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.

Thursday, March 27, 2014

Organization of the Hospitals in the Department of Washington

Excerpted from: civilwardc.org
By Susan C. Lawrence

"At the outbreak of the civil war," the author of the chapter on general hospitals in "The Medical and Surgical History of the War of the Rebellion" wrote, "this country knew nothing practically of large military hospitals; indeed, most of our volunteer medical officers knew nothing of military hospitals, small or large."

In fact, most of the volunteer medical officers would have known nothing of hospitals at all unless they had practiced in a city large enough to have had one or more charity hospitals, such as New York, Boston, Philadelphia or Washington, DC. Both volunteer and newly recruited medical officers must have quickly discovered that they needed to learn something about the military as well as something about hospitals in order to work in some of the ad hoc, transitory establishments that housed the sick and wounded at the start of the war. It was the military, after all, that requisitioned space, built new hospitals, provided supplies, and needed regular, complete reports of the numbers of sick and wounded. The military imposed order (or at least tried to) on the proliferation of hospital sites, working along both military and medical chains of command.

In theory, every regiment had a hospital (a regiment was 10 companies of 100 men each). For armies on the march, these were field hospitals, with supplies carried along in wagons and set up in whatever quarters could be found or organized around ranks of tents.

For armies encamped, there were post hospitals created out of tents or wooden barracks; these were organized at the regimental or brigade (3 to 6 regiments) level. The District of Columbia hosted huge camps for mustering the troops moving through the city to form the armies operating to the south and southwest, and so had flexible camp hospitals.

As the army constructed fortifications around the District, it also established post hospitals to serve those who garrisoned the forts. Field and post hospitals served only the companies and regiments assigned to them, and were under the authority of the highest ranking military officer in the specific command. Given the number of troops needed to garrison the posts and batteries, and to be held in reserve in case of attack, these post and camp hospitals provided care for tens of thousands of soldiers. They held those too sick or injured to remain in their camp or post quarters, but not sick or injured enough to be transferred to one of the general hospitals in Alexandria, Washington or Georgetown.

General hospitals, in contrast, primarily took care of the sick and wounded left behind as troops moved out and, more importantly, to deal with the influx of sick and wounded transported in from field hospitals for longer term care than could be managed near battlefields or by soldiers on the march. General hospitals took in soldiers from any company, and so had a place outside of direct military authority. The surgeon in charge of a general hospital held an officer's rank and reported to the Medical Director of the relevant Department. Medical Directors, in turn, reported to the Surgeon General. From the very beginning of the war, however, tensions flared between the surgeons-in-charge and local officers of higher rank over who had the authority to manage the general hospitals' organization and administration. The War Department had to send out several reminders that the surgeons in charge of general hospitals followed the orders of the Surgeon General, not the orders of higher ranking military officers around them, and that they were totally in charge of all medical decisions within their institutions.

The Defenses of Washington: Organization of the Post Hospitals
The defense of the capital preoccupied Washingtonians throughout the war. How many troops and resources were needed to march against the South and how many were required to protect Washington became significant bones of contention within the army and among politicians.

General Mansfield, placed in charge of the Department of Washington at the start of the war, began construction of new defensive forts in May, 1861. In late July, the task of defending the District fell to Major General George B. McClellan. Under McClellan's authority, construction began on the series of forts, redoubts, and batteries that would eventually encircle Washington and Alexandria with sixty-eight forts and one-hundred batteries by the spring of 1864. Brigadier General James S. Wadsworth organized all of the post hospitals in March of 1862. Then, on February 2, 1863, the defenses were formally divided into two divisions of the 22nd Army Corps, one for those forts north of the Potomac (Washington) and one for those south of the river (Alexandria). Forts were manned by specific volunteer regiments, organized into three to four brigades. Clusters of forts (and redoubts and batteries) shared one or more post hospitals, with a hospital usually (but not always) found at the fort serving as brigade headquarters. In July of 1864, the brigades north of the Potomac were again reorganized, with the 1st Brigade becoming the 2nd Brigade and vice versa; the 3rd Brigade remained the 3rd Brigade.

The location of post hospitals moved according to the distribution of regiments among the various forts, as well, with more or less consistent attempts to keep them equally accessible to all of the positions they covered.

Given the capital's location, it became a major point of care for Union soldiers. Indeed, by December, 1864, the Department of Washington (twenty-four of the twenty-five general hospitals in the Department of Washington were in the District of Columbia) had more beds (21,426) in its general hospitals than any other department in the war.

The organization of the general hospitals in the District fell to the Medical Director of the region, Robert O. Abbott. At the start of the war, the military simply requisitioned the civilian city hospital (the E Street Infirmary) and the Union Hotel to serve as general hospitals when needed for the first casualties, who arrived in May of 1861.

Other sites were soon located, such as rooms in the Patent Office, but the big push to claim sites for general hospitals started in March of 1862. The general hospitals in Washington and Georgetown were loosely organized throughout the war, with no clear hierarchical structure.

In contrast, nearly all of the general hospitals located in Alexandria were grouped into three divisions on September 20, 1862. The surgeon placed in charge of all of the division hospitals supervised the surgeons responsible for each of the divisional hospitals' branches. (It must be emphasized that the divisional structure of the hospitals in Alexandria had no relation to military divisions within the army, but only represents an unfortunate use of parallel terminology.)

The Union Hotel was only the first of the buildings that the military took over to use as a hospital. Churches, schools, homes, and warehouses had crews come in to fill them with beds and to organize rooms for managing hospital functions: kitchens, stores, laundries, surgeons' rooms and, of considerable concern, water closets. Next in use were the wooden barracks abandoned by troops moving out on campaign. Commentators, both during and after the war, complained bitterly about how inappropriate such makeshift accommodations were for hospitals.

Ventilation and sanitation were the watchwords of up-to-date hospital construction in the early 1860s. By the end of the war, however, the military had constructed relatively few buildings designed from the start to be hospitals. None were built in Alexandria, for instance. Indeed, only five institutions were erected specifically as hospitals in Washington itself: Judiciary Square (built on the site of the burnt-down City Infirmary), Harewood, Armory Square, Mount Pleasant, and Lincoln general hospitals. Yet even the latter three incorporated some existing barracks buildings or tents into their plans.

All five of these general hospitals were constructed in 1862, with Judiciary Square and Mount Pleasant opening in April of 1862, Armory Square in August, Harewood in September and Lincoln in December. Their plans followed contemporary wisdom: wards, with fourteen foot ceilings, a window between each bed, and floors raised off the ground, contained 60-63 beds each. They were built as separate buildings linked by open-sided covered walkways, all in order to maximize the circulation of fresh air. In overall design intention, if not in precise detail, these hospitals presaged the requirements for purpose-built, pavilion style hospitals laid out in a War Department Circular printed on July 20, 1864, and were sent to all departments to direct the future construction of general hospitals.

As the census figures for December 17, 1864 show, 7,783 (39%) of the hospital beds in the District of Columbia were in "proper" hospitals over two and a half years into the war. These numbers do not include the number of beds found in the District's post hospitals, moreover, so there was an even lower percentage of beds in facilities designed with medical goals in mind within the District and its circle of fortifications. Most sick and wounded soldiers, in short, spent their days in makeshift accommodations, from well-appointed houses to tents in muddy fields.

The Hospitals in Space and Time
The locations of all of the District's hospitals, including all of those established as part of the defenses of Washington, even if slightly outside the District's boundaries, are displayed on our maps, in the context of the District's fortifications, churches, bawdy houses and other institutions vital to the life of a city at war. The time slider allows the user to examine the chronological arc of the hospitals' presence, and reveals how these institutions were one of the dominant features of Washington's and Alexandria's landscapes during the intense years of 1862 to early 1865. A closer examination of the hospitals that appear and disappear from May 1861, to early 1863, documents the initial use of temporary housing, particularly of churches and government buildings (the Capitol and the Patent Office), and then the shift to the large hospitals positioned in barracks or purpose-built on empty sites. When the fiercest fighting of the war moved away from Washington, some of the post hospitals and smaller general hospitals began to close. At the end of the war, hospitals closed more rapidly, with only three remaining to serve regular army needs after September of 1866. Churches and chapels all returned to being churches and chapels, re-purposed barracks hospitals were torn down, and the purpose-built hospitals, for all their up-to-date design, ceased to exist. From constant reminders of the war's presence, and its human costs, to empty spaces in the District's terrain, hospitals were, ironically, one of the most transitory of features in the District's infrastructure.

Keeping the Soldiers Warm: Civil War Women Make Quilts

From: quilting101.com

Women held a paramount role during the American Civil War. Back in the 1850s the government did not provide for the military the same way they do now and it was often up to the women to provide clothing and bedding for the soldiers. This experience alone is said to have been one of the largest forces of confidence amongst women and what propelled the push for the right to vote!

Women’s role within the war was not always received well and there were many that were not happy with their commercial patriotism which was shown through the sale of their civil war quilts at local fairs. However as times were dire and money was needed for war supplies, women continued to make quilts for sale.

Despite the money that was brought in from the quilts as the war continued it soon became obvious that there was a desperate need for bedding and clothing for all the soldiers.

Many quilts were made for both fundraising and for the soldiers’ bedding during the Civil War. A great deal of commemorative quilts were made after the war as well.

The soldiers’ quilts were generally made with basic fabrics and very simple block patterns. Time was always an issue, so the faster the quilts could be made the better.

Often the quilter would place some inspiring words in one of the blocks to give the soldier some encouragement while they were at war. Many quilts were made from the most basic, but available fabrics.

As time went on, women would often cut up two existing bed quilts and re-sew them into three or four cot quilts! Money became more scarce and women had to raise money through selling their quilts at fairs in order to afford the material for their soldier’s quilts.

However as the war progressed and money began to tighten even more the women did not have enough fabrics, materials or money to make the soldiers quilts. It has been said that a yard of calico went for around $25 towards the end of the war! Even these days that is a unreasonable amount to pay for Calico!

Men’s clothing, old blankets, feed and fertilizer sacks, wool weave, old uniforms, suits, coats, twill flannel, sleeves, pocket-flaps and pants legs were all used to make quilts!

Sometimes they used the wardrobes of the men who had died fighting in the war to make blankets for other soldiers. Many of the quilts did not have batting as it was scarce and often could not be found. The backing was generally made out of old fertilizer or feed sacks.

These types of quilts were often very roughly put together, with large chick track stitching. Their purpose was solely practical and functional with the aim to keep someone warm, and there is no beauty or skill in the finished masterpiece.

Many soldiers were buried in their quilts and as a result very few original civil war quilts have survived. As most of the quilts were made hastily and were poorly constructed, many did not survive the war. By the time the war ended it is estimated that over 250,000 quilts had been made for the union soldiers.

Illnesses and Opiates

From: nchealthandhealing.com

People remember the Civil War for its tragically high casualty rates—about 970,000 in all, or 3 percent of the population. But among soldiers, disease actually killed far more than battlefield wounds.

Many soldiers fell sick in military camps. Constant exhaustion, lack of adequate clothing, exposure to severe weather and a diet of poorly cooked food made soldiers susceptible to a host of infectious diseases. Worst of all, drinking water contaminated by open latrines caused outbreaks of typhoid fever, which caused the most fatalities.

The most common problems, though, were diarrhea and dysentery. “No matter what else a patient had,” wrote one doctor, “he had diarrhea.”

Civil War–era doctors had few effective ways to cure illness. But they knew that morphine and other opiates (drugs derived from opium) could temporarily relieve the symptoms of a wide variety of ailments. So they readily prescribed them in liberal doses. Opium, which has constipating effects, was used for diarrhea and dysentery. Doctors also prescribed it to relieve violent convulsions from malaria. Because of its effectiveness as a painkiller, opium was commonly rubbed into or sprinkled on severe wounds.

Opiates are highly addictive. As a result of their treatment, a number of Union and Confederate soldiers acquired lasting drug habits. For example, William Anderson Roberts, a private in the 14th Regiment North Carolina Troops, spent a great deal of time in military hospitals. In 1862, he wrote this to his family from Moore Hospital:

“Of all the lonesome places on earth it is a evening in a Hospital. There is a deep gloomy melancholy settling down on my mind. I have taken an Opium pill to counteract the influence of depression of spirits. Opium, that sweet restorer of man as he was before the fall. The King of all medicines. The great restorer of ease and peace to both mind and body. Thanks to the great giver of all good things for that great gift.”

Roberts survived the war and returned home at its end. But he fought his addiction to opium until his death in 1900.

The Civil War: The Origins of Veterans’ Health Care

by Jerome W. Mapp

When the Civil War ended its bloody run on April 9, 1865 at Appomattox Courthouse, Va., more than 600,000 of the 2.4 million Union and Confederate troops were either killed in combat or by disease. Thousands more would require long-term care for their mental or physical wounds of war. America’s costliest and bloodiest conflict would have a profound effect on health care for Veterans.

When the Civil War began on April 12, 1861, it is estimated America had 80,000 Veterans from previous conflicts, who were treated at a handful of Veterans homes scattered across the nation. The Civil War added more than 1.9 million Soldiers, Sailors, and Marines to the rolls.

After the war, benefits for Civil War Veterans were restricted to those Veterans who had fought on the Union side; Confederate soldiers were not legally recognized as Veterans until 1958, when they were pardoned by the U.S. Congress for taking up arms against the nation.

According to Darlene Richardson, historian for the Veterans Health Administration, pre-Civil War Veterans received long-term treatment at a handful of Soldiers and Sailors homes scattered around the country.

“One of the original homes for veterans was the Naval Asylum in Philadelphia, which was established in 1811 and officially opened in 1834, it housed sick and disabled naval officers, seamen, and Marines.” according to Richardson.

“The National Soldiers Home, established in 1851, in [northeast Washington] D.C., housed Veterans of the War With Mexico (1846-1848) until the Civil War began, when Union soldiers received care there, too.” The National Soldiers Home today is known as the Armed Forces Retirement Home (AFRH) Washington, D.C.

In the 1960s, the Naval Asylum in Philadelphia closed and a new facility known as the U.S. Naval Home was constructed in Gulfport, Miss. Congress merged operations of the U.S. Naval Home with the National Soldiers Home into one administrative unit in 1991 and the National Soldiers Home was renamed as the Armed Forces Retirement Home (AFRH). Today, both facilities house men and women of all military branches.

St. Elizabeth’s Hospital in southeast Washington, D.C., authorized in 1855, was originally called the Government Hospital for the Insane, and was actively used during the Civil War. Union and Confederate Soldiers, Sailors, and Marines, including African-American troops, were treated at the hospital. President Abraham Lincoln, a frequent visitor to the hospital, noted that the many casualties created by the war often resulted in overcrowding at the hospital. Tents were erected behind the hospital to handle the overflow of combat casualties.

In 1865, with so many Veterans needing long-term care, Lincoln appealed to Congress and the nation in his second Inaugural address, “…to care for him who shall have borne the battle, and for his widow and his orphan.” Those words later became the motto of the Veterans Administration, which became the Department of Veterans Affairs in 1989.

“Lincoln’s efforts resulted in creation of the National Asylum for Disabled Volunteer Soldiers (NHDVS) in March 1865, which established a national government home for Veterans of the Union’s volunteer forces. The National Asylum was overseen by a Board of 12 managers. Eventually there were 11 National Homes.” Richardson said. “In 1873, they [the board] renamed it the National Home for Disabled Volunteer Soldiers because the word asylum was starting to have negative connotations.”

The eleven NHDVS properties established between 1865-1930 were known as: the Eastern Branch in Togus, Maine (now Togus VA medical Center); the Northwestern Branch in Milwaukee, Wis. (now Clement J. Zablocki VA Medical Center); the Central Branch in Dayton, Ohio (now Dayton VA Medical Center); the Southern Branch in Hampton, Va. (now Hampton VA Medical Center); the Western Branch in Leavenworth, Kan. (now Dwight D. Eisenhower VA Medical Center); the Pacific Branch in West Los Angeles, Calif. (now Greater Los Angeles Healthcare system-West Los Angeles Healthcare Center); the Marion Branch in Marion, Ind. (now VA Northern Indiana Health Care system); the Danville Branch in Danville, Ill. (now VA Illiana Health Care System); the Battle Mountain Sanitarium in Hot Springs, S.D. (now VA Black Hills Health Care System); the Mountain Home Branch in Johnson City, Tenn. (now Mountain Home VA Medical Center); and the Bath Branch in Bath, N.Y. (now Bath VA Medical Center).

Initially, each home served as little more than a domiciliary (soldiers’ home) that provided medical care. Over time, the homes offered recreational activities, libraries, and church services. According to the 1900 board of manager's annual report, several homes maintained theaters, libraries, and billiard halls.

Some of the homes offered Veterans games such as dominoes, checkers, chess, backgammon, cards, boating, skating, pool, and croquet. At the homes’ theaters, Veterans were entertained with concerts, comedies, melodramas, musicals, vaudeville, and lectures.

When the Veterans Administration was established in 1930, all 11 homes, plus three newly authorized homes in St. Petersburg, Fla., Biloxi, Miss., and Roseburg, Ore., became part of VA.

Four of the original National Homes are currently under consideration for designation as National Historical Landmarks. They are: the Northwestern Branch (Milwaukee, Wis.), the Western Branch (Leavenworth, Ks.), the Mountain Home Branch (Johnson City, Tenn.) and the Battle Mountain Sanitarium (Hot Springs, S.D.).

The organization of aid to America’s Veterans has changed over the decades, but our respect and sentiment for their contributions remains the same. VA is proud to carry on America’s legacy of caring for its military Veterans.

Image: Civil War Veterans receive medical treatment at the Bath Branch of the National Soldiers Home in Bath, N.Y. VHA Historical Photo

From: va.gov

Civil War Water Filter

From: joshuasattic.com

As shown in Lord's Civil War Encyclopedia, these are the two metallic parts of a "water filter" sold privately to soldiers.

The foul, often brackish waters near large numbers of encamped men often bore highly-deadly diseases like dysentery which lead to intense, chronic diarrhea, dehydration and frequent death. In fact, more men died from disease during the Civil War than battle!

Knowing the risks of drinking water, troops were lulled into a sense of false security by purchasing these filter sets in tin cases. The soldier was supposed to place the larger filter end into the stream or pond, drawing water up through a charcoal filter by sucking on the smaller mouthpiece. A mesh tubing connected the two, but has since rotted away while it was still underground. This was located near Fredericksburg along with two others.

It is said that soldiers' eyes bugged out like frogs as they vainly tried to suck water up through these. While the concept was good, it is unfortunate that the microbes culprits were small enough to pass beyond the charcoal!!! Men died in spite of their filters.

Health and Medicine During the Civil War

by Elaine Hirsch

From 1861 to 1865, the Civil War wreaked havoc on American life. Nearly 620,000 soldiers died and an additional 412,000 were wounded. The massive amount of injuries presented new challenges in the medical field. Hospitals and clinics were overwhelmed with patients, disease was rampant and sanitation practices were no where near as sophisticated as today’s standards. Standardized medical schools did not yet exist and there were less than 100 doctors in the army at the start of the war. These factors presented unique challenges that American hospitals were not prepared to meet. The National Museum of Civil War Medicine features a collection of online videos and resources to bring to life a medical world which we cannot imagine living in today.

At the war’s onset, the Union had not yet established its own hospitals and most public hospitals at the time were rat-infested, dirty, and plagued by diseases like smallpox. Soldiers had to rely on makeshift field hospitals to heal their wounds. Later, general hospitals were established near battlefields in civilian buildings like churches, schools, houses and farms.

According to the Colonel Eli Lilly Civil War Museum, injured soldiers were threatened by more than just the pain of their wounds. Many soldiers had never been exposed to diseases like chicken pox, the mumps or measles and were therefore more susceptible to the afflictions while being treated at unsanitary hospitals. At the time, doctors did not yet understand how many diseases were spread and used contaminated instruments on patients.

Today, strict sanitation guidelines reduces the risk of spreading diseases and infection, but this knowledge was unavailable during the Civil War.

Antibiotics now save millions of lives each year but were not available in the 19th century. Doctors performed surgeries without gloves, used bare fingers to inspect wounds and simply wiped instruments clean using their aprons. Due to these practices and the infections they caused, the National Museum of Civil War Medicine calculated that over half the casualties incurred were a result of disease, not gunshots or bayonet wounds.

Medical jargon was also different during the Civil War. Doctors spoke of mania instead of insanity, lung fever instead of pneumonia and jail fever instead of typhus. Clearly, legitimate medical transcription services were not available at the time. Syphilis was simply called pox, rickets was used to describe any problem with the skeletal system and any day-long illness was called diary fever. Lead poisoning was called dropsy, circulatory problems were attributed to flux of humor and anemia was known as green sickness. These now outdated reflect the uncertainty and lack of knowledge held by the medical community at the time.

While medical technology and knowledge have certainly improved since the Civil War, the National Museum of Civil War Medicine asserts that some 19th century practices are still used during warfare today. Medical professionals working out of field hospitals are still often the first responders to emergencies and evacuating wounded soldiers is a priority now as it was then. Lessons learned during the Civil War about keeping adequate medical supplies on hand are still valid today. These lessons contributed greatly to the advancement of medical knowledge and influenced the way we now practice medicine both on war fields and in civilian hospitals.

From: teachthecivilwar.com


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