army was dismal. What few hospitals existed were makeshift affairs and had high mortality rates from infection. Few provisions had been made for adequate beds and linen and none for an ambulance service. Transport was accomplished with whatever available wagons could be obtained on the spot, and the wounded were regularly transported while unprotected in foul weather. At the Battle of Sevastopol (1854–1855), the nearest aid station was sixteen miles away, and the trip in the open wagons took seven days.
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As mentioned previously, the most famous Russian surgeon to serve in the Crimea was Nikolai Pirogov. Well educated and having traveled extensively in Germany and the West, Pirogov had seen military duty in the Caucasus campaign in 1849 and was the first European military surgeon to use etherization in surgical procedures on battle casualties.
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Pirogov served two years in the Crimea as a battle
surgeon, was an observer in the Franco-Prussian War and the Turko-Russian conflict, and developed renown as Russia's greatest surgeon.
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He published two major works on military surgery,
Introduction to General Military Surgery
and
Principles of General Military Field Surgery
(1865), that are both regarded as classics. He was also a strong campaigner against large hospitals, which he viewed as cesspits of disease from overcrowding and poor sanitation. Instead, he recommended the use of pavilion hospitals along the model of those first used in the American Civil War.

Only two medical highlights emerged from the medical disaster of the Crimean War. First, the French surgeons' widespread use of chloroform and the Russians' use of ether convinced the rest of the world that anesthesia was an important and effective aid to field surgery. Although the British were slow to adopt its use, anesthesia became standard military medical procedure in the Union Army during the Civil War. A second important medical advance was the debut of plaster of Paris in splints. Antonius Mathijsen (1805–1878), a Dutchman, published his work on using plaster for bandaging broken bones in 1852. He may have called it plaster of Paris because in Paris in 1765 Antoine Laurent Lavoisier (1743–1794) had shown that a 95 percent solution of calcium sulfate with the right amount of water would crystalize and harden.
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Until plaster of Paris, physicians immobilized fractured limbs with a bandage stiffened with freshly made starch and cardboard, but the technique had little military use, since the starch took twenty-four hours to harden. While the evidence is less than clear, it seems likely that while in the Crimea, Pirogov was the first surgeon to use plaster of Paris splints in a military environment.
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Protected by its oceans, the United States remained little affected by the frequent wars in Europe. Accordingly, its military medical establishment had fewer opportunities to develop in response to actual field experience. The army was dismantled at the end of the American Revolution, and by 1802 the medical corps had only two surgeons and twenty-five mates. These few assets were assigned to garrisons and frontier posts and not the regiments. By 1808, the number of surgeons increased to seven and surgical assistants to forty. With the start of the War of 1812, the army found itself critically short of medical staff. Although additional medical personnel were obtained through the contract system, the number of medical officers was never sufficient to provide adequate medical care.
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The medical corps thus fell back on the old practices of the Revolution. Lacking an ambulance corps, the medical corps sent what few wagons it could obtain to search the battlefield and the woods to find the
wounded. There were no hospitals. Temporary shelters called “Indian houses” were built after each battle, and the wounded were treated there.
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Requests to establish an ambulance corps were ignored, and with the cessation of hostilities the army once again dismantled its medical service.
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The medical system of 1812 suffered most from the army's failure to provide a central authority responsible for creating and deploying medical assets. In 1818, Congress authorized the appointment of a surgeon general to head the medical corps, establishing for the first time an administrative organization for the medical department. Dr. Joseph Lovell (1788–1836), the first American surgeon general, served until 1836. At the start of the Mexican War in 1846, the American Army of 7,000 men included a medical corps consisting of a surgeon general and 71 medical officers. Congress increased the number of medical officers to 115 for the regular forces and 135 for the volunteers. The army had grown to about 100,000 men, proving even these increased medical assets inadequate.
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No provisions were made for an ambulance corps, although a few Larrey-type ambulances were used, and the old practice of begging available wagon transport from the quartermaster prevailed. Regimental hospitals used a few tents to provide primary medical care to the wounded; however, they were usually understaffed and inadequate to deal with the numbers of casualties. General hospitals were few and still created on an ad hoc basis. Both types of hospitals lacked stewards, nurses, cooks, adequate supplies, and trained physicians. Once again, the American Army suffered a medical disaster.

Of the 100,182 combatants committed to the Mexican campaign, 1,458 were killed in action and 10,790 died of disease. Statistically, the Mexican War was the deadliest from disease ever fought by an American force. Per 1,000 men per annum, mortality from disease averaged 110 men compared to a rate of 65 for the Civil War, 27 for the Spanish-American War, and 16 for World War I.
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The single positive medical contribution of the Mexican War was that an American military surgeon used ether anesthesia for the first time in combat. After the war, the American military medical service was once again reduced in strength, and no significant reforms were achieved.

Thirteen years later, no one was prepared for the magnitude of slaughter that accompanied the American Civil War. It was the first modern war insofar as the integration of the productive capacities of the Industrial Revolution with the military effort was complete. The magnitude of combat engagements was the largest in history to that time, and the exponential increase in the weapons' killing capabilities, especially the improvements in the rifle, produced rates of casualties beyond the imagination
of commanders and military medical personnel. In a five-year period, the combatants fought 2,196 engagements.
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A total of 620,000 men perished, 360,000 in the Union Army and 260,000 in the Confederate Army.
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Some 67,000 Union troops were killed outright, 43,000 died of wounds, and 130,000 were disfigured for life, often with missing limbs. In the Confederate forces, 94,000 men died of wounds.
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For the Union Army, the minié ball caused 94 percent of all wounds, artillery shell and canister led to nearly 6 percent, and the sabre and bayonet accounted for 922 wounds, of which only 56 were fatal.
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Thirty-five percent of the wounds were to the arms, 35.7 percent to the legs, and wounds to the trunk and head accounted for 18.4 percent and 10.7 percent, respectively.
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In a statistical sense, the Civil War was the most horrible war ever fought. The chance of a Civil War combatant
not
surviving the war was 1 in 4 compared to 1 in 126 for the Korean War. Of the Union dead, 3 of every 5 died of disease; in the Confederacy, 2 of every 3.
Tables 8
,
9
, and
10
provide statistical summaries of the official casualty data for the Union Army.

Table 8. Special Causes of Death in the Union Army

Table 9. Wounds and Sickness in the Union Army

Wounds

Of the 246,712 cases of wounds reported in the Medical Records by weapons of war, 245,790 were shot wounds and 922 were sabre and bayonet.

Sickness

Of 5,825,480 admissions to sick report there were:

One reason for the staggering increase in the number and seriousness of the men's wounds was the introduction of the new Springfield .58-caliber rifled-barreled firearm capable of propelling a minié ball at 950 feet per second to an accurate range of 600 yards. It used heavy, soft lead bullets that were unjacketed. The bullets flattened out upon impact, producing terrible wounds and carrying pieces of clothing into the wound itself. When the bullet nicked a bone, the weight and deformation of the projectile shattered the bone or severed it completely from the limb. Traumatic amputation or compound fracture was the most common result. Incredibly, the infantry continued to use the old tactic of massing forces to concentrate their firepower, which the old, inaccurate and limited-range musket necessitated, and made their formations vulnerable to long-range rifle fire. Moreover, the need to move the lines over greater frontages than ever before also increased the dispersal of the wounded to unprecedented levels, placing a greater premium on the ability to locate, treat, and evacuate the wounded. The Civil War medical officer faced problems of wound management that were unique for the time, and he was as unprepared to deal with them then as he had been in previous wars.