.

Civil War Hospital Ship

The U.S.S. Red Rover, a captured Confederate vessel, was refitted as a hospital ship.

Evolution of Civil War Nursing

The evolution of the nursing profession in America was accelerated by the Civil War.

The Practice of Surgery

Amputations were the most common surgery performed during the Civil War.

Army Medical Museum and Library

Surgeon-General William Hammond established The Army Medical Museum in 1862. It was the first federal medical research facility.

Civil War Amputation Kit

Many Civil War surgical instruments had handles of bone, wood or ivory. They were never sterilized.

Tuesday, December 9, 2014

Salisbury Prison

From "Stories from the Civil War", an online course for teachers.
Provided by North Carolina Museum of History.

During the early days of the Civil War, the Confederacy, unprepared to confine Northern prisoners of war and deserters or Southern deserters and dissenters, housed these men in jails and abandoned buildings. In July 1861 the Confederate government appealed to the states for a prison. North Carolina, the only state to offer a prison, suggested the site of a former cotton factory in Salisbury. Its location on a rail line would facilitate prisoner movement. The main structure, a four-story brick factory, and accompanying wooden buildings would sufficiently house the anticipated two thousand inmates. On November 2, 1861, the Confederate government purchased the sixteen-acre site. Guards were hired, and repairs and modifications to the site were made. On December 9, 1861, the first 109 Union POWs arrived. By May 1862 Salisbury Prison held more than fourteen hundred inmates.

The inmates enjoyed good conditions initially. Food, water, and space were plentiful. Religious services took place each Sunday. The men performed in concerts and theatrical routines, and played chess and cards. Some made trinkets to pass the time. But their favorite activity was baseball; they played nearly every day the weather allowed.

In late May 1862 negotiations resulted in the parole to the Union of about fourteen hundred POWs. Salisbury Prison held few inmates until October 1864, when thousands of captives began arriving. On November 6, 1864, the prison held 8,740 inmates, the largest number at any one time and far more than the 2,500 for which it was designed. Conditions quickly deteriorated. Inmates faced overcrowding, poor sanitation, meager rations of food and water, vermin, inadequate medical care, and lack of warm clothing and heating fuel. Tents and dugouts in the ground served as makeshift shelters as buildings were converted to hospitals for the growing number of sick. Up to twenty men a day died in the fall of 1864 owing to these harsh conditions.

Prison workers, although frustrated by the conditions the POWs faced, could do little to alleviate the situation. The workers themselves, particularly the guards, were ill clothed and ill equipped because of shortages. Food, water, and other staples were in short supply throughout North Carolina and the Confederacy, and the public and Confederate government complained if precious commodities went to the prison rather than to the troops.

Many captives attempted to escape from Salisbury Prison, often by tunneling under the fence surrounding the prison site. The most ambitious escape attempt occurred on November 25, 1864, when captives rushed the prison gates, wrenched guns from the guards, and tried to run into the surrounding woods. The guards fought back, firing a cannon three times and recapturing the men, who were weak from lack of food. About 250 men, including several guards, died in the desperate escape attempt.

On February 17, 1865, the Confederate and Union governments announced a general POW exchange. Over the next three weeks, more than five thousand prisoners left Salisbury. The sick went by train to Richmond; the able marched to Greensboro, and then went by train to Wilmington, where on March 2 they were officially exchanged for Confederate prisoners. Only a few civilian prisoners and those too sick to be moved remained in Salisbury Prison.

Confederate officials debated the future function of Salisbury Prison, deciding it should be used for urgent needs. But on April 12–13, 1865, before the site could be put to use, Union general George Stoneman and his army burned the prison buildings and destroyed much of the property.

Between November 1861 and February 1865, Salisbury Prison held about fifteen thousand prisoners. Approximately four thousand men died because of poor conditions. In 1867 the site became a national cemetery honoring Union soldiers who died in the prison. The United States government in 1873, the state of Maine in 1908, and the state of Pennsylvania in 1909 erected memorials at the cemetery. Today, visitors taking the Salisbury Civil War Sites Driving Tour can see the prison site, a remaining guard building, and the national cemetery.

From: learnnc.org

Image: A "Bird's Eye View" of the Confederate prison at Salisbury as it existed in 1864, published in the North some years after the war. (Illustration by C. A. Kraus, 1886, published by J. H. Bufford's Sons Lith., Boston, New York, & Chicago


Soldiers' Food

By John Heiser, Gettysburg National Military Park.

By far, the food soldiers received has been the source of more stories than any other aspect of army life. The Union soldier received a variety of edibles. The food issue, or ration, was usually meant to last three days while on active campaign and was based on the general staples of meat and bread. Meat usually came in the form of salted pork or, on rare occasions, fresh beef. Rations of pork or beef were boiled, broiled or fried over open campfires. Army bread was a flour biscuit called hardtack, re-named “tooth-dullers,” “worm castles,” and “sheet iron crackers” by the soldiers who ate them. Hardtack could be eaten plain though most men preferred to toast them over a fire, crumble them into soups, or crumble and fry them with their pork and bacon fat in a dish called skillygalee. Other food items included rice, peas, beans, dried fruit, potatoes, molasses, vinegar, and salt. Baked beans were a northern favorite when the time could be taken to prepare them and a cooking pot with a lid could be obtained. Coffee was a most desirable staple and some soldiers considered the issue of coffee and accompanying sugar more important than anything else. Coffee beans were distributed green so it was up to the soldiers to roast and grind them. The task for this most desirable of beverages was worth every second as former soldier John Billings recalled: “What a Godsend it seemed to us at times! How often after being completely jaded by a night march… have I had a wash, if there was water to be had, made and drunk my pint or so of coffee and felt as fresh and invigorated as if just arisen from a night’s sound sleep!”

Soldiers often grouped themselves into a “mess” to combine and share rations, often with one soldier selected as cook or split duty between he and another man. But while on active campaign, rations were usually prepared by each man to the individual’s taste. It was considered important for the men to cook the meat ration as soon as it was issued, for it could be eaten cold if activity prevented cook fires. A common campaign dinner was salted pork sliced over hardtack with coffee boiled in tin cups that each man carried.
The southern soldier’s diet was considerably different from his northern counterpart and usually in much less quantity. The average Confederate subsisted on bacon, cornmeal, molasses, peas, tobacco, vegetables and rice. They also received a coffee substitute which was not as desirable as the real coffee northerners had. Trades of tobacco for coffee were quite common throughout the war when fighting was not underway. Other items for trade or barter included newspapers, sewing needles, buttons, and currency.

From: learnnc.org

Image: Hardtack, a dry flour biscuit, made up a large portion of a soldier’s daily ration. Factories in the North baked hundreds of hardtack crackers every day, packed them in wooden crates and shipped them out by wagon or rail. If the hardtack was received soon after leaving the factory, it could be tasty and satisfying. Usually, the hardtack did not get to the soldiers until months after it had been made. By that time, they were too hard to be eaten without first being soaked in water or coffee. Sometimes they were infested with small bugs the soldiers called weevils.


Something to Eat

Major General Bryan Grimes to his daughter, April 16, 1862, in the Bryan Grimes Papers, North Carolina State Archives.

Yorktown — Va
April 16, 1862

My Dear Little Darling,
Your letters Cannot find me So I will write to you in order that you may know where to direct your letters.… at present I am stationed at Yorktown with the enemy in front of us not more than 1200 yds distant who are continually shoveling their big shot at us/ just as I had written that Sentence a large bomb in weight much heavier than you, Came rushing through the air which made us all drop flat upon the ground and fell within our regimental Camp not more than thirty or forty yds from where I am writing/ Three hours have elapsed since I Concluded the last Sentence the shells and shot of the enemy became too frequent and in too close proximity to us to remain quiet. So the regiment has been formed in what is called “line of battle,” and all… the positions in which we were ordered to stand or die but the firing gets slower and slower and in Consequence we have broke ranks to get something to eat. what at home would be a dinner but now it is merely a “filling up” to appease the cravings of hunger.… What would you think to See great grown Men eating Molasses and Sopping it out of an Oyster shell? and being well satisfied to be able to procure it any way. Our spoons were made by ourselves from a splint of pine — though for a week past we have had only Sassafras tea to drink and strange to say find it very palateable. We use Crackers… for plates and have found one great advantage in them that when we have finished all upon our plates — we turn in and eat them.… You doubtless would laught heartily to See us eating our meals. We frequently have the Colonels and Generals to dine and we all have to take it alike.… all this can be stood much better than laying down upon the… ground or at best upon one plank with not a particle of Covering to keep me warm — I frequently feel as tired when I wake as I did upon laying down and every bone in my body apparently grumbling at such rough treatment.… Dont you think we have hard times here — with nothing to sleep upon & but little time to do it even if we had an abundance of Necessary Covering. What will you think when I tell you that only one night Since the 8th day of March have I taken off any of my clothing to go to sleep and that Now I sleep with boots and all and half the time with Sword and pistol attached to my person — to be prepared to meet the foe at any Minute — but little to eat and Nothing to eat it upon — with the Yankees within 1/2 Mile shooting at us upon all occasions whenever we show ourselves — Not since my arrival here on the 10th of April has there been two Consecutive hours without their firing into our Camp and Sometimes at the rate of fifty a Minute — last Sunday night at about 2 O’Clock we all thought the battle was opened — Such a hail storm of iron and lead I had never Conceived of.… If you wish to imagine how a bomb or shot Sounds as it Come whizzing through the air get Spelman to make you a “whirlgig” that children often play with and whirl it around a few times and then the noise that it makes somewhat resembles the Sound except that you can hear the ball — that is a large one from a half Mile — and have time to drop behind the breastwork for protection.… Write me immediately upon the receipt of this… be a good girl — Remember me to all the family —
Afft. your father,
Bryan Grimes

From: learnnc.org


Life in Camp

Walter Waightstill Lenoir to Selina Louisa Avery Lenoir, March 2, 1862, in the Lenoir Family Papers, Southern Historical Collection, University of North Carolina at Chapel Hill.

Camp Lee, S. C., Mch. 2d 1862

Dear Mother,
As I write so many letters home to let you all hear from me and brother Tom, I will commence by telling you something about myself and him. I continue in very fine health, with my digestion improved, and hardly ever deranged now, even by my hearty meals which are always somewhat in excess. But I enjoy Uriah’s coarse corn bread & wheat bread & fried midling & rice & potatoes, so much so that it is hard to stop when I have eat enough. We have been out of coffee for some time, but are doing very well without it, & have all become so fond of Yeopon tea that we will continue to use it, although we have now got a new supply of coffee, at 75 cts per lb. I find the Yeopon so palatable & apparently wholesome that I would be glad to know that you had sent for a supply to Wilmington or Newberne. I have advised Mr Norwood by all means to order a bushel. I do not know that I am fattening any, but I am increasing in weight by the development of the muscles of my arms and legs, which are growing perceptibly larger & harder. All this fine progress which I am making as to my health, by becoming a soldier & adopting the life of the camps may of course be upset at any time by an attack of fever, if I escape safely from the other dangers of war. I am not, however, entirely negligent of my health. With the exception of eating too much, I am, I think, reasonably prudent in regulating my diet. I have my hair now trimmed quite short, without having caught cold by its loss, and I wash myself every morning to my waist carefully with cold water, including the whole of my head in the ablution; and then rub myself dry with a towel. And I wash my whole person at least once a week. I change my shirt, drawers, and socks but once a week, as soldiers can’t afford to be fastidious about their wardrobe. I don’t wear the cotton shirts that I brought, the [unclear] ones being quite sufficient to keep me warm in this mild climate, and I have very seldom worn my great heavy overcoat, but my other clothing has not become oppressively warm, as I can leave off the coat or waistcoat or both in the warmest weather. My heavy jeans will soon, however, I suppose, be quite unsuitable for the climate here. I will try, though, if we still remain here to supply myself if necessary with something lighter. I am more cheerful and light hearted here than I could possibly be at home during the continuance of the war, and on the whole may be said to enjoy myself amazingly, all things considered. The worst of it is I am getting gray much too fast.…
Your affectionate son
Walter

Image: This photograph of an encampment at Cumberland Landing, Virginia, was taken from a hill above the camp.

From: learnnc.org


A Plea for Supplies

Lt. Col. S. H. Walkup to Gov. Zebulon Vance, October 11, 1862, in the Governors Papers, North Carolina State Archives.
Camp Near Winchester Va. Octr 11th, 1862.

(This letter from Lt. Col. S. H. Walkup to North Carolina Governor Zebulon Vance describes the pitiful situation of Confederate troops in the fall of 1862.

From the beginning, the Confederacy was ill prepared for war. The Confederacy did not have a large supply of arms or ammunition and hoped to import the necessary tools of war from Europe. Most Confederate soldiers brought their own guns to war. The South also lacked factories for producing clothing or shoes, and by the middle of the war, soldiers were in desperate need of both. Food, too, became scarce as the Union blockade prevented the South from importing necessities from the Caribbean and Europe.

Making matters worse, the South had a much smaller population than the North, and most of its able-bodied men were eventually drafted into the army. This left few men at home to help grow food. Prices soared during the war, and the government had to pay extraordinary prices to speculators who bought up food and resold it at a great profit — or else simply confiscate the much-needed supplies.

By the end of the war, the lack of food, clothing, and equipment motivated thousands of men to leave the army. Not only were they starving and suffering, but the lack of supplies indicated to soldiers that their cause was hopeless — if the South couldn’t even provide soldiers with shoes, it was unlikely that the Confederacy would be victorious.

As you can see from this letter, the army was having trouble supplying its troops only a year and a half into the war.)

Govr. Z. B. Vance,

I lay before you for your consideration the destitute condition of our Regt. with the hope that you, who have experienced some of the severe trials of a soldiers life, may hasten up the requisite relief --
We have present Six hundred & nineteen men rank & file in the 48th Regt. N.C. Troops — There are of that number Fifty one who are completely & absolutely Barefooted — & one hundred & ninety four who are nearly as bad off, as Barefooted, & who will be altogether so, in less than one month. There are but Two hundred & ninety seven Blankets in the Regt. among the 619 men, which is less than one Blanket to evry two men.

In truth there is one Compy (I) having 66 men & only Eleven Blankets in the whole company — The pants are generally ragged & out at the seats — & there are less than three cooking utensils to each Company — This sir is the condition of our Regt. upon the eve of winter here among the mountains of Va. cut off from all supplies from home & worn down & thinned with incessant marchings, fighting & diseases — can any one wonder that our Regt. numbering over 1250 rank & file has more than half its no. absent from camp, & not much over one third 449 of them fit for duty? The country is filled with Stragglers, deserters, & sick men & the hospitals are crowded from these exposures. A spirit of disaffection is rapidly engendering among the soldiers which threatens to show itsef in general Straggling & desertion, if it does not lead to open mutiny.
Add to this that our surgeons have no medicines & don’t even pretend to prescribe for the sick in camp, having no medicines & you have an outline of the sufferings & prospective trials & difficulties under which we labor.…

Want we most pressingly need just now is our full supply of Blankets, of Shoes & of pants & socks. We need very much all our other clothing too. But we are in the greatest need of these indispensable articles & Must have them, & have them Now. Otherwise how can the Government blame the soldier for failing to render service, when it fails to fulfil its stipullated & paid for contracts? A contract broken on one side is broken on all sides & void.…

The soldiers of the 48th N.C. & from all the State will patriotically suffer & bear their hardships & privations as long as those from any other State, or as far as human endurance can tolerate such privations, But it would not be wise to experiment to far in such times & under such circumstances as now surround us upon the extent of their endurance. With Lincolns proclamation promising freedom to the slaves, What might the suffering, exhausted, ragged, barefooted, & dying Non slaveholders of the South, who are neglected by their government & whose suffering families at home are exposed to so many evils, begin to conclude? Would it not be dangerous to tempt them with too great trials?

Dear Sir… I feel the very earnest & solemn responsibility of my position as commander of this Regt. at this critical period & under these trying circumstances & wish to do all I can… to remove the evils by seeking a speedy supply of Blankets, Shoes & clothing. & therefore beg your earnest attention to the premises & your zealous & I hope efficient aid to supply our necessities.…
Your Excellencys most obt Servt.
S. H. Walkup Lt. Col. [Commanding]
48th Regt. NC Troops

From: learnnc.org


Enduring Amputation

Letter from Walter Waightstill Lenoir to Thomas Lenoir, April 8, 1863, in the Lenoir Family Papers, Southern Historical Collection, University of North Carolina at Chapel Hill.

(Walter Waightstill Lenoir was born in 1823 into the wealthy Lenoir family. He attended the University of North Carolina and practiced law in North Carolina before the Civil War. Although Lenior opposed slavery and disagreed with secession, he joined the Confederate army in January 1862. In September 1862, Lenoir was injured and his right leg was amputated. He returned to his family and moved to Haywood County, where he became a farmer. In 1883, he was elected as a representative to the North Carolina Assembly and served one term.

It is estimated that about 30,000 Union troops had a limb amputated, and it is probable that as many Confederate troops suffered a similar fate.)

Dear Thomas
My leg is finished at last, and I have been using it for over a week. It is, I suppose, as good as they make ‘em,’ but it is a wretched substitute for the one that I left in Virginia. It will take me a good while to become enough accustomed to it to know how it will do, as the skin and flesh where the weight is received will have to become hardened by degrees. At present I can’t walk near as well with it as I could with the one Rufus made me; but as I learned that others had the same difficulty at first in using such legs I will not get out of heart yet. I will have to make up my mind however to take very little exercise and to do very little work, which goes hard when I think how much I ought to do. I am greatly pleased to find that I can ride with ease, though I will have to have a gentle and sure footed horse to ride in safety. I can sit, too, much more comfortably with the new leg than I could with the old one.
Your Brother
WW Lenoir

From: learnnc.org



Civil War Army Hospitals

From "To Bind Up the Nation's Wounds: Medicine During the Civil War."
Provided by National Museum of Health and Medicine.

Nearly 200,000 men lost their lives from enemy fire during the four years of the war. However, more than 400,000 soldiers were killed by an enemy that took no side — disease.

From our modern perspective, medicine during the Civil War seems primitive. Doctors received limited medical education. Most surgeons lacked familiarity with gunshot wounds. The newly-developed minie ball produced grisly wounds that were difficult to treat. The Northern and Southern medical departments were ill-prepared for removing wounded men from the battlefield and transporting them to hospitals. Systems to provide hospital care for the sick and wounded had not been developed. Blood typing, X-rays, antibiotics, and modern medical tests and procedures were nonexistent.

Open latrines, decomposing food, and unclean water were the rule in the camps. Diarrheal diseases affected nearly every soldier and killed hundreds of thousands of men. Although surgeons used ether and chloroform routinely as anesthetics, surgery was performed with unwashed hands and unclean instruments, resulting in infected wounds. The most effective drugs were the pain-killers opium and morphine, while many of the other available drugs were useless or harmful. Despite these limitations, Civil War doctors achieved some remarkable successes in treating the wounded and comforting the sick.

Popular but generally incorrect images of Civil War medicine involve surgery-amputations without anesthesia, piles of arms and legs, the surgeon as a butcher. By modern standards, wartime surgery was limited. Despite the lack of both surgical experience and sanitary conditions, the survival rate among those who underwent the knife was better than in previous wars. Amputation was not the only surgical recourse available. Surgeons also extracted bullets, operated on fractured skulls, reconstructed damaged facial structures, and removed sections of broken bones.

As bullets hit their victims, shattered bone and shredded flesh became the calling cards of the minie ball. Most of the surgeons who had come from civilian practices had little or no experience in dealing with such wounds. They quickly became aware of the surgical options: remove the limb, remove the fractured portions of bone, or clean the wound and apply a dressing. Union surgeons documented nearly 250,000 wounds from bullets, shrapnel, and other missiles. Fewer than 1,000 cases of wounds from sabers and bayonets were reported.
Walt Whitman describes a battlefield hospital

FALMOUNT, VA., opposite Fredericksburgh, December 21, 1862. — Begin my visits among the camp hospitals in the army of the Potomac. Spend a good part of the day in a large brick mansion on the banks of the Rappahannock, used as a hospital since the battle — seems to have receiv’d only the worst cases. Out doors, at the foot of a tree, within ten yards of the front of the house, I notice a heap of amputated feet, legs, arms, hands, &c., a full load for a one-horse cart. Several dead bodies lie near, each cover’d with its brown woolen blanket. In the door-yard, towards the river, are fresh graves, mostly of officers, their names on pieces of barrel-staves or broken boards, stuck in the dirt. (Most of these bodies were subsequently taken up and transported north to their friends.) The large mansion is quite crowded upstairs and down, everything impromptu, no system, all bad enough, but I have no doubt the best that can be done; all the wounds pretty bad, some frightful, the men in their old clothes, unclean and bloody. Some of the wounded are rebel soldiers and officers, prisoners. One, a Mississippian, a captain, hit badly in leg, I talk’d with some time; he ask’d me for papers, which I gave him. (I saw him three months afterward in Washington, with his leg amputated, doing well.) I went through the rooms, downstairs and up. Some of the men were dying. I had nothing to give at that visit, but wrote a few letters to folks home, mothers, &c. Also talk’d to three or four, who seem’d most susceptible to it, and needing it.
— Walt Whitman, Specimen Days

Image: A U.S. Army field hospital in Savage Station, Virginia, during the Peninsular Campaign of May–August 1862. (Photograph by James F. Gibson in Civil War photographs, 1861-1865, compiled by Hirst D. Milhollen and Donald H. Mugridge (Washington, D.C.: Library of Congress, 1977), No. 0090

From: learnnc.org


William Hammond and the End of the Medical Middle Ages

By Pat Leonard, April 27, 2012

While other events of April 25, 1862, dominated the nation’s headlines — most notably the Confederate surrender of New Orleans — perhaps the most significant single event in the life of the average Union soldier was a presidential appointment that day that was hardly noticed outside Washington. Over the objection of Edwin Stanton, his secretary of war, President Lincoln named William Alexander Hammond as surgeon general of the Army.

Hammond was the preferred candidate of Gen. George B. McClellan and the handpicked choice of the United States Sanitary Commission, a civilian organization created to improve Army living conditions. Though only 33 years old and holding just an assistant surgeon’s rank, Hammond had attracted the commission’s attention through his work as an inspector of camps and hospitals.

Hammond quickly proved he was up to the job. Possessing a brilliant organizational mind and boundless energy, he started making changes at every level of the Army Medical Department. He established more stringent requirements for physicians joining the service and set up examination boards to evaluate their qualifications. He initiated a hospital inspection system and designed new pavilion hospitals with strict specifications for layout, lighting, ventilation and patient space allotments.

He standardized a medication table for military use, established laboratories to manufacture needed pharmaceuticals, founded the Army Medical Museum and collected information that formed the basis of The Medical and Surgical History of the War of the Rebellion. Finding no suitable text on the subject of hygiene, Hammond took pen in hand and wrote the industry standard, one of 30 books and more than 400 articles he would write in his lifetime. Hammond revolutionized the practice of military medicine almost overnight, saving the lives of thousands of men in the process.

Much of what Hammond advocated he had learned from his 11 years as an Army assistant surgeon in remote outposts, including present-day Arizona, Kansas and Florida. Unable to sustain a growing family on military pay, he had resigned his commission in 1860 to become an instructor at the University of Maryland Medical School in Baltimore.

He was in this position when he first attended to wounded Union soldiers: the Sixth Massachusetts Regiment, passing through Baltimore on its way to Washington, was attacked by a proslavery mob in April 1861. Hammond’s diligent treatment of the injured men led to his being offered the position of surgeon of a rebel regiment, an offer he rejected “with no great fastidiousness in the choice of his language.”

Hammond rejoined the Union Army shortly thereafter and was made a hospital and camp inspector in Maryland and what would soon become West Virginia. He impressed his superiors, as well as the Sanitary Commission, with his detailed reports and strident requests for improved hygiene. Those who met him found him equally impressive in person, standing 6 feet 2 inches tall with a booming voice that, one admirer said, “could be heard upwind in a hurricane.”

Appreciating Hammond’s talents from a distance, however, was apparently easier than working with him directly. Throughout his tenure as surgeon general, peers and subordinates described him as arrogant, impetuous, boastful and insensitive. Stanton, who had favored another, more senior officer for the pre-eminent medical post, found Hammond’s personality insufferable and his incessant demands excessive. Illustrating that point was Hammond’s $10 million budget for the 1863 fiscal year, which was four times what his predecessor had requested for 1862 – and which he still managed to overspend by 15 percent.

But the young surgeon general was effective. By one estimate – arrived at by taking the rate of mortality among sick and wounded soldiers in the war’s first chaotic year and extrapolating it across the carnage that followed – Hammond’s initiatives saved nearly 26,000 lives. Such calculations are guesswork, but there’s no question that his measures resulted in substantial improvements in the care and outcomes afforded Union soldiers and captured Confederates.

Yet even with his state-of-the-art initiatives to improve sanitation and save lives, Hammond was fighting an uphill battle. The American Civil War was fought during what he would later describe as “the end of the medical Middle Ages.” An understanding of germ theory was still a decade away, and thousands died not from their wounds but from infections or gangrene that developed later. During and following a major battle, doctors performed amputations by the hundreds, sawing off mangled limbs as quickly as men could be lifted onto makeshift operating tables, without so much as wiping their blades between procedures. The death rate following amputations ranged as high as 50 percent, especially when major limbs were involved or when soldiers had to wait more than a few hours to be treated.

And that wasn’t the worst of it. The greatest menace to Civil War soldiers was not enemy fire, nor even the infections that almost always inflamed their wounds and/or stumps. The majority of field fatalities – an estimated three out of five among Union dead, and two out of three among Confederates – were caused by preventable diseases that swept through camps and hospitals, including dysentery, typhoid fever, pneumonia, tuberculosis and even “childhood” ailments like measles, chickenpox and whooping cough.

Writing home, soldiers often remarked that they didn’t fear the big battles as much as being taken to a hospital, where they would be exposed to killers they couldn’t see and didn’t understand.

Hammond persevered through all of this, but at last his peremptory directives started to turn even some of his supporters against him, especially when he revised the approved medication table in 1863, removing two drugs that were very popular with surgeons in the field.

Sensing an opportunity, Stanton assembled a committee in July 1863 to investigate the Medical Department. Among the members of this committee were known rivals of Hammond, including a man he described as a “vulgar ignoramus” and another he had denounced as “unscrupulous, dishonest, cowardly and ignorant.” It can safely be surmised that such men would not be favorably, or even impartially, disposed toward the surgeon general.

Five weeks after the committee began its investigation, Stanton dispatched Hammond on an inspection tour of facilities in the South and West, and two days later replaced him with a surrogate. Hammond’s wife suspected something underhanded was taking place and asked Stanton if he intended to discharge her husband. The secretary denied her suspicions.

Returning from his inspection tour in late 1863, Hammond demanded his position back, or to be court-martialed. He tried to appeal to Lincoln, but – with the Sanitary Commission’s influence waning and Hammond’s former champion, McClellan, now a political foe – the president chose to ignore him. In all probability, Lincoln had tired of the bickering between Stanton and Hammond, and had decided to let his secretary of war handle the matter himself.

And handle it Stanton did, convening a court-martial staffed by nine generals hand-selected for the task, none of whom had a medical background but nearly all of whom either disliked Hammond or were beholden to Stanton. Hammond welcomed the trial, naïvely believing that his innocence would guarantee his exoneration.

Based on the investigating committee’s report, 3 charges and 10 specifications were brought against Hammond. These included a hodgepodge of accusations ranging from overpayment of suppliers to procurement of inferior goods to that military catch-all, conduct unbecoming an officer and a gentleman. Some of the charges were absurd and some, though plausible, were hardly criminal, given the exigencies of an all-consuming war. (If everyone who ever overpaid for military supplies was court-martialed for doing so, the War Department would have ceased to exist long before Hammond came along.)

Stanton not only stacked the deck; he didn’t even deal Hammond a playable hand. When Hammond requested a copy of the investigating committee’s report, Stanton refused. When, during the trial, Hammond presented a purchase order showing that Stanton had approved a procurement named in the specifications, the court would not allow it to be placed into evidence. And Hammond was unable to present a letter that would have exculpated him of one of the more serious charges — because it had mysteriously disappeared when his office was burglarized.

After nearly seven months of trial and 25,000 pages of testimony, the board deliberated for just 90 minutes before returning a guilty verdict on all three charges and most of the specifications. They removed references to corruption and tainted goods from the verdict, but nevertheless ordered Hammond “dismissed from the service and to be forever disqualified from holding any office of profit or trust under the Government of the United States.”

Again Hammond tried to appeal to Lincoln, as did his wife, but the president declined to see either of them. Lincoln approved the guilty verdict on Aug. 18, 1864, and Hammond was dishonorably discharged 10 days later.

The New York Times piled on in an Aug. 23 editorial, calling Hammond’s guilt “of a very vile sort,” asserting he had “stooped to the level of the lowest shoddy knave” and predicting “he will be remembered only to be loathed.” A day later, however, after receiving a letter from Hammond himself – in which he promised a review of the case and declared he had been “the victim of conspiracy, false swearing, and a malignant abuse of official power” – the Times backpedaled, admitting “we know nothing of the case beyond the fact of conviction,” and maintaining “we shall be most heartily rejoiced to be convinced of his innocence.”

Hammond moved to New York City and set out to have his conviction overturned and to rehabilitate his reputation. Though nearly penniless – “I did not know where my next meal was going to come from,” he wrote of this period – Hammond used his connections to set up a practice in the still-infant field of neurology, and within a decade he was one of the highest-paid physicians in the country.

In 1878, Hammond returned to Washington to restore his good name. He received a Congressional hearing, and both houses passed a bill annulling the court-martial proceedings and sentence. It was signed by President Rutherford B. Hayes on Aug. 27, 1879, and Hammond’s name was placed on the retired list of the Army as surgeon general with the rank of brigadier general.

Nine years later, Hammond sold his practice and moved from New York to Washington. He established a sanitarium and unfortunately engaged in some questionable business practices, which eroded the reputation he had fought so hard to regain. Ever flamboyant and ever the self-promoter, he had himself fitted with a surgeon general’s uniform late in life, for no other purpose than to have a portrait of himself painted. He died in 1900 at the age of 71.

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Sources: Bonnie Ellen Blustein, “Preserve Your Love For Science: Life of William A. Hammond, American Neurologist”; Frank R. Freemont, “Gangrene and Glory”; “The Embattled Surgeon, General William A. Hammond,” Alex Zeidenfelt, Civil War Times Illustrated, October 1978; Glenna R. Schroeder-Lein, The Encyclopedia of Civil War Medicine.

Pat Leonard is the editor and publisher of The Gold Cross, a magazine for volunteer E.M.T.s in New Jersey. He has written two novels, “Proceed With Caution” and “Damned If You Do.” His great-greatgreat uncle, Sgt. Jerome Leonard, 55th Pennsylvania Infantry, was wounded at the Battle of Cold Harbor and later died at Bermuda Hundred hospital after his leg was amputated.

From: opinionator.blogspot.nytimes.com


Civil War Era Photographs: Retinal Tissue

From: museumofvision.org

One of the least generally known uses of early medical photography was the work of New York surgeon Reed Brockway Bontecou, who photographed wounded Civil War soldiers between 1864 and 1865. He provides the earliest records of wounded and healed-state conditions of ocular injuries. Bontecou’s images are significant documents of pre-antiseptic era infection states and many of his cases were reproduced as engravings by the Surgeon General’s Office.

Photographs of retinal tissue, both gross and microscopic views, were important research tools used to identify retinal cell components and disease states. Budding ophthalmologists William Thompson and William Norris worked during the Civil War to create some of the highest magnification views of the retina.  However, photomicroscopic views of the retina did not begin to appear in medical journals until the mid 1880s. Here we see an illustration of the photomicrography apparatus as published in the “Catalogue of the Medical Section of the U.S. Army Medical Museum” in 1867.

In the mid 1860s gross pathological views of the retina played a surprising role in medico-legal medicine. Some criminologists believed the retina functioned exactly like film and that at death, a permanent image was formed on the retina that was the last scene observed by the deceased. Thus a murderer could be identified by his image on the retina of a murder victim. In 1868, photographs of the retina called ‘optograms’ were taken and published to disprove the idea.  Despite its implausibility the idea lives on in folk tales and some murderers destroy the eyes of their victims so as not to be identified.

The End of the Gutbuster

By Pat Leonard, July 5, 2012

July 4, 1862, was hardly a day of celebration for the soldiers of the Union’s Army of the Potomac. Having been routed during the recent Seven Days battles by their new lead adversary, Robert E. Lee, the demoralized men in blue were left clinging to a scrap of the Virginia Peninsula, their earlier cries of “On to Richmond!” now just a bitter memory.

The soldiers could not have known then, and would not know until years later, the immense impact on their lives that would be wielded by the single unassuming officer who entered their camps that day. Thousands of these men (and their eventual replacements) would perish in future battles, but thousands more would survive those battles, thanks to that solitary officer: Dr. Jonathan Letterman, who was reporting for duty as the Army of the Potomac’s new medical director.

If ever a man was the right person for a job, at the moment when his skills were most desperately needed, it was Letterman at the conclusion of George McClellan’s ill-fated Peninsula Campaign. An Army medical officer since 1849, Letterman was selected for the medical director position by his longtime friend and colleague, the surgeon general William Hammond. Letterman had previously served with both McClellan and Hammond in western Virginia, and the latter two men had conferred and agreed upon his appointment. For his part, Letterman later wrote: “It was a position I did not seek; it was one I could not decline.”

As good friends often are, Hammond and Letterman were complete opposites. Hammond was loud, impulsive and self-aggrandizing, while Letterman was soft-spoken, modest and methodical. Yet what both men held in common – an unflagging desire to reduce the sufferings and preserve the health of Union soldiers – made them an effective team during the Civil War’s most turbulent period.

Arriving on the peninsula, Letterman found an army not only in disarray but also in extremely poor health. Exhausted by ceaseless campaigning, ill-nourished and living in filthy conditions, some 25 percent of the men were suffering from a host of diseases like malaria, typhoid fever and scurvy. Letterman immediately set about improving their situation, requisitioning fruits and vegetables for their diet, implementing sanitary measures in their camps and evacuating men who were too sick or disabled to fight.

Letterman then turned his attention to the organizational deficiencies that had plagued the Army’s medical services since the Battle of Bull Run. He developed an independent ambulance corps, made up of men taken from the ranks to preserve unit cohesion, who would be trained in life-saving measures. He perfected and put into practice a triage system, similar to one developed by Napoleon’s armies, to bring about the best possible outcomes for the greatest number of wounded men. And he reformed field hospital operations, which had been divided by regiments and had often resulted in some stations being overwhelmed during battle while others stood idle.

McClellan gave Letterman a free hand to implement many of these reforms, issuing general orders that Letterman had actually composed, while others were instituted out of sheer necessity. For example, when Gen. John Pope’s Army of Virginia – which had not adopted the “Letterman system” – was crushed at the Second Battle of Bull Run in late August 1862, wounded Union men laid on the field for days, needlessly suffering and dying from thirst, exposure and starvation. Hammond was so outraged that he wrote a scathing letter to his superiors, Secretary of War Edwin Stanton and General-in-Chief Henry Halleck, demanding that Letterman’s reforms be embraced throughout the Army. Stanton, who did not like Hammond, and Halleck, who did not like change, refused, but the arrival of thousands of near-dead men on Washington’s doorstep, and the firestorm that ensued (fanned by the writings and speeches of an influential Boston physician, Henry Bowditch), eventually caused the upper echelons to relent.

Letterman modified his system as the war intensified. He soon discontinued the use of two-wheeled ambulances, which were highly maneuverable but so harsh-riding and prone to overturning that the men who were transported in them took to calling them “avalanches” and “gutbusters.”

Letterman’s system received its first real test at the Battle of Antietam in September 1862. Knowing roughly where and when the battle would take place, he and his staff rode hard to survey the countryside and established hospitals in barns, churches and other structures that could accommodate dozens, and in some cases hundreds, of wounded men.

The ambulance corps performed well at that battle, removing 8,350 wounded Union soldiers and more than 2,000 wounded Confederates from the field in less than two days. Medical supplies ran short, however, thanks to the enemy’s destruction of railroad bridges in the Army’s rear. This disruption caused Letterman to make yet another reform in his system to improve the distribution of supplies and reduce waste.

Writing after the war, Letterman commented on two additional practices developed in the wake of the Antietam bloodbath. One was his insistence that severely wounded soldiers not be released to well-meaning relatives who came to the field to take their loved ones home. Letterman believed that soldiers recuperated better at field hospitals along with their comrades and that unnecessary transport to faraway homes would more likely kill than heal them.

Moreover, in explaining his rationale for providing equal care to Confederate wounded, he made a statement of compassion with which he has ever since been identified. “Humanity teaches us that a wounded and prostrate foe is no longer our enemy,” he wrote in his memoir, “Medical Recollections of the Army of the Potomac.”

At the time, however, Letterman was not quite so charitable to those who criticized the surgeons under his command. Following the engagements at South Mountain and Antietam he wrote:

The surgery of these battle-fields has been pronounced butchery. Gross misrepresentations of the conduct of medical officers have been made and scattered broadcast over the country, causing deep and heart-rending anxiety to those who had friends or relatives in the army, who might at any moment require the services of a surgeon. These sweeping denunciations against a class of men who will favorably compare with the military surgeons of any country, because of the incompetency and short-comings of a few, are wrong, and do injustice to a body of men who have labored faithfully and well.

Letterman had to repeatedly make this point to the American public because, as another writer observed, “sick and wounded soldiers and their families tended to thank God when things went well, but blamed the physicians when things went badly.”

At the Army of the Potomac’s next major battle – Fredericksburg, in December 1862 – the Letterman system worked so admirably that, in spite of a resounding defeat, all of the Union wounded were removed from the battlefield and taken to field hospitals in less than 12 hours. Learning of this feat, Gen. Ulysses S. Grant shortly thereafter ordered the implementation of Letterman’s system for all the western armies, which gradually led to its official adoption through an act of Congress.

Yet Letterman still had more life-saving contributions to make. At the Battle of Chancellorsville, in May 1863, it was his ceaseless entreaties to his superiors, as well as his negotiations with his Confederate counterparts, that brought about the construction of a pontoon bridge over the Rappahannock River when the fighting had ended — a step that allowed medical supplies and personnel to reach the field, and to evacuate thousands of wounded who would have otherwise been abandoned.

Less than two months later, from July 1 to 3, the Army of the Potomac fought its most horrific battle, at Gettysburg. Because its location had not been planned by either side, when the battle commenced the ambulance train and medical supplies were still many miles away. Nevertheless, the ambulance corps marched as rigorously as the fighting men to reach the field (stretcher-bearers and hospital stewards not being allowed to ride in the ambulances), and then labored through the next three days, with little or no rest, to retrieve the wounded.

It is difficult to grasp the extent of the carnage that Letterman’s corps had to deal with at Gettysburg, but one way to envision it is through a modern example: the number of men treated for battle wounds – nearly 21,000 Union soldiers and Confederate prisoners – would fill up every bed in the 14 largest hospitals in America today. And that figure does not include thousands more Confederate wounded who were evacuated with Lee’s retreating army.

In spite of the staggering number of casualties, the Medical Corps performed magnificently: every single wounded soldier was removed from the battlefield to one of 160 field hospitals by the following day (July 4, 1863), while a massive 80-acre tent hospital – named Camp Letterman by the men – was set up on a farm field a mile and a half to the east. The tents were erected in six rows of roughly 24 tents each, with each tent capable of holding 12 or 14 cots. When they were well enough to travel, more than 3,000 men were cycled from Camp Letterman to hospitals in Philadelphia, Baltimore and Washington. Camp Letterman remained open until Nov. 20, 1863, the day after Lincoln delivered the Gettysburg Address.

Illustrating the effectiveness of the corps’ prompt and expert action was the low mortality rate among the wounded. While an estimated 25 percent of soldiers died of their wounds during the first two years of the war, at Gettysburg less than 10 percent perished.

Gettysburg was the last battle at which Jonathan Letterman served as the Army of the Potomac’s medical director. He was granted a leave during October 1863, during which he married Miss Mary Digges Lee of Maryland. At his own request, he was relieved of his position at the end of 1863, and served for less than a year as inspector of hospitals with the Department of the Susquehanna. He resigned from the Army in December 1864 and moved to San Francisco. Despondent after his wife died in 1867, Letterman himself succumbed to intestinal ailments on March 13, 1872. He was just 47. In his honor, the Army hospital at the Presidio in San Francisco was renamed Letterman Hospital in 1911.

Today Letterman is recognized worldwide as the father of modern battlefield medicine. His coordinated system was adopted by European armies (where it was known as the “American system”) and remained the pattern of organization for battlefield medicine until it was replaced, almost a century later, by helicopter evacuation. His system of triage, with some modifications, remains the standard for E.M.S. units today.

After the Civil War, many of Letterman’s colleagues praised him and his many reforms in their memoirs. Yet it wasn’t until 80 years after his death that he was paid perhaps the greatest tribute when Maj. Gen. Paul Hawley, chief surgeon of the European Theater of Operations during World War II, wrote to a friend: “I often wondered whether, had I been confronted with the primitive system which Letterman fell heir to at the beginning of the Civil War, I could have developed as good an organization as he did. I doubt it. There was not a day during World War II that I did not thank God for Jonathan Letterman.”

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Image: Dr. Jonathan Letterman (seated, left) and his staff.Library of Congress

From: opinionator.blogspot.nytimes.com

Sources: Jonathan Letterman, “Medical Recollections of the Army of the Potomac”; Alfred Jay Bollet, “Civil War Medicine: Challenges & Triumphs”; Gordon E. Dammann, “Jonathan A. Letterman, Surgeon for the Soldiers”; Bennett A. Clements, “Memoir of Jonathan Letterman”; Robert E. Denney, “Civil War Medicine: Care and Comfort of the Wounded”; Frank R. Freemon, “Gangrene and Glory”; Glenna R. Schroeder-Lein, “Encyclopedia of Civil War Medicine.”

Pat Leonard is the editor and publisher of The Gold Cross, a magazine for volunteer E.M.T.s in New Jersey. He has written two novels, “Proceed With Caution” and “Damned If You Do.” His great-greatgreat uncle, Sgt. Jerome Leonard, 55th Pennsylvania Infantry, was wounded at the Battle of Cold Harbor and later died at Bermuda Hundred hospital after his leg was amputated.


The Minister of Death

By Carole Emberton, August 17, 2012

From April 29 to May 30, 1862, some 300,000 men — including my great-great grandfather, Pvt. Edward Willis — converged at the tiny railroad depot of Corinth, in northern Mississippi, where they laid siege to the Confederate forces under Gen. P.G.T. Beauregard. The Union soldiers scarred the landscape with miles of earthen fortifications. But the trenches could not protect Edward and his fellow soldiers from what Thomas Macaulay called “the most terrible of all the ministers of death,” a predator that craved those close, confined spaces, where men’s blood, breath and spit mingled freely. Although they fought on opposite sides of the trenches, the Union and Confederate forces shared a common enemy: smallpox.

Edward was hospitalized for the two months following the Union’s capture of Corinth. While his service record gives no reason for his hospitalization, his wife Edith’s pension application after his death in 1878 claimed that he had contracted smallpox while in the Army, “which afflicted his eyes and head, from which condition said soldier never recovered.” It is likely that he spent June and July in a “pest house,” quarantined along with other soldiers displaying signs of what Army doctors called “eruptive fevers” – smallpox, scarlet fever, measles and erysipelas (a bacterial skin infection caused by streptococcus).

Of these infectious diseases, smallpox was not the most common, but it was the most feared. During the course of the war, the Union Army reported only about 12,000 cases of smallpox among white troops, compared to nearly 68,000 cases of measles. However, total deaths from both diseases were about the same — 4,700 and 4,200, respectively — with the death rate from smallpox hovering around 39 percent.

It is little wonder that medical personnel in both armies wrung their hands over the prospect of an impending smallpox epidemic, scouring Northern cities and the Southern countryside in search of small children to inoculate so that their scabs could be harvested to produce “pure vaccine” free from other diseases, like syphilis, that might be transmitted from adults. Fear of the “speckled monster” also led soldiers to take desperate measures, including self-inoculation with the pus from other men’s sores that they believed to be smallpox but could, in fact, be syphilis or some other gangrenous lesion. The resulting infections incapacitated thousands of soldiers for weeks and sometimes months. The inspector general for the Army of Northern Virginia estimated that when the battle of Chancellorsville was fought in May 1863, as many as 5,000 men were unfit for duty due to these “spurious vaccinations.”

It is widely accepted that disease claimed more lives than bullets during the Civil War. The first wave of infection hit new recruits soon after they arrived in camp. Men from rural areas were especially vulnerable, lacking immunity to the childhood diseases to which their urban counterparts most likely had been exposed. Before Edward’s regiment, the 17th Kentucky, left camp at Calhoun where they enrolled, an outbreak of measles “raged through the camp like some attacking army.” According to the unit’s historian, more than 20 men died in those first few months, before they even heard a rebel gun.

Historians of medicine commonly refer to the mid-19th century as the “medical Middle Ages” in the United States because of the lack of understanding about sanitation and contagion, and thanks to a medical profession that lagged behind its European counterparts in procedural knowledge, institutional structure and numbers of certified physicians. When the war began, the Union Army medical division consisted of fewer than 100 surgeons and assistant surgeons. There was no organized ambulance service to remove wounded soldiers from the battlefield, and those who did make it to a squalid camp hospital fared little better than those left to die where they fell. With the help of the United States Sanitary Commission and a reorganization of the Army medical corps, which included the creation of an ambulance corps to rival any European army and a modern general hospital system across the nation, the Civil War revolutionized medical care in the United States. But for those men who fell victim to smallpox and other infectious diseases, modernity mattered little.

Smallpox was an ancient disease. For millenniums, it had followed the routes of trade, empire and war. The earliest descriptions of smallpox’s telltale pustules date from the fourth century A.D. in China. However, scientists believe they have identified smallpox scars on the bodies of Egyptian mummies from the 12th century B.C. “An inveterate camp follower,” according to the historian Michael Willrich, the virus, whose Latin name variola means “spotted,” spread across the globe along with the armies of the Roman, Mongol and Ottoman Empires, claiming the lives of kings, queens and emperors as well as common folk. No one was safe. It followed Europeans to the “New World,” wiping out as much as 90 percent of the indigenous populations of North and South America and the Caribbean. By the time the English physician Edward Jenner introduced the first vaccine for smallpox in 1798, at least 400,000 Europeans were dying each year from the disease.

What made smallpox so deadly? W.W. Brown, a surgeon with the 7th New Hampshire stationed in St. Augustine, Fla., wrote that the disease, “when uncomplicated, requires no medication except an occasional anodyne to allay nervous irritation and procure rest.” Unfortunately, in an era before modern sanitation or antibiotics, not to mention in the middle of a war, few cases were “uncomplicated.” Many of the men stricken with smallpox were already suffering from other ailments – fatigue, malnutrition, typhoid or dysentery. With their immune systems compromised, smallpox struck a deadly blow. In the worst cases of “fulminating and malignant” smallpox, the patient began to bleed out through the mucus membranes and the skin sloughed off in great patches. The virus attacked the internal organs, resulting in “general toxemia” and eventual death. Post-mortem examinations revealed considerable tissue deterioration and severe internal hemorrhaging.

The case of 25-year-old Enos W. Bratcher of the Third Kentucky Cavalry was typical. Bratcher contracted smallpox while in the hospital near Madison, Ind., being treated for tonsillitis. Although the doctors noted that “his general health appeared good,” he also suffered from chronic diarrhea. As with other smallpox patients, doctors treated Bratcher’s sores with a tincture of iodine applied with a small brush to his face, where the pustules congregated and ran together. For pain, he was given the ubiquitous “Dover’s powders,” a crystallized combination of ipecac and morphine dissolved in liquid. He was encouraged to drink fluids, although the prescribed mix of “ale, milk-punch, egg-nog, chicken and beef tea” probably did not appeal to a man suffering from violent nausea. In other cases, when the oozing pustules invaded the mouth and throat, making it difficult for the sufferer to breathe or swallow, doctors gave a small dose of potassium chlorate as a gargle, a solution that could prove fatal if swallowed. In any case, nothing worked for Bratcher. Delirious with fever and with his tongue and teeth turned black, a common occurrence in patients suffering from dehydration and prolonged infection, he died after two weeks of hellish suffering.

For those like Edward, who survived smallpox, the road to recovery could be long. In addition to the pockmarks left on the skin, the disease could cause permanent hair loss, recurring eczema and deformities in limbs resulting from muscle and tissue damage. In men, it could result in sterility. The virus infected the eyes, causing eruptions on the eyelids and scarring of the cornea (the eye problems cited in Edith Willis’s pension application were consistent with the long-term effects of smallpox).

There were psychological effects as well. Walt Whitman may have admired “faces pitted with small-pox over all latherers,” but not everyone saw the scars as symbols of rugged masculinity. Instead, the disease’s association with filth, vagrancy and foreignness could stigmatize survivors long after their bodies had recovered, condemning them to social ostracism and loss of employment.

The racial politics of disease in the era of emancipation also complicated the cultural understanding of smallpox. After multiple epidemics among freed people, smallpox assumed a negative association with blackness, further adding to the popular belief that sufferers were both filthy and inferior. But if black soldiers and freed people suffered from smallpox disproportionately, it wasn’t because they were inherently susceptible to it because of their race. As the historian Jim Downs points out in his recent book on the health care of former slaves, smallpox spread among the freed population because of unsanitary living conditions, including the refusal of local officials to properly bury the dead and burn their belongings, which carried the contagion. Already malnourished and in poor health, many of the slaves flocking to Union lines and joining the ranks of the Federal Army stood little chance against the disease.

Other than his eye problems, I do not know what other scars Edward bore from his battle with smallpox. He had faced down an enemy much older, and in the grand scheme of things far deadlier, than the Confederacy. But there were no medals earned from his victory. By August 1862, he was back on duty, driving the commissary wagon.

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Sources: The Medical and Surgical History of the War of the Rebellion; John Blackburn, “A Hundred Miles, A Hundred Heartaches”; C.W. Dixon, “Smallpox”; Donald R. Hopkins, “Smallpox in History”; Michael Willrich, “Pox: An American Story”; Walt Whitman, “Song of Myself”; Jim Downs, “Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction.”

Carole Emberton teaches history at the University at Buffalo. Her first book, “Beyond Redemption: Race, Violence, and the American South After the Civil War” will be published next year by the University of Chicago Press.

From: opinionator.blogspot.nytimes.com

Monday, December 1, 2014

Under the Knife

By Terry L. Jones, November 17, 2012

On Aug. 28, 1862, Maj. Gen. Richard S. Ewell’s Confederate division was fighting desperately in the fields and pine thickets near Groveton, Va., during the Second Bull Run campaign. Heavy fire was coming from unidentified soldiers in a thicket 100 yards in front. To get a better look, Ewell knelt on his left knee to peer under the limbs. Suddenly a 500-grain (about 1.1 ounces) lead Minié ball skimmed the ground and struck him on the left kneecap. Some nearby Alabama soldiers lay down their muskets and hurried over to carry him from the field, but the fiery Ewell barked: “Put me down, and give them hell! I’m no better than any other wounded soldier, to stay on the field.”

The general lay on a pile of rocks while two badly wounded soldiers nearby cried out for help until stretcher bearers finally arrived on the scene. Despite their own painful wounds, the two men insisted Ewell be carried off first, but he instructed the litter bearers to take them away. Hours after being wounded, Ewell was finally placed on a stretcher and taken to the rear. Dr. Hunter McGuire, Gen. Thomas J. “Stonewall” Jackson’s medical director, amputated Ewell’s leg the next day.

Campbell Brown, Ewell’s aide and future stepson, witnessed the operation. McGuire and his assistants sedated Ewell with chloroform and used a scalpel to cut around his leg just above the knee. In his drug-induced fog, Ewell feverishly issued orders to troops, but he did not appear to feel any pain until McGuire applied the bone saw. According to Brown, the general then “stretched both arms upward & said: ‘Oh! My God!’”

McGuire opened up the amputated limb to show the officers in the room that the operation had been necessary. The bullet had “pierced the joint & followed the leg down for some inches,” Brown later wrote. “When the leg was opened, we found the knee-cap split half in two — the head of the tibia knocked into several pieces — & that the ball had followed the marrow of the bone for six inches breaking the bone itself into small splinters & finally had split into two pieces on a sharp edge of bone.” Brown and a slave wrapped the bloody limb in an oilcloth, and the slave “decently buried” it in the garden. Brown kept the two pieces of bullet as souvenirs for his mother, who was engaged to Ewell, although he never told the general he had done so.

Rank was no protection from such brutal operations, and General Ewell was just one of many high-ranking officers to face the surgeon’s knife. In fact, statistically speaking, a Confederate general was more likely to require medical treatment than a private. Almost one out of four died in the war, compared with 1 out of 10 Union generals. Of the 250 Confederate generals who were wounded, 24 underwent amputations. General Ewell was one of the lucky ones who survived and returned to duty many months later with an artificial leg.

Approximately two out of every three Civil War wounds treated by surgeons were to the extremities because few soldiers hit in the head, chest or stomach lived long enough to make it back to a field hospital. From a technical point of view, damaged limb bones presented the greatest challenge to surgeons. The war’s most common projectile, the large, oblong Minié ball, often tumbled when it hit the body and caused much more damage to bone than smoothbore musket balls. One Confederate surgeon observed, “The shattering, splintering, and splitting of a long bone by the impact of a minié or Enfield ball were, in many instances, both remarkable and frightful.” When bone was damaged, surgeons had to decide quickly on one of three possible treatments. If it was a simple fracture, a wooden or plaster splint was applied, but if the bone was shattered the surgeon performed either a resection or an amputation.

Resection involved cutting open the limb, sawing out the damaged bone, and then closing the incision. It was a time-consuming procedure and required considerable surgical skill, but some surgeons became quite proficient at it. After the Battle of Savage’s Station in 1862, one Union surgeon completed 26 resections of the shoulder and elbow in a single day. He was said to be able to eat and drink coffee at the operating table while pieces of bone, muscle and ligaments piled up around him.

Besides being a difficult procedure, resection also carried a high risk of profuse bleeding, infection and postoperative necrosis of the flesh. Successful resections, however, allowed the patient to keep his limb, although it was limp, useful merely to “fill a sleeve.” Because of the time required, resections were not always practical when there were large numbers of patients to treat, but they were used more frequently after surgeons learned that amputations had a much higher mortality rate.

The amputation process was fairly simple. After a circular cut was made completely around the limb, the bone was sawed through, and the blood vessels and arteries sewn shut. To prevent future pain, nerves were then pulled out as far as possible with forceps, cut and released to retract away from the end of the stump. Finally, clippers and a rasp were used to smooth the end of the exposed bone. Sometimes the raw and bloody stump was left untreated to heal gradually, and sometimes excess skin was pulled down and sewn over the wound. Speed was essential in all amputations to lessen blood loss and prevent shock. An amputation at the knee was expected to take just three minutes.

Civil War surgeons almost always had chloroform to anesthetize patients before an amputation. The chloroform was dripped onto a piece of cloth held over the patient’s face until he was unconscious. Although not an exact science, the procedure worked well, and few patients died from overdose. Opium pills, opium dust and injections were also available to control postoperative pain.

The mistaken belief that amputations were routinely performed without anesthetics can be partially attributed to the fact that chloroform did not put patients into a deep unconscious state. Bystanders who saw moaning, writhing patients being held down on the table assumed no anesthetic was being used. As in the case of General Ewell, patients often reacted to the scalpel and bone saw as if in pain, but they did not remember it afterward. After his left arm was amputated (Dr. McGuire also performed that operation), Stonewall Jackson mentioned that he had heard the most beautiful music while under the chloroform. Upon reflection, he said, “I believe it was the sawing of the bone.”

Because surgeons preferred to operate outdoors where lighting and ventilation were better, thousands of soldiers witnessed amputations firsthand. Passers-by and even wounded men waiting their turn watched as surgeons sawed off arms and legs and tossed them onto ever growing piles. The poet Walt Whitman witnessed such a scene when he visited Fredericksburg in search of his wounded brother. “One of the first things that met my eyes in camp,” he wrote, “was a heap of feet, arms, legs, etc., under a tree in front of a hospital.” Indeed, after the December 1862 Battle of Fredericksburg, Union surgeons performed almost 500 amputations.

Early in the war surgeons earned the nickname “Saw-bones” because they seemed eager to amputate. This eagerness stemmed not from overzealousness but from the knowledge that infections developed quickly in mangled flesh, and amputation was the most effective way to prevent it. Those limbs removed within 48 hours of injury were called primary amputations, and those removed after 48 hours were called secondary amputations. The mortality rate for primary amputations was about 25 percent; that for secondary amputations was twice as high, thanks to the fact that most secondary amputations were performed after gangrene or blood poisoning developed in the wound. Surgeons learned that amputating the limb after it became infected actually caused the infection to spread, and patients frequently died. Thus, the patient was much more likely to survive if a primary amputation was performed before infection set in.

Primary amputations were also preferred because it was easier and less painful to transport an amputee than a soldier whose broken bones and inflamed tissue made the slightest jostle sheer torture. One surgeon admitted that an excessive number of amputations may have been performed during the war, but he added, “I have no hesitation in saying that far more lives were lost from refusal to amputate than by amputation.”

Where the amputation was made on the limb was as vital to survival as when it was done. Generally, the higher up the amputation was made, the higher the mortality rate. This was especially true for thigh wounds. More than half of all soldiers who suffered a femur wound died, and amputations at or near the hip joint had a 66 percent mortality rate in the Confederate Army.

Nonetheless, it is estimated that approximately three out of four soldiers survived amputations. Amazingly, some, like Confederate Brig. Gen. Francis T. Nicholls, endured more than one. His lower left arm was amputated after he was shot at the First Battle of Winchester and his left foot was taken off when he was wounded at Chancellorsville. After the war, Nicholls was a popular Louisiana governor who was said to ask people to vote for “all that’s left of General Nicholls” and to support him for governor because he was “too one sided to be a judge.”

Often, surviving an amputation seemed to be completely random. While some, like Ewell and Nicholls, seemed unhindered by the surgery, others died from what appeared to be rather minor wounds. Two members of Company B, 19th Michigan Infantry, were shot in the index finger in the same battle during the Atlanta campaign. One man treated himself by cutting off the mangled finger with his pocket knife. He wrapped the stub in a handkerchief and waited until the battle was over to have the wound dressed at the field hospital. The other soldier went immediately to the surgeon for a proper amputation. Gangrene set in within days, and the surgeon was later forced to amputate his arm at the shoulder. The soldier died soon afterward. The man who treated himself made a full recovery and lived to a ripe old age.

Taking care of amputees put a significant strain on both wartime governments. The Union provided its disabled soldiers with prosthetic limbs made from cork wood, metal or rubber and gave amputees $8 a month as a pension. The Confederacy was unable to be so generous and by 1864 was providing just 10 percent of the needed prostheses. Incredibly, Mississippi’s single greatest state expenditure a year after the war ended was the purchase of artificial limbs for its veterans, which consumed 20 percent of the state’s budget. Some amputee veterans were forced to look after themselves and paired up to form “shoe exchanges” where they chipped in to buy a pair of shoes and each man took the one he needed.

Amputation was the most common Civil War surgical procedure. Union surgeons performed approximately 30,000 compared to just over 16,000 by American surgeons in World War II. One postwar British traveler noted that amputees were “everywhere in town and farm communities through the South.” The men who had survived the surgeon’s knife were a visible reminder of the Civil War for decades.

Follow Disunion at twitter.com/NYTcivilwar or join us on Facebook.

Sources: Terry L. Jones, “The American Civil War”; Terry L. Jones, ed., “Campbell Brown’s Civil War”; Donald C. Pfanz, “Richard S. Ewell”; Ira M. Rutkow, “Bleeding Blue and Gray”; Robert E. Denny, “Civil War Medicine”; Frank Vandiver, “Mighty Stonewall.”

Terry L. Jones is a professor of history at the University of Louisiana, Monroe and the author of six books on the Civil War.

From: opinionator.blogs.nytimes.com

Brother Against Microbe

By Terry L. Jones, October 26, 2012

On Oct. 27, 1862, the Confederate cavalry commander Jo Shelby filed a report on his brigade’s recent operations in Missouri. The colonel concluded with a sobering assessment of his troopers’ physical condition. “Our men, from being so poorly clad, and owing to the excessive duties that they have been compelled to perform, are rapidly becoming unfit for service,” he wrote. “Our brigade reports now some 500 sick. We have a great many men without a blanket, overcoat, shoes, or socks.” When the brigade was first organized, he went on, it numbered 2,319 men, and “the greater portion were reported for duty until within the last few days. Since this cold spell of weather set in, our reports show but 1,068 men for duty. The increase in sickness in Jeans’ and Gordon’s regiments is 100 per day.”

Colonel Shelby’s command was not unique. Measles, mumps, pneumonia, influenza and other maladies often put entire regiments out of action. In August 1861, 645 out of 920 men in the 7th Louisiana suffered an illness serious enough for them to be listed on the regiment’s hospital ledger. The Civil War may have been a fight of brother against brother, but it was equally a fight of brother against microbe.

The Union Surgeon General, William A. Hammond, famously claimed the Civil War “was fought at the end of the medical Middle Ages.” In 1864, Louis Pasteur had discovered that germs caused diseases, but his breakthrough was not widely accepted at the time, and Joseph Lister did not publish his findings on the use of antiseptics until two years after the Civil War ended. “We operated in our blood-stained and often pus-stained coats,” admitted one surgeon, the title given to all military physicians. “We operated with clean hands in a social sense, but they were undisinfected hands.” If a surgeon dropped a sponge or instrument on the floor, he said, “It was washed and squeezed in a basin of tap water and used as if it were clean.” Surgeons later came to recognize the primitive nature of Civil War medicine, but one Confederate doctor spoke for most when he declared, “We did not do the best we would, but the best we could.”

Unlike today, medical training at the time of the Civil War varied greatly. Most of the older physicians had learned their profession through apprenticeship, much as skilled laborers did. Medical schools had become fairly common in the decade before the war, but most had only a two-year course of study, with the second year essentially a refresher course of the first. There was virtually no laboratory training, and the study of anatomy was hampered by the fact that dissection was illegal in some states.

A stereo card showing a doctor tending to an injured soldier in a field hospital.Library of CongressA stereo card showing a doctor tending to an injured soldier in a field hospital.
At the time, medical practice was divided into several competing systems. Physicians believed the body had four “humors”: blood, yellow bile, black bile and phlegm. Most diseases were thought to be caused by the humors getting out of balance; it was necessary to purge the patient of a particular humor so the body could heal itself. Those who might be described as orthodox physicians practiced “heroic therapy.” This included bloodletting and the use of strong drugs and enemas containing toxic agents to remove the harmful humors.

Competing with heroic therapy were various unorthodox systems that believed toxic drugs and bloodletting should be avoided. Homeopathy and the Thomsonian System (also known as botanical medicine) were two of the more popular. The former used minute amounts of drugs to treat an ailment which in large doses actually caused the symptoms of the disease being treated. The latter system used natural herbs to purge the body of specific humors.

Although historical studies of the Civil War often concentrate on the treatment of battlefield wounds, disease caused two out of three deaths. Cramming thousands of men into small areas led to frequent outbreaks of measles, pneumonia and smallpox. Those soldiers from rural areas were especially susceptible to such diseases because they had never been exposed to them, as had soldiers who grew up in overcrowded cities.

Measles nearly wiped out entire regiments early in the war when many soldiers were first exposed. A Mississippi surgeon described his visit to a makeshift hospital during one measles epidemic: “About one hundred sick men crowded in a room sixty by one hundred feet in all stages of measles. The poor boys lying on the hard floor, with only one or two blankets under them, not even straw, and anything they could find for a pillow. Many sick and vomiting, many already showing unmistakable signs of blood poisoning.” In that particular epidemic, 204 men died in a single regiment.

Unsanitary living conditions caused such diseases as dysentery, diarrhea, typhoid and cholera. Regulations required men to bathe once a week, but soldiers almost universally ignored that rule. Tons of manure from cows, horses and mules, and the entrails from slaughtered animals, only added to the filth of a typical Civil War encampment. Armies on both sides ordered latrines to be dug and the contents to be covered daily with a fresh layer of dirt, but sometimes little thought was given to their placement. As a result, the slit trenches were frequently dug close to wells or upstream from the source of fresh water. Modest soldiers disliked using the open latrines and simply relieved themselves wherever they found a secluded place.

Dysentery was the single greatest killer of Civil War soldiers. It differed from common diarrhea because it was caused by a bacterial infection that gave a soldier loose and bloody bowels. Both dysentery and diarrhea were commonly called the “flux,” “Tennessee Trots” or the “runs,” and all Civil War soldiers suffered from them at one time or another. As one surgeon put it, “No matter what else a patient had, he had diarrhea.” Bacteria also caused typhoid and cholera. Typhoid was spread by flies that came in contact with feces or contaminated food, while cholera was caused by ingesting tainted food or water.

Malaria and yellow fever added to camp life misery, and both were common in the mosquito-infested Deep South. Malaria, or the “ague,” accounted for about 20 percent of all patients treated. A soldier with malaria first developed a high fever called the “shakes,” followed by a debilitating weakness that could leave him bedridden for days or even weeks. The symptoms gradually subsided and the man could return to duty, but the fever periodically returned and the process was repeated. Soldiers infected with yellow fever also developed a high temperature, followed by headache and the “black vomit” caused by internal hemorrhaging. Physicians at the time did not know that mosquitoes carried malaria and yellow fever and believed the diseases were caused by harmful swamp fumes, the breath of infected men or camp excrement.

Smallpox was another dreaded disease in Civil War camps, but soldiers were fortunate that a vaccine had been developed that helped prevent widespread epidemics. Unfortunately, the vaccine was primitive and dangerous, and men dreaded being inoculated. Surgeons took a small amount of pus from an infected cow and injected it into a soldier’s arm by making a cut through the skin. In describing his regiment’s vaccination, a Massachusetts soldier wrote, “Such a wholesale slashing and cutting of arms never was witnessed before. The commanding officer of each company would march up the men, all with bared arms. The doctor would make three or four passes with his knife, cutting through the skin, punch a little of the vaccinating matter into the wound, and the thing was done. The doctors went through the thousand men in about three hours, and the sore arms for ten days afterwards was a sight to behold.”

Syphilis and gonorrhea plagued both armies and became such a threat that generals were forced to start regulating prostitution. During the war, 8.2 percent of all Union soldiers contracted some sort of venereal disease, but this reflects only those men who sought medical treatment. Confederate records are incomplete. Few soldiers, however, were hospitalized or died from such infections. Surgeons treated most patients with mercury-based compounds that were applied to the skin. Poke roots, elder berries, sarsaparilla, zinc sulfate, silver nitrate, sassafras and jessamine were also popular treatments. Often the surgeons never knew what actually worked — whenever the symptoms disappeared they assumed the last treatment had cured the patient.

Soldiers often complained that the treatment surgeons prescribed for diseases was worse than the disease itself. Malaria and other fevers were treated quite effectively with quinine, but it had the severe side effect of loosening one’s teeth. Quinine was also used to treat diarrhea and dysentery, as was opium to ease abdominal spasms and pain. Calomel, blue mass (a mixture of mercury, honey and marshmallow plant), strychnine, castor oil, turpentine, silver nitrate and ipecac were popular treatments for dysentery and diarrhea, but they all had extreme side effects. Turpentine could damage the nervous system and kidneys and induce bloody vomiting. Calomel, castor oil and blue mass could cause diarrhea, even though they were used to treat the same condition, and ipecac induced vomiting. Calomel in particular caused explosive diarrhea and projectile vomiting which further dehydrated dysentery patients. Calomel and blue mass were also mercury-based drugs that caused extreme salivation, inflamed gums and loose teeth. Ulcers sometimes formed in the mouth and ate away bone and tissue, causing hideous facial deformities.

Other types of Civil War medical treatment seem almost like medieval torture. Incredibly, some surgeons cauterized the anus to treat dysentery and even the penis to treat venereal disease. Pneumonia patients were frequently bled or had heated mustard plasters placed on their chests to draw out fluid from the lungs. Surgeons treated one soldier’s stomach ailment by applying hot bricks to his feet and hot cloths to his stomach. The man wrote home, “Oh such hours of suffering, but the Lord was with me praise his name.”

The Union was blessed with ample stocks of medicine, but the Confederates were forced to look for substitutes when the blockade cut off medical supplies from Europe. All across the South, drug manufacturing and research facilities were established to produce medicine and search for viable alternatives. Virtually all drugs at the time came from plants, like quinine from South American tree bark, opium from poppies and turpentine from tree resin. As a result, the Confederates believed they could find substitutes growing naturally in the Southern forests. The bark of dogwood, poplar, blackberry, willow and sweet gum were among the substitutes Confederates tried for quinine. They also planted their own poppies in an attempt to produce opium. Soldiers were even sent into the woods to search for wild onion, garlic, mustard, sassafras, pokeweed, artichoke, pepper grass and dandelion as a citrus substitute to treat scurvy. Such efforts, however, were largely fruitless, and the Confederates had little success in developing medicines from their own resources.

Most soldiers had little respect for surgeons because some became alcoholics from having easy access to medicinal liquor, and some were incompetent because of poor training. Postwar books and movies have only reinforced this stereotype, but it is historically inaccurate: the vast majority of them were dedicated and caring physicians who labored under almost unimaginable conditions.

Indeed, Civil War surgeons had a higher mortality rate than any other military position. They sometimes worked days on end with little or no rest, making them vulnerable to the army of diseases they were treating. Nurses and other hospital workers generally praised the surgeons’ dedication, although they often criticized their dictatorial demeanor and sexist sentiments. Confederate nurse Fannie Beers wrote, “I never saw or heard of a more self-sacrificing set of men than the surgeons.”

One way to judge the quality of Civil War medicine is to compare it with the care soldiers received in our other wars of the same time period. During the Civil War, at least 185,000 soldiers died in battle and 435,000 died from disease and other noncombat causes, for a ratio of about 1:2. The ratio was approximately 1:7 for the Mexican War and 1:5 for the Spanish-American War. Despite the primitive state of Civil War medicine, it appears the men received the best medical care of any American soldiers of the 19th century.

Follow Disunion at twitter.com/NYTcivilwar or join us on Facebook.

Sources: Robert E. Denny, “Civil War Medicine”; Terry L. Jones, “The American Civil War”; Ira M. Rutkow, “Bleeding Blue and Gray”; The War of the Rebellion: The Official Records of the Union and Confederate Armies.

Terry L. Jones is a professor of history at the University of Louisiana, Monroe and the author of six books on the Civil War.


Counting the Costs of the Civil War

By Jeffrey Allen Smith and B. Christopher Frueh, November 7, 2013

While the desire to document military exploits and wars is as old as writing itself, the recording of military medical data is a relatively modern phenomenon. Although some initial attempts to chronicle the health of troops occurred in the first half of the 19th century, the first large-scale, wartime medical and behavioral health surveillance effort was conducted during the American Civil War.

This is partly a reflection on the dismal state of the medical profession before the mid-19th century. By the Civil War era, medical practice had improved markedly over the previous century, but it had yet to shake free of all the fetters of its lingering superstitions and misconceptions. For example, with the germ theory of disease still a generation away, it was commonly held that a variety of fevers and diseases, like cholera, were caused by miasma or the foul-smelling “bad” air that emanated from swamps and decomposing matter. On the other hand, medical sophistry notwithstanding, bloodletting had fallen out of fashion and belief in the prophylactic powers of cleanliness and proper hygiene were more widespread thanks in part to the hard work of Florence Nightingale during the Crimean War in bringing sanitation to British war hospitals. One ward’s mortality rate fell over 30 percent because of her efforts.

Thus, with medical advancements showing tangible results in lowering mortality rates and sickness, placing greater effort and funding into a larger systematic wartime recording of military medical data began to seem sensible, and feasible.

The United States Army Medical Department entered the Civil War understaffed and underfunded. This was partially the result of Surgeon General Thomas Lawson, an ossified War of 1812 sawbones, who infamously considered updated medical textbooks a superfluous use of funds. After Lawson died a month into the war, President Lincoln replaced him with Clement Finley, who soon ran afoul of Secretary of War Edwin Stanton in a fiery disagreement.

The choice of Finley’s replacement, William Alexander Hammond, was a stroke of good fortune for the department. Hammond, who had military experience and previously was the chair of anatomy and physiology at the University of Maryland Medical School, set about updating and modernizing the Medical Department. He is credited with increasing standards for army surgeons, reorganizing the ambulance service, founding the Army Medical Museum, expanding support to field and general hospitals and helping to establish the Army Nurse Corps.

Hammond also recognized that the medical record-keeping system for sick and wounded soldiers was “insufficient and defective” and in June 1862, barely a month into his tenure, his office announced a plan to compile the Medical and Surgical History of the Rebellion.

Still, it was not until Nov. 4, 1863, that the War Department issued General Orders No. 355, directing “Medical Directors of Armies in the field [to] forward, direct to the Surgeon General at Washington, duplicates of their reports… after every engagement.” A week later, the Surgeon General’s Office requested “all obtainable statistics and data in connection with past and future operations” and drew “particular attention” to a list of medical topics of elevated importance, the first on the list being “morale and sanitary condition of the troops.”

By January 1864, the scope and focus of the data collected expanded from the battlefield to include general hospitals. “Medical officers in charge of wards” were issued a “Register of Sick and Wounded” and a “Register of Surgical Operations” in which they kept “minutely and in detail, the particulars of all operations performed, or treated in [the] hospital.” These two registers later served as the foundation for the organizational structure of Medical and Surgical History of the Rebellion. A month later, the military began explicitly requesting medical reports for “Sick and Wounded Rebel Prisoners of War” and “White and Colored Troops.” With the inclusion of these medical reports, and a slight modification of a few others, the Surgeon General’s Office had in place a comprehensive system for tracking the medical condition of Civil War combatants by the spring of 1864.

Yet another year would pass before the office started to focus on medical reporting efficiency as well as effectiveness, but Hammond would not be around to see it. Apparently, in his zeal to modernize, Hammond fell victim to the “Calomel Rebellion.” After he banned the medicinal use of mercurial poisons like calomel, army physicians – who stood by these drugs as lifesavers – successfully ousted him from his post.

With Hammond gone, Secretary of War Stanton chose Joseph K. Barnes to serve as the fourth surgeon general in four years. Barnes studied medicine at Harvard University and the University of Pennsylvania before joining the military as an assistant surgeon in 1840. Unlike the previous surgeon generals, Stanton got along well with Barnes, and it showed in the War Department’s increased support of the Medical Department’s activities.

One of these endeavors was the organization of medical records. Bureaucratic delay, ineffectiveness and struggles to conceptualize and implement a final medical recording system notwithstanding, the unprecedented size and scope of the military medical data collected is truly impressive. Still, the struggle to organize the mountains of reports, analyze the data and effectively share it with the world would last longer than the war itself.

In June 1868, as the nation began to come to terms with the significance of the war, Congress commissioned Secretary of War Stanton to prepare for publication “five thousand copies of the First Part of the Medical and Surgical history of the Rebellion, [as] complied by the Surgeon General.”

A decade later the resulting tome, “The Medical and Surgical History of the War of Rebellion, 1861-65,” appeared, consisting of six volumes and totaling approximately 3,000 pages. Based exclusively on military and government medical records, it included statistical data on Union and colored troops broken down into a variety of subcategories. More than 100 separate tables organized by region and army group tracked 150 “diseases,” including “serpent bite,” gunshot wounds, dysentery, diabetes, “dropsy from heart disease” and even alcoholism and suicide. In addition, many of the “diseases” listed in the tables were in subsequent volumes given general descriptions, selective case studies, accounts of treatments and sometimes even illustrative photographs or color plates to further aid in contextualizing their effects on the health of the Civil War soldier.

Newspapers, photographs, diaries and soldiers’ letters all had the ability to create a visceral and real connection to the horrors and heroism of the Civil War. However, these sources could also prove selective and occasionally obscure the larger war. The “Medical and Surgical History” provides something else: an extremely detailed examination of the medical condition and toll taken on soldiers during the Civil War. Here, almost uniquely for the time, there is no euphemism, no soft focus, no attempt to diminish that cold, dispassionate arithmetic reality of the terrible cost borne by Civil War soldiers, both during the war and for decades after.

Image: William Alexander Hammond, physician

Follow Disunion at twitter.com/NYTcivilwar or join us on Facebook.

Sources: B. Christopher Frueh and Jeffrey A. Smith, “ Suicide, Alcoholism, and Psychiatric Illness Among Union Forces During the U.S. Civil War,” in the Journal of Anxiety Disorders, vol. 26 (2012).

Jeffrey Allen Smith is an assistant professor of history at the University of Hawaii, Hilo.

B. Christopher Frueh is a professor of psychology at the University of Hawaii, Hilo, a McNair Scholar, the director of research programs at the Menninger Clinic in Houston and, writing as Christopher Bartley, the author of “They Die Alone.”

From: opinionator.blog.nytimes.com

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