.

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, January 18, 2017

Mary Lincoln: The Last Sad Years

By Feather Schwartz Foster, 12-26-16

In late 1880, Mary Lincoln, no longer able to live on her own, left Europe and returned to live with her sister in Springfield, Illinois. She was sixty-one.

The Widow Lincoln in Exile
When Abraham Lincoln was assassinated in April, 1865, the effects on the country would be far-reaching. So would the effects on his widow, who was 46 at the time. Her emotional health had always been fragile. She frightened easily, had submerged herself into the Victorian mode of perpetual mourning, and could barely cope with the realities of her situation.

At the time of Lincoln’s death, Mary Lincoln had already lost two sons; one at three years, the other at eleven. She would lose another son at eighteen, and her sole surviving son would be lost to her by estrangement. Despite coming from a large family, she was, for all intents and purposes, alone in the world.

She had gone to Europe in 1868 to escape the humiliation and scandal from her aborted financial scheme to sell her clothing. Returning to America in 1871, she lost her last son, and saw her relationship with her eldest son Robert deteriorate along with her emotional health. By 1875, her condition had worsened to a point that Robert felt compelled to have his mother tried for insanity and placed in a sanitarium. Recovering from her “insanity” (which many historians believe may have been drug interaction from her various physical and psychosomatic ills), she lived for a time with her sister Elizabeth Edwards in Springfield, Illinois, in the very house where she met and later married Abraham Lincoln.

Unable to face the second humiliation and scandal of her troubled widowhood, she once again departed for Europe. This time she went to Pau, France.

Pau, in the south of France, was specifically chosen by Mary Lincoln, since it was said to have the best climate in Europe, and she was always prone to chills and fevers.  Good weather was a necessity for her refuge and the solitude she claimed to want.

She lived in a residence-hotel, one of many she had lived in during those years of her widowhood. Unable and unwilling to move back to the Lincoln house in Springfield, with its sad memories, she became virtually homeless. Residence hotels were common in those times. People who were alone in the world favored them for providing the amenities they needed while relieving them of the responsibilities of home-ownership they could neither afford or maintain.

For the better part of three years, she remained in general seclusion, making a few superficial acquaintances, and indulging in her preoccupation with shopping. Then her physical health began to fail. She was losing her eyesight, likely due to cataracts (and possibly an undiagnosed diabetes some historians suspect). In addition, she suffered a severe back injury from a fall. X-rays would not be invented for more than another decade, but it is not unlikely that a bone or two may have been broken. The chronic pain would plague her for the rest of her life.

It was time to go home. The only place she could call “home” was her sister Elizabeth’s house in Springfield. She booked passage.

Mary Lincoln’s Belongings
One of the very few people who the Widow Lincoln cared for and trusted was young Lewis Baker, her sister’s grandson, now a young man around twenty. He was sent to New York to meet Mary’s ship, and escort her back to Springfield. He was also tasked with helping to ship her belongings to the Edwards’ house.

Despite Mary’s homelessness, she had a huge amount of possessions trailing after her wherever she went – like the scattered debris tail of a comet. More than sixty crates and trunks and boxes were filled with the stuff of her life. Clothing and jewelry and household goods she hadn’t used in years and never would, Lincoln memorabilia, mementos from her White House years, artwork and decorative items she had purchased. Some things had never been taken out of their original boxes.

Elizabeth and Ninian Edwards had agreed to have her come.  She was family, and they knew she had nowhere else to go.  But they were unprepared for the general disturbance Mary-in-residence would cause them. They knew she was demanding and difficult, but they were overwhelmed at the wagonloads of her baggage.

In those days, an upstairs room was usually assigned to store a family’s empty luggage. Trips usually lasted for several weeks; clothing and accessories required a great deal of care and room in packing. Families could easily have more than a dozen large trunks.

With Mary’s arrival, sufficient room needed to be found in the Edwards’ house to store her  filled crates and trunks. Within days of Mrs. Lincoln’s arrival, the Edwards’ long-time housemaid resigned. It seems her bedroom was directly below one of the rooms containing Mary’s heavy trunks, and the ceiling was buckling. The maid had a legitimate fear that the ceiling would collapse from the weight, and fall on her when she was asleep.

Mary Lincoln seldom (if ever) left the house, and usually kept to herself and her room. Instead, she “visited” her trunks and belongings. Despite her bad back, she climbed the stairs and remained on her knees for hours, bending over various cases, examining their contents, unfolding and refolding, and thinking whatever private thoughts came to her mind.

Springfield children, too young to remember the First Lady of two decades earlier, regarded her as a peculiar old woman who sat alone in a darkened room upstairs, never lifting the shades. They were not completely wrong.

Sources:
Baker, Jean – Mary Todd Lincoln: A Biography – W.W.Norton & Co. 1999

Clinton, Catherine – Mrs. Lincoln: A Life – HarperCollins, 2009

Turner, Justin G. & Turner, Linda Levitt (eds.) – Mary Todd Lincoln: Her Life and Letters – Knopf, New York, 1972

Image 1: A “doctored” photograph of Mary, said to be the last ever taken.

Image 2: The home of Ninian and Elizabeth Edwards in Springfield, IL. Mary was married in that house, and died in that house.

From: featherfoster.wordpress.com


Early Days of Amputation in America

By Christine Dantz, February 2016

Medical amputation has come a long way since the American Civil War, in fact, today most of our country's war vets who loss a limb in the line of duty go on to live long, active lives. That wasn't always the case, during the Civil War, the chances of surviving and thriving after an amputation were similar to amputating a limb fast enough to stop a zombie infection today.

An estimated 60,000 amputations were performed by battlefield doctors during the American Civil War from 1861-1865, that is because 70 percent of all battle wounds were to the hands, arms, legs, and feet.

Here is a typical battlefront doctor's instrument case, the image is from the archives of the U.S. National Library of Medicine. This case has a surgical saw, a curved and straight surgical probe, and tweezers.

The probes were used to inspect the wound prior to amputation. There were two types of amputations done at this time, circular and flap. The circular peeled back the skin before severing the bone and then rolling the skin back down and sewing it together at the end around the bone creating the stump. The Flap cut the skin around the bone into two long flaps that would be sewn back together and around the end of the bone creating the stump.

An example of the crude leg amputations during the American Civil War is depicted in the photo below, of Private Charles Myer, taken by William Bell. While battlefield surgeons were working hard to save lives, the cuts made in their quickened hast left many veterans looking butchered. The cut and closure of the stump is important for prosthetic fittings.

Luckily for today's veterans, the bone saw is electric, pre-and-post surgical would care has improved greatly, and pain medication is safer, as well as more efficient.

According to the Amputee Coalition, there are about 2 million people living without a limb in the U.S. That number grows by nearly 200,000 each year.
References:

Davis, Laura June. "Photo Essay: Wounded Warriors: Civil War Amputation." Civil War Monitor. Accessed December 11, 2015. http://www.civilwarmonitor.com/photo-essays/album?albumid=1007.

"File:Wallen Wounded by Minie Ball.jpg." Wikimedia Commons. Accessed December 11, 2015. https://commons.wikimedia.org/wiki/File:Wallen_wounded_by_Minie_ball.jpg.

"File:Wbell-leg-amputation.jpg." Wikimedia Commons. Accessed December 11, 2015. https://commons.wikimedia.org/wiki/File:Wbell-leg-amputation.jpg.

"Limb Loss Statistics." Amputee Coalition. Accessed December 11, 2015. http://www.amputee-coalition.org/limb-loss-resource-center/resources-by-topic/limb-loss-statistics/limb-loss-statistics/.

"Lower Leg Amputation Surgery (Amputated Leg)." YouTube. September 28, 2009. Accessed December 11, 2015. https://www.youtube.com/watch?v=XFb2fXPZi8A.

"U.S. National Library of Medicine (archives)." Accessed December 11, 2015.

From: backintheusa.us

Cordelia Harvey Worked Tirelessly to Improve Medical Care for Soldiers

By Mark, 8-17-10

Wisconsin had a new governor in January 1862.  Louis P. Harvey, a Republican and former Wisconsin Secretary of State, took office on January 6th.  Four days later, Harvey addressed the state legislature, asking that more funds be made available for financial help for families of soldiers under the Soldier Volunteer Aid Act. Many families suffered financial hardship when the family breadwinner went off to war, and the Act provided some a small amount of money to those families.  A reluctant legislature finally provided funding in April.  Governor Harvey wanted to be an advocate for Wisconsin soldiers, and had taken the first step.

When the casualty reports were released after the Battle of Shiloh in Tennessee in April 1862, Governor Harvey called on the citizens of Wisconsin to donate medical supplies.  The state responded, and the governor personally delivered the supplies and some volunteer surgeons to the field hospitals near the battlefield.  He also visited Wisconsin regiments at their camps.  But on April 19th, while transferring between steamboats on the Tennessee River, Louis Harvey slipped and fell into the river and drowned.

But as the soldiers lost one advocate, another one emerged.  The governor’s widow, Cordelia Harvey, continued her late husband’s cause.  In September 1862, she was appointed a Sanitary Agent of the U.S. Sanitary Commission, a U.S. government agency set up to improve conditions for soldiers in camps and in hospitals.    Mrs. Harvey traveled to Missouri and inspected hospitals there.  She found them to be overcrowded, badly organized, and poorly staffed, including some surgeons she deemed “incompetent”.  She had the U.S. Sanitary Commission send medical supplies to the hospitals.

After reporting her findings to the new governor, Edward Salomon, Mrs. Harvey returned to the south and inspected hospitals in Missouri, Arkansas, Tennessee, and Mississippi.  As she did so, she came to the conclusion that the sick and wounded were receiving inadequate care and would receive much better care if they could be sent to hospitals closer to home.  When she visited General Ulysses S. Grant near Vicksburg, Mississippi in March 1863, she convinced Grant to send patients with chronic dysentery to northern hospitals for treatment.

Cordelia Harvey was now ready to take on her biggest challenge.  She wanted to establish military hospitals in the northern states and ensure that the sick and wounded would be sent to them from the south.  In September 1863, she went to Washington D.C. to meet with President Abraham Lincoln in the hope of establishing these hospitals.

President Lincoln listed to Mrs. Harvey, but was skeptical.  He felt that many wounded or sick soldiers sent north would desert from the army.  Lincoln then sent her to see Secretary of War Edwin Stanton.  Stanton listened, but wanted to hear a report from the Surgeon General (who was touring hospitals in New Orleans) before making any decision.  So she went back to Lincoln, who said he would talk with Stanton the nest day.  On her way out, someone asked Mrs. Harvey how long she planned on staying in Washington.  “Until I get what I came after” she replied.

She did get what she came after.  Refusing to take no for an answer, Mrs. Harvey returned to see Lincoln and adamantly restated her position.  Finally, the persistent Cordelia Harvey convinced Lincoln to establish the hospitals.  He signed an order for three to be built in Wisconsin, one at Madison, one in Milwaukee, and one at Prairie du Chien.

The hospital in Madison was named after Governor Louis Harvey.  Cordelia Harvey returned to the south and continued her work improving conditions for the sick and wounded, in hospitals and camps from  Memphis to New Orleans.  She was a welcome sight to the Wisconsin soldiers.  When the war ended, and the Harvey Hospital was to be shut down, she established an orphanage in the building for the children of Wisconsin soldiers killed in the war.  The orphanage remained in operation until 1875.

Sources:
Harvey, Cordelia A. P.  “A Wisconsin Woman’s Picture of President Lincoln.”  The Wisconsin Magazine of History, Volume I, Number 3, March 1918.
Klement, Frank. Wisconsin in the Civil War.  Madison, Wisconsin:  The State Historical Society of Wisconsin, 1997.
Quiner, E.B.  The Military History of Wisconsin in the War for the Union.  Chicago:  Clarke & Company, Publishers, 1866

From: ironbrigader.com

Dr. Jonathan Letterman and CW Medicine

From: featherfoster.wordpress.com

Evacuating the wounded from the battlefield could take days at the start of the American Civil War.

Dr. Jonathan Letterman is usually considered the Father of Battlefield Medicine.

Dr. Jonathan Letterman (1824-72) was an army surgeon who came from a distinguished medical family. During the 1850s, he was deployed at various locations “out west,” and learned firsthand the needs as well as the limitations of his profession. It also gave him ample time and opportunity to rethink a good many military medical procedures that had been entrenched since the Napoleonic Wars a half-century earlier.

At the beginning of the American Civil War, Dr. Letterman was appointed by the Surgeon General as the Medical Director of the Army of the Potomac. He was given the rank of Major. It was a fortuitous appointment. Jonathan Letterman was now in a position to put several of his unconventional (for the times) ideas into practice.

The Ambulance Corps Is Created

General George McClellan was an early and ardent advocate of Dr. Letterman ‘s approach to evacuation of casualties.

In 1861, the start of the Civil War, the system of retrieving wounded soldiers from the battlefield was inefficient at best. The army surgeons were in charge of the ambulances. The drivers and stretcher bearers were a motley assortment of non-combatants, i.e. buglers, drummers, cooks, etc. They were untrained, and in many cases, little more than children who would and did cave in under pressure and run from the field. It did not take very long before the army surgeons realized that they were overwhelmed with casualties and had neither the time nor facility to train their support underlings.

Special ambulance wagons were refitted with supplies and equipment to transport the wounded from the battlefield.

After the battle of Second Manassas (Bull Run) in midsummer, 1862, it took a week to remove the wounded from the battlefield. Many soldiers died unnecessarily whose lives could have been saved with nothing more than prompt treatment. Recognizing this gross ineffectiveness, General George B. McClellan, an ardent supporter of methods and training procedures, gave Dr. Letterman a free hand to employ whatever means he thought necessary to improve such poor medical service. Dr. Letterman had been thinking and rethinking such matters for a decade, and had many systems and changes in mind.

He immediately began organizing a well-trained and equipped Ambulance Corps, as an entity of its own. He designed special insignias for its members, which provided quick on-field recognition. It also gave the corps a sense of camaraderie amongst themselves and amongst the troops.

The Ambulance Corps was composed of non-medical personnel, but they would be trained and supervised by the army doctors. A chain of command was set in place to insure order rather than chaos. Each corps had a captain; each division a first lieutenant; each brigade a second lieutenant; and each regiment a sergeant. They would oversee all aspects of recovery from the field – including the care and maintenance of the ambulance wagons themselves.

The newly-created Ambulance Corp proved its value within months after it was established. Quick response likely saved hundreds of lives.

New ambulance wagons were properly equipped for the immediate care and transport of the wounded. It was a modified wagon well supplied with stretchers, kettles, lanterns, beef stock, bed sacks, and emergency medical supplies. The ambulance staff was recruited among rank and file soldiers.

Under Dr. Letterman’s system, ambulance personnel were specifically trained to lift and carry the wounded, and provide certain immediate treatment, such as applying tourniquets. They were also charged with cleaning, refitting and resupplying the ambulance wagons after a battle.

With proper training, a sense of its huge value and importance to the war effort, and most of all, lives saved by the timely removal of the wounded from the battlefield, the Ambulance Corps was able to provide quantifiable results in short order.

The Results of the Letterman System

When the Civil War began in 1861, no one was prepared for the horrendous number of casualties, both North and South. The original slap-dash measures of finding and evacuating casualties proved to be inefficient and humiliating to the army in general. Immediately after the Second Battle of Bull Run in the summer of 1862, (which took a week to remove the casualties) Dr. Jonathan Letterman was put in charge and in addition to organizing his Ambulance Corps, he also instituted a system for providing actual statistics regarding the evacuation of casualties.

The Battle of Antietam, September 17, 1862: 9500 casualties evacuated in twenty-four hours.

The Battle of Fredericksburg, December 13, 1862: 9000 casualties evacuated in twelve hours.

The Battle of Gettysburg, July 1-3, 1863: 14,000 casualties removed from the field by the morning of July 4.

So exceptional were the results of the Letterman System, that Congress mandated the system by law in 1864. Dr. Jonathan Letterman has rightly earned the title of “The Father of Battlefield Medicine.”

On Hospitals in Ships

By Thomas L. Snyder, 12-24-11

According to the International Red Cross, the history of hospital ships, at least in the west, starts in the 17th century, when navies began to routinely send ships intended for the care of wounded and sick sailors and soldiers in company with fleet actions. In the 17th and 18th centuries, naval authorities chose veteran combat vessels for hospital use. Typically these tired men-of-war served as warehouses for the sick and wounded–victims of the rigors and deprivations of long distance sailing, or of war. During the 19th century, the procedure of taking ships up from trade–contracting civilian passenger liners or cruise ships and converting them to hospital use–found increasing use among many navies. Even as recently as the war in the Falkland Islands, the British Royal Navy took SS Uganda up from her civilian service as an educational cruise vessel to serve UK and allied troops during that short but violent conflict.

By the twentieth century, while the vast bulk of ships serving hospital duty were taken up from trade, some nations–the United States in particular–began constructing purpose-built hospital ships, the first example being the USS Relief (AH-1), laid down in 1917 and commissioned in 1919. In World War II, the British, Australian, Canadian, New Zealand, Dutch, French and German naval services all boasted hospital ships taken up from trade and converted for hospital or sick-transport use. The U S Army commissioned 24 hospital ships, all in hulls converted from civilian use and manned by Navy crews and Army medical staffs. To this day, the vast bulk of ships serving a dedicated hospital role are commercial or transport hulls converted to hospital purpose.

In 1907, hospital ships received explicit international legal status with international legal protections from attack and seizure, under Article Four of the Tenth Hague Convention. In order to receive such international protection, the hospital ship must meet the following standards: they must carry on no military activities, including interference with navigation by enemy ships; they must be painted white and bear large images of the red cross, the red crescent, or the red lion and sun. In order to ensure their protection under the Convention, these ships may be illuminated at night and during periods of poor visibility in order to make their hospital ship status readily apparent. Ironically, it was the Russian Hospital ship Orel (Eagle) that, by being so illuminated, tipped off elements of the Japanese navy to the presence of the Russian Admiral Rozhesvensky’s fleet trying to sneak its way under cover of fog and dark through the Tsushima Strait to Vladivostok. This contact led directly to the 1905 epochal naval battle that devastated the combined Russian fleet, and confirmed the ascendancy of Japanese naval power.

In World War I, hospital ships continued their traditional role as transports of the sick and wounded, bringing them from far away points of combat back to their home country for definitive treatment. The same can be said for hospital ships in World War II, though by this time, increasingly sophisticated care could be provided aboard these ships. By the time of the Korean War, hospital ships could take the role of stationary hospitals simply located at sea. An example of this is the Danish hospital ship Jutlandia, which, operated by the Danish Foreign Ministry and staffed by Danish volunteers, and with agreement of the United Nations, anchored off the Korean city of Pusan, and later Inchon, to provide medical services to military and civilian casualties and sick alike for three years during the U N’s police action in that peninsular nation.

Today, only the U S (Mercy class), Chinese (Type 920) and Russian (Project 320 Ob’ Class) navies operate large hospital ships; these are almost inevitably hulls converted or adapted from other purposes. The Spanish Department of Labor operates a large purpose-built hospital ship to serve that nation’s commercial and fishing fleet, and many nations, including Argentina and Brazil, operate smaller hospital units afloat in their extensive river waterways to provide care to civilian populations. Given the trend toward delivering nearly definitive care to wounded soldiers very close to, or in, combat action zones, and the extensive use of air evacuation, many are questioning the need for large hospital ships. The American experience is instructive: since 2003, U S hospital ships have been absent in areas of U S combat operations; increasingly, they are seen as assets to provide humanitarian care in areas of natural disaster. The US, Chinese, British, and German navies increasingly use medical and surgical capabilities built into combat or combat support ships to provide at-sea medical support for operations distant from the home country. The US has extensive medical capability in amphibious warfare ships of the LHD, LHA, LPD and LSD classes; the British have the Royal Fleet Auxiliary (Aviation Training Ship) Argus, now designated as a Primary Casualty Receiving Ship) and the Germany navy counts two ships (with a third on order) in its Berlin Class of replenishment ships, designed to support German military forces away from their home ports.

It would appear that while the nature of hospital facilities at sea are changing, there is little doubt that soldiers, sailors and Marines can look forward to receiving medical and surgical care “from the sea” for some time to come.

Image: USS Relief

From: ofshipssurgeons.wordpress.com


The Confederate Cemetery in Madison, Wisconsin

By Mark, 6-15-15

Madison, Wisconsin is a long way from the battlefields of the Civil War or the states of the old Confederacy. It would seem to be an unlikely location for a Confederate cemetery, yet there is indeed such a cemetery in Wisconsin’s capital city. Confederate Rest, as it is called, is a section of Madison’s Forest Hill cemetery that contains the graves of 140 Confederate soldiers who died while prisoners of war in 1862 . It is the northernmost Confederate cemetery in the United States.

In March 1862, Union naval forces attacked the Confederate garrison on an island in the Mississippi River near New Madrid, Missouri called Island Number 10. The island and nearby mainland were heavily fortified to help stop the Federal advance down the river, which was a major transportation route. Eventually, Union forces surrounded the island, and with escape routes cut off, the Island Number 10 defenders surrendered on April 7th.

The Confederate prisoners of war were sent north to various POW camps. Some 1,156 prisoners, all of whom were enlisted men, were sent to Madison. They were first sent via transport vessels on the Mississippi River to Prairie du Chien, Wisconsin, and then by rail to Madison. The first group of 881 arrived by train on April 20th, and 275 more joined them on April 24th.

Townspeople in Madison came out to the train station to see the arrival of the prisoners. While the first group was in relatively good physical condition, the second group was in much worse shape, with many suffering from pneumonia, mumps, measles, and chronic diarrhea. These prisoners were taken off the train on stretchers. Island Number 10 was in an important strategic location, but the soldiers who were given the task of defending it had to do so under poor conditions. Men were exposed to cold rain and winds, with little food and medicine, standing knee deep in water in the trenches. It was no wonder many were desperately ill.

The POWs marched or were transported to Camp Randall, a large training camp for Wisconsin volunteer soldiers. It was not designed nor equipped to be a prisoner of war camp. At first, the camp was badly run and many of the ill prisoners received inadequate medical treatment. Things improved after a visit from Lieutenant Colonel William Hoffman, Commissary General of Prisoners for the Union Army. Later in the war, prisoner of war camps would be infamous for their appallingly bad conditions, but Hoffman made a sincere effort to improve things here. He ordered clothing, bedding, supplies, and medications for the camp, and improved sanitary conditions. Hoffman also brought in extra surgeons to deal with the rampant illnesses. Madison’s civilian population had been shocked at the condition of the ill prisoners and townspeople helped out by bringing food and other supplies to Camp Randall.

Despite these efforts, many of the seriously ill could not be saved by the 19th century medical practices of the day (far more soldiers died of disease than in combat in the Civil War). As many as 10 prisoners a day died.

The dead were taken to Madison’s Forest Hill Cemetery. They were buried side by side in one section of the cemetery, with wooden headboards marking each grave. After about three months, the prisoners were moved out of Madison to other camps, but a total of 140 had died and were buried in what the civilian population called Confederate Rest cemetery. One hundred ten of these men were from the 1st Alabama Infantry with the remainder from Arkansas, Tennessee, Louisiana, and Mississippi.

As time went on the site began to be overgrown with tall grass and weeds. Then in 1868, a southern born woman who had spent most of her life in the north moved to Madison. Although she did not personally know any of those buried there, Alice Waterman took an interest in the cemetery and removed the overgrowth, placed a fence around the site,  and replaced the deteriorating headboards at her own expense. (The wooden headboards were later replaced with headstones). She got the attention of Madisonians including Lucius Fairchild and C.C. Washburn, both of whom were former Union generals who went on to become governors of Wisconsin. She persuaded them to help improve the site, and Washburn personally led a group of former Union soldiers to the cemetery on a Decoration Day (today’s Memorial Day) when he was governor.

Today, the site of Camp Randall is occupied by the stadium where the University of Wisconsin’s football team plays its home games, though reminders of the location’s Civil War past are just outside the stadium. Forest Hill Cemetery, where many prominent Madisonians of the past are buried, is maintained by the City of Madison, and Confederate Rest receives the same care as the rest of the cemetery. A section of Union Army graves lies near the Confederate graves, and each Memorial Day, commemorative ceremonies are held at both sites.

One grave in Confederate Rest lies in front of the first row of soldier’s graves. After her death in 1897, Alice Waterman was buried at her request in the plot of ground containing the remains of soldiers she had never known, but whom she referred to as “her boys”.

Sources:
“A Wisconsin Burial Place of Confederate Prisoners of War” by William A. Titus, Wisconsin Magazine of History, Spring 1953.

History of the First Regiment Alabama Infantry C.S.A. by Edward Young McMorrries.

Mr. Lincoln’s Brown Water Navy: The Mississippi Squadron
by Gary D. Joiner

Official Records of the Union And Confederate Armies in the War of the Rebellion Series II Volume 3.

Images: Confederate Rest Cemetery Madison Wisconsin

From: ironbrigader.com

Advancements in Surgery Through the Ages

by Lisa J. Fulghum, 6-5-15

Imagine yourself standing in a medical tent on September 17, 1862 not far from Sharpsburg, Maryland, as the bloody battle of Antietam rages on the other side of the bridge. With nearly 22,000 dead and many more wounded after just 12 hours of fighting, what is a good surgeon to do? Your shirt is stained with the blood of the many you have already treated, yet more men than you can count lay suffering nearby. With only 98 medical officers to serve the entire Union army and just 24 for the Confederates when the war began, trained medical professionals are still hard to find.1 It will be a very long night. Your options are as limited as the precious time you have.

Ether and chloroform (when they are available) are the only viable methods of anesthesia, besides a stiff shot of whiskey. The best surgeons, commonly called butchers by reporters and patients, are the ones who are quick and hopefully accurate. Amputation is the most common surgery of the day, and a good surgeon can amputate a limb in just 15 minutes.2

Standing amidst the grizzly scene, you call for another cup of coffee, wipe your surgical saw on your apron and look for the nearest patient who is likely to survive long enough to complete a surgery. Inwardly, you hope that one day you will have a better method for dealing with such carnage.

An estimated 60,000 amputations were performed during the Civil War. Nearly 75% of amputees survived the surgery, though that depended greatly on the limb that was amputated. A forearm amputation mortality rate was 14%, but legs amputated at the hip had an 88% mortality rate.3

History of Surgery
Since the beginning of time, man has developed and refined instruments for surgical procedures and for healing people. Throughout our history, humankind has had notable physicians who made monumental contributions to medical science.

As early as 600 B.C. Sushruta , India’s preeminent surgeon, pioneered rhinoplasty and other forms of plastic surgery. Since cutting off a person’s nose was a common punishment, Sushruta’s expertise was highly valued.4 Among other things, believe it or not, he even documented cataract surgery.5 Developing and documenting 120 surgical instruments (in bronze, silver, and iron) and employing many relatively modern techniques, Sushruta was revered as a master physician 150 years before Hippocrates.

Around 1000 A.D. Abu al-Qasim al-Zahrawi (a.k.a. Albucasis in Europe), the master Muslim physician of Spain, wrote a 30-volume medical encyclopedia called Al-Tasrif (The Method of Medicine). It was the medical reference text used for over 500 years. Albucasis invented and described over 200 new instruments. With hand sketches of what instruments looked like, how they were constructed and how they were to be used, he documented instruments like his obstetric forceps and an urethrascope. Not only was he the first author to describe an ectopic pregnancy and the hereditary nature of hemophilia, but he also pioneered sublimation and distillation for the preparation of medicines. Albucasis described ligatures 600 years before Paré adopted their use, even using catgut for internal stitches so the stitches would dissolve as the patient healed.6

Surgery was not always the prestigious profession that it is today. During the middle ages in Europe, surgery was considered a lesser profession, and physicians did not deal with such things. The local barber was frequently the town surgeon.

Stop the Bleeding
During the Middle Ages, one of the major hindrances of a successful surgery was excessive bleeding. Medical innovators like Guy de Chauliac emerged. He released (1363) his 7-volume library of surgical knowledge, the Chirurgia Magna, in which he described the use of a tourniquet for blood control during an amputation. In his work, he also described intubation, suturing, blood clotting, and the use of surgical instruments.7

By the mid-1500s Ambroise Paré, a barber-surgeon, introduced the lost art of ligatures to control blood flow in wounds or during surgeries like amputation. He favored ligatures over cauterization that was the preferred method of the day, because ligatures reduced the pain patients suffered. Paré invented the crow’s beak hemostat to stop blood flow during amputation.8

Kill the Pain
The pain of surgery was a limiting factor. A doctor could only operate for the length of time a patient could endure. The introduction of anesthesia opened the door for a host of new procedures.

Humphrey Davy, the scientist who discovered the elements potassium and sodium, was one of the first to identify the anesthetic properties of nitrous oxide and ether in 1799. Both were used as recreational drugs at the time. In 1842 Dr. Crawford W. Long, who had observed the effects of ether at some of their nitrous oxide parties, was likely the first to use it in surgery. He administered it to James Venable before removing a cyst from James’ neck.9

In Scotland a year later (1847) James Young Simpson was assisting a woman with a difficult childbirth and used ether to minimize her pain. Because of the side effects, he began experimenting with chloroform. Chloroform was soon accepted, and even Queen Victoria used it for childbirth.

Physicians then began looking for a local anesthetic. The birth of the hypodermic needle (1850s) allowed for intravenous anesthetics.10 Surgeons like William Stewart Halsted, who was one of the “Big Four” founding professors of Johns Hopkins, was one of the first to explore the use of cocaine as a local anesthetic. He would inject the anesthetic into a nerve trunk to numb an entire limb or the spinal cord.11

Incidentally, it was he who introduced the radical mastectomy for treatment of breast cancer. In addition, he also invented the Halsted Mosquito Forceps, a small pair of hemostatic forceps. One of the other “Big Four” was Howard Atwood Kelly, who developed the Kelly Forceps, one of the most popular and commonly used hemostatic forceps.

With the introduction of anesthetics, medical science continued its forward advance. However, the discovery of effective anesthetics came with unintended consequences. While it made non-traumatic surgery possible and allowed for longer and more complicated surgeries, it also opened the patient to a greater chance of infection.12 By the mid-1800s when the use of anesthetics was the norm, it was not uncommon for a European hospital to have an 80% mortality rate for surgical patients.13

Wash Up
When physicians learned to combat infection, we cleared another medical hurdle. Honey, willow bark, balsam, wine, and vinegar were used historically as antiseptics to dressed wounds. However, before the mid-1800s, there was little concern for cleanliness among physicians. At that time, a bloody apron was considered a badge of honor. In 1795, Scottish physician Alexander Gordon suggested that doctors could transmit contagions, and he recommended that obstetricians wash their hands and clothes before treating patients. Opposing the standards of the day, American physician Oliver Wendell Holmes concluded in 1843 that the spread of puerperal fever (after childbirth) was connected with unwashed doctors. Independently, Hungarian doctor Ignāz Semmelweis made the same conclusion in 1847. Implementation of new cleanliness guidelines lead to a maternal mortality drop from a high of 18% to about 1%. Amazingly, these doctors understood what to do but not why.14

Louis Pasteur proved the existence of airborne microorganisms. By 1862, he completed his first tests indicating that bacteria cause wine, beer, and milk to sour. He then pioneered the process of pasteurization to kill the microorganism. Pasteur continued his extraordinary research in germ theory and went on to invent vaccinations for diseases like cholera, tuberculosis, and small pox.15

Following these discoveries, Joseph Lister put it all together. He determined that if airborne bacteria caused wine to spoil, then airborne microorganisms could also cause infection after surgery or childbirth. In 1865, he pioneered a method of using carbolic acid (phenol) as an antiseptic for treating wounds. He published his work in 1867 in The Lancet. It was not fully accepted until the 1890s when Heinrich Koch proved that germs cause disease.

Lister introduced sterile catgut for internal stitches. He also tied bones together with sterile, silver wire and left it inside of the patients. This was a revolutionary idea, because previously, the germs left behind by such a procedure would have caused gangrene and certain death.16 Lister also invented the Lister bandage scissors.

Hurdles to Modern Surgery
While the mechanics and instruments in a surgeon’s toolkit have changed dramatically through the ages, surgery still remains an intricate and delicate handicraft practiced and perfected by the gifted and skilled. As the science of surgery has evolved, three major hurdles had to be overcome: the control of bleeding, the control of pain, and the control of infection. In the last 150 years, these incredible medical advancements have completely revolutionized the surgical process and given humankind a much brighter future.

Now, as you stand in a modern operating theater, garbed in a sterile gown complete with surgical mask, binocular loupes and neoprene gloves, you can marvel at the array of gadgetry to monitor the patient’s heart rate, O2 levels, and blood pressure. The lead surgeon is assisted by a staff of anesthesiologists, nurses, and technicians. Complex surgeries of critical organs can take hours as skilled surgeons work miracles never before even imagined. The civil war surgeon would have marveled at the spectacle of a laser surgery, laparoscopy, MRI and CT technology, chemotherapy, and robotic surgery. Given the phenomenal advances of the last century, we have to wonder what revolutionary breakthroughs await us in the next 150 years. Will you be the Louis Pasteur, Ambroise Paré, Albucasis, or Joseph Lister of our modern age?

References

Civil War Medical Care, Battle Wounds, and Disease (Civil War Medical Care, Battle Wounds, and Disease) www.civilwarhome.com/civilwarmedicine.html 02/10/02
Clements, I.P. History of Surgical Amputation (HowStuffWorks) health.howstuffworks.com/medicine/modern-treatments/amputation2.htm
Billings, J. (2001). Hardtack and coffee, or the unwritten story of Army life. Scituate, Mass.: Digital Scanning. www.civilwar.org/education/pdfs/civil-was-curriculum-medicine.pdf
ISPUB.com (Internet Scientific Publications) Sushruta: The first Plastic Surgeon in 600 B.C. by S Saraf, R Parihar ispub.com/IJPS/4/2/8232
Roy, P., Mehra, K., & Deshpande, P. (1975). Cataract surgery performed before 800 B.C. British Journal of Ophthalmology, 59(171) bjo.bmj.com/content/59/3/171
Albucasis (Doctor - the Father of Modern Surgery) english.turismodecordoba.org/seccion/albucasis-doctor---the-father-of-modern-surgery
Guy de Chauliac www.thefamouspeople.com/profiles/guy-de-chauliac-447.php
Ambroise Paré www.apimsf.org/default.aspx?id=22
Dr. Long’s Discovery www.crawfordlong.org/id10.html
Blatner, A. (2009, February 16). Anesthesia / History of Medicine. The Discovery and Invention of Anesthesia. www.blatner.com/adam/consctransf/historyofmedicine/4-anesthesia/hxanesthes.html
The Four Founding Physicians http://www.hopkinsmedicine.org/about/history/history5.html
Antisepsis www.discoveriesinmedicine.com/A-An/Antisepsis.html
Lamont, A. (1992, March 1). Joseph Lister: Father of Modern Surgery. https://answersingenesis.org/creation-scientists/joseph-lister-father-of-modern-surgery/
Henderson, D.K., Lee, L., and Palmore, T (2014, June 1) The Contemporary Semmelweis Reflex: History as an Imperfect Educator www.infectioncontroltoday.com/Articles/2014/06/The-Contemporary-Semmelweis-Reflex-History-as-an-Imperfect-Educator.aspx
Louis Pasteur (2014) www.biography.com/people/louis-pasteur-9434402
Antisepsis

A Purdue University graduate, Lisa Fulghum is the Content Director at WPI. For nearly 50 years, WPI has been supplying laboratory equipment for life science researchers, including a variety of German and Swiss made surgical instruments.

Image: This toolkit is over 100 years old.

From: alnmag.com

Beware Gangrene! Treating This Deadly Disease

By Jake Hanson, 3-28-14

During the American Civil War, two-thirds of the 700,000 soldiers died, not from battlefield trauma, but from infections as a result of battlefield wounds. This means that though a man only took a bullet to his extremities—a hand or a foot—he had the potential to die from complications. The most dreaded of the diseases that could be caught was gangrene.

Confusion abounded about what it is and how to treat it. Indeed, in both the Union and Confederacy armies the mortality rate of soldiers who contracted gangrene was a dismal 45%. That is, if you got gangrene, you might as well flip a coin concerning your chances of survival.

We know today that gangrene is the result of microorganisms that dine on unhealthy flesh, and spread rapidly down the extremities and release poisonous gases as they go. They spread rapidly from person to person, and even from room to room.

Based on thousand year old treatment techniques for the condition from Classical times, Civil War medics treated infected soldiers by calming them with whiskey, giving them a balanced diet, debridement of dead flesh, and some form of topical treatments that had limited effectiveness and was often more harmful than helpful as in the case of the caustic nitric acid. And after treatment, medics would watch for ‘laudable pus’ which was erroneously believed to be a ‘sign of healing.’

In all, these treatments were ineffective and methods often unwittingly spread the disease throughout a hospital.

Dr. Middleton Goldsmith based in Louisville, Kentucky was Surgeon-in-Chief of all military hospitals in Kentucky as well as the Army of the Ohio. He was dissatisfied with conventional treatment and began to experiment with new ways to treat the condition. While he did not understand germ theory, which was currently being studied by Louis Pasteur, he understood the necessity of cleanliness in treatment which went a long way to the prevention of its spread.

The breakthrough for Goldsmith came when he began experimenting with bromine, a chemical element which he used aggressively to treat gangrene, first injecting it deep into infected tissue, then working his way out to a topical application. The result of his treatment was a drastic drop in the mortality rate from 45% to 2.6%. Goldsmith had found that the right medicine injected aggressively and rightly was the best way to treat this deadly disease.

The Apostle Paul writes in his second letter to his disciple Timothy that false teaching about Jesus spreads like gangrene—that is, it spreads aggressively. And without proper and aggressive treatment mortality rates increase. Just like Dr. Middleton Goldsmith found an effective way of treating gangrene, so also Dr. Paul gives us the way forward in treating the infectious disease of false teaching.

“Remind them of these things” writes Paul (2 Timothy 2:14). This is the medicine. What are ‘these things’? Paul just finished telling us the Gospel of Jesus Christ beginning in verse 8 that we are to remember Jesus Christ—Jesus Christ, the Son of God, who as John makes clear, “was God”(1:1) and this God “became flesh and dwelt among us” (1:14). Remember, Paul commands, Jesus who died for our sins, and rose up from the dead, and remember that He is the coming son of David whose reign will never end. And Paul continues to remind us that our salvation and life comes when we, by faith, die with Him, and we enter into eternal glory where we will reign with Him (can you imagine?) forever. This is all ours if we receive Him.

But, for those who reject Him (not those of us who have lapses in their faith), He also will reject us. An eternal and real rejection in hell.

Today, this teaching is being rejected, just as it was rejected in Paul’s day, and has been rejected ever since. We see it in the teaching that Jesus was just a good man, but not divine. We see it with those who reject the substitutionary atonement. We see it in those who teach that Jesus was not really resurrected from the dead. We see it in those who teach that we need not receive Jesus to be accepted by God. We see it when we hear that Jesus is but ONE way to God rather than THE way.

It does not take long to find these teachings. Open up a magazine article on Jesus this Easter season, watch a television show on the Bible, or enter into one of many churches around the country, and indeed the world, and you will find the epidemic of which Paul speaks—false teaching spreads like gangrene!

We tend to treat this disease in one of two ways. First, like the Civil War doctors treating gangrenous soldiers, some waited for “laudable pus.” “It’ll work itself out,” we say to ourselves. After all, false teaching has existed since the fall, but the Church still stands. But this lack of treatment fails to obey the commands of God: “Remind them of these things!”

The second way we tend to treat this condition is to, like some Civil War medics, throw caustic and abrasive acids on the wound, sometimes killing the gangrene, but taking out healthy flesh as well, bringing great pain and discomfort to those being treated. Often in our ‘prophetic’ voices we also pour acid on those infected by the gangrene of false teaching. Paul warns against this as well. “[Correct] those who are in opposition with gentleness” that “perhaps God may grant them repentance leading to the knowledge of the truth” (2 Timothy 2:24), knowing that those infected are not the real enemy, but the devil who holds them captive (vs 25).

But aren’t I being a bit drastic here? Insisting that Jesus is the ONLY way, that Jesus really was and is God who took on flesh, died for our sins and really rose from the grave and that only if we believe in Him can we be saved? Isn’t this the caustic acid of which I warn?

Dr. Middleton Goldsmith faced similar questions. Wasn’t pure bromine too strong? Here are his own words:

"Many of the surgeons had no experience in the use of the remedy [of using bromine]. They were imbued with the idea, prevalent in the profession, that this agent is a highly corrosive and irritating one; and hence, they almost uniformly used it, in the beginning, largely diluted with alcohol, water, or ether [. . .] As the surgeons gained experience with the remedy, they gained confidence in its efficacy, and learned that it was not the corrosive and irritating agent which they had supposed it to be.

"Isn’t that what the Gospel is? Good News, the remedy of our sin-sick condition, and also the remedy of false teaching? But we often want to water it down because we hear that it is highly corrosive and irritating, when in reality, it is the false medicine that is caustic.

"The use of this medicine does not guarantee, however, approval. Paul himself was imprisoned for this Gospel. And he promises us that we too may be rejected for giving the life-saving medicine."

Though a hero, Dr. Middleton Goldsmith was not treated as one after the war. Residents of Louisville, sympathetic toward the Confederacy, turned against him, and so he moved to Vermont where he consulted for difficult medical cases and lectured but never served in active medical practice again.

But his task was complete. He had found an effective treatment regimen for gangrene and it would never be treated the same way again. To do so would be folly.

So use the medicine. Remind them of these things, and nip gangrene in the bud!

Sources: Since I know next to nothing about gangrene, here are some sources I used concerning Middleton Goldsmith:

“Gangrene Therapy and Antisepsis Before Lister: The Civil War Contributions of Middleton Goldsmith of Louisville”

“Hospital Gangrene During The Civil War - Civil War Medicine by Dr. Scott Watson”

From: thedecidedlife.com

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