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.

Sunday, August 14, 2016

The Monitor and the Merrimac: The Medical Aftermath

From: med.navy.mil

David goes out to meet Goliath and every man who can walk to the beach sits down there, spectators of the first ironclad battle in the world... The day is calm, the smoke hangs thick on the water. The low vessels are hidden by the smoke. They are so sure of their invulnerability they fight at arm’s length. They fight so near the shore, the flash of their guns is seen and the noise is heard of the heavy shot pounding the armor. -Surgeon Charles Martin, USN on the Battle between the Monitor and Merrimac.

What was the medical aftermath of that now legendary combat: On the Union side, three men were injured on Monitor. One was the acting master whose knee came into contact with the turret at the same instant one of Virginia’s heavy shot struck it. Knocked senseless by the impact, he regained consciousness 10 minutes later. Another seaman in the turret was knocked unconscious in a similar manner. Acting Assistant Surgeon Daniel Logue described this sailor’s injury as a concussion of the brain. His circulation remained depressed and it became necessary to administer stimulants. When the patient regained consciousness, Dr. Logue watched for a reaction and then applied cold affusion to the head. Toward the close of the action, the Confederate ironclad inflicted its last and most significant casualty—Monitor’s skipper John Worden. Following the battle, only Worden left the ship for hospitalization in Washington. The other two patients returned to duty the following day. Worden, it turned out, proved to be the only serious casualty of the battle, permanently losing the sight in one eye and incurring a disfiguring scar on his face.

On the Confederate side, Virginia’s crew did not get away unscathed. In her unequal fight with Congress, Cumberland, and Minnesota the previous day, Virginia suffered several killed or wounded. In contrast, her wooden-hulled victims suffered enormous losses. Cumberland alone lost over 100 men. Before the ship went to the bottom, all the wounded who could walk were ordered out of the cockpit; but those of the wounded who had been carried into the sick bay and on the berthdeck were so mangled that it was impossible to save them. During her engagement with Virginia the following morning, Monitor’s two 11-inch Dahlgren smoothbores did moderate damage, wounding a few aboard the Virginia but killing no one. As it turns out, the Confederates got a lucky break. Although each 11-inch Dahlgren aboard Monitor threw a shot weighing 168 pounds, Worden was under orders from the Navy Department to fire half-weight powder charges of 15 pounds for fear the guns would explode.

The United States Military Railroad

Petersburg National Battlefield
From: nps.gov

The work of the United States Military Railroad Construction Corps (U.S.M.R.R.C.C.) was instrumental in the reduction and ultimate defeat of the Confederate army defending Petersburg and Richmond, Virginia in the closing days of the American Civil War.

In the nine months of the Siege of Petersburg, 21 miles of track would be laid, 25 locomotives and more than 275 pieces of rolling stock would be used, and 2,300,000 miles would be logged on the railroad.
Photo of locomotive at Union army supply base at City Point
Locomotive "John C. Robinson" at City Point, 1864.
Library of Congress

From the waterfront at City Point just below Richmond on the James River, Gen. Ulysses S. Grant had to supply an army of more than 100,000 troops and more than 65,000 horses and mules. For so vast an army, living off the land was not an option. All food, equipment and supplies had to be shipped in from northern ports and then delivered to the battlefront eight miles from away.

Eight wharves were built to accommodate hundreds of vessels conveying war material. More than 280 buildings were constructed by the U.S.M.R.C.C. at City Point by the end of the siege. The lumber was pre-cut as per orders and then assembled once it arrived. The sleepy little village took on the appearance of a thriving, bustling port in just a few days.

As the siege progressed, Grant extended his lines around Petersburg and the United States Military Railroad (U.S.M.R.R.) followed. After every major action, with few exceptions, the railroaders received orders to investigate the terrain and chose a site suitable for a temporary rail line. In the nine months of the siege, 21 miles of track would be laid, 25 locomotives and more than 275 pieces of rolling stock would be used, and 2,300,000 miles would be logged on the railroad. The line was used to transfer thousands of troops, but the primary cargo was food, weapons, and ammunition. Wounded soldiers were eventually transported by rail to the Depot Field Hospital at City Point.

Stations were established along the railroad for distribution of supplies. Sidings were built at these stations so trains unloading would not interfere with other trains on the line. On average 18 trains made the trip from City Point to the front and back again each day and timetables were published to ensure a smooth operation.

The ultimate Union victory over the Confederate army of Robert E. Lee at Petersburg is due in large part to the well-organized operations of the U.S.M.R.C.C.

Image: Locomotive "John C. Robinson" at City Point, 1864

Medicine and Medical Practices

Antietam National Battlefield, Harpers Ferry National Historical Park, Manassas National Battlefield Park
From: nps.gov

The story of Civil War medicine is a complex one. Through the dedication, innovation and devotion of surgeons and medical support staff, the foundation for today's modern military medicine was laid.

"Humanity teaches us that a wounded and prostrate foe is not then our enemy."
Dr. Jonathan Letterman

The Traveling Medical Department
After the Battle of Antietam, both Medical Departments were faced with the daunting prospect of treating and transporting a large number of wounded men. The newly-organized Union Ambulance Corps was helpful in the evacuation of the soldiers who could be moved, and a new concept of semi-permanent field hospitals was tested for the first time. It was an experiment brought on by necessity, since there were so many soldiers with serious injuries who could not bear even the twenty mile trip to more established hospitals in Frederick.

The Confederate wounded who could not be moved were treated by the Union Medical Department, and all received the same level of care as the Union wounded, for, as Dr. Jonathan Letterman stated, "humanity teaches us that a wounded and prostrate foe is not then our enemy."

Before the Battle of Antietam, Dr. Letterman arranged for the Medical Purveyor in Baltimore to gather supplies and have them ready to be shipped where and when he asked for them. Unfortunately, the destruction of the railroad bridge at Monocacy Junction near Frederick, Maryland, delayed the supplies in reaching the field hospitals at Antietam. Also, since medical supplies were shipped by the Quartermaster Department and not the Medical Department, they were often set aside in favor of other items like ammunition and food. These delays caused Letterman great frustration, since most of the medical supplies did not arrive at the field hospitals until four days after the battle.

From his experiences at Antietam, Letterman changed the way medical supplies were distributed to the regiments. He noticed waste occurred when large amounts were given out, and the abandonment of supplies when adequate transportation could not be found. He reduced the amount of medical supplies given to a regiment at one time, thus making the system more efficient. On October 4th, 1862, the new supply system was adopted. One wagon now sufficed for the medical supplies of a regiment, plus the hospital tents and baggage of the medical staff, with one additional wagon for a brigade.

"The [new supply system was intended to] reduce the waste that took place when large supplies were at one time issued to regiments, to have a supply given them, small, but sufficient for all immediate wants, and to have these supplies easily attainable, and replenished without difficulty, when required, and without a multiplication of papers and accounts." - Dr. Jonathan Letterman

Improvements to the System
The Civil War is considered a watershed in the history of medicine. Many of the innovations implemented during the war helped to bring the practice of medicine into the modern era, including:

-Advancements in surgical procedures and the management of traumatic wounds, including specialization in plastic surgery and nerve injuries

-The establishment of an organized ambulance system with trained stretcher-bearers

-The creation of a multi-layered system of care on the battlefield that included first aid stations and field hospitals

-The use of triage to maximize the survival rate of the patients

-Widespread use of anesthesia during surgery

-The establishment of fixed-bed hospitals as long-term care facilities

-The introduction of women into the hospitals as nurses, laundresses and hospital administrators

-The organization of civilian relief agencies that worked with the military to provide supplies, clothing and food

-Improvements in orthopedic medicine and the design of prosthetics

-Documentation of wounds, illnesses and treatments with the intention of using the records as a teaching tool

The story of Civil War medicine is a complex one. Through the dedication, innovation and devotion of surgeons and medical support staff, the foundation for today's modern military medicine was laid.

Unfortunately, little was known about the psychological damage suffered by those who had experienced the horrors of war. While it was recognized that war changed people, diagnosis and treatment of the emotional impact of combat had yet to be fully understood. Some people could not cope with their experiences and were traumatized for the rest of their lives. Others found ways to overcome the mental and physical trauma and enjoyed success after the war. Veterans groups came together to help support their stricken brothers. Of great importance is the fact that what was learned during the war was shared with the world, greatly adding to the quality of health care for everyone.

Advancements in medicine made during the war allowed wounded soldiers to return to their homes and lives. Medical professionals and the compassion and service of dedicated civilians kept them alive and gave them hope. Their own strength and resilience made them heroes.

Image: Photograph of an ambulance drill

5 Pioneering Women Doctors and Nurses of the Civil War

By Jocelyn Green, 3-29-15

The truth is, all women who were doctors and nurses during the Civil War were pioneers in their field. Prior to 1861, nurses--and all but two doctors in the United States--were men. But when social reformer Dorothea Dix pointed out to President Lincoln that he had a scant 28 surgeons in the army's medical department to care for the 75,000 volunteers he'd just called for, he reluctantly conceded that women be allowed to serve as nurses. I want to introduce you to five remarkable women who blazed the trail for women in medicine.

1) Dr. Elizabeth Blackwell. An English immigrant, Dr. Blackwell was the first woman to earn a medical degree in the United States, and ran an infirmary for women and children near the slums of New York City. When the Civil War broke out, she realized the Union army needed a system for distributing supplies and organized four thousand women into the Women’s Central Association of Relief (WCAR). The WCAR grew into chapters around the county, and this body systematically collected and distributed life-saving supplies such as bandages, blankets, food, clothing and medical supplies. Blackwell also partnered with several prominent male physicians in New York City to offer a one-month training course for 100 women who wanted to be nurses for the army. This was the first formal training for women nurses in the country. Once they completed their training, they were placed at various hospitals. By July 1861, the WCAR prompted the government to form a national version—the United States Sanitary Commission. And it all started because Dr. Blackwell decided to mobilize the women of the country to help the Union.

2) Georgeanna Woolsey. At 28 years old, Georgeanna should not have been allowed to serve the army as a nurse, but she got through the application process anyway. Against her mother’s and sisters’ wishes, she was one of the 100 women trained in New York City to be a nurse. Not content to sit in a parlor and knit or scrape lint, she was eager to go where the fighting was, to get her hands dirty in a way she had never been allowed to before as a wealthy, privileged woman. Georgeanna wrote many letters and accounts of her experiences, including this:

“Some of the bravest women I have ever known were among this first company of army nurses. . . . Some of them were women of the truest refinement and culture; and day after day they quietly and patiently worked, doing, by order of the surgeon, things which not one of those gentlemen would have dared to ask of a woman whose male relative stood able and ready to defend her and report him. I have seen small white hands scrubbing floors, washing windows, and performing all menial offices. I have known women, delicately cared for at home, half fed in hospitals, hard worked day and night, and given, when sleep must be had, a wretched closet just large enough for a camp bed to stand in. I have known surgeons who purposely and ingeniously arranged these inconveniences with the avowed intention of driving away all women from their hospitals. “These annoyances could not have been endured by the nurses but for the knowledge that they were pioneers, who were, if possible, to gain standing ground for others. . ."

Georgeanna Woolsey is the inspiration for my main character in "Wedded to War". Woolsey nursed patients in seminary buildings, the U.S. Patent Office, and aboard hospital transport ships which carried wounded and sick soldiers from the swamps of the Virginia Peninsula. After the war, Georgeanna and her husband, veteran Union surgeon Dr. Francis Bacon, founded the Connecticut Training School for Nurses at New Haven Hospital.  She also published Hand Book of Nursing for Family and General Use and co-founded the Connecticut Children's Aid Society.

3) Dr. Mary Edwards Walker After volunteering as a nurse in 1861, and then as an assistant surgeon, Dr. Mary Edwards Walker earned a Union army commission for her services as surgeon in 1863. In 1864, she was captured by Confederates, suspected of espionage, and thrown into Richmond's Castle Thunder prison where she remained four months before her release. In 1865, she became the only woman ever to receive the Medal of Honor. Dr. Walker appears in Spy of Richmond. The newspaper article Mr. Kent dictates to Sophie about Dr. Walker's imprisonment is verbatim from the original story that ran in the Richmond Enquirer--including the comment about her "homely" appearance.

4) Captain Sally Tompkins Sally Louisa Tompkins founded a private hospital in Richmond, Virginia, to care for the flood of Confederate wounded. During the war, her hospital cared for 1,333 soldiers and suffered only 73 deaths, which was the lowest mortality rate of any military hospital. The Robertson hospital, named for the judge who let Sally use one of his houses, returned 94 percent of its patients to service. Eventually Confederate authorities decided to close all private hospitals, declaring that soldier patients could only be cared for at government hospitals run by a commissioned officer with at least a rank of captain. When Tompkins heard the news, she called on Jefferson Davis and asked for an exception to the new rule. Since her hospital's remarkable record spoke for itself, Davis commissioned Tompkins a Captain of Cavalry, unassigned, making Robertson Hospital an official government facility. She was the only female commissioned officer in the Confederate Army. As an unassigned officer she could remain at the hospital permanently. The military rank also allowed her to draw government rations for her patients, but she refused to be added to the army payroll.

5) Clara Barton No list of groundbreaking nurses would be complete without her. Barton was fiercely independent, a self-appointed field-nurse for the Army of the Potomac. Working on her own, beyond the structure of the Sanitary Commission and Army Medical Department, she stockpiled supplies in her small Washington flat and then drove into the Virginia countryside, and into Maryland, to disperse them among the wounded.  At General Butler's request, she cared for the soldiers in the Army of the James during the summer campaigns of 1864, as well. Her work for soldiers and their families didn't end along with the war, however. She continued her service by opening the Missing Soldiers’ Office (link is external)in Washington, D.C. to help family members find the remains of their loved ones. By 1869, she had identified 22,000 missing men and received and responded to 63,182 letters from those trying to locate their soldiers. Later, Clara brought a chapter of the International Red Cross to life in America.

*The following is excerpted from my nonfiction book, Stories of Faith and Courage from the Home Front, to explain why women had such struggles as nurses at the beginning of the war.
The clash between surgeons and women nurses which Georgeanna Woolsey described had its roots in how each group of people viewed the woman’s place in society. Americans in the mid-nineteen century commonly believed that men and women had their own separate spheres of activity. Men occupied the commercial, business and political fields. Women’s activities were relegated to home, church, women’s clubs and reform groups, and circles of female friends and relatives. But in which sphere did the hospital fall?

Normally, when someone fell ill, a doctor visited the home, examined the patient, and left the nursing care to the female relatives living in the household. Wives, sisters, daughters, and grandmothers administered medicine, dressed wounds, and saw to the patient’s recovery. The only people treated in the hospital were those who didn’t have women at home to nurse them. Once the war began, medical care for soldiers had to be systemized since the troops could not recover at home (although many wives and mothers travelled hundreds of miles to personally nurse their own wounded family members). Male doctors held that the ward was part of the military hospital, so it fell under their dominion.

Popular opinion also held that women would faint in the presence of war’s gruesome casualties, and that their innocence would be marred with exposure to the naked male body. Women nurses were convinced the hospital ward belonged in the female domain, since they were treating sick soldiers the same way they would in their own homes—and the home was unequivocally within the female sphere. More tension arose between men and women when the female nurses viewed the doctors’ advice as suggestions rather than strict orders, for at home, they had the freedom to follow or not follow the doctor’s orders as they saw fit. Over the course of the war, the surgeons and nurses came to accept and work with each other as both groups proved their mettle and shared genuine desire to save lives and speed recovery of the soldiers.

Image 1: Elizabeth Blackwell
Image 2: Georganna Woolsey
Image 3: Sally Tompkins

From: jocelyngreen.com

From The Front Lines to the Hospital

Manassas National Battlefield Park

For the wounded near the front, their first recourse for care lay at the numerous aid stations scattered across the battlefield. Farmhouses, barns, and outbuildings provided places for the wounded to be gathered until they could be sent to the main hospital in the rear.

"The whole region of country between Boonsboro and Sharpsburg is one vast Hospital. Houses and Barns are filled with them, and nearly the whole population is engaged in waiting on and ministering to their wants."
Hagerstown Herald-Mail September 24th, 1862

The Stone House, a private home and tavern at the intersection of two major roads, became prominent as an aid station during not just one, but two major battles. During the First Battle of Manassas, Union battle lines swept past the house, leaving the dwelling to shelter wounded men brought inside amid the fighting. During Second Manassas, since the house lay more firmly in Union hands, Federal personnel were better able to give aid to the wounded, creating a more established field hospital. To mark the building's new purpose, Northern surgeons hung a red flag from a second floor window.

Despite the distinctive identifying flag, the Stone House did not escape hostile fire unscathed, underscoring the risks that wounded troops faced at forward aid stations. As Confederate forces mounted a massive counterattack on August 30th, a wounded Union soldier was attempting to reach the house for aid when an artillery shell hit the building, "knocking a hole that looked as big as a bushel basket" in the house's western face. The private continued rearward, determined to find a safer shelter. Scenes like this were common in the fear and confusion of a battle. Throughout the Maryland Campaign, many homes, stores, churches, schools, and barns served as aid stations.

Hospitals and Homes

After the Maryland Campaign, Frederick was inundated with wounded soldiers, whose sheer numbers overwhelmed the capacity of the existing hospital on the Hessian Barracks grounds. Additional buildings were taken over for hospital purposes and organized into seven General Hospitals, under the care of seven separate sets of surgeons. A total of 27 buildings were used, mainly churches, schools, hotels and large meeting halls. In addition, two hospital camps were set up in tents on the outskirts of the city and many private homes housed wounded officers.

Many local citizens helped tend to the wounded soldiers on the battlefield, some arriving as early as the evening of the Battle of Antietam. They gave freely of their time, food, money, and compassion. The scale of the relief effort cannot be overstated. One pregnant woman in town had torn the family's clothing and bedding into strips for bandages, packed water and goose grease into containers, and headed out to assist the wounded with her young children in tow. When families returned home and found their houses and barns taken over for hospitals, they often helped care for the injured soldiers. Local women also volunteered at large field hospitals. They brought food and delicacies, bandaged wounds, helped write and deliver letters, and read to the soldiers to help lift their spirits.

All of the hospitals, with the exception of General Hospital #1 on the Hessian Barracks grounds, were closed by March of 1863 and the buildings returned to their former uses. However, it took much longer for the soldiers and civilians who witnessed such carnage, pain, and death to recover from the psychological wounds of war.

Image: Stone House: Manassas, Virginia

From: nps.gov

The Reason Medical Practices Changed

From: nps.go

At the beginning of the Civil War, the practice of medicine was emerging from an era in which bleeding, cupping and purging were still practiced but were declining. Medical practitioners did not know the exact cause of many diseases or the mechanisms of infection, but they were beginning to understand the benefits of cleanliness and good sanitation in disease prevention and healing.

"Unless struck in the head or about the heart, men mortally wounded live some time, often in great pain, and toss about upon the ground."
Soldier from the 35th Massachusetts

What Medical Practitioners Did Not Know

By the 1850s, there were over forty medical schools in the United States and physicians typically received some sort of medical education. Many students supplemented their medical school instruction by apprenticing with a practicing physician. During the war, both Union and Confederate surgeons had to pass an exam to be appointed to their positions, helping to ensure an adequate level of care for the soldiers.

Surgeons stressed the importance of sanitation and cleanliness, but putting their ideas into practice was difficult. Camp life was often more dangerous to the soldiers than the battles. Two out of every three deaths in the Civil War were caused by disease rather than injury. Adequate nutrition, camp cleanliness, and preventative measures, such as smallpox vaccination and the use of quinine to prevent malaria, were all used in an attempt to lessen the toll of disease.

The First Battle of Manassas was the first major combat of the war. In the aftermath of the battle, startling numbers of killed and wounded shocked the nation and overwhelmed the medical establishment. Most doctors treating men there were seeing gunshot wounds for the first time. By the time of the Second Battle of Manassas, both the Union and Confederate medical departments were better prepared. Still, what waited for them along the banks of the Antietam tested their strength and skill.

On September 17th, 1862, the two armies clashed near Sharpsburg, Maryland in the Battle of Antietam. On that one day, over 23,000 men were killed, wounded, or listed as missing. Medical personnel from both armies, civilian organizations, local people, and the relatives of the wounded joined together to treat those men who had suffered wounds on the various battlefields.

Wounded soldiers often lay on the battlefield for hours as the combat swirled around them. If they were lucky, litter-bearers picked them up and carried them behind the lines.

As battle raged nearby, an assistant surgeon and a steward often provided the first level of care to a wounded soldier. At a field dressing station--often behind the cover of a few trees, rocks or in a slight depression in the ground-- medical personnel cared for the wounded. Here, soldiers had their wounds bandaged and might be given whiskey to combat shock or morphine to stop the pain. If the soldier was unable to return to the battle, he would be transported from the field dressing station to an aid station or field hospital via an ambulance or stretcher.

During the Revolutionary War and the War of 1812, soldiers primarily used smooth-bore muskets, which fired a round lead ball that usually broke the skin and shattered a bone. Civil War soldiers carried rifled muskets and new ammunition called a Minié ball. The faster and more accurate Minié ball could splinter bone and cause massive damage to the tissue around the wound.

Approximately 94% of all Civil War injuries treated by surgeons were caused by the Minié ball. The extensive trauma caused by the Minié ball often made it necessary for surgeons to perform amputations, since repairing the damage was either impossible or not prudent due to lack of time and the likelihood of infection. In the Union army, three out of every four operations performed in field hospitals were amputations.


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