A somber sunset closed the final day of the Battle of Gettysburg July 3, 1863. The bugles, bands and bravado were gone. Where wheat had grown on Cemetery Ridge there was a blistered earth littered with the bodies of horses and of men who wore both blue and gray. An eerie silence magnified the sporadic crackle of receding skirmish fire. Storm clouds were gathering.

According to Harry W. Pfanz in Culps Hill to Cemetery Hill, published in 1993, "Burial details from [Brig. Gen. Junius] Daniel's brigade, and probably others, performed their gruesome chore. The corpses had been lying in sun and rain for three days and had an awful odor. Private [Louis] Leon of Daniel's brigade thought it odd that 'all' of the Yankees' corpses had turned black."

Most of these young men were new to this experience. The Army Historical Series, The Army Medical Department, 1818-1865 describes the state of military medicine at the time: "The years between 1818 and the start of the Civil War were in many ways the darkest in the history of medicine in the United States."

Neither side of the conflict was prepared for the Civil War in terms of ferocity, the consequent flood of killed, wounded, and diseased or the logistical needs and the tragedies resulting in the civilian sector.

A hero of medicine

A capable doctor came to the rescue. US Civil War.Net, eHistory reports that Dr. Jon Letterman is "known today as the 'Father of Battlefield Medicine.'" Among his accomplishments: "As medical director of the Army of the Potomac, he developed an ambulance system for getting the wounded off the field. At Antietam, he managed to do this all within 24 hours."

In his report on Gettysburg, Letterman quoted surgeon John McNulty, medical director of the Union 12th Corps, who wrote of the new evacuation plan, "It enabled me to remove the wounded from the field, shelter, feed them, and dress their wounds within six hours after the battle ended, and to have every capital operation performed within twenty-four hours after the injury was received."

Even so, some wounded bled to death before the evacuation details could get to them.

Cannon fire frequently started grass fires. The wounded, unable to get away, suffered serious burns. If possible, fellow soldiers helped the wounded to the rear for medical care. Sometimes, the helper just kept going.

Battlefield care

The battlefield was sometimes the scene of crucial medical attention. Amputation of wounded extremities was the most expedient and life-saving procedure. The most successful were those performed within 48 hours of injury.

The Everything Civil War Book, by David Vaughan, states, "As horrible as Civil War surgery was, it was often amazingly successful in saving a wounded soldier's life. According to the Army Historical Series records, of nearly 30,000 amputations performed during the war, only 7,000 or so patients died as a result." That is about 77 precent saved.

According to the National Museum of Civil War Medicine, fatalities increased the closer the amputation was to the torso.

According to the Army Medical Department's Civil War Battlefield Medicine, "Bloody fingers often were used as probes. Bloody knives were used as scalpels. Doctors operated in pus-stained coats. Everything about Civil War surgery was septic. The antiseptic era and Lister's pioneering work in this field were in 1865, right as the war was ending. Blood poisoning, sepsis or Pyemia [Pyemia meaning literally pus in the blood] were common and often very deadly."

Surgical fevers also could develop, as could gangrene. One witness described surgery as such: "Tables about breast high had been erected upon which the screaming victims were having legs and arms cut off. The surgeons and their assistants, stripped to the waist and bespattered with blood, stood around, some holding the poor fellows while others, armed with long, bloody knives and saws, cut and sawed away with frightful rapidity, throwing the mangled limbs on a pile nearby as soon as removed."

It was hard to decide which was worse, the medical procedures or their aftermath. Most vehicles used as ambulances had no springs and the roads were rough.

A report by Confederate Brig. Gen. John D. Imboden quoted in Retreat from Gettysburg, Battles and Leaders of the Civil War, edited by Robert Underwood Johnson and published in 1956, described the conditions the next day: "Shortly after noon of the 4th the very windows of heaven seemed to have opened. The rain fell in blinding sheets; the meadows were soon overflowed, and fences gave way before the raging streams. During the storm, wagons, ambulances, and artillery carriages by hundreds -- nay, by thousands -- were assembling in the fields along the road from Gettysburg to Cashtown, in one confused and apparently inextricable mass."

'Why can't I die?'

Imboden went on to say, "From nearly every wagon as the teams trotted on, urged by whip and shout, came such cries and shrieks as these: 'O God! why can't I die?' 'My God! will no one have mercy and kill me?' 'Stop! Oh! for God's sake, stop just for one minute; take me out and leave me to die on the roadside.' 'I am dying! I am dying! My poor wife, my dear children, what will become of you ?'

"Some were simply moaning; some were praying, and others uttering the most fearful oaths and execrations that despair and agony could wring from them; while a majority, with a stoicism sustained by sublime devotion to the cause they fought for, endured without complaint unspeakable tortures, and even spoke words of cheer and comfort to their unhappy comrades of less will or more acute nerves."

As grim as battlefield surgery was, hospital treatment with its widespread infection could be worse. Disease and infection took twice as many lives as rifle and cannon. Most of the soldiers had never been vaccinated and had little or no immunity to the epidemic diseases. According to the Army Historical Series, "Diarrhea and dysentery alone claimed more men than did battle wounds. The Civil War soldier also faced outbreaks of measles, smallpox, yellow fever, malaria and pneumonia. ... Malaria was brought on by usually camping in damp areas" that were conducive to breeding mosquitoes. Lice were a universal problem for both sides, private to general.

Doctors knew little or nothing of bacteriology and were ignorant of what caused disease. Doctors during the Civil War for the most part had two years of medical school, though some pursued additional education. They were woefully behind Europe.

According to the Army Historical Series, "Harvard Medical School didn't even own a single stethoscope or microscope until after the war. The Army Medical Department had only 20 thermometers. Most Civil War surgeons had never treated a gunshot wound, many had never performed surgery." Treatments at best were uncertain.

Defective diet

"A potential cause of disease that received little attention early in the war was the Army's defective diet. Scurvy was already appearing by the end of 1861, even though it takes some weeks or months to make its appearance in men whose supply of vitamin C has previously been adequate," according to the army.

The Army Medical Department, 1818-1865 history was written by the Union Army, but the Confederates had the same problems, often more severe. Confederates kept fewer records and fewer still survived the confusion that followed the surrender at Appomattox Courthouse.

Commanders, trained in traditional tactical thinking, preserved the shoulder-to-shoulder line of battle, presenting an ideal target for longer-range and more accurate rifled cannon fire using ball, shell and canister shot. The same was true for the new, more accurate rifled-bore, shoulder arm, and the breech-loading, repeating rifle.

As horrid as it was, great advances in medicine resulted, mostly from the records and reports that Letterman demanded.

In addition, the medical profession was increasingly interested in the provable causes of disease. The burgeoning science of bacteriology was producing astonishing and useful information.

The role of the medical profession throughout the Civil War is remarkable.

The records of the Army Medical Department, 1818-1865 state, "During the struggle and the months immediately following it, more than 12,000 medical officers -- regulars, volunteers, and contract -- examined over 250,000 wounds and treated more than 7 million cases of disease. In the course of their duties, more than 300 army surgeons died from wounds, disease, or accidents."

Need for nurses

The need for nursing during the war brought 4,000 women volunteers to Union army hospitals and almost as many to the Confederates, according to The Everything Civil War Book. While many doctors resisted the presence of women, most came to appreciate their help in military hospitals.

Perhaps to combat the stereotype of women as frivolous, Dorothea Dix, placed in charge of all female nurses in Union hospitals, accepted only "women who were plain-looking and over 30 years old." Vaughan also describes the work of Clara Barton, given "permission from the U.S. surgeon general to take needed medical supplies directly to the front lines and field hospitals." No later war would find an American army as ill-prepared to handle battlefield casualties as were both sides in the War of the Rebellion.

"More Americans died during the Civil War than all other American wars combined, from the Revolutionary War to Vietnam, including both World War I and II," according to Vaughan's Everything Civil War Book.

Out of this horrific struggle came significant changes in the Army's Medical Department; in medicine, both military and civilian; as well as in medical research in general.

Robert M. Duff is a free-lance writer from Crofton.