Civil War Hospital Ship

The U.S.S. Red Rover, a captured Confederate vessel, was refitted as a hospital ship.

Evolution of Civil War Nursing

The evolution of the nursing profession in America was accelerated by the Civil War.

The Practice of Surgery

Amputations were the most common surgery performed during the Civil War.

Army Medical Museum and Library

Surgeon-General William Hammond established The Army Medical Museum in 1862. It was the first federal medical research facility.

Civil War Amputation Kit

Many Civil War surgical instruments had handles of bone, wood or ivory. They were never sterilized.

Saturday, August 23, 2014

The Slave South: Medicine Chests and Self-Sufficiency in Medical Care

From: historyengine.richmond.edu

R. Jeffery and A. Alt advertised the sale of aromatic snuff in the American Beacon and Commercial Daily on June, 27 1817 in Norfolk, Virginia. Jonathon P. Whitwell prepared and bottled the aromatic snuff in Boston. Whitwell shipped the snuff to Norfolk and various other locations across the East coast. Jeffery and Alt sold the aromatic snuff to Virginians who desired to fill their medicine chests in order to gain self-sufficiency in medical care.

According to Catharine C. Hopely, a tutor at Forest Hill near Tappahannock County in 1815, a capacious medicine chest is an inseparable part of a Southern establishment; and I have seen medicines enough dispensed to furnish good occupation for an assistant when colds or epidemics have prevailed. Virginians frequently resorted to home-remedies due to the inaccessibility of many farms to main highways, good roads and means to speedy transportation that prevented them from reaching physicians. Thus, Virginians on plantations, farms, and even urban households desired self-sufficiency in medical care. The desire for self-sufficiency stemmed from the economics of slave holding that instructed masters to do everything possible to keep their slave force healthy.

When caring for slaves, if a combination of drugs or particular medication arrested symptoms, slave owners used that treatment until a better one came along. According to historian Todd L. Savitt, plantation overseers and owners recorded useful medical recipes and clipped suggestion from newspapers into their journals. Most homes possessed a medical digest in addition to a well stocked medicine chest. Many Virginians owned Simon's Planters Guideand Family book of Medicine or Ewell's Medical Companion. Digests presented specific instructions on the treatment of many disease, the proper dosages of drugs for each age group, and the best uses for most medicine.

Historian Stephanie P. Browner claims that slaves frequently treated their diseases or illnesses themselves without their master's knowledge. Slaves did this for several reasons; to offset the failures and harshness of white remedies or the negligence of masters, and most often to exert some control over their own lives. Black home remedies secretly circulated throughout slave quarters, and elders passed them down to younger generations. According to Browner, some medicines contained ingredients that had purely superstitious values, but slaves mainly obtained cures from local plants. Occasionally, whites learned of an effective treatment that slaves used, and adopted it for themselves. However, this did not affect the business of Jeffery and Alt who traveled around Virginia and sold medicine to Virginians who desired to fill their medicine chests with a large assortment of remedies.

Slaves represented a financial investment that required protection, and it made enormous sense for masters to maintain the health of their slaves. Awareness that certain illnesses could easily spread to a master's own families if not properly treated became a strong incentive for masters to keep their slaves healthy. A sick and physically incapacitated slave could not work, and represented a financial loss. The economics of slave holding instructed masters to do everything possible to keep their slave force healthy. This required masters to keep a well stocked medicine chest and adopt an assortment of home remedies.

How the Civil War Changed Modern Medicine

By Emily Sohn

The American Civil War often gets credit for ending slavery and reshaping the federal government in this country. But the War Between the States has another, often overlooked legacy: It may have started a new era in modern medicine.

As soldiers fell in unprecedented numbers from both injuries and disease, anesthesia became a specialty. The fields of plastic and reconstructive surgery exploded. And doctors developed new ways to treat a surge in nerve injuries and chronic pain, marking the beginning of contemporary neurology.

At the same time, a visionary surgeon named Jonathan Letterman forever altered the flow of medical treatment from battlefield to hospital, said George Wunderlich, executive director of the National Museum of Civil War Medicine in Frederick, Md.

Now, 150 years later, Letterman's basic principles continue to affect medical care in a wide range of situations, from bombings in Afghanistan to heart attacks in American grocery stores.

"Civil War medicine was every bit as barbaric as it's made out to be, and surgeons weren't washing their hands," Wunderlich said. "But it was a million times more modern than almost anyone thinks. And there are a lot of lessons we can still learn from today."

Medically, the United States was woefully prepared when the Civil War began in the spring of 1861, said Michael Rhode, an archivist at the National Museum of Health and Medicine in Washington, D.C. Nearly 80 years had passed since the end of the American Revolution, the country's last major war. And the new conflict was happening on a much bigger scale.

Scientists, meanwhile, had yet to come up with the theory that germs cause diseases. Doctors didn't know that they should wash their hands before amputating limbs. As soldiers from small towns came together in large groups, they became newly exposed to pathogens that their bodies had never encountered before. But there were no antibiotics and no antiseptics.

As a result, for every Civil War soldier that died of an injury or gunshot wound, more than two died from dysentery, diarrhea or other infectious diseases.

"They had no idea what was causing it," Rhode said. "The theory was something called miasmas, or bad airs. But no, it's not a miasma when a guy is wiping his surgical knives on a bootstrap with horse dung on it."

Medicine has come a long way since then. Injuries that resulted in amputations 150 years ago now lead to X-rays, the setting of bones, and a four- to six-week recovery period before returning to battle.

Over the course of the war, doctors learned some lessons that forever changed the way medical care happens, both on the battlefield and beyond.

There was, for example, a growing sense that cleanliness reduced fatalities. Doctors who treated soldiers made leaps in understanding about neurology and other fields, and specialists continued their lines of research even after the war ended.

Then there was Letterman, who as medical director for the Union Army created a well-organized system of care that began with triage close to the source of harm and was followed by rapid transportation to a series of clinics, hospitals and specialists. Even though technological advances have replaced horse and carriages with helicopters and jets, Wunderlich said, those kinds of protocols continue to be essential today.

As the Civil War ended and soldiers returned home, they retained their expectations for quick and efficient treatment in all situations. If a wounded man could be picked up in the midst of the Battle of Gettysburg, after all, shouldn't everyone be able to get rapid help after falling off a ladder on the street?

As a result, the end of the war saw the beginning of ambulance systems in many major cities. Letterman's ideas also directly influence the way today's 911 call system works. And the National Museum of Civil War Medicine has used the surgeon's ideas to train hundreds of thousands of medical professionals who have been sent to Afghanistan.

The war "was a watershed that really changed all medicine to the point where it could never completely go back to the way it was before," Wunderlich said. "All these changes had come about, and people weren't willing to go back."

From: news.discovery.com

Susan Blackford Agreed to Take Up Nursing

From: historyengine.richmond.edu

On July 08, 1861, Susan Leigh Blackford wrote to her husband, a lieutenant who served in the Confederate army to inform him she was not “at father’s all day sewing for the [Confederate] soldiers,” her regular daily activities, but writing for a special occasion. Blackford agreed to open a local Ladies’ Hospital for injured soldiers with another woman, Mrs. Otey. Nineteenth century women were not allowed in the hospitals of soldiers; however with the establishment of a Ladies’ Hospital, the army would not have to pay for a female nursing staff, nor the extra care wounded men would receive once they were removed from the battlefield. The dedicated Susan Blackfield ended her letter with an explanation that she agreed to help only in so far as she believed her husband approved and that the woman setting up the hospital, Mrs. Otey, was pleased to work with her.

As nineteenth century war-time medicine shifted to modern techniques, organizations formed to ease the transition and extend the life of  injured soldiers. According to historian James McPherson, both Union and Confederate women were allowed to nurse the sick and injured in their homes. However, women were not allowed in military hospitals due to the unsightly and grotesque wounds of soldiers. The United States Sanitary Commission, created by women in 1861, offered charity to the military and began creating hospitals that allowed female nursing staff. Dale C. Smith, author of Military Medical History, claimed the U.S.S.C. “mobiliz[ed] the existing medical profession by providing consultations, transportation, and supplies.”

Susan Blackfield was a conventional southern woman; she sewed items in need for the Confederate soldiers, she was loyal to her husband, and she was willing to help the Confederate soldiers receive further medical aide after they were picked off the battlefield. Blackfield was only one of thousands of Union and Confederate women that was engaged in this type of nursing field work. As southern women felt that sewing uniforms and flags were not enough to help their military men survive, they went from needle and thread to needle and morphine to try and better the chance of Confederate survival.

An Assistant Surgeon Reports on Gangrene

From: historyengine.richmond.edu

Andersonville's prison had a hospital crowded with patients, due to the bad living conditions in the cells. The prison was overcrowded with prisoners crammed in rooms, inactive and secluded from society, lacking food, exercise and fresh air. The atmosphere was so polluted that people could hardly breathe. The promiscuity made sickness spread in a heartbeat, and in the winter of 1865, the prison witnessed an epidemic of what was called hospital gangrene, in addition to the usual scourges of diarrhea, dysentery and scorbutus. The assistant surgeon of the hospital reported that the epidemic was due to all these factors. Gangrene started from a bacterial infection in a wound and could spread to the whole body and eventually kill the patient if not handled in time. In the hospital, out of 325 patients, 208 died over the three months before January. Usually gangrene could be handled easily, but the hospital was so over-burdened and not prepared to medical care, that far more people died than typical. The patients of the prison's hospital formed a crew of 1,600 to 2,000 people, who slept in tents, with at least five other persons. They wore their battle clothing that they had not washed in six months or more. In their state, they needed strong food that could give them strength, but the hospital could not provide it for them. The medicines that the hospital received lasted only for ten days, and then they had to accommodate with what they could, such as vegetables picked in nature around the hospital. They were in such a lack for medicine that they had to carry out experiments on the patients, out of natural plants that they picked up in the countryside. The good will of the surgeons was not to question though, they were at peace with God and with themselves by trying all that was possible to improve the conditions of the prisoners.

This report reveals the conditions of prisoners of war Andersonville, the most infamous of prisons. Many of them entered in good health and caught lethal diseases there. According to Freemon, hospital gangrene was a sickness in which skin tissues became black, and it happened only in certain hospitals, due to horrific sanitary conditions. He believed that the hands of the surgeons themselves could be responsible for the spread of the disease from a wound to the other. In Catton and McPherson's view, the living conditions were atrocious and the death rates were alarmingly high. They say it was due less to the good will of people than to the heartlessness of the war. Apparently the conditions were equally bad in the prisons North and South, but no effort was made to change things.

Image: Hospital Gangrene as illustrated in the Medical and Surgical History of the War of the Rebellion.

Armory Square was a Military Hospital

From: historyengine.richmond.edu

Armory Square was a military hospital that sprang up in Washington D.C. during the Civil War, from 1862-1865, which recorded unprecedented numbers of soldier casualties and deaths.

While not the first military hospital to open in Washington D.C. during the Civil War, Armory Square Hospital is known for receiving some of the worst soldier casualties from Virginia’s battlefields. Situated nearest the steamboat landing at the foot of Seventh Street, S.W., and the lines of Washington and Alexandria railroad, Armory Square Hospital was the first and only stop for many Union soldiers as the seriously wounded could not afford to travel any farther, according to Martin G. Murray’s article Traveling with the Wounded: Walt Whitman and Washington’s Civil War Hospitals. The Armory Square Hospital Gazette and The National Republican papers reveal that Armory Square Hospital had an unprecedented number of soldier deaths. Notably, “from August 1861 to January 1865, Armory Square recorded the largest number of deaths of any Washington military hospital, 1,339 out of 18, 291 deaths” as recorded in the February 25, 1865 edition of the Armory Square Hospital Gazette (Murray).

Armory Square was one of the six “model” hospitals built in Washington D.C. during 1862. Whereas “barracks” hospitals were converted from unused Army barracks, “model” hospitals like Armory Square were specifically made according to the U.S. Sanitary Commission and their recommendation of a pavilion principle (Murray). There were as many as 56 separate facilities used as hospitals in Washington D.C. during the course of the Civil War, and Murray notes that Armory Square was one of 43 in use when it opened in 1862.

The Armory Square Hospital Gazette was first published on January 6, 1864. The opening page of the gazette presents the harsh reality of many a soldier’s gruesome fate--it claimed: “the Hospital is an episode in  soldier’s life--sometimes a painful termination of it, which has many an event worthy of a chronicle. Such we propose this paper to be” (“Salutatory”). While recording the deaths of soldiers who died, the gazette also notes soldiers admitted to Armory, returned to duty, transferred to different hospitals, and discharged.

As a large hospital tending to those grievously wounded, Armory Square was frequented by a few notable people. President Abraham Lincoln and poet Walt Whitman visited Armory Square, meeting with many soldiers in the hospital ward (Murray). One of Lincoln’s many visits was recalled and recorded by Armory Square nurse Amanda Akin. Whitman also went to many Washington D.C. hospitals and attended to the soldiers. He wrote copious notes about his visits, and on page 18 of his hospital journal he jots down: “In ward G, H, or I, young man I promised to come in and read to--sick with fever--he cannot read steady himself--his hand swerves--take him the paper” (Whitman). However, Whitman writes that he visited Armory Square most often “because it contains by far the worst cases, most repulsive wounds, has the most suffering and most need of consolation--I go every day without fail, and often at night” (Whitman).

Armory Square Hospital captures one side of the Civil War, but reveals volumes about the tragedy of the war through the sheer number of men dying from casualties and the hospital’s prominence through multiple visits by President Lincoln and the poet turned nurse Walt Whitman.

Surgeon Matt Turner Writes Letter of Hope and Worry to Home

From: historyengine.richmond.edu

Assistant surgeon to the 22nd regiment of Alabama Infantry, Matt Turner wrote a letter to his mother on May 27, 1863, speaking of his weariness in waiting to hear news from home. He served on picket duty for the past three weeks, but was now managing the Wither’s Division hospital in Shelbyville, Tennessee. Turner found working at the hospital comfortable, although he spoke of the continuous changing circumstances that were a part of military life. He wrote, “… though everything is so uncertain in the army that I am never surprised or disappointed at anything that ‘turns up’.” Turner also mentioned both his uneasiness and his confidence about the war effort. With the siege of Vicksburg having started only nine days before this letter was written, Turner wrote of the ongoing battle, “We are all looking with anxious eyes toward Vicksburg and feel as if a speedy peace will follow the sweep of our arms at that place.” With confidence in the Confederacy, he continued on, “I feel that it is impossible for Grant to extricate himself from his present hazardous condition and, with the reinforcements we have already sent on, [Grant] must be ‘cut to pieces’ or captured. May we not hope that the beginning of the end is near?”

Vicksburg was one of the longest battles of the United States Civil War, lasting from May 18, 1863, to July 4, 1863. Union General Ulysses Grant laid siege to the city on May 26, 1863. Turner, like many Confederates, knew the importance of Vicksburg in turning the tide of the war. Vicksburg sat along the Mississippi River, which was essential to northern military and commercial interests. Furthermore, the River split the Confederacy into an eastern and western half. Gaining control of this waterway was of paramount strategic importance for the Union; this would prevent CSA soldiers and supplies from moving across each side of the Confederacy. If the city did not fall, the Confederacy might win the war, and Turner was optimistic of this outcome. The Siege of Vicksburg lasted forty-seven days. Union casualties totaled 9,362 men and Confederate casualties 29,500 men. In a decisive victory, the Union managed to gain control of Vicksburg.

As an assistant surgeon in the war, Turner was a valuable resource, for he could attend to the wounded with care. Historian Harold Straubing wrote of doctors, nurses, surgeons, and others in the medical field at that time, “They dealt with the soldiers, the wounded, the diseased, and the dying. They were never too far behind the fighting front lines, often in the battle itself as forces crisscrossed the same land.” On both sides, these men and women were unsung heroes. They attended to the wounded and were often placed into the heat of battle in service to their respective country. Much of what is known in the medical industry today can be attributed to the impact of Civil War doctors, surgeons, and nurses, such as Matt Turner.


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