James Hangar--A Teenager's Legacy

by Pat Granstra

When men lost their lives in the Civil War, their families lost sons and brothers, husbands and fathers–  and the world lost their potential.  Forever incalculable, the magnitude of those losses can only be suggested by acknowledging the accomplishments of those who survived the conflict.  Here is the story of a teenager whose single day of military service became a boon to soldiers of both sides.

 Throughout the morning of June 3, 1861, a young Confederate soldier lay unconscious and bleeding in a stable near Philippi, in northwest Virginia (now West Virginia).  Four hours after a Union cannonball tore through his left thigh, soldiers of the 16th Ohio Volunteers found him and summoned their surgeon, Dr. James D. Robinson, to the scene.

Determining that the lad’s life could be saved only by immediate amputation, Dr. Robinson performed surgery on a table improvised from a stable door.  During a 45-minute operation (done without benefit of anesthetic), he removed the young Confederate’s leg seven inches below the hip and stitched a flap of skin over the wound.  Dr. Robinson did not know he had completed the first of over 50,000 Civil War amputations.  He also did not know that the successful outcome of his surgery would impact not only his patient but also thousands of amputees long after the war.

*****

Robinson’s patient  was eighteen-year-old James Hanger from Churchville, Virginia.   A sophomore majoring in engineering at Washington College in Lexington at the start of the war, Hanger chose the Confederacy over the classroom and returned to Churchville to enlist in the town’s cavalry troop as two of his older brothers had done.  He was not among the orignial enlistees, but when an ambulance corps rolled through town on its way north to support the Churchville Cavalry and other Confederate forces under Colonel George Porterfield, young Hanger rode with it.

Outside Philippi on the evening of June 1, the ambulance corps encountered the Churchville Cavalry among Confederate forces retreating south before vastly superior Union forces.  Along with several other young men, he enlisted the next day.   The night of June 2 brought heavy rain, and as Hanger later wrote, the new soldiers “did not move, perhaps on account of the rain and the belief that the enemy would not march in such rain and darkness.”

In reality, the more experienced Union soldiers, two columns of them, had marched,  intending to trap the rebels between them at Philippi.  The weather had not deterred them, but it did upset their timing.  One column fired its opening shots before the other was in position, a misstep that afforded most of the southern soldiers an escape route.

Writing later, Hanger claimed he was hit by the third shot of a skirmish newspapers ostentatiously hearlded as the first land battle of the Civil War.  “The first two shots,” he wrote, “were canister and directed at the Cavalry Camps, the third shot was a 6 pound solid shot aimed at a stable in which the Churchville Cavalry Company had slept.  This shot struck the ground, richochedtted [sic], entering the stable and struck me.”

Robinson’s quick action and surgical skill saved Hanger’s life, and competent post-operative care, first in a private home and later in a Union hospital near Philippi, prompted a quick recovery.  Within a few weeks, Hanger’s stump healed sufficiently for him to be fitted with a wooden leg and sent to Camp Chase near Columbus, Ohio.  He next went to Norfolk, Virginia as part of a prisoner exchange and returned to his parents’ home near Churchville in August.

Hanger’s impressive three-month recovery from near death was about to eclipsed by his activities of the next three months.

*****

Upon returning home, young James went upstairs, said he wanted to be left alone, and locked himself in his room. His parents respected his wishes, feeling that he needed time alone to come to grips with his life-changing injury.  They left meals and personal care items outside his door.  When he asked for oak barrel staves, they provided them. When buckets of wood shavings appeared outside his door, they assumed his was whittling to pass the time.  When he asked for pieces of metal, leather, and rubber, they complied.  When, after three months, he finally came downstairs, they were amazed.

Hanger had clumped upstairs on a clumsy wooden leg in August, but in November, he walked downstairs on the world’s first articulated prosthetic leg with knee and ankle joints.  Rather than succumbing to depression as an amputee, the former engineering student had turned to invention, designing and handcrafting a revolutionary artificial limb.

The leg functioned so well that Hanger was able to complete his enlistment committment by serving in the Stauton Home Guards.  While doing so, he was asked by other amputees to fashion limbs for them.  As the war dragged on and the number of amputations increased, Hanger realized that he and his penknife could not keep up with demand and set up production factories, first in Staunton and later in Richmond.  On March 23, 1863, he received Patent #155 “for an artificial limb” from the CSA patent office.  The following August, he filed patent papers for a newer, better version.  James Hanger, at age twenty, was a businessman.

*****

The end of the war did not bring an end to Hanger’s business, but it did bring changes. In 1871, Hanger returned to Churchville and produced prosthetics there.  Within a short time, the Commonwealth of Virginia contracted with him to produce limbs for veterans, and he expanded his business.  He also filed for additional patents, this time with the United States Patent Office.  In 1883, he moved the main office of J. E. Hanger, Inc. to Washington, D. C.

Hanger, who had married in 1873, moved his family to Washington as well.  Eventually all six of his sons joined in managing the ever-growing business.  Although Hanger officially retired in 1905, he continued to work on behalf of the firm.  He traveled to Europe following World War I to study amputation techniques there and made corresponding adaptations to his prosthetic devices.  He also picked up contracts in England and France.  When he died on June 15, 1919, his Washington-based company had branch offices in London and Paris as well as in Philadelphia, Atlanta, and St. Louis.

*****

In 1989, J. E. Hanger, Inc. was purchased by Hanger Orthopedic Group, Inc., one of largest producers of prosthetic limbs and related services worldwide.  The legacy of a Civil War teenager continues to enable hundreds of thousands of people across the world to regain normalcy following amputation.

From: Civil War Primer

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Is War Good For Medicine? War's Medical Legacy

By Christopher Connell

From Thermopylae to Baghdad, from the Gallic wars to Vietnam, war has proved an exacting but efficient schoolmaster for physicians. Hippocrates wrote, “He who would become a surgeon should join an army and follow it.” Second-century Greek physician Galen honed his skills not only in the sanctuary of Aesclepius, god of healing, but as physician to the gladiators of Pergamon. The American teenager pried from a twisted wreck on a Friday night and sped to a suburban hospital owes a debt of gratitude to the horse-drawn wagons (known as “flying ambulances”) that Dominique Jean Larrey, MD, invented to carry injured soldiers in Napoleon’s army and the professional ambulance corps that Jonathan Letterman, MD, instituted for the Army of the Potomac after the disastrous first Battle of Bull Run, where the wounded were left on the field when Union troops fled back to Washington.

Gunshot victims wheeled into any big city trauma center benefit from techniques that a generation of EMTs and surgeons first learned repairing combat wounds. “Most of the emergency medical response doctrine in practice in the United States today evolved from medical experiences in the jungles of Southeast Asia in the late 1960s,” says Lt. Gen. Kevin Kiley, MD, surgeon general of the U.S. Army.

For all the destruction and chaos it wreaks, war spurs some medical advances. Historically, trauma surgery, emergency care and infectious disease treatments leap the furthest ahead. Military medicine stretches back to antiquity. Augustus Caesar formed a medical corps for his legions. Roman surgeons tied ligatures and clamped arteries to control bleeding, and the vinegar they poured into wounds acted as an antiseptic. Galen, court physician to Marcus Aurelius in Rome, performed bold operations and gained an understanding of the human anatomy that was unsurpassed well into the second millennium. Ambrose Paré, the 16th-century French physician who figured out that wounds healed faster if you didn’t pour boiling oil onto them, observed that the only people who gain from warfare are young surgeons. French Army surgeon Jean Louis Petit’s invention of the screw tourniquet in 1718 made it possible to amputate legs above the knee without bleeding the patient to death. His device, which cut the flow from the femoral artery, would be in every military surgeon’s kit until well after the U.S. Civil War. Even with such equipment, until anesthetics came along, surgeons’ reputations rested principally on the speed with which they could saw off limbs.

While wars provide ample opportunities for surgeons to hone their skills, some historians believe their contributions to the medical arts are modest if not minimal. F.H. Garrison, MD, in An Introduction to the History of Medicine (1929), wrote about World War I, “Viewed after the lapse of a decade, the medical innovations and inventions of the war period seem clever, respectable, but not particularly brilliant.” More recently, British sociologist Roger Cooter, PhD, made the argument that, “For the most part, war has accelerated research into old medical problems of military importance, the bulk of which are highly specific to that context and of little value outside it.” During most modern wars, Cooter says, civilians’ health needs have taken a back seat to the medical needs of the military.

Throughout most of recorded history, disease, not arrows, bullets or bombs, was the scourge of armies. Generals have long understood the importance of sanitation to the health of their troops. The French Army instituted physical exams for new soldiers in the early 18th century; soon recruits and conscripts were being poked and measured in all of Europe’s armies. At Valley Forge in 1777, Gen. George Washington ordered the Continental Army inoculated against smallpox. “Should the disorder infect the Army in the natural way and rage with its usual virulence, we should have more to dread from it than from the sword of the enemy,” wrote Washington, whose visage bore the scars of a bout with smallpox at age 19.

Still, among the 70,000 colonials who died during the Revolutionary War, nine were felled by disease for every one who died at the hands of the redcoats. Among the 31,000 British fatalities, just 4,000 were killed in action. In the Civil War, three-fifths of the 304,369 Union dead were victims of disease, not casualties of battle. It took until the 20th century for the arts of medicine and warfare to advance to the point where more combatants died from battle wounds than from diseases. The United States was a late entrant to World War I, but there were 53,402 Americans killed in action and 63,114 dead from other causes. By World War II, the Pentagon counted 291,557 deaths in action and 113,842 from other causes.

Over the centuries, as armies moved away from frontal combat and learned to unleash deadlier force across greater distances, war became less lethal for combatants and more lethal for civilians. More than 6 million of the 15 million lives lost in World War I were civilians; in World War II, the first global conflict, at least 35 million civilians perished — including more than 200,000 in Hiroshima and Nagasaki from atomic bombs, and 6 million European Jews by genocide — dwarfing the 20 million military fatalities.

Whatever the historians’ verdicts, wars are popularly associated with medical advances in the public mind, such as the blood banks that Oswald Hope Robertson, MD, created for the Army Medical Corps in France in 1918, and penicillin, the antibiotic that came to prominence and became widely available during World War II. But Dale Smith, PhD, who chairs the medical history department at the Uniformed Services University of the Health Sciences, or USUHS, in Bethesda, Md., says that in both instances, the real breakthroughs occurred in laboratories in the decade before the world wars.

Still, when the United States entered World War I, manuals for battle surgeons contained illustrations showing them how to sew a donor’s radial artery to the basilic vein of the wounded comrade for direct transfusion. “By the end of the war, those pages are gone and those same books show how to keep blood in storage boxes protected by ice and sawdust, and how to treat the blood to transfuse it safely,” says Col. David Burris, MD, chief of the Norman M. Rich Department of Surgery at USUHS. While Sir Alexander Fleming’s accidental discovery of penicillin took place in 1928, the antibiotic remained in short supply until the U.S. pharmaceutical industry performed a second miracle in gearing up industrial production of the scarce antibiotic during World War II.
 
Emergency medicine’s crucible
The Mobile Auxiliary Surgical Hospital, or MASH, not only saved lives in Korea, but entered American folklore thanks to Robert Altman’s 1970 black comedy, M*A*S*H, and the hit television series. The idea for MASH, however, originated in World War II with a Boston chest surgeon, Col. Edward “Pete” Churchill, MD, who in 1943 moved his best surgeons forward into rudimentary, auxiliary field hospitals during the invasion of Italy. A young Michael DeBakey, MD, serving on the surgeon general’s brain trust in Washington, later helped institutionalize the practice.

Vietnam gave new meaning to the term “flying ambulances” as daring Huey helicopter pilots ferried the wounded out of jungle battle zones. Even “dust off” — the military call sign for those evacuations — entered the American lexicon. Indeed, President George W. Bush held a ceremony in the White House in late February to present the Congressional Medal of Honor to Maj. Bruce Crandall, one of those Huey pilots, for darting in and out of a raging firefight in Vietnam’s Ia Drang Valley 14 times on a single day in November 1965 to rescue and resupply a 1st Cavalry battalion. His wingman, Ed Freeman, received the same honor in 2001.

Such feats not only proved the pilots’ mettle, but demonstrated what a lifesaver the sturdy little Huey — the Bell UH-1 Iroquois — could be. That lesson was not lost on hospital administrators and trauma surgeons back home. The Pentagon in 1968 lent helicopters for a pilot program to rescue accident victims from highway crashes in San Antonio and Dallas, and Baltimore trauma surgeon Adams Cowley, MD, convinced Maryland authorities to create the first statewide transport system in the early 1970s. Today, no self-respecting trauma hospital is complete without a helipad.

The crucible of conflict whets appetites for more and better medicine. Cooter, the British sociologist, wrote in the Companion Encyclopedia of the History of Medicine (1993): “Wars such as the American Civil and the First World War exposed large numbers of men to modern medicine and dentistry for the first time: one by one, recruits were stripped for examination, measured, weighed, tapped, and interrogated. Along with the soldiers and sailors whose lives were spared by the skills of military surgeons, such men may have returned home from war with higher demands for and expectations of orthodox medicine than when they left.” Smith, the historian of military medicine, notes the same phenomenon occurred after World War II, in which 30 percent of the nation’s physicians had been pressed into service to attend to the needs of the 8 percent of the population under arms.

Perhaps war’s greatest contribution to medicine is the chance to run public health experiments on a grand scale under exigent circumstances. Letterman’s Civil War ambulance corps was a dry run for today’s emergency medical services. Indeed, the municipal ambulance system that New York’s Bellevue Hospital launched in 1869 was modeled on the medical transports that Edward Dalton, MD, organized for the Army of the Potomac. Back home as sanitary superintendent for New York, Dalton convinced commissioners that the city needed an ambulance corps of its own. Each horse-drawn ambulance was stocked with “a quart flask of brandy, two tourniquets, a half-dozen bandages, a half-dozen small sponges, some splint material, pieces of old blankets for padding, strips of various lengths with buckles, and a two-ounce vial of persulphate of iron,” according to a January 2000 History Magazine account.

The Civil War’s impact on the practice of medicine was profound, according to Civil War buff and surgeon F.W. Blaisdell, MD, class of 1952, who’s known as the father of the modern trauma center. It set the standards for handling mass casualties and for combining field hospitals with large, pavilion-style hospitals in the rear. The latter became the model for municipal hospitals built across the United States for the next 75 years, Blaisdell wrote in The Archives of Surgery in 1988.

Those clean, well-ventilated hospitals were part of the legacy of Surgeon General William Hammond, MD, promoted at age 34 from first lieutenant to brevet brigadier general in 1862 to shake up the Union Army’s backward medical bureaucracy. Hammond laid the groundwork within Army medicine for a culture and passion for science and research, but his strong opinions also made him enemies. He defied medical orthodoxy by banning calomel, a popular mercury-based purgative that Hammond recognized was toxic. Court-martialed and driven from his post in 1864, Hammond went on to postwar distinction as a neurologist.

It was Hammond’s idea, too, to create an Army Medical Museum and to instruct field surgeons to send back to this fledgling museum and laboratory in Washington “specimens of morbid anatomy” in hopes that they might yield insights on improving care of the Union’s soldiers. After the fighting stopped, the museum took on the task of compiling a definitive medical record. Published in six volumes over 18 years, Medical and Surgical History of the War of the Rebellion became an early testament to evidence-based medicine. It was the work of many hands, but its chief compiler was Lt. Col. Joseph Janvier Woodward, MD, who helped conduct the autopsies of both Abraham Lincoln and assassin John Wilkes Booth.

“It stood for many years as the finest example of military medical reporting ever,” says Adrianne Noe, PhD, director of the National Museum of Health and Medicine, located on the campus of Walter Reed Army Medical Center. “We know the date of the soldier’s injury and the history of all of his care. This becomes valuable not only for historians, but also those studying injuries in a contemporary setting.”

Noe holds a position once occupied by the dauntless Maj. Walter Reed, the scientist-physician who conducted the famous experiments in Havana, Cuba, in 1901 confirming that yellow fever was carried by mosquitoes. Notwithstanding the recent scandal over poor outpatient conditions, for nearly a century the storied hospital that bears Reed’s name has cared for generals, privates and presidents, and its researchers have made major contributions to medical science and clinical care.

It isn’t quite a Medical and Surgical History of the War of the Rebellion, but the Vietnam Vascular Registry that military surgeon Norman Rich, MD, class of 1960, established at Walter Reed in 1966 after a year as chief of surgery at a MASH in a jungle clearing in Vietnam’s Central Highlands has paid dividends for American servicemen and servicewoman injured in subsequent wars. Rich went to Vietnam fresh from a surgical residency under Carleton Mathewson, MD, at Letterman Hospital in San Francisco. Mathewson, a Stanford surgical legend, encouraged his protégé to keep careful records on his MASH patients, with an eye toward publishing the results.

Rich became fascinated with vascular surgery, including the repair of popliteal arteries. A tear in this artery behind the knee once portended amputation, but military surgeons had begun doing autologous vein transplants back in Korea, and that remains the treatment of choice today. More than 600 battle surgeons contributed records from 8,000 vascular wound cases to Rich’s registry, which today helps surgeons operating on soldiers who suffer similar wounds in Afghanistan and Iraq.

“Evidence-based medicine is everything today, and this large, unique database lets us know what happens when vessels with certain types of injuries are repaired in certain ways. Our younger colleagues are doing much the same thing with the injured coming back from Afghanistan and Iraq, and we keep comparing the two sets of experiences to come up with the best current management of casualties,” says Rich, the former USUHS surgery chief, who at 73 still gets to work by 5:30 a.m. Recalling Ambrose Paré’s axiom about young surgeons, Rich says, “I did more in a short period than I ever would have done in a civilian setting — around the clock, seven days a week, without distractions. It was a phenomenal experience.”

Burris, the chief of surgery at USUHS, often uses the phrase “new wounds for new surgeons” to explain what surgeons are up against in Iraq and Afghanistan. “The explosions in the wars since World War I all do the same thing to the human body. There are only so many ways you can survive and be badly mangled,” says Burris, who spent three months performing operations in an auxiliary hospital at the Baghdad International Airport. Rich expressed similar sentiments. “People who have not been in a war before are absolutely overwhelmed by the horrors of war — but that doesn’t mean that wars or wounds are getting worse. It just means that new people are seeing horrible wounds that other people have seen in the past.”

Notwithstanding the images Americans see daily on their television screens, most of the 25,000 injuries that U.S. service men and women have suffered in Iraq “are mild to moderate, just like in car wrecks or anything else,” Burris says, and half the wounded return to duty without leaving the theater of war. While it might seem from the television news “like everybody’s lost their leg,” the actual number is fewer than 750, he says. Half those killed in battle die from bleeding before a doctor sees them, and most of the others suffer “massive neurological injuries that are non-survivable. You couldn’t fix them even if they were blown up in front of you,” the trauma surgeon says. The real challenge in this war as in every other is to save the lives of that 5 percent with massive injuries who can survive if “everybody does everything perfectly,” Burris says.

Not every wound involves fractured bones or punctured tissue and organs. In war, some of the gravest injuries occur to the psyche, though the harm might not manifest itself until long after the battle stops. Operation Desert Storm — the 1991 Gulf War to oust Iraq from Kuwait — ended in weeks, with an official Pentagon count of 382 deaths and 467 wounded. But among the 700,000 American troops deployed during Operation Desert Storm, “approximately 80,000 veterans have reported various symptoms in the years following the war, and scientists have agreed that many veterans have unexplained illnesses,” including fatigue, pain, headaches, memory loss, rashes and disturbed sleep, according to a 2004 Government Accountability Office report. There well could be a similarly long shadow to Operation Iraqi Freedom.

Armies have struggled for centuries to help troops cope with the stress of battle. From the late 17th to the late 19th century, “nostalgia” was the official diagnostic term for the homesickness and despair that practically paralyzed some soldiers. But only after Vietnam did “post-traumatic stress syndrome” became recognized as a disorder. The Department of Veterans Affairs in 1989 carried out a congressional order to create a National Center for Posttraumatic Stress Disorder to study PTSD, headquartered at the Veterans Affairs Medical Center in White River Junction, Vt. Its executive director, Matthew Friedman, MD, PhD, a professor of psychiatry and pharmacology at Dartmouth Medical School, says, “The PTSD field has matured to the point where we have evidence-based treatments that work. We couldn’t make that statement following the Vietnam War 30 years ago. But we now have very, very effective psychosocial treatments.” Friedman adds, “We’ve moved way beyond thinking of PTSD as exclusively a military issue. We’ve gotten into post-sexual trauma, disasters, tsunamis, Katrinas, terrorist issues.”

In Iraq, while “we are saving many people who would have died in previous conflicts… it also means that they are at considerable risk to develop psychological problems along with whatever physical sequelae they have,” Friedman says. The military now screens soldiers for mental health problems before and after they are sent to theaters of war. Friedman says military psychiatrists are uncovering and treating problems while these soldiers are still in uniform, rather than letting the problems fester for years, as happened with many veterans of the Vietnam War.

Next challenge: the health-care system

If better understanding and treatment of stress was a medical legacy of Vietnam, traumatic brain injuries may be what soldiers and the American public will remember most from Operation Iraqi Freedom. Today’s improved body armor protects a soldier’s torso and limbs, but the brain remains vulnerable. Thousands of U.S. troops who survived explosive blasts with no visible wounds could suffer neurological disorders because of internal damage, U.S Department of Veterans Affairs neurologists say. And that is on top of the nearly 1,900 U.S. troops who survived with brain injuries caused by severe penetrating trauma.

Saved by heroic medical measures, these mostly young service members must for the rest of their lives deal with brain injuries and other incapacitating wounds. The VA has established four so-called polytrauma centers in Richmond, Va.; Tampa, Fla.; Minneapolis; and Palo Alto. Each of the 350 patients treated to date at these centers has suffered at least two major injuries from a list that includes traumatic brain injury, hearing loss, amputations, fractures, burns and visual impairments. The VA spends $31 billion a year providing health care for the nation’s 24 million veterans and their families. After reforms and changes in the 1990s, the VA’s coordinated system of care is often touted as a model for the nation.

But Kenneth Kizer, MD, architect of that transformation as VA under-secretary for health from 1994 to 1999, and a Stanford University alumnus, is not sanguine about the capacity of the U.S. health system to deliver the care severely injured Iraq war veterans will need. “These traumatic brain injuries combined with multiple amputations and other serious injuries are creating a type of casualty the likes of which has never been seen before, or at least certainly not in the numbers now being produced by this war,” says Kizer.

Kizer, whose Marine son-in-law is on his second tour of duty in Iraq, says, “Places like Stanford and Palo Alto-VA may be relatively well-prepared [for these patients] but they are very special places. These people aren’t going to live in the VA forever. They are going to want to go home to their communities” far from elite academic medical centers. “How many nursing homes are prepared to deal with a patient with multiple amputations, traumatic brain injury and God knows what else?” he asks.

It was Abraham Lincoln, in the closing words of his Second Inaugural, who first spoke of the government’s obligation “to care for him who shall have borne the battle, and for his widow, and his orphan.” Despite advances over the years in war and in medicine, that solemn challenge remains daunting.

From: stanmed.stanford.edu

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Elizabeth Blackwell Breaks the Bonds— “Women will not be what they are now”

From: The FASEB Journal, Gerald Weissmann, Editor-in-Chief

You ask me what I did, and what can be done as a lady. I entered the Maternité, dissected at l’Ecole des Beaux-Arts alone, employed a répétiteur who drilled me in anatomy and smuggled me into the dead-house of La Charité at great risk of detection, where I operated on the cadaver. I once made the rounds of his wards in the Hôtel-Dieu with Roux, heard his lectures, and saw his operations. I attended lectures at the College of France and Jardin des Plantes…It is my impression, for I ought only to put it in that modest form, that the ruling class in America is less humane, more addicted to money-getting and party spirit; and that reform ideas in America are much more talked of, but less acted on.
Elizabeth Blackwell, Letters to her sister Emily (1850–54)


PREJUDICE IS MORE VIOLENT THE BLINDER IT IS
The images above document a sea change in American medicine. After Elizabeth Blackwell broke the bonds, women were no longer there simply to be acted upon (left), but could themselves take action (right). The New York Times noted the critical event in adjacent news reports on March 1, 1867. The evening before, at Steinway Hall on 14th Street, Dr. Albert Lewis Sayre had presided over the graduation ceremonies of Bellevue Hospital Medical College at which 140 gowned men marched down the aisle to the music of Wagner (2)⇓ . A founder of the school, and the first Professor of Orthopedic Surgery in the US, he was famous not only for his “suspension” treatment of spinal deformities but also for his textbook illustrated by provocative dorsal views of female patients. On the same evening, and only three blocks away at the New-York Historical Society on 11th Street, Dr. Elizabeth Blackwell had addressed an audience of men and women on the subject of “The Medical Education of Women.” The Women’s Medical School that she founded with her sister had just been chartered, and she appealed for funds to permit women to gain “a thorough knowledge of the science of medicine (3)⇓ .” Scientific knowledge of the body, she pleaded, could only be obtained by practical, hands-on work, as in the revolutionary practice of learning anatomy by dissection. Leslie’s Illustrated Newspaper spread the shocking news that a woman could become a doctor over the dead body of a man [see above, .

The founding of a medical school for women had its origins in 1854 when Elizabeth Blackwell, described by Lancet as “the first woman medical graduate in the modern meaning of the phrase (5),” arrived in New York after clinical work in Paris and London. In Paris she had been exposed to the bracing notion of Lamarckian evolution at the Jardin des Plantes and to the experimental medicine of Magendie and Claude Bernard at the Collège de France. In London she caught the fervor of sanitary and social reform and became a lifetime devotee of Florence Nightingale.

America in 1854 was not ready for Elizabeth Blackwell, nor for other women of her stripe and, alas, our country remains unready for them today. Although many women have found places in the public sphere, some near the very top, our country seems forever committed to customs Blackwell called “money-getting and party spirit” (read zealotry). Two current items remind us of the pre-bellum country that Blackwell encountered on her return, an America where money-getting trumps the facts of science and zealots wave the flag of bigotry:

New York Times, May 3, 2007: THE REPUBLICAN CANDIDATES DEBATE—

Mr. Vandehei: I’m curious, is there anybody on the stage that does not agree—believe in evolution? [Senator Brownback, Mr. Huckabee, Representative Tancredo raise their hands.

Chicago Tribune May 5, 2007: RELIGIOUS LEADERS RIP HATE CRIME BILL—

A hate-crimes bill passed Thursday by the House, extending coverage to people victimized because of sexual orientation, gender identity or disability, is attracting opposition from an unusual… coalition of evangelical, fundamentalist and black religious leaders that is mounting a furious assault on the bill, airing television ads and mobilizing members to stop its progress. And President Bush has said he may veto the measure.

A HUNDRED YEARS HENCE
Born in England to Samuel Blackwell, a well-off sugar refiner and dissident lay preacher, Elizabeth Blackwell was brought to Cincinnati in 1832. Her education was peripatetic, in circles where abolitionist politics and Transcendental values held sway. She received medical tutorials in the private practices of Philadelphia doctors, but despite her thorough preparation in textbook anatomy and a solid educational record, she was refused admission by 17 medical faculties in the United States. However, there was a small college in Geneva, New York, that granted the degree of Doctor of Medicine, provided lectures were attended for two years and a thesis was written. In those pre-Flexnerian days, Geneva’s requirements for the M.D. degree were par for the course, as it were.

Blackwell matriculated in November 1847, was more or less well received by town and gown, and performed splendidly in all courses, especially therapeutics. In the summer of 1848, she undertook clinical instruction at the Philadelphia Hospital where “ship fever” (epidemic typhus) had broken out among Irish immigrants. Blackwell carefully recorded its spread from case to case and recommended prevention by light, air, and washing hands with soap and water. This exercise in clinical epidemiology became her doctoral thesis, a work almost as persuasive as that of Oliver Wendell Holmes on puerperal fever (1843). Indeed, Blackwell’s thesis relied heavily on the work of Holmes’s teacher, Prof P. C. A. Louis of Paris, who first distinguished typhoid from typhus. By February of 1849, Blackwell’s thesis had been published in the Buffalo Medical Journal and Review, and all that remained for her doctorate was to graduate with distinction.

CLAUDE BERNARD, A DISTINGUISHED YOUNG INQUIRER
The degree won, Blackwell determined to obtain the best clinical training possible. Since in those days young American doctors properly regarded Paris as the center of clinical science, Blackwell sailed off to the City of Light. She arrived with an introduction from her Philadelphia preceptors to none other than Professor P.C.A. Louis himself “then at the height of his reputation.” She felt instinctively that his visit was one of inspection and passed with flying colors. Thanks to Louis’ intervention, she was admitted in autumn of 1849 for a six months course at the Maternité lying-in hospital. In that convent-like atmosphere her most intellectually stimulating companion was the interne, M. Hippolyte Blot. [In later years, Blot (1822-1888) went on to a professorship at the Maternité, having discovered the relationship between eclampsia and albuminuria.

Interne Blot and pupil Blackwell exchanged lessons in English and histology, spending hours over the young man’s microscope. Blot taught Blackwell that the erythrocyte was biconcave, streaking a drop of blood on a slide to show “that what appeared to be a central spot in each globule was owing to the convexity not being in focus, and it disappeared when the focus was a little lengthened.” In the Paris of 1849, experimental medicine was everywhere in the air. Hippolyte Blot told Blackwell of his friend,

Claude Bernard, a distinguished young inquirer, who is now, he thinks on the eve of a discovery that will immortalize him … of the power which the liver has of secreting sugar in a normal state when animals are fed on certain substances which can be so converted; also of the curious experiment by which a dog was made, in his presence, to secrete albuminous or diabetic urine .

BLACKWELL AND THE GONOCOCCUS
Attending to her patients at the Maternité, a grave accident befell Elizabeth: “in the dark early morning, whilst syringing the eye of one of my tiny patients for purulent ophthalmia,” some of the water spurted into her left eye. By nightfall of November 4, the eye had become swollen, and by the next morning, the lids were “closely adherent from suppuration.” The diagnosis of purulent ophthalmia (the dreaded venereal disease of newborns and those that attended them) was made and the 28-year-old Blackwell was placed in the student infirmary. The disease is caused by the gonococcus, is due to chronic gonorrheal infection of the female reproductive tract, and was part of the load borne by the prostitutes and working women who gave birth in the public hospitals of Paris. The bacteriologic revolution has all but eliminated it, but Albert Neisser did not discover the microbe until 1879, and it was not until 1884 that Carl Credé made it clear that eyedrops of 1% silver nitrate on the lids of newborns were an effective prophylactic. Thanks to rigorous maternal health laws, by the turn of the century, prophylaxis had pretty much eliminated neonatal ophthalmia from advanced countries. Today resistant strains are making an unfortunate comeback in many parts of the globe.

Elizabeth Blackwell was treated by the accepted methods of the day: cauterization of the lids, leeches to the temple, cold compresses, ointment of belladonna, opium to the forehead, purgatives, and footbaths. Dr. Blot came in every two hours, day and night, to tend the eye. But despite his efforts, after three days it became obvious to her doctors that the eye was hopelessly infected:

"Ah! how dreadful it was to find the daylight gradually fading as my kind doctor bent over me and removed with an exquisite delicacy of touch the films that had formed over the pupil! I could see him for a moment clearly, but the sight soon vanished, and the eye was left in darkness."

She lay in bed with both eyes closed for three weeks, but then the right eye gradually began to open. Soon she could start to do little things for herself and assured an uncle in England that she could write without difficulty, read a little, and hoped to return to her studies. She was discharged permanently blind in one eye, and because of this handicap disqualified herself from surgery or obstetrics as a career.

Blackwell next applied to St. Bartholomew’s Hospital in London, then, as now, perhaps the strongest teaching hospital of the city. The illustrious Sir James Paget endorsed her admission as a student “in the wards and other departments of the hospital,” and on the 14th of May 1850 she was accepted at Bart’s. Once on the wards, she soon spotted the difference between the medicine of Paris and London at mid century:

"I do not find so active a spirit of investigation in the English professors as in the French. In Paris this spirit pervaded young and old, and gave a wonderful fascination to the study of medicine, which even I, standing on the threshold, strongly felt.".

But overall, her London hours were instructive, she made many new female friends; some were socially prominent, among them Miss Nightingale. She also encountered more than the expected rebuffs. Her mentor gave her sound advice, which elicited a passionate response:

Mr. Paget who is very cordial, tells me that I shall have to encounter much more prejudice from ladies than from gentlemen in my course. I am prepared for this. Prejudice is more violent the blinder it is…but a work of the ages cannot be hindered by individual feeling. A hundred years hence women will not be what they are now.

WOMEN WILL NOT BE WHAT THEY ARE NOW
Her experiences in Paris and London made her anxious to start out on her own in America. In November of 1850, she wrote of her future plans to her sister Emily, who had decided to follow in her sister’s footsteps: “I shall commence as soon as possible building a hospital in which I can experiment.” On her return to New York she was too poor to realize the dream of building an experimental hospital. “If I were rich,” she had told her sister, “I would not begin private practice, but would only experiment. As however I am poor. I have no choice.” She set up a general practice and spent cold winters and steaming summers in the city trudging the pavements with her black bag. Her early years as this country’s first woman doctor of medicine were not encouraging. She confessed deep unhappiness: “I had no medical companionship, the profession stood aloof, and society was distrustful of the innovation. Insolent letters occasionally came by post, and my pecuniary position was a source of constant anxiety.

It was impossible to rent an office, the term “female physician” having been preempted by ill-trained abortionists, and she went into debt by buying a house on East 15th Street. She worked in the attic and basement, renting out the remainder of the house. Her isolation prompted her to adopt a seven-year-old orphan, Katharine Barry, and this young child became a life-time companion, friend, and housekeeper.

Slowly, Elizabeth Blackwell began to attract support from the New York Quaker community and by 1854, opened a one-room dispensary on the Lower East Side in which she treated over two hundred women in the first year. By 1856, she was reunited with her sister who had received medical training in Europe after an M.D. from Western Reserve. In 1857, with the help of progressive philanthropists like their good friend Horace Greely, the Blackwells established the New York Infirmary for Women and Children at 64 Bleecker Street. They successfully overcame each of the social objections of the time: that female doctors would require police protection on their rounds; that only male resident physicians could control the patients, that “classes and persons” might be admitted whom “it would be an insult to treat” (i.e., beggars and prostitutes); that signatures on death certificates might be invalid (the legal rights of women in the pre-suffrage era were fragile); that the male trustees might be held responsible for any “accidents”—and that, in any case, no one would supply women with enough money to support such an unpopular effort.

With Emily now in charge of a going concern, Elizabeth traveled back to England and became the first woman to be registered as a physician in the UK. She studied programs of maternal hygiene, looked over public health programs for women and children, and toyed with the notion of spending the rest of her life working in a country hospital together with Florence Nightingale, with whom she had formed an intense personal relationship.

KNOWLEDGE NOT SYMPATHY
When Elizabeth returned once more to New York in 1860, the sisters enlarged the infirmary, added new staff, and put in place the preventive measures of the Sanitarian revolution. The Civil War fully engaged their abolitionist spirit. On the day after Fort Sumter was fired on, the Blackwells helped to found the National Sanitary Aid Society (in turn, the Sanitary Commission), a major service to public health in the Union cause. With war over, Elizabeth’s dream was realized: a hospital in which to experiment. In 1867–1868, the sisters founded the Women’s Medical College of New York Infirmary, which by 1899 had graduated 394 women doctors! The laboratories for instruction in both basic and applied sciences were among the most up-to-date in the country, and the three-year curriculum exceeded in rigor much of what passed for medical education in this country. Elizabeth Blackwell became the first Professor of Hygiene and it was due to her efforts that hands-on science—anatomy, histology, physiology—came first:

"It is observation and comprehension, not sympathy, which will discover the kind of disease. It is knowledge, not sympathy, which can administer the right medicine; and though warm sympathetic natures, with knowledge, would make the best of all physicians, without sound scientific knowledge, they would be most unreliable and dangerous guides."
.
On the one hand, the social causes to which the Blackwells devoted themselves have by and large prevailed: medical education of women advanced, the Union preserved, sanitation promoted, infections curbed, child and maternal health protected by the state, and so forth. On the other hand, we have a way to go. The personal lives of Elizabeth and Emily Blackwell remained private and monogamous. Aside from that passionate episode with Florence Nightingale, Elizabeth spent all of her life—the last thirty years in seaside retirement—with her adopted daughter/friend Kitty Barry. Emily and her lifelong companion, Dr. Elizabeth Cushier, spent 28 happy years together in a Gramercy Park brownstone and on the coast of Maine.

Sadly, these days, perhaps the only place Elizabeth Blackwell and Florence Nightingale could live together in legal peace would be Massachusetts. We are still some distance from realizing her fondest hope, written in reply to an invitation from the Convention for Women’s rights in Worcester, Massachusetts (1850):

The great object of education has nothing to do with woman’s rights or man’s rights, but with the development of the human soul and body. My great dream is of a grand moral reform society, a wide movement … combined that it could be brought to bear on any outrage or prominent evil.



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Convalescent Camp

Letter written home by James D. Chadwick, a graduate of Allegheny College in the class of 1861.

Near Fort Blenker,2 miles N. W.  of  Alexandria, VA.,                                                                                 Oct. 1, 1862

Dear Father:-
                I am out of the hospital at last, but only “out of the frying -pan into the fire” for I have been sent to the Convalescent Camp near Alexandria instead of being sent to my regiment as I desired.
                I had been at the Camp only a day or so and had become so disgusted with the place that I left it yesterday and am now up about one and one-half miles distant with a detachment of the 124th Pa. Vols., who are going to Harper’s Ferry to-morrow. I am to go with them to that place and then I can find my Division in a day or so.
                There are about 12,000 or 15,000 men at that “Convalescent Camp”—some stragglers—recruits—paroled prisoners—convalescents—and deserters.  It is a horrible place to stay, being very dirty, filthy and infested with vermin.  Such a set of fellows as those prisoners from Richmond you never saw—ragged, dirty—LOUSY and without money.
                George Junkin  and Pete Conver’s brother are among the number, they are well but look in a sad plight. John Nickle is a nurse in a hospital in Alexandria. Harrison McDonald’s son, William, is quite sick in the camp of his regiment—the105th—and I was over to see him yesterday. He has had a fever and it has settled on his lungs. I fear he will not live long. His discharge is being made out and he may get home soon. I asked the Captain of his company, an old classmate of mine [Levi Bird Duff], to do everything in his power to hurry up his discharge. He said he would.
                John  Downing is in that convalescent camp,  recovering from his wounds. John Compton is also there endeavoring to get to his regiment.
                If we get to Washington this afternoon, we will start for Harper’s Ferry in the morning. I am anxious to get back to the Division.
                I send a list of the casualties of our Division which you may not have seen. I think the Division is somewhere between Sharpsburg and Harper’s Ferry.
                Direct letters to the regiment for I shall surely be there soon if nothing happens. I have fully recovered my health, though not my strength, this I will soon gain, however, for I have a good appetite. I expect to mail this as we go through Washington. We are to take cars and go by rail.
                I will close,          Yours affectionately—J. D. C.

IMAGE: Convalescent Camp near Alexandria, Virginia

FROM: sites.allegheny.edu

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Civil War Casualties

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

Causes of death during the Civil War were many. Bullets and artillery took their share of lives on both sides, but more than twice as many men died from illness than from enemy fire.

Soaring Casualties
The casualty statistics are staggering. According to an analysis of government records, slightly more than 350,000 Union soldiers died from various causes during the Civil War. The majority of deaths were from disease. Nearly 25,000 men died from causes such as suicide, execution, sunstroke, and accidents. The Union navy lost nearly 5,000 men to illness, accidents, and battle injuries.

Records of Confederate deaths aren't nearly as comprehensive as those of Union casualties; military and government files were destroyed during and after the war. However, a generally accepted estimate is 150,000 dead of disease and 95,000 killed or mortally wounded in combat. No statistics survive regarding deaths among Confederate naval personnel.

To put these figures in perspective, consider that more Americans died of disease and battlefield wounds during the Civil War than all other American wars combined, from the Revolutionary War to Vietnam, including both World Wars. In fact, the Battle of Antietam resulted in four times the casualties as the landings on the Normandy beaches on D-Day, June 6, 1944.

Casualty by Disease
The high number of battlefield deaths during the Civil War is easy to understand. Civil War-era weapons caused massive physical damage when they hit their targets, and outdated battle tactics often put large numbers of soldiers in harm's way. But the number of deaths related to disease requires a little explanation.

The Civil War took place shortly before a number of important advances in human medicine. There were no vaccines for the most common of illnesses, and hygiene was poor, especially in mobile military camps. Young men who had lived their entire lives in relative seclusion in small towns and hamlets simply didn't have immunity to many types of illnesses, and they fell sick from the most innocuous of diseases.

One of the leading contributors to wartime illness was the latrine, usually a simple hole or trench used by all members of the camp. When the stench of the latrine became unbearable, it was covered over and a new one dug. As might be expected, camp latrines were veritable breeding grounds for every imaginable form of illness. They also attracted a lot of insects, particularly flies, which would deposit germs and bacteria on the food the men ate and the water they drank. Numerous outbreaks of diarrhea and epidemics of cholera and other contagious diseases resulted. Whooping cough, measles, scarlet fever, smallpox, and dysentery also took a huge toll, as did environmental ailments such as sunstroke, frostbite, and tetanus. Many soldiers suffered from gastrointestinal ailments and other complaints for almost the entire length of their enlistment.

Civilian Casualties
Soldiers weren't the only ones to die during the Civil War. The conflict also took a huge toll on the civilian population, particularly in the South. While the number of Northern citizens who died as a direct result of the war is relatively small, some historians estimate that up to 50,000 Confederate citizens may have perished from various causes, including stray bullets and poor sanitation following the devastation of entire towns and cities.

IMAGE: Soldiers Cemetery, Alexandria, Virginia

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Veteran Reserve Corps

From Wikipedia

The Veteran Reserve Corps (originally the Invalid Corps) was a military reserve organization created within the Union Army during the American Civil War to allow partially disabled or otherwise infirm soldiers (or former soldiers) to perform light duty, freeing able-bodied soldiers to serve on the front lines.

The Invalid Corps
The corps was organized under authority of General Order No. 105, U.S. War Department, dated April 28, 1863. A similar corps had existed in Revolutionary times. The Invalid Corps of the Civil War period was created to make suitable use in a military or semi-military capacity of soldiers who had been rendered unfit for active field service on account of wounds or disease contracted in line of duty, but who were still fit for garrison or other light duty, and were, in the opinion of their commanding officers, meritorious and deserving.

Qualifications
Those serving in the Invalid Corps were divided into two classes:

Class 1, partially disabled soldiers whose periods of service had not yet expired, and who were transferred directly to the Corps, there to complete their terms of enlistment;

Class 2, soldiers who had been discharged from the service on account of wounds, disease, or other disabilities, but who were yet able to perform light military duty and desired to do so.

As the war went on, it proved that the additions to the Corps hardly equalled the losses by discharge or otherwise, so it was finally ordered that the men who had had two years of honorable service in the Union Army or Marine Corps might enlist in the Invalid Corps without regard to disability.

The soldiers shown in the rosters of the 15th Massachusetts Volunteer Infantry Regiment (where they originally enlisted) and who then transferred to the V. R. C. belong to Class 1.

The Veteran Reserve Corps
The title "Veteran Reserve Corps" was substituted for that of "Invalid Corps" by General Order No. 111, dated March 18, 1864. The men serving in the Veteran Reserve Corps were organized into two battalions; the First Battalion including those whose disabilities were comparatively slight and who were still able to handle a musket and do some marching, also to perform guard or provost duty. The Second Battalion was made up of men whose disabilities were more serious, who had perhaps lost limbs or suffered some other grave injury. These later were commonly employed as cooks, orderlies, nurses, or guards in public buildings.

Uniforms
Invalid Corps members stood out because of their unique uniforms. According to General Orders No. 124, issued May 15, 1863:

The following uniform has been adopted for the Invalid Corps: Jacket: Of sky-blue jersey, with dark-blue trimmings, cut like the jacket of the U.S. Cavalry, to come well down on the loins and abdomen. Trousers: Present regulation, sky-blue. Forage cap: Present regulation.

Invalid Corps troops also wore standard dark blue fatigue blouses from time to time. Standard forage caps were to be decorated with the brass infantry horn, regimental number, and company letter.

Officers also wore sky blue; a frock coat of sky-blue cloth, with dark blue velvet collar and cuffs, in all other respects according to the present pattern for officers of infantry. Shoulder straps were also to match current patterns but dark-blue velvet. Officers also wore gold epaulets on parade. Eventually officers were allowed to wear the standard dark-blue frock, ostensibly because sky-blue frocks soiled easily. Some officers had their frocks cut down to make uniforms or shell jackets. By the war's end, however, the army was still making sky-blue officers' frocks.

Organization
There were twenty-four regiments in the Corps. These regiments were organized into one division and three brigades.[1] In the beginning, each regiment was made up of six companies of the First Battalion and four of the Second Battalion, but in the latter part of the war, this method of organization was not strictly adhered to. The 18th Regiment, for example, which rendered exceptionally good service in Virginia at Belle Plain, Port Royal, and White House Landing in the spring and early summer of 1864, and in or near Washington DC in the latter part of the summer and through the fall of that year, was made up of only six Second Battalion companies.

There were from two to three times as many men in the First Battalion as in the Second, and the soldiers in the First Battalion performed a wide variety of duties. They furnished guards for the Union prison camps at Johnson's Island, Ohio, Elmira, New York, Point Lookout, Maryland, and elsewhere. They furnished details to the provost marshals to arrest bounty jumpers and to enforce the draft. They escorted substitutes, recruits, and prisoners to and from the front. They guarded railroads, did patrol duty in Washington DC, and even manned the defenses of the city during Jubal Early’s raid against Fort Stevens in July 1864.

During the war, more than 60,000 men served in the Corps in the Union army; several thousand more served in a Confederate counterpart, although it was never officially organized into actual battalions. Four members from Company F of the Fourteenth Veteran Reserves conducted the execution of the four conspirators linked to the assassination of Abraham Lincoln on July 7, 1865 at Fort McNair in Washington, D.C. They knocked out the post that released the platform that hanged Mary Surratt, Lewis Powell, David Herold, and George Atzerodt.

The Federal corps was disbanded in 1866 following the close of the Civil War and the lessening of a need for reserve troops.

IMAGE: Band of the 10th Veteran Reserve Corps. Washington, D.C. April, 1865

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The Invalid Corps

From Wikipedia

The Invalid Corps is a popular song dating from the time of the American Civil War, circa 1863. The first stanza tells the story of a Union conscript attempting to join the military, only to be rejected because of his poor health. The rest of the song humorously depicts the rejected conscript's experience in the Invalid Corps. The words and music were composed by Frank Wilder.

The Invalid Corps, or the Veteran Reserve Corps, was indeed a real branch of the military during the Civil War, created within the Union Army to allow partially disabled or formerly disabled soldiers to perform some form of light duty, thus allowing able soldiers to be sent to the front lines.

Song Lyrics

I wanted much to go to war,
And went to be examined;
The surgeon looked me o'er and o'er,
My back and chest he hammered.
Said he, "You're not the man for me,
Your lungs Are much affected,
And likewise both your eyes are cock'd,
And otherwise defected."
CHORUS

So, now I'm with the Invalids,
And cannot go and fight, sir!
The doctor told me so, you know,
Of course it must be right, sir!
While I was there a host of chaps
For reasons were exempted,
Old "pursy", he was laid aside,
To pass he had attempted.
The doctor said, "I do not like
Your corporosity, sir!
You'll "breed a famine" in the camp
Wherever you might be, sir!"
CHORUS

There came a fellow, mighty tall,
A "knock-kneed overgrowner",
The Doctor said, "I ain't got time
To take and look you over."
Next came along a little chap,
Who was 'bout two foot nothing,
The Doctor said, "You'd better go
And tell your marm you're coming!"
CHORUS

Some had the ticerdolerreou,
Some what they call "brown critters",
And some were "lank and lazy" too,
Some were too "fond of bitters".
Some had "cork legs" and some "one eye",
With backs deformed and crooked,
I'll bet you'd laugh'd till you had cried,
To see how "cute" they looked.
CHORUS

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Interesting Facts About Northern Nurses

From: emergingcivilwar.com

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

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

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

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

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