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.

Tuesday, April 18, 2017

Failed Objects: Bullet Proof Vests and Design in the American Civil War

By Sarah Weicksel, 4-29-13

Scholar Sarah Weicksel continues her exploration of Civil War clothing with a look at the bullet proof vest.

In late March 1862, Illinois officer John Cheney wrote home to his wife Mary about recent happenings in camp. "Lew Smith is here selling those bulletproof vests," he relayed. "I think they are a good thing and may buy one" (quoted in Gordon Armstrong, ed., Illinois Artillery Officer's Civil War, 24).

John Cheney was one of many Union soldiers who were tempted by advertisers' promises of the merits of bullet proof vests. Such protective battle garments were not, of course, altogether new—armor had been used for centuries. But, continued advances in weaponry—and ballistics technology in particular—far outpaced the technology used in the design of such protective garments, posing a serious dilemma for military men in the mid-nineteenth century.

Multiple styles of bullet proof vests were commercially available and advertised during the Civil War. Although they were not issued by the army, soldiers or their families with disposable income could purchase vests by mail, in stores, or from camp peddlers like Lew Smith for between $5.00 and $8.00 (approximately $115.00 to $147.00 in today's currency)—the equivalent of roughly one-third to one-half of a private's monthly pay.

Advertisers made great claims about the effectiveness of these vests, touting them as having "saved the lives of Generals, Colonels, Captains, and thousands of soldiers" and asserted that the vests would continue to save the lives of thousands more. Wearing such a vest, they explained, would "double the value and the power of the soldier," presumably suggesting that, with the appropriate battle garments, a Union soldier could achieve an even more glorious victory.

The most widely available vest seems to have been "The Soldiers' Bullet-proof Vest" that was advertised in Harper's Weekly, a widely-circulated New York City-based newspaper.

These vests, as one soldier aptly described, "were nothing more than ordinary vests with metal plates between the lining and the outside of the front of the vest" (DeVelling, History of the Seventeenth Regiment, 119). Sheet-iron or cast iron plates were formed to fit the general curvature of a man's torso before being inserted between layers of cotton and wool fabric. The vests, however, were far from custom-made. Instead, they could be purchased in sizes "Nos. 1, 2, and 3." According to the pictured advertisement, No. 2 would fit nearly all men. Potential purchasers were also assured that the vests were "repeatedly and thoroughly tested" and would repel rifle bullets at 40 rods (220 yards) and pistol bullets at 10 paces.

In theory, the vests were appealing. As one soldier wrote: "To be 'iron clad' when the bullets should fly as thick as hail! What more could a soldier ask?" (Walker, History of the Eighteenth Regiment Conn. Volunteers, 21). In actuality, however, the vests proved to be failed objects on multiple levels, ranging from ease of use to their effectiveness. Although advertisers claimed that the vests were "simple" and "light," soldiers found them extremely cumbersome due to their inflexibility and weight. Colonel Charles F. Johnson of New Jersey explained to his wife: "the only objection that I have to them is that they are so confounded heavy for this season of the year" (quoted in Pelka, ed., The Civil War Letters of Colonel Charles F. Johnson, 112). Many soldiers' letters and memoirs recounted the abandonment of bullet proof vests along the march, where they littered the side of the road along with other unwanted gear.

With no oversight to ensure the reliability of manufacturers' claims, it was the soldier's prerogative as to whether or not to accept assurances that the vests had been "repeatedly and thoroughly tested." While some soldiers wore the vests into battle, others opted to first test the effectiveness of the garments themselves. Colonel Johnson, for instance, sat down one morning in May 1862 to write a letter to his wife, telling her that he and his fellow field officers were just about to test their newly arrived bullet proof vests with muskets, rifles, and pistols. He resumed his letter a few hours later, reporting that they had "just returned with the great, mighty, powerful 'bullit proof' vest and the result is that a common musket put a ball clear through it at 50 yards, through yes, and carried some four or five inches of the stuff with it." The metal and cloth fragments carried by the bullet into a man's body, he surmised, "would have killed the devil himself if it all had entered his body" (Pelka, 112-113).

The vests did provide some degree of protection, judging from the bullet-shaped dents in surviving vests. But they were ineffective in close combat, and, as Johnson rightly pointed out, wearing a vest could have resulted in an even more deadly wound if a man was shot at close range, whether from immediate impact, or an infection festering around the bits of cloth and metal that the bullet pushed into his body.

While it is difficult to calculate how many bullet proof vests were actually sold, most soldiers who did purchase these vests seem to have abandoned them relatively quickly, although not always prior to battle. Men were occasionally discovered to be wearing the vests as they lay on the battlefield, wounded or dead.

American manufacturers continued to experiment with bullet proof technology after the Civil War. However, it was not until one hundred years later, in the 1960s, that chemist Stephanie Kwolek developed Kevlar, the first technology to successfully repel bullets with any consistency.

Sarah Weicksel is a Ph.D. Candidate in the Department of History at The University of Chicago, and a Graduate Scholar-in-Residence at The Newberry Library. She is currently at work on her dissertation project: "The Fabric of War: Clothing, Culture and Violence in the American Civil War Era." She has also blogged about other types of clothing in the Civil War.

Image 1: This regular, non-bullet proof vest was worn by a colonel in the Confederate Army Infantry.

Image 2: The Soldiers' Bullet Proof Vest, "Harper's Weekly," March 15, 1862, p. 176

From: americanhistory.si.edu

Hannah Myers Longshore: Pioneer Physician and Professor of Anatomy

By Maggie MacLean, 8-23-14

Hannah Myers Longshore graduated from the Female Medical College of Pennsylvania's first class in 1851 and became Philadelphia's first woman doctor with a medical degree to establish a private practice, which she continued for forty years. She also lectured extensively first at the Female Medical College, and later in public speeches about sexual health at a time when there was little public discussion of any kind on the subject.

Early Years
Hannah Myers was born May 30, 1819 in Sandy Spring, Maryland, where her father taught at a Quaker school. She was the daughter of Samuel and Paulina Myers, Quakers from Bucks County, Pennsylvania who believed in equal education for boys and girls. While Hannah was still very young, her family moved to Washington, DC, where she attended a Quaker school until her early teens.

Her father, an abolitionist, was angered by the existence of slavery in the nation's capital. In 1833 he moved the family to a farm in Columbiana County, Ohio, where they could be close to the Quaker colony at New Lisbon. From an early age, Hannah was interested in science. Her early education was obtained at New Lisbon Academy, but she was unable to attend Oberlin College due to a lack of funds.

In 1841, Hannah Myers married Thomas Ellwood Longshore, a teacher at the New Lisbon Academy and a staunch supporter of advanced education for women. Thomas supported his new wife's plans to go to medical school but Hannah's education was again postponed by the birth of two children: Channing (1842) and Lucretia (1845), named after abolitionist Lucretia Mott.

In 1845, Thomas lost his teaching position because of his abolitionist convictions, and he then moved his family to his hometown, Attleboro, Pennsylvania, where he again began teaching at a Quaker school.

Thomas' brother, Dr. Joseph Skelton Longshore, was a physician in Attleboro who strongly supported medical education for women. Dr. Longshore was involved in some of the earliest efforts to open the field of medicine to women in the United States. He encouraged both Hannah and his sister Anna Longshore to study his medical books and to observe his work with patients.

Female Medical College of Pennsylvania
On March 11, 1850, the Pennsylvania legislature passed an act to incorporate the first regular medical school for women in America: the Female Medical College of Pennsylvania in Philadelphia. The school was founded by Dr. Joseph S. Longshore and three other physicians, as well as four philanthropists, several of whom were Quakers.

In its early days, the Female Medical College of Pennsylvania faced serious opposition from the male medical establishment. These men believed that women were, first of all, too feeble-minded to learn the demanding curriculum, and they were also too delicate to endure the physical requirements of practicing medicine.

One of the most serious barriers to the success of the college was the lack of clinical experience available to its students and interns because area hospitals would not allow women to attend lectures or to treat patients. To remedy this situation, Dr. Ann Preston, also a member of the College's first graduating class, founded Woman's Hospital of Philadelphia in 1861.

hannah-longshore2In 1850, Hannah Myers Longshore, thirty-one year old mother of two, enrolled in the first class at the Female Medical College of Pennsylvania. On October 12, 1850, forty students were greeted by six faculty members. Thomas' sister Anna Longshore was also a member of the first graduating class of the Female Medical College.

Image: Female Medical College of Pennsylvania

Completing the customary four months of training, Longshore was one of eight women who received MD (Doctor of Medicine) degrees, all with the unfailing support and encouragement of her husband. Dr. Hannah Longshore was then appointed instructor of anatomy at the Female Medical College, serving in that capacity from 1851 to 1852.

The Myers family was very active in Philadelphia medicine in the 19th century. Hannah's sisters, Mary Frame Myers Thomas and Jane Viola Myers, also graduated from medical schools. Dr. Mary Frame Thomas became a prominent physician in Fort Wayne and Richmond, Indiana (1854-1888). Despite the unpopularity of women physicians at that time, Dr. Thomas was elected a member of the Wayne County Medical society in 1875.

Dr. Mary Frame Thomas studied at the Western Reserve College of Medicine, was president of the Indiana State Medical Society and worked with the Sanitary Commission during the Civil War. She was also a leader in the causes of temperance, prison reform and women's suffrage, and operated an Underground Railroad station for escaped slaves.

Learn more about these fascinating women in Frederick Clayton Wait's book, The Three Myers Sisters: Pioneer Women Physicians.

From February to June 1852 Dr. Hannah Longshore served as an instructor of anatomy at the New England Female Medical College in Boston, becoming one of the first women faculty members at an American medical school. She also gave public lectures on sexual health at a time when there was little public discussion of any kind on the subject.

She returned to Philadelphia to work at the Female Medical College later that year, but left in 1853 after a rift with the college faculty over how medicine should be taught. When Dr. Joseph Longshore and others left the college to start a new medical school, the Pennsylvania Medical University, Dr. Hannah Longshore went with them. She taught anatomy at the Pennsylvania Medical University for the next four years.

When Dr. Hannah Myers Longshore began her private practice in 1858, she became Philadelphia's first woman doctor in private practice, a role she maintained for forty years. Despite her eventual success, her early work in private practice was not without challenges. Many male doctors would not consult with her; one advised her to "go home and darn your husband's socks." Many pharmacists would not fill her prescriptions. For a time, she had to prepare her own medicines by hand.

Despite objections, Dr. Longshore offered a series of public lectures on physiology and hygiene, encouraged by women's rights leaders such as Lucretia Mott. Dr. Hannah Longshore's frank discussions of sexual matters shocked conservatives but brought her praise by others, and many patients.

Dr. Joseph Longshore served as chair of obstetrics at the Penn Medical University until his death in December 1879, and remained active writing and publishing books on obstetrics and medical education for women. His obituary stated that, "to educate women in medicine was the leading desire of the last 30 years of his life [and] by his voice and pen, in private and public, he advocated and defended it amid great opposition."

Over the years, Dr. Hannah Longshore's practice became very successful. At one point, her practice included around three hundred families, a record met by few other doctors of the time. After forty years, she retired in 1892. Thomas Longshore died on August 19, 1898 in Philadelphia.

Dr. Hannah Myers Longshore died October 19, 1901 at the age of 82, leaving a remarkable legacy of four decades in private practice.

Her daughter, Lucretia Mott Longshore Blankenburg, became active in women's rights.

Longshore Family Papers
National Library of Medicine: Dr. Hannah Myers Longshore
Female Medical College and Homeopathic Medical College of Pennsylvania

Image 1: Hannah Myers Longshore

Image 2: Female Medical College of Pennsylvania

From: civilwarwomenblog.com

Nostalgia and Malingering in the Military During the Civil War (excerpt)

By Donald Lee Anderson, Godfrey Tryggve Anderson

In lieu of an abstract, here is a brief excerpt of the content:

The American Civil War witnessed a revival of nostalgia, a mental disorder that had created problems for armies for centuries. It is not within the scope of this study to trace the origins of nostalgia in detail. If we were to attempt this we might begin in early biblical times and consider the words of the psalmist: "By the waters of Babylon, there we sat down, yea, we wept, when we remembered Zion".

As early as 1569, a Swiss officer reported that one of his cadets had succumbed to homesickness. References to this problem can also be found in the first half of the seventeenth century. In 1688 Johannes Hofer, a medical student in Germany, wrote a dissertation on the subject. He was the first to use the term "nostalgia" and to identify it as a disease. He described the symptoms as anorexia, insomnia , slow fever, irritability, anxiety, and a general wasting away of the organism. Hofer pointed out that separation from the homeland was the basis of this ailment and that an "afflicted imagination" was an important cause of this malady. In the course of his description of this "wasting disease" he used such expressions as "nervous fluid" and "the animal spirits".

During the seventeenth and eighteenth centuries, this malady attracted the attention of German physicians. Prominent also in the consideration of nostalgia were the Swiss, who seemed to have particular problems with this malady. It was believed, incorrectly, that those from the vicinity of Bern were especially susceptible to homesickness when they left their native habitat. However, at various times people of Scotland, Wales, Ireland, Lapland, and almost every country showed symptoms of this problem. Beginning at about the time of the French Revolution and extending into the nineteenth century, the French physicians became very concerned with problems of nostalgia in their military ranks. Nostalgia was of epidemic proportions in the French army of the Rhine in 1793.

The official records of noninfectious diseases in the federal army during the American Civil War reveal 5,213 cases of nostalgia and 58 deaths from this malady among white troops from May 1861 to June 30, 1866. The record for "colored troops" reveals 334 cases of nostalgia and 16 deaths. The number of cases of nostalgia is relatively small when compared with such diseases as rheumatism and typhoid, yet the cases which were labeled nostalgia posed a perplexing problem in some areas for the army during the entire duration of the war.

During the early years of the conflict the number of cases of nostalgia among Northern troops increased. In the year that ended June 30, 1863, 2,057 cases and 12 deaths were reported. The next year the number of cases decreased by 800, and the last year of the war the number of cases dropped markedly, although deaths continued to increase slowly but steadily. The year following the war brought a drastic drop to less than 200 cases. The decline after 1863 was due in part to the type of men being taken into the service and the more realistic view of the duration of the war at this time. It was generally felt that nostalgia was most prevalent among the young recruits, and partly for this reason the surgeon general favored increasing the age for induction from 18 to 20 years. Early in 1863, the assistant surgeon general, Dr. Dewitt C. Peters, described nostalgia as found in the military at this time: "... a species of melancholy, or mild type of insanity, caused by disappointment and a continuous longing for the home . . . and is daily met with in its worst form in our military hospitals and prisons, and is especially marked in young subjects".

From: Perspectives in Biology and Medicine
Volume 28, Number 1, Autumn 1984
pp. 156-166 | 10.1353/pbm.1984.0021

From: muse.jhu.edu

Robert E. Lee’s “Right Arm”

From: warfarehistorynetwork.com

Although Stonewall Jackson’s death was unpreventable, given the state of medicine at the time, it is more likely that he died from thromboembolism than from the indirect cause of pneumonia.

Although Stonewall Jackson’s death was unpreventable, given the state of medicine at the time, it is more likely that he died from thromboembolism than from the indirect cause of pneumonia.
Following his greatest victory, at the Battle of Chancellorsville on May 2, 1863, Confederate Lt. Gen. Thomas J. “Stonewall” Jackson was scouting ahead of the lines with members of his staff when tragedy struck. In the pitch blackness of the early spring evening, Jackson and his men were mistaken for Union cavalry and fired upon by their own side. Jackson sustained a severe wound to his upper left arm, necessitating amputation. Upon hearing the news, victorious General Robert E. Lee remarked, “He has lost his left arm, but I have lost my right.” Lee’s words proved prophetic. Eight days after the amputation, Stonewall Jackson was dead.

Dr. Hunter McGuire, medical director of the Confederate Army II Corps believed that pneumonia was the cause of Jackson’s death, along with the general’s other attending physicians. However, modern-day analysis raised the more likely possibility of pulmonary embolism. The source of Jackson’s so-called “pleuro-pneumonia,” as McGuire put it, was presumed to be a lung contusion incurred during Jackson’s fall from a litter after leaving the battlefield at Chancellorsville. However, from the distance of a few feet at most, the ribs would have absorbed most of the force of the fall, protecting the underlying lung. There would also have been external evidence of trauma such as bruising in an injury serious enough to result in a lung contusion. Neither McGuire nor the other physicians found any evidence of such trauma.

Pleuro-pneumonia is a medical term that is rarely used today. Pleurisy occurs when inflammation involves the pleura, or outer surface, of the lung. Pleuritic chest pain often accompanies pneumonia, thus the term pleuro-pneumonia. Sir William Osler’s 1892 edition of his classic textbook, The Principles and Practice of Medicine, states: “Pneumonia is a self-limited disease, and runs its course uninfluenced in any way by medicine. It can neither be aborted nor cut short by any means at our command.” Osler went on to say that “the first distressing system is usually pain in the side, which may be relieved by local depletion—by cupping or leeching.” Such treatment was used unsuccessfully on Jackson.

Did Jackson Die of Pneumonia?
According to the thinking of the day, Jackson’s clinical presentation fit with pneumonia. His physicians cannot be faulted for their diagnosis or treatment, although it should be noted that 19th-century physicians were adept at eliciting the subtle physical signs of pneumonia, such as hearing a cracking sound in the lungs with a stethoscope or finding dullness to percussion of the chest. Neither of these classic signs of pneumonia was found by any of Jackson’s doctors.

In terminal pneumonia, the clinical course typically goes from bad to worse. But in Jackson’s illness, there were two distinct, sudden episodes of deterioration. These occurred on May 3 and May 6, and both were described as being associated with the onset of acute chest pain, shortness of breath, fatigue, and perhaps fever. These symptoms are consistent with pulmonary emboli, which are blood clots traveling to the lungs. Among the numerous complications following amputation of an extremity are nonhealing of the stump, infection, and thromboembolism, or the formation of a blood clot within a large vein. According to McGuire, Jackson’s wound appeared to be healing properly and infection did not seem significant.

It is known today that an amputee is at significant risk for venous thromboembolism and pulmonary embolism. Immobilization of the patient following surgery can allow the blood to pool and clot within the veins. More dangerous is the formation of clots in the large veins that are tied off during amputation. The tying off of the veins, or ligation, leads to stagnation of blood in the veins, which leads in turn to a thrombus, or clot, which can then travel to the lungs and kill the patient.

Even with today’s advanced technology, it is estimated that as many as half of all pulmonary emboli go undetected by physicians. The current treatment and prevention of thromboembolism is accomplished by the use of blood-thinning agents such as Heparin and Lovenox. Although Stonewall Jackson’s death was unpreventable, given the state of medicine at the time, it is more likely that he died from thromboembolism as a direct consequence of his wound and amputation, than from the indirect cause of pneumonia.

Documentary Production Update: The United States Army War College

April 12, 2017

The "Civil War Medicine" documentary team is selecting 3,000 still images for the series. We are now working with the amazing collections in the library of the U.S. Army Heritage and Education Center (USAHEC) in Carlisle, Pennsylvania.

This incredible facility "makes available contemporary and historical materials related to strategic leadership, the global application of Landpower, and U.S. Army Heritage to inform research, educate an international audience, and honor Soldiers, past and present."

Among their components are the Army Heritage Museum, the U.S. Army War College Library and the Military History Institute.

JAMCO Films is honored to be accessing the resources of this incredible facility. Visit the USAHEC Library with us in our next Production Update!

Follow us on Twitter @CivilWarRx

You can make a tax-deductible contribution to "Civil War Medicine: The Documentary Series" on the home page of this website. Thank you!

Documentary Production Update: The Library of the United States Army War College

From JAMCO Films:

The "Civil War Medicine" documentary team is selecting 3,000 still images for the series. We are now working with the amazing collections in the library of the U.S. Army Heritage and Education Center (USAHEC) in Carlisle, Pennsylvania.

Researcher Gail Tomlinson from the "Civil War Medicine" team is pictured in this incredible repository. You can see the multiple set-ups, including lights and copy stands, for photographing materials from the collections.

We will be returning to USAHEC later this month to continue working with the photography collection.

JAMCO Films is honored to be permitted to access these wonderful resources  Visit the USAHEC Library with us in our next Production Update!

Follow us on Twitter @CivilWarRx

Visit our website and view more than 1500 articles. You can make a tax-deductible contribution to "Civil War Medicine: The Documentary Series" on the homepage of this website. Thank you!

The Creation of the U.S. Sanitary Commission

By Lawrence Weber

The U.S. Sanitary Commission assisted the hard-pressed Medical Department in providing aid and comfort to sick and wounded soldiers.

In the spring of 1861, a group of influential northern men and women, led by Unitarian minister Henry Whitney Bellows and social reformer Dorothea Dix, met in New York City to discuss the formation of a sanitary commission, modeled after the British Sanitary Commission established during the Crimean War, to provide relief to sick and wounded soldiers in the Union Army. At the meeting, which took place on April 25, various topics were discussed, including how best to carry out much-needed sanitation and relief work on a grand scale for the benefit of Union soldiers spread throughout the country. By the conclusion of the meeting, the group had laid the foundation for a provisional sanitary commission to be called the Women’s Central Association of Relief for Sick and Wounded in the Army, or WCAR for short.

Creating the WCAR
The goal of the WCAR was to organize and implement a wide-reaching group of women who would provide humanitarian aid to wounded and sick Union soldiers. One of the most important members of the WCAR was Dr. Elizabeth Blackwell, the first woman in the United States to earn a medical degree. Blackwell’s knowledge of medicine was critically important for training new nurses who would eventually travel to army camps to tend the sick and wounded. The goals were noble and humane, but implementing them successfully would prove to be daunting. To be effective, the provisional sanitary commission would need to be assisted by the national government. Bellows felt that it was imperative to go to Washington, D.C., to examine the existing system of medical relief already established by the government. He set off with a small group of doctors, dubbed the Sanitary Delegation, to investigate the government’s ability to respond to the Army’s mushrooming health and relief needs.

Bellows discovered that the government was woefully unprepared for the great national crisis that was already occurring; an extensive sanitary and relief system overhaul was needed immediately. Bellows’s delegation consulted with military and hospital departments for ways to supplement the all-too-apparent governmental deficiencies. They sent letters to the surgeon general of the United States Army, Colonel Thomas Lawson, and to Secretary of War Simon Cameron, requesting that a permanent sanitary commission be established.

Pushing the WCAR Through
Cameron did not reply immediately, and the letter sent to Lawson failed to reach him before the surgeon general died suddenly on May 15 of apoplexy. The letter made its way to the desk of interim Surgeon General Robert C. Wood instead. Wood, the son-in-law to former president Zachary Taylor and the brother-in-law of Confederate President Jefferson Davis, found the letter persuasive and wrote to Cameron endorsing the group’s request. “The Medical Bureau would, in my judgment, derive important and useful aid from the counsels and well-directed efforts of an intelligent and scientific Commission,” Wood advised.

Cameron waited until a new permanent surgeon general was appointed before making a decision. After President Abraham Lincoln chose Dr. Clement Finley to replace the deceased Lawson, Cameron presented Finley with Bellows’s suggestion for a sanitary commission. Meanwhile, Bellows fired off another letter to Cameron outlining the creation of a formally recognized United States sanitary commission. The letter highlighted the goals of the Sanitary Commission, with specific attention paid to the prevention of infection and disease among the sick and wounded.

After careful consideration of the letters and with the new surgeon general’s blessings, Cameron drafted a resolution on June 9 endorsing the creation of the United States Sanitary Commission. He sent the resolution to President Lincoln for approval, and on June 18, Lincoln signed the necessary paperwork establishing the United States Sanitary Commission. As a reward for his hard work, Bellows was named president of the commission. Other members included Robert C. Wood; George Templeton Strong, the famous Civil War diarist who became the commission’s treasurer; renowned landscape architect Frederick Law Olmsted, who had designed New York City’s Central Park; and Dorothea Dix, who was appointed superintendent of women nurses.

The Search for Recruits and Sponsors
The Sanitary Commission went to work immediately, attempting to increase its membership across the Union. In its first year, the commission’s membership grew almost exponentially. By 1863, there were more than 500 branches working under the umbrella of the U.S. Sanitary Commission, which was divided into three departments: the Department of Preventive Service, sometimes called the Department of Inspection; the Department of General Relief; and the Department of Special Relief. The Preventive Service Department was responsible for the inspection of volunteer forces, with specific attention paid to the area of disease, field conditions, and proper medical care. Special focus was placed on the soldiers’ diet, which was often high in calories but low on nutrition. Hardtack, salted pork, coffee, crackers, and preserved beef were staples of the soldiers’ daily fare.

Conspicuously missing were fresh fruits and vegetables, which were hard to acquire. Food was often fried or undercooked, causing many soldiers to become ill from the poorly prepared, non-nutritious foods.

Once the Sanitary Commission was sufficiently organized and staffed, volunteers set out at once to take their message to the soldiers. One of the best ways the Sanitary Commission was able to get out its message was through the printed media. The commission distributed 18 short treatises written by eminent medical men to regimental surgeons and commanding officers. Since the Medical Department had not issued any such treatises to them, the little books were of inestimable value. Sanitary Commission circulars, pamphlets and broadsides were also critically important in keeping the public informed and supportive. To raise money, publications such as the Sanitary Commission Bulletin and Drum Beats were sold for profit, and agents traveled across the country lecturing and fund-raising.

First Battle, First Challenges
The ideas contained in the treatises were put to the test in July 1861, after the First Battle of Bull Run. There was no systematic method of gathering sick and wounded men from the battlefield to the field hospitals. The soldiers who could do so simply straggled in disarray, away from the battle, in search of help. When the Sanitary Commission investigated some of the reasons for the Union Army’s failure at First Bull Run, they discovered that many of the soldiers were too fatigued and hungry to fight properly.

To prevent the mistakes of First Bull Run from happening again, the Sanitary Commission submitted an article, written by Dr. William H. Van Buren, to Harper’s Weekly, which had a circulation of over 200,000 readers. The piece, published on August 24, roughly a month after the battle, was entitled “Rules for Preserving the Health of the Soldier.” The article, like the earlier treatises, included a great deal of useful information for the soldiers to consider. Included in the article were tips on food preparation (frying meat in camp was unsafe and wasteful), the use of spirits (men who used alcohol regularly were the first to fail when strength and endurance were required), campsite selection, and proper grooming habits (hair and beard should be closely cropped). There was also advice on the proper marching pace (90 to 100 steps to the minute), tent spacing (tents should be placed as far from each other as possible, and never less than two paces), and tips on the treatment of wounded men (it was not always necessary to extract a bullet; in fact, more harm might be done in attempts to remove them). The article succeeded in spreading the Sanitary Commission’s message to a wider audience.

Adapting to Challenges
As the war continued, the Sanitary Commission became more efficient. Dressing stations were established on the outskirts of a battlefield and staffed with assistant surgeons, stretcher bearers, and nurses. The staff of a typical dressing station came equipped with bandages, whiskey, brandy, opium pills, and morphine for injured soldiers. Soldiers who were treated at dressing stations but still in need of advanced care walked to field hospitals if their injuries allowed. Soldiers who could not transport themselves to field hospitals were taken by ambulance—provided there were ambulances.

If a soldier survived surgery or treatment in a field hospital, he still faced mortal danger from surgical fevers triggered by infection. Blood poisoning, pneumonia, or erysipelas (a subcutaneous skin infection) could rapidly lead to death. Perhaps the most famous example of this scenario came following the Battle of Chancellorsville in May 1863, when Confederate General Thomas J. “Stonewall” Jackson died from complications brought on by infection after his left arm was amputated.

Upon reaching a permanent hospital, the wounded soldier would be placed under the care of nurses. One of the most famous Sanitary Commission nurses was Louisa May Alcott, famed author of Little Women. In 1863, Alcott published a book entitled Hospital Sketches containing reflections on her life as a Sanitary Commission nurse. Alcott described a common scene: “To me, the saddest sight I saw in that sad place, was the spectacle of a grey-haired father, sitting hour after hour by his son, dying from the poison of his wound,” she wrote. “The old father, hale and hearty; the young son, past all help, though one could scarcely believe it; for the subtle fever, burning his strength away, flushed his cheeks with color, filled his eyes with luster, and lent a mournful mockery of health to face and figure. When the son slept, the father watched him, and though no feature of his grave countenance changed, the rough hand, smoothing the lock of hair upon the pillow, the bowed attitude of the grey head, were more pathetic than the loudest lamentations.” After his son died, the grieving father told Alcott and the other nurses: “My boy couldn’t have been better cared for if he’d been at home; and God will reward you for it, though I can’t.”

Expanding the Sanitary Commission
By 1862, the Sanitary Commission’s role had grown as the scope and nature of the war had grown. The Peninsula campaign of 1862 witnessed the launch of one of the first Union hospital ships during the Civil War, Daniel Webster No. 1, which was able to support some 1,000 sick and wounded soldiers. Most hospital ships were outfitted and staffed by the Sanitary Commission. The objective of the hospital ships was to transport injured soldiers from the war zone as quickly as possible to safe locations where they had access to better medical treatment. During the campaign, some 19 hospital ships were assigned to the Virginia peninsula. It was hard work, but every patient on the ships had a good place to sleep and something hot to eat, and the sickest were given every medical essential.

As 1862 moved along, the Sanitary Commission was severely tested at Fort Donelson, Shiloh, Second Bull Run, Antietam, and Fredericksburg. The commission responded admirably and even seemed to outperform the government’s Army Medical Department, which was slow to respond to battlefield needs and often less efficient. That year saw another important addition to the Sanitary Commission’s already critical work: the creation of the Hospital Directory, an agency that provided information to the general public about the location of sick and wounded soldiers in the army’s general hospitals.

The Creation of the Hospital Directory
Established because of the tremendous influx of letters from families inquiring about the status of their loved ones, the Hospital Directory was headed by John Bowen. Under Bowen’s leadership, the directory recorded information on more than one million soldiers. The information was sent to the directory’s four main offices in Washington, Louisville, Philadelphia, and New York, where it was used to answer questions about missing soldiers and offer comfort and closure to families in despair.

The Hospital Directory also served as a data- gathering center, recording hospital and patient information that was used, in turn, by the Statistical Bureau for the evaluation of medical performance. The Statistical Bureau compiled data on the sanitary conditions of Army life through questionnaires that contained some 190 questions on such topics as camp soil, drainage, quality of available food, water supply, and the background of medical personnel. Through the careful evaluation of the questionnaires, the Sanitary Commission could understand more fully the dangers and complexities of camp life and, consequently, tweak and improve its own relief work.

Acceleration of the War
The year 1863 was especially tumultuous. The battles that took place that year were some of the largest and most consequential of the entire war—Chancellorsville, Vicksburg, Gettysburg, Chickamauga, and Chattanooga. The Sanitary Commission was there for all of them. At Gettysburg, where the carnage was perhaps the most gruesome (approximately 22,000 soldiers from both sides needed medical attention after the battle), Sanitary Commission volunteers worked without rest. When the work of tending to sick and wounded was done, the surgeons in charge of the general hospitals near Gettysburg took the time to write the Sanitary Commission inspector at Gettysburg a letter expressing gratitude “at the manner in which the affairs of the United States Sanitary Commission have been managed since the late battle. The supplementary articles for the sick and wounded have been abundant, comprising every requisite which the exigency demanded, and which nothing but a well-regulated system, with much experience and forethought, could have secured.”

In 1864 came some of the worst carnage of the war. In such places like the Wilderness, Spotsylvania, Cold Harbor, Petersburg, Atlanta, and Nashville, the Sanitary Commission went to offer relief. The commission extended its Department of Special Relief to include the Army and Navy Claim Agency, based in Washington, which was designed to assist soldiers and their families in filling out the proper government forms to obtain back pay, pensions, bounties, and prize money. Many soldiers in the hospital, with families sorely in need of help, were unable to obtain the money that was due them or that was so tied up in red tape that it was beyond their power to collect. Agents of the commission, authorized by the Paymaster’s Department, helped remove such difficulties. In Stanton Hospital alone, the back pay of 56 men, amounting to $3,008.96, was procured in a single week.

Maintaining a Presence
When the Civil War ended in April 1865, the work of the Sanitary Commission continued. The commission worked to negotiate the return of prisoners of war, helped to smooth the process of discharging Union soldiers, and continued to care for hospitalized soldiers. The commission also continued the good work of the Hospital Directory by reuniting soldiers with their families whenever they could and by offering comfort and closure to families who had lost loved ones. Not until October 1, 1865, did the commission’s active relief work officially end. And though it is true that more soldiers died during the Civil War from infection and disease than from bullet wounds, the numbers surely would have been higher without the tireless contributions of the United States Sanitary Commission.

Originally Published February 2010

Image 1: A Sanitary Commission barge at City Point, one of 19 hospital ships assigned to the Virginia peninsula.

Image 2: Sanitary Commission nurses and officers pose at Fredericksburg, Virginia, during the 1864 Wilderness campaign.

From: warfarehistorynetwork.com

History of PTSD in Veterans: Civil War to DSM-5

By Matthew J. Friedman, MD, PhD, Senior Advisor and former Executive Director, National Center for PTSD

Exposure to traumatic experiences has always been a part of the human condition. Attacks by saber tooth tigers or twenty-first century terrorists have likely led to similar psychological responses in survivors of such violence. Literary accounts offer the first descriptions of what we now call posttraumatic stress disorder (PTSD). For example, authors including Homer (The Iliad), William Shakespeare (Henry IV), and Charles Dickens (A Tale of Two Cities) wrote about traumatic experiences and the symptoms that followed such events.

The PTSD diagnosis has filled an important gap in psychiatry in that its cause was the result of an event the individual suffered, rather than a personal weakness. PTSD became a diagnosis with influence from a number of social movements, such as Veteran, feminist, and Holocaust survivor advocacy groups. Research about Veterans returning from combat was a critical piece to the creation of the diagnosis. War takes a physical and emotional toll on Servicemembers, families, and their communities. So, the history of what is now known as PTSD often references combat history.

Early attempts at a medical diagnosis
Accounts of psychological symptoms following military trauma date back to ancient times. The American Civil War (1861-1865) and the Franco-Prussian War (1870-1871) mark the start of formal medical attempts to address the problems of military Veterans exposed to combat. European descriptions of the psychological impact of railroad accidents also added to early understanding of trauma-related conditions.

Nostalgia, Soldier's Heart, and Railway Spine
Prior to U.S. military efforts, Austrian physician Josef Leopold (1761) wrote about "nostalgia" among soldiers. Among those who were exposed to military trauma, some reported missing home, feeling sad, sleep problems, and anxiety. This description of PTSD-like symptoms was a model of psychological injury that existed into the Civil War.

A second model of this condition suggested a physical injury as the cause of symptoms. "Soldier's heart" or "irritable heart" was marked by a rapid pulse, anxiety, and trouble breathing. U.S. doctor Jacob Mendez Da Costa studied Civil War soldiers with these "cardiac" symptoms and described it as overstimulation of the heart's nervous system, or "Da Costa's Syndrome." Soldiers were often returned to battle after receiving drugs to control symptoms.

The thought that physical injury led to PTSD-like symptoms was supported by European reports of "railway spine." As rail travel became more common, so did railway accidents. Injured passengers who died had autopsies that suggested injury to the central nervous system. Of note, Charles Dickens was involved in a rail accident in 1865 and wrote about symptoms of sleeplessness and anxiety as a result of the trauma.

Shell Shock
In 1919, President Wilson proclaimed November 11th as the first observance of Armistice Day, the day World War I ended. At that time, some symptoms of present-day PTSD were known as "shell shock" because they were seen as a reaction to the explosion of artillery shells. Symptoms included panic and sleep problems, among others. Shell shock was first thought to be the result of hidden damage to the brain caused by the impact of the big guns. Thinking changed when more soldiers who had not been near explosions had similar symptoms. "War neuroses" was also a name given to the condition during this time.

During World War I, treatment was varied. Soldiers often received only a few days' rest before returning to the war zone. For those with severe or chronic symptoms, treatments focused on daily activity to increase functioning, in hopes of returning them to productive civilian lives. In European hospitals, "hydrotherapy" (water) or "electrotherapy" (shock) were used along with hypnosis.
Battle Fatigue or Combat Stress Reaction (CSR)

In World War II, the shell shock diagnosis was replaced by Combat Stress Reaction (CSR), also known as "battle fatigue." With long surges common in World War II, soldiers became battle weary and exhausted. Some American military leaders, such as Lieutenant Gen. George S. Patton, did not believe "battle fatigue" was real. A good account of CSR can be found in Stephen Crane's Red Badge of Courage, which describes the acute reaction of a new Union Army recruit when faced with the first barrage of Confederate artillery.

Up to half of World War II military discharges were said to be the result of combat exhaustion. CSR was treated using "PIE" (Proximity, Immediacy, Expectancy) principles. PIE required treating casualties without delay and making sure sufferers expected complete recovery so that they could return to combat after rest. The benefits of military unit relationships and support became a focus of both preventing stress and promoting recovery.

Development of the PTSD diagnosis
In 1952, the American Psychiatric Association (APA) produced the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I), which included "gross stress reaction." This diagnosis was proposed for people who were relatively normal, but had symptoms from traumatic events such as disaster or combat. A problem was that this diagnosis assumed that reactions to trauma would resolve relatively quickly. If symptoms were still present after six months, another diagnosis had to be made.

Despite growing evidence that trauma exposure was associated with psychiatric problems, this diagnosis was eliminated in the second edition of DSM (1968). DSM-II included "adjustment reaction to adult life" which was clearly insufficient to capture a PTSD-like condition. This diagnosis was limited to three examples of trauma: unwanted pregnancy with suicidal thoughts, fear linked to military combat, and Ganser syndrome (marked by incorrect answers to questions) in prisoners who face a death sentence.

In 1980, APA added PTSD to DSM-III, which stemmed from research involving returning Vietnam War Veterans, Holocaust survivors, sexual trauma victims, and others. Links between the trauma of war and post-military civilian life were established.

The DSM-III criteria for PTSD were revised in DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000), and DSM-5 (2013) to reflect continuing research. One important finding, which was not clear at first, is that PTSD is relatively common. Recent data shows about 4 of every 100 American men (or 4%) and 10 out every 100 American women (or 10%) will be diagnosed with PTSD in their lifetime.

An important change in DSM-5, is that PTSD is no longer an Anxiety Disorder. PTSD is sometimes associated with other mood states (for example, depression) and with angry or reckless behavior rather than anxiety. So, PTSD is now in a new category, Trauma- and Stressor-Related Disorders. PTSD includes four different types of symptoms: reliving the traumatic event (also called re-experiencing or intrusion); avoiding situations that are reminders of the event; negative changes in beliefs and feelings; and feeling keyed up (also called hyperarousal or over-reactive to situations). Most people experience some of these symptoms after a traumatic event, so PTSD is not diagnosed unless all four types of symptoms last for at least a month and cause significant distress or problems with day-to-day functioning.

Today VA operates more than 200 specialized programs for the treatment of PTSD. In Fiscal Year (FY) 2013, more than a half million Veterans diagnosed with PTSD received treatment at VA medical centers and clinics.

VA is committed to provide the most effective, evidence-based care for PTSD. It has created programs to ensure VA clinicians receive training in state-of-the-art treatments for PTSD. At of the end of FY 2013, VA had trained more than 5000 of its clinicians to use Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE), which are cited by the Institute of Medicine Committee on Treatment of PTSD as proven to be effective treatments for PTSD.

VA's National Center for PTSD was created in 1989 by an act of Congress, and celebrated its 25th anniversary on August 29, 2014. We continue to be at the forefront of progress in the scientific understanding and treatment of PTSD. In addition to improving upon existing treatments, we are researching effective new treatments. We are also developing new educational products such as our What is PTSD? whiteboard video. For more information on the National Center for PTSD, please visit our About Us section of the website.

Portions of this fact sheet originally appeared in a Veterans Day observance post on VA's blog, VAntage Point (November 7, 2013). For more information about the history of the PTSD diagnosis, see PTSD History and Overview in the "Professional Section" of our website.

From: ptsd.va.gov


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