.

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.

Thursday, January 26, 2017

Soldiers’ Dreams with Jonathan White

By Ashley Whitehead Luskey, 1-18-17

Over the course of this year, we’ll be interviewing some of the speakers from the upcoming 2017 CWI conference about their talks. Today we are speaking with Dr. Jonathan White, Associate Professor of American Studies and the Senior Fellow at the Center for American Studies at Christopher University.  His research interests focus on the U.S. Constitution, the American Civil War, and treason in American history.  He has authored, co-authored, and co-edited numerous books and articles for both scholarly journals and popular magazines.  His most recent works include "Emancipation, the Union Army, and the Reelection of Abraham Lincoln" (LSU Press, 2014, winner of the 2015 Abraham Lincoln Book Prize, and finalist for both the 2014 Jefferson Davis Prize and the 2015 Gilder Lehrman Lincoln Prize); “Our Little Monitor”: The Greatest Invention of the Civil War (co-authored with Anna Gibson Holloway, forthcoming, 2017); and "Midnight in America: Darkness, Sleep and Dreams during the Civil War" (forthcoming, 2017).  He is currently at work on a new book project entitled "Abraham Lincoln and the Slave Trade".

CWI:  What did dreams mean to Civil War-era Americans?  What did their dreams reveal about their experiences during the war?

WHITE:  Many Americans who lived through the Civil War were captivated by their dream lives.  They recorded them in letters and diaries.  Some even recalled them years later in memoirs and regimental histories.  They wrote them down, I think, because they recognized that their dreams revealed something about who they were and how they experienced this tumultuous period.  Some believed that their dreams were signs from God.  For that reason they could find comfort in them–even when they were dreams that portended death or other harm.

CWI:  How did dreams either help or haunt Americans during the Civil War? How did dreaming change, or remain the same, in the immediate wake of the war?

WHITE: Soldiers in both armies found comfort in their dreams.  We tend to assume that most soldiers suffered from traumatizing nightmares during the war.  To be sure, many had such dreams–and they wrote plenty about them.  But most soldiers’ dreams appear to have been pleasant.  They became an escape from the harsh realities of soldier-life, and a respite from heavy marching and fighting.  One of the most interesting things I found is that in the immediate wake of the war some soldiers found comfort in their dreams of war—reliving moments they had experienced on the battlefield—not in fearful ways, but with a sense of longing to return to their comrades.

CWI:  What are some of the major similarities or differences between Union and Confederate “dreamers” and the ways in which dreams were interpreted or viewed in the North and the South?

WHITE:  ‪Northern and Southern soldiers tended to have similar dreams.  Most often they dreamt of home, of loved ones, and of things that were familiar to them (like food).  These dreams helped encourage them during periods of long separation.  In a very real way, soldiers’ dreams of home were like visitations with loved ones, reminding men of what and who they were fighting for.

‪Northern and Southern women, by contrast, had very different types of dreams.  Of course, wives in both sections had terrible nightmares of their husbands being killed in battle.  But Northern and Southern women’s dreams were different in one fundamental way.  Southern civilians often dreamt of Yankee invasions, while Northern women often dreamt themselves going to battle.  Both could be terrifying in their own way, but each reflected the different experiences of civilians in the different sections.

Image 1: Currier & Ives,“The Soldier’s Dream of Home,” 1862, in Harper’s Weekly. Image courtesy of the Library of Congress.

Image 2: “The Soldier’s Dream,” in Harper’s Weekly, November 7, 1863. Image courtesy of the Library of Congress.

From: gettysburgcompiler.com

The Day Lincoln Died: The Final Premonition

By Christopher Coleman

As every school child knows (or should know) Abraham Lincoln, our sixteenth President, was assassinated on April 14, 1865, and died in the early morning hours of the following day, April 15.  Less well known is that, that very morning, Lincoln revealed to his cabinet a premonition—a presentiment some would call it—of his very own death.

The incident has been a favorite anecdote of Lincoln biographers for generations, although academic historians have tended to dismiss or ignore it.  In researching The Paranormal Presidency, however, I went back to the primary sources, to people who worked with Lincoln or were his friends, to verify the story. Often times an anecdote, especially one about Lincoln, makes for a good story and is repeated over and over, yet has not any basis in fact. At first glance, this premonition of Lincoln’s might seem to fit that category.

While I give Lincoln’s final premonition in full in Chapter 17 of the Paranormal Presidency of Abraham Lincoln, a brief synopsis is that, during a cabinet meeting the morning of April 14, while waiting for the meeting to begin in earnest, Lincoln related a strange dream he had had the night before. It was about a ship sailing to an indefinite shore. What was peculiar about the dream was that he told his cabinet (and General Grant) that he had had this very same dream before every major event of the war. As Lincoln was hourly expecting news from the Carolinas from Sherman, that the last major Confederate army had surrendered, Lincoln assumed it would be good news from that front.

Doubtless at the time of the meeting, it was regarded as yet another of Lincoln’s little anecdotes that his cabinet had to suffer through.  It was only after he was assassinated that night that everyone present realized that Lincoln had actually foretold his own death.

As noted above, this incident has been told and retold by many folks over the years. Charles Dickens gave a dramatic version of the story, obviously with added Dickensian touches; Lincoln’s close friend and sometime bodyguard, Ward Hill Lamon, likewise ornamented the story a bit. Moreover, as time went on, many writers elaborated on it. So, for the professional debunkers out there, it has been easy to dismiss the story as fiction, something invented long after the fact.

The trouble with professional cynics is that starting from a priori assumptions, they rarely look at the facts objectively; more often than not, they skip over primary sources that are inconvenient to their thesis. Some skepticism is a healthy thing: cynicism in not; neither is shoddy scholarship.

In fact, there were at least two men present during the Cabinet meeting in question who reported Lincoln’s prophetic dream.  There are slight variations in quoting Lincoln’s exact words, as there are with Lamon’s account; but anyone who has dealt extensively with eyewitness accounts of an event knows that is to be expected.

Moreover, within days of his death, news of the incident had spread far and wide. When Lincoln’s body was being returned by train to Springfield, Illinois stopped in Philadelphia, on April 22, his body put on display for mourners to view. Among the many memorial wreaths beside the body was one which stood out. It had a banner emblazoned across it which read:

“Before every great national event I
have always had the same dream.
I had it the other night. It is of a
ship sailing rapidly….”

The crowd in Philadelphia that April 22, needed no explanation; word of Lincoln’s last prophetic dream had already become common knowledge. It is not prima facie evidence, true; but is proof that the story was no later invention.

Lincoln’s last premonition is thus a historic fact. If one chooses to dismiss it as mere coincidence, that is always a convenient out for inconvenient truths and people are free to believe what they want. But it did happen.

Walt Whitman, who was in Washington during the war years, was so inspired by Lincoln’s prophetic dream that he turned it into one of his most famous poems, O Captain! My Captain! When I was a boy, in fact, we were required to memorize it, along with other famous pieces of American poetry. I doubt they do that any more; and I doubt that many folks who are familiar with the poem really know the true background behind it.

Clearly, Lincoln dreamed of his ship approaching that “indefinite shore,” and while soon after, “The ship is anchor’d safe and sound, its voyage closed and done,”
Lincoln, its captain, did not live to see the ship of state safe in port.

For more on this last, best documented, of Lincoln’s premonitions, as well as the full text of Walt Whitman’s “O Captain! My Captain!” read The Paranormal Presidency of Abraham Lincoln.  Oh yes, and be sure to memorize the poem for class next Monday.  Class dismissed.

About Christopher Coleman
I am an author, lecturer, and sometime instructor. My interests span a variety of subjects, including Southern tales of the supernatural, American history and folklore, military history in general, as well as archaeology, anthropology, plus various and sundry things that go bump in the night. I currently have five books in print: Strange Tales of the Dark and Bloody Ground, Ghosts and Haunts of the Civil War, Dixie Spirits and Ghosts and Haunts of Tennessee. My latest is The Paranormal Presidency of Abraham Lincoln, a documenary history of some more esoteric aspects the sixteenth President. My next book will also be a Civil War tome dealing with famous author Ambrose Bierce's military experiences in the Late Unpleasantness, due for release soon.

From: thelateunpleasantness.wordpress.com

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Dr. Jonathan Letterman’s Report on the Union Army Medical Corps at Gettysburg

By Mark, 7-7-13

Dr. Jonathan Letterman was the Medical Director of the Army of the Potomac at the time of the Battle of Gettysburg.  At the time, Letterman had only been in his position for a year but had instituted sweeping changes in the way the Army took care of the wounded.  Letterman established the Army’s ambulance service, established field hospitals, aid stations, and an efficient medical supply system  He also designed the first triage procedures used by the Army to evaluate the wounded.  Medical care and survival rates improved dramatically under his leadership, and many of his procedures and concepts are still used today in battlefield medicine.

Letterman’s procedures were put to the test at the Battle of Gettysburg and its aftermath.  There were over 14,500 Union wounded when the fighting was over, and some of the over 18,000 Confederate wounded had fallen into Union hands.  Those numbers would overwhelm any system, but under Letterman’s procedures, the care of the wounded was much more organized and effective than it had been a year earlier, resulting in more lives saved.

In his official report on the Army of the Potomac’s  medical department’s performance at the Battle of Gettysburg and its aftermath, Letterman criticized some decisions by army commanders that he believed inhibited his department’s effectiveness, praised the actions and efforts of the army’s medical personnel, and dismissed civilian doctors who volunteered to help as virtually worthless.  Here’s Dr. Jonathan Letterman’s refreshingly blunt and honest assessment of the army medical department at Gettysburg.

HEADQUARTERS ARMY OF THE POTOMAC,
MEDICAL DIRECTOR’S OFFICE,
Camp near Culpeper Court-House, Va., October 3, 1863.

GENERAL: I have the honor to submit the following report on the operations of the medical department of this army at the battle of Gettysburg, July 1, 2, and 3:

As the subject of transportation has an important bearing upon the manner in which the wounded are attended to after a battle, it is necessary to make some allusion to the manner in which this department was supplied. It is scarcely necessary to say that if-the transportation is not sufficient to enable the officers of the department to conduct it properly, the effect must fall upon the wounded.

In the autumn of 1862, I investigated the subject very carefully, with the view to the adoption of some system instead of the irregular method and want of system which prior to that time was in vogue, to limit the amount necessary, and to have that amount always available. The transportation was one wagon to each regiment and one to each brigade. This gave all that was required, and it was not too much; and, it may be remarked, was a reduction of nearly one-half of that which had been in use prior to that time. This system worked well. At the battle of Chancellorsville, the department had upon the left bank of the Rappahannock means sufficient, had it been allowed to use them, for taking care of many more wounded than there came under its control.

On June 19, while the army was on the march, as it were, from before Fredericksburg to some unknown point north of the Potomac River, the headquarters being near Fairfax Court-House, Va., the transportation of the department was cut down by Major-General Hooker on an average of two wagons in a brigade, in opposition to my opinion, expressed verbally and in writing. This reduction necessitated the turning in of a large portion of the supplies, tents, &c., which were necessary for the proper care of the wounded in the event of a battle. Three wagons were assigned to a brigade of 1,500 men, doing away with regimental wagons. This method in its practical working is no system at all, as it is liable to constant changes, and proved to be, what I supposed at the time it would be, a failure to give the department the means necessary to conduct its operations.

The headquarters left Fairfax Court-House on June 26 ultimo, for some point as yet unknown in Maryland or Pennsylvania.

On the 25th of that month, I directed Assistant Surgeon [Jeremiah B.] Brinton, U.S. Army, to proceed to Washington, and obtain the supplies I had ordered the medical purveyor to have put up, and there await orders.

On the 26th, he was ordered to proceed with them to Frederick. This step was taken to obviate the want of supplies consequent upon the reduction of transportation. At this date it was not known that the army would be near Frederick; still, the risk had to be run, and the event justified the order, Dr. Brinton arriving at Frederick on June 28, the day after the arrival of headquarters there, with twenty-five army wagon loads of such supplies as would be most required in case of a battle. The train with these supplies followed that of headquarters until we reached Taneytown.

On July 1, the trains were not permitted to go farther, and, on the 2d, were ordered farther to the rear, near Westminster.

On the 1st, it was ordered that “corps commanders and the commander of the Artillery Reserve will at once send to the rear all their trains (excepting ammunition wagons and ambulances), parking them between Union Mills and Westminster.”

On the 2d, these trains were ordered still farther to the rear, and parked near Westminster, nearly 25 miles distant from the battlefield. The effect of this order was to deprive the department almost wholly of the means for taking care of the wounded until the result of the engagement of the 2d and 3d was fully known. I do not instance the effect of this order, excepting to show the influence of it upon the department. The expediency of the order I, of course, do not pretend to question, but its effect was to deprive this department of the appliances necessary for the proper care of the wounded, without which it is as impossible to have them properly attended to as it is to fight a battle without ammunition. In most of the corps the wagons exclusively used for medicines moved with the ambulances, so that the medical officers had a sufficient supply of dressings, chloroform, and such articles until the supplies came up, but the tents and other appliances, which are as necessary, were not available until July 5.

The supply of Dr. Brinton reached the field on the evening of July 4. This supply, together with the supplies ordered by me on July 5 and 6, gave more than was required. The reports of Dr. Brinton and Dr. [John H.] Taylor show that I ordered more supplies than were used up to the 18th of July, when the hospitals were taken from under my control. Surgeon Taylor, medical inspector of this army, who was ordered on July 29 to Gettysburg, to examine into the state of affairs there, reports to me that he made “the question of supplies a subject of special inquiry among the medical officers who had remained with the wounded during and for a month subsequent to the battle. The testimony in every instance was conclusive that at no time had there been any deficiency, but, on the contrary, that the supply furnished by the medical purveyor had been and still continued to be abundant.” This is, perhaps, sufficient to show that not only were supplies ordered in advance, but that they were on hand when required, notwithstanding the difficulty in consequence of the inability of the railroad to meet the requirements made upon it, until after General Haupt took charge of it on July 9. I have not deemed it necessary to present any tables showing the amounts ordered and issued, considering what I have just given as ample enough to show the action of this department. The chief want was tents and other appliances for the better care of the wounded. I had an interview with the commanding general on the evening of July 3, after the battle was over, to obtain permission to order up the wagons containing the tents, &c. This request he did not think expedient to grant but in part, allowing one-half the wagons to come to the front; the remainder were brought up as soon as it was considered by him proper to permit it. To show the result of the system adopted upon my recommendation regarding transportation, and the effect of the system of field hospitals, I may here instance the hospital of the Twelfth Corps, in which the transportation was not reduced nor the wagons sent to the rear at Gettysburg.

Surgeon [John] McNulty, medical director of that corps, reports that “it is with extreme satisfaction that I can assure you that it enabled me to remove the wounded from the field, shelter, feed them, and dress their wounds within six hours after the battle ended, and to have every capital operation performed within twenty-four hours after the injury was received. I can, I think, safely say that such would have been the result in other corps had the same facilities been allowed–a result not to have been surpassed, if equaled, in any battle of magnitude that has ever taken place.

A great difficulty always exists in having food for the wounded. By the exertions of Colonel [Henry F.] Clarke, chief commissary, 30,000 rations were brought up on July 4 and distributed to the hospitals. Some of the hospitals were supplied by the commissaries of the corps to which they belonged. Arrangements were made by him to have supplies in abundance brought to Gettysburg for the wounded; he ordered them, and if the railroad could have transported them they would have been on hand.

Over 650 medical officers are reported as present for duty at that battle. These officers were engaged assiduously, day and night, with little rest, until the 6th, and in the Second Corps until July 7, in attendance upon the wounded. The labor performed by these officers was immense. Some of them fainted from exhaustion, induced by over-exertion, and others became ill from the same cause. The skill and devotion shown by the medical officers of this army were worthy of all commendation; they could not be surpassed. Their conduct as officers and as professional men was admirable. Thirteen of them were wounded, one of whom (Asst. Surg. W. S. Moore, Sixty-first Ohio Volunteers, Eleventh Corps) died on July 6 from the effects of his wounds, received on the 3d. The idea, very prevalent, that medical officers are not exposed to fire, is thus shown to be wholly erroneous. The greater portion of the surgical labor was performed before the army left. The time for primary operations had passed, and what remained to be done was to attend to making the men comfortable, dress their wounds, and perform such secondary operations as from time to time might be necessary. One hundred and six medical officers were left behind when the army left; no more could be left, as it was expected that another battle would within three or four days take place, and in all probability as many wounded thrown upon our hands as at the battle of the 2d and 3d, which had just occurred. No reliance can be placed on surgeons from civil life during or after a battle. They cannot or will not submit to the privations and discomforts which are necessary, an-d the great majority think more of their own personal comfort than they do of the wounded. Little more can be said of those officers who have for a long period been in hospitals. I regret to make such a statement, but it is a fact and often a practical one. Dr. [Henry] Janes, who was left in charge of the hospitals at Gettysburg, reports that quite a number of surgeons came and volunteered their services, but “they were of little use.” This fact is so well known in this army that medical officers prefer to do the work rather than have them present, and the wounded men, too, are much better satisfied to be attended by their own surgeons. I, however, asked the Surgeon-General, July 7, to send 20 medical officers to report to Dr. Janes, hoping they might prove of some benefit, under the direction of the medical officers of this army who had been left behind. I cannot learn that they were ever sent.

Dr. Janes was left in general charge of the hospitals, and, to provide against contingencies, was directed, if he could not communicate with me, to do so directly with the Surgeon-General, so that he had full power to call directly upon the Surgeon-General to supply any want that might arise.

The ambulance corps throughout the army acted in the most commendable manner during those days of severe labor. Notwithstanding the great number of wounded, amounting to 14,193, I have it from the most reliable authority and from my own observation that not one wounded man of all that number was left on the field within our lines early on the morning of July 4. A few were found after daylight beyond our farthest pickets, and these were brought in, although the ambulance men were fired upon when engaged in this duty by the enemy, who were within easy range. In addition to this duty, the line of battle was of such a character, resembling somewhat that of a horseshoe, that it became necessary to remove most of the hospitals farther to the rear as the enemy’s fire drew nearer.

This corps did not escape unhurt; 1 officer and 4 privates were killed and 17 wounded while in the discharge of their duties. A number of horses were killed and wounded, and some ambulances injured. These facts will show the commendable and efficient manner in which the duties devolving upon this corps were performed, and great credit is deservedly due to the officers and men for their praiseworthy conduct. I know of no battle-field from which wounded men have been so speedily and so carefully removed, and I have every reason to feel satisfied that their duties could not have been performed better or more fearlessly.

Before the army left Gettysburg, and knowing that the wounded had been brought in from the field, six ambulances and four wagons were ordered to be left from each corps, to convey the wounded from their hospitals to the railroad depot, for transportation to the other hospitals. From the Cavalry Corps but four ambulances were ordered, as this corps had a number captured by the enemy at or near Hanover a few days previous. I was informed by General Ingalls that the railroad to Gettysburg would be in operation on the 6th, and upon this based my action. Had such been the case, this number would have been sufficient. As it proved that this was not in good running order for some time after that date, it would have been better to have left more ambulances. I acted on the best information that could be obtained.

The number of our wounded, from the most reliable information at my command, amounted to 14,193. The number of Confederate wounded who fell into our hands was 6,802, making the total number of wounded thrown by that battle upon this department 20,995. The wounded of July 1 fell into the hands of the enemy, and came under our control on the 4th of that month. Instruments and medical supplies belonging to the First and Eleventh Corps were in some m-stances taken from the medical officers of those corps by the enemy.

Previous to leaving Gettysburg, I, on July 5 and 6, ordered supplies to be sent to Frederick from Washington and Philadelphia, to meet the wants of the department in the event of another battle, which there was every reason to suppose would occur shortly after the army left Gettysburg. While at the latter place, I asked the Surgeon-General to have 50 medical officers ready to meet me at such a point as I should thereafter indicate.

On July 7, I desired them to be sent to Frederick. Late in the night of July 9, 47 reported. These officers were designed to make up, as far as possible, the deficiency of medical officers existing in consequence of the large detail from this army left at Gettysburg.

Tents were ordered by my request, and the corps supplied as far as their transportation would permit, and the remainder kept in reserve. It is not necessary to enter into a detailed list of the articles ordered and on hand ready for the anticipated battle. I have the orders in my office, and it is with pleasure I can state for the information of the commanding general that, notwithstanding the short time in which I had to make the necessary preparations, this department was, when near Boonsborough, fully prepared to take care of the wounded of another battle of as great magnitude as that which this army heat just passed through at Gettysburg.

It is unnecessary to do more than make an allusion to the difficulties which surrounded this department at the engagement at Gettysburg. The inadequate amount of transportation; the impossibility of having that allowed brought to the front; the cutting off our communication with Baltimore, first by way of Frederick and then by way of Westminster; the uncertainty, even as late as the morning of July 1, as to a battle taking place at all, and, if it did, at what point it would occur; the total inadequacy of the railroad to Gettysburg to meet the demands made upon it after the battle was over; the excessive rains which fell at that time– all conspired to render the management of the department one of exceeding difficulty, and yet abundance of medical supplies were on hand at all times; rations were provided, shelter obtained, as soon as the wagons were allowed to come to the front, although not as abundant as necessary on account of the reduced transportation. Medical officers, attendants, ambulances, and wagons left when the army started for Maryland, and the wounded were well taken care of, and especially so when we consider the circumstances under which the battle was fought and the length and severity of the engagement.

The conduct of the medical officers was admirable. Their labors not only began with the beginning of the battle, but lasted long after the battle had ended. When other officers had time to rest, they were busily at work–and not merely at work, but working earnestly and devotedly.

I have not considered it necessary to give in this report other than a very general outline of the operations of this department at that time. To enter into a detailed account of them would, I presume, be more than the commanding general would desire.

I am, general, very respectfully, your obedient servant,

JON A. LETTERMAN,
Medical Director.

Brig. Gen. S. WILLIAMS,
A. A. G., Army of the Potomac.

Official Records of the War of the Rebellion, Series I, Volume XXVII, Part 1.

From: ironbrigader.com

Kate Cumming: Confederate Immigrant Nurse and the Shiloh Disaster

By Patrick Young, Esq., 1-14-16

More than 16,000 men were wounded at Shiloh, the bloodiest battle in American history up to that time.

Kate Cumming was a child in Scotland when her family immigrated to North America. They did not come to the United States, but to Montreal in Canada. She then moved with her family to Mobile, Alabama. Although her days in her native Edinburgh were short, throughout her time in the United States she identified herself as a Scottish immigrant and sought a sense of identity in the culture of her homeland.

Unlike many immigrants in the South during the 1850s, she came to embrace the cause of secession in the late 1850s when she was in her late twenties and early thirties. When war broke out in 1861, she decided that she wanted to follow in the path of her role model Florence Nightingale and become a nurse. The problem was that women were not considered fit to nurse men in the 1860s.

It may seem strange that a profession that in the 20th Century was identified as a field for women once closed them off from serving wounded men. To become a military nurse Cumming did not have to overcome only the objections of the army, she also had to defy her own family. Handling men’s bodies and assisting them with their bodily functions was not considered the sort of respectable occupation that would suit a middle-class woman for marriage. Perhaps the objectors were right, for this woman who tended thousands of wounded men would never marry.

Early in April of 1862, Kate Cumming and a small band of women recruited by a minister who insisted the Confederate armies needed the work of women nurses headed out from Mobile by train, hoping to assist a large Confederate army in Tennessee. As they neared the army, they heard news that a great battle had just been fought at a place called Shiloh. 

The women were not certain what they would find when they arrived at their destination. Their services had not been solicited by the Confederate government. They did not even know of the help they offered would be accepted by the men running the army.

As they headed towards the scene of the fighting, the women passed a train carrying the wounded away from Shiloh. Brief glimpses of the suffering patients presaged the horrors they were to see a couple of days later.

When the nurse cadets presented themselves at a military hospital they were rebuffed.  Cumming said that “the surgeons entertain great prejudice against admitting ladies into the hospital in the capacity of nurses.” In fact, the chief surgeon “has carried this so far that he will not even allow the ladies…to visit his patients,” she wrote in her Journal. Frustrated, Cumming wrote, “I only wish that the doctors would let us try and see what we can do!” 

On April 10th the women nurses were allowed to proceed to the main Confederate hospitals at Corinth. During the final stage of their journey, Cumming confessed, she became nervous about what her reaction to seeing the hospitals after a battle would be. 

The scene Cumming saw when she arrived in Corinth was worse than she could have imagined. The camp of the Confederate army was all mud. “As far as the eye could reach, in the midst of all this slop and mud,” she wrote, were the tents of the men, “suggestive of anything but comfort.” Although Kate Cumming had tried to prepare herself emotionally for the work she was about to begin, she wrote that “nothing that I had ever heard or read had given me the faintest idea of the horrors witnessed here.” Romantic notions fell away quickly, she wrote, saying that “none of the glories of the war were presented here.” She wondered if she could ever adequately describe what she saw, because, she wrote, “I do not think that words are in our vocabulary expressive enough to present to the mind the realities of that sad scene.”

Battlefield wounded were often left outdoors and unattended in the first year of the war. Medical services were inadequately staffed and inefficiently run. The photograph of Union wounded in a “hospital” is from 1862 after the Battle of Savage Station.

Cumming wrote in her Journal that she saw old men and “beardless boys,” Union and Confederate soldiers alike, “mutilated in every imaginable way,” just lying on the floor untreated. They were crammed together so closely, she said, “that it was almost impossible to walk without stepping on them.” She was so overcome by the scene that she wrote that “I could not command my feelings enough to speak, but my thoughts crowded upon me.”

The Confederates, like their Union enemy, had completely underestimated the physical toll in wounded men that the war would eventually claim. Shiloh was the first massive battle in the Western Theater of the war, and it left more than 23,000 men killed, captured, or wounded. The untried Confederate medical system collapsed before the end of the battle. For example, while Kate Cumming arrived at Corinth three days after the battle, wounded men were still arriving at the hospitals there. Many of those men who had arrived a day or two earlier and who were too badly injured to take care of themselves, had not been even been fed, let alone treated, when Cumming got there.

The first thing Nurse Cumming did was to try to feed the men. Supplies were so inadequate that all she had to offer them was some bread, a biscuit, and coffee or tea. The hospital did not even have plates, so she passed out the meager food to the men from her hands to theirs.

Sanitary conditions in the hospital were deplorable. There were no cots for the wounded and dying, or any order to where the men were placed. Cumming wrote that “the men are lying all over the house, on their blankets, just as they were brought from the battle-field.” Because the hospital lacked attendants, they were lying in their own filth and blood. “The foul air from this mass of human beings at first made me giddy and sick,” she recalled. To help the men, she had to walk through blood and mud on the floors. When she fed those unable to feed themselves she had to kneel in the slops.

Two days after she arrived at Corinth, Cumming wrote that even then “There seems to be no order” in the hospital. “All do as they please,” she observed. “The men doing the nursing knew nothing of caring for the sick.” She said, and they were never given the time to learn. They were just common soldiers who would work a few hours in the hospital and then be given a new assignment and be replaced by new and equally inexperienced men. “I cannot see how it is possible for them to take proper care of the men, as nursing is a thing that has to learned,” she remonstrated.

The next day, April 13, Cumming wrote in her Journal, “The confusion and want of order are as great as ever.” She was beginning to see men die from lack of care. Although resources were increasing at the hospital, they were not being used properly. “The amount of good being done is not near what it might be, if things were better managed,” she wrote. She said that “Some one is to blame for this state of affairs.”

When some beds arrived that day, Nurse Cumming was happy, both because it meant that the most severely wounded could have some comfort and because elevating the men would allow her to clean up some of the filth that had accumulated on the floors over the last three days.

When a surgeon learned that some wounded Union prisoner was given a bed, he ordered the women to remove the enemy so that a Confederate could take his place. Cumming went to carry out the directive, but she found that she could not do it. “Seeing an enemy wounded and helpless is different from seeing him in health,” she wrote. The hated enemy soldier was, she discovered, a boy with a “childish face” whose eyes teared up when she asked him about his mother. “His lips quivered so that he was unable to speak” about the mother he might not see again, she told her Journal. “I was deeply moved myself,” she says, “spoke a few words of comfort, and left him. I would not have had him give up his bunk for the world. Poor child.”

Image 1: More than 16,000 men were wounded at Shiloh, the bloodiest battle in American history up to that time.

Image 2: Kate Cumming was a Scottish immigrant with a brother serving in the Confederate army.

From: longislandwins.com

Writing on the Operating Table: Letters of James Langstaff Dunn, Civil War Surgeon

by Sarah Johnson, 2-8-13

Gerald Linderman’s Embattled Courage defines the pursuit of courage as the prime motivator for Civil War soldiers. For men going off to war, idealistic notions of courage and duty caused them to rise above their fears and fight for their cause. However, the last chapter of Embattled Courage, titled “Disillusionment”, argues that eventually Civil War soldiers developed a hardened and stoic indifference to the suffering around them. Linderman argues soldiers stopped feeling like a vital part of an important cause and more like a small, insignificant piece of a vain struggle. The letters of James Langstaff Dunn, volunteer surgeon of the 109th and later 111th Pennsylvania Volunteers, offer a different interpretation, one that copes with the death and destruction by a grisly determination to see the war to its end.

Dunn’s early letters reflect Linderman’s analysis of Victorian ideals about courage. He wrote his wife on May 2, 1861 assuring her that “the boys are healthy and in good spirits, ready to do their duty.”[i] The 109th PA received their baptism of fire on August 9, 1862 at the battle of Cedar Mountain. In the aftermath, Dunn spent twenty-four hours in surgery with no food and little water. He performed twenty-two amputations of the thigh alone, and “a great many” on arms.[ii] Dunn would go on to be involved in Second Bull Run, South Mountain, Antietam, Chancellorsville, and Gettysburg before being transferred to the west to Chattanooga, Lookout Mountain, Mission Ridge, and the Siege of Atlanta, in addition to other minor engagements.[iii]

Along the way, Dunn experienced, first-hand, the destruction the war brought. Stealing a moment to himself after Chancellorsville, he wrote to his wife assuring he was safe. The letter begins, “I have just one minute to write and I am writing it on the operating table.”[iv] Charged with putting broken men back together, Dunn was forced to evaluate the costs of the war and justify them to himself. The first patient Dunn lost haunted him. Lieut. Austin, a New Jersey cavalryman, was described by Dunn as “a handsome fellow, not over 21 or 22…I will remember his boyish looks and earnest appeals for help as long as I live.”[v]

A second incident that deeply affected Dunn was the loss of his hometown friend, J. W. Patton. Patton was hit by a shell at the top of the humerus, near where the arm articulates with the shoulder. The hit caused his humerus to fracture all the way down to his elbow. Dunn examined the wound and determined the arm could be saved, but after he passed on to treat another soldier, the arm was amputated by another surgeon.[vii] Amputation of the arm at the shoulder was a relatively simple procedure for an experienced surgeon, disarticulating the humerus at the joint with the shoulder was a natural place to separate and there was rarely a problem with controlling the bleeding. Three-fourths of shoulder amputees survived.[viii] Patton, however, did not. Dunn was profoundly hurt by what he deemed as an unnecessary loss of life; had not thought the arm needed amputation in the first place.

Dunn’s response to the trauma of war was not with disillusionment.  His war experiences reflect determination. Dunn’s letters reveal, instead of bitterness with the war, frustrations with the political wavering at home; he was a severe critic of Copperheads and Peace Democrats of the North. Dunn’s tirades against the Copperheads boiled down to a belief that the broken men on the field, bleeding and dying, deserved better than quasi-commitment at home.[ix]  Dunn’s 1864 New Year’s Resolution demonstrates his convictions and his justification for the costs of war:

"Still, my life is spared. Tomorrow is New Years Day. I hope…that its end may see the close of this fearful War, to be crowned with garlands of a glorious peace in and undivided country, and with every man, black or white, enjoying the rights that God has given him. I know that some call this abolitionism, but it must come as the fruits of the many fearful sacrifices that have been, and are now being made by the best blood of the nation."[x]

[i] Paul Kerr, Civil War Surgeon-Biography of James Langstaff Dunn, MD, AuthorHouse, 2005, Letter to wife, Temperance, May 5, 1862, 21.

[ii] Kerr, Civil War Surgeon, Letter to wife, August 15, 1862, 63.

[iii] Kerr, Civil War Surgeon, 333.

[iv] Kerr, Civil War Surgeon, Letter to wife, May 4, 1863, 92.

[v] Kerr, Civil War Surgeon, Letter to wife,  May 12, 1863, 89.

[vi] Kerr, Civil War Surgeon, L
etter to wife, May 12, 1863, 89.

[vii] Kerr, Civil War Surgeon, Letter to wife, May 17, 1863, 94-95.

[viii] Medical and Surgical History of the Civil War, Volume X, Wilmington: Broadfoot Publishing Co., 1991.

[ix] Kerr, Civil War Surgeon, Letter to wife, January 27, 1863, 82.

[x] Kerr, Civil War Surgeon, Letter to wife, December 31, 1863, 153.

Photos from the National Archives.

From: gettysburgcompiler.com

Nutritional Night Blindness during the Crimean War and the U.S. Civil War

By Douglas Lanska, 2-12-13

ABSTRACT

OBJECTIVE: Determine whether night blindness among soldiers in the Crimean War and the U.S. Civil War was due to vitamin A deficiency (VAD) or to malingering as commonly attributed.

BACKGROUND: VAD can result in nutritional night blindness (from impaired phototransduction in retinal rod cells) and corneal epithelial disorders.

DESIGN/METHODS: Review of reports of night blindness and corneal epithelial disorders identified through compilations of the U.S. Surgeon General, electronic databases and search engines, bibliographic compilations, diaries, memoirs, medical journals, and monographs. Quantitative morbidity data were obtained from extensive tabulations of the U.S. Surgeon General from July 1861 through June 1866. Incident cases of night blindness, scurvy, and diarrheal diseases, and mean troop strength among Union troops, were abstracted by month, year, and race.

RESULTS: In both wars, medical officers commonly attributed night blindness to malingering among soldiers. However, a dietary deficiency basis is supported in both wars by: (1) the severely inadequate vitamin A content of military rations; (2) close correspondence of clinical descriptions with the full spectrum of VAD eye disease; (3) occurrence of night blindness in conjunction with other disorders that cannot be readily feigned, and that are now known to result from nutritional deficiencies (keratomalacia and scurvy); and (4) resolution of night blindness with appropriate dietary modification. Also, during the U.S. Civil War marked seasonal variation in night blindness incidence among Union soldiers corresponded closely to seasonal variations in both the availability of foodstuffs and the incidence of scurvy and diarrhea.

CONCLUSIONS: Nutritional night blindness occurred among soldiers forced to subsist on nutritionally inadequate diets during both the Crimean War and the U.S. Civil War. The seasonal pattern during the U.S. Civil War is consistent with seasonal variations in the availability of foodstuffs with high vitamin A content (or provitamin A carotenoid content) superimposed on marginal vitamin A reserves.

Supported by: Department of Veterans Affairs.

Disclosure: Dr. Lanska has received personal compensation from Medlink Neurology for medical publishing and editorial responsibilities.

From: neurology.org

Andersonville Prison

By Robert Scott Davis, 1-21-03; Last edited by NGE Staff on 10-18-16

In 1970 Andersonville was named a National Historic Site, and includes the Confederate prison site, the cemetery, and the National Prisoner of War Museum. It is the only park in the National Park System that serves as a memorial to all American prisoners of war.

February 1864, during the Civil War (1861-65), a Confederate prison was established in Macon County, in southwest Georgia, to provide relief for the large number of Union prisoners concentrated in and around Richmond, Virginia. The new camp, officially named Camp Sumter, quickly became known as Andersonville, after the railroad station in neighboring Sumter County beside which the camp was located. By the summer of 1864, the camp held the largest prison population of its time, with numbers that would have made it the fifth-largest city in the Confederacy. By the time it closed in early May 1865, those numbers, along with the sanitation, health, and mortality problems stemming from its overcrowding, had earned Andersonville a reputation as the most notorious of Confederate atrocities inflicted on Union troops.

Prison Conditions

An illustration of Andersonville prison bears the caption,"Let us forgive. But not forget."

Andersonville had the highest mortality rate of any Civil War prison. Nearly 13,000 of the 45,000 men who entered the stockade died there, chiefly of malnutrition.

Andersonville station, the third of three sites considered by Confederate officials for the prison, lacked ready access to supplies. It was chosen, in fact, for its inland remoteness and safe distance from coastal raids and because there was little opposition from the inhabitants of this sparsely populated area. Local black labor—slave and free—was impressed into service to build the camp, which consisted of a stockade and trench enclosing more than sixteen acres. A small creek, Stockade Branch, ran through the middle of the enclosed area.

The camp was planned for a capacity of 10,000 prisoners, but with the breakdown in prisoner exchanges, which would have removed much of its prison population, its numbers swelled to more than 30,000. As the number of imprisoned men increased, it became increasingly hard for them to find space to lie down within the vast pen. The prisoners, nearly naked, suffered from swarms of insects, filth, and disease, much of which was generated by the contaminated water supply of the creek.

Approximately 45,000 prisoners were held at Andersonville Prison, or Camp Sumter, the largest prison camp of the Confederacy. In 1998 the National Prisoner of War Museum opened at Andersonville.

Andersonville had the highest mortality rate of any Civil War prison. Nearly 13,000 of the 45,000 men who entered the stockade died there, chiefly of malnutrition. Guards were also issued poor rations but had the option of foraging for food elsewhere. Critics charged that though the Confederate government could find the resources to move prisoners hundreds of miles and to build a facility in which to incarcerate them, it failed to provide adequate supplies or living conditions for the inmates or even for the staff.

In the summer of 1864 camp administrators, using the labor of Union prisoners and slaves, expanded the prison's size and facilities by constructing a hospital, a bakery, and some barracks. They also extended the stockade walls, adding an additional ten acres to the original site. Yet the overwhelming number of prisoners rendered their efforts hopelessly inadequate.

Prison Life

By August 1864, Andersonville prison's population reached its greatest number, with more than 33,000 men incarcerated in the camp.

Prisoners did little to improve the miserable conditions under which they lived. Firewood details were curtailed when prisoners seized the opportunity to escape. The small stream that served as the camp's primary water supply, both for drinking and bathing, was polluted by the unsanitary habits of some inmates and by sewage and other garbage dumped into the swampy area that fed the stream. Wells were covered over and made inaccessible after prisoners used them to hide escape tunnels.

Camp inmates often preyed upon each other. Gambling tents and "stores," operated mainly by prisoners from Union general William T. Sherman's western troops, fleeced new arrivals. Roving gangs of raiders, chiefly from eastern regiments, robbed fellow inmates, despite efforts by guards to stop them. The prisoners hanged six of the raider leaders on July 11, 1864. After that, a new police force made up of prisoners sought to impose discipline on their fellow inmates. They tried to enforce sanitation practices, curtail robberies, and force captive officers to take care of the men under them. Their strong-arm tactics led some inmates to see these new "regulators" as no better than the raiders. Men detailed to take care of the sick often robbed the hospital of food and supplies.

In late March 1864 Captain Hartmann Heinrich "Henry" Wirz took charge of the prison. The Swiss-born commander, a physician in Louisiana when the war broke out, tried to impose order and security, but his lack of authority over the guards and supply officers limited his effectiveness. He quickly became the primary target of prisoners' resentment and hostility.

By August the prison population reached its greatest number, with more than 33,000 men incarcerated in the camp. But as Sherman's troops moved deeper into Georgia, the threat of attacks on Andersonville led to the transfer of most prisoners to other camps, particularly Camp Lawton, near Millen, and Camp Sorghum, in Columbia, South Carolina. By November the prison population was a mere 1,500 men. Transfers back to Andersonville in December brought the number back up to 5,000 prisoners, where it remained until the war's end five months later.

Prison Security

Andersonville's garrison consisted of troops from various units over the course of its fourteen months in operation.

These included the Fifty-fifth Georgia Infantry, the Twenty-sixth Alabama Infantry, and a battery from Florida. As these troops were called away for combat duty elsewhere, Georgia state reserves and militia from Georgia and Florida replaced them. These grossly outnumbered and poorly armed guards, many of them old men and boys, kept their charges at bay with a "dead line." A feature of other prisons as well, North and South, this marked strip of ground bordering the stockade walls served as a killing zone for any prisoner who stepped into it. Cannons, guard towers, dog packs, and a second wall also served to foil escapes.

Most of the prisoners who did escape Andersonville fled from work details on duties that took them outside the camp walls. Inmates also attempted to dig at least eighty tunnels, nearly all of which were exposed by informants. Compared with other Confederate prisons, very few of those incarcerated at Andersonville made successful escapes. Those who did escape received help from sympathetic or war-weary white Southerners but found slaves to be their greatest allies. Winslow Homer's famous painting Near Andersonville portrays the irony of the imprisonment of Union soldiers who had come south to free slaves.

After the War
On May 7, 1865, just after the war's end, Captain Wirz and another officer, James W. Duncan, were arrested and tried separately for war crimes by federal military courts in Washington, D.C. Both the defense and the prosecution tried to prove that the defendants were following orders. The prosecutors hoped to prove that Duncan and Wirz were receiving orders from Confederate superiors, including President Jefferson Davis, and the defense attorneys hoped to absolve their clients of responsibility by passing it up the chain of command. After two and a half months, Duncan received a fifteen-year sentence, and Wirz was sentenced to death. Duncan escaped after serving only one year at Fort Pulaski. On November 10, 1865, Wirz was hanged in the courtyard of the Old Capitol prison, just behind the Capitol in Washington.

For decades, historians claimed that Wirz was the only man executed for war crimes committed during the Civil War, and some southerners came to see him as a martyr. The United Daughters of the Confederacy erected a monument to him in the town of Andersonville, and each year on the anniversary of his execution, local residents hold a ceremony paying tribute to him. Wirz was, in fact, one of a few Confederates to be tried and executed for crimes committed during the war. Robert Kennedy, a Confederate officer, was tried and executed by a military tribunal in March 1865 for plotting to blow up New York City landmarks, and Champ Ferguson, a Confederate guerrilla fighter based in Tennessee, was tried and executed in October 1865 for killing Union prisoners of war.
In the decades following the war Andersonville's notoriety was fueled by memoirs written by former prisoners, many of whom were inspired by public interest in the prison and by efforts to lobby Congress for special veterans' benefits for POWs. The propagandistic and exaggerated nature of these accounts perpetuated several myths and misconceptions about the prison and its officials. John McElroy's Andersonville: A Story of Rebel Prisons, published in 1879, provides a good example of the tone and interpretation of narratives written by former prisoners.

Writer MacKinlay Kantor drew on such memoirs for his best-selling novel Andersonville, which won the Pulitzer Prize for fiction in 1956 and was adapted as a television miniseries for Turner Network Television in 1996. Another fictionalized account of the prison's history is found in Saul Levitt's 1959 play, The Andersonville Trial, which is based on the Wirz case and serves as a morality tale about criminal acts committed under military orders. The play was adapted for television in 1970.
The prison site was preserved as a national cemetery soon after it closed, in 1865, largely due to efforts by Clara Barton, founder of the American Red Cross, who worked to have all the graves identified and marked.

Andersonville National Historic Site, which lies mostly in Macon County with a small portion in Sumter County, has long been a major tourist attraction. More recently, southerners who felt that Andersonville had unfairly borne the brunt of horror stories of prison treatment campaigned for the creation of a museum at Andersonville to commemorate all American POWs. The National Prisoner of War Museum, which opened in 1998, documents the poor conditions not only at Andersonville but also at Northern camps during the Civil War, as well as those in World War II (1941-45), Korea (1950-53), and Vietnam (1964-73).

Image: Union prisoners of war are being buried at the Civil War prison at Camp Sumter, or Andersonville.

Achievements and Failures During the Civil War

From: amedd.army.mil

The Medical Department had intended that its detailed and copious records concerning the Union's sick and wounded guarantee the emergence of something of value to medical science as well as to the Army from the most frightful conflict that the nation had ever faced. During the struggle and the months immediately following it, more than 12,000 medical officers- regulars, volunteers, and contract- examined over 250,000 wounds and treated more than 7 million cases of disease. In the course of their duties, more than 300 Army surgeons died from wounds, disease, or accidents.

In spite of their heavy case loads, many were able to record what they saw for posterity. The value of their observations, however, was to some degree negated by the fact that they, like their civilian counterparts, knew little of bacteria and the methods by which one microscopic creature could be clearly distinguished from another. Furthermore, the heavy demands placed on Army surgeons left little time for the careful consideration of the significance of what they saw. As a result, their observations were haphazard and often of little value. Since surgery was usually performed in great haste and under difficult circumstances, there was also little time available for trying new or intricate techniques. The frightening mortality that resulted from infection obscured the possible achievements of new approaches to surgery. The most important progress made by the Medical Department during the Civil War involved practical matters of organization and administration and resulted in the creation of an effective and efficient medical department for the large and active Union Army.

Disease

In the nineteenth century, disease exacted a heavy toll when large groups of men were gathered closely together under conditions of stress and poor sanitation. In the Civil War, it killed twice as many men as battle. The conflict thus provided millions of cases of various diseases for study, but Union surgeons, like their counterparts everywhere, were still unable to distinguish harmless organisms from those causing disease-the developments that would make this possible were yet to come.

The book devoted by the editors of the Medical and Surgical History of the War of the Rebellion exclusively to the greatest scourge of nineteenth century armies, dysentery, illustrates both the intensity with which the Medical Department conducted its attempts to learn more about this problem and the reasons why these efforts were unavailing. More than 1.6 million cases of diarrhea and dysentery were diagnosed in the Union Army, and an average of 14.31 per 1,000 mean strength died from it. A Union medical officer found "the prevalence of diarrhoeas among the rebel prisoners ... absolutely astonishing." But the gradual realization that living organisms might be causing this and other major problems would gain impetus only after the Civil War. Lacking the staining and culturing techniques available a few decades later, physicians were also unable to compile records that would enable the modern scientist to identify positively the organisms responsible for the Union Army's epidemics of dysentery. It seems probable that Entamoeba histolytica, Shigella, Giardia, Salmonella, and Campylobacter were afflicting the soldiers of 1861-1865. Nevertheless, fourteen years after the end of the war, Joseph Janvier Woodward, editor of the volume on dysentery and since 1864 a pioneer in the art of staining specimens, was still skeptical about the possibility that minuscule forms of life could be causing diarrhea and dysentery. He, like others of his contemporaries, refused to take seriously an 1876 publication maintaining that an ameba might be capable of causing this disease.

Since they did not know what was really causing diarrhea and dysentery, medical officers had little chance of devising a cure. Shrewd observation based on trial and error was the only hope for progress, but they were also handicapped by their apparent assumption that dysentery was a single disease. Although occasional success was reported with the use of ipecacuanha, which is effective against amebiasis, when trials at a Washington hospital proved disappointing, this drug was rarely used. Among other medicines used to treat diarrhea, opium was often mistrusted, especially after medical officers began to realize it was only a palliative and not a cure. Bismuth subnitrate, also somewhat effective in easing the symptoms of dysentery, was used with caution because the presence of arsenic as an impurity was "exceedingly common." Strychnine, oil of turpentine, and cathartics, including mercurials and castor oil, were among other remedies tried without success. A few surgeons used lead acetate, but the very genuine risk of lead poisoning made many others reluctant to try it. Since malaria could cause diarrhea, quinine was "extensively employed," and "with a liberal hand." Although they had little control over the purity of the water the men drank in the field, doctors took great care to ensure the purity of the water their dysentery patients consumed, preferring rainwater, distilled water, or boiled water, or, as a last resort, the addition of a little claret to whatever was available. Their efforts to treat dysentery and diarrhea were to no avail, however. Although only 1 in 178 dysentery patients died in the first year of the war, by June 1865, when long campaigns, disease, and deprivation had weakened many soldiers, 1 in 29 was failing to survive.

The most effective steps taken against the diarrheal diseases involved sanitation. Without knowing precisely why, military experts had long realized that filth, especially when large numbers of men were grouped together, was associated with disease. But in an army composed largely of amateurs, enforcing strict standards of sanitation and hygiene posed great problems. When many were afflicted with diarrhea, these problems became even more urgent, both in hospitals and in camps. Officers often ignored regulations requiring the digging of sinks for every camp. Men ignored trenches that were dug for this purpose, which were "often so badly managed that it was disgusting to use them." When drinking water came from shallow wells, pollution was inevitable, and typhoid as well as diarrhea and dysentery resulted. The need for improved camp sanitation inspired sanitary commissions from the beginning of hostilities, and with time, and perhaps as the men themselves began to understand the importance of sanitation, the number of diarrheal cases per 1,000 men began to drop, from 770 in the year ending June 1862 to 686 three years later, and this despite the rising death rate.

Unlike dysentery, malaria no longer formed a serious threat to the Union Army as long as adequate supplies of quinine could be obtained. Wishing to reduce the amount of even temporary disability caused by malaria, Union surgeons continued to experiment with the prophylactic use of quinine, mixing the dose with whiskey to increase its attractions. It was not always possible, however, to obtain enough of both ingredients, and even when several times the normal dose of three to eight grains was administered daily, fever paroxysms might still occur. The disease was reported to return with even greater severity if the prophylactic doses were stopped once started, and prophylactic quinine never became routine.

The Medical Department's interest in malaria extended to the question of the relative susceptibility of blacks and whites. Perhaps on the assumption that blacks were less likely to be disabled by this disease, the Army tended to send black regiments to areas with higher malaria rates. Although department statistics suggested that blacks contracted and died from malaria more frequently than whites, Charles Smart, editor of part three of the Medical volume of the Medical and Surgical History, blamed this situation on the greater exposure of blacks to the disease. The death rate for blacks with malaria was twice that of whites suffering from that disease, but he remained convinced that blacks had a lesser susceptibility to malaria than whites, a belief that modern research has to some extent confirmed.

Typhoid was yet another disease about which medical officers discovered little that was new during the Civil War, despite devastating epidemics. Although many soldiers coming from the North were exposed to both typhoid and malaria at essentially the same time, the announcement that the resultant collection of symptoms constituted typhomalarial fever merely added to the confusion. Medical officers, though aware of the connection between poor sanitation and typhoid, remained as much mystified by the disease in 1865 as in 1861. The data collected in the Medical and Surgical History did, however, help Army physicians after the war to realize that water was indeed one source of typhoid infections.

Smallpox was no longer the formidable threat it had been during the American Revolution, but medical officers still had to treat many cases, since an average of 5.5 per 1,000 mean strength among whites and 36.6 among blacks contracted the disease. It was not always possible to immunize immediately the thousands of volunteer troops who came pouring in, and doctors were already aware that periodic revaccination was necessary if the spread of smallpox was to be prevented. Surgeons learned that possible complications made it advisable, however, not to immunize those suffering from scurvy. They also discovered that vaccine could be safely preserved and shipped in narrow glass tubes, three inches or less in length, for each dose so stored. Because of the efforts of the Medical Department, during the autumn of 1863 and the winter of 1864 more people were vaccinated than had ever been immunized before in a comparable period of time.

The inroads of other diseases, including the very prevalent respiratory infections that also afflicted Union soldiers, were relatively easy to appreciate, but the effects of a deficient diet were not. Medical officers, helpless to solve the transportation problems that led to the deficiency, were well aware that the standard ration of the soldier in the field was likely to lead to scurvy, although they were not aware that the soldier who refused to eat desiccated vegetables was also in danger of suffering from a lack of vitamin A. Surgeons usually recognized cases of scurvy at its worst, but the less obvious effects of subclinical scurvy were hard to pinpoint. As a result, one can only conjecture about precisely how much the vigor and effectiveness of troops in the field were affected by the depression and lethargy that accompanied the earliest stages of a vitamin C deficiency, since they could have resulted from or been reinforced by other health problems as well. It is difficult, too, to estimate to what extent a deficient diet, sometimes low in protein and calorie content as well as in vitamins, contributed to the prolongation of other ills, to the failure of injuries to heal, and to devastation wrought by open wound infections. A Sanitary Com-mission official familiar with the problems caused by scurvy commented, however, that "The pecuniary loss to the nation, by badly regulated and insufficient army ration, constitutes one of the great burdens of taxation now pressing upon the people."

Although the Army did what it could to treat the sick, many soldiers returned to their homes and to civilian life with their health permanently impaired by chronic disease. Usually the lingering illness involved diarrhea that, even when inactive, hung like the sword of Damocles over the veteran's head, likely to fall when his body was overstressed. Many deaths from dysentery acquired during the war occurred in peacetime in soldiers whose health declined slowly even after they returned to their families. Veterans suffering from malaria acquired when they were far from their northern homes became a potential source of infection for local Anopheles mosquitoes. A study of former soldiers in Massachusetts made in the 1890s showed that they also suffered from such diseases as tuberculosis and rheumatism at a rate far greater than that of the general population of that state. The rate of diarrhea and dysentery among veterans was almost fifty-six times that among the rest of the population, that of rheumatism five times, that of heart and circulatory problems six times (possibly as a legacy of streptococcal infections), and that of consumption twice. There was no indication, however, whether returning soldiers spread dysentery and diarrhea among those who had remained at home.

Except for offering supportive care, doctors could do little during the Civil War to help those stricken with diseases other than malaria. Except for improved sanitation, they could do little to prevent diseases other than smallpox, but their renewed appreciation for sanitation undoubtedly contributed to a marked drop in the disease rate in the postwar Army as compared with the prewar force. Despite voluminous records, medical officers made no significant progress during the Civil War toward finding ways in which to prevent or cure the diseases that ravaged the Union Army.

Infection and Wounds

Although aware that scurvy or even a scorbutic taint delayed healing, medical officers were ignorant of how infections spread from wound to wound. As a result, they were initially unable - to combat the horrors of what now appear often to have been streptococcal infections. These bacteria spread through hospital wards, turning even small wounds into gaping, oozing pits of hospital gangrene, poisoning the bloodstream, and spreading the rash of erysipelas among wounded and unwounded alike. On the basis of the many cases they saw during the war, some surgeons did begin to suspect that these infections as well as scarlet fever, rheumatism, and some forms of heart disease might all be related, but they blamed them on miasmas or the poisons produced by decaying flesh.

Medical officers could not afford to take these infections lightly. Some had a very high mortality; of 2,812 cases diagnosed as pyemia, a systemic infection, 2,747 were fatal. Surgeons recorded surprisingly few cases of tetanus, but much gangrene, which killed 45 percent of its victims and necessitated surgery that would not otherwise have been performed. Of the wounded afflicted with erysipelas with its spreading areas of swollen, empurpled skin, 41 percent died. Surgeons observed once again that patients in tent hospitals suffered less from infection than those housed indoors and that good ventilation reduced the infection rate. Although some theorized that erysipelas spread through the blood, many were convinced that it moved through the air, noting that it seemed to spread in the direction the wind was blowing. Case histories revealed patients who suffered first from one form of infection, then another, gangrenous wounds that healed only to be followed by erysipelas and then even pyemia.

Hospital gangrene, probably caused by Streptococcus pyogenes, had such a rapid and horrible effect on wounds that it inspired both dread and strong efforts to find a cure. The skin around gangrenous wounds sloughed off, revealing flesh that slowly turned "reddish, greenish, purplish, or black," while the gray edges of the opening grew wider at the rate of half an inch an hour. Arteries and even bones were rapidly exposed and the stench of rotten meat filled the air. As his skin turned gray the patient's breath became sickly sweet, his body alternated between chills and sweats, and his pulse grew ever faster, ever feebler. So great was the fear of the spread of this infection that in several areas medical officers established special facilities to isolate its victims.

Gas gangrene was not the infection that caused so much alarm in the military hospitals of the Civil War. Civil War records reveal that one of the most terrifying aspects of hospital gangrene was the rapidity with which it spread from patient to patient, but gas gangrene is not contagious. The presence of a clostridial infection cannot be ruled out, however, especially since the occasional mention of a sweetish odor from the wounds strongly suggests its presence. We know, however, that less than a third of all wounds become infected with clostridia, and only 5 percent of these actually develop gas gangrene. Gas gangrene, moreover, tends to appear in deep wounds, especially when damage to major blood vessels has reduced the oxygen supply to the muscles, a type of injury that during the Civil War usually led to relatively prompt amputation before gas gangrene could develop in the wound. Hospital gangrene, on the other hand, actually caused a higher death rate when it originated in flesh wounds than it did in wounds accompanied by fractures.

The horror of hospital gangrene inspired urgent efforts during the Civil War to find both a preventive and a cure. Among the remedies used, the halogens- iodine, chlorine, and bromine-proved to be more useful against hospital gangrene than nitric acid, which was also tried but with less widespread enthusiasm. Apparently finding bromine the easiest to use, surgeons began applying it to wounds and the rash of erysipelas, vaporizing it to disinfect the air, and mixing it with glycerine for internal use, not thinking, however, to use it to sterilize instruments. One successful technique involved inserting bromine on wooden sticks into diseased tissue; another called for injecting bromine by hypodermic into healthy tissue bordering the infected area. These procedures could cause so much pain as to require the use of anesthesia. Used in adequate strength and quantity, bromine prevented the spread of gangrene both in the individual patient and among patients. Although some surgeons using bromine reported that deaths from hospital gangrene had been entirely eliminated, others remained skeptical and apparently regarded the approach as something of a fad.

Attempts to find the cause of hospital gangrene and other infections met with less success than efforts to find a cure. Microscopic studies revealed an elevated white blood cell count in the victims of hospital gangrene, but beyond that "only the ordinary bacteria which are to be observed in every decomposing animal substance." This last comment, although strange to modern ears, was the natural result of ignorance about the range and variety of disease-causing organisms and the absence of stains and other techniques that would emphasize the characteristics of cells seen under the microscope.

The injuries that were the sites of such grim infections usually resulted not from bayonet or saber but from the slow-moving minie ball, which shattered bone and crushed soft tissues, carrying into the body bacteria-laden bits of clothing and other debris. A few minie balls were actually explosive and, while shattering bone still further, embedded bits of copper, lead, and pewter in the shredded flesh. Many victims bled to death on the battlefield. Even without infection, the fractures caused by the minie ball would challenge a twentieth century orthopedist. When streptococci filled the wound and spread ever more widely beyond the injury, even amputation often failed to save the victim. Thus the death rate was high. Sixty-two percent of those with chest wounds died, as did more than 87 percent with abdominal wounds, usually within two days of the moment when the bacteria-filled contents of the injured intestines spilled into the peritoneal cavity. Few surgeons would open the abdomen unless fecal material was actually oozing from the wound. Of the 253,142 wounds recorded in the Surgeon General's Office, however, most involved the extremities, more than 35 percent the legs and feet, and another 33 percent the arms and hands.

Confronted with so many injuries and imbued with the pragmatism characteristic of their profession, surgeons tried to test the effectiveness of both old methods and newly proposed approaches. One area of experimentation involved the hermetic sealing of chest wounds. Although this procedure gave instant relief for breathing difficulties and bleeding, it also eliminated the possibility of external drainage and thus provided no improvement in the management of infection. Many surgeons vigorously opposed its use. Another area of relatively intense study involved nerve injuries. Medical officers tried various forms of stimulation upon paralyzed patients, including electrical currents and alternating applications of cold and heat. Although 55.5 percent of those with spinal injuries died of their wounds, in at least one instance doctors were able to keep a "nearly complete paraplegic" whose bladder could be emptied only by catheter alive for at least seventeen years.

So great was Surgeon General Hammond's interest in nerve injuries that he turned an entire hospital over to S. Weir Mitchell, a pioneering neurologist, for the exclusive use of patients with nerve injuries and nervous diseases. Here Mitchell, George R. Morehouse, and William W. Keen, Jr., studied the victims of phantom limb and nerve damage, epileptics, malingerers, and shell-shock victims (although "shell shock" is a term of more recent origin), men whose ills were psychological in origin and who usually received little attention from physicians. In one year alone Mitchell used 40,000 injections of morphine in his attempts to relieve the torments of his patients. He experimented also with hypodermic injections of atropine to ease muscle spasms. In this facility he took thousands of pages of notes in preparation for later publication.

Since such a large proportion of wounds involved the extremities, much of the data collected on wartime surgery dealt with amputation, excision (the removal of a major portion of bone), and attempts to preserve bone essentially intact. Surgeons seeking to preserve a limb tried many devices to immobilize it, but apparently distrusted casts, fearing impaired circulation. Sandbags and elongated box splints limited motion during transportation, and several different kinds of splint were used in the hospital, including one designed by an Army surgeon. In cases where the femur, or thigh bone, was fractured, extension or traction devices were rarely used. Such treatment might prevent solid contact between the broken ends and thus inhibit or preclude healing, but without it, a leg tended to mend inches shorter than it had been and at times could be badly deformed as well. Other complications included abscesses and sinuses or abnormal channels that lasted for years and drained the patient's strength, and splinters of shattered bone left in the wound that continued to work their way to the surface, adding to the patient's lingering anguish. Some of the wounded thus died after years of suffering and slow decline. Medical officers attributed most deaths in those whose limbs they had tried to save to pyemia or other forms of systemic infection.

Since the treatment to be accorded fracture cases was chosen on the basis of the patient's condition rather than at random, the death rates do not necessarily reflect the merits of the various forms of treatment. Although there was much disagreement on the value of a conservative approach to the management of shot fractures, the mortality of patients chosen for conservative treatment proved less than that of those treated with excision or amputation. In a series of 386 men with shot fractures of the hip, for example, 249 of 304, or 82 percent, treated conservatively died, but 53 of 55, or 96 percent, undergoing excision failed to survive, and 25 of 27, or almost 93 percent, enduring amputation died. Of 2,369 victims of shot fractures of the shoulder, only 2 5. 1 percent treated conservatively died, while 36.6 percent of excision patients died, as did 29.1 percent of the amputees.

The chief value of excision, with its high death rate, lay in the fact that it could preserve some function of the arm and, when the periosteum (the bone-forming connective tissue covering all bones) was preserved, doctors could hope for some bone regeneration. One surgeon maintained that he had seen the entire shaft of the tibia (the principal bone of the lower leg) regenerated. Even without regeneration, however, an arm could be surprisingly useful despite the removal of a large amount of bone, and doctors regarded any function as better than none. Such removal might mean, however, that the limb would dangle loosely from the shoulder. Unfortunately, time might cause such an arm to deteriorate and to swell because it was dangling unsupported. In one such case, although Army doctors considered the result to be satisfactory, a pension examiner recommended amputation in 1867. Excision became less popular as the war went on- the chances for infection were great, the period of healing was long, and the results, except in the instances when the usefulness of a hand was retained, were questionable, if not actually disastrous. The death rate, furthermore, was comparable to or greater than that in amputations, with pyemia the chief danger and hemorrhage a significant problem.

Although occasional reports of excessive enthusiasm for amputations did surface during the Civil War, this form of surgery was apparently often undertaken only after careful consideration of the alternatives. Excision was generally viewed as the least desirable choice, however, in cases where there was damage to the upper leg, and damage to a joint was often regarded as necessitating amputation. The records concerning the number of amputations performed are not complete, but the figure was at least 30,000. The most common amputation was that of the hand or fingers, while the highest fatality rate, of 83.3 percent, occurred after amputation at the hip joint. Surgeons discovered that amputation at the knee took a surprisingly high toll of 57.2 percent, and even amputation of the lower arm was followed by the deaths of 20.7 percent of those operated on. Considerable difference of opinion existed as to how the amputation was to be performed in any event, with many favoring a flap procedure that could be quickly done on the field and involved less danger from bleeding than the circular form of the operation. Some surgeons favored immediate operation, others a very brief wait until the first shock had worn off. The surgery itself was apparently a rapid procedure even though anesthesia was generally used. A hip amputation reportedly took two minutes, including the time needed to tie off the femoral artery.

Some surgeons were still a little wary of anesthesia, however, and avoided its use when the patient's condition was very poor. Few deaths were actually blamed on these agents, but surgeons noted the adverse effects on appetite and the nausea and vomiting that followed their use. Some continued to believe that anesthesia prevented quick healing and therefore led indirectly to increased rates of infection and hemorrhage. Nevertheless, by the time of the Civil War, most Army surgeons, even conservative Surgeon General Thomas Lawson, had accepted its use.

Anesthetics were used in at least 80,000 cases during the Civil War. More than 76 percent of the time the agent used was chloroform, but ether was popular in general hospitals, and a combination of ether and chloroform was used in 9.1 percent of the cases. A failure to use any form of anesthesia was recorded only 254 times. The debate over which anesthetic to use centered around the difficulties and dangers involved. Deaths from chloroform averaged 5.4 per 1,000 cases, those from ether 3 per 1,000. Ether was flammable and particularly hazardous when operations were performed by candlelight, while chloroform caused some inexplicable deaths, although it was easy to take and even a small amount acted with considerable speed. Surgeons well aware of its dangers and its reputation still preferred to use this anesthetic, although they did so with care, attempting to limit the length of time it was administered and to ensure that an adequate amount of air was inhaled with it.

An anesthetic, whether ether, chloroform, or a mixture of the two, was apparently usually administered by means of an impregnated cloth, which might have been rolled into a cone with an anesthetic-soaked sponge at its apex, held over the mouth and nose. Experience taught medical officers that in the open air where so many amputations were performed, merely pouring an anesthetic on a cloth was not effective. Premedication, if given, might take the form of a dose of whiskey. As a rule no ill effects resulted from the inhalation of an anesthetic. On occasion, however, a patient inhaling chloroform would begin to make convulsive movements, and the veins in his neck would start to swell. The physician would often note that his patient's heart was either at the point of arrest or had already stopped beating. In such cases, respiration soon also ceased, and all the efforts of doctors and nurses were often to no avail. It was only in March 1865, however, that the surgeon general was sufficiently disturbed over the problem of anesthesia deaths to order his surgeons to report on their experiences with these agents.

In addition to anesthetics, medical officers used analgesics, including both alcohol and opiates, in their battle against pain. Alcohol was used not only to relax a patient before the administration of anesthetics, but also to serve as a vehicle for quinine. Some physicians, including Letterman, feared that this free use of alcohol could induce addiction or mask symptoms, but alcoholism did not become a significant problem during the Civil War. Authorities should perhaps have been more concerned about the possible overuse of opiates, since many cases of addiction after the war were blamed on the free prescribing of such drugs during the conflict. Opium itself had long been prescribed for diarrhea, but during the Civil War morphine was also dusted in wounds or administered by hypodermic. Occasional mention was also made during this period of the use of cannabis for patients with tetanus or head injuries.

The hypodermic, apparently used chiefly to inject morphine, was one of a few new devices slowly gaining in popularity in the Army during the Civil War. It was regarded to some extent as experimental. Although the Medical Department did have clinical thermometers, they were not in common use, and the model available was very long, intended for use in the armpit. Such instruments as hemostatic forceps, retractors, and dilators were not available, and few doctors knew how to use an ophthalmoscope or laryngoscope. Microscopes were few and far between. Real progress, however, was being made in the design of artificial limbs, enabling crippled soldiers to walk with only a limp or, with the aid of gloves, to conduct their lives with few aware that they had lost a hand or an arm. A relatively new development was mobility in the ankle of an artificial leg. A device developed by one firm for patients with resections of the elbow or shoulder was so effective that it permitted a greater reliance on this form of surgery as opposed to amputation. Medical officers also developed considerable ingenuity in devising for those whose lower jaws had been torn away prostheses that limited drooling and made taking liquids possible. The actual selections of the firms to make prostheses and of the designs to be used was apparently significantly influenced by a committee of distinguished doctors appointed by Surgeon General Hammond. The soldier whose artificial limb was approved by the Medical Department could choose any limb costing $50 or less from one of several authorized manufacturers.

The benefits to medical science arising from the Civil War are not easily established, but undoubtedly the civilian population profited from the presence of surgeons like S. Weir Mitchell and his colleagues who had received more training and experience during that conflict than they would otherwise have had in a lifetime. Although the records and specimens that would form the Medical and Surgical History, and the Army Medical Museum were of little help in improving the care of the sick or wounded during the struggle, both would be of value to future generations, just as would be the techniques in staining specimens for the microscope and in photomicrography pioneered in the museum late in the war.

Organization and Administration

The effect of Civil War experiences on the size, organization, and administration of the Medical Department was more pronounced than the Civil War experiences' effect on medical science. A more effective use of the department's newly huge medical staff was but one of its achievements. Great flexibility proved necessary to care for the enormous numbers of sick and wounded that poured in from battlefields and camps, both east and west. No ratio of surgeons to men that would be adequate under all circumstances could be efficiently established for a given unit. To deal with this situation, the Department departed from the Mexican War pattern to create positions for surgeons and assistant surgeons of the volunteers, who could be assigned as needed and whose qualifications were determined by the Medical Department. More than 500 of these physicians worked with a Regular Army staff numbering less than half that figure. Almost 6,000 regimental medical officers, whose qualifications were initially ascertained at the state level, also served at one time or another in the Union Army. An equivalent number of civilian doctors unwilling or unable to join the Army worked as contract surgeons, either for short periods when necessity dictated or in general hospitals in the cities where they lived. Although a few Army doctors, especially in the early months of the war, earned unenviable reputations, the Department was apparently able to gather a medical staff that was on the whole highly regarded. The new type of organization, where regular medical officers shared their responsibilities at all levels with a large volunteer staff, was needed more in war than in peace, but it blazed a trail that would not be forgotten.

The war also served to emphasize the necessity for abandoning the customary haphazard approach to the problem of providing an adequate number of hospital attendants, nurses, clerks, and guards. Expecting to find a sufficient number of able and disciplined men and women to work in hospitals on short notice proved unreasonable. Complaints about the caliber of the nurses rounded up to care for military patients were numerous, yet by the end of the war, the problem remained only partially resolved. Line officers understandably resented having to leave healthy and competent men behind to care for the sick. As the war progressed and the number of invalids grew, the Invalid Corps significantly eased the staffing shortage, but few were available early in the war. Since these men had no training in the care of the sick, their usefulness was limited. Moreover, few women had any formal training in nursing, although their practical experience in caring for their families stood many in good stead. The obvious need for professional training of nurses influenced those responsible for staffing civilian hospitals after the war, not only to give nurses the expertise needed but also to separate the dedicated from the dilettante. Of the latter, many had found their way to the hospitals in the guise of nurses during the war.

The Medical Department also introduced greater system into the management of field hospitals. Early in the war, surgeons started organizing these facilities principally on a division basis rather than a regimental one. Medical officers also established small stations near the battlefield and evacuation hospitals at rail depots or near wharves along waterways. Tents, marked as hospitals by yellow flags with green numerals, became an increasingly common sight in the field, since they offered many advantages over the buildings that might be available near a battlefield. They could be pitched in an hour by someone familiar with them, and although those designed for hospital use could accommodate only eight patients comfortably, their design permitted two or more to be joined to serve larger numbers of wounded. Smaller tents could be used to shelter medical officers and medical and kitchen supplies. Surgeons found that there was less infection among patients sheltered in tents, where in good weather the walls could be raised to achieve perfect ventilation. An experienced Army surgeon concluded, "One of the most valuable lessons taught by the experience of the American War of 1861-65 was the demonstration of the inestimable value of the tent as a hospital.

Unlike field hospitals, base or general hospitals were located almost entirely in buildings, although tents were occasionally used to increase their capacity. Authorities soon discovered that structures erected for some other purpose did not usually make good base hospitals. In a former hotel or barracks, no amount of purification, cleaning, and disinfecting could disguise the odors that spoke of inadequate ventilation. Maximum efficiency by a large staff, furthermore, was impossible in a badly designed building; every 1,000 patients required a staff of 20 wardmasters, 100 nurses, 5 or 6 cooks, 8 to 10 assistant cooks, 4 or 5 launderers with occasional assistants, 3 or 4 bakers, 10 to 15 men to run the stables and shops, 3 or 4 more men to manage the morgue and cemetery, 10 in the headquarters and library, about 15 physicians, and an undetermined number of medical cadets, all under the command of a regular or volunteer medical officer.

As a result of the inconvenience and the sanitation problems involved in using existing buildings to house general hospitals, the Army began to design and erect structures intended from the outset for this purpose. Small post facilities had been designed and built specifically to house sick and wounded soldiers ever since the days of Lovell, but the Medical Department had never before encountered such a pressing need to design very large hospitals. Experiments undertaken in its drive to create them contributed considerably to civilian medicine too. The concept of the pavilion hospital was later adopted by such famous institutions as the Johns Hopkins Hospital, for which John Shaw Billings, who as a young medical officer worked on the design of the Army's new general hospitals, drew the plans.

In the pavilion hospital, thousand of patients could be sheltered and the spread of infection and contaminated air limited by the division of patients into relatively small groups, each kept separate from the others. Since the separation could result in administrative problems, various arrangements of the pavilions were tried to achieve the best combination of good ventilation and efficiency. On occasion, a hybrid hospital design was created by adding pavilions to a preexisting structure, which was used as the administration and storage building. Some of the earliest facilities, hastily erected, were of frail construction as well as poor design, and their walls eventually required buttressing to prevent their collapse. One design that proved satisfactory called for pavilions 24 to 25 feet wide and 12 to 14 feet high, which represented a 7-foot increase in width and a 4- to 6- foot increase in height over the earliest models, with the length cut from 200 feet to 150 feet. This plan also called for ridge ventilation on well-spaced buildings.

Hospital designers believed that the ideal facility would consist of one-story buildings set 3 to 4 feet above ground level where each patient had 1,000 cubic feet of air. In warm weather, ventilators at the ridge of the roof, sheltered from the rain by a small roof of their own, would keep the air circulating, and open corridors would add to the fresh air available. Cold weather ventilation would be achieved by closing shutters in the ridges and using a system of shafts that minimized the loss of the heat generated by stoves.

Although city water and city sewers were available to some general hospitals, the problems involved in achieving sanitation goals, already difficult when so many patients suffered from diarrhea, were in some instances exacerbated by water shortages and the need to dispose of patient waste without city plumbing. The Medical Department was forced to experiment with solutions to such difficulties. In a Wilmington, Delaware, hospital, where city water was available but city sewers were not, a long trough under the seats of the latrine was flushed two or three times a day and emptied by pipe into a deep covered pit some distance from the buildings. When hospital effluvia was discharged near the building or retained any length of time within it, odor became a problem, a particularly alarming one because doctors assumed that with odor came infection.

As a rule, base hospitals sheltered patients suffering from every kind of disease, wound, and infection, but a few specialized facilities were beginning to appear. One such facility was the hospital in Philadelphia, where Mitchell, Moorehouse, and Keen studied patients with neurological and nervous problems. In 1863 the Army also established an eye and ear hospital in St. Louis, while in Nashville patients with erysipelas had their own facility. At Wilmington, Delaware, patients who had lost feet or toes to frostbite were hospitalized together, and in the fall of 1862 Surgeon General Hammond ordered the establishment of a facility for "mutilated soldiers" in New York City.

Innovative thought was as necessary in dealing with evacuation as it was with hospitalization. The enormity of the conflict made it plain early in the war that the casual approach of peacetime would not be adequate for the wounded and sick of 1861-1865. The two-wheeled ambulance proved too fragile and too uncomfortable for wide use on the battlefield. The Army was forced to experiment to find a conveyance that could move the wounded quickly from the battlefield to the nearest aid station and sturdier models to move them thence the longer distance to a hospital, hospital train, or hospital transport. Ironically, although many ambulance designs were tried, some of which were presented for approval by such Army surgeons as Finley and Tripler, the most useful one was the work not of a medical officer but of Brig. Gen. Daniel H. Rucker, a Quartermaster's Department officer. Mule litters of varying design were also tried, but without significant success. The best stretcher proved to be one weighing less than twenty-four pounds and designed to be carried by man rather than beast.

The Medical Department also discovered that it was highly desirable to have trains and ships equipped specifically for the evacuation of the wounded. Early in the war, the wounded who traveled by train lay on straw in boxcars or, if they could manage it, sat up in passenger cars. Gradually, however, with the help of charitable organizations, more and more hospital cars of varying design and offering greater comfort began to appear, and in time these were combined into hospital trains that might include cars used specifically for cooking, dining, storage, or sleeping quarters for the medical staff. In Sherman's army, civilians hired by the Quartermaster's Department served as conductors and train crew, while enlisted men served as cooks and nurses. The Medical Department staff present on such a train usually consisted of a surgeon in charge, an assistant surgeon, and a hospital steward. Clearly identified by its bright red smokestack, engine, and tender, and its three red lanterns at night, the hospital train was apparently never molested by the enemy. The various sanitary commissions also helped outfit specially equipped hospital ships and provided more vessels of their own when necessary.

Although the most important obstacle had been surmounted when the Medical Department recognized the simple fact that a formal organization, careful planning, and trained and disciplined personnel were necessary to successful evacuation, not everyone within the Army was willing to grant the department the control necessary to ensure its efficient operation. Letterman's struggle to have the ambulance corps placed under the command of medical officers succeeded in the Army of the Potomac only with General McClellan's support, and his approach was officially adopted throughout the Army late in the war. Medical Department control over hospital transports was not generally conceded until early 1865.

The improvements in the management of hospitalization and evacuation achieved during the course of the Civil War were considerable. By the end of the war, evacuation tended to be as prompt and as systematic as the military situation permitted. As a result, the number of regimental medical officers and attendants drawn away from the battlefield was minimal, and the need for tents and equipment for field and depot hospitals was limited. Although many patients still had to endure the heavy ride of Army wagons for short distances, increasing numbers made the major portion of their journey north or east in the comfort of well-appointed hospital ships or trains. The hospitals they stayed in along the way were more likely to be efficiently organized, and there was a better chance that the hospitals they reached at the end of their trip would be carefully designed and ventilated institutions where the staff was able to work with maximum efficiency.

In 1965 Army surgeons remained to a large degree helpless in the face of disease, and because of the devastating infections they, confronted, they made little progress in their handling of wounds. The Medical Department did, however, reestablish order after a chaotic beginning and create an organization competent to meet the demands of a war that was waged on a scale never before encountered. These accomplishments were initially impossible, however, because those who shaped the Medical Department policies understood neither the unprecedented nature of the conflict nor the demands it was placing upon them. After William Hammond inspired the department's overwhelmed medical officers to withstand frustration and adversity while he initiated new and determined approaches to their problems, there was no turning back to the old ways. By cooperating closely with one another, the very men who had been Hammond's undoing were able to continue successfully along the path he had laid out.

Epilogue

The creation of the Medical Department on a permanent basis in 1818 had far-reaching consequences both for the U.S. Army and for medical science. Endowed by Congress with the responsibility for a permanent organization rather than a temporary wartime expedient, the surgeon general was in a position from this time onward to make long-range plans for the care of the Army's sick and wounded in war and peace and to direct continuing efforts to contribute to the sum of medical knowledge. Much depended, however, on the ability of the physician who served as surgeon general.

The first man to head the Medical Department was the young and brilliant Joseph Lovell, who quickly moved to improve the caliber of his staff and to begin collecting information on factors that might be affecting the Army's health. Because of Lovell's efforts, the highly trained and disciplined physicians who gradually replaced the motley crew that formed the department in 1818 began to regard themselves as members of a proud profession. The beneficial effects of this change in attitude were soon evident, for, on the whole, the first career military surgeons in the nation's history worked diligently to meet the responsibilities placed upon them.

The appointment of the most senior surgeons in the department rather than the most able as Lovell's two immediate successors did not augur well for further progress in the Medical Department. Nevertheless, Thomas Lawson's enthusiasm for the department and its work led to the winning of rank for Army surgeons. He also obtained the right to enlist hospital stewards, continued the collection of data started by Lovell, and worked to develop an effective ambulance. Lawson grew old and ill in office, however, and when he died, the department was still unprepared for war. Lawson's successor, Clement Finley, while healthier than his predecessor was probably less competent and came to office entirely because of his seniority.

As a result, the Medical Department began to meet the challenge of the Civil War only when Finley was succeeded by a physician who was, like Lovell, both young and talented. Appointed surgeon general despite his lack of seniority, William Hammond built upon the small but sturdy foundation laid and maintained by his predecessors. Forcing through the changes in the department's organization and administration that were necessary to meet the needs of vast numbers of sick and wounded, with the assistance of the Department's small nucleus of Regular Army surgeons, Hammond, like his successor, initiated thousands of civilian physicians into the mysteries of their wartime duties.

Unlike his predecessors during the Civil War, Joseph Barnes, who took over as surgeon general upon Hammond's disgrace, was regarded with great favor by Secretary of War Stanton. He was, therefore, able to continue along the lines set out by Hammond with far greater ease than Hammond himself. During Barnes' tenure, Congress finally created the ambulance corps for which Hammond and his supporters had fought. In the last months of the war, Barnes finally gained for the Medical Department complete control of evacuation and the management of hospitals. The last Civil War surgeon general so pleased his superiors that he was brevetted major general in March 1865.

Although five surgeons general directed the Medical Department from 1818 through 1865, two of them were principally responsible for the shaping of the department's character to meet the demands placed upon it. Lovell professionalized the care that the Army's sick and wounded would in the future receive and, in insisting on regular and detailed reports on all matters that might relate to the soldier's health, let it be known that the Medical Department planned to play a major role in the world of medicine. Circumstances required that Hammond create the department anew, but even as he worked to reorder the structure under which the sick and wounded received care, he demonstrated his agreement with Lovell's ambition for the department by calling for the gathering of case histories and specimens from his surgeons. As they strove to adapt the Medical Department's structure and operations to the needs of their times, both Lovell and Hammond blazed clear paths that their less talented successors could follow.

Nevertheless, the willingness of the first surgeons general to take advantage of the department's potential for contribution to science and their determination to improve the medical care offered to the nation's soldiers did not result in major scientific discoveries. The era when clinical observations and statistical compilations were the principal approach to the mysteries of human health was rapidly passing. As the tribulations of William Beaumont proved, even in peacetime the Medical Department of the 1818-1865 period was not in a position to foster experimental research.

The department was able during this period to contribute to medical science in lesser, practical ways because the use of any remedy or treatment in relatively large numbers of patients by physicians working under the discipline of a single organization inevitably constitutes a trial of its worth. It was the Army's experience since 1800 that clearly demonstrated the benefits of mass vaccination against smallpox. Army surgeons established both the advisability and safety of using higher doses of quinine than those customary outside the South and the powers of bromine against infection. The Army's Civil War use of anesthetics demonstrated on a large scale the benefits and the relative safety of these agents when carefully used.

With the acceptance of the germ theory, however, would come the discovery of the causes of typhoid, malaria, dysentery, and other major diseases, and the resultant development of better ways in which to prevent and treat these scourges. In comparison to these dramatic events, the Army's informal testing appears insignificant. As the end of the century approached, however, and medical science moved forward with great rapidity, medical officers of the U.S. Army would be in the forefront of many great advances. Army surgeons would be increasingly able to prevent and cure disease and infection. With new and better weapons, post-Civil War physicians would wage a more successful struggle against disease and infection, but they would never conduct a more gallant fight than the Army surgeons of 1818-1865.

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