When Mark Twain said, “Don’t let schooling interfere with your education,” he might have been thinking about the American medical system in the 19th century. It was called primitive, even medieval. In 1861, at the outbreak of the Civil War in America, the combined total of qualified doctors for both sides was only 122. Prior to the war, there were less than six medical training hospitals in the United States. Their standards were slack and not comprehensive - only requiring the student to complete two years of study, sometimes even less. On top of this, clinical work was not offered and there was no requirement for the prospective doctor to even attend college.
For example, in Richmond, The Medical College of Virginia simply required the candidate to sign up for two medical seminars. The seminars were short, some lasting only a few days, and absences, even chronic ones, were allowed. There was no form of standard licensing or even a responsible agency to provide oversight. To be a medical doctor one just needed to claim he was one. Thus, most Civil War doctors had little to no experience or training. Many times they were either politically appointed, or for various reasons ended up in the medical corps.
The Civil War came as a perfect storm. The country had not fought a major war for more than fifty years. Politicians were still stuck in a mindset of a previous time, and both sides were confident, as well as naive. Since the early 1800’s military weaponry had improved by light years. There was, unfortunately, little consideration of the human loss that would come from using these weapons. In some of the early battles there were over 20,000 casualties, but only a handful of medical people to help.
Ninety four percent of the battlefield injuries were caused by bullet wounds. The minie’ bullet was a half-inch sized cylindrical shaped soft lead bullet. It originally had a small iron plug in the base that helped propel it forward. As the war began the bullet was redesigned from round to elongated, and the iron plug was eliminated. The change doubled the accuracy of the bullet to nearly 500 yards and the damage to the victim was catastrophic. No one had imagined the horror that came from this one modification.
America was busy during the 1800’s. Modernization was sweeping through the country. Research was going on to develop hand grenades and machine guns – decades before their time. Elevators were being installed in the cities of Boston and New York. Farming was being revolutionized with the invention of the harvesting machine. Steam engines and steel ships were being designed, and the industrialization of America was underway. Despite the progress in these areas and other areas, medicine was a dead field. It was acceptable for untrained doctors to go to war with a new mahogany surgical kit and a textbook on how to amputate a soldier’s limbs.
There are many stories about the poor medical treatment received by Civil War soldiers. Most of the complaints were related to battles in the first year or two. Towards the end, however, historians agree that standards had improved significantly. The improvements were due to the experience gained by the doctors. Some studies even suggest that doctors who received their training on the battlefield did as well as those who were classroom trained. Mark Twain would have been proud.