Modern Medicine in the American Civil War

In a lot of ways, the men (and small numbers of women dressed as men) who fought the American Civil War had the worst of both worlds: They were fighting (especially in Phase II, 1864-1865) a modern industrial war; but unlike their counterparts in World War I, didn't have the benefits of modern medicine. It did not have to be thus: the "pieces" of modern medicine were lying around Western civilization for a very long time--microbes had been known about since the 1600s, bacteria from the early 1800s;before being assembled, quite quickly, very soon after the ACW into something instantly recognizable to us 21st-century types. The two biggest things that would have helped Billy Yank and Johnny Reb in practice: antiseptic procedures, and modern field sanitation.
There's most likely a single POD in the 1830s or 1840s that would bring the whole package to America before Fort Sumter, but I can't puzzle it out. So I'l cheat a bit and do a twofold POD: 1) Germ theory shows up in France, a single generation before it did OTL, and is transmitted to American medical schools via academic vectors; and 2) the British Army figures out the basics of field sanitation during the Crimean War. There's an extremely clear vector for that one: Gen. George McClellan was the U.S. Army's official observer there, and for all his faults the man was an excellent organizer and instiller of discipline (a necessary component of field san. even today), and cared about the welfare of his troops. Let's leave triage out and say it was developed as OTL, i.e. by Jonathan Letterman and pals in 1861 and 1862. So by the time Antietam is over, the Union at least has as good a medical system (with one key shortfall, to be discussed later) as the British Army had in 1914 (although horse-drawn ambulances instead of lorries, but that's barely a disadvantage given the primitive state of motor transport in '14).
This is by no means a trivial change. In the Civil War, roughly 2 Union soldiers died of disease/non-battle injury (DNBI) for every one that was Killed in Action (KIA) or died of wounds (DOW). In World War I, roughly 17 British soldiers were KIA/DOW for every 1 DNBI. Now, the ratio wouldn't be quite as high: fewer ACW soldiers will be KIA/DOW because of the absence of machine guns and barbed wire; and more will still be lost to DNBI because, even if Union doctors understood the malaria vector and mitigated it through field san., they still couldn't treat it until quinine was invented (that, plus the fact that Belgium and northern France aren't anopheles country, is the big advantage that solders in WW1 would still enjoy). So let's say that there's "merely" a reversal of the ratio and that ATL, 1 Union soldiers is DNBI for every 2 KIA/DOW. Even if the Confederates maintain the same ratio (they might; because although their triage system was weaker, their doctors were probably about as good *and* their folks didn't die of malaria nearly as often due to 'seasoning'), this is still a massive advantage for the Union.

So, obvious result: Union wins faster. But are there any *other* major impacts?
 
The strain of malaria that exists in the US South is nowhere near as potent as what's found in Africa.

In any event, this will be a massive boon to civilian society post-Civil War. Many people who may have died of disease or infection will now be alive. This will have its attendant effects on history.
 
The strain of malaria that exists in the US South is nowhere near as potent as what's found in Africa.
Well, sure, but it was potent enough to kill, in spades, the Yankees, Germans, and Irish who crossed the anopheles boundary somewhere in central Virginia. I don't remember the statistics, but I saw them once, but I believe that about 30% of Union DNBI (disease and non-battle injury) casualties were from malaria. The most common, of course, was dysentery, from living in camps for long periods of time and thus drinking water contaminated with fecal matter and its attended E. coli.

In any event, this will be a massive boon to civilian society post-Civil War. Many people who may have died of disease or infection will now be alive. This will have its attendant effects on history.
True. On the other hand...it's pretty clear to me that an earlier Union victory is *not* to the advantage of the Americans who had the most at stake in the war: enslaved African-Americans. The earlier Union victory occurs, the worse off AAs will be. A rapid Union victory in 1861 (which would not be a likely outcome given this POD at all) probably preserves slavery in at least some areas of the U.S. IN fact, any Union victory before fall 1862 is likely to preserve it in at least the Unionist slave states. I think this POD is likely to accomplish a Union victory in either 1863 or early 1864; beyond the Emancipation Proclamation, but without the U.S. Colored Troops having proven their value to the Union cause.
 
don't be so sure that it helps the union more. yes the numbers of "not dead":confused: is in there favor they already had a huge pop advatge .the add on the souths might help more. it will still end with the union victory but it might be a few months to a year and a half later than OTL.
 
If someone pays attention to Simmelweiss's treatise in 1847 and pays attention to other goings on maybe John Snow puts theory to use and brings down cholera cases in London in 1854. Germ theory gains greater acceptance and Americans, desperate to get their people back to the killing fields, decide that maybe there's something to this after all. In OTL 1867 Baron Joseph Lister began sterilization of instruments and hand-washing in 5% phenol solutions, it would not be a stretch to see this begun in the US (likely with the Union Army, though if desperation breeds innovation maybe the rebels start the trend). If properly done maybe someone even decides to read Varro's treatise "On Agriculture" and blunders onto a crude antibiotic or decent public health schema in the 1860s. This could avert lots of yellow fever and cholera deaths in hte late 19th century and might even save the life of President Garfield, who died after his surgeon explored the bullet wound with his bare hands following the assassin's gunshot. If left in place or not probed at all perhaps the President lives on. This leads to a potential for expanded civil rights for American blacks, an earlier naval revival, an earlier Panama Canal, and a whole lot more butterflies.
 
From:

http://www.civilwarhome.com/casualties.htm

Union dead: 110,070 battle deaths, 250,152 other deaths, 360,222 total.
Confederate dead: 94,000 battle deaths, 164,000 other deaths, 258,000 total.

The Confederate figures are of course approximations, but the Union figures should also be viewed with caution. If we assume that most of the non-battle deaths are due to disease and the ratio with improved sanitation and hygiene is 2 battle deaths to 1 death from other causes, then the revised figures would be:

Union dead: 110.070 battle deaths, 55,035 other deaths, 165,105 total.
Confederate dead: 94,000 battle deaths, 47,000 other deaths, 141,000 total.

In other words a reduction of 50% in the death toll.

However, the reduced figures given above would not be the actual casualties for the war. Less men struck down by disease means more men in the ranks means higher battle casualties for both sides. As a rough guess, if battle casualties are 50% higher, then the revised figures are:

Union dead: 165,000 battle deaths, 82,500 other deaths, 247,500 total.
Confederate dead: 141,000 battle deaths, 70,500 other deaths, 211,500 total.

Thiis is a reduction of 150,000 from the OTL figures, which is definitely a desirable result.
 
The germ theory of disease will pay off, but you're still going to get a lot of deaths from overworked and understaffed and chaotically organized hospital systems.

Field sanitation will take even longer to properly install. Its not that OTL no one had any idea how to set up a proper camp. Its that the army was swamped by volunteers who largely ran their own affairs anyway, their was little organization and staff, etc. In addition, many of the deaths were rural boys dieing of childhood diseases they hadn't run across before. Increased sanitation won't help that much.

This POD will save a lot of live, but maybe not as many as you'd think.
 
The major issue with field sanitation was, on both sides, an inability to get the troops to follow the rules. This was even when officers/NCOs tried to enforce them, in many cases officers/NCOs thought the rules and/or the effort to enforce them were unnecessary. This persisted long after in OTL with command levels ignoring medical advice (see Kitchener in the Boer War for example, lots of others). Simply enforcing the rules already on the books would be helpful, as would be properly (with alcohol, carbolic acid (what Lister used) etc.) instruments & so forth. Simply doing the above was a key in the difference between disease problems in the French Army (bad) and German Armies (good) in the Franco-Prussian War of 1870.

Immunizations (other than smallpox which already existed) are a minimum of 35-40 years after the ACW, and the first effective antibiotics (sulfa drugs) about 65-70 years in the future. Also note that distinguishing between malaria and typhoid took another 20-30 years, the diagnosis of "typho-malarial fever" was common.

Tons of other details are important...but to make a huge difference from "science" as opposed to simply following rules already out there, you need to advance medical science by about 50 years (to WWI levels) and even then no antibiotics. Any "science" advancements will favor the Union rather than the Confederacy, as the former has the industry to produce any "stuff" needed to improve medical outcomes, whereas the latter imported from the north or Europe EVERYTHING medical and OTL supplied its military medical service partially with captured northern supplies and some "herbal" alternatives (Quinine was almost nonexistent in the CSA by the end of the war because of the blockade).
 
The germ theory of disease will pay off, but you're still going to get a lot of deaths from overworked and understaffed and chaotically organized hospital systems.
I dunno...I'm again forgetting the exact stat, but if you made it to a Union general hospital, you had a pretty good chance (75%?) of surviving. Add antisepsis and this should go up even higher. Nosocomial infection was fairly rare in military hospitals, because people were there to recover from gunshot wounds, not because of contagious disease.
Field sanitation will take even longer to properly install. Its not that OTL no one had any idea how to set up a proper camp. Its that the army was swamped by volunteers who largely ran their own affairs anyway, their was little organization and staff, etc.

Little organization and staff? This is just not true of the army of the Potomac by 1863.


In addition, many of the deaths were rural boys dieing of childhood diseases they hadn't run across before. Increased sanitation won't help that much.

This POD will save a lot of live, but maybe not as many as you'd think.
 
don't be so sure that it helps the union more. yes the numbers of "not dead":confused: is in there favor they already had a huge pop advatge .the add on the souths might help more. it will still end with the union victory but it might be a few months to a year and a half later than OTL.
Nah. If Grant can keep a larger army in the field, with fewer of them dying of camp disease, he can throw more men into infantry attacks and thereby kill more secesh. lee can't replace his losses. Obviously northern Virginia isn't the only theater, and not even the most important one, but the dynamics appear t o be about the same for all the field armies, don't they?
 
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