School of the Sick Soldier"
Capt. Steve Oreck, M.D.

In conjunction with presentations by the medical staff of the 2nd Wisconsin will help you both in your understanding of the life of the soldier during the Civil War, and in your personal impression. In the diseases of the soldier, behavior of the wounded, and the interactions of the soldier with the medical staff, accuracy is just as important as your uniform, drill, or musket. We will cover some general organization of the medical department of the U.S. Army as it existed during the Civil War, the organization in an infantry regiment, sick call and diseases, and behavior if you are wounded.
For every solider who died of wounds, two died of disease. Furthermore, statistics indicate that the number of soldiers reported ill, in other words those sick enough to be at least taken off the duty roster temporarily, exceeded by several times, the strength of the Union Army during the war. What this means is that it is likely that every soldier who served was moderately ill at least once, and most had several bouts of sickness that took them off duty during the course of their service.

U.S. Army Medical Department in the Civil War
At the start of the war, the medical department was very small, hidebound, and basically incapable of dealing with the demands that came upon it. By 1863 the Army Medical Department had evolved to a basic structure that is similar to what exists today. By 1863 the medical department consisted of medical officers who were MDs - these were both regulars and volunteers. There were medical officers attached to regiments (infantry and cavalry usually), those attached to brigade and higher staffs, medical inspectors, and those medical officers attached to fixed hospitals. Hospital stewards, who ranked approximately as 1st sergeants, were skilled individuals who were usually apothecaries (pharmacists) or sometimes medical students - hospital stewards. were not   "medics", and they usually dispensed drugs (and compounded them), kept the records. They might assist with dressing wounds or giving anesthesia. There was a corps of Army nurses, these were under the "command" of Miss Dorothea Dix, and were required to be over 30, single, and "plain". These nurses served in more fixed hospitals and were not seen in the field. By late 1862 an ambulance corps, centered at the divisional level but with brigade detachments, was established and effective - these were soldiers detailed to this corps with distinctive insignia.
Various civilian organizations, the Sanitary Commission and the Christian Commission being two examples, consisted of volunteers, doctors and nurses, who assisted with the wounded, again usually off the field either in more fixed hospitals, on hospital steamers, etc.
Care began at the regimental level with the regimental staff (usually 2 doctors and one or two stewards). In garrison, there were fixed or semi fixed hospitals. In battle, one of the regimental doctors and the steward would set up an aid/dressing station close behind the lines and treat and evacuate the wounded. The aid station was usually marked with a red flag. Doctors from the regiments in excess of this number would be gathered in to brigade or divisional hospitals where most of the actual surgery would take place. A hospital (brigade/division/corps) was marked by a yellow flag with a green "H" - the size of this flag would vary with the level of the hospital, and this symbol was not adopted until 1862 .
Medical officers were surgeons or assistant surgeons. Surgeons would rank as majors or captains, and assistant surgeons as first lieutenants or captains. Medical officers had shoulder straps with a dark blue (staff) background and usually on the shoulder straps, on the caps would usually be a wreath with  in it and, as appropriate for the type of hat, a gold staff officers cord. Trousers might have a gold staff stripe or not. Medical officers wore a green sash (this was also true of Confederate doctors). Hospital stewards had green half chevrons with a caduceus in them on each sleeve, and red NCO stripes on the trousers. On the hat would be (usually) a wreath with  in it. Stewards wore a crimson NCO sash.
In an infantry regiment there would be a surgeon and an assistant surgeon and at least one hospital steward, at least on the books. It would not be unusual for a regiment to have only one doctor, the second being ill, on leave, wounded, or simply having resigned. In addition to the medical staff, there would be a certain number of soldiers detailed to the surgeon to act as nurses. At the beginning of the war, bandsmen were usually detailed for this, however this was changed due to it not working.

The Infantry Regiment/Sick Call
One of the most important jobs of the regimental surgeon was to see that the sanitary/cleanliness regulations were enforced. This included enforcing use of the sinks, and the shifting of these on a regular schedule. Camp cleanliness was also covered by regulation, as was the disposition of cooking garbage and the inspection of food/rations. Inspection for compliance with these regulations was the job of the surgeon, enforcement of the regulations was the responsibility of the company officer, and of course the NCOs.
First thing in the morning, the surgeon would hold sick call, with the sick being brought to the surgeon by the first sergeant. At sick call the surgeon would diagnose the patient, and the steward would keep the records and dispense/compound medications. A sick soldier could be returned to full duty, placed on restricted duty, allowed to rest in his quarters/tent, or admitted to the regimental hospital. If on the march, or about to begin a campaign those too sick to march would be sent to the rear - this was discouraged if at all possible, as men sent to the rear rarely made it back to their regiment for quite some time.
Sick call might be held in the afternoon/evening as well as circumstances might dictate.

Symptoms, Disease, and Treatment
Before we go too far in this section, remember that the average Civil War soldier was very unsophisticated as far as medicine went - nothing like the "informed consumer" of today. Many, if not most, of the soldiers had little if any contact with a doctor prior to entry in to the military. A soldiers description of his symptoms would be simple and straightforward - a cough, a fever, loose or tight bowels etc. Details of bodily functions would not always be easy for someone to discuss, remember that body/personal modesty was much greater during the Civil War, so it would be the doctor's job to ask the right questions, details of the diarrhea for example.
Symptoms would be fairly straightforward. In general the soldier would have complaints involving the bowels, urinary problems, pulmonary (lung) problems, feverish illness, skin disorders (including "camp itch" and boils), and mental problems.
Bowel problems were the most common for the soldier - bowels were either loose (diarrhea), or tight (constipation). Diarrhea is frequent stools. The doctor will want to know how frequent the movements are, are they "watery", is there blood and/or mucus in the stools. Questions about the diet (foraged foods etc.) will also be asked. A change in appetite ferquently accompanies bowel problems. Similarly, if constipated the doctor will want to know how long since the last time the soldier moved his bowels.
Urinary problems were not too common with the exception of venereal disease. Difficulty in urination, pain with urination would lead the doctor to ask about recent sex. An exception would be painful urination with some blood, this would lead the doctor to consider a bladder or kidney stone.
Lung problems were common. The key elements of symptoms would be cough, fever, and a change in breathing (breathing becoming rapid and/or labored). The doctor will want to know about exposure to dampness, and whether the soldier has a long history of cough, or has been living in close contacts with pards who have a cough. The character of the cough would be important: was it dry, producing mucus, purulent material (pus), or was there blood in the expectorant.
Feverish illness would cover a wide variety of diseases that would all present with fever. The fever could be acute or chronic. It could be high and spiky or it could be "remittent", that is coming and going on a regular schedule - every 12 hours, every 24 hours, etc. Prescence of fever only at night is an important distinction, and the prescence or abscence of chills preceeding the fever is another important distinction.
Skin disease/camp itch covers a wide variety of skin ailments. The basics in deciding how to treat would be based on the type of eruption and where. Prescence of pustules, and whether the itch is in the "hairy" areas (head/groin/underarms) or in the "cuff" areas (like waist band, ankles, wrists etc.). Another "skin" disease would be boils.
Mental illness would be manifested in several ways. "Simplemindedness" was not too uncommon, especially among soldiers enlisted once the draft was started - many mentally handicapped individuals were put forward to fill quotas, and some made it too the regimental level. Depression or mania could be seen - depression would have the soldier or pards describe him as "blue", the manic soldier would be described as always awake, and talking rapidly. "Combat fatigue" was seen during the CW (see below) - the soldier who had perhaps just seen too much might be withdrawn, not saying much or just talking of going home.
Diseases would not have been well understood by the average soldier. The disease that he might know would be pneumonia, consumption (tuberculosis), catarrh (influenza), typhoid, malaria, venereal disease, and various forms of mental illness (frequently called nostalgia - the CW equivalent of "combat fatigue").
Treatments during the CW were in a period of flux - the so-called "heroic" treatments with purging and bleeding were considered old fashioned. Treatments for the soldier would include dietary modification - with nutritious foods, wine, brandy. The use of whiskey as a stimulant was advised for most conditions. Quinine was used frequently for most fevers, and was actually effective especially in malaria - it would be given until the soldier had ringing in the ears and then the dosage would be reduced. For the bowels one would use either a purgative (laxative), typically "blue mass" (a mercurial compound) if the bowels were tight, or various opiates (such as opium pills or paregoric) were utilized as anti-diarrheals. For pneumonia, usage of expectorants for congestion, and application of external agents (like a mustard plaster) or cupping might be used. For boils surgical drainage was used.

The Wounded Soldier
Once a soldier was wounded severely enough that he could not carry on, he would go or be brought to the regimental aid station. There he would be examined, and his wounds dressed. If they were minor enough minor surgery might be performed, and he could be sent back to the battle. All of the wounded would receive "stimulants", that is whiskey, and might receive pain medication. Pain medication would be some form of opium such as paregoric or laudanum. From the aid station the soldier would walk if he could or be taken by ambulance to the hospital usually a mile or two from the battlefield. There he would receive more stimulants and/or pain medication as needed. His wounds would be reexamined and he would be taken in for surgery as needed. It must be stressed that almost all surgery during the Civil War was performed using anesthesia (chloroform or ether). The picture of the soldier having a limb amputated biting a bullet or just "liquor up" is wrong.
A very important point is the behavior of the wounded soldier. A shirker would exaggerate his wound to get off the battlefield, but the respectable soldier would be expected to bear up in a manly fashion. To the extent possible this would mean dignified, not hysterical, behavior on the part of the wounded. Please note that the wounded would be given alcohol and/or opiates so that by the time they made it as far as the hospital they had had some pain relief. The importance of "manly behavior" cannot be over emphasized. This was not only an ideal that was to be lived up to, but the "manly" behavior of the wounded was remarked upon in many sources.
It would not be untoward for a soldier to ask the surgeon to spare his limb, even to be somewhat forceful about it, but hysteria was the exception not the rule. Delirium is not very common in acutely wounded soldiers - if you go in to shock you generally just fade in to unconsciousness. Head wounds, if not severe enough to cause unconsciousness, may induce delirium. If you have a fever (malaria, typhoid, etc.) you may be delirious. A delirious soldier would usually call out for his mother, wife, or sweetheart.
Certain wounds, most abdominal and chest wounds for example, were considered "mortal" and beyond the capability of Civil War medicine to care for. Surgeons would make these soldiers comfortable, and generally would tell them their situation. These soldiers would frequently use this time to write a last letter home, gaze and a picture of their family, pray, or some combination of the above. If you are mortally wounded, writing a letter and asking one of your pards to send it to your family would be very appropriate.
As you would expect, the shirker would attempt to exaggerate symptoms, illness, or injury to get out of fatigue duty or combat. When such a soldier showed up the first sergeant would show obvious disdain when he brought the shirker to sick call, and the surgeon might exclaim "what? you again?". One scenario would be for the surgeon to have the shirker take off his shirt, and paint "deadbeat" in iodine on his back, then tell him to go back to his company and take off his shirt and show his back to the first sergeant who would "know what to do".
A final word, this is only a brief introduction to the soldier and his disease and injuries - which were a part of his daily life. Please feel free to take time to ask the surgeon or steward for more info or details to help you with your impression.

RE-ENACTMENTS/LIVING HISTORY SENARIOS

The soldier who wishes to portray a catarrh patient would present himself at sick call complaining of a dry cough, head cold, and some soreness to the throat. He may also complain of alternating chills and hot flashes. The doctor should question what color the patient's sputum is and if there is any blood in it. He should also ask the soldier/patient whether or not he has recently slept in wet clothes and/or on the damp ground, if this is not already known by the doctor.

The soldier who wishes to portray a malaria patient should complain of chills followed by fever, especially after standing picket duty or marching at night in or near swamps/marshes. He may state that his tongue feels/tastes strange and that his pards have told him he looks sickly. The reenactor doctor can and should ask questions pertaining to the appearance of symptoms described in the text above.

In senarios depicting mental illness/"alienation", the reenactor team of physician and patient should work togethcr to create an impression in which the doctor evaluates by observing the patient's behavior and asking questions. The patient is both symptomatic and responsive, if mildly impaired, or unresponsive, but showing symptoms, if seriously impaired.
The doctor will ask the patient these, and other, questions if the patient is mildly-moderately impaired. He will ask the patient's comrades if the patient is severely impaired and cannot respond.
(Bearing in mind all of the symptoms and diagnoses above)

SAMPLE QUESTIONS
Q: What seems to be the trouble?
Q: How long has this been going on?
Q: When did this first start?
Q: What are your (his) bad habits?
Q: What do you (does he) talk about?
Q: How much? How often?
Q: What has he done that was strange?
Q: Is he more violent than most of the troops?
Q: How do you (does he) sleep?
Q: What's peculiar about him?
Q: What are your (his) moods like?
Q: What's the worst thing you've (he's) done lately?
Q: How do you feel?
Q: Has this happened before? When?
Q: Has this happened to anybody in your (his) family?
Q: How are you (is he) eating?
Q: When are you sad or crying?

Moderate to severe cases will be the most apparent and interesting impressions. The truth is often obtained from those who know the patient well.

They may describe his behavior, and he may act, in any terms of the of the diagnostic symptoms listed above to create a particular condition of mental alienation. These may be treated by the medications you have on display for the public that you would like to perscribe.

You've read them! You've Wondered About Them! Hopefully not been accused of having them....

Health Terms - 18th Century and Later...
Ague Malaria,
Chills, Fever
Canine Hydrophobia
Catarrh Sinus infection
Commotion Concussion
Consumption Tuberculosis
Corruption Infection
Costiveness Constipation
Cramp colic Appendicitis
Dropsy Edema
Falling sickness Epilepsy
Felon Infection finger
Flux of humor Circulation
French Pox, Spanish Pox, Venereal disease
Green sickness Anemia
Grippe Influenza
Hallucination Delirium
Hepatic Melancholy Cirrhosis of the Liver
Hives Acute allergy
Infantile paralysis Polio
Lung sickness Tuberculosis
Lung fever Pneumonia
Mania Insanity
Mortification Infection
Piles Hemorrhoids
Pink eye Conjunctivitis
Putrid fever Diphtheria
Remitting fever Malaria
Sanguinous cyst Scab
Seven year itch Scabies
Ship, Jail, Campfever Typhis
Sleeping sickness Encephalitis
Sore throat Quinsy
Strangury Rupture/stricture
Stroke Rupture of blood vessel
Throat ailment Diphtheria
Vapors Fainting
Wan Sebaceous cyst

Susan Johnson