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Tuesday, September 3, 2013

Operation and Daily Life in the Vermont Hospitals

From: vermonthistory.org


For most of its term of operation Sloan General Hospital was commanded by Waterbury physician Henry Janes, who already had three years experience with wartime medical practice when he took over as surgeon-in-charge on October 15, 1864. Janes enlisted in 1861 as surgeon of the Vermont Third Regiment, supervised the operation of the military hospital at Frederick, Maryland, following the battle at Antietam, and was in charge of the medical corps treating the wounded at Gettysburg, where he reformed battlefield medicine by convincing the 250 surgeons under his command to reduce the number of amputations.

A major in the army when he took command of Sloan General Hospital, Janes brought to his new post a commitment to rehabilitating wounded soldiers. He followed personally the progress of many of the gunshot patients and, like some other surgeons, used the new technology of photography to record wounds and treatment. Janes commanded the Montpelier hospital until its decommissioning in December 1865, then returned to private practice in Waterbury and kept most of his Civil War papers, which provide detailed information about the day-to-day operations of Sloan General Hospital.

Like every other general hospital, those in Vermont operated under military rules and regulations. Each hospital was run by a surgeon-in-charge, who had full military command over the persons and property connected with the hospital. The Vermont surgeons-in-charge were assisted by executive officers, who did some of the administrative work, including the routine but burdensome tasks of compiling and filing a myriad of bureaucratic forms: daily and weekly reports to the medical director of the Department of the East; monthly reports to the surgeon general and adjutant general of the United States; bimonthly muster and payroll reports to the adjutant general and paymaster; quarterly reports of property purchased with hospital funds and annual inventories of medicine and hospital stores to the surgeon general of the United
States; and inventories of camp and garrison equipment to the quartermaster general of the U.S. Army.

The surgeon-in-charge also had responsibility for keeping records of admissions; alphabetical registers and registers by state of sick and wounded; records of casualties, deaths, discharges, transfers, and relations with local government officials; accounts of hospital fund property; and miscellaneous correspondence. Most important, but perhaps often buried under the bureaucratic requirements of the job, the surgeon-in charge established some medical practices and policies at his hospital.

A corps of ward physicians served under the surgeon-in-charge, in theory one doctor for every seventy-five patients at the hospital. At the beginning of 1865, when Sloan General Hospital had 399 patients, it was staffed by a total of five medical officers, including Dr. Janes. The ward physicians provided medical and surgical treatment of the patients in their ward and had general responsibility for its condition. Each ward physician also served in turn a twenty-four-hour rotation as medical officer of the day. In addition to his regular duties, the medical officer of the day toured all the wards, inspected the hospital kitchens, enforced lights out, supervised guard duty and discipline, submitted a daily report on the condition of the hospital, and had authority to act in emergencies.

The ward physicians were assisted by the wardmaster, who supervised the nursing staff, oversaw the physical condition and supplies of the ward, and supervised the medical cadets, young men (frequently medical students) who served as clerks and wound dressers. The non-medical staff of the hospital was led by a group of three or four hospital stewards, who ran the dispensary and had charge of the hospital’s medical property, served as quartermaster for the installation, and coordinated the subsistence for patients and staff. The hospital stewards handled significant amounts of money and large quantities of physical resources. It is not too surprising, therefore, to find an example of peculation and abuse of power among these officers. Early in 1865 Dr. Janes received several letters charging Hospital Steward Lt. G. A. Lee with abuse of power, including allowing his family to send their clothes to be washed at the hospital while forbidding other stewards from doing the same, diverting to his family articles of clothing given to
the hospital for patients (even altering some shirts to fit one of Lee’s young children), diverting food from the hospital storerooms for his and his family’s personal use, and selling for his own profit 270 barrels of swill and grease from the hospital kitchens. An investigation revealed more offenses and on February 13, 1865, charges were brought against Lt. Lee for misappropriation of government property, getting drunk on stimulants taken from the hospital dispensary, appropriating clothing for his family, destroying accounts of hospital funds, and neglect of duty.

Other nonmedical personnel at the hospitals included a chaplain; male and female nurses—in January 1865 there were twenty-four male nurses at Sloan General Hospital, the records show no female nurses—cooks, bakers, and kitchen assistants; laundry workers; a blacksmith, carpenter, painter, and shop and stable hands; attendants in the knapsack house (which held the patients’ personal property), dispensary, quartermaster’s and hospital store rooms; workers in the dead house; and clerks for various administrative duties. A large hospital could have a staff of up to 200 employees, although the Janes papers do not suggest that Sloan General Hospital had so large a staff. Civilians, whom the army considered unreliable, subject to military draft, and likely to make a sudden departure, held few if any of these positions.

Each hospital received medicines, equipment, and standard rations through army contracts, but also maintained a hospital fund for special purchases, most often additional food. Some hospitals supplemented their rations with produce from their own gardens. The hospitals were also allowed to set up a fund derived from the sale of nonconsumable and waste items such as paper and barrels of grease and swill like those Lieutenant Lee sold on the side. The surgeon-in-charge exercised discretionary use of this fund.

In his discussion with Lincoln and Stanton about the hospitals, Governor Holbrook accurately assessed their virtues and risks. He argued that soldiers sick with malaria, swamp fever, and a variety of illnesses bred by close and unsanitary conditions in the camps and field hospitals would recover better and sooner if removed to a healthier climate. Hospital records at the National Archives show that of the 8,574 patients admitted to the Vermont hospitals (including Burlington’s post hospital) from May 1862 to December 1865, only 175 died while under treatment. About 66 percent returned to duty. This compared quite favorably with the 25 percent rate of return to duty from the Washington, D.C., and Philadelphia hospitals.

The majority of patients sent north for treatment were diagnosed upon admission with dysentery (“chronic diarrhea” in the record books), high fever, or one of several diseases associated with overcrowding and poor sanitation. Aside from altitude, fresh water, and less crowding, little could be done to cure the effects of dysentery, and hospital records for Brattleboro and Burlington show far more deaths from this than from any other cause.

Following the Wilderness campaign in May 1864, the hospitals received many patients suffering from “general debility”—battle fatigue and nervous breakdowns. Sloan General Hospital opened just in time to receive casualties from Cold Harbor (May 23–June 12, 1864), and here for the first time a far greater number of patients arrived with gunshot wounds than those suffering from illness or disease. Following the Battle of Cedar Creek on October 19, 1864, the admissions records in Brattleboro also show a higher proportion of gunshot wounds. In almost all these cases, however, the wounds were not critical and usually not fatal.

Clearly, battlefield hospital surgeons had adopted a system of “triage” and sent north those with illness, disease, and gunshot wounds to their hands and feet—in other words, those whose prospects for recovery were highest. Surgeons’ reports for the hospitals also show a higher proportion of “excisions” than amputations and consequently a high survival rate among patients admitted for gunshot wounds. Physicians and the all-important state agents, who roamed the wards of field hospitals and the general hospitals closest to the front looking for patients from their state, resolved Lincoln’s and Stanton’s concerns about the feasibility of moving wounded soldiers by moving mostly those who could bear the trip.

Roger Hovey of Worcester, a corporal in Company A of the Vermont Eighth Regiment, is a case in point. Wounded in the left shoulder by a minié ball early in the battle of Winchester, Virginia, on September 19, 1864, he was transported by baggage wagon to Harpers Ferry—a fifteen-hour trip over poor roads—then transferred to Baltimore, and sent on to Saterlee Hospital in West Philadelphia, where he arrived on September 25. In a letter to his sister, Martha, Hovey initially described his wound as “slight as no bones were broken and my arm is not stiff”; but it healed slowly.

In mid-October the army judged him fit to make the four-day trip to the General Hospital in Brattleboro, where he stayed—despite his repeated requests for a transfer to Sloan General Hospital—from October 21 until January 7, 1865.

Lincoln and Stanton also worried about desertion. Hospital records show that there was some cause for concern, but that it was not a serious problem. Of the 8,574 patients admitted, 481 were recorded as having deserted—slightly over 5 percent. Emendations to the hospital records show that many of the charges of desertion were later dropped.

These figures can be interpreted in several ways. A substantial number of the patients arrived in Vermont on their way to hospitals in their home states of New Hampshire, Maine, Massachusetts, and upstate New York. Facing an uncertain future, they may have taken the opportunity to visit their families before being officially transferred, discharged from the hospital, or sent back into combat. Some, healthy enough to be mobile but restless, lonely, close to home, and denied furloughs by nervous army doctors who feared the very behavior they provoked, left the hospitals without leave or passes, then returned. Some, it appears, deserted and reenlisted to obtain a second bounty payment from the government or from a town eager to fill its quota. And some doubtless did desert. These men had suffered through some of the fiercest fighting of the war. The prospect of recovering only to be thrust back into battle constituted a severe test of patriotism and nerve.

Moreover, life in the hospital was neither luxurious nor always restful and conducive to recovery. Hovey wrote of loneliness and boredom, constantly beseeching his sister for letters. In Brattleboro, he complained of Dr. Phelps’s refusal to grant furloughs, writing to Martha, “I believe it is more than meat and drink to that man to torment, aggravate, and abuse the soldiers under his charge.”

In December 1864, Hovey wrote that several men had complained by letter to Governor Smith, who sent Lieutenant Governor Paul Dillingham to inspect the hospital. “Since then we have lived much better,” he noted, but added that Dr. Phelps took his revenge by denying requests for transfers to Sloan General Hospital in Montpelier.

Frustrated in his efforts to obtain a transfer to Sloan, Hovey eventually wrote to President Lincoln for a transfer for himself and a comrade. Surprisingly, Lincoln replied with an order to Phelps either to discharge the two soldiers or transfer them. A furious Phelps confronted Hovey, threatened to send him back into active duty, but finally agreed to transfer him to Sloan. Phelps failed to take action before the army transferred him from Brattleboro, but Hovey eventually obtained his transfer to Sloan, where he could be close to his family and sweetheart.

Late in his stay at Sloan, Hovey reported that Surgeon-in-Charge Janes arranged to have classes in bookkeeping, grammar, arithmetic, writing, and “declamation” offered to the patients.

Whether this program was unique to Sloan Hospital is uncertain. Possibly Janes initiated it to relieve his patients’ boredom and thereby forestall potential discipline problems. Possibly, too, he understood and acknowledged that these men from farms and rural areas, disabled by their wounds, would need new skills in order to find new employment when they left the hospital or when the war ended.

Another patient at Sloan General Hospital, Norman William Johnson of East Montpelier (Company F, Second Vermont Regiment), kept a diary of his recovery from wounds to the right side and wrist received at Spotsylvania on May 12, 1864. Struck down in the morning, he arrived at the field hospital by 4:00pm. The next day he was moved to Lincoln Hospital in Washington, D.C. On May 29 he wrote, “the Vermont State Agent came through to transfer us to Burlington.” Johnson left Washington by train on June 2, arrived in Philadelphia at daybreak, June 3, in time for breakfast, and reached New York City at 9:00pm. At midnight the train pulled out, headed for New Haven, Connecticut, where it arrived at 7:00am. on June 4.

Three hours later Johnson boarded another train headed north, arrived at Brattleboro at 10:00am., June 5, and was admitted to the general hospital. He recorded on June 8: “Had a comfortable night. Very cold. Seventy new cases came in last night.” On June 12 he recorded having his wounds burned with caustic to prevent gangrene. “There is a caravan and exhibits near here. I did not go up.” A week later Johnson’s wife visited him and he obtained an overnight pass. His wife stayed in Brattleboro through June 20 and he received day and evening passes into town to be with her.

On July 2 Johnson got a furlough to return to East Montpelier for forty eight days. Back in the Brattleboro hospital on August 18 he wrote that breakfast consisted of beans, bread, applesauce, and hash. On August 22, Johnson noted the arrival of 114 new patients. Later that week, the process began for transferring him to Sloan General Hospital, where he arrived on September 10. Almost immediately he received a four-day pass to be with his family again in East Montpelier. On September 26 he participated in a lottery for clothes and equipment, probably donated by the Christian or Sanitary Commission. He “drawed two pairs of drawers and one haversack.”

Johnson’s entry for September 30 shows us that discipline and security at the hospital were ongoing issues. “Five men picked up downtown, three of them put to bed and clothes taken away. No passes given today.” Security remained a persistent problem at all the hospitals. Janes complained upon his arrival at Sloan General Hospital that “The grounds are open on all sides, and consequently, I can neither keep soldiers in nor civilians out of the Hospital. I find vendors of pies and peddlers of various sorts circulating about to the detriment of the sick and the injury of the others.”

He quickly erected a fence around the hospital grounds, and was allocated a contingent of Veterans Reserve Corps troops to serve as guards. Late in his stay in the military hospitals, now back in Brattleboro, Johnson himself was assigned to guard duty, one way the army used recovering patients, thereby releasing more able-bodied men for active duty on the front, where they were desperately needed.

The experiences of Hovey and Johnson show that hospital administrators used furloughs to alleviate overcrowding and as rewards, and withheld them as punishments. They may also have used them in hopeless cases, so that men could die at home with their families. At least twenty men died on furlough, according to hospital records. One of them was Private John Piper of Company K, Tenth Vermont Regiment.

Admitted to the Baxter General Hospital at Burlington on February 13, 1864, at the age of forty-two, he received a furlough on March 14 and died at home on April 16. Under “remarks” in the hospital register, the clerk wrote, “He left this vain world without a fear[,] without a struggle or a tear to mingle with the dead, His relatives so well pleased that they did not notify the hospital of his death until May 27, 1864.”

For others who died on furlough the clerks noted more laconically the receipt of death certificates, and for those who died in the hospital, they noted the cause, date of death, and when the family of the deceased claimed his body or possessions.

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