.

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.

Monday, July 14, 2014

Georgeanna Woolsey : A Day in the Life of a Northern Nurse

From: civilwar.org

Georgeanna Woolsey was a young unmarried woman when the Civil War began. Shortly after the start of the war, the Woman’s Central Relief Association (a part of the U.S. Sanitary Commission) organized a volunteer nursing staff for the United States Army. In May 1861 she was one of one hundred women selected to become a volunteer nurse. With no prior medical training, she was sent to New York for, what she called in her diary, "a month’s seasoning in painful sights and sounds".

"We took off our bonnets and went to work. Such a month as we had of it, walking round from room to room, learning what we could—really learning something in the end, till finally, what with writing down everything we saw, and making elaborate sketches of all kinds of bandages and the ways of applying them, and what with bandaging everybody we met for practice, we at last made our ‘reverses’ without a wrinkle; and at the end of the month were competent to any very small emergency, or very simple fracture."

She was assigned to Washington D.C. in July 1861 where, she wrote, "Miss [Dorothea] Dix received us kindly and gave us a good deal of information about the hospitals, and this morning we went to the Georgetown Hospital to see for ourselves. We were delighted with all the arrangements. Everything was clean and comfortable. We shall go again and take papers and magazines."

Her pleasant early experiences were misleading, however. Later, looking back on her nursing career, she remarked, "No one knows who did not watch the thing from the beginning, how much opposition, how much ill-will, how much unfeeling want of thought, these women nurses endured. Hardly a surgeon whom I can think of received or treated them with even common courtesy. Government had decided that women should be employed, and the Army surgeons—unable, therefore to close the hospitals against them—determined to make their lives so unbearable that they should be forced in self-defense to leave."

She did not leave. As fighting became more intense, a makeshift hospital was set up in the Washington, D.C. patent office (now the National Portrait Gallery) where she continued to work as a nurse. She described her experiences:

"On the stacks of marble slabs…we spread mattresses, and put the sickest men. As the number increased, camp beds were set up between the glass cases in the outer room and we alternated—typhoid fever, cogwheels and patent churns, typhoid fever, balloons and mouse traps…Here for weeks, went on a sort of hospital pic-nic. We scrambled through with what we had to do…Here for weeks we worked among these men, cooking for them, feeding them, washing them, sliding them along on their tables, while we climbed up on something and made up their beds with brooms, putting the same powders down their throats with the same spoon, all up and down what seemed half a mile of uneven floor; coaxing back to life some of the most unpromising—watching the youngest and best die."

Georgeanna Woolsey lived with her married sister Eliza Woolsey Howland in Washington, D.C. while Eliza's husband, Joseph Howland, was serving in the Union Army of the Potomac. When the Army of the Potomac was ordered to leave the capital, Georgeanna and Eliza wanted to travel with it. They tried several times to get permission but were unsuccessful until the Sanitary Commission gave them positions on the hospital ship Daniel Webster. They sailed after the army in April 1862. She wrote, "Sunday, the first day [on the ship] was gone. As for us, we had spent it sitting on deck, sewing upon a hospital flag fifteen by eight, and singing hymns to take the edge off this secular occupation. It is to be run up at once in case we encounter the Merrimac."

Georgeanna's letters after 1862 were lost to a fire, but it is easy to see how the war had affected her over the course of one year. In May 1862, she wrote, "We are changed by all this contact with terror, else how could I deliberately turn my lantern on his [a wounded soldier’s] face and say to the Doctor behind me, “Is that man dead?” and stand cooly, while he listened and examined and pronounced him dead. I could not have quietly said, a year ago, 'That will make one more bed, Doctor.'”

—Source Letters of a Family During the War 1861-65, Privately published in 1899 by Georgeanna Woolsey Bacon and Eliza Woolsey Howland.


On Bodies and Minds: Effects of the Civil War

From: news.pennmedicine.org

It’s hard to fathom, but to this day one startling Civil War statistic stands: approximately 625,000 American men – the equivalent of 6 million men today – were killed in action or died of disease between April 12, 1861 and April 9, 1865. That’s more than in World War I, World War II, the Korean War and Vietnam War combined.

#48 - Hospital for the Insane - Dept. for FemalesWith defeat of the Southern Confederacy, the Civil War – referred to during its time (depending upon what side you were on) as the War of Southern Rebellion or War of Northern Aggression – resulted in three new amendments to the U.S. Constitution, the abolishment of slavery and the preservation and subsequent redefinition of the U.S. as a single nation. These are the usual take-away points we glean from the history books. But what of the survivors? The physically and mentally maimed veterans and collaterally damaged civilian victims of the Civil War era?

No stranger to American history, Pennsylvania Hospital (PAH) – the nation's first hospital, founded in 1751 by Benjamin Franklin and Dr. Thomas Bond – is currently hosting two free, historical exhibits which offer a retrospective look into the effects the Civil War had on the bodies and minds of Americans.

On loan from the National Institutes of Health, the first exhibit, Life and Limb: the Toll of the American Civil War, is on display in PAH’s Historic Surgical Amphitheater until October 6th. (NOTE: This exhibit is now closed.)

Over three million soldiers fought in the Civil War over the course of four years. Over half a million died, and almost as many wounded survived. Many veterans were permanently disabled from battlefield injuries or surgery which, even during a time of no antibiotics and not enough ether to go around, saved lives by sacrificing limbs. The Life and Limb exhibit explores the harrowing experience of these disabled veterans, which transformed them into indelible symbols of a fractured, young nation and a reminder of the high cost of war.

One floor down from the Surgical Amphitheater in PAH’s original building, the Pine Building, is the Historic Medical Library. Open since 1762, the Library is the oldest medical library in the United States and the home of the second exhibit: Mental Health During the Civil War: Thomas Story Kirkbride and the Pennsylvania Hospital for the Insane. This one-of-a-kind exhibit explores the treatment of the mentally ill during the Civil War period from a very direct and “hands on” point of view. Brought to PAH by the Hospital’s own Curator and Lead Archivist, Stacey Peeples, this exhibit will be on display and open to the public until September, 1, 2013.

Setting the Scene
As the nation's first hospital, PAH was also the first to treat mental illness and became a primary force in shaping the attitude of colonial Americans toward people with emotional and psychological disorders. PAH was the first in the nation to take the stance that mental illness was a disease of the mind, rather demonic possession. Consistent attempts were made to actually treat the mentally ill, not just warehouse them. By today’s standards the care would not seem so humane – it might be perceived as horrific – nor was it often effective. However, the approach was groundbreaking, placing great emphasis on recreational and occupational therapies, a tactic still employed today. The number of insane patients at PAH far outnumbered physically ill throughout much of the 18th and 19thcenturies.

“While Pennsylvania Hospital was chartered to accept the mentally ill, the care of those individuals proved more complex than anticipated,” Peeples said. “The mentally ill did not enter the hospital for a short term visit, but very often became permanent guests, spending years and sometimes decades, at the hospital. Try as they might, the physicians did not have the answers to curing the mentally ill.”

And issues were mounting, as hospital staff attempted to keep the presence and cries of the mentally ill from upsetting and disturbing the other physically ill patients. Segregation was the first step in trying to best accommodate all Hospital patients. So with space at a premium, the Hospital's Board of Managers agreed to purchase a large farm in West Philadelphia on which a facility could be built to house mentally ill patients.

“Moving the mentally ill into the WInstitute Collection - Kirkbride Stereoscopeest Wing of the Pine Building was one small step forward, but the proverbial giant leap came when Dr. Thomas Story Kirkbridewas hired as superintendent of the new, 101 acre institution in West Philadelphia,” said Peeples.

The Pennsylvania Hospital for the Insane, later called the Institute of Pennsylvania Hospital, was opened in the winter of 1841, when 100 mentally ill patients were slowly transferred in carriages from the bustling city streets at 8th and Spruce Streets to the new, rural facility west of “then” Philadelphia, that had been specially prepared for their care.

A 31-year-old Quaker physician at the time of his hiring, Kirkbride, though trained as a surgeon, had gained early experience working with the insane. As the new asylum's first chief physician, Kirkbride was a maverick in his field as an advocate for “moral treatment” of the mentally ill. His basic tenet was that the mentally ill could be treated humanely, in a rational manner, and brought back to their rational selves. While only half of Kirkbride's patients eventually recovered and resumed their positions in the world, this still remains a striking accomplishment in an era when effective medications and other modern treatments were virtually non-existent.

In the years running up to the Civil War, the need for appropriate treatment facilities to house the mentally ill only increased. In 1859, five blocks west of the Pennsylvania Hospital for the Insane, a twin version of the mental hospital is opened at 49th and Market Streets. The original campus becomes The Department for Females, and the newer campus is The Department for Males.

“From the official record, it seemed as if the Civil War had minimum impact on the Institute or Dr. Kirkbride, but looking at his correspondence, it is evident that the war was an ever present reality,” said Peeples. “Kirkbride was extremely well connected and corresponded with almost every ‘asylum keeper’ or superintendent across the country.”

Throughout the Civil War years, Kirkbride faced many challenges to method of care for those under his charge. The south was literally and figuratively cut off from the north, prohibiting families from sending money to fund care for their mentally ill relations institutionalized at the Institute. “This caused a great deal of stress for everyone involved, including the Board of the Pennsylvania Hospital, who briefly considered discharging those southern patients for lack of payment,” said Peeples. “Luckily for all involved, the Board decided to loan the Institute the money it was lacking to continue the care of those individuals and their families were to be contacted after the war to resume payment.”

Some of the gems visitors can see at the Mental Health During the Civil War exhibit include:
  • Displays covering the improvements in professions nursing and surgical techniques as a result of the Civil War years
  • Displays and images of Kirkbrides’ Magic Lantern Shows and how they reinforced his method of “moral treatment of the mentally ill"
  • “Reformers & Friends” display, including actual letters between Kirkbride’s and Dorothea Dix.
  • Kirkbride’s annual report to the Board of Managers of the Pennsylvania Hospital for the Insane, 1861-1865
  • Period photographs and more
Image: Pennsylvania Hospital for the Insane, circa, 1860


Prison Camps

by Dr Julius Bonello, MD

Nineteen thousand Confederates died in Union prisons during the war, while 26,000 Federal soldiers died in southern prisons during the war. The most famous of which was in Andersonville, Georgia. This prison was built to house 10,000 soldiers but, at its height, confined over 33,000 prisoners, making it the fifth largest city in the Confederacy.

Prisoners were allowed no means to build shelter. Their daily ration was one cup of cornmeal, three teaspoons of beans and a teaspoon of salt. For every 1,000 soldiers imprisoned there, 793 died. Stating it another way, one prisoner died every 11 minutes. This was almost twice the mortality rate seen in the most infamous northern prison camp, Elmira, New York, where 441 of every 1,000 soldiers died.

Image: Andersonville Prison Camp

Excerpted from: Wellness Directory of Minnesota

Remains of 40 Confederate Soldiers Discovered in Virginia Cemetery

By Christina Corbin, Published May 26, 2014

Their remains sat, unmarked, in shallow graves at the Old City Cemetery in Lynchburg, Va., for decades. Now, some 150 years after the Civil War, the bodies of 40 Confederate soldiers discovered over the past two months will receive a proper memorial.

"It's been very meaningful to us to find these spots, identify these soldiers and bring closure to families," said Ted Delaney, the cemetery's assistant director, who, along with a team of archaeologists, uncovered the exact resting place of some 40 Confederate soldiers as well as the plots where Union soldiers were once buried and later exhumed.

Delaney told FoxNews.com that, beginning in April, the team dug a 45-by-10-foot trench within "Yankee Square" at the cemetery where they found a mix of red and orange squares, which they determined were Confederate soldiers' graves. He said 35 to 40 graves were found during this latest search and that 50 were uncovered in the same area last year.

Delaney said he is now tasked with identifying each soldier's grave and giving it the tribute it deserves.

"Our goal is to put a marker at each grave space to identify the soldier and note when he died and his military unit," said Delaney, who is optimistic about the project because, "the undertaker's notes are so detailed and complete."

He said that when all is done, about 80 Confederate soldiers will be properly identified. He noted that the remains of Union soldiers were exhumed and removed from the plot of land in 1866.

"This has been an incredible process of discovery," he said. "It’s always been very frustrating for those descendents who come to us because they can't find their ancestor's grave. Now we can bring some of them closure."

The task to identify and maintain the graves of Civil War soldiers at the cemetery began in April 2013. Delaney and his team are receiving an annual $2,500 grant from the Virginia Department of Historic Records Work to document unknown graves within "Yankee Square," which was first intended as a burial site for Union soldiers and then came to include Confederate soldiers -- many of whom died from diseases such as small pox.

Delaney's crew is not the first to uncover unidentified Civil War graves in recent years.

Sam Ricks, who works as graves registrar for the Sons of Confederate Veterans' Pennsylvania Division, has long been on a quest to restore the graves of America's bravest. Ricks and his team are responsible for uncovering unmarked graves at Mount Moriah cemetery, an estimated 380-acre historic graveyard straddling Philadelphia and Yeadon, Pa., and the state's largest -- where 2,300 Navy service members and Marines dating from the Revolutionary War to the War of 1812 all the way to the Korean and Vietnam wars are buried.

In 2007, Ricks received an unusual request, which led him to a discovery that was "like finding a needle in a haystack."

Ricks was approached by a descendent of Nathan Tiernon Walton, a cadet from the Virginia Military Institute who, along with 294 other cadets, fought the Battle of New Market in Virginia for the Confederate Army on May 15, 1864. The battle is well-known to Civil War historians because the small Confederate Army, which consisted largely of the teenage cadets from VMI, defeated the Union soldiers and forced them out of the Shenandoah Valley.

Walton later became estranged from his family when he left his wife and daughter in Baltimore to find work in Atlanta and later Philadelphia, according to Ricks.

"He was a recluse," Ricks said, "And no one ever knew what became of him."

It was long believed by the family that Walton was buried in Baltimore, alongside his wife. But that theory was discounted when Walton's great-grandson, Bill Banks, visited Loudon Park Cemetery in Baltimore and found no evidence Walton was buried there.

Banks was on a quest that began 100 years ago with his grandmother, Walton's daughter, who handed down a large cast iron Southern Cross of Honor grave marker to be placed at her father's grave if it was ever found.

It was later discovered that Walton died in Philadelphia during the Great Influenza Pandemic of 1918, leading Ricks to eventually find his unmarked grave on Memorial Day in 2008 at Philadelphia Memorial Park in Frazer, Pa.

In November 2008, Ricks, as well as descendents of Walton, were finally able to mark his grave 90 years after his death with the cross passed down by his daughter.

"I'm reminded of this case every Memorial Day," Ricks said. "Walton's daughter had handed down to generations a marker to be placed at his grave should it ever be found. And then we actually did it. We fulfilled her wish."

Image: The Old City Cemetery in Lynchburg, Va., where archaeologists recently uncovered the unmarked remains of at least 80 Confederate soldiers.Ted Delaney

From: foxnews.com

The Effects of Bullet/Shell/Sabre

by Janet King, RN, BSN, CCRN.

The three primary causes of wounds in the Civil War were:
  • small arms ammunition: bullets, round balls, minie balls.
  • artillery fire: solid shot, case shot, canister; and
  • bayonet or sabre strokes.
It is said that the tactics of war always lag behind the weapons, and in the Civil War this was especially true. Soldiers were taught to fight as "massed" units and the range of the weapons and their destructive force was devastating on these masses.

The minie ball was a fairly recent invention at the onset of the war. Some 94% of the total combat injuries were attributed to this missile. It was designed to be fired from a rifled musket; was made of soft lead; traveled at a high velocity (for that era) of 950 ft/sec; and was accurate at 200 to 300 yards. As it traveled, it would spin from the rifled barrel of the musket and would deform and tumble on impact. Its effect on bone and tissue was incredibly devastating. It would smash, tear apart, and disintegrate what it hit. Most of the amputations that occurred were because of this great devastation.

Often there would be 1 or 2 inches of bone entirely pulverized or missing altogether after the ball impacted, and the only recourse the surgeon had was to amputate. One surgeon, describing such damage, wrote, "The shattering, splintering, and splitting of a long bone by the impact of the minie ball is in many instances, both remarkable and frightening." In addition to its destruction of bone and the mangling of skin and muscle, the ball would carry foreign material, i.e. pieces of uniform, bits of metal from belt plates, bone chips etc. into the surrounding wound and virtually guarantee an infected wound.

The other common small arms ammunition - round balls - were slightly less dangerous. The soldier might get "lucky" and the ball glance off the bone instead of shattering it. Also, if luck was with him, he would be hit in an extremity. Some 71% of Union wounded were so "fortunate." Why? Because, the lack of knowledge of bacteria and the difficulties of chest and abdominal surgeries in the Civil War era made the mortality very high for soldiers receiving wounds in those areas. For example - a soldier hit in the abdomen, where the ball struck the small intestine, and causing leaking of fecal material into the abdomen - had a 87% to 100% chance of his wound being a mortal one.

 Some surgeons advised that "When balls are lost in the capacity of the belly one need not amuse himself by hunting for them." Still, there were surgeons who questioned this stance. Eventually the majority of doctors would try some type of repair, if for no other reason than to give the patient one last chance. Some treatments did succeed, and others were miserable failures. The trial of "hermetically sealing" certain chest wounds ended when the mortality was determined to be 100%. Sometime, the surgeons realized, it was best to "let nature run its course."

The surgeons attended soldiers wounded in every body part including: damaged eyes; faces torn apart; jaws broken into bits; pelvic wounds that, because the bladder had been hit, leaked urine constantly onto the skin; intestines protruding from the abdomen and many others. Some surgeries had been done seldom if ever in their civilian practices and thus they had much to learn. Artillery fire accounted for some 5.5% of the Union wounded in the Civil War. This included artillery projectiles such as solid shot; canister, and spherical case shot; as well as torpedoes and grenades.

One surgeon stated the primary effect of artillery was the "demoralization of the troops under fire." Here he noted the psychological effect of war injuries. In WW I this would come to be known as "shell shock" and today would be listed as "post traumatic stress disorder." In the 1860s these terms and syndromes were not understood, and often the soldier was simply considered to be "demoralized" or "unnerved." In some cases the soldier was accused of cowardice. ( A mistake General Patton of WW II fame, would also make).

One soldier described his feelings of being under fire as "...I feared that if I ever lost control of myself under shell fire my mind would be shattered...To be under heavy shell fire was to me by far the most terrifying of combat experiences...Fear is many faceted and has many subtle nuances but the terror and desperation endured under heavy shelling are by far the most unbearable."

That soldiers did suffer long term psychological wounds from shell fire is well documented. Drunkenness, severe depression or "melancholia," desertion and other manifestations of mental health problems can be found throughout unit histories and in reviewing soldiers lives after the war ended.

Although the wounds from artillery fire were less numerous than small arms fire, they were more often deadly. A single round cannon ball - in one instance - killed the captain of one company outright, severed the orderly sergeant's arm, a corporal's leg and a private's head before bouncing off into the woods!

Some artillery projectiles were designed to explode either in the air or on the ground, creating a shrapnel effect where hundreds of bits of heavy iron or lead would be thrown into or over a group of soldiers (who were in their massed formations), wreaking havoc.

One soldier described the bursting of a shell - "...Clouds of smoke shot out from the redoubt and out of these - large, black balls rose upward...passed, shrieking shrilly. Through the dust and uproar I saw men fall, saw others mangled by chunks of shell, and saw one, struck fairly by an exploding shell, vanish!"

The effect of this shelling upon the body was to tear off limbs, slice through tissue and scatter metal fragments throughout wounds. At times metal and other fragments the shell hit - i.e. nails, wood etc. would be carried into the wound as well. All in all, the wounds were often torn, lacerated and mangled.

Less than 0.4% of Union casualties were the result of sabre or bayonet wounds. This, however, did not make them less deadly. Approximately 50% of such wounds occurred to the scalp, skull, face or neck. Sometimes the victim had been involved in "fierce hand to hand combat", but a large number of the cases were found to be due to "private quarrels, brawls, or inflicted by sentinels in the discharge of their duty." The surgeons found these injuries tended to "excite inflammatory action in deep seated tissues and cavities, with the danger of formation and confinement of pus from the injury to blood vessels, nerves and viscera and the possibility of pyemia, gangrene, and tetatnus."

Sabre blows to the head often resulted in the brain itself being injured with problems of epilepsy (seizures), loss of hearing or vision, and "impairment of the mental faculties or insanity" sometimes resulting. These problems were sometimes short-lived, but often stayed with the soldier throughout his life.

If the sabre or bayonet cut into a vital organ or major blood vessel, the soldier often bled to death. Corpses of men killed in such fashion upon the battlefield were "rare and conspicuous by their peculiarly contorted look."

From: vermontcivilwar.org

A Summary of Civil War Medicine

 by Dr Julius Bonello, MD

“If one wants to learn surgery, one must go to war,” Hippocrates wrote. The number of deaths surrounding the Civil War is staggering. Of the nearly three million soldiers who participated in the conflict, approximately 618,000 died— two-thirds by disease, one-third in battle. The total mortality of the war represents the loss of 2 percent of the entire United States population at that time. Union statistics document the treatment of almost one-half million injuries and six million cases of illness. Nearly 500,000 men came out of the war permanently disabled. In Mississippi, in 1866, one-fifth of the state’s revenue was spent on artificial limbs. Of the 12,344 surgeons in the Union medical corp, 336 were killed in the line of duty or died while in service. In his manual for military surgeons, Chisolm wrote, “the surgeon on the battlefield must participate in the dangers.”

America has never again witnessed pain and death in such magnitude as the Civil War. More Americans died in that conflict than in all other US wars combined. The battle at Shiloh, Tennessee, caused 24,000 casualties. This number of casualties easily surpasses the combined number of Americans who died in the Revolutionary War, the War of 1812 and the Mexican War. The battle at Antietam, Maryland, on September 17, 1863, took 23,000 casualties, making it the bloodiest day in American history. Between July 1-3, 1863, 51,000 people were killed, wounded or missing at Gettysburg, Pennsylvania. The number of casualties is almost as many as were killed during the 15-year Vietnam War conflict. On June 3, 1864, at Coldharbor, Virginia, in a frontal assault led by General Ulysses S Grant, the Union army lost more than 12,000 men; 7,000 of them dead in the first seven minutes. General Robert E Lee lost 2,500 men.

The American Civil War was the last great conflagration before the discovery of bacteria. Although Louis Pasteur’s work was carried out during the 1850s, it was not available for general knowledge until 10 to 15 years after the war. In 1867, Joseph Lister published his landmark work on surgical antisepsis, Antiseptic Principle. His principles met wide resistance, especially by American physicians, but were finally accepted and put into effect by World War I. In 1878, Robert Koch discovered the role that bacteria play in causing disease. It would take another war, World War II, and the discovery of antibiotics to bring this chapter to a close.

Excerpted from: Wellness Directory of Minnesota


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