The Professionalization of Child Health Care

Growth and Development of a Specialty

From: medscape.com
By Cindy Connolly

Compared to nursing, medicine's road to professionalization and specialization was direct. State licensing acts, passed in every state by 1900, clearly defined the practice of medicine. Between 1864 and 1880, a number of medical specialty organizations began to appear, including ophthalmology, neurology, otology, dermatology, surgery, gynecology, and laryngology. Founded by white males with elite medical educations, being a member of a specialty conferred much prestige upon them as physicians. Specialists had access to appointments at teaching hospitals, a mechanism through which distinguished careers could be built by overseeing the medical needs of private patients, caring for and trying new therapies on the sick poor, and teaching medical students (Numbers, 1985).

The first medical lectures on the diseases of childhood were offered in 1860 by physician Abraham Jacobi, considered by most to be founder of modern pediatrics. Until the Civil War, pediatrics was considered part of obstetrics in the United States. Before Jacobi, specialties centered around a particular organ or technology. Jacobi felt that pediatrics should have a broader, more conceptual, focus. His vision was that pediatricians should concern themselves with child health well beyond mere disease. He advocated for pediatricians to become involved in infant feeding, child hygiene, and disease prevention in well children. The pediatrician, he argued, could also use his talents to facilitate the Americanization of immigrants. Jacobi articulated a model for pediatrics with a focus well beyond specific diseases, one that involved disease prevention in healthy children, educating parents about child rearing, and social activism for children's rights.

In 1880, Jacobi and a few other interested physicians founded the American Medical Association's section on the Diseases of Children. In 1888 a new organization, the American Pediatric Society, helped to solidify pediatrics as a distinct branch of medicine. Jacobi served as the first president of both groups. Framers of the American Pediatric Society recruited prominent physicians into their membership ranks to advance pediatrics' acceptance. Articulate early pediatricians such as Jacobi wrote prolifically in new journals and textbooks that focused exclusively on childhood diseases, the need for more children's hospitals, and for the expansion of pediatric content in medical school curricula. By 1900, 10 schools of medicine had full-time pediatricians (Halpern, 1988; Meckel, 1990; Viner, 2002).

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The Father of American Pediatrics

Dr. Abraham Jacobi, 1830-1919

From: faqs.org

The father of American pediatrics, Abraham Jacobi championed children's care in both academic and medical spheres. During his life, every medical school in the United States established a department of pediatrics.

Jacobi earned his medical degree at the University of Bonn in 1851. When he traveled to Berlin to take his state medical exams, he was arrested and held in prison for nearly two years on a charge of promoting political and social reform in the German revolution of 1848. Though he viewed his imprisonment as a badge of honor, he left Germany in 1853 to avoid being arrested again.

Jacobi arrived in New York later in 1853, where he practiced general medicine, surgery, and obstetrics, as was the custom of most of his contemporaries. Medical specialization was frowned on as being degrading, making physicians too much like tradesmen.

Jacobi wrote prolifically, publishing 200 articles and books during his career. His early contributions to the New York Medical Journal helped establish the field of pediatrics. In 1857, Jacobi lectured on childhood diseases of the larynx at the College of Physicians and Surgeons, his first formal pediatric lecture.

In 1860, Jacobi accepted a position as professor of infantile pathology and therapeutics at New York Medical College (not connected with the modern medical school of the same name). This appointment signaled a turning point as it was the first pediatric medical position and launched pediatrics as a medical and  academic discipline in the United States.

In his first year at New York Medical College, Jacobi established a method of bedside clinical teaching, a landmark in medical education. Up to that point, physicians did not conduct teaching rounds on medical wards. In the same year, Jacobi also founded the first pediatric free clinic.

Jacobi accepted the position of clinical professor of diseases of children at New York University Medical College in 1865. The College of Physicians and Surgeons (Columbia University) appointed Jacobi as professor of clinical pediatrics in 1870. Jacobi worked at almost every hospital in New York, but he concentrated on the Jews Hospital (later Mount Sinai Hospital), where he set up the first outpatient pediatric clinic in 1874. By 1878, the Jews Hospital had the first department of pediatrics in a US general hospital. Jacobi declined several invitations to accept prestigious medical appointments in Germany.

Throughout his career, Jacobi took care to balance professional success with social commitment, and he advocated medical care for children on the basis of social justice. Though he tempered his socialist views later in life, he corresponded with Karl Marx through the 1860s. Jacobi is best recognized for his achievements in infant nutrition. He studied breast feeding and safe breast milk substitutes. After the safety of pasteurization (Louis Pasteur) was proven, he fought to dispel the old belief that raw milk was beneficial. He advised parents to boil milk until bubbles appeared and advocated diluting milk. His support of boiled milk was thought to have saved more lives than any measure besides antibiotics.

Jacobi also studied diphtheria, gastrointestinal disorders, dental disease, and treatment of pediatric diseases. He invented the first laryngoscope but never patented it. He was one of the early advocates of birth control. Jacobi wrote about medical history and specialized in topics of pediatrics in the era of 1800, meningitis, tracheotomy and nursing. Jacobi's best known text is Intestinal Diseases of Infants and Children, published in 1887.

Jacobi was one of the first to treat diphtheric croup with intubation,the passage of a tube down the throat to help the patient breathe. Previously, physicians had been treating diphtheric croup by cutting into the larynx to establish an airway. Jacobi used diphtheria antitoxin as soon as it was available and advocated its use. In 1880, he published monograph on diphtheria.

Jacobi, who had been widowed twice, married the physician Mary Corinna Putnam in 1873. Mary Putnam Jacobi worked tirelessly with her husband on issues of child welfare and aid for the needy. They coauthored an article on infant feeding and Mary Putnam Jacobi published nearly 100 articles on her own, in addition to receiving the Boyleston Prize from Harvard. In 1883, the Jacobis were devastated to lose their 7-year-old son to diphtheria.

Professional recognition of pediatrics took another leap forward when Jacobi established the Pediatric Section of the American Medical Association in 1880, and the Pediatric Section of the New York Academy of Medicine followed in 1885. With the founding of the American Pediatric Society in 1888, Jacobi setup the first independent medical specialty society in the United States. Jacobi also served as president of the American Medical Association in 1912. Throughout his career, he pressed for regular attendance at medical society meetings. He wrote for numerous medical journals and lobbied Congress to publish the Index Catalogue of the Library of the Surgeon General's Office.

Jacobi had nearly completed his autobiography when a 1918 fire destroyed his only manuscript, along with his personal papers, letters and notes. He died within a year. Jacobi was honored with pediatric divisions named after him at Lenox Hill and Roosevelt hospitals in New York City. The Albert Einstein College of Medicine established the Abraham Jacobi Hospital as a memorial.

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The Uniforms of Civil War Nurses

What Did Civil War Nurses Wear?

From cwnurses.tripod.com

"It seems heartless to see women caring for curls and colors."
(Nurse Sarah Palmer, "the worst dressed woman in the whole army")

When Dorothea Dix assigned northern women as nurses, she placed restrictions on their type of dress. "All nurses are required to be plain looking women," she stated. "Their dresses must be brown or black, with no bows, no curls, no jewelry, and no hoop-skirts." However, for many nurses of the North or South, such regulations were not significant. As the War progressed, female nurses learned to adapt their clothing to the conditions at hand. Dresses were often dark in color, either solid or patterned, so that filth and other stains would not easily be seen. These dresses were also primarily constructed of cotton fabric, which could easily be washed when soiled. Cage crinolines were almost never worn because they got in the way of work, so petticoats were worn instead. Hospital aisles were so narrow that women's hoops could not fit between them. Jane Grey Swisshelm once recounted an event in which another woman wearing a cage crinoline proceeded to walk down one of the aisles of hospital cots. She passed a soldier who was cautioned by the Surgeon in Charge to remain "in absolute stillness" unless he wished his wound to tear open. The woman caught her hoop on the cot the soldier was lying on, the sudden jolt opening his wound and causing him to soon die from the loss of blood.

The range of garments worn by female nurses varied greatly. The Catholic Sisters wore their traditional black habits (although, the Sisters of Charity wore blue habits). Georgeanna Woolsey favored a zouave jacket, blouse, and skirt rather than a dress with a fitted bodice, because the jacket gave her "free motion to the arms." Katherine Wormeley believed flannel shirts were the most comfortable garments to wear when on duty. Nurses from the Portsmouth General Hospital in Rhode Island devised their own uniform "consisting of a skirt of blue army flannel, a zouave jacket lined with red with gilt United States buttons, and a round hat and cavalry gloves." Amanda Farnham was known to wear the "Rational Dress" or "Bloomer Costume" when she worked, consisting of "full pants buttoning over the tops of her boots, skirts falling a little below the knee, and a jacket with tight sleeves." We must understand, however, that generally these forms of dress were not frequently worn by nurses.

The most common style of nurse attire was nicely illustrated in an 1862 article written for the Chicago Times. It expressed that "[t]hey [nurses] seem imbued . . . with the idea that there is nobody to look at them, and the customary attire is a faded calico loose gown, straight from top to bottom, ignoring waist and personifying the theory of the shirt on a bean-pole." Nevertheless, such dress made work for the nurses much easier to accomplish. An apron (either white or patterned), work shoes, and sometimes a bonnet of some sort, usually completed the outfit. The hair was then tied back, most likely into a bun at the nape of the neck, and a few even held their hair back in a dark hairnet (although this was not as common). However the nurse wore her hair or clothed herself was adapted only so she could conduct her tasks in the most efficient manner.

IMAGE: Dress, worn by Mrs. Beach during her service as a nurse. This is a typical work dress made of cotton with a calico print. Notice the blood stains on the fabric, all of which have been tested positive for human blood.

IMAGE: Nurse Marsh is wearing a typical dark colored dress and white apron
(Courtesy of Mass. MOLLUS)

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Heart Disease During the Civil War

By Glenna R. Schroeder-Lein

During the Civil War, as in other eras, some people suffered from congenital or early onset heart defects, including heart murmurs, valve malfunctions, enlargement, and other problems, that caused a recruit to be rejected and a soldier to be discharged, if detected.

In the days before electrocardiograms and other modern imaging tests, Civil War doctors relied on the methods of percussion and auscultation. These involved tapping the area of the chest and listening to the resulting sound, such as dullness or shifting fluid, with the ear or with a stethoscope. Although some writers on Civil War medicine have claimed that Civil War surgeons rarely used the stethoscope, recent research demonstrates that some physicians were quite skilled in its use.

During the Civil War soldiers suffered from two main types of heart problems: rheumatic fever and "soldier's heart". Rheumatic fever, frequently called acute rheumatism during the period, was especially prevalent during the winter. Now known to be a streptococcal infection, rheumatic fever begins with a sore throat and progresses to extremely painful swollen joints. More seriously, rheumatic fever can involve inflammation of the sac around the heart and the heart valves, leading to abnormal heart function or even heart failure and death. The illness usually lasted one to two months. Patients were treated with opiates, quinine, baths, and compresses to reduce the pain and inflammation., Many soldiers who survived had to be discharged because of resulting heart problems.

"Soldier's heart" or "irritable heart" was first studied and described during the Civil War by Dr. Jacob Da Costa, a physician who worked with a ward of cardiac patients at Turner's Lane Hospital in Philadelphia. The symptoms of irritable heart included palpitations, rapid heartbeat, and lightheadedness. Evidently the syndrome was related to severe mental or emotional stress. The patients recovered best when given an extended opportunity to rest.

The most notable person who apparently had heart disease during the Civil War was Confederate general Robert E. Lee. However, historians have engaged in considerable controversy about what type of heart disease he had. Some have suggested that he had coronary artery disease, others that he had pericarditis (inflammation of the sac around the heart) since that was what his physicians diagnosed. Yet others suggest angina pectoris, arteriosclerosis (thickening of the artery walls), or rheumatic fever with resulting heart disease. Whatever Lee had seems to have begun with an illness in March and April 1863, from which he never fully recovered and which cannot now be conclusively diagnosed.

From: "The Encyclopedia of Civil War Medicine"

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Civil War Nurses: What They Did

From cwnurses.tripod.com

"I struggled long and hard with my sense of propriety, with the appalling fact that I was a woman, whispering in one ear, and groans of suffering men, . . . thundering in the other."
(Clara Barton)

Before we can appreciate the work of the Civil War nurse we need to place them within a contextual framework. We must understand that female nurses did not really exist in America at the time. Unfortunately, women during the mid-nineteenth century faced entirely different roles than women do today. Grace Greenwood, in her 1850 book entitled Greenwood Leaves, claimed that "true feminine genius is ever timid, doubtful, and clingingly dependent; a perpetual childhood. A true woman shrinks instinctively from greatness." Obviously, Greenwood's views would be opposed by women today even though they were quite common in her lifetime. Imagine the opposition society threw at these women when they first began to volunteer their services. None of them had any training or experience other than personal experience or a few short courses in most cases. The general public believed women would only be a nuisance and get in the way of the doctors. Others worried that women would lose their moral stature and become vulgar beings after becoming associated with the army for a time. Some claimed that young women were attracted to hospitals only with the intentions of finding love. Thus, it is not surprising that throughout the War, female nurses were outnumbered by male nurses 1 to 4.

While general consent asserted that the use of female nurses was absurd, there were a few people who thought the idea would be beneficial. For instance, Henry W. Bellows of the U.S. Sanitary Commission suggested that soldiers would profit greatly from the care of females rather than other males who were not as sensitive. An anonymous writer claimed that a woman's touch could make "all the difference." A letter that was printed in a medical journal at the time stated that if women could not be of any other use in the hospitals, they could at least keep the floors clean.
Regardless of what society thought, women applied to nurse positions by the thousands. Their work was truly significant; all sharing multiple responsibilities and being forced to make critical decisions. Historian, Daniel J. Hoisington asserts that female nurses had three distinct purposes. First, they regulated, prepared, and served patients their meals during their hospital stays. Annie Wittenmeyer described the women who occupied such positions as "superintendents of special diet." The surgeons would prescribe each patient either a "full," "half," or "low diet" depending on his status. For instance, the "low diet" was prescribed only to seriously ill or wounded patients and usually consisted of coffee and toast or farina. The nurses' duty was to assure that all patients were fed the correct diet. Second, they also managed the physical needs of patients, including the distribution of linens and clothing or supplies received from the U.S. Sanitary Commission or other aid societies. Finally, and probably most importantly, female nurses cared for the emotional and spiritual needs of the patients. This included a whole range of activities, from daily conversation with patients to writing letters for them or reading to them. The list goes on and on, varying from one nurse to the next depending on her personality. While one nurse might have made a point to sing to the men of her ward every evening, another might have cheered them up by placing flowers by their cots or decorating the wards. In any case, most sources indicate that patients truly appreciated the efforts made by their nurses. The presence of females in the general hospitals lightened the hearts and minds of the soldiers, many not having seen a woman for months on end. For them, female nurses took on the roles of mothers, daughters, or sisters.

Even though female nurses busied themselves with several diverse tasks, they were still discouraged from undertaking other types of work because they were simply women. For example, few nurses were ever present on the actual battlefields. Instead, the majority of nurses were assigned to general hospitals or hospital transports. Some women, such as Clara Barton and Annie Etheridge, did indeed courageously offer their help on the battlefields. Another task that very few women ever participated in was surgery. Louisa May Alcott mentioned in Hospital Sketches that she did not believe many nurses were present during surgeries. However, she did express that it was possible for women to watch some procedures if the surgeon in charge approved. She wrote: "I witnessed several operations . . . Several of my mates shrunk from such things; for though the spirit was wholly willing, the flesh was inconveniently weak." Clara Barton, however, was one of the few women who actually performed an operation. At the Battle of Antietam she removed a minie ball from a wounded soldier's cheek, then cleaned and bandaged the wound. Mary Ellis assisted a surgeon with several surgical procedures following the Battle of Pea Ridge. She wrote: "there was no part of the work of a nurse that I did not do . . . I stood at the surgeon's table, not one or two, but many hours, with the hot blood steaming into my face . . ." It is difficult to determine the percentage of female nurses who were present on battlefields or aided surgeons in operations, but they were extremely low. Such duties were strictly preserved for their male counterparts.

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Study: Combat Trauma Seen in Civil War

Veterans who saw more death had higher rates of postwar illness

From: The Associated Press

CHICAGO — A look at the medical records of Civil War soldiers suggests post-traumatic stress disorder existed back then, too, according to a study.

The researchers found that veterans who saw more death in battle had higher rates of postwar illness. Younger soldiers, including boys as young as 9, were more likely than older ones to suffer mental and physical problems after the war.

"Increased war trauma leads to increased physical and mental illness," said study co-author Roxane Cohen Silver of the University of California at Irvine. "That message can be applied to wars around the globe."
The findings, published in the February issue of Archives of General Psychiatry, were drawn from pension records on more than 15,000 Union Army veterans. The researchers examined the records, which included doctors' reports of illnesses, to find signs of cardiac, gastrointestinal and mental health problems.

Warring soldiers have carried home psychological scars for centuries. In American wars, the phenomenon has been called shell shock, combat fatigue and post-Vietnam syndrome. Medical authorities first accepted PTSD as a distinct psychiatric condition in 1980 at the urging of Vietnam veterans and their doctors.
In an editorial accompanying the new study, Dr. Roger Pitman of Harvard Medical School said the findings "should lay to rest the notion that there was something psychiatrically unique about the Vietnam Conflict or about what used to be called 'post-Vietnam syndrome.'"

In PTSD, stress hormones like adrenaline scorch a painful event deep into long-term memory, scientists believe. People get edgy, fearful and prone to nightmares or flashbacks.

The study relied on a database managed by the University of Chicago.

Eric T. Dean, author of "Shook over Hell: Post-Traumatic Stress, Vietnam, and the Civil War," used the same records in his research. He said he is skeptical the 19th-century medical records could be made standard enough for the researchers' statistical analysis to be valid.

He also questioned relying on the diagnoses of doctors from the 1800s.

"This is a heroic effort," Dean said. "I just think it's a stretch. Beyond proving war is hell, I just question their nuanced conclusions."

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Hospital Stewards

From: wtv-zone.com

The lowest ranking members of Union and Confederate Medical Departments during the Civil War were usually hospital stewards, noncommissioned officers who received the pay and allowance of a sergeant major. Each regiment was authorized to have one hospital steward, who was often chosen by the regimental surgeon from the enlisted men in the unit.

Army regulations specified that men selected as hospital stewards had to be of good character: "temperate, honest, and in every way reliable, as well as sufficiently intelligent, and skilled in pharmacy. Temperance was an important quality since one responsibility of the hospital steward was controlling and dispensing medicinal whiskey. As he was responsible for keeping many medical records, the steward also needed to be literate and intelligent.

His other duties included assisting the field surgeons in operations, supervising hospital cooks and nurses, and even prescribing drugs and performing minor operations during emergencies.

Regulations called for Union hospital stewards to wear the red trimmed uniform of artillerymen. Their uniform insignia consisted of an emerald green, yellow edged, half-chevron that bore a two-inch-long yellow caduceus (staff with two entwined snakes and two wings at top). Hospital stewards of volunteer regiments, however, were known to wear a variety of different uniforms and insignia. Confederate hospital stewards' uniforms and insignia were not officially regulated, but one surgeon recalled that on the uniform many wore, the chevrons on the coat sleeves and the stripe down the trousers very similar to those worn by an orderly or first sergeant, but were black in color.

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The Irritable Heart

Increased Risk of Physical and Psychological Effects of Trauma in Civil War Vets

From K. Kris Hirst

Using open source data from a federal project digitizing medical records on veterans of the American Civil War (1860-1865) called the Early Indicators of Later Work Levels, Disease, and Death Project, researchers have identified an increased risk of post-war illness among Civil War veterans, including cardiac, gastrointestinal, and mental diseases throughout their lives. In a project partly funded by the National Institutes of Aging, military service files from a total of 15,027 servicemen from 303 companies of the Union Army stored at the United States National Archives were matched to pension files and surgeon's reports of multiple health examinations. A total of 43 percent of the men had mental health problems throughout their lives, some of which are today recognized as related to post-traumatic stress disorder (PTSD). Most particularly affected were men who enlisted at ages under 17. Roxane Cohen Silver and colleagues at the University of California, Irvine published their results in the February 2006 issue of Archives of General Psychiatry.

Studies of PTSD to date have connected war experiences to the recurrence of mental health problems and physical health problems such as cardiovascular disease and hypertension and gastrointestinal disorders. These studies have not had access to long-term health impacts, since they have been focused on veterans of recent conflicts. Researchers studying the impact of modern conflict participation report that the factors increasing risk of later health issues include age at enlistment, intimate exposure to violence, prisoner of war status and having been wounded.

The Trauma of the American Civil War

The Civil War was a particularly traumatic conflict for American soldiers. Army soldiers commonly enlisted at quite young ages; between 15 and 20 percent of the Union army soldiers enlisted between ages of 9 and 17. Each of the Union companies was made up of 100 men assembled from regional neighborhoods, and thus often included family members and friends. Large company losses--75 percent of companies in this sample lost between five and 30 percent of their personnel--nearly always meant the loss of family or friends. The men readily identified with the enemy, who in some cases represented family members or acquaintances. Finally, close-quarter conflict, including hand-to-hand combat without trenches or other barriers, was a common field tactic during the Civil War.

To quantify trauma experienced by Civil War soldiers, researchers used a variable derived from percent of company lost to represent relative exposure to trauma. Researchers found that in military companies with a larger percentage of soldiers killed, the veterans were 51 percent more likely to have cardiac, gastrointestinal and nervous disease.

The Youngest Soldiers were Hardest Hit

The study found that the youngest soldiers (ages 9-17 at enlistment) were 93% more likely than the oldest (ages 31 or older) to experience both mental and physical disease. The younger soldiers were also more likely to show signs of cardiovascular disease alone and in conjunction with gastrointestinal conditions, and were more likely to die early. Former POWs had an increased risk of combined mental and physical problems as well as early death.

One problem the researchers grappled with was comparing diseases as they were recorded during the latter half of the 19th century to today's recognized diseases. Post-traumatic stress syndrome was not recognized by doctors--although they did recognize that veterans exhibited an extreme level of 'nervous disease' that they labeled 'irritable heart' syndrome.

Children and Adolescents in Combat

Harvard psychologist Roger Pitman, writing in an editorial in the publication, writes that the impact on younger soldiers should be of immediate concern, since "their immature nervous systems and diminished capacity to regulate emotion give even greater reason to shudder at the thought of children and adolescents serving in combat." Although disease identification is not one-to-one, said senior researcher Roxane Cohen Silver, "I've been studying how people cope with traumatic life experiences of all kinds for twenty years and these findings are quite consistent with an increasing body of literature on the physical and mental health consequences of traumatic experiences."

Boston University psychologist Terence M. Keane, Director of the National Center for PTSD, commented that this "remarkably creative study is timely and extremely valuable to our understanding of the long term effects of combat experiences." Joseph Boscarino, Senior Investigator at Geisinger Health System, added "There are a few detractors that say that PTSD [Post-traumatic stress disorder] does not exist or has been exaggerated. Studies such as these are making it difficult to ignore the long-term effects of war-related psychological trauma."
Source

Judith Pizarro, Roxane Cohen Silver, and JoAnn Prause. 2006. Physical and Mental Health Costs of Traumatic War Experiences Among Civil War Veterans. Archives of General Psychiatry 63:193-200.

An abbreviated version of this article first appeared in Science 311:927. February 17, 2006

By K. Kris Hirst, About Guide to Archaeology.

From: psychology.about.com

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Esther Hill Hawks, Civil War Army Doctor and Teacher

Army Physician During the Civil War

From zoominfo.com

Dr. Esther Hill Hawks was an army physician and a teacher during the Civil War. A woman ahead of her time, Dr. Hawks taught both freed slaves and whites in what may have been Florida's first interracial school, before returning to New England to practice medicine.
...
Dr. Esther Hawks joined him there in 1862. She provided medical care for the blacks and worked as a contract physician in General Hospital Number 10, which was established for black soldiers in nearby Beaufort, South Carolina. In July 1863, she helped care for the black soldiers from the 54th Regiment Massachusetts Colored Infantry after its ill-fated attempt to take Fort Wagner, in which their valiant colonel Robert Gould Shaw was killed.

Already defying convention by being a certified woman physician, Dr. Esther Hill Hawks did a brief stint as the regimental surgeon, but was forbidden to continue practicing medicine after a new doctor took charge of the hospital.

Thereafter Dr. Esther Hawks spent her days educating the African American soldiers and their families so that they would be able to live better lives after the war ended. After the war, she continued to work in the area, caring for former slaves and teaching school.

She kept a diary that covers the Civil War and the Reconstruction period. The South she described consisted of carpetbaggers, occupation troops, zealous missionaries, freed slaves and their hungry children. She described the South she saw - conquered but still proud.

After the war, the soldiers and slaves that Drs.Esther and John Hawks had cared for in South Carolina joined them on a trek to Volusia County, on the east coast of Florida.
...
Dr. Esther Hill Hawks arrived in Florida one month after her husband. As a teacher with the Freedmen's Aid Society, she established what might have been the first integrated school in Florida. She taught black adults, and both black and white children.

There was a delay in getting a sawmill up and running, so the people lived in crude huts at the beginning, and the schoolhouse was unfinished for quite some time. So, Esther taught school outside, building a log fire for warmth when needed.
...
Dr. Hawks continued teaching, even after the colony failed. She traveled far to be closer to the students who had left the settlement. That also brought her closer to unsympathetic whites, who despised integrated schools. In January 1869, a new schoolhouse was torched.

Dr. Esther Hill Hawks returned to New England, where she was able to practice medicine again.

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Kate Cumming, Confederate Nurse and Matron

From The New Georgia Encyclopedia

Kate Cumming is best known for her dedicated service to sick and wounded Confederate soldiers. She spent much of the latter half of the Civil War (1861-65) as a nurse in hospitals throughout Georgia.

Born in Edinburgh, Scotland, circa 1830 (sources differ on the exact date), Cumming migrated with her family to North America as a young child, stopping first in Montreal, Canada, before permanently settling in Mobile, Alabama. Inspired by both the Reverend Benjamin M. Miller, who in an address urged the women of Mobile in early 1862 to aid wounded and sick Confederates, and by Florence Nightingale, the heroic British nurse who served in the Crimean War, Cumming, despite having no formal nursing training, decided to offer her services. Much to the distress of her parents, who firmly believed that ladies did not belong at the battlefield, she left Mobile in April 1862, along with forty other local women, including the novelist Augusta Jane Evans (although Evans did not make it to the front), for the Mississippi-Tennessee border. There, until June 1862, she cared for Confederate soldiers injured at the Battle of Shiloh (April 1862).

Unlike most women nurses, who served only temporarily, Cumming continued as an active nurse for the duration of the war. After a two-month respite in Mobile during the summer of 1862, she traveled to Chattanooga, Tennessee, to volunteer at Newsome Hospital, where she remained for the next year. While there, the Confederate government reluctantly decreed in September 1862 that hospitals could legally pay nurses rather than rely on them as volunteers. Thus Cumming's status changed from volunteer to professional; for the war's duration, she was officially enlisted in the Confederate Army Medical Department.

After the fall of Chattanooga in the summer of 1863, Cumming moved on to Georgia, where she served in numerous mobile field hospitals established throughout the state in response to the destruction inflicted by Union general William T. Sherman's troops. As the major military forces moved southward and eastward, so did the location of these facilities. Confederate field hospitals were set up in many Georgia locations, including Catoosa Springs, Cherokee Springs, Dalton, Kingston, Marietta, Ringgold, Rome, and Tunnel Hill, during the Atlanta campaign of 1864. Later they were established in other Georgia locales: Americus, Athens, Augusta, Barnesville, Columbus, Covington, Forsyth, Fort Gaines, Greensboro, Griffin, LaGrange, Macon, Madison, Milner, Newnan, Oxford, Thomaston, and Vineville. Though not employed in all these hospitals, Cumming spent considerable time in several of them, specifically those at Americus, Cherokee Springs, Dalton, Newnan, and Ringgold. When the war ended in April 1865, she was working in southwest Georgia.

Cumming returned to Mobile after the war, and in 1866 she published A Journal of Hospital Life in the Confederate Army of Tennessee from the Battle of Shiloh to the End of the War, a chronicle of her day-to-day nursing experiences on the Civil War battlefields of Tennessee and Georgia. In 1874 she moved with her father to Birmingham, Alabama. She never married. She resided there as a teacher and active member of the United Daughters of the Confederacy until her death on June 5, 1909. She is buried in Mobile.

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The Death of Willie Lincoln

From: Abrahamlincolnonline.org

In an elegant White House guest room, the 11-year-old son of Abraham and Mary Lincoln lay ill in a huge carved rosewood bed, now known as the Lincoln Bed. At five p.m. on February 20, 1862, William Wallace Lincoln died. Elizabeth Keckly, the former slave who designed Mrs. Lincoln's beautiful wardrobe, washed and dressed him. When the president gazed at him, he mourned, "My poor boy, he was too good for this earth. God has called him home. I know that he is much better off in heaven, but then we loved him so. It is hard, hard to have him die!"

She watched him bury his head in his hands, "his tall frame convulsed with emotion." At the foot of the bed she stood "in silent, awe-stricken wonder," marveling that so rugged a man could be so moved. "I shall never forget those solemn moments -- genius and greatness weeping over love's idol lost." President Lincoln then walked down the hall to his secretary's office. He startled the half-dozing secretary with the news: "Well, Nicolay, my boy is gone -- he is actually gone!" John Nicolay recalled seeing his boss burst into tears before entering his own office.

Mary Lincoln was inconsolable in the loss of her favorite son. To add to the anguish, Tad, her youngest son, lay seriously ill in another room. Both children apparently suffered from typhoid fever, a common illness in disease-ridden Washington, D.C. Willie was the third son born to the Lincolns in Illinois, arriving on December 21, 1850, the same year their second son died. Now with Willie's death, the family circle grew smaller yet. Robert, a student at Harvard College, was the eldest son, the only one who would outlive his parents.

In the words of a government official's wife, "The White House is sad and still, for its joy and light have fled with little Willie. He was a very bright child, remarkably precocious for his age, and had endeared himself to every one who knew him." Mary Lincoln's cousin said he was "noble, beautiful ... a counterpart of his father, save that he was handsome." Mary herself called him the "idolized child, of the household."

Willie's body was taken downstairs to the Green Room where it remained until burial. Drs. Brown and Alexander handled the embalming, a procedure they would perform three years later after the president's assassination. Willie lay in a flower-covered metallic coffin designed to resemble rosewood, with his name and date of birth and death inscribed on a silver plate. Friends came to pay their respects on February 24, the morning of the funeral.

Just before the service the Lincoln family gathered around the coffin for a private farewell. Benjamin French, who supervised the arrangements, wrote, "While they were thus engaged there came one of the heaviest storms of rain & wind that has visited this city for years, and the terrible storm without seemed almost in unison with the storm of grief within, for Mrs. Lincoln, I am told, was terribly affected by her loss and almost refused to be comforted." Mary Lincoln grieved in her bedroom upstairs during the funeral and burial.

The funeral began at 2 p.m. in the East Room, where the huge gilt mirrors were draped in mourning, with black fabric covering the frames and white covering the glass. Dr. Phineas D. Gurley, pastor of the nearby New York Avenue Presbyterian Church, conducted the service. The Lincoln family attended Dr. Gurley's church, where Willie recently told his Sunday School teacher he wanted to become a teacher or preacher of the gospel.

President Lincoln, his son Robert, and members of the Cabinet sat in a circle, surrounded by a crowd which included representatives from Congress and foreign countries. The writer Nathaniel Parker Willis recalled the service as "very touching." He saw "[General] McClellan, with a moist eye when he bowed in prayer ... and senators, and ambassadors, and soldiers, all struggling with their tears -- great hearts sorrowing with the president as a stricken man and a brother."

Following Dr. Gurley's sermon, Dr. John C. Smith of the Fourth Presbyterian Church concluded the service in prayer. Most of the mourners accompanied the body to Oak Hill Cemetery in Georgetown, creating a long procession. Two white horses drew the hearse, while two black horses pulled President Lincoln's carriage down Washington's unpaved streets and up the hill to the cemetery.

When the procession arrived at the cemetery, Willie's body was placed in the small chapel for a brief service of Scripture and prayer. He later was transferred to the Carroll family vault on the cemetery's northwest end (Lot 292). This vault, purchased by William and Sallie Carroll in 1857, contained the bodies of their three sons. Orville H. Browning, a political friend of the Lincolns from Illinois, inspected the vault the day before the funeral with William Carroll, clerk of the Supreme Court. Carroll offered this space temporarily to the Lincoln family until they returned to Illinois. After President Lincoln's assassination in April 1865, Willie's coffin was removed and placed on the funeral train. Both father and son are permanently buried at Oak Ridge Cemetery in Springfield, Illinois.

Willie's death left deep marks on the Lincoln family. Elizabeth Keckly said Mary "was an altered woman .... she never crossed the threshold of the Guest's Room in which he died, or the Green Room in which he was embalmed."

The artist Alban Jasper Conant noticed something different about Lincoln following Willie's death, saying, "ever after there was a new quality in his demeanor -- something approaching awe. I sat in the fifth pew behind him every Sunday in Dr. Gurley's church, and I saw him on many occasions, marking the change in him."

John Hay, another White House secretary, wrote that the president "was profoundly moved by his death, though he gave no outward sign of his trouble, but kept about his work the same as ever. His bereaved heart seemed afterwards to pour out its fullness on his youngest child." On the day President Lincoln was assassinated, he told Mary, "We must both be more cheerful in the future. Between the war and the loss of our darling Willie we have been very miserable."

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Health and Medicine During the Civil War

By Elaine Hirsch
From: teachthecivilwar.com

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 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 this inflictions 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 terms 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.

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The Man Who Killed John Wilkes Booth

Boston Corbett and the Year of the Mad Hatter

By Grant/Hankering for History, People & Places/21 Aug 2013

The story of one Boston Corbett is certainly an interesting one–a story full of religious fanaticism, self-castration, and murder. Now that I’ve piqued your interest, let me give you some of the backstory. In 1832, Thomas P. Corbett was born in London, England. Several years later, in 1839, Corbett’s family emigrated to the United States. When Thomas Corbett was old enough to work, he took up the trade of a hatter, in Troy, New York. After the unfortunate death of his wife, Corbett moved to Boston. It was in Boston that Corbett became a Christian and changed his name to Boston.

So far so good, right?

In July of 1858, in an attempt to curb his desire to give into tempestuous prostitutes, Boston Corbett castrated himself. As if this act was not odd enough, he did not seek medical attention until after he had eaten dinner and attended his previously-scheduled prayer meeting.

I guess that the Union Army was hard up for soldiers because they enlisted Boston Corbett into the 12 Regiment New York Militia, in April of 1861. He served the term of his enlistment, then he re-enlisted to be in the 16th New York Cavalry Regiment. On April 24, 1865, (now sergeant) Boston Corbett rode out with twenty-five other brave men to hunt down the abominable John Wilkes Booth. In two days’ time, the men cornered the detestable soul–the man who assassinated President Abraham Lincoln–and surrounded him inside of a barn.

The 16th New York Cavalry Regiment was under the orders of Edwin M. Stanton,  Secretary of War, to capture John Wilkes Booth alive. However, Boston Corbett had other plans…

Boston Corbett aimed his revolver at John Wilkes Booth and fired. The shot hit true, severing Booth’s spinal cord, killing him within hours. Edwin Stanton had Corbett arrested for breaking his orders; however, Stanton dropped that charges claiming that, ”The rebel is dead. The patriot lives.”

Corbett originally stated that he shot Booth because he thought that Booth was going to shoot him. However, Corbett later said that “Providence directed me.” So, Corbett castrated himself to abstain from sex with prostitutes and killed John Wilkes Booth because God instructed him too…

It’s no secret that those that worked as hatters spent a lot of time around mercury–which was found to have a lasting effect on the brain. The majority of historians concur that Corbett’s behavior was due to his years spent as a hatter. Could it be a coincidence that the year Boston Corbett snapped is the same year that Lewis Carroll published Alice’s Adventures in Wonderland. The same Alice in Wonderland who had the character Mad Hatter. Either way, 1865 was clearly the Year of the Mad Hatter.

From: Hankeringforhistory.com

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Willie and Tad Lincoln get the Measles

From: history.com

March 20, 1861
On this day in 1861, President Abraham Lincoln's sons, Willie and Tad, are diagnosed with the measles, adding to the president's many troubles.

Few U.S. presidents worked as hard in office as Abraham Lincoln did during the Civil War. Besides managing his generals and the war effort, Lincoln had to deal with prospective office-seekers, foreign affairs, and the basic functions of government. The president's third and fourth sons, Willie, born in 1850, and Tad, born in 1853, offered Lincoln a welcome respite from the rigors of the executive office. The playful boys caroused in the White House, invaded cabinet meetings, and accompanied their father when he inspected troops in the camps around Washington, D.C. They enjoyed playing with the soldiers that guarded the White House, members of the Pennsylvania Bucktail regiment who entertained Willie and Tad with stories and races. The boys set up a fort on the roof of the executive mansion and armed it with small logs painted to look like cannon. The boys often played with pets given to them by friends, including a pony and two goats that roamed the White House lawn.

The boys recovered from the measles; however, in 1862, Willie contracted typhoid fever. He lay sick for weeks before dying on February 20. His death crushed Lincoln, who cried to his secretary, John Nicolay, "...my boy is gone--he is actually gone." Lincoln and his wife Mary grieved for months and the president never fully recovered from the loss.

Tad Lincoln died from illness at age 18 in 1871. The Lincoln's second son, Eddie, died shortly before his fourth birthday, in 1850. Only the Lincoln's first child, Robert, lived to an advanced age; he passed away at age 82 in 1926.

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Medicine in the Civil War

From the National Museum of Health and Medicine

The spring of 1861 saw the opening shots of the Civil War fired on Fort Sumter, South Carolina. Years of disagreement between the Northern and Southern states over the issues of state's rights, slavery, and the cultural differences dividing industrial and agrarian economies culminated in war. From 1861 until 1865, Union and Confederate armies and navies drew weapons in hundreds of battles from Pennsylvania to New Mexico. Nearly 200,000 men lost their lives from enemy fire during the four years of the war. However, more than 400,000 soldiers were killed by an enemy that took no side-disease.

From our modern perspective, medicine during the Civil War seems primitive. Doctors received limited medical education. Most surgeons lacked familiarity with gunshot wounds. The newly-developed minie ball produced grisly wounds that were difficult to treat. The Northern and Southern medical departments were ill-prepared for removing wounded men from the battlefield and transporting them to hospitals. Systems to provide hospital care for the sick and wounded had not been developed. Blood typing, X-rays, antibiotics, and modern medical tests and procedures were nonexistent.
Open latrines, decomposing food, and unclean water were the rule in the camps. Diarrheal diseases affected nearly every soldier and killed hundreds of thousands of men. Although surgeons used ether and chloroform routinely as anesthetics, surgery was performed with unwashed hands and unclean instruments, resulting in infected wounds. The most effective drugs were the pain-killers opium and morphine, while many of the other available drugs were useless or harmful. Despite these limitations, Civil War doctors achieved some remarkable successes in treating the wounded and comforting the sick.

The staff of the Army Medical Museum, the predecessor of this museum, measured the effectiveness of the Union medical response. Founded in 1862 by Surgeon General William Hammond of the Union Army, the Army Medical Museum was a clearinghouse for medical information collected from Union surgeons. After the war, the staff of the museum collected information on Union and Confederate medical care and patient information. This collecting program culminated in the publication of the "Medical and Surgical History of the War of Rebellion." These volumes provided information on the state of medicine and documented the medical histories of tens of thousands of sick and injured soldiers. Our collection of pathological specimens, medical artifacts, and medical illustrations and photographs comprise an incomparable resource for the study of Civil War medicine.

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Report from the Union Medical Director at the Battle of Shiloh

MEDICAL DIRECTOR'S OFFICE, ARMY OF THE OHIO,
Camp on Field of Shiloh, April 21, 1862.

SIR: I have the honor to submit the following report of the operations of the medical department during and after the battle of the 6th and 7th instant:

On the morning of the 6th I was at Savannah, and being ordered to remain at that place, I occupied myself in procuring all the hospital accommodation possible in that small village and in directing the preparation of bunks and other conveniences for wounded. In the afternoon the wounded were brought down in large numbers, and I then superintended their removal to hospitals, and did all in my power to provide for their comfort. On Sunday evening, the divisions being under orders to come up as rapidly as possible, I ordered the medical officers, as it was impossible to take their medical and hospital supplies -- the teams and ambulances being in the rear and the roads blocked up with trains -- to take their instruments and hospital knapsacks and such dressings and stimulants as could be carried on horseback, and to go on with their regiments. I left Savannah by the first boat on Monday, and arrived at Pittsburg Landing at about 10 a.m. I found the principal depot for wounded established at the small log building now used as a field post-office. They were coming in very rapidly, and very inadequate arrangements had been made for their reception. I found Brigade Surgeon Goldsmith endeavoring to make provision for them, and at his suggestion immediately saw General Grant, and obtained his order for a number of tents to be pitched about the log house.

I then rode to the front and reported to you. The great number of wounded which I saw being transported to the main depot, and the Almost insurmountable difficulties which I foresaw would exist in providing for them, convinced me that my presence was needed there more than at any other point on the field. After spending an hour in riding a little to the rear of our lines, and seeing as far as possible that there were surgeons in position to attend immediately to the most urgent cases, I returned to the hill above the Landing, and used every exertion to provide for the wounded there. I ordered Brigade Surgeons Gross, Goldsmith, Johnson, and Gay to take charge of the different depots which were established in tents on the hills above the Landing, directing such regimental and contract surgcons as I could find to aid them. Many of the wounded were taken on board boats at the Landing and some of our surgeons were ordered on board to attend them. On Tuesday I had such beats as I could obtain possession of fitted up with such bed-sacks as were on hand and with straw and hay for the wounded to lie upon, and filled to their utmost capacity, and at once dispatched to convey the worst cases to the hospitals on the Ohio River, at Evansville, New Albany, Louisville, and Cincinnati. In removing the wounded we were aided by boats fitted up by sanitary commissions and soldiers' relief societies and sent to the battle-field to convey wounded to the hospitals. Some of these, especially those under the direction of the United States Sanitary Commission, were of great service. They were ready to receive all sick and wounded, without regard to States or even to politics, taking the wounded Confederates as willingly as our own. Others, especially those who came under the orders of Governors of States, were of little assistance, and caused much irregularity. Messages were sent to the regiments that a boat was at the Landing ready to take to their homes all wounded and sick from certain States. The men would crowd in numbers to the Landing, a few wounded, but mostly the sick and homesick. After the men had been enticed to the river and were lying in the mud in front of the boats it was determined in one instance by the Governor to take only the wounded, and this boat went off with a few wounded, leaving many very sick men to get back to their camps as they best could. By the end of the week after the battle all our wounded had been sent off, with but few exceptions of men who had been taken to camps of regiments in General Grant's army during the battle. These have since been found and provided for.

The division medical directors were very efficient in the discharge of their duties, and they report most favorably of the energy and zeal displayed by the medical officers under them in the care of the wounded under most trying circumstances -- of want of medical and hospital stores, and even tents. Owing to the fact that a large majority of the wounded brought in on Monday and Tuesday were from General Grant's army, some of whom had been wounded the day before, it was impossible to attend particularly to those from our own divisions. Many Confederate wounded also fell in our hands, and I am happy to say that our officers and men attended with equal assiduity to all. Indeed, our soldiers were more ready to wait on the wounded of the enemy than our own. I regret to say that they showed incredible apathy and repugnance to nursing or attending to the wants of their wounded comrades, but in the case of the Confederates this seemed in some measure overcome by a feeling of curiosity and a wish to be near them and converse with them.

We were poorly supplied with dressings and comforts for the wounded and with ambulances for their transportation, and it Was several days after the battle before all could be brought in. Our principal difficulty, however, in providing for the wounded was in the utter impossibility to obtain proper details of men to nurse them and to cook and attend generally to their wants, and in the impossibility of getting a sufficient number of tents pitched, or in the confusion which prevailed during and after the battle to get hay or straw as bedding for the wounded or to have it transported to the tents. The only details we could obtain were from the disorganized mob which lined the hills near the Landing, and who were utterly inert and inefficient. From the sad experience of this battle and the recollections of the sufferings of thousands of poor wounded soldiers crowded into tents on the wet ground, their wants partially attended to by an unwilling and forced detail of panic-stricken deserters from the battle-field, I am confirmed in the belief of the absolute necessity for a class of hospital attendants, enlisted as such, whose duties are distinct and exclusive as nurses and attendants for the sick, and also of a corps of medical purveyors, to act not only in supplying medicines, but as quartermasters for the medical department.

I append a list of the number of killed and wounded in each regiment, brigade, and division engaged, in all amounting to 236 killed and 1,728 wounded.(*)

Very respectfully, your obedient servant,
R. MURRAY,
Surgeon, U. S. Army, Medical Director.
Col. J. B. FRY,
Asst. Adjt. Gen. and Chief of Staff, Army of Ohio.

From: ehistory.osu.edu

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Juliet Opie Hopkins “Florence Nightingale of the South”

From: JDRHawkins.com

Juliet Opie Hopkins was a pioneer in the advancement of women at a time when most were overlooked for supervisory positions. Her extraordinary abilities awarded her the position of leadership and power that didn’t exist anywhere else.

She was born on May 7, 1818 at her family’s Woodburn Plantation in Jefferson County, Virginia. Her father owned around 2,000 slaves, which established him in elite society. During her childhood, she was home-schooled, and was sent to Miss Ritchie’s private school in Richmond when she reached adolescence. When she was sixteen, however, her mother died, so she left school to return home, where she helped manage Woodburn.

In 1837, Juliet married Commodore Alexander Gordon of the United States Navy. However, Gordon died in 1849, leaving her a young widow. She remarried in 1854, to a widower who was twenty-four years her senior. Arthur Hopkins was a lawyer and prominent businessman who had served as a United States senator and Chief Justice of the Alabama Supreme Court. They adopted a niece, and considered her to be their daughter.

When the War Between the States broke out, Juliet sold her estates in New York, Virginia, and Alabama. She donated the money to the Confederacy for the establishment of hospitals. The Confederate military system dictated that each state was responsible for the care of its own patients.

In June 1861, she moved to Richmond and began organizing money and supplies that were sent from Alabama. In August, she set up a hospital for Alabama’s soldiers, and by November, had established a larger second hospital as well. During the November session, the Alabama legislature assumed responsibility for supporting the hospitals and appointed Juliet as chief matron. In the spring of 1862, she established a third hospital, and received the help of 92 women’s auxiliary groups in Alabama who made clothing and collected supplies.

During the Battle of Seven Pines, on June 1, 1862, she was shot twice in the leg while attempting to rescue wounded men from the battlefield. Her injuries required surgery and left her with a permanent limp.

Although her husband was technically named State Hospital Agent, she was the one in charge. Regardless of her tremendous responsibilities, Juliet found time to personally care for soldiers by writing letters, making furlough requests, providing books, and keeping a thorough list of the deceased. She even collected hair samples from the dead to send to their families, which was common practice at the time.

A nurse in the Third Alabama Hospital, Fannie Beers, wrote about her:

“I have never seen a woman better fitted for such work. Energetic, tireless, systematic, loving profoundly the cause and its defenders, she neglected no detail of business or other thing that should afford aid or comfort to the sick and wounded. She kept up a voluminous correspondence, made in person every purchase for her charges, received and accounted for hundreds of boxes sent from Alabama containing clothing and delicacies for the sick and visited the wards of the hospitals every day. If she found any duty neglected by nurse or surgeon or hospital steward, her personal reprimand was certain and very severe. She could not nurse the sick or wounded personally, for her whole time was necessarily devoted to executive duties, but her smile was the sweetest, I believe, that ever lit up a human face, and standing by the bedside of some poor Alabamian, away from home and wretched as well as sick, she must have seemed to him like an angel visitant.”

In March 1863, the Confederate Medical Department assumed control over all hospitals. Many patients were sent to larger facilities, which prompted the closure of 35 units, including two of Juliet’s hospitals. The third hospital was closed in October, so she moved back to Alabama. Finding supplies scarce, she had the carpets in her Mobile home cut up and used for blankets. She continued her work in Tuskagee and Montgomery hospitals. When the state was invaded in April 1865, she and her husband fled to Georgia. After the war ended, they returned to Mobile, and her humanitarian efforts became more well-known, making her a living legend.

Judge Hopkins died later that year, so Juliet left Alabama to live on property she still owned in New York City. Because she and her husband had lost most of their wealth, she lived the rest of her life in relative poverty. She died on March 9, 1890 while visiting her daughter in Washington D.C. Scores of veterans attended her funeral, including Confederate Generals Joseph Wheeler and Joseph E. Johnston, as well as Union General John Schofield. Members of the Alabama congressional delegation served as pallbearers. She was buried with full military honors at Arlington National Cemetery in the same gravesite as her son-in-law, Union General Romeyn Beck Ayers. In 1987, a marker was finally placed on her grave.

It is estimated that Juliet donated between $200,000 and $500,000 for the Southern cause. She was so revered by her peers that her picture was printed on Alabama Confederate paper currency 25-cent pieces and $50 bills. She is a member of the Alabama Women’s Hall of Fame.

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What Was Tad Lincoln's Speech Problem?

By John M. HutchinsonJ

From: Journal of the Abraham Lincoln Association

Volume 30, Issue 1, Winter 2009

Thomas "Tad" Lincoln (1853–1871), the fourth son of the sixteenth president, had a speech problem. This came to my attention shortly after assuming the presidency of Lincoln College. In an effort to find out more about the man for whom the college is named, I visited the Abraham Lincoln Presidential Library and Museum in Springfield, Illinois. In the rotunda of the museum are life-sized sculptures of the Lincolns and three of their sons, Robert, William, and Thomas (Tad), which present accurate likenesses of the family as they appeared during the White House years. As I examined the sculptures, I was intrigued by the sculptor's creation of a small fissure just to the left of the midline on the upper lip of Tad Lincoln (see Figure 1). As an academically trained speech/language pathologist who has taught courses in cleft palate and served on interdisciplinary cleft-palate teams, I recognized that such a deformity often signals other midface anomalies, including some form of cleft palate.

Figure 1.

A cursory inspection of the literature reveals many references to both communicative and cranio-facial deformities in Tad Lincoln. For example, Benjamin P. Thomas makes several references to Tad's speech, contending that "he had a cleft palate and lisped."[1] Thomas also avers that Tad's speech was marked by a rapid rate and low intelligibility.[2] David Herbert Donald attributes the reduced intelligibility, in part, to dental abnormalities[3] that were severe enough to require special dietary preparations.[4] Other authors have described the speech problem as "baby words,"[5] "baby tongue,"[6] "tongue-tied,"[7] "stammering utterances,"[8] "stuttering,"[9] "mix[ing] words in a lisp,"[10] and a fluency pattern described as "words fairly tumbling over each other."[11] Added to these descriptions are a number of references to other developmental, behavioral, and medical problems. There is agreement among biographers that Tad was slow in learning to read and write, signaling a possible generalized delay in speech and language development.[12] Some have suggested that Tad's communication problems resulted from intellectual delays and limitations.[13] He has been described as impulsive, hyperactive, and slow in reaching certain developmental milestones (e.g. learning to dress himself).[14] Finally, Milton H. Shutes, upon examination of photographs of Tad and Willie, concluded that "the post-nasal cavities of the two younger boys were fairly well occluded with adenoids."[15]

From the perspective of the clinical discipline of speech/language pathology, the aforementioned array of descriptors creates a confusing, uncertain, and potentially inconsistent assessment of Tad Lincoln's communicative problems. This is understandable because most of the descriptions have been offered by historians unfamiliar with terminology in speech/language pathology or by eyewitnesses and family members who lived prior to the development of speech/language pathology as a discipline during the twentieth century. Nevertheless, based upon descriptions in the literature, it is possible to establish with some degree of confidence Tad Lincoln's communication problems.

Categorization of speech and language disorders

Before conducting a more thorough examination of the speech and language problems presented by Tad Lincoln, it is helpful to provide a brief overview of the different types of communication disorder. For purposes of this study the following simple six-fold categorization scheme will be used:

Disorders of language. A disorder of language occurs when a child or adult exhibits some level of incapacity in encoding or decoding the symbolic structure and content of his/her native language at the highest central nervous system level. Such disorders may result from limitations in brain development and/or maturation, inadequate environmental stimulation, disease, hearing loss, or trauma to the brain. Language disorders may involve difficulties in semantic (meaning), syntactic (grammatical structure), and/or phonemic (sound unit) processing. Often speech/language pathologists distinguish between receptivelanguage disorders in which the patient cannot process incoming language symbols and expressive language disorders where the person cannot produce appropriate language, even though it may be understood. In childhood language development, expressive language competence lags behind receptive language ability.

Disorders of programming. In some cases, a person may be able to understand language and encode a message but cannot translate the centrally generated message into a motor program that can be executed by the peripheral speech mechanism (lungs, larynx, tongue, jaws, soft palate, etc.). Disorders of programming are referred to as apraxia, which means inability to use a tool. For example, a patient might know intellectually what a table fork is used for and may have the muscular capacity to manipulate a fork but cannot translate the central understanding into muscular patterning that will allow proper use of the utensil. Similarly, when one has apraxia of speech, he/she cannot translate the centrally coded message into meaningful patterns of speech. Thus, a patient with apraxia may look at the picture of a tornado and call it variously a "tornoodie," a "nortado," or a "tednado." In a case of pure apraxia, the patient will know that such attempts are in error.

Disorders of fluency. A disorder of fluency occurs when the "flow" of speech is disturbed in some way. Historically, three terms have been used to describe disorders of fluency:stuttering, stammering, and cluttering. Stuttering is a generic term referring to either a complete stoppage in the flow of speech or a repetition of a sound, syllable, word, or phrase that has no linguistic purpose. In the United States, the term stammering is archaic. However, in Europe and elsewhere stammering may refer narrowly to speech blockages as opposed to stuttering, which is reserved for repetitions. Cluttering is characterized by a rapid speech rate, articulation (pronunciation) errors, repetitions, and "telescoped speech" wherein the last portion of an utterance may be produced with an accelerated rate and less precision. Cluttering is typically one component of a broader syndrome with other behavior disturbances.

Disorders of the voice. Vibration of the vocal folds (cords) within the larynx produce a buzzing sound that generates the voiced portion of speech. Certain sounds require voicing (all vowels, the nasal consonants /m, n, η/, and other orally articulated consonants such as /z/, /v/, /b/, /l/, /r/, etc.), whereas other sounds are unvoiced (e.g. /s/, /t/, /p/, etc.). When a condition causes a disturbance in the vibration of the vocal folds, a disorder of the voice may result. Terms such as "strained," "hoarse," "tense," and "breathy" are often used to describe a voice disorder.

Disorders of articulation. The stream of voiced and unvoiced air emanating from the lungs and larynx is modulated as it enters the oral cavity (mouth). This modulation gives rise to the distinctive sounds of speech (vowels and consonants) and is accomplished by the articulators (tongue, jaw, lips, palate, and to a lesser extent the throat or pharynx). Any disturbance in the proper placement of the articulators gives rise to a disorder of articulation. Sounds may be substituted one for another (such as /w/ for /r/ in "wed wobin"), added, distorted, or deleted.

Disorders of resonance. In the English language, three sounds are produced with the soft palate in a lowered position. These are the so-called nasal consonants /m, n, η/ and involve resonance of the nasal cavities. All other English sounds are produced with the soft palate in an elevated position, which occludes the opening to the nasal cavities. If there is a deformity or malfunctioning of the soft palate (such as a cleft palate), the nasal cavity may not be properly closed off and a nasal quality pervades the person's speech. Alternatively, if there is some obstruction in the nasal cavity, it cannot properly resonate for the nasal consonants, which gives a cold-in-the-nose quality to the speech. Properly speaking, disorders of resonance are disorders of articulation, but for purposes of this study, they will be classed separately.

Cleft lip and palate

Because there is incontrovertible photographic evidence that Tad Lincoln had some form of notching just to the left of the midline on his upper lip (see Figure 2), a brief overview of cleft lip and palate, as it occurs in human beings, is warranted. Cleft lip can occur with or without a cleft of the palate. Clefts of the palate may be partial, involving a portion or the entirety of the uvula, soft palate, hard palate, and/or alveolus (gum ridge). Some children are born with complete clefts of the uvula, soft palate, hard palate, alveolus, and lip. One form of partial palatal cleft is the so-called submucous, occult, or occult submucous cleft. With a submucous cleft, the peripheral tissue of the palate may be complete but the underlying muscle and/or bone is incomplete. As with clefts of the palate, clefts of the lip can be partial or complete. With rare exception, clefts of the lip occur to left or right of the midline. Cleft lip alone and cleft lip + cleft palate are much more common in males, while cleft of the palate alone is more common in females. Left-sided clefts of the lip are more common than right-sided clefts.[16]

Figure 2.

Figure 2.

Cleft lip and/or palate can result from a variety of etiological factors both genetic and environmental. Of particular importance is the heritability of the disorder. There is mounting evidence that clefts of lip and palate run in families, with a high probability of recurrence in first-degree relatives (siblings, parents, offspring) and a rapidly decreasing frequency with decreasing degrees of relationship.[17] It would appear that cleft lip and cleft lip + cleft palate constitute a qualitatively different disorder than cleft palate only.[18]

Tad Lincoln's speech and language problems

The six-fold categorization provides a framework for analyzing Tad Lincoln's speech and language problems. Special attention will be devoted to the probable cranio-facial anomalies and consequent speech problems signaled by the left-sided lip fissure shown in Figures 1and 2.

Disorder of language

There is indirect evidence in the literature that Tad Lincoln presented a language problem during childhood. References to baby talk, delayed development, and slow learning would certainly suggest the possibility of a language problem during his early years. Indeed, language problems are often co-morbid with multiple articulation disorders[19] and, as will be shown later, in all probability Tad had a complex articulation problem.

Another indicator of Tad's potential language problems derives from his difficulties in learning to read. It is well-documented that early delays in language development put a child at risk for later problems in learning to read.[20] It must be understood that not all children who have difficulty reading have language development problems. Conversely, not all language development problems inevitably lead to later literacy issues. However, the very strong correlation lends credence to the possibility that, because Tad Lincoln had undisputed problems in learning to read, he may also have suffered from delays in language development as well.

It has also been suggested that Tad had an aversion to formal schooling—one that was condoned by his father—and that it led to his delay in reading.[21] However, his illiteracy was extensive for the entire period of the White House years. Elizabeth Keckley, who attended Mary Todd Lincoln in the White House, recounts the familiar story of Tad's inability to read the simple wordape, as late as age twelve. When shown a picture of an ape, Tad insisted it was a monkey and that the single-syllable, three-letter word a-p-e spelled monkey.[22] His illiteracy is confirmed by Mary Todd Lincoln in a letter written from Chicago to Alexander Williamson, dated December 16, 1866. She wrote, "Taddie is well Can now read, quite well—as he did not know his letters when he came, here, you will agree he learns rapidly."[23] It seems improbable that such a massive deficit characterized by simple failure to learn even the letters of the alphabet can be attributed solely to parental indulgence and childhood aversion to school. Tad did have formal schooling, not dissimilar to that of his older brother Willie, and one might assume that with even a limited attention span, he would have learned the alphabet and spelling of simple words. That his brother flourished in the same educational environment suggests that Tad may have had some linguistic deficit that delayed his learning to read. Today, he would be characterized as a "late bloomer," because he eventually did learn to read and became increasingly proficient in the mastery of his studies. His capacity to "catch up" would imply normal intelligence and the development of coping skills that ultimately allowed him to overcome his probable language impairment.

Disorder of programming

Clearly, Tad Lincoln had limited intelligibility that made it difficult for those who did not know him to understand what he was saying.[24] One possible cause of limited intelligibility is childhood apraxia of speech. In addition to limited intelligibility, childhood apraxia of speech is characterized by several principal symptoms including:

Limited babbling in infancy

Receptive language competence substantially exceeding expressive language competence

Slow, effortful, halting speech production; evidence of struggle behavior

More evident in volitional, intentional speech than in automatic speech[25]

Comparison of these symptoms with Tad Lincoln's speech patterns reveals some similarities beyond limited intelligibility. There is a possibility that he had delayed language development, and it is likely this would have differentially affected receptive and expressive language competence, with the latter being more compromised. However, there is no evidence that Tad had limited infant babbling, and he certainly did not have speech characterized by slow, effortful, or halting utterances. In fact, his speech was characterized as a "flood,"[26] "jabbering,"[27] or "tumbling,"[28] hardly the descriptors of labored and effortful expressions. Finally, there is no evidence in the literature that his speech problems became exacerbated during volitional utterances. In short, despite limited intelligibility and delayed language, it is unlikely that Tad suffered from childhood apraxia of speech.

Disorder of fluency

There is a 1930 reference to Tad's speech fluency while he was a student at the Elizabeth Street School in Chicago. A correspondent writing in theChicago Tribune reported that Tad had a nervous demeanor characterized in part by "stuttering." Indeed, the reporter stated that the children in the school called him "Stuttering Tad." However, it was the reporter's contention that Tad did not stutter but had a "slight deficiency of speech" and was teased by students because of this speech problem and his timidity.[29] This is a passing reference and there is no available information regarding the correspondent's sources or observations. There are no other references in the literature indicating that Tad stuttered or exhibited the essential symptoms of stuttering, namely, involuntary blockages in the flow of speech or repetitions of the smaller units of speech (sounds, syllables, words of one syllable). Laypersons, particularly in the mid-nineteenth century, prior to the development of a generally accepted terminology for speech disorders, might easily have used a term such as "stuttering" to refer to any number of speech problems, including the "slight speech impediment" noted by the aforementioned correspondent, among others. It seems unlikely that Tad was a person who stuttered.

A careful examination of Tad's speech pattern and his behavioral profile do lend some support to the possibility of cluttering. Cluttering is characterized by a rapid speech rate, telescoped speech, articulation errors, and dysfluencies. The evidence from the literature certainly confirms the presence of articulation errors and a rapid rate of speech in Tad.[30] There is no firm indication of telescoped speech or dysfluency. However, since persons who clutter are often unintelligible because of the telescoped speech problem, it is tempting to speculate that Tad's unintelligible speech occurred for the same reason. Moreover, those who clutter often present other sequelae such as lack of awareness of the speech problem, language difficulties, social and vocational problems, distractibility, and hyperactivity.[31] It would seem that in the early years Tad was relatively unconcerned about his speech problem and had certain social/vocational problems (e.g. delayed ability to dress himself). Arguably, he was distractible and hyperactive.[32] If, as noted earlier, he had language problems, the evidence begins to mount that he may have had a cluttering disorder. However, cluttering is difficult to diagnose, even by contemporary and competent speech pathologists. Consequently, caution is necessary in applying the label "cluttering" to Tad Lincoln's speech pattern.

Disorders of the voice

There are few descriptors of Tad Lincoln's voice. The president's secretary, John Hay, described his voice as a "shrill pipe."[33] The context in which Hay offered this description is one describing Tad as high-spirited, over active, and undisciplined. The incidence of vocal nodules or vocal polyps on the margins of the vocal folds is much higher in children who are hyperactive.[34] These growths appear when there is abnormal strain on the voice, causing the vocal folds to hyper-adduct or occlude with high degrees of force. Evidence suggests that the hyperactivity is often associated with shouting and screaming which, in turn, causes hyper-adduction of the vocal folds. Vocal nodules and polyps typically produce a combination of breathy voice with a strained, strangled voice quality. It is possible that Tad had vocal nodules or polyps at some point during his childhood years, though there is no direct reference in the literature.

Disorders of articulation

Repeated references to Tad Lincoln's lack of intelligibility give virtual assurance that he had an articulation disorder, perhaps of some severity. At least four firsthand accounts confirm Tad's difficulties in pronouncing the sounds of English: (1) Sometime baby-sitter to the Lincolns' younger boys, Julia Taft Bayne, noted that "a slight impediment in his speech made it difficult for strangers to understand him."[35] (2) Elizabeth Keckley, who attended Mrs. Lincoln, confirmed that Tad "suffered from a slight impediment in speech."[36] (3) Tad is reported to have consistently mispronounced the surname of William H. Crook, a bodyguard for President Lincoln.[37] (4) In correspondence between Robert Lincoln and Judge David Davis, Tad's older brother makes reference to his "bad habits of speech."[38] A possible fifth eyewitness reference to Tad's articulation difficulties appears in the correspondence of Mary Todd Lincoln. Thomas F. Schwartz and Kim M. Bauer, presenting a series of unpublished works by Mary Todd Lincoln, note a letter from the president's wife to Col. Benjamin W. Richardson, in which reference is presumably made to Tad's speech problem. Specifically, Mrs. Lincoln wrote, "Taddie in Germany became quite proficient in the language, but in the mean time, his own mother tongue, was so much neglected, that it has become necessary to place him with an English tutor."[39] Schwartz and Bauer contend that this statement is an attempt by Mary Todd Lincoln to "rationalize" Tad's speech problem.[40]

The available eyewitness accounts also provide insight into the specific articulation difficulties encountered in Tad's speech. Elizabeth Keckley wrote that Tad always called her "Yib," presumably substituting /y/ for /l/ in the nickname "Lib." Crook reported four articulation errors in his account. First, Tad pronounced Crook's name as "Took," substituting /t/ for /k/. Second, he omitted the /r/ in the /kr/ consonant cluster. Third, he called his father "Papa day," a substitution for "Papa dear." The second and third error patterns would suggest difficulty in pronouncing the liquid consonant /r/. Fourth, when referring to Tom Pendel, Tad dropped the non-stressed second syllable of Pendel. He would say "Tom Pen." Ruth Painter Randall recounts a story of Tad's referring to a neighbor, Mrs. Sprigg, in an "appealing lisp" as "Mith Spwigg."[41] If this is an accurate transcription, it confirms Tad's difficulty in producing /r/ and suggests inconsistent substitution of "th" (θ) for /s/. If the substation of /θ/ for /s/ were consistent in all contexts, Tad would have said "Mith Thpwigg." In a fictionalized account of Tad Lincoln's life (Tad Lincoln: A True Story by Wayne Whipple), the author contends that Tad could not produce the /s/ sound and omitted it in the initial position when producing such words as "Tanton" for "Stanton" and "pankin'" for "spanking."[42] Though these latter examples would be consistent with a child exhibiting developmental articulation problems involving /s/, not much credence can be placed in their accuracy because the reference is from a fictional account, despite the title's claim to veracity.

All of these articulation errors are consistent with immature speech patterns that typically disappear by age five. Three sounds (/r/, /l/, and /s/) are particularly difficult for children to produce because of the necessary lingual precision. Moreover, these sounds are among the last to be accurately and consistently produced in all contexts as children progress through normal phonological development.[43] The dropping of "weak" syllables such as the unstressed syllable "del" in "Pendel" is also typical of immature speech patterning but usually disappears by age three.[44] The substitution of /t/ for /k/ is a phenomenon known as "fronting" or "velar fronting." Fronting involves substituting a sound with a more anterior lingual placement for one with a posterior placement. Accordingly, "kiss" becomes "tiss," "go" becomes "do," "sing" becomes "sin." Fronting is typical of immature speech development and can be a compensation found in the speech of children with cleft palate. If the aforementioned reference to the presence of hypertrophied adenoids in Tad Lincoln's nasopharyngeal region is true, it is also possible that he had enlarged tonsils, which can result in more anterior placements of the tongue as a compensation for the reduced space in the tonsilar region at the rear of the oral cavity. These speech problems continued into Tad's teen years. Robert Todd Lincoln disclosed that he had secured the services of a Mr. McCoy, an elocution teacher, who had begun to work successfully with Tad in helping him to "pronounce correctly."[45] Tad was fourteen at the time.

Wayne Whipple's fictionalized account does make an interesting suggestion. Whipple contends that because of Tad's cleft palate, he could not pronounce /s/; therefore he said such things as "I want hum - [some] one to ... "[46] or "abhunt" for "absent." This is an astute observation, if true, because it reveals the substitution of a laryngeal fricative /h/ or perhaps a pharyngeal fricative /?/ for /s/. Such substitutions are very rare in children with developmental articulation problems. However, /h/ and /?/ for /s/ substitutions are extremely common in children with cleft palate. The sound /s/ is a fricative characterized by the impounding of air pressure in the mouth behind the tongue, which permits the creation of a turbulent or sibilant sound. However, if the soft palate is absent, short, or weak, it cannot occlude the nasal cavity, which impairs the ability to impound intra-oral air pressure. The air leaks through the nose, and the speaker can neither initiate nor sustain sufficient pressure to produce the required turbulence. This often forces the speaker with an incompetent soft palate to create a turbulent sound source below the point where nasal leakage would occur; namely, deeper in the pharynx or at the level of the larynx. Alternatively, some speakers with oral clefts, simply omit fricative sounds, which is consistent with Whipple's account of Tad's omission of the /s/ in "Tanton" and "pankin'." The term "lisp" has been used to describe Tad's speech problem. Typically, a lisp refers to some disturbance in the production of /s/ or /∫/ ("sh"). Conceivably, the presence of pharyngeal and/or laryngeal fricatives in Tad's speech could have prompted use of the term lisp to describe his speech. It is interesting that Whipple would have reported these rather insightful observations, and one is tempted to speculate that he had some source unknown to this author upon which he based his writing. Perhaps, on the other hand, he simply had experience with individuals having a cleft palate and, as an astute observer of their speech patterns, simply assumed that Tad would have exhibited the same errors in production.

Disorders of resonance

There is no mention in the literature of a nasal quality to Tad Lincoln's voice, which would indicate the absence of a resonance disorder. However, as will be shown later, it is probable that he had at least a partial cleft of the soft and/or hard palate. If the cleft were very mild, involving only the uvula or a small segment of the soft palate, his capacity to valve the nasal cavity may have been essentially normal, thereby explaining the absence of any commentary about a nasal voice quality. Further, if Shutes is accurate in his observation that Tad had an adenoid facies (thus hypertrophied adenoids), there would have been partial obturation of the nasopharynx by the enlarged adenoid pad. This would have augmented the valving of the nasal cavity and perhaps compensated for a marginally deficient soft palate. Of course, a more severe cleft would have given rise to a resonance disorder and, with the absence of palatal surgery in those days, he would have exhibited a resonance disorder that was simply not recorded in any surviving accounts.

Tad Lincoln's cleft lip (and palate)

Re-examination of Figure 2reveals that the notching or fissure to the left of the midline runs from the lower margin of the upper lip up to the left naris or nostril. It is not a complete cleft of the lip and, using contemporary parlance, would be termed a microform cleft or forme fruste. Figure 3 depicts a clear image of the forme fruste pattern of clefting, and one can see the clear similarity of this example with that in the photograph of Tad Lincoln shown in Figure 2. Without question, the forme fruste is a less severe variant of cleft lip and has sometimes been referred to as a "congenital healed cleft lip," suggesting spontaneous and nearly complete closure of the cleft lip in utero.[47]

Figure 3.

Of particular significance is the suggestion in the literature that this particular phenomenon runs in families.[48] Close inspection of a photograph presumed to be that of Tad's grandfather and namesake, Thomas Lincoln, shows the same forme fruste of the upper lip on the left side (see Figure 4). Though there are too few cases upon which to base firm conclusions, it would appear that forme fruste clefts have a higher degree of heritability than open cleft lip and/or palate. Thus, the grandfather-grandson recurrence in the Lincoln family points to an almost certain inheritance that skipped the sixteenth president.

Figure 4.

It should be noted that the presence of cleft lip often signals deeper anomalies involving the alveolus and palate. There are repeated references in the literature of a cleft palate or partial cleft palate in the case of Tad Lincoln. In addition, there is ample evidence of dental abnormality. For example, in the January 1868 letter from Robert Todd Lincoln to David Davis, reference is made to an early form of orthodontic appliance that had been placed in Tad's mouth to straighten his teeth. Dental anomalies, particularly in the upper jaw, are common in children with cleft palate. In addition, with more severe clefts of the palate, the child has difficulty chewing and swallowing. The previously mentioned reference to preparing Tad's food so that he could more easily consume it might imply not only dental problems but a cleft palate as well. It should be noted that the forme fruste variant of cleft lip is associated with a lower heritability of cleft palate than open variants of cleft lip. This would suggest that Tad's forme fruste lip problem was more likely to have been an isolated anomaly than if it had been an open deformity. Of course, it is impossible to know if he had a cleft of the palate and/or alveolus and, if so, to what extent.

Conclusion

Table 1provides a summary of the various forms of communicative disorder and their respective likelihood in the case of Tad Lincoln. Inspection of Table 1 reveals a developmental articulation disorder to be the only certain pathology. This certainty is derived from the evidence of multiple firsthand accounts of Tad's speech difficulties. It is also highly probable that Tad had a language problem. Developmental articulation problems and delayed literacy are both associated with delayed language. The co-occurrence of articulation and literacy disorders renders delayed language much more probable. If Tad Lincoln had an overt or submucous cleft of the soft and/or hard palate, the possibility of a cleft-related articulation problem, along the lines suggested by Whipple, would be possible. In addition, as noted earlier, cluttering cannot be ruled out, nor can the possibility of a laryngeal voice disorder or a resonance problem. It is unlikely that Tad stuttered or had childhood apraxia of speech.

Table 1. Probabilities of the occurrence of speech and language problems in the case of Tad Lincoln

Disorder Certain Probable Possible Unlikely

Language Disorder (Delayed Development) X

Programming Disorder (Childhood Apraxia) X

Fluency Disorder

Stuttering X

Cluttering X

Voice Disorder X

Developmental Articulation Disorder X

Disorder of Resonance X

Table 2 summarizes the likelihood that Tad suffered from one of the several forms of oral cleft. The only certain form, based upon the photographic evidence and the heritability of the problem, is the forme fruste notching in the lip. Because of the frequency of citations in the literature regarding clefting, dental problems, and chewing/swallowing difficulties, it is likely that Tad also had some form of cleft palate, more probably a partial cleft of the soft and hard palate.

Table 2. Probabilities of the occurrence of cleft lip and palate in the case of Tad Lincoln

Deformity Certain Probable Possible Unlikely

Cleft Lip (Forme Fruste Variant) X

Cleft Alveolus

Partial X

Complete X

Cleft of the Hard Palate

Partial (Including Submucous) X

Complete X

Cleft of the Soft Palate

Partial (Including Submucous) X

Complete X

Given the evidence reviewed in this study, it is probable that Tad Lincoln had a complex speech and language disorder that today would have necessitated early and extensive intervention by a speech/language pathologist to address, at a minimum, a delay in language development and the developmental articulation problem. In addition, today, his cleft would have been repaired within the first few years of life by a plastic surgeon; special educators and child psychologists could have helped with potential learning differences or attention deficit/hyperactivity disorder; an orthodontist could have substantially improved the alignment of his teeth with considerably less pain and interference with speech. In a larger sense, today's dramatically improved medical care would no doubt have given the child of a prominent American citizen such as Tad Lincoln a much longer life span with possibility for greater fulfillment of his potential, including normal speech.

Notes

Benjamin P. Thomas, Abraham Lincoln: A Biography (1952; reprint, New York: Barnes & Noble Books, 1994), 90.return to text

Ibid., 482.return to text

David Herbert Donald, Lincoln(New York: Simon & Schuster, 1995), 428.return to text

R. J. Brown, "Tad Lincoln: The Not-so-Famous Son of a Most Famous President," HistoryBuff.com, http://www.historybuff.com/library/reftad.html.return to text

Ruth Painter Randall, Lincoln's Sons (Boston: Little, Brown, 1955), 6.return to text

Ibid., 156.return to text

W. A. Evans, Mrs. Abraham Lincoln: A Study of Her Personality and Her Influence on Lincoln (New York: Knopf, 1932), 58. See also Lloyd Lewis, "When Tad Lincoln Had 'A Girl' in Chicago," Chicago Daily News, February 5, 1930, midweek section.return to text

Wayne C. Temple, "Sketch of 'Tad' Lincoln," Lincoln Herald 60 (Fall 1958): 80.return to text

Evans, Mrs. Abraham Lincoln, 58.return to text

Stephen B. Oates, With Malice Toward None: A Life of Abraham Lincoln (New York: Harper Perennial, 1994), 96.return to text

Randall, Lincoln's Sons, 6.return to text

For example, see ibid., 43; Jean H. Baker, Mary Todd Lincoln: A Biography (New York: Norton, 1987), 254–55.return to text

William E. Barton, Lincoln at Gettysburg (Brooklyn, N.Y.: Braunworth, 1930), 49; Baker,Mary Todd Lincoln, 255.return to text

Baker, Mary Todd Lincoln, 190; Thomas, Abraham Lincoln, 482.return to text

Milton H. Shutes, Lincoln and the Doctors: A Medical Narrative of the Life of Abraham Lincoln(New York: Pioneer Press, 1933), 79.return to text

F. C. Fraser, "The Genetics of Cleft Lip and Cleft Palate," American Journal of Human Genetics 22 (1970): 336–52.return to text

Ibid., 341.return to text

Emily W. Harville et al., "Cleft Lip and Palate versus Cleft Lip Only: Are They Distinct Defects?"American Journal of Epidemiology 162 (2005): 451.return to text

D. Keating et al., "Childhood Speech Disorders: Reported Prevalence, Comorbidity, and Socioeconomic Profile," Journal of Paediatrics and Child Health 37 (2001): 431–36.return to text

Rhona Larney, "The Relationship between Early Language Delay and Later Difficulties in Literacy,"Early Childhood Development and Care 172 (2002): 183–93. See also Bruce K. Shapiro et al., "Precursors to Reading Delay: Neurodevelopmental Milestones," Pediatrics 85 (1990): 416–20.return to text

Evans, Mrs. Abraham Lincoln, 59.return to text

Elizabeth Keckley, Behind the Scenes or Thirty Years a Slave and Four Years in the White House (New York: Oxford University Press, 1988), 217–18.return to text

Mary Todd Lincoln, Mary Todd Lincoln: Her Life and Letters, ed. Justin G. Turner and Linda Levitt Turner (New York: Fromm International, 1987), 399.return to text

Julia Taft Bayne, Tad Lincoln's Father (Lincoln: University of Nebraska Press, 2001), 3.return to text

Shelley Velleman, "Childhood Apraxia of Speech," http://www-unix.oit.umass.edu/~velleman/cas.html (accessed July 11, 2007).return to text

Thomas, Abraham Lincoln, 482.return to text

Donald, Lincoln, 428.return to text

Randall, Lincoln's Sons, 6.return to text

"Earlier Chicago," Chicago Tribune, July 26, 1930, Wake of the News section, 13.return to text

Randall, Lincoln's Sons, 6.return to text

Kenneth O. St. Louis et al., "Cluttering Updated," The ASHA Leader Online (2003, November 18), 2, http://www.asha.org/about/publications/leader-online/archives/2003/q4/f031118a.htm?print=1.return to text

Oates, With Malice Toward None, 288; Bayne, Tad Lincoln's Father, 78.return to text

Michael Burlingame, ed., At Lincoln's Side: John Hay's Civil War Correspondence and Selected Writings (Carbondale: Southern Illinois University, 2000), 111.return to text

Ginnie Green, "Psycho-Behavioral Characteristics of Children with Vocal Nodules," Journal of Speech and Hearing Disorders 54 (1989): 306–12.return to text

Bayne, Tad Lincoln's Father, 3.return to text

Keckley, Behind the Scenes, 216.return to text

Randall, Lincoln's Sons, 155.return to text

Robert T. Lincoln to David Davis, January 17, 1868, copy in Box 7, Folder A-109, David Davis Papers, Abraham Lincoln Presidential Library, Springfield, Illinois.return to text

Schwartz and Bauer, "Unpublished Mary Todd Lincoln," Journal of the Abraham Lincoln Association 17(Summer 1996), 31, http://www.historycooperative.org/journals/jala/17.2/schwartz.html.return to text

Ibid., 3.return to text

Randall, Lincoln's Sons, 35return to text

Wayne Whipple, Tad Lincoln: A True Story by Wayne Whipple (New York: G. Sully, 1926), 15, 20.return to text

Eric K. Sander, "When Are Speech Sounds Learned?" Journal of Speech and Hearing Disorders 37 (1972): 55–63.return to text

Carol Stoel-Gammon, Evaluation of Phonological Skills in Preschool Children (New York: Thieme Medical Publishers, 1988).return to text

Robert T. Lincoln to David Davis.return to text

Whipple, Tad Lincoln, 15.return to text

E. E. Castilla and M. L. Martinaz-Frias, "Congenital Healed Cleft Lip," American Journal of Medical Genetics 58 (1995): 106–12.return to text

Ibid., 27.return to text

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