Interesting Facts About Northern Nurses

From: emergingcivilwar.com

One great misconception many people have regarding nurses in both the Union and Confederacy is that they assisted the surgeons in medical procedures. This was for the most part not the case, except in rare situations in the field. During the Civil War women of both sides confined their duties to fit within the domestic sphere including providing religious counsel, aiding the mortally wounded soldier to face a “good death,” and writing about that death to his family.

Here are some interesting facts about Northern Civil war Nurses/Matrons:

Women hospital workers were classified into job categories, but usually soldiers referred to any hospital worker as a nurse or matron. Formal union hospital worker classifications using the term “matron” referred to the woman who had the responsibility of supervising the ward nurses in a general hospital. Union soldiers referred to regimental women (camp followers) who were hired to nurse, cook and do laundry in the field as “matron.” The term “matron also referred to someone who was a chamber maid.

•  Over half of the hospital workers were not formally appointed or paid, but volunteer workers.
• Contrabands (African-American slaves who fled into Union lines) were put to work in Union camp hospitals doing various menial jobs such as cooking and laundry.
• Women of all classes worked as hospital workers (very rich, working women, middle-class, Northern free African-Americans, African-American contrabands).
• Working as a nurse or hospital worker was not considered a reputable job for a woman.
• The Union hospital system and paid women nurses di not exist until late 1861 after the First Battle of Manassas.
• Nursing was not a profession prior to the late 1800’s

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Medical Treatment During the Civil War

By Sean Rooney

The Civil War is often seen as a turning point in the history of warfare. It was the first big industrial war and foreshadowed the type of warfare that would characterize World War I. At the same time, it still had some of the characteristics of older wars. One of these characteristics was medical treatment. Although Civil War soldiers suffered from modern weapons like the repeater riffle, they did not have access to modern medical care. Thus, many soldiers died in spite of, or sometimes because of medical treatment.

Without an understanding of the germ theory of medicine, army doctors did not know what caused diseases and infections. They could only attempt to treat the symptoms as best they could. By that time symptoms showed, however, it was often too late to do anything. For example, many soldiers died from infection because doctors did not treat infection until it had progressed to the point that it was visible. By that time, it was far too late to do anything about it. Further, because they did not know about germs, they thought it was good for pus to start coming out of a wound. Civil War doctors thought it was a sign that the body was replacing the wound with clean tissue. Because treated soldiers usually left for a regular hospital after being treated at the field hospital, field doctors had few opportunities to connect infection with death.

Treatment options were limited. Generally speaking, doctors only treated wounds to the extremities. Soldiers wounded in the torso, the head, or the neck were given up as mortally wounded. They might be given some strong alcohol or morphine to ease their pain, but they were usually left to die of excessive bleeding or a disease doctors called "blood poisoning." Treatment for wounds to the arms and legs began with removing any shrapnel or bullets lodged in the body. This was usually done with unwashed hands. After removing the cause of the wound, doctors usually packed it with lint or cotton and applied a cold, wet bandage. If a soldier was lucky he might receive some liquor or drugs for his pain.

Often, doctors determined that amputation was needed. In the North, soldiers were usually given chloroform as an anesthetic. In the South, however, soldiers rarely had the luxury of an anesthetic for surgery. Whether or not they had anesthetic, doctors removed many, many wounded limbs. Often, the pile of amputated limbs could reach several feet high. Obviously, the blood and gore from all of these amputations were a tremendous health hazard and gave the field hospital a horrible odor.

Everything was done without any thought to sterility or even cleanliness, so many of the wounded died of infection. Not all of them did, however, and doctors in the Civil War saved more men than had doctors in previous wars. Still the conditions in the hospitals were far from good and resulted in the unnecessary deaths of thousands.

From: voices.yahoo.com

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The Turpentine Remedy

by Biff Hollingsworth

You never know what you’re going to find in our collections. Today, while looking for something totally unrelated, I happened upon a folder with an intriguing title: “Prescription and Diet Book, circa 1800s.” I thought I might have stumbled on some sort of early new age work. So, I started thumbing through.

What I found was that it was a record book, apparently from a Civil War hospital near Greensboro, North Carolina, that listed daily treatments that were given to wounded soldiers and others convalescing during the war.

In this record book are listings for some run of the mill treatments and remedies that were ordered on patients of the hospital such as, “light diet,” “light dressing applied to wound,” or “beef soup.” But then I started seeing some more, shall we say, experimental treatments listed. The regimen given to one particular patient named G. P. Milton was especially striking (see image shown here).

Sunday’s entry: “Rx…Whiskey and Turpentine every 3 hours”

Monday’s entry: “Died Jan. 8, 1865″

I guess turpentine isn’t always good for what ails you. Anyone know if this was once a common treatment? And if so, for which ailment was it usually prescribed? Was it ever successful?

[The item described comes from collection #612-z from the Southern Historical Collection.]

IMAGE: The turpentine treatment, as given to patient, G.P. Milton, who died the following day (January 8, 1865). From collection #612-z, Southern Historical Collection.

This entry was posted in Collections, Featured Z-Collections and tagged Civil War, diet, hospital, prescription, remedies, treatments, turpentine, whiskey.

From: blogs.lib.unc.ed

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The War Doctors' Education

by Brooke C. Stoddard and Daniel P. Murphy, Ph.D.

One of the biggest medical problems during the Civil War was the inadequate training most doctors received. Just before the war, the majority of physicians served as apprentices rather than attending medical school, which meant that many were woefully unprepared for what they encountered on the battlefield.

In Europe, four-year medical schools were fairly common, and students received a great deal of laboratory training. As a result, European physicians had a far better understanding of the causes and treatments of disease and infection. Students in American medical schools trained for less than two years and received almost no clinical experience and very little laboratory instruction. Amazingly, Harvard University didn't own a single stethoscope or microscope until after the war.

At the onset of the war, the Federal army had fewer than 100 medical officers, and the Confederacy had only twenty-four. By 1865, however, more than 13,000 Union doctors had served in the field and in hospitals. In the Confederacy, approximately 4,000 medical officers and a great many volunteers tended to the wounded.

Despite their lack of training and the horrible conditions under which they often worked, Civil War doctors did an astounding job of caring for the sick and wounded. Millions of cases of injury and disease were treated in just forty-eight months, and for the most part, doctors were compassionate and caring individuals who tried to put the concerns of their patients first.

NOTE: As horrible as Civil War surgery was, it was often amazingly successful in saving a wounded soldier's life. According to U.S. Army records, of nearly 29,000 amputations performed during the war, only 7,000 or so patients died as a result. The most successful were those surgeries performed within forty-eight hours of injury; wounds tended later than that had a much poorer prognosis.

From: netplaces.com

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Commission of U.S. Navy's First Hospital Ship

December 26, 1862

The USS Red Rover, the first hospital ship of the U. S. Navy, was commissioned on December 26th, 1862, after a year of service in the Army during the Civil War. An article in the November 1968 issue of Proceedings, written by W. T. Adams, commemorates the Red Rover’s brief but successful career, which ended in 1865. Not only was the Red Rover the first ship of her kind, but she also served a variety of capacities for the Union forces during the War, far beyond the demands of an ordinary hospital ship.

To those familiar with modern standards of naval medical care, it may be difficult to visualize the days when treatment of the shipboard sick and wounded was limited to the surgeon working in a makeshift sickbay—with no hope of better facilities until the ship reached a port which might have a hospital, days or even weeks into the future. It was a situation that existed in the U. S. Navy, however, until the chaos of the Civil War produced the USS Red Rover, the Navy’s first hospital ship.

“No one but those who have witnessed it,” wrote Flag Officer Charles H. Davis of the Western Gunboat Flotilla, “can comprehend the sufferings to which our sick have been exposed by the absence of proper accommodations on board the gunboats and by the necessity for frequent and sometimes hasty change of place . . . When the ship was cleared for action . . . it was necessary to take down their cots and hammocks more than quickly into out of way and uncomfortable places. This must have been attended with pain and distress, if not positive injury. The arrival of the Red Rover will put a stop to all this . . .”

Although the Red Rover was the first hospital ship provided for support of the naval forces, she was by no means the first ship used as a floating hospital during the Civil War. The Army and the Sanitary Commission had begun to use transports and chartered steamers as makeshift hospitals early in the war; however, none of these could even remotely compare with the Red Rover, which has been described as a veritable floating palace.

A side-wheel steamer of 786 tons, the Red Rover was built at Cape Girardeau, Missouri in 1859. Purchased by the Confederacy in November of 1861, she was converted into a barracks ship to provide quarters for the crew of the floating battery New Orleans. Her Confederate service was short-lived, however, for she was captured by the Union gunboat Mound City some five months later when Island Number 10 on the Mississippi River fell into Union hands.

The Red Rover’s conversion into a hospital ship began shortly after her capture, with the work being supervised by Army Quartermaster Captain George Wise, since naval forces on the Western Rivers operated at that time under control of the War Department. Within two months the basic work had been completed. “I wish that you could see our hospital boat, the Red Rover, with all her comforts for the sick and disabled seamen,” Captain Wise wrote to Flag Officer Andrew H. Foote. “She has decided to be the most complete thing of the kind that has ever floated,” he continued, “and is in every way a . . . success.”

With the advice and assistance of the Western Sanitary Commission, which had contributed $3,200 toward outfitting the hospital ship, Captain Wise had provided well for the sick and wounded of the naval forces. The Red Rover had “bathrooms, laundry, elevator for the sick from the lower to the upper deck, amputating rooms, nine different water closets, gauze blinds to the windows to keep the cinders and smoke from annoying the sick, two separate kitchens for the sick and well, and two water closets on every deck.”

Although the “regular corps of nurses” on board the Red Rover consisted of males, Sister Angela of the Sisters of the Holy Cross offered the assistance of that order in providing nurses when needed. The offer was gratefully accepted, and various Sisters served on board in a temporary capacity from time to time in 1862.

The Red Rover’s capabilities for care of the sick were further enhanced by an icebox that held 300 tons of ice in storage, while her holds carried enough general stores for her crew for three months, along with medical supplies sufficient for two hundred men for the same period. In short, as Commander Pennock reported when she left the Naval Depot at Cairo, Illinois, on her first cruise, “The boat is supplied with everything . . . for the restoration to health of sick and disabled seamen.”

The facilities of the hospital ship were soon it great demand, and it was necessary to issue a general order specifying the limitations on patients that might be transferred to her. “All sick persons in the fleet are not to be sent on board the hospital boat indiscriminately,” it read. “It will be understood, on the contrary, that only those patients are to be sent to the hospital boat who . . . [are] expected to be sick for some time and hose cases may require more quiet and better attention and accommodation than can be provided on board the vessels to which they belong. Slight disorders and accidents will be treated by the surgeon under whose care they happen to fall.”

During this period, the Red Rover, along with the other ships of the Western Gunboat Flotilla, technically “belonged” to the Army, although they were commanded by naval officers and manned primarily by naval personnel. It was a strange situation. “At first, the naval forces on the Western Rivers were put under the direction of the War Department,” Admiral Porter later write, “as it was supposed the armed vessels would be a mere appendage of the land forces; and there does not seem to have been a man in the cabinet at that time who knew the difference between a gunboat and a transport.”

Others apparently shared Porter’s view, and control of the naval forces on Western waters was the subject of considerable difference of opinion. The matter was finally resolved, however, by an Act of Congress directing transfer of the “Western Gunboat Fleet” to the Navy Department. The U. S. Navy officially took possession of the ships 1 October 1862; although the Red Rover was not formally commissioned until nearly three months later on 26 December.

It was in the same month of December that the first female nurses were officially assigned to a hospital ship of the U. S. Navy, when Sister M. Veronica, Sister M. Adela, and Sister M. Callista were transferred to the Red Rover from the Army hospital at Mound City, Illinois. The first two of these remained with the hospital ship for the duration of the war, being assisted from time to time by additional Sisters of the Holy Cross, as well as other female nurses.

When first commissioned, the Red Rover mustered a crew of 12 officers and 35 men, plus various medical department personnel numbering about 30, although the latter varied from a high of 40 to as few as eight at times during her career. During her seven months of Union Service in 1862, this force could boast a total admission list to Red Rover’s sick wards of some 374 patients, 332 of whom had been discharged, 37 had died and five had deserted.

It was an auspicious beginning for the Navy’s first hospital ship, particularly since the Red Rover’s service was by no means restricted to that of providing medical care.  In that day when the status of hospital ships was not so clearly defined as to make them noncombatants, the Red Rover was armed with a 32-pounder and considered to be available for any naval duties that occasion might demand.

She began 1863, for example, as guardship at the mouth of the White River while the gunboats of the Mississippi squadron stood up the river.  Later that same month, the Red Rover was fired on by the Confederates, two large shots entering the hospital. With her large capacity for general stores, medical supplies, and ice, she also served as a storeship for the fleet, particularly in the matter of furnishing fresh provisions.

Her primary duty, however, remained that of a floating hospital for the naval forces, where sickness often reached epidemic proportions. “Of the one hundred and thirty men of the mortar fleet, one hundred are sick and off duty,” Flag Officer Davis wrote. “The crews of the gunboats are, many of them, reduced to one half their number . . . the Department would be surprised to see how the most healthy men wilt and break down under the ceaseless and exhausting heat of the pernicious climate. Men who are apparently in health at the close of the day’s work, sink away and die suddenly at night, under the combined effects of heat and malarial poison. . . .”

Operating from Cairo to New Orleans during 1863 and most of 1864, the Red Rover supported the Mississippi squadron along the entire Mississippi River and played a major role in evacuating the wounded from such notable operations as the Fort Hindman expedition, the Yazoo River operations, the Siege of Vicksburg, the Fort Pillow attack, and the Red River expedition. Then, in December 1864, as the war on the Western waters waned, the Red Rover was assigned to her final station at Mound City, Illinois. There she remained, continuing to provide care for the sick and wounded until her last 11 patients were transferred off on 17 November 1865.

When the Red Rover was mustered out of naval service and sold at public auction later in November, her log showed that the Navy’s first hospital ship had provided treatment for 2,947 patients during her career. As so correctly predicted by Flag Officer Davis when the Red Rover first entered Union Service, she had succeeded in putting a stop to much of the pain and distress in the naval forces of the Western Rivers.

From: navalhistory.org

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Nurses and Clara Barton

by Brooke C. Stoddard and Daniel P. Murphy, Ph.D.

Clara Barton is well known as the founder of the American Red Cross, but it was her remarkable humanitarian efforts during the Civil War that established her reputation as the “Angel of the Battlefield.” She was also an ardent feminist, the first female diplomat, and an important advocate of health and education reform and civil rights.

Barton worked as a clerk in the U.S. Patent Office in Washington, D.C., where she saw the first casualties of the Civil War. She observed the inadequate medical care and noted that the wounded frequently went without sufficient food or clothing. Working independently of other relief agencies, Barton started lobbying to change the horrific conditions of battlefield medicine.

In July 1862, Barton received permission from the U.S. surgeon general to take medical supplies directly to the front lines and field hospitals. She risked her life to help the soldiers on the front at important battles such as Cedar Creek, Second Manassas, Antietam, and Fredericksburg. She also provided medical aid during the Carolinas campaign and in Virginia during Grant's 1864 offensives, where she was granted an official position with the Army of the James under the command of General Benjamin Butler.

As the war began to wind down, Barton was given a nearly overwhelming task by President Lincoln. He asked her to oversee the search for missing and captured Union soldiers, compile lists of the sick and wounded, and identify the Union dead buried in mass graves at Andersonville prison and elsewhere. The endeavor took Barton four long years to complete, but her efforts went a long way toward ensuring that Union soldiers who died on the battlefield and in prison were given decent burials and, more importantly, were remembered for their sacrifice.

Clara Barton was not the only woman who made tremendous sacrifices for the men who served in uniform. Women were by and large denied the opportunity of attending medical school, but thousands volunteered for medical service during the war. Union records show that approximately 4,000 women served as nurses in Union hospitals. Three thousand of these were recruited by Dorothea Dix, who volunteered for the Union in 1861 at the age of fifty-nine. She had worked before the war improving conditions for prisoners and the mentally ill. She was placed in charge of all female nurses for the Union and served in that capacity throughout the war at no salary. The number of Southern women who acted as nurses in Confederate hospitals is unknown but believed to be as high as that for the Union.

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How the Civil War Transformed U.S. Medicine

Posted by Circulating Now on September 3, 2013
From: circulatingnow.nim.nih.gov

Shauna Devine spoke today at the National Library of Medicine on “The Civil War, the Army Medical Museum, and the Surgeon General’s Library: Medical Practice and the Science of American Medicine.” Dr. Devine also contributed to the NLM’s book Hidden Treasure. Circulating Now interviewed her about her work.

Circulating Now: Tell us a little about yourself. Where are you from? What do you do? What is your typical workday like?

Shauna Devine: I am currently a visiting research fellow and adjunct professor at the Schulich School of Medicine and Department of History at Western University. I am entering the writing stage of my second book project on the Civil War, which examines the state of Confederate medicine, its relationship to civilian practice and the larger differences between northern and southern medicine. I also teach the American Presidency in the Department of History. My days are usually spent preparing for lectures and writing.

CN:  Can you tell us about the work you presented in your lecture, “The Civil War, the Army Medical Museum, and the Surgeon General’s Library: Medical Practice and the Science of American Medicine.” ?

SD: Today I presented material from my forthcoming book with the University of North Carolina Press, Learning from the Wounded: The Civil War and the Rise of American Medical Science. I discussed the role of the Civil War in the transformation of American medical science.  In the years before the war, training for physicians in the United States was mostly unregulated, and medical schools’ access to cadavers for teaching purposes was highly restricted.  I suggested, that in spite of these limitations, Union army physicians rose to the challenges of the war, using methods of study and experimentation, including dissection and microscopy, for new research into infectious disease processes, which I argue, would have a lasting influence on the scientific practice of medicine.

CN: How did you originally become interested in the History of Medicine? What inspires you in your work? Have you ever made a discovery in your work that made you say “wow!” ?

SD: I have long been interested in all aspects of the History of Medicine and the American Civil War. I decided to do my Master’s thesis on the health crisis in Andersonville prison. The paper began mostly as an epidemiological analysis of the prison, but what struck me in my research, was that southern physician Joseph Jones traveled to Andersonville at the request of Surgeon General Moore, to study both the disease conditions in the prison and the effect of so-called southern diseases on northern bodies. He set up a rudimentary laboratory, he had a microscope and dissection kit, along with two assistants, and he proceeded to study tissues, organs, and bodily fluids in the attempt to understand specific disease conditions. I was struck by this for two reasons: first, I had the impression that the Civil War was a medical disaster and that methods were generally backwards. And yet Jones investigated disease in a way that elite, contemporary European physicians would understand. Historians generally locate the development of the medical sciences in America with the next generation of physicians and students—particularly those that studied in Germany. I decided, then, that I wanted to see if Jones’s methods of investigation were atypical and I wanted to explore the larger impact of the war on American medical science. What I found was a transformational experience for many American physicians—both the elite and rank and file. I hope my book will shed new light on how the doctors’ innovations in the midst of crisis transformed northern medical education and gave rise to the healing power of modern health science.

CN: What brings you to use the collections of the NLM? Is there an item in our collection that has been particularly useful in your studies, or for which you have special interest?

SD: I extensively used many of the collections at the NLM—they were in fact invaluable and I spent about six weeks at the Library early on in my dissertation research. My book has a chapter on the 1866, 1867, and 1873 cholera outbreaks and the NLM has excellent resources on cholera. I also looked at many of the Surgeon General’s Records, circulars and the “receipt of circulars” from various international medical colleges, libraries, etc. as John Shaw Billings worked to build the Library in the postwar period. I also used a number of photographs , many submitted by R. B. Bontecou in my current work on medical photography. Moreover, the staff at the NLM has been a great resource—and very supportive of my research.  Stephen Greenberg was extremely helpful in suggesting sources that I had not anticipated, Michael Sappol offered a lot of suggestions along the way making my work much stronger, and I am grateful that Jeffrey Reznick invited me to speak at the lecture series and share my research with members of the NIH community.

CN: How do you see your work making a difference in the world?

SD: I hope my book will challenge and even correct some of the pervading myths surrounding Civil War medicine—the idea that “saw-bones” were merely hacking off limbs and inadvertently spreading disease. It is true that 750,000 people died as a direct or indirect cause of the war. So it might seem counterintuitive to suggest the war was a stimulus to the development of American medicine. But it was, as I argued earlier, one of the most significant educational interventions of the 19th century—not simply as a school for experience, but also as a conduit for infusing new tools for exploring, explaining, and managing disease into the larger fabric of American medicine.

Dr. Devine’s presentation was part of our ongoing history of medicine lecture series, which promotes awareness and use of NLM and other historical collections for research, education, and public service in biomedicine, the social sciences, and the humanities.

IMAGE: Photograph of Ludwig Kohn by Reed B. Bontecou taken to illustrate his medical case for the Army Medical Museum.

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Insignia of the Medical Corps of the Confederate Army and Navy

Office of Surgeon General United Confederate Veterans
New Orleans, LA, April 9, 1890
From: civilwarhome.com

INSIGNIA OF THE MEDICAL CORPS OF THE CONFEDERATE ARMY AND NAVY.
        In conclusion, comrades, the speaker would urge the adoption of some badge or device which should serve to distinguish the survivors of the Medical Corps of the Southern Confederacy.

        The objects of this reunion and of this association are historical, benevolent and social, and the medal or seal which marks its realization should embody within a brief circle these sacred and noble sentiments.

        The outer circle bearing the words "Medical Corps Confederate States of America, Army and Navy, 1861-1865," expresses the great historical fact, that within the circle of these four years a nation was born and exhibited to the world its existence, power and valor, in its well organized and efficient army and navy. Within the brief space of time, 1861-1865, was enacted one of the greatest and bloodiest revolutions of the ages, and a peculiar form of civilization passed forever away.

        Upon the silver field and embraced by the outer circle rests a golden cross with thirteen stars--the Southern cross--the cross of the battle flag of the Southern Confederacy.

        The reverse of the medal bears at the apex of the circle the letters U. C. V., and at the line under, the date 1890. The laurel leaf of the outer circle surrounds the venerated and golden head of the great Southern captain, General Robert E. Lee, who was the type of all that was heroic, noble and benevolent in the Confederate Army and Navy. Grand in battle and victory, General Lee was equally grand and noble in defeat; and his farewell address to his soldiers has been the most powerful utterance for the pacification of the warlike elements of his country and the rehabilitation of the waste places of the South by the peaceful arts of agriculture, manufacturers and commerce.

        Whilst the Southern armies were wreathed in victory, the thunderbolts of war, which made wide gaps through their ranks, inflicted irreparable damage. When the brave soldiers of the South sank to rest upon the bosom of their mother earth, they rose no more; the magnificent hosts which watered the plains, valleys and mountains with their precious blood were the typical and noble representatives of their race.

        Whilst the North increased in resources and men, as the war went on, the Southern Confederacy was penetrated and rent along all her borders; her fertile plains were overrun and desolated, her gallant sons fell before the iron tempest of war, and her final overthrow and subjugation followed as the night does the day.

        Comrades, survivors of the Medical Corps of the Confederate Army and Navy. is it not our solemn duty to commemorate the deeds of our comrades who yielded up their lives in the struggle for Southern independence, on the battle-field, in the hospital and in the military prison? Shall we not adopt a simple but imperishable medal which may be handed down to our children?"

FROM:  II. Brief Report of the First Reunion of the Survivors of the Medical Corps of the Confederate Army and Navy, July 2, 1890, in N. B. Forrest Camp, Chattanooga, Tennessee--Address of Surgeon-General Joseph Jones, M. D., United Confederate Veterans, Containing War Statistics of the Confederate Armies of Mississippi and Tennessee; also Casualties of Battles of Belmont, Donelson, Shiloh, Perryville, Murfreesboro, Chickamauga; Engagements from Dalton to Atlanta; Battles Around Atlanta, Jonesboro, Franklin and Nashville.

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Montgomery's Confederate Hospitals

From: lat34north.com

Situated away from main battlefields and with good rail and river connections, Montgomery was ideal for Confederate hospitals. Two locally operated were Soldiers' and Wayside. The government staffed six during the conflict. Citizens rendered services including food and nursing. Ladies, General, Madison and Concert Hall hospitals were on Commerce and Market streets; Stonewall and Watts, tent units, were west of town near the Alabama and Florida Railroad. After Shiloh and during the Atlanta Campaign, the hospitals were very busy, but throughout the War they tried diligently to heal wounds and diseases, often with limited supplies. These approximately seven hundred and fifty graves represent their failures. The commemorative marker was placed by the Ladies Memorial Association.

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Juliet Opie Hopkins: Superintendent of Alabama's Hospitals in Virginia

From: Alabama Department of Archives and History

One-fourth of the one million Southern men who fought in the Confederate army died of wounds or disease. Inadequate doctors and medical services, and lack of medicines contributed to this number. Also, the Confederate government was slow in setting up a medical service, therefore states authorized hospitals to be set up close to the battlefields. Nursing as a profession had not developed in Alabama before the war, except in Mobile where Catholic sisters operated a hospital. Nevertheless, during the war women provided much of the care for the sick and wounded. "Southern women always nursed family, neighbors, and slaves but never strange men. The war changed this social standard, and hospitals staffed by 'respectable ladies' of the community were established all over the state. " (Rogers, Ward, Atkins, Flynt, 200) One of these "respectable ladies," Juliet Opie Hopkins of Mobile, served as Matron and Acting Superintendent of the hospitals from 1861-1864.

The Alabama Hospitals in Richmond, Virginia were established by an Act of the Alabama Legislature in November 1861. The legislature appropriated $30,000 to establish hospitals in Virginia to care for sick and wounded soldiers from Alabama, serving in the Army of the Potomac, later known as the Army of Northern Virginia. Subsequent legislation authorized the governor to establish a medical depot at Manasses Junction, Virginia, and to appoint "an efficient and skillful medical man" to oversee the receipt and distribution of food, clothing, medical supplies and money provided by the state, benevolent associations and private individuals for the benefit of wounded Alabama soldiers in Virginia. In December 1861, Governor John Gill Shorter appointed Judge Arthur Francis Hopkins to serve as Superintendent of Alabama Hospitals in Virginia. Because of his advanced age and poor health, Hopkins' wife, Juliet Opie Hopkins, served as the chief administrator of the three hospitals that were eventually established for Alabama troops in Richmond, Virginia. For several months prior to the official establishment of the hospitals, Juliet Hopkins had been collecting and distributing clothing and medical supplies and caring for wounded soldiers.

State funding for the hospitals was irregular and insufficient; Mrs. Hopkins was forced to rely on charitable donations from Ladies Aid Societies throughout Alabama and she donated nearly $500,000 of her own money for the maintenance of the hospitals. When the Alabama legislature ordered the hospitals closed and the property to be sold in December 1863, Mrs. Hopkins continued her exertions for several more months. She eventually returned to Alabama in 1864 and served as administrator of the military hospital at Camp Watts in Macon County. Her humanitarian efforts in behalf of Alabama soldiers were recognized by the Alabama legislature which authorized her picture to be printed on several denominations of state currency.

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When Robert E. Lee Began to Die

by Martha M. Boltz

In a somewhat different way to look at Robert E. Lee’s life, it is interesting to look at his death and do some reading between the lines in the light of today’s medical knowledge.

Throughout the numerous writings about Lee,  the basic stories revolve around his actions in camp and on the field, before and after battles, and what he accomplished.

Writers and historians are prone to stick to the subject matter at hand — the battles — and adjunctive aspects such as the health of the leader are given short shrift, bare mentions as they tell the story of the war.

And thus it was with Robert E. Lee.  Looking  at Lee’s life and picking out different phases in it, an interesting story evolves of a man who apparently was beset by physical problems all of his adult life,  which were given scant diagnosis and treatment commensurate with the medical knowledge of the time.

Lee’s stamina  often appeared  hearty during the War years,  but had always been unpredictable at best.  And he had learned to live with it.

During the Mexican War, the healthy and robust Lee had fainted for the first and only time in his life. He had been, in his own words, “almost paralyzed” by the strain of battle and the sleeplessness of preparations for the attack on Chapultepec. However,  he was described as  looking strong and ruddy.

It was the silent forerunner of things to come, as in hindsight we are able  to look back, and predict.

Two years later while supervising construction of Fort Carroll in Baltimore Harbor, he developed a fairly high fever, temporarily debilitating him.  It was most likely a malarial strain, and would recur later in life, although at the time he seemed to be back to full strength.

In March 1863, around the time of Chancellorsville, he developed a very sore throat, then stabbing  pains in his chest, back, and arm. Moved from headquarters to a private home on March 30, he tried to recover, writing Mrs. Lee that he was simply “suffering with a bad cold.”

The doctors thought the throat infection had settled into pericarditis, or an inflammation of the pericardium - the sac surrounding  the heart. He continued to complain of “paroxysms of pain,” or stabbing sensations, so recognizable now in many cardiac patients.

Though he seemed to recover, all through the siege of  Gettysburg he suffered from the loosely diagnosed “rheumatism,” worse during damp weather. Some records indicate that the malaria  returned again later on, though diarrhea and dysentery were common physical complaints, North or South.

The Chancellorsville illness was particularly significant, and while it seemed to disappear, it also seemed to  affect him permanently.  His health was erratic thereafter, alternating between periods of almost debilitating discomfort  and relative good health.

On August 8,1863, he felt that his health was problematic enough to write President Jefferson Davis asking that he be relieved of command. Davis declined the request.

Less than a month later, he suffered violent pains in his back, which were attributed to lumbago, sciatica or — again — rheumatism.  In the light of current medical knowledge, they were probably the  precursor to angina pectoris, the temporary decrease in blood supply to the heart musculature, with resulting pain and discomfort.

It was at this time that horseback riding became almost unbearable for the General best known astride Traveller. Many campaigns were conducted with Lee doing his best, but riding in a wagon.
Several other attacks occurred during the Wilderness Campaign. Still he attempted to continue his position of leadership. Incidences of illness and near collapse continued, often attributed to “bad food and long hours.”  The duration and effect seems to have been more in line with a primary intestinal infection such as bacillary dysentery rather than just “bad food.”

From June 1864 through Appomattox, Lee seems to have been in relatively good health, including the nine-month siege of Petersburg; he had gained weight and his face looked “ruddy” again,   a description that should be remembered.

When he came to head Washington College (later Washington and Lee) he again seemed in fairly good health, but the so-called rheumatism of old continued.  As early as 1868 he began talking of getting old and having only a short span of life left.

In March 1869 he fell ill to a severe respiratory infection and although he seemed to recover, records indicate that in reality, his health steadily declined.  He had some strong reservations if he could attend the college’s graduation ceremony that year, for fear that the happy proceedings might prove his undoing.  Not uniquely, the patient was more aware of the serious condition of his health than his physicians were.

A year passed and the doctors would again diagnose the initial problem first mentioned at Chancellorsville — inflammation of the heart sac, or pericarditis.  He again had the pain on the right side, chest and back, and difficulty breathing.  His walking was restricted to about 200 yards.

He decided to take a trip as a rest, going on a six week tour through North and South Carolina, Georgia and Florida. Instead of resting,  he was overwhelmed with crowds everywhere he went, complete with receptions, dinners and crowds of people. It was hardly a restful trip. He began having  worse chest pain. Examined in Savannah, and then back home in Richmond, as well as Norfolk, the diagnosis confirmed “chronic pericarditis”.

September 28, 1870 was the beginning of the end. He’d left a faculty meeting and insisted on walking to church for a 4:00 p.m. vestry meeting in the rain, to an unheated Church.  Around 7:00 p.m. he walked back home through the rain, and while Mrs. Lee noticed he looked unwell, she only chided him gently that he rarely made them late for dinner.

Sitting down in his chair, he bowed his head to say Grace, and was unable to speak. He leaned back further in his chair, and still could not say a word. Mrs. Lee was stricken with concern and fear.

Sensing the seriousness of his condition, servants carried him to a couch and the physicians were called immediately. He would never rise from his bed again.  The doctors came and went, his family attended closely, but life was ebbing from the valiant general.  He spoke only occasionally, and that in a delirious state.

Modern physicians, reviewing all the records in the light of current knowledge, seem to think that actually a cerebral thrombosis (a clot in a blood vessel of the brain) had occurred.  This, they believe, was due to a degree of atherosclerosis (or thickening of the arterial walls, the buildup of plaque) which he had probably had for years.

This would have led to the description of his complexion being “ruddy” or “florid.”  What they saw as a healthy appearance then, we now know is possibly symptomatic of medical trouble brewing.  Most likely hypertension accompanied this, but in this era the taking of blood pressure was unknown — sphygmomanometers had yet to be invented.

He was attended by Drs. Robert Lewis Madison and H. T. Barton of Lexington, VA. who waited by his bedside, unable to minister further. It was said by those who watched that their anguish was palpable. They could do nothing for Lee.

At the very end, at 9:30 a.m. on Wednesday, October 12, 1870, the noble General of the South breathed his last.  His final words were quite clearly, “Strike the tent.”  General Robert E. Lee had gone home.

From: communities.washingtontimes.com

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Dr. Alexander Thomas Augusta, the First African American Faculty Member of an American Medical School

Written by Akosua Lowery Alexander
From: theburtonwire.com

“I would like to be in a position where I can be of use to my race.” - Letter from Alexander Thomas Augusta to President Abraham Lincoln in African Americans in the Military by Catherine Reef
Dr. Alexander Thomas Augusta

Alexander Thomas Augusta, the first African American faculty member of an American medical school, Howard University, was born free on March 8, 1925. He was a surgeon, professor of medicine, and veteran of the American Civil War.

Augusta applied to study medicine at the University of Pennsylvania but was refused admission. As he was determined to become a physician, Augusta travelled to California and earned the funds necessary to pursue his goal of becoming a doctor. Concerned that he would not be allowed to enroll in medical school in the U.S., he enrolled at Trinity College of the University of Toronto in 1850. He also conducted business as a druggist and chemist. Six years later he received a degree in medicine.

Augusta remained in Toronto, Canada West, establishing his medical practice.

Augusta went to Washington, D.C. and wrote to Abraham Lincoln offering his services as a surgeon and was given a Presidential commission in the Union Army on October 1862. On April 4, 1863 he received a major’s commission as surgeon for African American troops. This made him the United States Army‘s first African American physician out of eight in the Union Army and its highest-ranking African American officer at the time.

Augusta taught anatomy in the recently organized medical department at Howard University from November 8, 1868 to July 1877, becoming the first African American appointed faculty of the school and also of any medical college in the U.S.

He was never a member of the American Medical Association, as he was rejected due to his race. At Augusta’s death in 1890, he became the first black officer buried at Arlington National Cemetery, in a plot set apart from white officers’ graves.

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Treatment of Venereal Disease During the Civil War

By Dr. Michael Echols
From: medicalantiques.com

During the Civil War, as in all wars, venereal disease was a major problem since it disabled the soldier and decreased his effectiveness to fight or be moved from battle to battle. Dr Freeman Bumstead was one of the leading authorities on venereal disease during the Civil War and his treatment of one of the most common diseases is outlined below. A copy of his book on the topic of  "Venereal Disease" is a part of this collection.

Preface to the second edition with comments about knowledge of venereal disease during the Civil War
From the Medical and Surgical History regarding the incidence of venereal disease during the War:

"Venereal diseases were associated with intemperance in the conditions which favored their causation. Hence they were more frequent at the beginning and the close of the war than during its progress, and among troops stationed in the vicinity of cities than among those on active service. Elevations of the lines of prevalence during the continuance of the war correspond with the accession of fresh levies or the return of furloughed veterans. Among the white troops, 73,382 cases of syphilis were reported, and 109,397 cases of gonorrhea and gonorrheal orchitis, giving a total of 82 cases of venereal disease annually per thousand men, as compared with 87.86 in our army before the war and 87.62 from the records of the ten years immediately following the war period. Among the colored troops syphilis had an annual rate of 33.8 cases and gonorrheal affections 43.9 cases per thousand of strength. The variations in the monthly rates are shown in the diagram facing page 890. The lines of syphilis and gonorrhœa run courses parallel to that of their consolidation."

Edited from Dr. Freeman Bumstead's text-book on Venereal Disease (in this collection)
The treatment of gonorrhea must be adapted to the general condition of the patient, and especially to the stage of his disease. In the great majority of oases met with in practice, acute inflammatory symptoms have already set in at the time the patient first applies to the surgeon; but in those exceptional cases which are seen at an early period, and in those only, we may often succeed in cutting short the disease by means of the treatment termed abortive.

Abortive Treatment of the. First Stage.—During the first few days after exposure, varying in number from one to five in different cases, before the symptoms have become acute, when the discharge is but slight and chiefly mucus, and while as yet there is no severe scalding in passing water, we may resort to caustic injections with a view of exciting artificial inflammation, which will tend to subside in a few days, and supplanting the existing morbid action, which is liable to continue for an indefinite period and is exposed to various complications. This is known as the " substitutive," or more commonly as the " abortive treatment" of gonorrhea. This method has been inordinately praised and as violently attacked ; its true merit is probably to be found between these two extremes. It is certainly liable to be greatly abused, and, if so, is both unsuccessful and  capable of producing the most unpleasant consequences; but. when limited to the early stage of gonorrhea and used with proper caution, it is a highly valuable method of treatment, unattended with danger, and undeserving the censure sometimes cast upon it.

In employing the abortive treatment, there are several points which it is important to recollect:

1. The disease, in the stage to which this treatment is applicable, is limited to the anterior portion of the urethra, known as the fossa navicularis, or extends but a short distance beyond it; it is not necessary, therefore, that the injection should reach the deeper portions of the canal.

2. For the treatment to be successful, the whole diseased surface should receive a thorough application of the injection, for if any portion remain untouched, it will secrete matter that will again light up the disease.

3. When once a sufficient degree of artificial inflammation is excited, the caustic has accomplished all that can be expected of it and should be suspended. Since a solution of nitrate of silver, which is commonly used in the abortive treatment, is readily decomposed by contact with metallic substances, metal syringes should l>e avoided. Glass syringes, if well made, answer every purpose; but, as found in the shops, they are apt to be unequal in calibre in different parts of the cylinder, the wadding of the piston contracts in drying and a portion of the fluid fails to be thrown out, as is seen by its overflow when the syringe is filled a second time. For these reasons, I never advise a patient to purchase an ordinary glass syringe, knowing that it will probably give him much annoyance, and perhaps prevent his deriving benefit from treatment. We have an excellent substitute in the hard-rubber syringes, which can be obtained at the druggists'
"No. 1 " (Fig. 1) is the one generally sold when no special form is directed by the surgeon, but its nozzle is objectionable; it is unnecessarily long, its point is apt to irritate the internal wall of the canal, and it is not well adapted to fully distend the meatus.
" No. 1, A " (Fig. 2), is preferable. The abrupt shoulder near the point is well adapted to fill the meatus, and the short and rounded end cannot abrade the sensitive mucous membrane.
Fig. 3 represents another excellent form, and one which is recommended by Prof. Sigmund, of Vienna. I find a figure of the same in the work of Dr. H. A. Hacker, Die Blcnnorrhden tier Genitnlien, Erlangen, 1850.

The " urethral syringe with extra long pipe " (Fig. 4) is, in fact a syringe united to a catheter, and is adapted for injections of the deeper portions of the canal. The catheter portion may lie bent to any curve desired by first oiling it and heating it over a spirit-lamp; its form is then retained by dipping it in cold water.

The solution of nitrate of silver, in the abortive treatment of gonorrhea, may be of considerable strength, when only one injection will be required; or it may be weak, and in that case should be repeated at short intervals until the effect produced be deemed sufficient. I much prefer the  latter course, especially with patients who apply to me for the first time, since it enables me to graduate the effect according to the susceptibility of the urethra, which varies in different persons. Inject the weak form of silver nitrate and water:

The patient should be made to pass his water immediately before injecting, or, better still, a quarter of an hour before. We wish to clear the urethra of matter, and to have the bladder empty, so that the injection may have some time to act before it is washed away by another passage of the urine, and yet a short interval between the last act of micturition and injection is advisable, in order that as much of the urine as possible may have drained from the canal and little be left to decompose the nitrate of silver. The prepuce should now be fully retracted, and the glans penis exposed. The latter should be wiped dry, so as to afford a firm hold to the thumb and forefinger of the left hand, applied laterally, not from above downwards, and firmly compressing it around the point of the syringe. Call the patient's attention to the fact that the opening of the urethra is a vertical slit; that compressing the glans from above downwards makes this opening gajw while the compression from side to side closes it; hence the importance of exercising the compression in the latter way while taking the injection. If the pressure be properly made, not a drop of the solution will be lost, as the piston of the syringe is slowly forced down by the forefinger of the right hand holding the instrument, and the whole contents will be discharged into the canal. The syringe should now be withdrawn, and th« fluid still retained for a few seconds by continuing the compression of the glans. When the injection is allowed to escape, it will be found to be of a milky-white color. This is due to the partial decomposition of the contained salt by the remains of the urine and the muco-pus in the canal. As this de-coin posit ion has prevented the application of the injection in its full strength to the urethral walls, a second syringeful should be thrown in, and retained for two or three minutes. During this time a finger of the disengaged hand should be run along the under  surface of the penis from behind forwards, so as to distend the portion of the canal occupied by the injection, and insure the thorough application of the fluid to the whole mucous surface.

This description of the method of using the syringe is, in the main, applicable to all the injections which may be required in the course of a gonorrhea; but we are now speaking of the abortive treatment, by means of weak injections of nitrate of silver. We will suppose that this first injection has been administered by the surgeon, who, at the same time, has explained the various steps of the operation to the patient. The directions with regard to diet, etc., that will presently be mentioned in speaking of the second stage, should now Ik- given ; the patient should be ordered to repeat the injection every three hours, and, for the present, it is best that he should be seen by the surgeon twice a day. It is also well at this time to prescribe an active purge.

The first effect of the caustic injections is manifested in a few hours; the discharge becomes copious and purulent, and considerable scalding is felt in passing water. In the course of twenty-four to forty-eight hours, however, the discharge grows thin and watery, and, very likely, is tinged with blood. It is now time to stop the injection and omit all medication for a few days, until we see how much good has been accomplished. If the treatment meets with success the discharge will gradually diminish, and finally disappear in from three to five days. Sometimes, however, after growing less, it again increases, showing a tendency to relapse. In this case, I usually advise weak injections of acetate of zinc, as recommended in the third stage of the disease. Some surgeons prefer to resume the caustic injections in the same manner as at first if, after a week has elapsed, any traces of the discharge remain.

The chief objection to this modification of the abortive treatment is, that it is necessary to leave the administration of most of the injections to the patient, who may be prevented by ignorance, or the requirements of his occupation, from using them as thoroughly or as often as is necessary. If we have reason to fear this, we may resort to a stronger solution, and inject it once for all, with our own hands, but I have found the effect decidedly less satisfactory. It was this method of employing the alwrtive treatment that was recommended by Debeney of France, and Carmichael of England, by whom this treatment was first introduced to the profession. The same method is also still employed and highly recommended by many surgeons, and especially by M. Diday of Lyons. The strong injection should not contain less than ten grains (0.65) of the nitrate of silver to the ounce (30.00) of distilled water, and more than fifteen grains are objectionable, unless with patients who have been under treatment before, and in whom the urethra has been found to be quite insensible.
Citations from the Medical/Surgical History--Part III, Volume I
Chapter XI.--On Certain Diseases Not Heretofore Discussed.
V.--Venereal Diseases.

Venereal diseases were associated with intemperance in the conditions which favored their causation. Hence they were more frequent at the beginning and the close of the war than during its progress, and among troops stationed in the vicinity of cities than among those on active service. Elevations of the lines of prevalence during the continuance of the war correspond with the accession of fresh levies or the return of furloughed veterans. Among the white troops, 73,382 cases of syphilis were reported, and 109,397 cases of gonorrhœa and gonorrhœal orchitis, giving a total of 82 cases of venereal disease annually per thousand men, as compared with 87.86 in our army before the war and 87.62 from the records of the ten years immediately following the war period.(*) Among the colored troops syphilis had an annual rate of 33.8 cases and gonorrhœal affections 43.9 cases per thousand of strength. The variations in the monthly rates are shown in the diagram facing page 890. The lines of syphilis and gonorrhœa run courses parallel to that of their consolidation.

The hospital records present 426 cases of venereal disease,--53 of gonorrhœa and 373 of syphilis. Of the former 50 were simple cases and 3 complicated with suppurating bubo. Of the latter 194 developed no constitutional symptoms,--among these, gonorrheal complications were present in 41 and supurating bubo in 77. It is impossible to determine, from the language of the record, the character of the primary sores in 179 cases which were followed by secondary symptoms. The most notable point connected with their history is the frequency with which sore throat, cutaneous eruptions and other manifestations of the constitutional taint are reported as having followed venereal sores associated with suppuration of the inguinal glands: 19 such cases are recorded.

Treatment as a rule was first restricted to the local lesions, mercury or iodide of potassium being withheld until the development of secondary symptoms. No reference is made to scorbutic complications nor to untoward results in constitutions undermined by the hardships of military service. In fact, a similar series of cases might easily have been gathered during the same period in the wards of our civil hospitals. A few reports on file indicate individual views of the method of treating these diseases:

Ass't Surgeon ROBERT F. STRATTON, 11th Ill. Cav., June 30, 1862.--It was impossible to cure gonorrhœa while the patients were exposed to the rain and had to sleep on the damp ground and live on a salt and stimulating ration.

Surgeon WILLIAM R. BLAKESLEE, 115th Pa., Alexandria, Va., Oct. 20, 1862.--Gonorrhœa was greatly modified and in most cases completely subdued by injecting a solution of chlorate of potash, one drachm in eight ounces, every hour for twelve successive hours, and then gradually ceasing its use during the next two or three days by prolonging the interval between each injection. Dietetic rules were observed, with rest and occasionally a saline laxative.

Surgeon A. F. PECK, 1st N. M. Cav., Los Lunas, N. M., Sept., 1862.--Nearly one-third of the cases this month consisted of gonorrhœa, which readily yielded to treatment. With much inflammatory action in the first stage, I generally prescribed a saline cathartic, rest, cooling lotions and low diet. After this stage had passed I found balsam of copaiba, powdered cubebs and magnesia given as a bolus, four or five times a day, to be very effectual. At the same time I used an injection of chloride of zinc, two to four grains to the ounce of water, once or twice a day. When the system is much reduced tonics are beneficial.

Surgeon ISAAC F. GALLOUPE, 17th Mass., Feb. 20, 1863.--Syphilis and gonorrhœa prevailed extensively in the regiment during its stay in Baltimore. Rapid and complete recovery was secured in all cases treated as follows:--Gonorrhœa: Injections of a weak solution of sulphate of zinc, one grain to one ounce of water, every hour or half hour; light diet. By this treatment the disease was always cut short, no discharge appearing after the first use of the injection. Syphilis: Cauterization of the chancre in the first instance, followed by the continuous application of black wash. All cases thus treated recovered without secondary disease.

Ass't Surgeon P. W. RANDALL, 1st Cal., Fort Bragg, Cal., Jan. 1, 1863.--For gonorrhœa my treatment, which is successful, consists of a thorough cleansing of the alimentary canal, rest, low diet, the balsam and cubebs internally, with urethral injections of nitrate of silver, sugar of lead or sulphate of zinc. For syphilis I use mercurial and saline purges, rest, low diet, iodide of potassium and bichloride of mercury, with caustic to chancres, warts or vegetations.

Surgeon J. G. BRADY, 26th Mass., New Orleans, La., Jan. 1, 1863.--Of the various forms of venereal disease chancre of the non-indurated variety is the most prevalent. It is accompanied in a majority of cases with bubo. The sores yield readily to cauterization with acid nitrate of mercury and applications of black wash, the bowels meanwhile being regulated and the patient kept on low diet. But one case of indurated chancre has been observed, and this was unaccompanied by a bubo. It was treated with mercurials internally and pernitrate of mercury to the sore. Sufficient time has not yet elapsed to determine whether secondary symptoms will be developed, No case of non-indurated chancre has been followed by constitutional symptoms. Gonorrhœa is much less frequent than chancre, and more obstinate under treatment. My practice has been to use injections of sulphate or chloride of zinc; occasionally, when there is irritability of the bladder, I employ diuretics. The cases are prone to become chronic. I have no faith in the empirical use of balsams and diuretics, so long considered specifics in this disease. I consider that, by their tendency to over-stimulate the kidneys, they do more harm than good.

Surgeon DAVID WOOSTER, 5th Cal., Sacramento, Cal., Jan. 13, 1862.--I inoculate every case of chancre. If the virus take, I treat locally and hygienically alone; if it fail to produce chancre after the third inoculation, I use protiodide. The cures in both series of cases are generally reasonably prompt, occupying from fifteen to rarely sixty days. I have not yet had secondary developments in cases the primary accidents of which have been treated at this post.

Surgeon ALLEN F. PECK, 1st N. M. Mounted Vols., Fort Stanton, N. M., Dec. 31, 1862.--Primary: Cauterize with nitrate of silver, after which apply black or yellow wash until the sore is healed. Consecutive: If there is no constitutional contraindication I give mercurials,--the protiodide yields better results than any other preparation. If the patient improves I continue the remedy until the sores are healed and the induration dissipated, using at the same time disinfecting mercurial and astringent washes. If the system is exhausted I give tonics.

Surgeon EZRA READ, 21st Ind., Baltimore, Md., Sept. 5, 1861.--For many years I have pursued the method of treatment by mercurial fumigation, which deposits the mercury upon the surface of the body when in a state of perspiration induced by the heated vapor of water surrounding the patient confined in a close and air-tight bath. This treatment is commended to our consideration because it eradicates the disease in a shorter period of time than is required by the internal use of mercury; moreover, when thus applied the constitutional effects of the mercury are under satisfactory control. In primary syphilis, after careful and thorough cauterization of the chancre, I regard fumigation as the best method of treating the disease, and as the most reliable means of preventing constitutional manifestations. In the secondary form I think it the only method by which a perfect cure can be effected.

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Appropriating Allowances for Maimed Confederate Soldiers (No. 48)

OFFICE OF SURGEON GENERAL UNITED CONFEDERATE VETERANS
NEW ORLEANS, LA., April 9, 1890.

Appropriating Allowances for Maimed Confederate Soldiers (No. 48)

        AN ACT to amend an act, approved October 24, 1887, entitled "An act to carry into effect the last clause of article 7, section 1, paragraph 1, of the Constitution of 1877 and the amendments thereto."
        SECTION I. Be it enacted by the General Assembly of Georgia, That the act approved October, 24, 1887, entitled "An act to carry into effect the last clause of article 7, section I, paragraph 1, of the Constitution of 1877, as amended by vote of the people October, 1886," be, and the same is hereby, amended by striking therefrom the first section of said act, and inserting in lieu thereof the following, to-wit: "That any person who enlisted in the military service of the Confederate States, or of this State, during the civil war between the States of the United States, who was a bona fide citizen of this State on the 26th day of October 1886, who lost a limb or limbs while engaged in said military service, occasioned by reason of such military service, or who may have thus received wounds or injuries which afterward caused the loss of a limb or limbs," or who may have been permanently injured while in said service, and who may be a bona fide citizen of this State at the time of making application for the benefits herein provided for, shall be entitled to receive, once a year, the following allowances or pay for the purposes expressed in article 7, section 1, paragraph 1 (and the amendment thereto), of the Constitution of 1877, to wit:
        For total loss of sight, one hundred and fifty dollars.
        For total loss of sight of one eye, thirty dollars.
        For total loss of hearing, thirty dollars.
        For loss of all of a foot or loss of leg, one hundred dollars.
        For loss of all of a hand or loss of arm, one hundred dollars.
        For loss of both hands or both arms, one hundred and fifty dollars.
        For loss of both feet or both legs, one hundred and fifty dollars.
        For the loss of one hand or foot, and one arm or leg by same person, one hundred and fifty dollars.
        For permanent injuries from wounds whereby a leg is rendered substantially and essentially useless, fifty dollars.
        For permanent injuries from wounds whereby an arm is rendered substantially and essentially useless, fifty dollars.
        For the loss of one finger or one toe, five dollars.
        For the loss of two fingers or two toes, ten dollars.
        For the loss of three fingers or three toes, fifteen dollars.
        For the loss of four fingers or four toes, twenty dollars.
        For the loss of four fingers and thumb, or five toes, twenty-five dollars.
        For other permanent injury from wounds or disease, contracted during the service, and while in line of duty as a soldier, whereby the person injured or diseased has been rendered practically incompetent to perform the ordinary manual avocations of life, fifty dollars.
        The applicant shall also procure the sworn statements of two reputable physicians of his own country, showing precisely how he has been wounded and the extent of the disability resulting from the wound or injury or disease described. All of said affidavits shall be certified to be genuine by the Ordinary of the county where made, and he shall in his certificate state that all the witnesses who testily to applicants' proofs are persons of respectability and good reputation, and that their statements are worthy of belief, and also that the attesting officer or officers are duly authorized to attest said proofs and that their signatures thereto are genuine.
        SEC. IV. Be it further enacted by the authority aforesaid, That said act be further amended by adding: That the beneficiaries under the Acts of 1879 and the acts amendatory thereof, granting allowances to ex-Confederate soldiers who lost a limb or limbs in the service, shall be entitled to the benefits of this act, at the time the next payments are made to other disabled beneficiaries under the Act of 1887. And the sum necessary to make the payments provided by this act is hereby appropriated out of any money in the treasury not otherwise appropriated.
        SEC. V. Be it further enacted by the authority aforesaid, That all laws and parts of (*) laws in conflict with this act be and the same are hereby repealed.
Approved December 24, 1888.

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Nurses in the U.S.Civil War

From: questia.com

Civil War nurses were actually not part of the military and did not serve as part of any army. Most of those nurses who tended to the dying and wounded of the Confederate or the Union armies were volunteers and not paid for their work. Even as volunteers they were confronted with difficulties with regard to paternalism and bureaucracy in order to help soldiers both on and off the battlefield.

The Civil War is known to have been the impetus and catalyst for many good things. It was the main source for volunteerism which became an integral part of American society. Although battlefield hospitals and medicine were nearly non-existent during the Civil War, women helped and saved countless numbers of soldiers. There are many famous names associated with Civil War nursing and they were instrumental in revolutionizing the way battlefield medicine and healthcare in the military were administered and delivered.

The most famous pre-Civil War nurse was Florence Nightingale (1820-1910), who was instrumental in obtaining better medical care for the soldiers who required medical attention during the Crimean War (1853-1856). Many nurses of the Civil War had studied Florence Nightingale's way of working and were exposed to her philosophies of nursing care, which advocated a clean environment and fresh air, as well as guaranteeing that every wounded soldier received kind, compassionate and humane care. The Civil War produced some very famous nurses. They include Clara Barton, Mary Todd Lincoln, Dorothea Dix, Louisa May Alcott and even one man -- the famous poet, Walt Whitman. All of them served as nurses during the Civil War and had a profound impact on the lives of many soldiers.

It is estimated that more than 2,000 nurses served in the Civil War with most of their names being unknown. They are considered the unsung heroes of the war. Due to poor record-keeping and the lack of appreciation and attention given to the many individuals -- mainly women -- who worked the battlefields providing medical care to the soldiers, their names were either lost or never recorded. Some of the nurses of the time kept diaries or journals while others wrote their memoirs after the war. It is through those written records that some names and people became prominent for the causes they championed.

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The Civil War Slowed Medical Malpractice Suits

October 2, 2012
From: theindianalawyer.com

Doctors who think people have never been more litigious than they are today can take heart in knowing that people sued their physicians just as much in the 1850s.

This is what Terre Haute attorney Michael J. Sacopulos discovered after months of research. Now, he’s going to a conference for the National Museum of Civil War Medicine to talk about his findings.

Sacopulos and Dr. David A. Southwick, chief of staff at Union Hospital in Terre Haute, are traveling to Maryland this weekend to present on “Effects of the Civil War upon Medical Malpractice Litigation in the United States.” This year marks the 150th anniversary of the Battle of Antietam – the bloodiest one-day battle in American history.

Medical professionals have said they think right now is the worst it’s ever been for doctors as far as medical malpractice lawsuits, which led Sacopulos to do a little digging into the history of medical malpractice suits. Sacopulos, a partner at Sacopulos Johnson & Sacopulos, works with physicians to develop strategies and techniques to avoid medical liability claims.

Sacopulos and Southwick turned to the Internet, as well as books and interviews with medical historians, to find that doctors are about as likely to be sued in the 1850s as they are today.

Most of the cases dealt with orthopedic injuries. Plaintiffs argued that the doctor didn’t do a good job either setting broken bones or performing amputations. Back then, medicine was not standardized and anesthesia was still relatively new. Germs and antibiotics weren’t even considered.

Sacopulos said that with some of the quotes he found from doctors in these old cases, you couldn’t tell if someone was saying them today or 160 years ago. The sentiment from physicians was the same: Lawyers are suing us out of business.

 Even if the prevalence of medical malpractice suits hasn’t changed much now as compared to the 1850s, the outcomes tend to favor doctors more these days. Based on his research, Sacopulos said it appeared as though plaintiffs won more cases 160 years ago.

After the Civil War, there was a decrease in medical malpractice claims across the country. Sacopulos attributes this to the standardization of medicine.

This conference isn’t Sacopulos’ first entry into Civil War-era legal history. Sacopulos wrote an article several years ago about President Abraham Lincoln being a medical malpractice defense attorney in Indiana and Illinois, which is how he caught the attention of the museum.

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Civil War Era Medicine

By Thomas Sweeney, retired physician and long-time avocational Civil War historian

From ozarkscivilwar.org

The medical establishments within the U.S. Army and the nascent Confederate Army were almost totally unprepared for either the scope or duration of the conflict. The peacetime U.S. Army possessed only 113 physicians to care for more than 16,000 personnel scattered across the country. The Army’s Surgeon General, Dr. Thomas Lawson, was unable to think beyond the needs of small, frontier post hospitals. Fortunately for the Union, the Medical Department entered a new era under a relatively junior physician, Dr. William A. Hammond, on April 25, 1862. The Confederate Medical department had to begin from scratch.

Contrary to popular belief, nineteenth century military medicine was not always crude and ineffective. Lack of preparedness was the foremost problem, and it was responsible for much otherwise unnecessary suffering. The Civil War brought important advances in both organization and technique. While shortages often crippled the Confederacy’s efforts, by the end of the conflict the medical treatment available to Union soldiers was probably the best in the world. It gave sick and injured soldiers a greater opportunity of recovery than in any previous war.

With the outbreak of war civilian doctors entered the ranks of the Northern and Southern forces in large numbers. While some had served only an apprenticeship with an experienced practicing physician, formal medical education was becoming common. Diploma mills existed, but so did an increasing number of respected medical schools, such as the McDowell Medical College in St. Louis. By modern standards the curriculum in even the best schools was surprisingly brief lasting two years, with the second year being merely a repeat of the first. Not surprisingly, the quality of military surgeons differed considerably. Late in 1861 the U.S. Army Medical Department began giving examinations to weed out unqualified physicians. The Confederacy soon took similar and perhaps even more rigorous steps.

Education and peacetime practice did little to prepare physicians to treat the mass casualties of war. The border troubles labeled “Bleeding Kansas” in the Eastern press gave Missouri a reputation for violence, yet prior to the Civil War relatively few physician within the state ever treated a gunshot wound or performed more than minor surgery, much less attempted the amputation of a limb. The same was true elsewhere. Moreover, once in uniform, few military surgeons considered it to be their duty to address the basic requirements to keep the men healthy to fight, such as proper sanitation, food, and shelter. Civilian organizations, often labeled “sanitary commissions,” sprang up to address these needs, but in Missouri the dynamics of the conflict limited these to the Union side. St. Louis became the center of the regional Western Sanitary Commission, as well as the local St. Louis Ladies Union Aid Society and parallel Colored Ladies Union Aid Society.

In Union and Confederate volunteer service, and in the Missouri State Guard, regulations authorized each regiment a surgeon, an assistant surgeon, a hospital steward with the rank of sergeant major, and several enlisted men serving as orderlies. Each morning at “sick call,” the surgeons listened to soldiers’ complaints and provided treatment. The steward was responsible for supplies and medicine chests. Orderlies were jacks-of-all-trades, men who showed an interest and aptitude in nursing and were appointed by the surgeon. During combat the medical team set up a field hospital close to the action. The assistant surgeon usually manned an aid station treating wounded at the edge of the battlefield until they could be removed to the surgeon’s care at the field hospital. Near the end of 1861 the Union army began consolidating regimental hospitals into division and corps hospitals to handle larger bodies of troops more efficiently, but an Ambulance Corp was not formed until well into 1862. Prior to that wounded were brought from the field either by comrades or by musicians from the regiment’s band, if it had one.

Gunshots accounted for 94 percent of the recorded battle wounds. Injuries from artillery projectiles were less common, while bayonet and sword wounds were quite rare. The most common wounds were to the extremities, with almost equal involvement of the arms and legs. In combat involving muzzle-loading weapons, limbs often remained vulnerable even when a soldier fired from a protected position. Non-extremity wounds almost always resulted in death on the battlefield. Penetrating gunshots to the abdomen or head were about 90 percent fatal, those to the chest about 60 percent.

Contrary to myth, Civil War doctors did not perform excessive numbers of amputations because they were ignorant of, or unwilling to consider, alternatives. Doctors usually performed amputations in cases involving the penetration of a joint, a compound fracture, substantial tissue or bone destruction, or evidence of infection (gangrene). They had to consider the fact that survival rates were much greater when amputations were performed within the first twenty-four hours of injury. This was called primary amputation. Secondary amputations were performed after the 24 hour period and resulted in higher mortality and morbidity caused by bacteria having more time to enter the open wound. Surgeons were aware that the presence of foreign material such as wadding, clothing fragments, or dirt in wounds increased the likelihood complications. Tragically, it was not until just after the war ended that European physician Joseph Lister, using the work of Louis Pasteur, demonstrated the role that bacteria played in wound infection, too late to save the lives of tens of thousands of men in uniform.

One of the war’s most important advances was the popularization of anesthesia. Military surgeons employed ether and chloroform, which had first come into use at the time of the Mexican War, 1846-1848. Both drugs had drawbacks. Highly flammable ether, which took sixteen minutes to take effect, posed a danger when operations were performed by candle or lantern light. Chloroform was nonflammable and worked in about nine minutes, but improper application could result in death. During those nine minutes the patient passed through an excitable stage and might need to be restrained. The process was poorly understood by laymen observers and led to the myth that many operations were preformed without any anesthetic at all, which was rarely the case. Recovering patients received either morphine or opium, which were effective painkillers but addictive.

Although more than a thousand military engagements occurred in Missouri, disease killed over twice as many men as bullets. Infections spread rapidly in overcrowded camps. Measles, mumps, rubella, and chicken pox ran rampant, particularly among newly-enlisted soldiers from rural areas who lacked immunities from prior exposure. But even more fatalities resulted from dysentery and diarrhea contracted due to unsanitary conditions. The Western Sanitary Commission worked tirelessly throughout the war to improve conditions in camps, hospitals, and prisons. Science largely ignorant of the cause of diseases and most medications were ineffective. Malaria was the only major disease combated successfully, being treated with quinine, a drug made from the bark of the Peruvian Cinchona tree.

Because of its rail and river connections St. Louis became the most important center for military medicine west of the Appalachian Mountains. Only Washington, D.C., and Richmond, Virginia, played a greater role during the war. The process was driven by necessity. At the beginning of the war there were only two military hospitals in Missouri, one at the St. Louis Arsenal and the other at Jefferson Barracks, south of the city along the Mississippi River. These and the city’s civilian hospitals were overwhelmed by the casualties from early war battles, but before the conflict ended the city was home to fifteen military hospitals and a fleet of hospital boats serving the war effort in the Mississippi River valley.

The campaigning and fighting in the Ozarks, with its poor roads, rugged hills, and lack of adequate water and rail connections, posed particular medical challenges. Early in the war almost all sick and wounded were treated locally, often with the help of the civilian population. The impact on communities could be devastating, as the case of Springfield demonstrates. When Union forces under Nathaniel Lyon occupied the city in July 1861, they set up military hospitals in tents and buildings to accommodate their routine sick personnel. When Lyon was defeated at the nearby battle of Wilson’s Creek on August 10, 1861, the victorious Southerners occupied Springfield and shifted hundreds of casualties (Union as well as their own) to the town, taking over public spaces, churches, and private homes. Men and women came from miles around to help. O. A. Williams, a surgeon for the Missouri State Guard, wrote to John Willsen about the conditions in Springfield shortly after the Battle of Wilson’s Creek.

Headquarters, General Hospital, Missouri State Guard, Springfield, Missouri

Dear John -

I suppose ere this you have had correct information in regard to the fight so I will say nothing about it. I am not in good health – nor in very good spirits. I can see no end to this infernal war… Springfield presents rather a gloomy appearance, every house nearly has been converted into a Hospital. The wounded are generally well. There has been a great many amputations. I have taken off a good many legs and arms – until I am sick and tired… We get nothing to drink (and) little to eat… Give my love to Mary… (and) respects to… friends and tell my enemies to go to hell…

Yours fraternally,

O.A. Williams, Assistant Surgeon 

Witnesses reported that the streets literally stank from the odor of wounded and dying soldiers. Weeks passed before the situation was under control. The Federal wounded that remained were eventually moved to St. Louis by rail road from Rolla. By this time smaller hospitals had been opened at intervals along the rail line in Missouri from Sedalia and Rolla to St. Louis to take care of the less severely wounded and avoid overcrowding of St. Louis Hospitals. The damage to Springfield civilian property was great; the emotional and psychological impact on families whose homes became treatment facilities is impossible to calculate. Springfield changed hands six times during the course of the conflict and was for much of the war a major Union supply depot and hospital center. By mid-war half of the homes were destroyed and more than half of the population was refugees.

The much larger Battle of Pea Ridge, fought on March 7-8, 1862, only a short distance into Arkansas from the Missouri border, was an even greater disaster. Union medical preparations were minimal, while the attacking Confederates made almost none. Although the Union forces were victorious, it proved impracticable to shift the severely wounded from the battlefield to the expanding facilities in St. Louis. There were no navigable rivers nearby, and the closest rail line to St. Louis began at Rolla, 240 miles from the battlefield. The roads to Springfield, the next best option, were severely rutted and without bridges, while guerrillas roamed the surrounding countryside. As a consequence, the closer small communities Cassville and Keitsville, Missouri, were virtually transformed into hospitals. When the news of the battle reached St. Louis the Western Sanitary Commission worked day and night packing medical supplies and shipping them as fast as possible to the scene of the crisis.

As the war in the Ozarks progressed both the military and the Western Sanitary Commission became better at averting crises by anticipating needs and stockpiling supplies at key points. One of these key points was Springfield. Large quantities of medical supplies were stockpiled in that city in anticipation of further battles in the western Ozarks. The Union victory on December 7, 1862, at Prairie Grove in northwestern Arkansas produced over 1,000 wounded, and once again poor roads and the threat of guerrillas made evacuations impracticable. On this occasion, however, Sanitary Commission agents in Springfield immediately dispatched two ambulances and stockpiled medical supplies to Fayetteville, which became the main treatment center. They sent additional supplies within ten days.

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