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.

Wednesday, March 11, 2015

The Army Medical Department Civilian Corps: A Legacy of Distinguished Service

By Major Kenneth M. Koyle, AMEDD Center of History and Heritage, 3-9-11

Civilians have played a vital role in Army medicine from the very beginning. In fact, virtually all medical functions were provided by civilians in the first few decades of the Army’s existence. The history of civilian support to the Army Medical Department (AMEDD) is an integral and inseparable component of our overall medical history.

On 27 July 1775 the Continental Congress established a medical department to provide care for the nascent Continental Army. Although it outlined a rudimentary system of care for the military, the legislation creating the medical department did not designate military rank for medical personnel, nor did it specify the correlation of the department to the larger army. This ambiguity left a corps of pseudo-civilian medical providers to carve out their own place in the Army structure, and spawned counterproductive infighting and confusion that persisted throughout the American Revolution and the subsequent War of 1812.

Despite the challenges of working in this ill-defined system, the civilian cadre of the early AMEDD made significant strides in planning and organizing battlefield medicine, preventive care, and basic logistical support for the Army. Under the purview of a Director General (antecedent of the Surgeon General), the surgeons, assistant surgeons, apothecaries, and purveyors worked tirelessly to overcome obstacles and provide the best care possible. These personnel served in a peculiar, indeterminate state—not exactly soldiers, because they had neither rank nor uniforms, but not exactly civilians, because they were subject to the rules, regulations, and restrictions of the Army. Their pay was meager and the conditions of service were arduous. According to one surgeon who served on the Canadian frontier during the War of 1812, most medical men were only willing to serve for a single year in these circumstances, and then only because of curiosity and a thirst for adventure.

In 1818 Congress finally established a permanent Medical Department with a Surgeon General at its head, although neither he nor the surgeons and assistant surgeons under him held military rank. By 1840 the military surgeons had a standardized uniform and their pay was approaching that of the line officers. Although they were commissioned, they still held no military rank and were not entitled to salutes. This indistinct status was clarified in February 1847, when Congress granted official rank to medical personnel. From this point forward there would be a distinction between the military surgeons and their civilian colleagues, but their roles would often merge and their military functions were frequently indistinguishable.

The contract surgeon was the most prevalent manifestation of civilians serving the AMEDD in the 19th century. These civilian doctors were hired to fill shortages throughout the medical system, often with service at isolated frontier posts or other austere locations. Field commanders were authorized to hire contract surgeons as needed to provide adequate medical care for their units. Their numbers rose steadily over the ensuing years, and during the Civil War more than 5,500 civilian doctors served with the Medical Department. Many of these contract surgeons performed heroically in action with the units they supported. Perhaps the most striking example is the story of Mary Walker, a contract surgeon who served at Bull Run, Chickamauga, Richmond, and Atlanta, and spent time as a prisoner of war. In 1865 Dr. Walker became the first woman to receive the Medal of Honor, and she did it as a civilian in the Army Medical Department. To this day she remains the only female recipient of the award.

At the end of the 19th century the Army continued to augment its regular medical force with civilian doctors, nurses, dentists, veterinarians, and purveyors serving under contract. Contract medical personnel served in Cuba, Puerto Rico, and the Philippines during the Spanish-American War, and when Surgeon General George Sternberg appointed Major Walter Reed to chair a commission investigating yellow fever, he staffed the commission with three contract surgeons. These civilian researchers—Aristides Agramonte, James Carroll, and Jesse W. Lazear—traveled to Cuba with Reed and studied the deadly disease to determine how it was transmitted. Everyone involved in the research was exposed to disease risks, and Lazear died after allowing himself to be bitten by an infected mosquito. Their work proved that yellow fever was transmitted by mosquitoes, and led to sanitation and preventive medicine policies that saved countless lives around the world.

The 20th century ushered in significant changes in the structure of the Army Medical Department. At the turn of the century the AMEDD was comprised of only two corps, the Medical Corps and the Hospital Corps (precursor to the AMEDD Enlisted Corps). Hundreds of civilian contract nurses had been in service during the Spanish-American War, and in 1901 they traded their contracts for commissions with the creation of the Army Nurse Corps. The contract dentists followed suit with the creation of the Dental Corps in 1911, then the Veterinary Corps in 1916 and the Sanitary Corps (later Medical Service Corps) in 1917. By this time, with five officer corps, plus a Medical Reserve Corps (civilian physicians who had agreed to serve in time of need) and a corps of enlisted Soldiers, most contract medical positions had been converted to active military status. However, this did not eliminate the need for civilian augmentation to the AMEDD. When the United States entered World War I, the AMEDD was woefully small and inadequate for the colossal task of supporting over four million troops in a distant war. The majority of the vast surge in medical manpower was filled through the Medical Reserve Corps, but the scope of the required growth necessitated hiring more than 80 contract surgeons. Army hospitals were typically staffed with civilians in a wide variety of positions, including unique specialties and new practice fields that had not yet been fielded in the active force. Civilian reconstruction aides (later termed physical therapists and occupational therapists), dieticians, x-ray technicians, and other medical specialists helped bring state-of-the-art medicine to the Soldiers. A number of Civil Service personnel, including psychologists, also aided in screening new recruits and draftees.

From: history.amedd.army.mil

The Poet Laureate of the South: Margaret Junkin Preston

From: acws.co.uk

Margaret Junkin Preston (19 May 1820 - 28 March 1897), poet and writer, was born in Milton, Pennsylvania, the daughter of Rev. George Junkin and Julia Rush Miller. A Presbyterian minister, her father was called to Easton, Pennsylvania, in 1832 to assume the presidency of the newly established Lafayette College. As a child, Margaret was tutored by members of the Lafayette faculty as well as her parents. Dr. Junkin became president of Miami University in Oxford, Ohio, in 1841; three years later, he returned to Lafayette. In 1848, having accepted the presidency of Washington College (later Washington and Lee University), he moved his family to Lexington, Virginia.

Training her eyes by sewing and reading, Margaret Junkin had seriously impaired her vision by the time she was twenty-one. Nevertheless, after the move to Lexington, she began to publish poems and stories in newspapers and magazines. In 1856, she published anonymously Silverwood: A Book of Memories, a novel that satirized the emphasis Virginians placed on ancestry. The following year, she married Major John T. L. Preston a widower with seven children, who helped found the Virginia Military Institute and taught Latin there. Margaret's sister Eleanor married Major Thomas Jonathan Jackson, later famous as "Stonewall" Jackson, who was professor of mathematics at the Institute. Margaret and John Preston later had two sons of their own.

Preston's family, like many others, was divided by the Civil War. Dr. Junkin was forced to resign the presidency of Washington College in 1861 because of his Unionist sympathies. Although Major Preston opposed secession, he went along with Virginia and served under Stonewall Jackson; Margaret Preston shared his political views. Espousing the southern cause, she wrote some of the most popular verse in the Confederacy.

In the intervals between housekeeping duties, Preston kept a wartime diary, which became the basis for her second book, Beechenbrook: A Rhyme of the War. Her husband, now a colonel, had an edition of 2,000 copies printed in Richmond in 1865. Most of this edition was destroyed during the burning of Richmond. The work sold over 7,000 copies when it was republished in Baltimore in 1866. After the war, the Prestons were reunited. John Preston returned to his professorship at the Virginia Military Institute, a position he held until his retirement in 1882. During Reconstruction, Margaret Preston continued to combine the roles of housewife, mother, and poet. She published poems and reviews in southern magazines and newspapers and even in such northern magazines as Lippincott's.

Margaret's tribute to 'Stonewall'
Jackson. A Sonnet

Thank God for such a Hero!--
Fearless hold
His diamond character beneath the sun,
And brighter scintillations, one by one,
Come flashing from it. Never knight of old
Wore on serener brow, so calm, yet bold,
Diviner courage: never martyr knew
Trust more sublime,--nor patriot, zeal more true,--
Nor saint, self-abnegation of a mould
Touched with profounder beauty.
All the rare,
Clear, starry points of light, that
gave his soul
Such lambent lustre, owned but one sole aim,--
Not for himself, nor yet his country's fame,
These glories shone: he kept the clustered whole
A jewel for the crown that Christ shall wear!

Thoracic Surgery in the Civil War

Excerpted from: U.S. Army Medical Department, Office of Medical History

Of a total of 253,142 wounds recorded in the Civil War, 20,607 (8.1 percent) involved the chest, and 8,715 of these (42.3 percent) were penetrating wounds (5). The overall case fatality rate for chest wounds was 27.8 percent and for penetrating chest wounds 62.6 percent. A number of cases were reported in which complete recovery followed gunshot wounds of both lungs. A number of recoveries were also reported after penetrating gunshot fractures of the sternum, apparently because the causative missiles were of low velocity.

In 1863, Assistant Surgeon Benjamin Howard recommended to Brig. Gen. William A. Hammond, The Surgeon General, that penetrating wounds of the chest in which suppuration had not occurred should be managed by removal of all foreign bodies; control of bleeding; paring of the edges of the wound; closure by metallic sutures; and the application of an airtight dressing, so that the wound would be hermetically sealed. In this recommendation, the implications of the physiology of chest wounds, their mechanics, and the principles of wound suppuration and wound healing were all overlooked. Because of failure to realize that sealing the wound hermetically was only part of the problem, infection was common, and a high case fatality rate was inevitably associated with this type of treatment.

Pneumothorax is mentioned in the Civil War history a number of times but apparently seldom reached an alarming stage. Tension pneumothorax is mentioned only a half dozen times.
Hemothorax, either alone or in combination with pneumothorax, was recognized as a dangerous complication, particularly because of the extreme dyspnea often associated with it. Early in the war, it was believed that the surest way to arrest bleeding was by bleeding the casualty further. In the Confederate Manual used during the war, however, venesection was described as a time-honored absurdity, and it is doubtful that it was ever practiced by any Confederate surgeon. The routine plan, when hemothorax was present, was to try to identify the bleeding point, control it, and then employ such general measures as cold acidulated drinks together with the administration of digitalis or opium. It was recognized that if the hemothorax was not absorbed, empyema would result.

Thoracentesis was used to relieve the effects of effusions resulting from acute and chronic pleurisy or from "traumatic pneumonia" (a term used to indicate infected hematoma, atelectasis, lung abscess, and other infectious sequelae). This method was not used, as in World War II, to evacuate hemothoraces and promote rapid expansion of the lung.

Operation was sometimes necessary to control bleeding from the great vessels. The usual procedure was to ligate only the proximal end of the vessel, and it is not surprising that there were no recoveries in wounds of the axillary artery, though there were 5 survivals in 25 casualties with wounds of the subclavian artery.

Four recoveries were recorded in gunshot wounds of the heart. Patients with wounds of the pericardium sometimes languished for several weeks with suppurative processes, but, in one series of 51 cases, there were 22 recoveries. It was noted that extreme dyspnea might accompany a wound of the heart because of intrapericardial pressure, which could be relieved by paracentesis.

Wounds of the esophagus are not specifically mentioned in the Civil War history, but a disproportionate amount of space is given to descriptions of hernia of the lung. Such hernias, it was stated, were extremely uncommon among British casualties at Waterloo as well as in the Crimean War. One case, described in detail, was managed by the technique first described by Tolandus of Parma in 1449 (1) and used successfully by Whittemore (6) in 1929 on nine patients. This technique, which amounts to a two-stage lobectomy, consists of creation of a hernia of the lung, followed by excision of the protrusion after adhesions have formed.

From: history.amedd.army.mil

Clement A. Finley, Surgeon General

From: history.amedd.army.mil

CLEMENT ALEXANDER FINLEY (May 11, 1797 - Sept. 8, 1879), Surgeon General, May 15, 1861 - April 14, 1862, was born at Newville, Cumberland County, Pa.  His father, Samuel Finley, served in the Virginia cavalry during the Revolutionary War attaining the grade of major.  President Washington appointed him receiver of public moneys in the northwest, which position took him to Chillicothe, Ohio, about 1796, where he received a large allotment of land for his Revolutionary War service.  Here the son spent his childhood and youth and here obtained his early education.  With the educational facilities of Chillicothe exhausted, he was sent to Carlisle, Pa., near his birthplace, to Dickinson College where he was graduated in 1815.  He then went to Philadelphia where in 1818 he was given the degree of M. D. by the University of Pennsylvania.

His father's military service attracted him to the army, which had recently emerged from the War of 1812-15, and on August 10, 1818, he was commissioned as a surgeon's mate of the 1st Infantry.  The forty-three years that intervened before he became Surgeon General were filled largely with routine garrison duty, but included much field service in the wars of the period.  His first assignment carried with it four years with his regiment in Louisiana, then two years in what was then the wilds of Arkansas, at Fort Smith.  In the years from 1825 to 1828 he served at Fort Gibson, Arkansas, in Florida, at Jefferson Barracks, Missouri, and at Fort Leavenworth, Kansas.
Following this he passed three years at Fort Dearborn, Illinois, where he saw the beginning of Chicago's marvelous growth.

In 1831 he was ordered to Fort Howard, Wisconsin, and while on this duty he was detached for service as chief medical officer of the forces operating under General Winfield Scott in the Black Hawk War of 1833.  He served a year with the 1st Dragoons in Florida, then two years again at Jefferson Barracks.  In 1834 he was again sent to Florida where he served throughout the Seminole War until 1838.  With hostilities over he was sent to Fortress Monroe, Virginia, for a year, and then to Buffalo, N. Y., for another year.  From 1840 to 1844 he served at Carlisle Barracks, Pa., where he renewed his acquaintance with his alma mater, Dickinson College. The outbreak of the Mexican War found him again at Fortress Monroe, from where he was sent in 1846 to the army which was invading Mexico across its northern border.

By virtue of his rank he became medical director of this army commanded by General Zachary Taylor, but shortly after was sent north on account of sickness.  During this detached service be acted as member of a number of examining boards.  In 1847 he returned to duty in Mexico with the army, under General Scott, which was invading the country by way of Vera Cruz.  He was medical director of this force until again sickness required that he be sent north.  He was permanently relieved from Mexico duty and ordered to Newport Barracks, Kentucky.  In 1849 he went to Jefferson Barracks for a third tour of duty and in 1854 to duty in Philadelphia with his quarters at Frankford Arsenal.

The years upon this detail largely involved work on examining boards and it was on this sort of duty that he was engaged when in 1861 he received the appointment to the office of Surgeon General.  Surgeon General Lawson's death came unexpectedly and it was generally considered that his successor would be Surgeon Robert C. Wood, a high ranking officer who was in charge of the office during Lawson's absence.  Wood was son-in-law to former President Taylor and brother-in-law to Jefferson Davis and from his long duty in the War Department had many other influential friends.  But a new political party was now in control and President Lincoln chose Finley, the senior officer of the corps, for the coveted place on May 15, 1861.  Finley retained Wood as his assistant and their relations appear to have been entirely cordial.

The new Surgeon General was sixty-four at the time of appointment, but was in good physical condition and entered the office keen for the heavy duties devolving upon him.  Beyond his office work he was busy in the furtherance of legislation and in the selection of hospital buildings and sites in the capital city.  It is difficult at this time to determine to what extent Finley influenced the policies and legislation affecting the medical department during his term of office.  The Sanitary Commission was active with criticism and recommendations and had high influence with Congress.  The act passed on August 3, 1861 (12 Stat. 288), increasing the number of officers and providing for the employment of medical cadets and female nurses was no doubt in response to recommendations from both the office of the Surgeon General and the Sanitary Commission.  The act also provided for the creation of boards for the consideration of cases of disability.  A provision for two assistants to the Surgeon General with the rank of lieutenant colonel, contained in the original bill, was stricken out.

On April 16, 1862, an act was passed (12 Stat. 378) for the reorganization of the medical department which gave the Surgeon General the rank of brigadier general, created an assistant Surgeon General and a medical inspector with rank of colonel, eight medical inspectors with the rank of lieutenant colonel, and provided for medical purveyors.  This was the first time when actual rank in the medical department had exceeded the grade of major, except that the Surgeon General had the grade of colonel.  But Finley was not to achieve the advanced grade, as he was retired on his own application on April 14, 1862, two days before the passage of that act.  He had incurred the displeasure of Secretary of War Stanton by a hospital appointment and after a heated interview with the Secretary had been relieved from his office and directed to repair to Boston and await orders.  From Boston he appealed against the treatment accorded him, but despite the efforts of influential friends no action could be obtained and hopeless of justice and redress he applied for admission to the retired list.  In the meantime, and until the appointment of his successor, Surgeon Wood performed the duties of Surgeon General.

After his retirement Finley made his home in West Philadelphia, where he passed eighteen peaceful years and where he died on September 8, 1879.  In the meantime, in 1865, he was given the brevet rank of brigadier general "for long and meri-torious service in the army."  General Finley was a notably handsome man, six feet tall, of good figure and good military bearing.  During most of his service he wore the so-called military beard in a fashion that few could achieve.  He was a talented physician and was absorbed in the care of his patients.  During the Black Hawk War he received the official thanks of General Scott for his handling of the cholera outbreak in the command.  His whole career was marked by conspicuous and efficient service.  Any estimate of his personal achievements as Surgeon General is obscured by the presence of a highly able assistant and a meddlesome Sanitary Commission.  In 1832 he married Elizabeth Moore, daughter of Dr. Samuel Moore, at that time director of the United States Mint at Philadelpbia and formerly member of Congress from Bucks County, Pa.

Sources:  H. E. Brown, Medical Department of the U.S. Army from 1775 to 1873  (1873);  J. E. Pilcher, Surgeon Generals of the Army (1905);  W. P Atkinson, Physicians and Surgeons of the U. S. (1878),  G. V. Henry,  Military Records of Civilian Appointments (1873);  Appleton’s Cyclopedia of American Biography, Vol. II (1887).

[Extracted from "Chiefs of the Medical Department, U.S. Army 1775-1940, Biographical Sketches,"  Army Medical Bulletin, No. 52, April 1940, pp. 38-41, compiled by James M. Phalen, Colonel, Medical Corps, U.S. Army retired]

The Pampered Louse

From: acws.co.uk

No one should attempt a collection of Confederate humour without including an account of the old-time "grayback" louse, or Pediculus Vestimenti. These tiny unforgiving creatures were so well known by all Civil War Soldiers, as to have become "legends in their own time." One infantry man summed up their ever-presence by declaring simply, that each louse should have had stamped on his or her back; "IFW", "In for the war."

There are hundreds of excellent primary sources that make mention of these devilish insects. One favourite which chronicles the "comings and goings" of this "depraved little pest," was recorded by Captain William ‘Buck’ Walton, Company B, 21st Texas cavalry. Here is his excerpted version:

Head Louse
I found that many of the men had been familiar with these varmints a long time - and become accustomed to their presence. So much so, that it was part of their amusement to catch big ones and bet on their fighting qualities. It is true that the grown bug, when taken from the bodies of different men - and placed together, will rush at one another like bulldogs, and fight to the death - or until one, being whipped and wounded, will scramble out of reach if his adversary. This I saw tested one day when a number of my men were gathered together, watching very intently such a fight. They had two "big fellows" on the top of a hat, smoothed out. There was considerable excitement, and the men had their Confederate money - and were flourishing it, as I have seen men do at a horserace. I walk up to see what was the matter and saw the whole fight. The bugs were just coming together - and they certainly were mad. The gladiators unarmed save with their natural weapons were joined in conflict. It was a battle royal. They stood up on their hind feet. They closed in grapple and would roll over and over. They seemed never to weary. The battle lasted five or six minutes. The blood was very perceptible on each one. Their legs were broken and there were wounds on their bodies - to such an extent that they were maimed - and neither could run from each other. The two warriors could do nothing, but lay on the field of battle and lingering die.

Actually some of the men would not molest a very fine specimen - but let him grow and fatten on his own blood until the thought he had the most robust "gladiator" in camp and then would draw him forth privately and try his powers on a smaller specimen, that he would borrow or steal from another man. When he had tested him and made him bold by whipping smaller fellows--his owner would challenge the field - having the champion--& offer to bet on him, like he owned a press that threw off Confederate money as wanted. Sometimes they made a run with their pampered louse, and became very flush. And then some man would find a still more pampered one and win all his money. Many are the ways that idle soldiers find to amuse themselves - but I really think this was one of the most unique ways that I saw in the army. I called on two boys for two of their champion "gladiators" - for a special purpose. They cheerfully gave them, and I took them & in a letter to my Captain’s wife Mrs. Wm. Rust at Burnet, Texas, enclosed them to her - to see what we could do in the army. They were received - and proved of the right gender - & before she was aware of it, she was in possession of a flourishing colony, which caused much washing and disinfecting before she could get rid of them.

Ambulance Trains

From: replications.com

Immediately prior to the break out of hostilities between the National Government and the Confederate States, the U.S. Army had developed and built a quantity of ambulances.  Up to that time, there was no purpose built ambulance in government service.  In previous wars, various wagons were pressed into service for the transporting the sick and wounded.  Most were found unsuitable.

The commission that developed the specifications for the first U.S. Army ambulances examined European designs and those submitted by American sources.  It was decided that a light, single horse, two-wheeled cart and a heavier, two (sometimes four) horse, four-wheeled wagon be built.   A Battalion of Infantry was to receive an allotment of one two-wheeled cart per company plus one more two-wheeled cart and a four-wheeled wagon per battalion.  Later, men were drafted from regiments to form an Ambulance Corps.  An innovation of Jonathan Letterman, the Ambulance Corps first officially appears in the Army of the Potomac (1862).  Congress would later make the institution a mandated part of the establishment (1864).

The two photographs on this page illustrate the usage of the three most common ambulances used during the war.  The first photograph shows the 2 wheeled ("Coolidge") and 4 wheeled ("Tripler") approved for use in  1859.  The second photograph shows the lighter 4 wheel pattern ("Roscrans/Wheeling") that begins to appear in numbers about the time of Fredericksburg and will generally replace the earlier models by the end of 1863.

Medical Inspector Frank Hamilton noted that the two wheeled variety continued in use through the end of the war where the roads were smooth.

Near the end of the war, an improved 4 wheeled ambulance ("Rucker") was adopted and was the standard Army pattern ambulance for the post war Indian campaigns.


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