Civil War: Triage

Teacher: Lindsay Peown

Class/Subject: 7th grade Science
Date: 11/18
Time: 60 minutes
Number of Students: 17-23
Common Core Standard(s)

RST.6-8.1 Cite specific textual evidence

Todays Learning Target(s)

I can determine the relative seriousness of a common Civil War disease or
injury using Dr. Lettermans triage system
I can justify my claims using evidence from research

Compone
nt

Description

Engage
and
Grapple

Todays Problem that students will grapple with:

How did Civil War doctors triage sick and injured patients?
Students will be given a list of patients with various medical
conditions. Students will attempt to order the patients by
determining who they would treat first, second and so on.
As I circulate, Ill be looking for:
- How students are prioritizing patients
- Student justification of their choices

5-10
minutes

Discuss
10-12
minutes

Students will share their thinking about the triage grapple in table
groups(mixed ability level)
The discussion protocol is a modified conversation caf (See
attached)
As I listen to their arguments, Ill be listening for:

Student justification of the order they picked

Ideas that connect fieldwork to activity

Focus
10 minutes
maximum

Misconceptions about Civil War surgery and medical care (ex.

Amputation=death)

Todays learning target(s):

I can analyze a set of medical patients and apply triage
strategies to treat them
I can justify my choices using evidence from research
I will review any important information from my notes below.
We will introduces and unpack the learning targets.
I will introduce the text and model how to pull information
from the text and use it to support my triage claims.
Notes from the previous steps:
Good ideas to build on:

Gaps in understanding to address:

- Civil War Disease/Amputation Article

Misconceptions to start clearing up:

Connections to science vocabulary & underlying science

structures:
- Triage= the assignment of degrees of urgency to wounds or
illnesses to decide the order of treatment of a large number of
patients or casualties.

Additional problems and/or models of student work that I

might share:

Apply
10-15
minutes

Students will work individually and in the same groups as

before to read the text and use it to modify the claims they
made in the grapple. Students will focus on using specific
pieces of evidence form the text to support their triage

decisions. Student work will be recorded on the organizer.

As I circulate, I expect to:

Synthesiz
e
5-10
minutes

Provide support to students who are still struggling to

identify which disease/injury would be considered a 1st
priority on the battlefield.
Assess for these skills/concepts:
o Identifying which disease/injury was most
severe/deadly
o Using evidence from text to support a claim/opinion
Catch small groups or whole for these types of issues or
needs:
o Repeat directions, review science civil war content,
read aloud

Students will synthesize in small groups and as a whole class. In

our synthesis students will discuss their new claims with their table
group. They will compare the triage decisions they made along
with the evidence used to support their decisions.
The protocol for students to share their thinking is:
2 mins to share out with table group
5 mins for speaker to share group thoughts with class
WHAT:
As a whole class we will debrief the process by discussing
overall thoughts on how triage can be used to make
treatment more effective.
- What would have been treated first, and injury or an
illness?
- What signs did doctors use to determine who to treat
first?
SO WHAT:
Amputations and physical injury would be treated first
even though fewer soldiers died from injury compared to
disease.
Dr. Lettermans system wouldnt save everyone but many
more would have died without it.
NOW WHAT:
Introduce final product: Journal entries from a Civil War
soldier or doctor who is experiencing a common disease or
injury and its treatment.

Additional work I plan to assign is:

Materials:
Triage scenarios (attached)
Conversation Caf protocol (attached)
Disease and amputation statistics article (attached)

Beat the Odds: Civil War Wounds

Here are five (5) different situations. Using what you know about disease and amputations
during the Civil War; diagnose the patients and rank them from #1 to #5.
1 = You would treat them first (most severe)
5 = You would treat them last (least severe)
Colonel Abner Morgan: shot through the left leg, wounding his horse as well. The wounded
leg was shot through the calf. He is bleeding.

Diagnosis: ______________________________________________________
Explain Rank:

________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________
Corporal James Good: shows signs of bloody diarrhea, fever and fatigue.
Diagnosis: ______________________________________________________
Explain Rank:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________
Private Frank Weaver: wounded with a bullet piercing his chest. It entered the left front and
shot through to the back. He is bleeding heavily, unconscious and is having trouble
breathing.
Diagnosis: ______________________________________________________
Explain Rank:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________
Private John Smith reports to the doctor and shows signs of a fever, cough and a rash.
Diagnosis: ______________________________________________________
Explain Rank:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________

Private Clark Hannah: wounded in the right lower arm, shattering both bones.
Diagnosis: ______________________________________________________
Explain Rank:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________

Conversation Caf Protocol

Agreements for a Great Conversation

Open-mindedness: listen to and respect all points of view

Acceptance: suspend judgment as best you can
Curiosity: seek to understand rather than persuade
Discovery: question old assumptions, look for new insights
Sincerity: speak for yourself about what has personal heart and meaning
Brevity: go for honesty and depth, but dont go on and on

Conversation Caf Process

Preparation (3 minutes): Choose a facilitator and timekeeper. Facilitator reads
the agreements aloud. Facilitator reads the question that guides the conversation
at their table aloud.
Round one (1 minutes per person): Each person speaks in turn, going around
the circle once. During this round, each person speaks briefly about what is on
their minds regarding the question. Everyone is asked to express themselves fully
yet briefly, allowing time for others to speak. No feedback or response.
Spirited Dialogue (5 minutes): Now the conversation opens up and people can
speak in no particular order. This conversation will take up most of the time. If
there is an only one person speaking, argument, or lack of focus, the facilitator
may remind the group of the agreements.
Closing (4 minutes): The facilitator will ask everyone to go around the circle
again, giving each a chance to say briefly what they are taking away from the
conversation.

Civil War Diseases and Amputation

There were a whole host of Civil War diseases. The worst out of the bunch was by far Dysentery.
This one disease accounted for around 45,000 deaths in the Union army and around 50,000 deaths
in the Confederate army. What was the reason for this huge death rate? The answer is painfully
simple, contaminated water. Hygiene was not a big issue when it came to health care in those days.
During a Civil War surgery cleanliness was a mere afterthought. Unfortunately for people back then
they didnt realize that there was a link between hygiene and health. Go figure. Putting a latrine right
next to the water supply was the reason for the water contamination. Now you dont exactly need to
be a doctor to realize that putting these two things that close together is probably not the brightest
idea in the world.

Dysentery is an inflammatory disorder of the intestine, especially of the colon, that results in severe
diarrhea containing mucus and/or blood in the feces with fever and abdominal pain. If left untreated,
dysentery can be fatal. Frequency of urges to defecate, the presence of mucus and/or blood in the
stool, vomiting of blood, severe abdominal pain, fever, shock, and delirium can all be symptoms.

Pneumonia was responsible for the deaths of 20,000 Union and 17,000 Confederate troops. 1 in 6
people who got this disease died from it. Stonewall Jackson died from Pneumonia after being shot
during the battle of Chancellorsville by his own men.
Pneumonia is an inflammation of the lungs caused by infection. Bacteria, viruses, fungi or parasites
can cause pneumonia. The signs and symptoms of pneumonia may include: fever , lower-thannormal body temperature in older people , cough, shortness of breath, sweating, shaking chills,
chest pain that fluctuates with breathing (pleurisy), headache, muscle pain, and fatigue.
Pneumonia was more of an opportunistic type of disease. It looked for weak people to inject itself
into. If you became wounded on the battlefield or became sick with something else there was a good
chance Pneumonia was going to find you.

Measles killed a lot of people during the Civil War around 11,000 soldiers total. Not as many as other
diseases did but it had its fair share. With so many people gathered in such small areas this disease
was able to spread rapidly. About 1 in 20 people who got this disease died as a result of it.
Measles is an infection of the respiratory system. The classical symptoms of measles include fourday fevers and the three Cscough, coryza (head cold) and conjunctivitis(red eyes). The
characteristic measles rash is classically described as a generalized, red area covered with bumps
that begins several days after the fever starts. It starts on the head before spreading to cover most of
the body, often causing itching. The rash is said to "stain", changing color from red to dark brown,
before disappearing. The measles rash appears two to four days after initial symptoms, and lasts for
up to eight days

Amputation
At the field or tent hospitals (which were close to battle lines and in range of bullets
and shells) surgeons used their fingers to search for bullets and tried their best to
control bleeding.
And, believe it or not, three-fourths of a surgeons time was spent amputating limbs
(Tenting Tonight, 33). Most wounds suffered by Civil War soldiers were to the arms and
legs.

An Army of Tennessee surgeon wrote that the shattering, splintering and splitting of a
long bone by the impact of the Minie or Enfield ball were, in many instances, both
remarkable and frightful, and early experience taught surgeons that amputation was
the only means of saving life (Tenting Tonight, 92).
Amputation was the wounded soldiers best chance of survival. Union soldiers suffered
174,000 extremity wounds (arms and legs). Of these, 30,000 resulted in amputations.
(Tenting Tonight, 92) Three-fourths of the amputees survived (Tenting Tonight, 92). The
sooner the amputation was performed, the better the chance of survival. If amputation
was delayed more than 48 hours, blood poisoning, bone infection, or gangrene would
set in, and the death rate would double (Tenting Tonight, 92). This was a very painful
way to die. It was actually best to amputate within 24 hours (Museum of the
Confederacy). Many doctors used anesthesia in the forms of chloroform and ether
when they operated, especially near the end of the war.
A patients chance of survival depended on how far the wound was from the trunk of

the body.
When soldiers were wounded in battle, the Infirmary Corps carried the wounded to a
forward aid station located within the lines of battle (Museum of the Confederacy).
There, an assistant surgeon would give the soldier alcohol and painkillers and would
try to stop the bleeding by packing the wound with lint and bandaging it. (Lint was
obtained by scraping linen fabric. Think of the junk that collects on the filter of your
clothes dryer.) If the bleeding would not stop, a tourniquet would be applied. This
would stop the flow of blood to the limb, which meant that the limb would have to be
amputated. Next, the wounded soldiers would be transported by ambulance to a field
hospital, which was a short distance behind the lines.

Dr. Jonathan Letterman

Introduction of Triage
- Wounded are treated and evacuated in order of priority
- Use of a 3 tier system of priority
1. Most serious but survivable wounds are first priority
2. Less serious wounds are second priority
3. Likely fatal wounds (head, abdomen, etc.) are last priority
- Dressers in field hospitals prioritize and prepare wounded for surgery
Early battlefield medicine operated on a system of first come, first served.
This was replaced during the Civil War by the universal application of triage
as part of the Letterman Plan. American surgeons did not invent triage it
was already being used sporadically by surgeons in Europe and Russia but
the Union Army was the first to apply it formally and uniformly in the field.
This began in field hospitals where medical officers were assigned to act as

dressers, preparing patients for

surgery and organizing them in
order of urgency. Cases considered
hopeless were made comfortable
and treated last. As the war
progressed, this system of prioritizing
the wounded was extended to forward
aid stations and the order of
evacuation from the battlefield.