(gentle pensive music) (fire crackling) - [Narrator] It's a time of really of change in medicine.

A lot of things that we take for granted today are an outgrowth of the war.

(explosion booming) (air whooshing) - [Narrator] Residents came face to face with disease, with bloodshed, and with the very unfortunate reality of all that warfare brings.

- [Narrator] The most common remedy for the injuries that take place on the Civil War battlefield is amputation.

- [Narrator] The infection is really what you're fighting when you do an amputation.

If we did not have antibiotics, we would have to do exactly what they did.

- [Narrator] The seeds for Nashville to become kind of a center for medicine really starts during the Civil War.

- [Narrator] It was because of the educational institutions.

These schools became the mecca of the medical capital.

(dramatic music) (air whooshing) - [Announcer] The Citizenship Project is brought to you in part by a grant from the Tennessee Civil War National Heritage Area and by the Memorial Foundation.

(air whooshing) (dramatic upbeat music) - [Jackie] By the eve of the Civil War, Nashville had evolved from an isolated frontier outpost into a prosperous, well-connected state capital, a transformation that would soon make it one of the most strategically important cities in the South.

- Before the war, Nashville was actually a pretty bustling place.

Nashville had an abundance of mercantile and, you know, lively activity.

The population was growing.

- It was already known as the Athens of the South.

It featured schools and churches.

It had produced two presidents, Andrew Jackson and James K. Polk.

And Nashville, in particular, was in a very good and unique place for economic growth.

- Nashville is a very commercial center, especially in Tennessee.

We have the Cumberland River right down here.

We also have major road networks, and then of course the railroads that intersect in Nashville.

(horn honking) - [Jackie] The city's network of rivers, rails, and roads fueled its rapid economic growth, and signs of prosperity could be seen throughout the city.

- [Narrator] Belmont Mansion was built as the summer home for the Acklen family.

It would be the largest home built in Tennessee prior to the American Civil War.

And what it shows us is that the amount of wealth that could be amassed by Southern planters through the domestic slave trade, which is the money that built Belmont, it is really a demonstration of how wealthy these families were.

(chickens clucking) - [Narrator] Nashville depended on enslavement heavily as far as domestics, transportation, agriculture, the production of goods, and also just the daily upkeep of the city.

- It's an integral part of the society at that time.

In Davidson County, on the eve of the Civil War, there's about 15,000 enslaved people.

They probably make up between 20 and 25% of the population here in Nashville.

(dramatic upbeat music) (soldiers chattering) - [Jackie] When Tennessee seceded from the Union, the city was transformed almost overnight by the realities of war.

- Tennessee's the last Southern state to secede from the Union.

It is occupied by Confederate forces until February of 1862.

Nashville fell to Union forces after the fall of Fort Henry and Fort Donelson.

(air whooshing) (explosion booming) The fall of Fort Henry and Fort Donelson happened very quickly.

And then all of a sudden, less of a week later, Union transports and gunboats are arriving here in Nashville.

- For locals that remained here in the city, this place has transformed from a nice city on the Cumberland River into the second most important city for the Union Army's cause in the country, outside only of Washington, D.C.

So it is one vast military installation.

- [Narrator] What residents could expect to see during occupation is really a transformation of the landscape.

And that would happen on many fronts.

The physical landscape, of course, would have barracks, blockade points, maybe even arsenals, as well as other fortifications or earthen works.

But it's also going to see a transformation in the physical built environment.

So buildings being transformed into offices for generals or military leaders and hospitals.

- [Narrator] Every church within the city becomes a Union Army hospital.

In addition to that, the state capitol will become not only the office and operation center for the military governor, Andrew Johnson, it becomes a fortification in itself, which they called Fort Johnson.

And so you had entrenchments and artillery pieces all along Capitol Hill.

- [Narrator] It becomes this massive military base.

And it's not just the hospitals, it's all the supplies for the war effort moving south.

Practically, every soldier in the Union Army who will fight in the Western Theater comes through Nashville.

(dramatic upbeat music) (locomotive wheels clattering) - The Civil War is the railroad war.

Almost everything is done by rail.

In fact, I believe the Union Army of the Cumberland takes 965,000 pounds of supplies a day just to keep the Army.

And that's not counting ammunition, to keep the Army supplied.

It's also a means for evacuating and moving the wounded.

So places that are rail junctions tend to become hospital centers.

- There were some established Confederate hospitals in the area, but they were nothing like what we would see come with the occupation of Union forces.

- [Narrator] With thousands of soldiers pouring into Nashville, you're seeing the need for stronger, more robust instances of support.

And that can probably best be seen through the vignette of medical treatment in the hospitals and facilities.

- [Narrator] Prior to the war between the states, most people, when your physician treated you, he came to your house.

Only people who were traveling or were indigent went to the hospital.

During the war, the hospital becomes the place to treat sick and wounded people.

- [Narrator] The medical field before the war was definitely in a more primitive state.

This idea of an organized style of medical care was not prevalent (chuckles) and really not existent prior to the war.

And then realistically during the war, as individuals with varying levels of skills and training were put to the test to aid in the large number of individuals seeking medical attention.

- [Narrator] It's a time of really of change in medicine.

A lot of things that we take for granted today are an outgrowth of the war.

- [Jackie] At the outset of the Civil War, American medicine was entering a period of transformation.

Physicians were well-trained for their time, but their understanding of disease remained limited.

Treatments such as bloodletting, cupping, and purging were still common.

And modern concepts like germ theory and antiseptic surgery had yet to develop.

- The germ theory of a disease, that is bacteria and viruses make you ill, really doesn't become common knowledge till after the war.

When people tend to think about Civil War medicine, they tend to think about Gettysburg, Chickamauga, Franklin, big battles.

But the truth of the matter is the soldiers spent 50 days on the camp or march for every day they spent fighting.

Disease, not battlefield wounds, is the major thing they have to overcome.

- With the influx of people from all different landscapes and all different places, and some from different places throughout the country, when we think about the kind of intermixed regiments of the Union Army that are all coming together, disease and illness is kind of a commonality.

And one of the things that we see is that many of the soldiers, both with the Union and the Confederacy, as they traveled and moved around, would also take a number of these illnesses as well.

We also have to think about things that we don't think about as much, i.e., infections to wounds and long-term care, but also just the poor dietary needs and what is happening in living conditions.

So with poor living conditions, weather conditions, their diet being what it was, could all cause for a cocktail of disproportionate health.

- The first of the war, these are diseases of close confinement.

Measles, chickenpox, things we would not ascribe mortality to, but measles killed thousands of men in the outbreak of the war.

Later as the war progresses though, the diseases get more serious.

Smallpox, typhoid, typhus.

The biggest killer of all the diseases though were complaints of the bowels.

Diarrhea and dysentery will kill nearly as many men as all the battles of the war combined.

And this is a byproduct of the water they have to drink, the food they have to eat, basically the conditions under which they have to live.

Now, the way they treat it makes it worse.

The first thing they do is reach in one of those large medical kits, and they would get out opium.

Now, opium tends to constipate you.

Then four hours later, they would reach into their medical chest, and they would give you mercury, which is a strong laxative, a very strong laxative.

And they would give you that to drive the disease-causing ill humors out of your body.

Needless to say, that just makes the man worse.

I mean, you're dehydrating your patients when it comes down to it.

Treating some of the diseases was a disaster.

It was not because they were incompetent or they didn't care.

They were just doing the best they could with the information that was available to them at the time.

- Also, the tools of the trade are really kind of barbaric-looking.

There's this view, sort of stereotypical view of the butchery and the barbarity of these surgeons.

(dramatic music) (soldiers chattering) - [Jackie] Civil War medicine is often remembered for its brutality, but the reality was more complex.

Surgeons commonly used anesthesia, and amputations were frequently life-saving procedures rather than acts of desperation.

- I always tell people that they're overwhelmed.

It's like your worst day at work times 300.

And they're dealing with it as fast as they can because people are suffering.

- In the war, we used the term surgeon.

And that to us, 21st-century people, implies a medical specialty.

That man is a specialist in surgery.

Most Civil War surgeons were not.

Surgeon is simply a military term for doctor.

The extent of their training varies widely.

- [Jackie] Medical education at the time was far different than it is today.

Many physicians entered practice after apprenticing with an established doctor and attending only a handful of medical lectures.

Few had extensive surgical experience, and some had never performed a major operation.

- [Narrator] The most basic unit of the war was the regiment.

On paper, it was 1,000 men, 10, 100-man companies.

Each unit gets a surgeon and an assistant surgeon.

- [Narrator] If they're put into a bad spot and have a bad day on that battlefield, that surgeon can be working on those men for 48, 72 hours straight.

- [Narrator] At Chickamauga, there were 20,000 wounded men.

70% of those wounds are in the arms or legs.

That's 14,000 potential amputations.

- The most common remedy for the injuries that take place on the Civil War battlefield is amputation.

In this sort of assembly line of care that you're doing on a battlefield, really the only way to mitigate some of those injuries is to amputate.

(explosion booming) The bullets are soft lead.

They begin to flatten out as soon as they hit something.

(air whooshes) They travel slow enough that they'll take pieces of your clothing into the wound.

So that's where you get all this infection.

So if that Minie ball hits your arm bone or your forearm, it doesn't just break that bone, it's going to shatter it.

And the surgeons don't know how to assert that will heal 'cause they don't have the technology, you can't really do it.

So the best thing is to come up and take your arm off there and hope that this wound heals.

(gun popping) (soldiers bellowing) - If that man goes without an amputation for longer than 48 hours, his chances for survival dropped to about 15 to 20%.

And it's because of the resulting infection.

It's not the trauma, he's not going to bleed to death.

That seems like to us the cruelest thing they could have done, if we did not have antibiotics, we would have to do that.

(soldiers bellowing) There's probably no bigger myth about Civil War medicine than the myth of anesthesia.

Chloroform and ether had both been discovered in the 1840s, a good 20 years prior to the war.

(hooves thudding) The best description I found of being chloroformed comes from Confederate General Stonewall Jackson.

He said, "What an inestimable blessing chloroform is to the sufferer."

He said, "It was the most pleasant physical sensation I have ever felt."

He said, "It felt so good.

The sound of the bone saw going through my arm was the sweetest music I ever heard."

Now, that tells me he was conscious, but he's oblivious to pain by and large.

Now, the important thing to take from this, there is a technique.

They did not simply grab a bone saw and saw your arm off like there was a limb.

Within the amputation kit, there's a tourniquet.

The tourniquet would be placed above the wound.

It stops or diminishes the blood flow.

The initial incisions through the skin and muscle are made with knives.

Bone and muscle cut in such a way as when the surgeon is through, there will be a well-formed flap that covers the bone that will accept a prosthesis.

At least that's ideally what he's aiming for.

But the point is, there's a technique.

It's not till he's cut through that skin and muscle with the knives does he get out the bone saw and saw through the bone.

(saw rasping) Once he saws through the bone, the next thing he does, he reaches in the case for amputation.

He gets a little, basically it's a hook.

It's called a tenaculum.

He actually hooks the large main vessels, and they're elastic like a rubber band, and they extend them out from the stump.

And either he or his assistant ties a piece of surgical silk around them to keep 'em from bleeding.

The skin is pulled down over that.

It's loosely sutured up.

It's bandaged, and that's an amputation.

Good surgeon can do it in 2 to 5 minutes depending on the location on the body.

Survival rate on average was around 75%.

Whereas the untreated wound, survival rate's only 10 to 15%.

So your chances when you undergo an amputation are much higher.

(horn honking) (gentle music) - [Jackie] Nashville became one of the Union's largest hospital centers.

Soldiers suffering from wounds and disease arrived daily.

And churches, schools, hotels, and other public buildings were transformed into hospitals, creating a vast medical network unlike anything the city had ever seen, and forever, the way care was delivered.

- There were definitely medical advancements in the Civil War.

A lot of them come about because of the sheer volume.

When you're seeing this many cases over and over and over again, you start to see commonalities in the treatment and commonalities in healing.

Here in Nashville specifically, the medical department of the Departments of the Cumberland and the Ohio managed all of the hospitals here in Nashville.

And Dr.

Middleton Goldsmith here starts treating gangrene with bromine.

What he starts seeing as he's recording is that gangrene, once it sets in on amputees or gunshot wounds, it's about a 45% mortality rate.

But his treatment of soldiers with bromine, which is just an external treatment, putting it on the wound, cuts that down below 4%.

So you have almost a 40% decrease in fatalities from gangrene with his bromine treatment.

So they're starting to see things like that.

By the end of the war, there is this widespread acknowledgement of germ theory.

By the end of the war, you do start seeing a lot more treatment of medical instruments from patient to patient.

Clean bandages also become a big emphasis during the war.

So instead of allowing someone to sit maybe for five, six days in the bandages, you're changing bandages daily.

Also, moving people, even if you're kind of incapacitated, like try to figure out how to get you in a chair, get some movement, get some air around your body.

These are basic things, but seeing enough of them, they turn into bigger advancements after the war, especially when people can sit back and take account of everything they've observed in those four years.

(gentle music) (dramatic music) (guns popping) (soldiers chattering) - [Jackie] By war's end, surgeons had treated hundreds of thousands of wounded soldiers, and they had accumulated something medicine had never possessed before on such a scale, experience.

- It provides a huge learning experience because most physicians, they've never been exposed to any of this stuff.

Also, the government has the foresight to collect all this information.

And after the war, they published six big volumes called the "Medical and Surgical History of the War of the Rebellion."

It causes the widespread dissemination of the information or the techniques across the country.

- The Civil War brought a large tone of understanding about how wounds are treated, how individuals in mortal situations are treated.

And I think in Nashville, it was realized that we must do something to enhance or bring more current the medical field.

One vital advancement was this idea of a more centralized place for the sick and those who needed care.

- There is groundbreaking medical research being done here in the city by the Union Army during the war.

And it's very interesting that the seeds for Nashville to become kind of a center for medicine really starts during the Civil War.

And so it is a part of our history that goes all the way back to this Union occupation that is still with us today.

- We start to see the movement of the medical evolution that focuses more on care and inching forward towards what we have now, which is preventative care.

- [Jackie] Before the Civil War, hospitals were often considered places of last resort, but the extraordinary demands of war transformed them into centers of organized care, innovation, and learning.

After the war, those advances continued to shape healthcare in Nashville, paving the way for a new generation of medical education and institutions that would carry that legacy forward.

(water sloshing) (dramatic music) - At the conclusion of the Civil War, and really with the emancipation of newly freed, formerly enslaved individuals, there's a very short list of things that African Americans do.

Number one, they seek to reunite with family.

Number two, they form pockets of community.

But number three, they seek to educate themselves.

And education becomes this sprawling guide right, this key to unlock freedom, wealth, longevity.

And so you see a number of schools pop up on the landscape during the time after the Civil War, known as Reconstruction.

- One of the big government organizations is the U.S.

Freedmen's Bureau.

And the U.S.

Freedmen's Bureau works with African Americans to get loans, to acquire property, but also in things like healthcare and education too.

- You have the rise of Black education in the city.

We're all familiar with Fisk University.

It's certainly the most famous.

But there were three other colleges that were established in the city in the aftermath of the Civil War to educate former slaves.

- [Narrator] Under the direction of the Freedmen's Bureau, Dr.

John Braden started Central Tennessee College in 1866.

- [Jackie] In the years after the Civil War, Central Tennessee College expanded educational opportunities for newly freed African Americans from elementary instruction to college-level studies.

Recognizing the urgent need for physicians, the school established a medical department that became the first medical school in the South to educate African-American doctors.

- And that's the Meharry story.

Samuel Meharry, he was pulling a salt wagon, and it became mired, stuck in the mud.

As it would happen, an older Black man came out to help him.

Now, the bravery of the Black man was that he could have been taken back into slavery.

He didn't know who this man was, but Samuel Meharry, in his gratitude for the man helping him, said, "Someday, I'm going to do something for your people."

Fast-forward 50 years, it became an opportunity for him to do something for the people.

Dr.

Braden asked what he would contribute to a medical school.

He not only contributed, but he told his family about it.

In total, they gave about $3,000 to the opening of Meharry Medical College.

The first graduating class was a class of one, 1877.

After that, three.

After that, five, after that, seven.

By the time it was 1910, 100 students.

To me, that's an amazing story to say that I came out of slavery and I'm a doctor.

Most of them didn't stay in Nashville.

They went back to their hometowns and created hospitals and clinics.

So Meharry was the genesis.

(dramatic music) We talk about the Athens of the South.

There was Vanderbilt, right behind it was Fisk.

Of course, we have Meharry.

Somewhere in there is Trevecca, Tennessee State.

You name it, we probably have more schools per capita than any other city.

I do think these schools became the mecca of the medical capital.

- We actually see the literal example of everyone being able to tap in to medical access and what that looks like as a whole for the overall health of the city, not just for one particular group.

Because what we learned from the Civil War and during the Civil War is that disease knows no separation.

And I think that's one of the strongest elements of why we see medicine really move forward during the Civil War.

The two hallmarks that the Civil War left us with is that death, disease, and infection know no difference.

They know no politic, they know no race.

When we think about the legacy of the Civil War today, we're learning how America in a very ubiquitous way and perhaps even ominously, you know, benefited in the progression of medical science with the progression of schools that are training not just White but African-American doctors and later nurses.

And so I think what we should take away from the war and all of its horror is that it brought a true or a more firm sense of continuity as far as who America is.

And it opened the doorway for who America could and would become.

- [Jackie] Nashville's Civil War hospitals are long gone, but the ideas born within them endure in the hospitals that care for us, the physicians who train here, and the institutions that continue to serve communities across Tennessee.

From the hardships of war came lessons that transformed medicine, proving that even in humanity's darkest moments, compassion and innovation can leave a lasting legacy.

(dramatic music) (dramatic music continues) (no audio) (upbeat music)