Healers or Horrors: Civil War Medicine

By Richard A. Gabriel, 9-22-16

Safe behind its ocean barriers, the United States paid scant attention to the wars that raged abroad during the early 19th century, taking little notice of the lessons that might have been learned from the European experience with mass killing. With few opportunities for its own military medical establishment to acquire field experience, the U.S. Army’s military medical service remained primitive. In 1802, the U.S. Army Medical Corps comprised only two surgeons and 25 orderlies. By 1808, the number of surgeons had increased to seven and surgical assistants to 40. There was no ambulance corps during the War of 1812; after the battle wagons were sent to search for the wounded. There were no hospitals, either, and the wounded were treated in temporary shelters near the battlefield. Even these primitive facilities were dismantled when the war ended. In 1818, Congress finally authorized the appointment of Dr. Joseph Lovell to head the medical corps as surgeon general.

At the start of the Mexican War in 1846, the American medical corps consisted of one surgeon general and 71 medical officers. Statistically, the Mexican War was the deadliest ever fought by an American army. Of the 100,182 soldiers committed to the campaign, 1,458 were killed in action and another 10,790 died of disease, a disease mortality rate of 11 percent. This compared to a similar rate of 6.5 percent for the Civil War, 2.7 percent for the Spanish-American War, and 1.6 percent for World War I. The single medical contribution of the Mexican War was the first use of anesthesia by a military surgeon in combat. The medical service was once more reduced in strength when the war ended. At the outbreak of the Civil War, no one on either side was remotely prepared for the magnitude of the slaughter, forcing both sides to endure a medical catastrophe that was unprecedented in military history.

The Shocking Casualties of Total War
The Civil War was the first modern war in which the productive capacities of the industrial state were completely integrated into the war effort. The number of combat engagements was the largest in history to that time, and exponential increases in the killing power of weapons produced rates of casualties beyond the imagination of military medical planners. In a four-year period, 2,196 combat engagements were fought, in which 620,000 men perished—360,000 in the Union Army and 260,000 in the Confederate Army. Some 67,000 Union soldiers were killed outright, 43,000 died of wounds, and 130,000 were disfigured for life, often with missing limbs; 94,000 Confederate soldiers died of wounds.

Deadlier Rifles
The minie ball (actually a bullet) caused 94 percent of all wounds, artillery shell and canister accounted for 6 percent, and the saber and bayonet fewer than 922 wounds, of which only 56 were fatal. Some 35 percent of all wounds were to the arms, 35.7 percent to the legs, and wounds to the head and trunk accounted for 18.4 percent and 10.7 percent, respectively. In a statistical sense, the Civil War was the most life-threatening war ever fought. The chances of not surviving the war were one in four, as compared to one in 124 in the Korean War.

The staggering increase in the number and seriousness of wounds was due to the .58-caliber rifle-barreled firearm, which was capable of propelling a bullet 950 feet per second to a range of 600 yards. The heavy, soft, unjacketed lead bullet flattened out on impact, producing severe wounds and carrying pieces of clothing into the wound. When the bullet struck a bone, its weight and deformation shattered the bone or severed it completely from the limb. The old tactic of massing troops to deliver mass fire, once made necessary by the inaccuracy and limited range of the musket, persisted, making troop formations extremely vulnerable to long-range rifle fire. The deployment of troops over greater frontages also increased the dispersal of the wounded, making it difficult to locate, treat, and evacuate them. The Civil War medical officer faced problems of wound management that were unique for the time.

More Limbs Lost Than in Any Other American War
The improved kinetic power of the rifle bullet made amputation the most frequently performed battlefield operation. Of the 174,200 gunshot wounds to the arms and legs suffered by Union soldiers, 29,980 required amputation. Confederate soldiers suffered 25,000 primary amputations. The mortality rate for primary amputation was 26 percent, compared to 52 percent for secondary amputation. Another 26,467 wounds of the extremities that were complicated by an injury to the bone were treated by expectation (left alone to heal), with a mortality rate of 18 percent. More limbs were lost in the Civil War than in any other American conflict before or since.

In the first years of the war, control of bleeding (hemostatis) was achieved mostly through the use of tourniquets and cauterization, methods dangerous to the patient when practiced by physicians with limited experience. As the physicians gained experience, pressure dressings and ligature became the primary methods for controlling bleeding. But ligature often led to infection. The mortality rate for these secondary infections was 62 percent. The usual array of infections—tetanus, erysipelas, gangrene, and various streptococcus infections—was always present, and the mortality rate in hospitals from such infections reached 60 percent in the early days of the war. By the end of the war, this had fallen to 3 percent. Hospital infection remained a major problem on both sides throughout the war, however. William W. Keen, a surgeon in the Union Army, observed in his memoirs that “it was seven times safer to fight all through the three days of Gettysburg than to have an arm or leg cut off and be treated in a hospital.”

Battlefield Drugs and Anesthetics
For the first time in history, anesthesia was used on an unprecedented scale by military physicians. No fewer that 80,000 applications of anesthesia were administered. General hospital records show that anesthesia was used in 8,900 operations, of which 6,784 used chloroform and 811 used ether. In 1,305 cases, a combination of the two was used. Remarkably, only 37 deaths were attributed to anesthesia. Advances were also made in the immobilization of limbs using plaster of Paris. In 1863 the famous Hodges splint, still used today in the fracture of the lower femur, was introduced by Union surgeon John Hodges.

The use of drugs was primitive at best. Calomel (mercurous chloride) was so heavily prescribed that the Surgeon General forbade its use as dangerous. The most useful drugs were morphine, opium, and quinine, the latter as a preventative for malaria. Morphine was usually dusted directly on the wound, and only occasionally injected hypodermically. The hypodermic syringe appeared in the 1850s but was used only rarely in the Civil War—at least on the physically wounded. Dr. Silas Weir Mitchell noted that in the army hospital for nervous diseases, more than 40,000 doses of morphine were given hypodermically to psychiatric patients in a single year. A staggering 10 million opium pills were given to patients during the war, along with 2,841,000 ounces of other opium-based preparations such as laudanum, opium with ipeac, and paregoric. In all, 29,828 ounces of morphine sulphate were administered. Not coincidentally, by 1900 there were 200,000 drug addicts in America.

Disease: The Number-One Killer
Disease was the number-one killer of soldiers on both sides during the Civil War. Most recruits were physically unfit for the rigors of war. Three-quarters of the Union soldiers discharged from the army in 1861 were so unfit that they should never have been allowed to enlist. Most recruits came from isolated rural towns, and this isolation prevented them from developing immunity to a wide range of common childhood diseases. Being brought together in the close quarters required of military life, many fell ill with diseases to which they had never previously been exposed. Poor physical condition, few immunities, poor nutrition, and the general stress of military life reduced resistance to disease. Scurvy was endemic, and outbreaks of cholera, typhus, typhoid, and dysentery took a heavy toll. Disease killed approximately 225,000 men in the Union Army and 164,000 men in the Confederate ranks. It is estimated that disease killed five times as many men as weapons fire.

The Union Army Adapts its Medical Corps
The Union medical service was completely unprepared for war. In 1860, the 26,000-man army was scattered along the frontier and had no military medical service to speak of. The army had only 36 surgeons and 83 assistant surgeons, 24 of whom resigned to join the Confederacy. Medical supplies were in short supply, and there were no army general hospitals. There was no ambulance service to locate and evacuate the wounded. The incumbent surgeon general was Thomas Lawson, a sick and dying man who economized on expenditures by refusing to purchase medical books and supplies.

In the 1850s, then-Secretary of War Jefferson Davis had ordered two officers, one of whom was Captain George B. McClellan, to prepare a study of medical lessons learned from the Crimean War. The report recommended the creation of an army ambulance corps. But by 1860, no such corps had been established. For the first two years of the war, there were no systematic provisions to evacuate the wounded. At the Battle of Bull Run, wagons had to be commandeered from the streets of Washington to transport the wounded. In the Peninsular Campaign, a Union Army corps of 30,000 men had ambulance transport sufficient for only 100 casualties.

At the Battle of Wilson’s Creek, Missouri, in August 1861, the wounded could not be moved for six days due to the lack of ambulances. In November of that same year, Brig. Gen. Ulysses S. Grant abandoned his wounded at Belmont, Missouri, because there were no ambulances. In 1861, Lawson was replaced by Dr. William Hammond, who appointed Dr. Jonathan Letterman as surgeon general of the Army of the Potomac. Letterman immediately set about creating an ambulance corps.

Each army corps now acquired its own organic medical transport. Each division, brigade, and regiment had its own medical officer who answered to the corps’ medical officer responsible for coordination at all levels. The chief surgeon within each division controlled the ambulance corps. Each regiment was assigned three ambulances and a complement of drivers and litter-bearers, and each division had its own ambulance train of 30 vehicles. The ratio of ambulances to men averaged 1 to 150. Only medical personnel were permitted to remove the wounded from the battlefield, a regulation designed to reduce the manpower loss that often resulted when several men left the line to transport their wounded comrades to aid stations. Ambulance wagons were removed from control of the quartermaster and used only for medical transport. They were posted near the front of the column to be within easy reach once a battle began.

Transporting the Wounded: Letterman’s Ambulance System
The first test of Letterman’s ambulance system came at the Battle of Antietam in September 1862. Union forces alone suffered 10,000 wounded scattered over a six-mile area. The system reached and evacuated most of them within 36 hours. A month later at Fredericksburg, the system worked so well that the wounded piled up at aid stations faster than they could be treated. Within 12 hours, all 10,000 wounded had been located, transported, and cleared through the aid stations. Letterman’s ambulance system was integrated into the larger network of casualty evacuation from field hospitals at the front to general hospitals in the rear. Railroads evacuated casualties from collection points behind the battlefields to the general hospitals. By the end of the war, Northern railroads had transported 225,000 sick and wounded men from the battlefields to the general hospitals.

The Union medical service also used coastal steamers and river steamboats under the control of the medical corps to transport the wounded. In 1862, the Union Army contracted for the use of 15 steamboats on the Mississippi and Ohio Rivers and 17 seagoing vessels for use along the Atlantic coast. In the last three years of the war, 150,000 casualties were transported by boat to the general hospitals. The first use of a hospital ship was at the Battle of Fort Henry in February 1862, when the City of Memphis transported 7,000 casualties to hospitals along the Ohio River. Also in 1862, the navy purchased the D.A. January as its first hospital ship. By the end of the war, January had transported 23,738 casualties on the Ohio, Missouri and Illinois rivers, with a mortality rate of only 2.3 percent, significantly lower than the rate in land-based hospitals. The first naval nurses in America, the Catholic order of the Reverend Sisters of Mercy, served aboard Red Rover, tending the wounded after the siege of Vicksburg, Mississippi. In March 1862, Hammond recommended that all Union armies adopt Letterman’s system, which until then had been limited to the Army of the Potomac. Congress approved the recommendation in March 1864. It was only at the end of the war, however, that Letterman’s reforms were fully implemented.

Reforming the Field Hospital System
Letterman also changed the structure of the field hospital system by turning regimental hospitals into frontline aid stations. Treatment of the wounded at these stations was limited to control of bleeding, bandaging wounds, and administering opiates for pain. This allowed medical officers to hold the slightly wounded there and return them to the line, reducing manpower loss due to needless evacuation. Behind the aid stations, Letterman created mobile surgical field hospitals. These hospitals were the critical link between the frontline aid stations and the rear-area general hospitals. The system was tied together by the field ambulance corps, railways, and hospital ships.

The general hospitals were located in major cities along established water and rail routes. By 1862, a building program was undertaken in the North to construct additional hospitals. A year later, the Union Army had 151 general hospitals with 58,715 beds ranging in size from small facilities of 100 beds to the Mower General Hospital in Philadelphia with 4,000 beds. Some of these hospitals became treatment centers for medical specialties such as orthopedics, venereal disease, and nervous disorders. St. Elizabeth’s in Washington, D.C., became the first military psychiatric hospital in the country.

Another of Letterman’s innovations was the establishment of a modern medical supply system that worked well under field conditions. Until this reform, medical supplies and equipment were obtained from the quartermaster through the usual supply system. This often led to medical units not receiving adequate supplies. Letterman established basic medical supply tables, equipping all medical units from regiment through corps with basic loads of medical provisions. Each unit was to carry with it supplies for 30 days. A medical purveyor accompanied the army and was responsible for continually replenishing the medical supplies of each unit.

13,000 Physicians and Surgeons
Most surgeons in both armies were commissioned by state governors to provide medical support for the regiments raised by the states. With few standard licensing procedures for medical certification, it is not surprising that basic competence was a major problem. Few of the physicians entering the state regiments had surgical training. As the war dragged on, however, many of the marginally competent physicians and surgeons became excellent practitioners as a result of their battlefield experience.

About 13,000 physicians and surgeons served with the Union Army. Of these, 250 Regular Army surgeons and assistant surgeons were appointed by Congress to serve as staff and administrators. Some 547 brigade surgeons were commissioned by Congress to assist the corps of regular surgeons. Another 3,882 regimental surgeons and assistants were appointed by governors to state regiments. These surgeons usually served in the aid stations and mobile field hospitals. The army hired 5,532 contract surgeons, mostly civilian doctors, to staff the general hospitals. An additional 100 doctors staffed the Veterans Corps to provide aid to the disabled, and 1,451 surgeons and assistants served with the 179,000 Black troops in 166 regiments. One of the Union surgeons was Mary Edwards Walker, the first woman in American history to hold such a position. Women mostly served as nurses, however. In the North, 3,214 female nurses served in military hospitals under the control of Dorothea Dix, who had been appointed as superintendent of Women’s Nurses. One of Dix’s nurses, Clara Barton, went on to found the American Red Cross. The special place of women in Southern culture militated against using women in military hospitals. Consequently, female nurses were not used there on a large scale.

With the end of hostilities, the Union Army was demobilized and along with it the military medical service. By the end of 1866, the Union Army had been reduced to a force of only 30,000 men. The army and its skeleton medical corps were scattered among the 239 military posts throughout the country. By 1869, the entire medical service corps consisted of only 161 medical officers. Most military posts had no surgeons at all, and they were forced to rely on contract physicians for medical support. Only 282 surgeons were available to the military. Letterman’s system for dealing with mass casualties disappeared virtually overnight.

The Confederate Medical Corps
In general, the Confederate medical service was organized and operated very much like the Union system, although it suffered more from shortages of personnel and equipment that magnified its shortcomings. The total number of medical officers in the Confederacy was 3,236, of which 1,242 were surgeons and 1,994 assistant surgeons. The Confederate naval medical corps had only 107 medical officers, including 26 surgeons and 81 assistant surgeons.

The South’s shortage of physicians was to some extent self-inflicted. For reasons that remain unclear, all medical schools in the South with the exception of the University of Virginia were closed at the start of the war, cutting off the Confederate armies from an invaluable source of trained medical personnel. Moreover, the Confederate surgeon general established unrealistically high qualifications for physicians wishing to join the medical service, causing still more shortages. Worse yet, he examined those physicians already in the medical corps for competency, forcing significant numbers to resign. The Confederacy was never able to provide adequate numbers of surgeons and other physicians to deal with the heavy casualties it suffered on the battlefield.

Deficiencies in Confederate Supplies
The Confederate ambulance service was never adequate and suffered from a chronic shortage of wagons and other transport. In 1863, Confederate medical officers complained that there were only 38 ambulances in the entire Army of the Mississippi. The situation worsened as the war continued. In 1865, not a single ambulance could be found in the combat brigades of the armies of West Virginia and East Tennessee. The shortage of ambulances forced the South to make greater use of steamboats and railroads to transport its wounded. But the undeveloped nature of the Southern railroad system resulted in a shortage of efficient track routes over which to transport casualties. Small 100-bed hospitals were constructed at rail junctions to deal with the problem.

Shortages of vital medical supplies plagued the South until the end, including shortages of quinine and anesthetics. Paradoxically, these shortages sometimes produced beneficial if unexpected results. It had been the common practice on both sides to cleanse wounds with sea sponges kept in buckets of water next to the operating table. Squeezed in dirty water and used repeatedly, these sponges became major sources of infection transmission. The shortage of sponges in the South as a result of the Union blockade forced Confederate surgeons to use cotton rags instead. Since the rags were used only once, disease transmission was reduced considerably.

The used rags were recycled, a process that required them to be washed, boiled, and ironed, and thus made sterile. Bandages, too, were better in the South since they were made of cotton that had first to be baked to be made useable. It had been common practice to use harness-maker’s silk for ligatures and sutures. With no silk available, Southern surgeons used horsehair instead. To make horsehair pliable enough for suturing, it first had to be boiled. Boiling made the suture material sterile.

The South recognized dentistry as an important medical specialty. As secretary of war before hostilities broke out, Jefferson Davis had tried to convince the army to establish a separate dental corps, but had failed to do so. The South had a more comprehensive dental care program than the North, which contented itself with transferring to the artillery any toothless soldiers who could not bite off the ends of their cartridge packets.

Medical Personnel Become Noncombatants
The Confederacy’s general hospital system was perhaps the only element of the military medical service that was somewhat equivalent to the system in the North. The largest hospital on either side was the 8,000-bed Chimborazo Hospital outside of Richmond. With 150 single-story pavilions organized into five divisions, each with 40 to 50 surgeons and assistant surgeons per division, it was the largest military hospital ever built in the Western world. The pavilion-style hospital proved to be the best design for reducing infection by improving ventilation and isolation. These hospitals consisted of a series of long, single-story buildings isolated from each other. High ceilings with vents at the top and sufficient windows provided ventilation. Usually connected to a central semicircular corridor, these 60-patient buildings were sometimes unconnected, providing excellent isolation for disease wards. The pavilion-style hospital is generally credited to Dr. Samuel Moore, the Confederate surgeon general, who supposedly got the idea from British hospitals used in the Crimea. In fact, the design is actually much older and reflects the design of legion camp hospitals used by the Roman medical service.

One of the more significant military medical contributions of the South is attributed to Lt. Gen. Thomas “Stonewall” Jackson. In 1862, Jackson ordered all Union medical officers held by his command to be released and henceforth treated as noncombatants. By June of that year, both Lee and McClellan agreed to a similar practice. Medical personnel were no longer to be subject to capture. If taken, they were to be allowed to treat their wounded and immediately released. All medical personnel held in Union and Confederate prison camps were freed in 1862, and exchanges of captured medical personnel continued until the end of the war. Jackson had instinctively anticipated the regulations dealing with medical personnel that were adopted by the First Geneva Convention a few years later.

Medical Advances of the Civil War
A number of advances in military medicine resulted from the Civil War. Hammond created the Army Medical Museum to collect and study artifacts and information relevant to military medical care. John Shaw Billings began the Library of the Surgeon General’s office which remains the largest military medical library in the world. Congress established a pension system for disabled soldiers far more generous and comprehensive than anything seen in Europe at the time. The
pension system was chosen over the asylum system of permanent care because it provided the disabled soldier with more freedom and mobility. For the first time an accurate medical records system was created that made it possible to track casualty records for every soldier. One consequence was the publication of the massive Medical and Surgical History of the War of the Rebellion, which remains the standard against which all such works are judged.

The Civil War saw the development of the first effective military medical system for dealing with mass casualties, including aid stations, field and general hospitals, ambulance and theater-level casualty transport, along with an effective staff to coordinate it. For its time it was the best military medical system ever deployed, and it remained a model for other countries for decades. The introduction of the pavilion-style hospital was so effective in reducing disease mortality that it became the standard design for both military and civilian hospitals for the next 75 years. Wide use of anesthesia, primary amputation, the splint, and debridement (cutting away dead tissue) were the first effective methods of wound management in the modern age. These techniques, taught to thousands of physicians through hard experience, were carried back to civilian life, elevating the general level of medical care available to the nation as a whole.

The prevalence of facial injuries encountered during the war stimulated the development of the new medical specialty of plastic surgery. Civil War surgeons performed six reconstructions of the eyelid, five of the nose, three of the cheek, and 14 of the lip, palate and other parts of the mouth. Dr. Gordon Buck performed the first total face reconstruction in history. Joseph Woodward, another war surgeon, became the first person to link the new technology of the camera to the microscope, and he published the first microphotographs of disease bacteria. He is also credited with the technique of using analine dyes to stain tissues for microscopic analysis. The advent of microphotography served to make the American military medical establishment receptive to the germ-fighting discoveries of Pasteur and Lister when they came along a few years later.

Despite the terrible slaughter and suffering that it caused, the Civil War ironically marked one of the most progressive periods in the history of military medicine. That it came at a cost of hundreds of thousands of ruined lives and shattered families goes without saying.

Image: Zouave soldiers prepare an injured comrade for the amputation of his right arm while surgeons stand by with their instruments.

From: warfarehistorynetwork.com

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Robert E. Lee’s “Right Arm”

From: warfarehistorynetwork.com

Although Stonewall Jackson’s death was unpreventable, given the state of medicine at the time, it is more likely that he died from thromboembolism than from the indirect cause of pneumonia.

Although Stonewall Jackson’s death was unpreventable, given the state of medicine at the time, it is more likely that he died from thromboembolism than from the indirect cause of pneumonia.
Following his greatest victory, at the Battle of Chancellorsville on May 2, 1863, Confederate Lt. Gen. Thomas J. “Stonewall” Jackson was scouting ahead of the lines with members of his staff when tragedy struck. In the pitch blackness of the early spring evening, Jackson and his men were mistaken for Union cavalry and fired upon by their own side. Jackson sustained a severe wound to his upper left arm, necessitating amputation. Upon hearing the news, victorious General Robert E. Lee remarked, “He has lost his left arm, but I have lost my right.” Lee’s words proved prophetic. Eight days after the amputation, Stonewall Jackson was dead.

Dr. Hunter McGuire, medical director of the Confederate Army II Corps believed that pneumonia was the cause of Jackson’s death, along with the general’s other attending physicians. However, modern-day analysis raised the more likely possibility of pulmonary embolism. The source of Jackson’s so-called “pleuro-pneumonia,” as McGuire put it, was presumed to be a lung contusion incurred during Jackson’s fall from a litter after leaving the battlefield at Chancellorsville. However, from the distance of a few feet at most, the ribs would have absorbed most of the force of the fall, protecting the underlying lung. There would also have been external evidence of trauma such as bruising in an injury serious enough to result in a lung contusion. Neither McGuire nor the other physicians found any evidence of such trauma.

Pleuro-pneumonia is a medical term that is rarely used today. Pleurisy occurs when inflammation involves the pleura, or outer surface, of the lung. Pleuritic chest pain often accompanies pneumonia, thus the term pleuro-pneumonia. Sir William Osler’s 1892 edition of his classic textbook, The Principles and Practice of Medicine, states: “Pneumonia is a self-limited disease, and runs its course uninfluenced in any way by medicine. It can neither be aborted nor cut short by any means at our command.” Osler went on to say that “the first distressing system is usually pain in the side, which may be relieved by local depletion—by cupping or leeching.” Such treatment was used unsuccessfully on Jackson.

Did Jackson Die of Pneumonia?
According to the thinking of the day, Jackson’s clinical presentation fit with pneumonia. His physicians cannot be faulted for their diagnosis or treatment, although it should be noted that 19th-century physicians were adept at eliciting the subtle physical signs of pneumonia, such as hearing a cracking sound in the lungs with a stethoscope or finding dullness to percussion of the chest. Neither of these classic signs of pneumonia was found by any of Jackson’s doctors.

In terminal pneumonia, the clinical course typically goes from bad to worse. But in Jackson’s illness, there were two distinct, sudden episodes of deterioration. These occurred on May 3 and May 6, and both were described as being associated with the onset of acute chest pain, shortness of breath, fatigue, and perhaps fever. These symptoms are consistent with pulmonary emboli, which are blood clots traveling to the lungs. Among the numerous complications following amputation of an extremity are nonhealing of the stump, infection, and thromboembolism, or the formation of a blood clot within a large vein. According to McGuire, Jackson’s wound appeared to be healing properly and infection did not seem significant.

It is known today that an amputee is at significant risk for venous thromboembolism and pulmonary embolism. Immobilization of the patient following surgery can allow the blood to pool and clot within the veins. More dangerous is the formation of clots in the large veins that are tied off during amputation. The tying off of the veins, or ligation, leads to stagnation of blood in the veins, which leads in turn to a thrombus, or clot, which can then travel to the lungs and kill the patient.

Even with today’s advanced technology, it is estimated that as many as half of all pulmonary emboli go undetected by physicians. The current treatment and prevention of thromboembolism is accomplished by the use of blood-thinning agents such as Heparin and Lovenox. Although Stonewall Jackson’s death was unpreventable, given the state of medicine at the time, it is more likely that he died from thromboembolism as a direct consequence of his wound and amputation, than from the indirect cause of pneumonia.

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Oriana Moon Andrews: First Woman Doctor in the Confederate Army

By Maggie MacLean, 4-8-15

Dr. Oriana Moon Andrews was a remarkable woman who served as the first female doctor in the Confederate Army. After the Civil War, she was physician to women and children, but her family had to move so frequently she was not able to establish a consistent practice. Chronic illness and childbirth at an advanced age ended her life much too soon.

Early Years
Oriana Russell Moon was born August 11, 1834 the second of seven children born to Anna Maria Barclay Moon and Edward Harris Moon. Oriana lived with her family at Viewmont, a 1500-acre estate in Scottsville, Albemarle County, Virginia. Edward Moon was a wealthy merchant, while Anna Maria had inherited her own wealth from her stepfather, including Viewmont and all of its slaves.

Edward Moon was a well-educated man, and he purchased an unusually large library, which included history, poetry, fiction and scientific works. He then hired the finest tutors for his children in literature, history, music and science. For the first sixteen years of her life, Oriana was addicted to reading, sometimes refusing to stop reading to eat.

At a time when Southern society dictated that young women be tutored privately and trained in the household arts, Edward Moon permitted his daughters to pursue their own interests. Oriana attended Emma Willard's Troy Female Seminary in Troy, New York during the 1850-1851 school year. After graduating there, she returned to Virginia, talking about the independence of Northern women.

Then, at the age of eighteen, Miss Moon decided she wanted to be a doctor. Edward Moon readily agreed that she should pursue a medical career, but he did not live to see her become a doctor. In 1854, Oriana enrolled in the Female Medical College of Pennsylvania in Philadelphia. At that time the general public believed that women were not capable of mastering the subject matter, and they would be much too squeamish to actually practice medicine.

Career in Medicine
Oriana proved them all wrong, but her path would not be easy. Female students were not allowed to work in hospitals to gain clinical experience working with patients, so the College set up its own clinic where they treated women and the poor. As her thesis, she wrote about the relationship between cardiac and pulmonary diseases, and she was awarded her Doctor of Medicine in 1857.

Oriana then returned to Viewmont. In 1858, her uncle, James Turner Barclay, decided to return to Jerusalem with his family for a second missionary tour as a Disciples of Christ minister, physician and student of the Holy Land. Oriana accompanied the Barclays and practiced medicine during her stay there.

In the summer of 1859, Oriana returned to her Virginia home, where she continued her medical practice as a woman's physician for her social circle and for the the Moon family slaves. Her patients adored their young female physician. Some male physicians grudgingly accepted Oriana as an unusual woman doctor. However, despite much urging, Dr. Moon consistently declined to 'hang out her shingle' as a general practitioner.

The Civil War
The the Civil War broke out in 1861, and Virginia seceded from the Union on May 23, 1861. Oriana, her mother and her brother drove the family carriage to Charlottesville ten miles away. Their journey was made to convert the family's cash and other marketable assets into currency or bonds for the Confederacy. A notice on the bank wall stressed the urgent need of physicians, surgeons and nurses for the Confederate Army.

Dr. Moon volunteered her services to the Confederacy in several letters written to General John H. Cocke between April and July 1861. In a letter dated July 19, 1861, she wrote:

"My most respected Friend,
Owing, I suppose, to our regular postal arrangements, your kind communication of Tuesday has just been received. I have not as yet entered into service; neither shall I, without consulting you, if you will allow me that high privilege! I have been willing and even anxious to be engaged in ministering to the wants of the sick, but after you so kindly proposed to take the matter in hand, I thought it would be better to wait and learn the result...

"If it will not be too great an imposition on your time and generosity, I would prefer to have you make any arrangements for me you may see proper. If the ladies of Richmond address me on the subject, I will enclose their communications to you. Enclosed I send you some suggestions, which strike me as being good...

"I would prefer to be in a Surgical Hospital where I would assist in the operations... I will go anywhere or do anything they may see fit to assign me, if it is to follow the army and seek the wounded on the field of battle."

Woman Surgeon in the Confederacy
On July 22, one day after the First Battle of Bull Run, Dr. Moon received word to report to the Charlottesville General Hospital which included buildings converted for that purpose at the University of Virginia. Soon the hospital overflowed with wounded from Bull Run and spilled over to private homes nearby. Dr. Moon was assigned a ward in this hospital, and was awarded a surgeon's commission as a captain in the Confederate Army, reportedly the only one given to a woman.

A letter appeared in the Richmond Daily Dispatch on August 1, 1861, describing the situation at that hospital and Dr. Moon's role there:

"The state of the hospital is most satisfactory. The few cases of death are extremely cheering. But one of the wounded has so far died; he was a Yankee and fearfully injured. The largest number of wounded belong probably to the 4th Alabama Regiment, and there are also several young men of the Oglethorpe Light Infantry from Savannah, and half dozen students from the University of Oxford, Mississippi here. By far the large majority of sick are down with the measles and will easily recover. Among the more seriously wounded are also two Yankee captains from a New York Regiment.

"Thanks to the energy and zeal displayed on all sides, order begins to reign and system to prevail amid the immense number. More physicians have arrived from other towns; among them Dr. Alexander Rives, late house-surgeon of Bellevue Hospital, New York; Dr. Moon, a young lady of the neighborhood, to whose skillful and experienced hands the care of a ward has been entrusted..."

Dr. John Andrews
When the Civil War broke out, Dr. John Summerfield Andrews, aged 23, was a practicing physician in Memphis, Tennessee. He quickly arranged his personal affairs and headed for Virginia. Arriving a few days before the Battle of Bull Run on July 21, 1861, he cared for his brothers after they were injured in that battle.

When Confederate General Bernard Bee visited the field hospital, he immediately commissioned Dr. Andrews a surgeon and put him in charge of the wounded men of the 4th Alabama Regiment. After the battle ended, the Confederate wounded were taken to the Charlottesville General Hospital, John discovered that his brother Robert's medical condition was grave.

Dr. Andrews asked for another surgeon to examine his brother, and Dr. Moon was called in. When John looked up from his seat at his brother's bedside, he was astonished to see a young woman. After a thorough examination, the doctors retired to an adjoining room for consultation. Dr. Moon advised against surgery, fearing it would kill the young soldier. John agreed that the operation should be deferred. They packed ice around Robert's chest to reduce his fever, but he died two days later.

A few months later illness forced Dr. Moon to give up her ward. She returned to Viewmont where she was cared for by her mother. At his first opportunity, Dr. John Andrews hired a horse and rode the ten miles to Viewmont to check on Oriana's health. He remained there several days before returning to Charlottesville.

Marriage and Family
Dr. Andrews also installed himself as physician to Dr. Moon, who would be confined to bed for more than a month. His visits to Viewmont multiplied and their friendship took on a deeper meaning. John requested leave to get married, and on November 28, 1861, John Andrews and Oriana Moon married at Viewmont. She was 27.

After their wedding, Dr. John Andrews was granted leave to seek reassignment in Richmond. These hospitals daily received wounded soldiers other areas of Virginia. Every medical person was needed, but records show that John did not resurface in Richmond until late January 1862. On February 1, 1862, Dr. Andrews appeared before a medical review board, and he was declared unsatisfactory as a Confederate surgeon. He resigned his commission the same day.

Civilian Life During the War
John and Oriana continued living at Viewmont, and their first child, Henry Horton Andrews, was born there on October 30, 1862, but he died from croup in May 1863. On October 1, 1863, a second son, James Barclay Andrews, was born. The Andrews family moved from Viewmont to the Bel Air estate, approximately three miles from Viewmont. On February 9, 1865, Oriana gave birth to a third son, William Luther Andrews.

General Philip Sheridan's Union soldiers marched through the area enroute to Scottsville in early March 1865. Sheridan's goal was to destroy the canal and any food and supplies that would aid the Confederacy. Oriana and John moved their two sons back to Viewmont, where they remained until Lee surrendered at Appomattox on April 9, 1865.

Move to Alabama
In 1869, Dr. John Andrews' family in Alabama assured him that there was a physician's position for him in Florence, Alabama. Oriana and their youngest son caught a train in Charlottesville, while John and their eldest son drove a wagonload of their possessions to Florence.

John soon realized that the Florence area could not pay much more than gratitude for his medical services. In early 1870, he purchased a small tract of land in Hardin County, Tennessee and built a rough board dwelling for his family. Oriana and their two sons moved there later that year. Although accustomed to far more comfort, she accepted her new situation with quiet dignity.

In their three years there, the Andrews family moved three times. Their patients lived in poverty and could not pay their physician for services rendered. Due to a chronic heart ailment, Oriana's health suffered under the strain and she was confined to bed. The Moons urged the family to return to Viewmont.

John disposed of all of their furniture and shipped their books, clothing and a few small trunks of keepsakes via railroad to Virginia. He also purchased four mules and a new wagon with canvas stretched over the bows and a bed with springs in the rear. John and Oriana made the six-week trip back to Virginia in stages to avoid antagonizing Oriana's fragile health.

Late Years
In 1874, the family settled down at Viewmont again, where Oriana tutored her sons in the family library, with the books her father had purchased for her many years before. Five months of the year, the boys hiked five miles to Church Hill, the home of their Uncle Isaac Moon who taught a public school there. When not studying, the boys roamed the woods and helped with corn planting in the nearby fields. Another son was born in 1875: Owen Merriweather Andrews.

In 1879, the heirs of Anna Marie Barclay Moon, Oriana's mother, decided to dispose of her estate and divide the proceeds among them. The Andrews had to move again, this time to a farm in Buckingham County, Virginia. In 1880, Oriana gave birth to another son, Frank Moon Andrews. (She was 46!)

Oriana's health worsened. Within a year, the Andrews moved to Norwood, Nelson County, Virginia, where they rented a farm. Dr. John Andrews found an active medical practice in Norwood and also planted corn in the fields along the James River. During the spring of 1881, torrential rains fell and swept away their crops. The Andrews once again returned to Scottsville.

In 1882, John and Oriana rented Old Hall, a mansion built in 1830 when Scottsville was a thriving river town. There the two doctors opened the First Sanatorium of Southside Albemarle and began active practice with women and children as their patients. It must have been gratifying for Oriana to finally be able to practice medicine again, but they had more patients than they could accommodate, and the work continually taxed her strength. She was forced to quit the practice in December 1883.

In the early morning hours of December 24, 1883, Dr. Oriana Moon Andrews died of pneumonia at age 49. She was buried at the Scottsville Presbyterian Cemetery.

Image 1: Dr. Oriana Moon Andrews in 1861 with her husband, Dr. John Andrews. Credit: Woman's Missionary Union

Image 2: Viewmont, the Moon family estate where Oriana lived most of her life. Credit: Scottsville Museum

Image 3: Old Hall in Scottsville, Virginia. Oriana died in the east bedroom. Credit: Scottsville Museum

From: civilwarwomenblog.com

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The Women of Winchester, Virginia

By Virginia R. Bensen, 11-30-11

We are happy to welcome guest author Virginia R. Bensen.

This is the Introduction to a series of articles that will follow over the next few months about the Civil War women of Winchester, Virginia. What is interesting about these women is each represents either a Unionist or Secessionist perspective. The articles in this series will sometimes focus on just one woman from Winchester or Frederick County, Virginia. In other articles, there will be a bantering of diary entries between two or more women.

At first I thought I would write about all Secessionists, and then all Unionists, or all about the younger women or older women, but in thinking about presentation, I decided it would be more interesting to mix up these women and present the series more in a chronological order. This will provide the reader an opportunity to make easier comparisons of perspectives and attitudes of the women.

Scholarly work that has been presented about Southern women has been primarily about the wealthy plantation mistress. Only during the past twenty years has the focus changed to examining the lives and experiences of other classes and races of women of the Civil War period. All of the women of course who wrote diaries were literate and fairly well educated. In reading these diaries and manuscripts, it appears that when the women are occupied by their enemy, it is at that time they are prolific writers. The articles will span a focus from the wealthy socialite to the mercantile store keeper, and to those in between. Most of the writers are widowed or single and the ages range from a 14-year-old to a 45-year-old. Unlike the plantation mistresses or belles who were found in the Deep South, these women represent the women who lived in the Shenandoah Valley region.  Their values and beliefs in some ways are similar to those in the Deep South, but in other ways they are quite different.

The women of Winchester, Virginia regardless of whether they supported the Union or the Confederacy, tended to be tenacious in their loyalties. This brought about a tension that built over time between those who were pro-Union and those who were pro-Confederate. To complicate the situation, Winchester changed Union and Confederate occupations over 70 times during the Civil War. The town’s majority of civilians supported the Confederacy, and the women although restricted from fighting in the military demonstrated their support for the South in many ways that were within the boundaries and sometimes slightly over the boundaries of womanhood for that time.

In order to fully understand the complexity of the situation, here is a very brief background of Winchester, Virginia. At the beginning of the Civil War, Winchester dominated the lower Shenandoah Valley because of its network of seven major roads that radiating out in various directions to connect it to other large towns and cities in Virginia. Two of the roads were macadamized and connected Winchester to both the lower and upper Valley – Martinsburg to the north, and Staunton to the south. The road system made the town a major trade center for the Valley. In 1860 Winchester had a population of 4,392, which included 680 free blacks and 708 slaves. (Click here for a map of the area.)

The majority of whites were non-slaveholders.  The town itself had multiple shops, taverns and hotels.  It was one of the few towns in the Valley that had gaslights and a water system.  There were warehouses and a railroad depot.  It also had two banks, two newspapers, more than fifty stores several fire companies and ten churches.   In addition, it housed the Winchester Medical College which was the first medical school in Virginia, and four private schools for educating the children.  For the most part, the community “embraced a middle class work ethic, which was similar to that of a Northern market region than to the hierarchical slave society.”   Sheila Phips observes, that Winchester during this time “Had all of the amenities expected of an urban area, if on a smaller scale.” In the words of historian Jonathan Noyales, “The strategic location of Winchester promoted its economic prominence and that location brought about its wartime problems.”

Prior to secession the majority of civilians in the town were against leaving the Union, but when Virginia seceded, that majority became the small minority in the town.  Many who supported the Confederacy did so because they felt the United States had abandoned them in many ways.  For the most part, they did not want to secede from the Union, but did so because they believed they had a higher and deeper loyalty to their state of Virginia.

When Virginia seceded, the townspeople went into a mass celebration. The young men were in a frenzy to join the militias to serve the Cause.  The romance of war became a fever, and the women encouraged that fever.  There is a story that is told among historians of Winchester, that is probably from oral history, since no one can find the source. One young man was reluctant to join a local militia unit. Some of the younger women in town had a gift package delivered to his home.  When he opened the package it contained a pair of ladies bloomers with frills and lace. Lying on top of the pantaloons was a note that read, “If you don’t sign up to fight, you might as well put these on. The next day the young gentlemen joined the militia. Throughout the Civil War the Secessionist women encouraged their men to continue fighting for the Southern Cause.  Even during the Union occupations, many smuggled letters to their “boys” and also smuggled contraband goods such as sugar, coffee, fabrics, thread and needles from Baltimore into Winchester not so much for civilian use, but to feed and clothe the Confederate sick and wounded.

During the initial Confederate occupancy in 1861 and early 1862, the women of Winchester participated in the usually expected activities such as organizing sewing and knitting groups to make socks, shirts, and caps for the Confederate troops. During the early part of summer of 1861, many of the troops became ill with measles, and the women took those soldiers into their homes and cared for them during their recovery.  Both Union and Confederate sympathizers housed the Confederate soldiers during this timeframe.

Although there were some minor skirmishes during June 1861, it was not until after the First Battle of Manassas, that the Winchester woman witnessed the horrors of war. In diaries there were descriptions of men with their faces mutilated, gut shot men, dead men, and of piles of amputated limbs.  Many Winchester women, especially of Confederate loyalty described going to the hospitals and nursing “their boys.”  Nursing to many of these women meant reading, writing, and feeding the wounded, not cleaning or bandaging wounds.

Although tensions between the Unionist and Confederate civilians were fairly amicable in the beginning of the war, when General Stonewall Jackson began arresting many of the prominent Winchester area Unionists in the fall of 1861 and winter of 1862, tensions intensified.  Jackson’s arrests started a total distrust by the Unionists toward the Secessionists.  On the other hand, the Secessionists by the end of 1861 withdrew from any socializing with the Unionists, and only made contact with them when absolutely necessary. By the time General Nathaniel Banks took occupation of Winchester in the spring of 1862, relations between the Unionists and Confederates rose to a hostile level.  Because of this tension, civilians identified with either the Unionists or the Secessionists. Remaining neutral meant that you were open to hostilities by both the Unionists and Secessionists.

After spending hours reading these diaries and manuscripts, it seemed that I was becoming friends with these individuals.  Through their writings I was invited into their inner most thoughts and feelings, and sometimes I wanted to shout at these women for acting like such fools, or for being so stubborn about some of the pettiest issues. Then, it dawned on me that these women have been dead for over a hundred years! I do not live in the nineteenth century, I live in the twenty-first century. What I consider to be a petty issue, to the women living in the 1860s that same issue was far from petty.

Through these diary accounts of the Civil War experiences of the women of Winchester, Virginia, there becomes a serialized story of the Winchester Civil War civilians and in particular the women’s experiences. This story contains drama, intrigue, romance, as well as comedy.  Each woman relates her own perspective. Yet, each contributes to the rich tapestry of the Civil War history itself.

About the Author: Virginia R. Bensen has a doctorate in Higher Education Leadership, an MBA and has taught a variety of college business courses. She has designed award winning workforce and education programs.  After finishing her doctoral dissertation, she decided to write a historical novel focusing on the civilian and women’s experiences in Civil War Winchester, Virginia.  Although familiar with social science research methods, but feeling rather intimidated with historical research, she enrolled in a Masters of American History program at American Public University. Her research interests are Civil War women and women’s identity change. She enjoys writing both popular and scholarly history.

From: emergingcivilwar.com

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Dr. Francis Peyre Porcher: Civil Practice to Civil War

From: waring.library.musc.edu

Francis Peyre Porcher was born at Ophir Plantation in St. John’s, Berkeley County, South Carolina on December 14, 1824 to Dr. William and Isabella Sarah Peyre Porcher. Through his mother's side, he was a descendant of the well-known English botanist, Thomas Walter author of Flora Caroliniana, the first catalog of the flowering plants of South Carolina published in 1788.

Porcher graduated from the South Carolina College (now the University of South Carolina) in 1844 after which he enrolled in the Medical College of the State of South Carolina.  He graduated with first honors, out of a class of seventy-six, in 1847 and his thesis, A Medico-Botanical Catalogue of the Plants and Ferns of St. John’s, Berkeley, South Carolina, was published later that same year by the faculty of the Medical College.  After graduation Porcher spent two years traveling and studying medicine in Europe. Upon his return to Charleston, he entered practice and in 1852 with Dr. E. Belin Flagg opened the Charleston Preparatory Medical School of the Medical College and lectured on materia medica and therapeutics.

During his long affiliation with the Medical College, Porcher served as professor of clinical medicine and chair of materia medica, which position he held from 1874 to 1891. He also served as attending physician at the Marine Hospital in Charleston from 1855 to 1860. Porcher was editor of the Charleston Medical Journal and Review and served as president of the South Carolina Medical Association (1871), the Medical Society of South Carolina (1874), and as vice-president of the American Medical Association (1880).  With fellow Medical College alumnus Julian J. Chisolm (1830-1903), Porcher opened a hospital specifically for the care of plantation slaves.

At the outbreak of the Civil War, Porcher joined the Confederate Army as a surgeon to South Carolina’s Holcombe Legion and was then transferred to the Naval Hospital at Norfolk, Virginia in March 1862.  He finished his Confederate service in the South Carolina Hospital at Petersburg, Virginia.

When the war ended, Porcher returned to Charleston and resumed his academic positions at the Medical College.  He was on the staff of the City Hospital from 1866 to 1887 and again served a three-year term as editor for the Charleston Medical Journal and Review.  As his professional career thrived, he remained a prolific contributor to the medical literature and wrote on a variety of topics including yellow fever, diseases of the heart, typhoid, and malaria. Porcher received many honors during his career including an LL.D. of the University of South Carolina (1891); he was one of the founders of the American College of Physicians, was one of the committee of ten U.S.  physicians selected to attend the International Medical Congress in Berlin (1890), and was chairman of the section on general medicine at the Pan American Congress of 1892.

After suffering a paralytic stroke, Porcher died at his home, 38 Meeting Street, Charleston, on November 19, 1895.

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Porcher’s Resources of the Southern Fields and Forests

From: waring.library.musc.edu

It is intended as a repertory of scientific and popular knowledge as regards the medicinal, economical, and useful properties of the trees, plants, and shrubs found within the limits of the Confederate States, whether employed in the arts, for manufacturing purposes, or in domestic economy, to supply a present as well as a future want.
Francis Peyre Porcher
Preface, page iii

At the outbreak of the Civil War, Francis Peyre Porcher joined the Confederate Army as a surgeon to South Carolina’s Holcombe Legion and was then transferred to the Naval Hospital at Norfolk, Virginia in March 1862. He finished his Confederate service in the South Carolina Hospital at Petersburg, Virginia. While in Virginia Porcher was “released temporarily from service in the field and hospital” [Preface, page iii], by C.S.A Surgeon General Samuel Preston Moore to write, Resources of the Southern Fields and Forests, Medical, Economical and Agricultural; Being Also a Medical Botany of the Confederate States; with Practical Information of the Useful Properties of Trees, Plants, and Shrubs, first published in Charleston in 1863. The handbook identified local plants with therapeutic qualities that could be used not only by Confederate surgeons, but planters and farmers, in place of manufactured drugs made unavailable because of the Union blockade. The handbook was of such value that a revised edition was published in 1869.

The Regimental Surgeon in the field, the Physician in his private practice, or the Planter on his estate may themselves collect and apply these substances within their reach …
Preface, page iii

Four editions of the manual were produced during the course of the war and are now available for research use at the Waring Historical Library:
1863 edition
1869 edition
1863 edition, [transcription]

1869 edition
I here introduce a notice of upwards of four hundred substances, possessing every variety of useful quality. Some will be rejected as useless, others may be found upon closer examination to be still more valuable. The most precious of all Textile Fibres, and Grains, Silks, Seeds, Oils, Gums, Caoutchouc, Resins, Dyes, Fecula, Albumen, Sugar, Vegetable Acids, Starch, Liquors, Spirit, Burning Fluid, material for making Paper and Cordage, Barks, Medicines, Wood for Tanning and the production of Chemical Agencies, for Timber, Ship-building, Engraving, Furniture, Implements and Utensils of every description--all abound in the greatest munificence, and need but the arm of the authorities or the energy and enterprise of the private citizen to be made sources of utility, profit, or beauty.
Preface, page vii-viii

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Julian John Chisolm: Class of 1850

From: waring.library.musc.edu

Julian John Chisolm was born in Charleston, SC, on April 16, 1830. He graduated from the Medical College of the State of South Carolina in March 1850 and went on to spend two years studying, with an emphasis on eye surgery, at various hospitals in Paris. Returning to Charleston in 1852, Chisolm began a private practice and was very involved in the local medical community. In 1857 he was part of a group that founded the Charleston Preparatory Medical School, and with Joseph Palmer Cain established a free hospital for slaves. He became professor of surgery at the MCSSC in 1858 but returned to Europe in 1859 to visit hospitals in London and Paris. After war broke out between Italy and Austria, Chisolm traveled to Milan to observe the treatment of wounded soldiers from Magenta and Solferino. It was during this time that Chisolm gained knowledge and experience of military surgery. After returning to Charleston in 1860, Chisolm opened a private surgical hospital.

With the outbreak of the Civil War in April 1861, Chisolm treated wounded at the Battle of Fort Sumter. He was appointed the rank of surgeon on September 20, 1861 and was given the first commission as a medical officer to be issued in South Carolina, and some historians believe in the entire Confederacy. During the war Chisolm was stationed at the South Carolina Hospital in Manchester, VA, and in Charleston, Columbia, Chester and Newberry, SC. While in Virginia, Chisolm set up one of the first general hospitals in the Confederacy. He transferred to Charleston in November 1861 and established a medical purveyor’s office, which oversaw the receipt and distribution of surgical instruments and medicines to Confederate physicians in the field and in hospitals. In 1862 the purveyor’s office was moved to Columbia. Confederate Surgeon General Samuel Preston Moore granted Chisolm the authority to establish one of the first medical laboratories in the Confederacy in Columbia.

After the Civil War ended, Chisolm resumed his practice in Charleston and became president of the Medical Society of South Carolina, a position he held until December 1867. He was appointed Dean of the Medical College of the State of South Carolina in 1867 and served for a brief time. He relocated to Baltimore, MD in 1868 and joined the faculty of the University of Maryland and became Dean of its medical school. During his four years as dean, Chisolm served as a lecturer in military surgery, a professor of operative surgery, and clinical professor of diseases of the eye and ear. He became a full professor in eye and ear medicine in 1873, one of the first such professorships in the country. Chisolm held this position until 1896, two years after being seriously incapacitated by a stroke. It was also during this time that Chisolm was involved in the establishment of the Baltimore Eye and Ear Institute (1871) and the Presbyterian Eye, Ear, Nose and Throat Charity Hospital (1877).

Two years after suffering a stroke, Chisolm moved from Baltimore to Petersburg, Virginia in 1898. He died there on November 1, 1903 and is buried in Baltimore.

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Confederate Medical Department

From: waring.library.musc.edu

Officially, 257 South Carolinians served in the Confederate Medical Department though most of these doctors were general practitioners with no real experience performing surgery, treating large numbers of wounded at a time, or providing for field sanitation.

Combat was less often a cause of death than disease. By some accounts soldiers were incapacitated from illness an average of six times during the course of their military service. Many enlisted men came from rural areas where they had not been exposed to or developed immunities to communicable diseases like measles, tuberculosis, malaria or yellow fever.

Additionally, sanitation in most military camps and hospitals was less than ideal and led to debilitating outbreaks of cholera, typhoid, diarrhea, gangrene, and dysentery. Infections and disease were made worse by lack of drugs due to the Union blockade of southern ports and a scarcity of southern pharmaceutical laboratories. In response to these conditions President of the Confederacy, Jefferson Davis, appointed Medical College of the State of South Carolina alumnus Samuel Preston Moore surgeon general.

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Kate Cumming (ca. 1830-1909)

By Katherine E. Rohrer, University of Georgia, 10-12-2007

Kate Cumming is best known for her dedicated service to sick and wounded Confederate soldiers. She spent much of the latter half of the Civil War (1861-65) as a nurse in hospitals throughout Georgia.

Inspired by Florence Nightingale, Kate Cumming served as a nurse during the Civil War. She treated wounded Confederate soldiers in numerous field hospitals throughout Georgia. After the war she published a chronicle of her wartime nursing experiences.

in Edinburgh, Scotland, circa 1830 (sources differ on the exact date), Cumming migrated with her family to North America as a young child, stopping first in Montreal, Canada, before permanently settling in Mobile, Alabama. Inspired by both the Reverend Benjamin M. Miller, who in an address urged the women of Mobile in early 1862 to aid wounded and sick Confederates, and by Florence Nightingale, the heroic British nurse who served in the Crimean War, Cumming, despite having no formal nursing training, decided to offer her services. Much to the distress of her parents, who firmly believed that ladies did not belong at the battlefield, she left Mobile in April 1862, along with forty other local women, including the novelist Augusta Jane Evans (although Evans did not make it to the front), for the Mississippi-Tennessee border. There, until June 1862, she cared for Confederate soldiers injured at the Battle of Shiloh (April 1862).

Unlike most women nurses, who served only temporarily, Cumming continued as an active nurse for the duration of the war. After a two-month respite in Mobile during the summer of 1862, she traveled to Chattanooga, Tennessee, to volunteer at Newsome Hospital, where she remained for the next year. While there, the Confederate government reluctantly decreed in September 1862 that hospitals could legally pay nurses rather than rely on them as volunteers. Thus Cumming's status changed from volunteer to professional; for the war's duration, she was officially enlisted in the Confederate Army Medical Department.

After the fall of Chattanooga in the summer of 1863, Cumming moved on to Georgia, where she served in numerous mobile field hospitals established throughout the state in response to the destruction inflicted by Union general William T. Sherman's troops. As the major military forces moved southward and eastward, so did the location of these facilities. Confederate field hospitals were set up in many Georgia locations, including Catoosa Springs, Cherokee Springs, Dalton, Kingston, Marietta, Ringgold, Rome, and Tunnel Hill, during the Atlanta campaign of 1864. Later they were established in other Georgia locales: Americus, Athens, Augusta, Barnesville, Columbus, Covington, Forsyth, Fort Gaines, Greensboro, Griffin, LaGrange, Macon, Madison, Milner, Newnan, Oxford, Thomaston, and Vineville. Though not employed in all these hospitals, Cumming spent considerable time in several of them, specifically those at Americus, Cherokee Springs, Dalton, Newnan, and Ringgold. When the war ended in April 1865, she was working in southwest Georgia.

Cumming returned to Mobile after the war, and in 1866 she published A Journal of Hospital Life in the Confederate Army of Tennessee from the Battle of Shiloh to the End of the War, a chronicle of her day-to-day nursing experiences on the Civil War battlefields of Tennessee and Georgia. In 1874 she moved with her father to Birmingham, Alabama. She never married. She resided there as a teacher and active member of the United Daughters of the Confederacy until her death on June 5, 1909. She is buried in Mobile.

Further Reading Jeanne Bryner, Tenderly Lift Me: Nurses Honored, Celebrated, and Remembered (Kent, Ohio: Kent State University Press, 2004).

Kate Cumming, The Journal of a Confederate Nurse (Baton Rouge: Louisiana State University Press, 1998).

From: georgiaencyclopedia.org

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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

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