04/09/2026
Meeting Summary: April 2026 – "Civil War Medicine"
The April 2026 meeting of the Cleveland Civil War Roundtable featured an exceptional presentation by Dr. Fred Marquinez. Fred's presentation focused on medical treatment of soldiers during the Civil War. His presentation was extremely informative, very thorough, and truly engrossing. Fred covered a wide range of topics related to Civil War medicine and did so in a detailed and engaging way.
Fred noted that the Civil War occurred at a time of transition in medical thinking from an ancient point of view to a more modern perspective. The more modern thinking was not yet widely accepted in the U.S. at the time of the Civil War, which resulted in antiquated medical treatments for soldiers. Fred explained that at the beginning of the Civil War, the procedures that were in place for handling the wounded were appalling. He stated that after both the First and Second Battles of Bull Run, some wounded soldiers remained on the battlefield for as long as a week. Fred went on to discuss that two men, William Hammond and Jonathan Letterman, were chiefly responsible for implementing innovative and improved procedures for treating the wounded.
As Fred described, Letterman devised a protocol for handling the wounded that provided rapid removal from the battlefield, initial medical treatment soon thereafter, and long-term treatment until recovery. Letterman's implementation of rapid removal from the battlefield soon became evident when at the Battles of Antietam and Fredericksburg the wounded were removed within a day. Hammond, as surgeon general of the Union Army, mandated extensive record-keeping of the treatment of wounded soldiers. This facilitated the collection of large amounts of information regarding outcomes, which gave rise to informed revisions of procedures to effect better results in the future. Hammond also mandated an improved layout for larger hospitals, such as pavilion hospitals, which had high ceilings for greater openness, better air flow, and more light. This provided a better environment for long-term recovery.
Fred noted that by far the vast majority of Civil War wounds resulted from bullets rather than swords or artillery. Fred explained that Civil War bullets caused extensive tissue damage when they entered a human body. As Fred discussed, head and abdominal bullet wounds were almost always fatal, but he presented the stories of a few Civil War soldiers who made incredible recoveries from severe head or abdominal wounds that were pronounced mortal by the surgeons. Bullet wounds to an arm or a leg typically resulted in extensive bone damage, because when the bullets impacted a bone, the bone was often shattered beyond the capacity for repair. This is why amputations were so widespread in the Civil War, because no other treatment was possible for survival of the wounded soldier. Fred also described the advancements in prostheses for amputees.
Fred discussed that the most serious problem impacting survival after amputation was disease, such as gangrene. This led Fred into an overall discussion of diseases among Civil War soldiers, which, as Fred pointed out, caused more deaths than combat. Some of the diseases contracted by Civil war soldiers were typhoid fever, smallpox, dysentery, and malaria. Treatment of diseases was inadequate, primarily because of the lack of knowledge about the causative agents, that is, germs. Without antibiotics, disease medicines were mostly ineffective and included such things as opiates, turpentine, bromine, and calomel. Calomel (mercurous chloride) was widely used, but had very deleterious side effects, such as facial bone erosion.
Fred ended his detailed discussion of Civil War medicine with the astounding experiences of a Union soldier named Henry Barnum. Barnum was shot through the pelvis at the Battle of Malvern Hill, and his wound was considered fatal, but Barnum survived. Months later, his still open wound was examined by doctors, who cleaned the wound and covered it with a fabric tent to keep the wound open and draining. Fred showed a famous photograph of a wide-awake and standing Barnum with a rod inserted completely through his pelvis from the entrance wound to the exit wound. Astonishingly, the wound did not become infected. Even more astonishingly, Barnum returned to active service and was twice wounded during subsequent battles. He survived the war and had a post-war career, including some time in elected office.
Fred concluded his excellent presentation by indicating that current medical practices in the military can be viewed as Civil War medical procedures onto which have been overlaid technological advancements that have occurred since then, such as medical evacuation (but with contemporary vehicles), rapid treatment of the wounded (but with better medicines and treatments), hospital trains and ships (but with modern trains and vessels), and prostheses (but with modern designs and materials). The Roundtable is extremely grateful to Fred for his outstanding, exceptionally thorough, and very engrossing presentation.
A more detailed summary of Fred's superb presentation can be found on the home page of the Roundtable's website (www.clevelandcivilwarroundtable.com).
