Wednesday, August 5, 2015

Occupational Medicine in the Civil War


The new technology of iron and steam in the Civil War introduced brand-new hazards—exploding boilers, scalding with live steam, burn injuries, and primary and secondary wounds resulting from large caliber, rifled naval guns. Ironclad vessels also introduced environmental and occupational concerns for sailors aggravated by badly ventilated and hell-hot engine rooms. It is estimated that a typical low ranking coal heaver aboard a poorly ventilated ironclad routinely endured temperatures approaching 130 degrees F. In fact, aboard Monitor in summer, temperatures of 125 degrees were recorded on the berth deck and 150 degrees in the galley. One cannot underestimate the utility of awnings in deflecting the sun from ironclads decks.

Even the fuel that fired an ironclad’s boilers was a threat. Coal, while not a new fuel used by the Navy, had the potential of becoming a silent killer. Fossil fuels require proper ventilation and this concept was not yet adequately understood by Civil War engineers. Untold casualties, some fatal, occurred when crewmen either loaded wet bituminous coal in below-deck bunkers or bilge water contaminated the fuel. Both the Mississippi Squadron and the South Atlantic Blockading Squadron reported a number of cases of sailors being discovered either dead or unconscious below deck. The more fortunate were revived when exposed to the fresh air. Besides unconsciousness, surgeons described their patients as being cyanotic—blueness of the skin caused by oxygen starvation with foreheads and eyelids markedly swollen.

There were many differences between wounds sustained in battle on the old wooden ships and those encountered aboard ironclads. Shots striking wooden vessels tended to throw about splinters which, as secondary projectiles, caused many of the wounds. Burns were uncommon. In yardarm engagements and during the hand-to-hand fighting resulting from boarding an enemy’s vessel, many wounds were caused by small arms, cutlasses, bayonets, and pikes. In ironclad fighting, splinters might be fewer, but burns and fragment wounds became commonplace. The so-called protected environment an ironclad warship provided was illusory. If anything, it offered fatal hazards the crew of a wooden ship rarely experienced. Take the example of the monitor Nahant. Engaged in Samuel Du Pont’s attack on the Charleston forts in April 1863, shellfire from the forts slammed against her pilot house and turret with such velocity that broken bolts ricocheted about her pilot house like bullets, killing one man and injuring two others, including her captain.

Iron shot weighing over 150 pounds were now common, making the 24- and 32-pound size thrown by earlier guns seem quite puny in comparison. What’s more, a newer generation of rifled guns that could pulverize masonry forts could do worse to those enclosed within an iron-sheathed hull. What resulted was the “garbage can” effect. Imagine yourself encased in a typical galvanized steel garbage pail or a 55-gallon steel oil drum, ears unprotected, and then having your antagonists hurling 50-pound cement blocks against your cocoon, one per second. With blood dripping from nose and ears, crewmen were sometimes driven mad under the barrage of both rifled and unrifled artillery impacting against iron armor. And if not driven mad, many Sailors had their eardrums ruptured or, at very least, suffered temporary or permanent deafness. Civil War Sailors frequently described ringing in the ears or tinnitus. With noise levels aboard Civil War ironclads routinely exceeding 130 decibels, one can only conjecture what kind of hearing damage resulted among these warriors.

Needless to say, under these conditions, the psychological health of Sailors was often in question. “Give me a discharge and let me go home,” a distraught coal-heaver begged his skipper after months of duty outside of Charleston. “I am a poor, weak, miserable, nervous, half-crazy boy. Everything jarred upon my delicate nerves.” In the Civil War we begin seeing terms “nostalgia,” “melancholia,” and “irritable heart” masking conditions that would in future years be called “shell shock,” “combat fatigue” and “PTSD.”

Image: "Coal Heaver" by Alfred Waud

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