Civil War Hospital Ship

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

Evolution of Civil War Nursing

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

The Practice of Surgery

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

Army Medical Museum and Library

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

Civil War Amputation Kit

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

Friday, February 28, 2014

Civil War Sutures

By Rita, Oconto County WIGenWeb Coordinator

After the war, 1861 - 1865, the medical doctors from North and South came together in an attempt to exchange what they had learned. This information was to be used in the emergency treatment of civilians.

One glaring difference was the substantially higher number of ancestors who survived major surgery in the South than in the North, where the post treatment infection rate caused high numbers of fatalities.

The doctors of the North (often called "sawbones" for all the amputations done) used imported silk thread for stitching wounds. It was strong, light and "slick" , making use much easier during stitching.

Because of the naval blockades, there was no silk thread in the South, for even the most prominent of patients. Cotton thread was not a success as it broke down before the wound had healed sufficiently. Horse hair was tried. But because it was too stiff to make sutures in it's natural state, it was boiled in water to soften and become more pliable.

The result was that the Northern silk thread had been handled by countless unwashed hands from several continents and introduced all the pathogens it carried right into the wound.

The horse hair was sterile when it came from boiling, and handled by significantly fewer numbers of people. Far fewer pathogens were introduced right into those wounds.

With antibiotics and sterile procedural practices still years away, many folks owe their ancestral branches to the boiled horse hair sutures, and to the women and men who devised that method of softening the fibers for using in textiles.

Sunday, February 23, 2014

Post-Operative Hemorrhage

by Janet King, RN, BSN, CCRN.

Doctors classified major bleeding after the surgical procedure as "primary", "secondary" or "intermediary."

Primary hemorrhage was defined as a major escape of blood occurring from a ruptured blood vessel(s) within 24 hours of receipt of a wound. Intermediary hemorrhage was defined as occurring "from 24 hours until the establishment of suppuration on the fifth or sixth day" from receipt of wound. Secondary hemorrhage was described as occurring from the sixth day to even months after the injury or surgery.

Secondary hemorrhage was usually caused by an infection which had disintegrated the blood vessel�s wall, usually an artery, which then resulted in massive and irreversible blood loss and death.

As has been noted in the description of an amputation, the surgeon would "tie off" the bleeding blood vessels with a ligature (suture) of non-sterile silk, linen or cotton thread. One end would be left hanging out of the wound. On daily rounds, the surgeon would tug on this ligature to see if the loop on the blood vessel had rotted loose. When this suture came away, the surgeon hoped a blood clot had formed thus preventing the vessel from bleeding. If this was not the case, then a secondary and frequently fatal hemorrhage would occur. Unfortunately this happened with "dreadful frequency." Sometimes the patient would be almost to the point of discharge from the hospital and ready to return home, when suddenly - due to the disintegration of the arterial wall - the vessel would bleed profusely. The surgeon would try to stop this, first by manual compression of the artery, and perhaps an attempt to re-tie the vessel. In most cases it was a lost battle, while the soldier bled to death in front of his doctors, nurses and comrades.

The surgeons tried various styptics (blood clotting agents) such as astringents i.e. alum, tannic acid and persulphate of iron, perchloride of iron and silver nitrate - but these did little good. This deadly post-operative complication held a 62% mortality rate.


The Nuns of the Battlefield: How Sisters Nursed the Wounded During the Civil War

by Thomas J. Craughwell, Jun 10, 2011

For the next four years — 2011 through 2015 — the United States will commemorate the 150th anniversary of the Civil War, so brace yourself for a blizzard of books, articles and documentaries about battlefields and generals. But there is one story that may be overlooked in all the hoopla — the more than 600 Catholic nuns who nursed the wounded, the sick and the dying throughout the war.

In the mid-19th century, Catholics were almost universally despised in America. Typical of the time was an editorial published in The New York Times, which linked Catholicism — “popery,” the newspaper called it — with slavery as two institutions “incompatible with the spirit of the age, and liberty and civilization.” The editors went on to say that they looked forward to the “speedy destruction” of both. Such notions were dispelled in part by the selflessness and tender patient care of the nursing sisters who treated the most gruesome wounds, risked their lives to care for men suffering from contagious diseases, and looked after patients written off as hopeless cases by the physicians.

Trained Nurses
Most orders of nuns in the United States in the mid-19th century operated hospitals, and, as a result, many of the sisters had medical training (unlike most of the laywomen who volunteered as nurses). Glenna Schroeder-Lein, author of The Encyclopedia of Civil War Medicine, observes that the nuns “were the only trained, experienced nurses in the nation when the war began.”

Very quickly, military surgeons and civilian doctors came to prefer the nursing nuns to laywomen nurses. In addition to their medical skills, the nuns were patient, efficient and tireless. They followed the doctors’ orders, were never argumentative, and never complained about their accommodations (although they did insist upon a room that would serve as their chapel). In contrast, many physicians complained that laywomen nurses were quarrelsome, defiant and dissatisfied. Worst of all were the nurses who formed romantic attachments with their patients — something that was not an issue with the nuns. The federal government discovered yet another quality that made the nuns superior: Laywomen demanded a salary of $12 per month, but the nuns worked for free.

According to historian Ellen Ryan Jolly, who in 1927 compiled the first comprehensive history of the nursing nuns of the Civil War, sisters of a dozen religious orders, including the Ursulines, the Sisters of St. Joseph, the Sisters of the Holy Cross and the Sisters of Mercy, worked in the hospitals during the war, but Mother Elizabeth Ann Seton’s Daughters of Charity supplied the largest number of nurses: 270 sisters.

The Daughters of Charity motherhouse is only 15 miles from Gettysburg. The first Daughters of Charity arrived on the scene the day after the battle to find 50,000 wounded men, many of them still lying on the fields. Sister Petronilla Breen, Sister Juliana Chatard and Sister Emerito Quinlan went immediately to the battlefield, where they cleaned and bandaged soldiers’ wounds, administered painkillers and prayed with the dying. In the days that followed, more sisters from Emmitsburg, Md., came to Gettysburg. They were assigned to the hospital in the Methodist church and the hospital in the Catholic Church of St. Francis Xavier. The wounded filled every pew in the nave and the gallery and lay side by side on the floor, even inside the sanctuary. The church vestibule was used for surgery.

One of the nursing nuns is on her way to sainthood. In the summer of 1863, Blessed Mother Mary Frances Schervier, foundress of the Sisters of the Poor of St. Francis, traveled from Germany to her order’s convent in Cincinnati with four sisters who were trained in surgery. When they arrived, they found the wards of St. Mary’s Hospital crammed with wounded soldiers, so the German nuns went to work immediately. One night a young soldier was brought in; his wounds were so severe and gruesome that he begged the doctors to let him die. Mother Mary Frances had him carried to a quiet alcove, where she managed to get some broth into him. Next, she persuaded him to at least let her clean his wounds. Then she convinced him to let her apply some salves and clean bandages. Blessed Mary Frances spent the entire night with the young man, and in the morning she had him bandaged, medicated, fed and lying in a clean bed. Then she walked across the corridor to the hospital chapel to join her sisters in morning prayer.

Sisters in the South
Although most Catholics and most religious communities were in the North, there were convents in the South. About 35 sisters of Our Lady of Mercy from Charleston, S.C., served in the city’s hospitals. Food was in short supply in the South, especially during the final months of the war. Whenever an ambulance stood idle, Sister Xavier Dunne drove around Charleston, begging butchers and grocers for meat or produce they could not sell. One of her greatest triumphs was the day a butcher gave her the head of a steer, which she used to make beef stock.

In July 1863, General Ulysses S. Grant captured Vicksburg; the Confederate forces retreated, and a handful of Sisters of Mercy followed the army, tending the wounded who had been loaded into rickety wagons and carts. At Oxford, Miss., they found hundreds of wounded men in the classrooms and administration buildings of the University of Mississippi.

As a Union army advanced on the town, the Confederates fell back again. The sick and wounded were to be evacuated by train, and not until all their patients had been loaded on the train did the nuns finally climb aboard the last car.

In 1914, Ellen Ryan Jolly, president of the Ladies Auxiliary of the Ancient Order of Hibernians, proposed that the organization release funds to erect a monument in Washington, D.C., in honor of the nursing sisters of the Civil War. Ten years later, the “Nuns of the Battlefield” monument was unveiled. The bronze bas-relief depicts sisters of the 12 religious orders who served in the battlefields and in the hospitals. Visitors to Washington will find the monument in an appropriate spot: across the street from St. Matthew’s Cathedral.



by Janet King, RN, BSN, CCRN.

Gangrene [Hospital gangrene; Moist gangrene; Dry gangrene; Mortification]:Civil War surgeons were often indiscriminate in categorizing the patients who had gangrene. Some stuck with the term they were most familiar with, so determining how many cases of gangrene, and of what type, is difficult. Today's doctors classify gangrene into 3 main types. The following examples are those which occurred during the Civil War, although the doctors of that era did not know the precise cause.

Moist Gangrene: This results from the loss of blood circulation due to a sudden stoppage of blood flow - i.e. accident that destroys tissue (cannon ball or bullet wound); blood clot; tourniquet that was left on too long. At first the wound tissue looks like a bad bruise, is swollen and perhaps blistered. Later as the disease progresses the tissue is destroyed and the gangrene spreads rapidly and toxins are formed and absorbed into the general circulation.

Dry Gangrene: This occurs more gradually as blood flow is slowly reduced through the arteries. The tissue of the affected part gradually shrinks, becomes cold and without a pulse.

Gas Gangrene: Although the surgeons of the 1860's did not know the cause of this type of gangrene, they surely saw the results. Most likely they classified what they saw into the other types of gangrene. This condition occurs in wounds infected by a bacterium (clostridium) and is often attributed to dirty, lacerated wounds in which the deeper tissues of muscle and fat become filled with gas and a bloody-serous fluid fills the wound. The bacteria eat away the tissue and produce toxins. This type of wound would have been produced by such mechanisms as pieces of shell, deep sabre wounds or deep bullet wounds.

Hospital Gangrene: This form of gangrene is now considered "extinct." There is no agreement to its nature, though some feel it was some type of bacterial infection, perhaps streptococcus. The effects, as seen by the surgeons and soldiers of the 1860's were devastating and deadly. "The patient might see a black spot the size of a dime appear on a healing wound, and watch with horrified interest it's rapid spread until his whole leg or arm was but a rotten, evil-smelling mass of dead flesh."

1860's Treatments: Some hospitals made efforts to isolate gangrene cases, as it had been noted to be "contagious and infectious." Surgeons tried various drugs in a "conservative" approach at treatment. These included the use of bromine, considered one of the "miracle drugs." The patient was given ether or chloroform as an anesthetic; the diseased and sloughing tissue would be clipped and cut out until the wound was as clean as possible. Then pure bromine (a very costive agent!) would be applied beneath the edges of the wound. Lint moistened with a weak solution of bromine would be used to fill up the entire cavity or ulcer. Sometime "miraculous" results occurred and the patient was saved from amputation or further treatment. Other drugs used included: nitric acid, creosote, poultices of cinchona, ginger and flaxseed and various nutrients and stimulants.

Modern Knowledge:Today the specific cause of gangrene would be determined. If the problem required surgical intervention to remove a clot or bypass the blocked blood vessels this would be done. Wounds would be tested to determine what bacteria was causing the infection and antibiotics would be given accordingly. Removal of dead tissue, and as a last resort - amputation, would be performed if needed.


Harewood General Hospital (Corcoran Farm), Washington, D.C.


As the war progressed, Washington became home to several hospitals. Some were new constructions while others were in renovated buildings. Harewood Hospital was located on 7th Street, NW, near the Soldiers Home. Harewood was supervised by Surgeon Reed Bontecou. It held 2,000 beds in the permanent wards. At one time 312 hospital tents holding 1,872 beds were also on the grounds.

Located on the rolling hills of the Corcoran Farm, the hospital was built in a "V" pavilion style. A few wooden barracks and a brick farm house were incorporated into the hospital arrangements. The hospital consisted of nine wards, with 63 beds each, for a total of 945 beds. To these were added hospital tents, each of which held six beds. At one point, 312 hospital tents were in use on the site, with a capacity of 1,872 beds. In the bed census of Dec. 17, 1864, the hospital had 2,080 beds, with 1207 occupied, under the direction of Surgeon R. A. Bontecou, U.S.V.

Hospital Nuns: The Sisters of Mercy in the Civil War

By Mary Pat Kelly
Excerpted from:

The Sisters of Mercy were the first women to go with Florence Nightingale during the Crimean War in 1854. They worked with her to make nursing more effective and to improve sanitary conditions.

In America, the Sisters of Mercy would make their impact on the battlefields in the Civil War, beginning a legacy in health care that is still going strong today.

“Veritable angels of mercy” are the words President Abraham Lincoln used to describe the nuns he saw tending wounded soldiers at one of the 25 military hospitals hurriedly set up around Washington to receive the more than 20,000 casualties – Union and Confederate – of some of the bloodiest battles of the Civil War.

“Of all the forms of charity and benevolence seen in the crowded wards those of the Catholic sisters were among the most efficient,” Lincoln wrote after visiting Stanton Hospital, staffed by the Sisters of Mercy, the order founded by Catherine McAuley in Dublin barely 30 years before. “More lovely than anything in art are the pictures that remain with me of these sisters going on their rounds of mercy among the suffering and dying.”
A nice sentiment, but by sanctifying these sisters he unintentionally diminished their human accomplishments. The 36 sisters who nursed at Stanton Hospital, near Washington, D.C., were not angels but women. Tough, determined, intelligent women with names like Murphy, Byrne, Ward, Leahy, and Maguire. Surely, they had to push themselves beyond their fears to face the horrors of war.

Six hundred nuns from twelve religious communities served as U.S. Army nurses during the Civil War.

They served on the battlefield and gave their lives. A group of Sisters of Mercy traveling to St. Louis on a Union steamboat took fire from a Confederate gun battery and worked through it, tending the wounded. At Gettysburg one St. Joseph sister wiped the blood-covered face of a young soldier to discover that he was her 18 year-old brother.

When the Sisters of Providence (the community I was a member of for six years) took over the military hospital in Indianapolis during the Civil War, they found, as hospital inspector Dr. John M. Kitchen would write in a report, “a miserable state of filth and disorder, the sick in wretched conditions,” and would go on to create “a clean comfortable house for the sick soldiers . . . Whatever success may have attended our efforts is due in great degree to these meek and worthy women.”

Worthy? Yes. Meek? No. The orders who sent their sisters to the front line did so despite the fact that Dorothea Dix did not want them. All biographical information on Dix, who had been appointed by the U.S. government to recruit nurses, mentions her anti-Catholicism. She refused to accept Catholic women and nuns as nurses.

But nuns were already operating 30 hospitals around the country, and the doctors and public officials who knew their work by-passed Dix and welcomed them.

The Irish Sisters of Mercy, like orders of Polish, German and Italian, opened their hospitals to all no matter their religion, background or ability to pay.

The Sisters of Mercy in Chicago, who founded Mercy Hospital in 1847, also founded a nursing academy and subsidized the hospital with the tuition collected from the young women in their academic programs.

A great number of the hospitals and education academies throughout the U.S. were built with money raised by nuns. Yet they were always at the mercy of the bishops. In 1871, Mother Theodore Guerin, the French founder of the Sisters of Providence, was excommunicated by Hal Italiandiere, the local bishop, for refusing to hand over the deed to Saint Mary-of-the-Woods women’s college in Indiana. She appealed to Queen Amelie of France, the bishop was replaced, and she was reinstated.

In 1864, Bishop James Duggan of Chicago, whose sister Mary Jane was a Mercy nun, decided to take over Mercy Hospital and gave the Sisters two days to evacuate their patients. Led by Mother Frances Monhalland, the nuns moved 100 sick and dying people to St. Agatha’s Academy, which would become the core of the new hospital.

As it turned out, the bishop’s hospital burned down in the Chicago Fire of 1872 and the new Mercy Hospital was much needed. By that time Bishop Duggan had been institutionalized as mentally incompetent.

In the years following the Civil War, nuns established 800 hospitals, the basis for a network of Catholic hospitals that now serves one in six patients, the largest private group in the U.S.

Cupping and Bloodletting

This painful procedure was performed during the Civil War on Sarah Morgan, a wealthy refugee from Baton Rouge after a wagon accident left her unable to walk. She described the experience in her journal, which has recently been published as “The Civil War Diary of a Southern Woman,” as follows:

“I was interrupted yesterday morning by Mrs Badger who wished to apply a few dry cups to my back, to which I quietly submitted, and was unable to move afterwards with[out] pain, as a reward for my patience.”

When the doctor visited her later, she wrote of the pain she experienced, the large amount of blood lost and the reactions of her sister and friends during another cupping procedure. "two dozen shining, cutting teeth were buried in my flesh....Then came the great cups over the cuts that I thought loosened the roots of my teeth with their tremendous suction power, and which I dare say pulled my hair in at least a foot."

By the end of the Civil War, cupping was no longer such an accepted practice in the medical community.  However, it was recently brought to my attention that cupping has become somewhat fashionable recently. Celebrities are touting the health benefits of cupping, and are happily displaying the marks left from these treatments.

It appears that the celebrities don’t have quite the same experience with cupping as poor Sarah Morgan.  However, I strongly suspect that the health “benefits” gained are the same in both cases!

Collector of Nursing Artifacts Featured At National Gallery

By Bryan Shupe

Physician Liaison and Registered Nurse at Bayhealth Medical Center Chris Foard has been a collector of historical artifacts for over a decade, focusing his searches on the American Civil War and the evolution of the medical field in the United States. With over 3,000 pieces in his personal collection, Foard currently has four pieces of history from that collection featured in the National Gallery of Art, located on the National Mall in Washington DC.

A veteran of the United States Army, Foard served his country for four years and received an education as a civil engineer in the service. After working for an engineering firm in Wilmington, Delaware for several years, Chris decided to change his profession to a not only growing industry but an occupation that has been an tradition among the Foards. As he decided to go into the nursing field, he joined a total of fourteen nurses in his family.

Joining his passion of nursing and collecting historical artifacts together, Chris began his large collection of civil war nursing uniforms, photos, literature and instruments. Donating his unique pieces to several historical institutions including the Museum of Civil War Medicine, Clara Barton National Historic Site and Carlyle House Historical Park, Foard is very excited about his historical artifacts that are on display currently at the National Gallery.

“I have always been intrigued with early nursing, commented Foard. “It is so interesting to see the instruments they used and the procedures they followed. Educating the public and sharing my collection is a big part of what I am about.”

Among the four piece of history Chris is displaying as part of an exhibit on the 54th Massachuettes Regiment, one of the first African American regiments during the Civil War, is a photograph of Clara Barton, founder of the American Red Cross and one of the most well know humanitarian in United States history. The photograph is signed by Barton herself and according to Foard is only one of two in existence. Another piece on display is a book written by Susie Taylor, the only African American to publish a memoir of her experiences during the Civil War.

“So many people do not know the history of our country and how far the medical field has come,” commented Chris. “It is also interesting to see some of the same practices still used in modern day nursing such as infection control, prioritizing care and compassion for patients. Nurses today can learn a lot from these nurses and their ability to give the therapeutic touch to their patients by showing compassion and just being there for the patients.”

A larger part of Foard’s collection can be viewed locally on display at the Milford Museum in downtown Milford, which he donated to the organization in 2010. This collection includes records and equipment from the Milford Memorial Hospital School of Nursing , which originally came from Mrs. Amelia Donovan McSweeny who graduated from the school in 1934.

In addition to viewing the collection at the Milford Museum, Mr. Foard encourages individuals to check out the National Gallery exhibit, The 54th Massachusetts Regiment and Augustus Saint-Gaudens’ Shaw Memorial, in Washington DC.

“The National Gallery is so close to us and has so many interesting exhibits on our history. You do not have to be a nurse or in the medical field to enjoy the exhibit on the 54th Regiment,” commented Foard. “Learning about our own history is very interesting and exciting.” Individuals can find more out about the exhibit on theThe 54th Massachusetts Regiment by visiting the National Gallery online at

The Cost of Civil War Provisions


In all places and periods, supply and demand dictate market prices. Retail food price comparisons between the North and South during the Civil War are complicated because they had different money and inflation rates at different points during the War. Context is key.

Most of the American Civil War was fought on Southern soil. Historians confirm Union forces specifically targeted Confederate food supply to gain physical advantage. Transportation blockades (railroads, rivers, ports), supply reallocation (commandeering forts and merchants inventory) and farm destruction (pillage, burning) proved effective. Food was scarce; prices rose. Northern food prices reflected lack Southern produce but most folks above the Mason Dixon line were not starving. And, of course, seasonal availability was still a consideration. Enter: bartering.

About food supply in the South
"The Confederate-controlled Fort Henry and Fort Donelson protected major agricultural areas in Western Tennessee and well as crucial railroads and rivers on which provisions were transported withing the Confederacy...Fort Henry fell to Union naval forces, and the Union army proceeded overland to take Fort Donelson. Despite its strategic location, the garrison at Fort Donelson ran out of provisions...The effects of these losses were felt as far east as Macon, Georgia, where beef prices went from ten to twenty cents a pound in a few days...The scarcity of provisions for the arm and the price for food in the marketplace caused concern throughout the South." ---Starving the South: How the North Won the Civil War, Andrew F. Smith [St. Martin's Press:New York] 2011 (p. 32-33)

"When food became unaffordable for many Southerns, the Confederate government stepped in and tried to place price controls on various commodities in the hope of keeping prices down. However, farmers hoarded staples rather than sell them at the artificially lower prices, resulting in less food on the open market. Price controls were discontinued, but inflation then ran rampant." ---ibid (p. 41)

"[In Richmond VA] By February 1863 the price of flour had more than doubled. Bacon, which cost $1.25 per pound in 1860, sold for $10, while the price of sugar increased more than fifteen-fold and coffee cost forty times what it had previously...Rapidly escalating prices encouraged hoarding and speculation, which drove prices up even more. Since the salaries of soldiers, government workers, and factory laborers were fixed--or at least did not rise quickly enough to cover inflation--food became unaffordable." ---ibid (p. 53)

"[In Atlanta, 1864] food prices...escalated--a pound of butter cost $15, a bushel of potaotes sold for $24, a barrel of flour went for $250, and one hundred pounds of bacon cost $500." ---ibid 9p. 168)

"Even before the sieve of Vicksburg commenced, food was a problem in the city. Confederate soldiers engaged in 'the customary pilfering--fruits, vegetables, chickens, and livestock disappeared; troops drained the sity of supplies, created shortages, and sent prices soaring. Food became scarce. Butter sold for $1.50 a pound, and flour was virtually unavailable...Although food was plentiful outside Vicksburg...plantation owners were often unwilling to sell food to the military authorities, simply because farmers could get better prices on the open market. Well before the arrival of the Federal army, Vicksburg residents had to drive into the countryside to purchase salt for $45 a bag and turkeys at $50 each, which were unavailable in the city."
---ibid(p. 99-100)

Prices in the Macon [Georgia] market.--The prices for all leading articles are considerably lower than in any other city, as is conclusiveley demonstrated by the fact that our merchants are daily shipping goods to all the principal cities in this and adjoining States. Retail country dealers have therefore only to choose whether they will pay the prices demanded by our merchants and thus keep the good share, or let them be sold to other points. Our merchants, so far, have not ran the prices up to correspond with other cities, and prices have only advanced with the heavy demand. For instance, the single article of Lard Oil is quote in New Orleans at from 2.50-3.00 per gallon; it is quoted in our market at from 2.75-3.00 per gallon.

Bacon.--The market has been stationary. Clear sides held firm at 2-3 cents. Hams 24 to 26 cents and Shoulders 24-25 cents. The stock on hand is nearly exhausted. Canvasses and country ham, 28-30 cents.
Lard.--Stock exhausted. Selling at 25 cents
Flour. Advancing. Superfine, 3.50-3.75, Family, 4.00. Stock light
Corn meal. Good demand at 1.00-1.05
Coffee.--Very light stock. Rio, 40-45 cents. Laguria, 45-50 cents. Java, 45-50 cents.
Rice. Very good stock. Sells from 3.5-4.5 cents
Sugars.--New Orleans, 9.5-13.5 cents. The stock of A, B, and C Refined Coffee Sugars have become exhausted. Crushed and Powdered, 25 cents.
Molasses.--Declined 5 cents per gallon. Cuba 50-55 cents. Golden Syrup, 80 cents-1.00. New Orleans Syrup, 50 cents.
Soda.--Super Carbonate, 25 cents. Considerable advance. Salt.--7.50-8.00. This article is rapidly advancing.
Wheat-In good demand at 1.25
Corn.--New corn is selling at 75 cents
Oats.--But few in market quoted at 60-65 cents shelled
barley.--Barley brings 1.50/bushel
Peas.--In great demand. A large quantity can be disposed of at from 85-90 cents.
---SOURCE: Macon [Daily] Telegraph, Macon Georgia, October 31, 1861


By Lori Eggleston

Cupping is an ancient practice which was very popular during the period of “Heroic Medicine” prior to the Civil War.  Though cupping was beginning to wane in popularity at the start of the war, it was still practiced.

Cupping involves heating small cups, usually made of glass, and then placing them on the skin.  As the cup cools, a vacuum is created inside and the skin is drawn up inside the cup to form a raised blister.  In dry cupping, the cup would be left on the skin for several minutes.  This was thought to promote better blood flow to the area where the cups were applied.  In wet cupping, small cuts would be made in the skin so that the cups would also draw out blood from the area.  Bleeding was thought to reduce the “bad humors” in the body.

Pyemia ("Pus in the Blood"); ("Blood infection")

by Janet King, RN, BSN, CCRN.

This disease affected some 2,818 men - killing all but 71 of them! Often the soldier would seem to be recovering well. Suddenly his fever would go up, he would exhibit symptoms of dehydration, his wound would draining a "watery, thin and foul smelling fluid," and the sutured area would separate. Death generally followed in a few days. Doctors were beginning to regard this "disease" as a "contagion arising spontaneously in any putrefaction of wound products." They were also beginning to believe that it could be spread by the surgeons hands and recommended greater cleanliness in surgery.

1860's Treatments:Tonics, stimulants, dilute sulfuric acid, quinine, iron, opium and liquor.

Modern Knowledge:Today doctors categorize pyemia more precisely based on where the infection is. If bacteria is found in the blood, the term septicemia is used. The first goal is to determine the causative organism i.e. streptococcus or staphylococcus and a host of other potential bacteria. The second goal is to find the best antibiotic for the job, both of which are done by culturing blood samples. Fluids and special drugs are given to combat the shock-like effects of this widespread bacterial infection. Comfort measures and cooling measures i.e. Tylenol for temperature would also be utilized. If caught quickly this infection can be eliminated, but in some cases the patient still succumbs.


Sunday, February 16, 2014

Gross Medicine: Maggots, Leeches and Dirt

Hundreds Of Years Ago, Maggots, Leeches, And Dirt Were “Medicine Cabinet” Staples. Now Old Is New Again: Ready To Try Them?

By Maia Weinstock and Mark Bregman | October 19 , 1991

You're lying in the emergency room, in agonizing pain from an open gash on your leg. You crashed your bike weeks ago, but the wound has gotten worse — black, festering, and foul-smelling. Now you have acute gangrene — "flesh-eating" microscopic bacteria are feeding on your live tissue. What would it take to destroy the bacteria causing your leg to rot?

Well, how do maggots sound? That's your doctor's recommendation: unleash dozens of tiny worm-like fly larvae to feast on your leg. Is this a putrid nightmare? Have you become the star of yet another sequel — Halloween: When the Bugs Bite ???

It may curdle your blood, but science is re-examining a host of "folk" remedies to heal all kinds of wounds and diseases. They include maggots, leeches (a type of segmented worm), and even geophagy or dirt-eating.

Alternative folk cures were standard medical fare for centuries. But late-19th-century advances like the sepsis theory — keeping wounds and instruments free from germs promotes healing — and 20th-century drugs called antibiotics, helped banish folk remedies from modern hospitals.

Now, recent studies suggest some old remedies may do the trick as well as, or better than, some techniques that replaced them. "We no longer think of antibiotics as the cure-all for every infection," says Dr. Ronald Sherman, at the University of California at Irvine.

"Almost by chance we're relearning that nature's medicines — often called 'gross' — are sometimes the best," adds Michele Root-Bernstein, author of Honey, Mud, Maggots and Other Medical Marvels (Houghton Mifflin, 1997). Maggot and leech therapies are a growing trend, says Root Bernstein, though you probably won't find them in your local doctor's office. "Doctors are likely to turn to maggots and leeches only when nothing else works," she says.

Today, as in the past, maggots are used to eat dead tissue, thereby cleaning open wounds. During the Civil War and again in World War I, battlefield physicians saw that soldiers' wounds infested with maggots tended to heal better than non-infested wounds. Soon maggot therapy was born.

On the other hand, leeches were put to the test in a practice called phlebotomy, or bloodletting, a remedy once as popular as today's aspirin. A leech's bite was only one tactic used to drain human blood — knives, sharp stones, teeth, and thorns also proved popular. Though they didn't know why at the time, doctors found bloodletting reduced severe fever. A doctor might use leeches to drain ounces or pints of blood — in extreme cases, up to 1/5 of a person's total blood supply! Today, leeches are making a comeback in reconstructive surgery when, for example, surgeons reattach a severed finger.

Maggot therapy
Today, more than 200 hospitals in the U.S. and Europe have prescribed maggots to treat patients with infections from injuries like pressure ulcers ("bed sores"), leg and foot ulcers, stab wounds, and post-surgical wounds that won't heal. In fact, about 5,000 laboratory grown and disinfected (microorganism-free) maggots are delivered to hospitals across the U.S. every week!

"It's faster than any non-surgical method for wound-healing and not as likely to injure healthy tissue," says Dr. Sherman. He grows the larvae in his Irvine laboratory and ships batches to hospitals around the world. The flies that lay maggot eggs are force-fed on Gainers Fuel 100, a body-building supplement. Sherman puts up to 20,000 maggot eggs in a single vial, and after hatching, feeds them sterilized meat. The larvae are then placed in special bandages which hold the maggots in after they are applied to a human wound.

Here's an example of when and how maggot therapy works: Open, untreated wounds can become infected and gangrenous if left untreated. Gangrene is the death of human cells or tissues caused by a blockage of blood supply to a wound. If gangrenous tissue isn't removed, the affected limb eventually begins to rot. And if bloodless tissue should become infected by poisonous bacteria such as clostridium, results can be fatal.

Maggots are immature blowflies (a type of fly) in their second or larval stage of life. Young blowfly maggots are implanted directly onto a wound, where they eat dead flesh, clean out dead skin, and kill harmful bacteria that need injured tissue to survive. Once maggots reach their fill of dead and dying flesh, they're removed from the wound and new maggots are applied. Blood can then flow throughout the tissue, promoting the growth of new flesh.

Are patients totally grossed out by maggot therapy? "I've never had anyone freak out — not even those who are initially extremely reluctant," says Dr. Jane Petro, a plastic surgeon at Westchester County Medical Center in Valhalla, New York. Maybe someone should conduct a study on how her patients got such strong stomachs!

Leeches: out on a limb
Maggots may not be the only healing creepy critters to have earned a foul rap. For 2,500 years, doctors have used blood-sucking leeches for bloodletting. A leech can gorge itself with up to five times its body weight in blood!
In 1994, a woman's scalp was ripped off when her hair was yanked into moving machinery. Doctors performing micro-surgery at the University of Southern California reattached the scalp, but one area swelled with congested blood. They applied leeches, one at a time for eight days, to suck up stagnant blood. Eventually new capillaries, or tiny blood vessels, formed in the scalp wound, leading to healing circulation.

Is something repulsive going on? All leeches have two suckers — one on each end of its body — and the mouth end has hundreds of teeth. When applied to an injury or reattached limb, leeches dig their teeth right into the flesh and start sucking. Surprisingly, the bite doesn't seem to hurt. That's because leech saliva contains a natural anesthetic, or pain-killer.

Leech saliva is also full of other important curative chemicals. One is called hirudin, which keeps blood from clotting. Scientists have devised a method to genetically engineer hirudin, which they hope to prescribe as an alternative treatment for unclogging blood vessels during heart surgery.

Another leech benefit is an agent that prevents bacteria from infecting the wound area. And a third is a vasodilator, which causes human blood vessels to open. "Leeches are like a mini-drugstore, because of the 'cocktail' of chemicals within their systems," says Anna Baldwin at the Biopharm Leech Center in Charleston, South Carolina. The potent leech cocktail seems to promote the circulation of blood critical to healing a wound. By the way, when a leech has finished sucking your blood, it simply falls off. How comforting!

Will such creepy folk remedies become part of the future's mainstream medicine? Would you let a doctor apply slimy maggots or leeches to your body? If you love gross-outs, your prayers have been answered.


The Confederate Cavalry and the "Great Glanders Epizootic"


Horses and mules were essential to the operation of the Civil War, and vast numbers of animals were needed. Lynchburg, one of the four quartermaster depots for the Confederacy, was supplying General Robert E. Lee's Army of Northern Virginia. In 1863, following the Battle of Brandy Station, the Confederate Army ended its practice of private ownership of cavalry mounts and began to supply the necessary horses. Thousands of horses and mules were quartered in Lynchburg, in the Quartermaster's stables at the "fairgrounds," which included the present-day E.C. Glass High School campus.

Over a 15 month period, of the 6875 horses stabled there, only 1000 were sent into the field. Almost 3000 died, 449 were shot, and the rest were unfit for service.

The "great glanders epizootic," or epidemic, was taking a tremendous toll.

The Research
Drs. John Jay Terrell and John R. Page, two of the physicians attending the wounded and sick in Lynchburg's many hospitals, were designated by Major James G. Paxton, Quartermaster in Charge, to do research on the respiratory disease glanders. The "baneful scourge," glanders, was ravaging the horses and mules and affected humans as well. The research was done in a quarantined horse stable, located behind the Pest House, on what is now Cemetery property. The Pest House was a quarantine hospital for smallpox and other contagious human diseases.

In what was considered a landmark study of early pathological experimentation, Drs. Terrell and Page studied 19 horses stricken with glanders, conducting postmortem examinations at various stages of the disease's progression. They also were able to transmit the disease intentionally from a diseased horse to a sound one, sacrificing the animal 33 days later to study its advanced and terminal symptoms. The researchers' results and recommendations were published in 1864 in a pamphlet, Glanders and Farcy in Horses, which was distributed by the Confederate authorities to all of its facilities for quartering horses and mules.

The Result
It was concluded that this glanders disease, which caused major respiratory distress and death, was caused by "a virus" and was spread at watering troughs and in unhealthy crowded stable conditions where animals were prone to nuzzle. Infected mucous was easily passed from one animal to another. There was no cure. Prevention of the disease was the only solution to controlling the epidemic. This was achieved by housing horses and mules in uncrowded, well-ventilated stables, introducing good sanitation and a healthy diet, and by destroying the infected animals.

Horses use the nose and the sense of smell to identify and to communicate with one another. Thus the nose played host to a sense vital in their daily lives and can likewise serve as a host to such a deadly virus. Therefore, the doctors strongly recommended that the animals not use communal watering troughs.

When the Civil War ended, so did the need to quarter such large numbers of horses and mules together. Glanders was no longer an epidemic. The historic first steps in veterinary medicine, so similar to Dr. Terrell's innovations in the treatment of smallpox in the Pest House, attest to a local medical legacy of great importance.

© 2003–2011 by Southern Memorial Association

"The Widow of the South" by Robert Hicks: A Tale of Carrie McGavock

Book Review By Teresa Wasson, The Associated Press

FRANKLIN, Tenn. -- The story of Carrie McGavock was too good to be left untold but too incomplete to be told as history.

When music publisher Robert Hicks couldn't find a professional writer to tell what he considered the intriguing story of plantation mistress Carrie McGavock, he wrote the book himself, titling it "The Widow of the South."

McGavock was the mistress of a Southern plantation when the Civil War arrived at her door Nov. 30, 1864. The Battle of Franklin turned her mansion, Carnton, into a Confederate field hospital and McGavock into a nurse to thousands of injured soldiers lying, moaning and dying on the floors and grounds.

When farming threatened to unearth the Battle of Franklin's dead from shallow graves in 1866, McGavock and her husband, John, reburied 1,481 Confederate soldiers at Carnton. McGavock tended the backyard cemetery with a passion, visiting it each day and cleaning the graves of even the smallest twigs. She soon became known as "The Widow of the South."

Robert Hicks fell in love with McGavock's story while a volunteer board member for the historical site now at Carnton, and he tried to persuade professional writers to take on the book. But he couldn't find anyone who had his thirst to tell it right.

So he put aside a career in country-music publishing to share McGavock's story in his new best-selling novel, "The Widow of the South."

Hicks, who has cherished Carnton as fiercely as McGavock, centered his book on a fictional relationship between McGavock and a wounded Confederate sergeant named Zacariah Cashwell because he knew little about the plantation mistress. He says that he didn't intentionally change McGavock's story, but at times he just didn't have all the facts to fully tell it.

"Every fact I know about Carrie McGavock could fit in a small booklet," he says.

So Hicks filled out the tale with a love story.

"If I wanted to do this, it needed to be fiction," he says. "I needed to put meat and flesh onto the bones of the facts."

Warner Books bought the novel after seeing only the first third of it. The publisher is strongly backing the book, which went on sale Aug. 30, with a first printing of 250,000 copies and an extended book tour. It quickly hit the top 10 on the Publishers Weekly list of best sellers.

Warner calculates that the Civil War reality in the book will hook some history buffs, but for editor Amy Einhorn, it resonates more fully as a piece of fiction. "This is an amazing epic love story," she said.

Agent Jeff Kleinman said the book presented a strong three-part package for the publisher: First, Hicks crafts an authenticity of Carnton that is comparable to that of Savannah, Ga., in John Berendt's nonfictional "Midnight in the Garden of Good and Evil"; second, there's good writing; and third, the 54-year-old author makes an eloquent front man.

Hicks is a vivid storyteller who heard tales about the Civil War from his father, who heard them from his father, but he's not a sage of the Civil War in the patrician style of historian Shelby Foote. Hicks is more laid-back, a man as comfortable with his shaved head and goatee as he is wearing dark-framed glasses and layered shirts.

He lives in an 18th-century log house a few miles west of Carnton, just south of Nashville. His home is filled with period antiques typical of a Southern plantation such as Carnton, but is dominated by an esteemed collection of primitive art, including paintings by outsider artist Howard Finster and three-dimensional slave pottery known as face jugs.

Hicks eases his large frame into a side chair in his living room, and quickly rattles off facts. He recalls a wounded soldier's account of his care by McGavock and often ends his answers by asking, "Does that make sense?"

Hicks grew up in the South, spending his childhood summers at the family home in Hicksville, an eponymous community now swallowed up by Jackson in western Tennessee. But his planter-class family, which helped found GM&O Railroad, spent winters among the wealthy in South Florida.

Hicks liked books but wasn't influenced by classic literary Civil War books such as "The Killer Angels" or "Shiloh," which he never read. He didn't put Foote's seminal three-volume history of the Civil War into his extensive personal library until he began doing research for "The Widow of the South." He had to bone up on the facts of the Battle of Franklin to ensure accuracy but was confident in building a story for his heroine.

"This is a book that has real heart. Robert is a guy who poured his heart out on every page," Kleinman says.

The book shifts viewpoints among the McGavocks, Cashwell, a slave named Mariah Reddick and several minor characters. The lovers speak in first person while others, notably John McGavock, are presented in third-person narrative form.

"I don't know John," Hicks says. "I could read things about him all day, but I couldn't quite get my hands on him. Because I couldn't figure out who he was is kind of why Zacariah came on the scene. I wanted someone who could kind of lead her to self-discovery."

The book structure was shaped by his appreciation of William Faulkner, an archetype of Southern fiction, and the love themes in Boris Pasternak's "Dr. Zhivago" and other Russian novels.

"What a good Russian novel does is, you see these people tossed and turned by events of their lives," Hicks says. "The difference is I didn't want Cashwell to miss Carrie. I wanted him to come back -- as opposed to Lara and Zhivago."

So at the end of their lives, Hicks reunites his lovers.

Fictionalizing McGavock into a near-adulterer doesn't bother her descendants. They came to appreciate Hicks for spearheading improved scholarly research and a renovation at the family's former mansion. Two of McGavock's great-great-grandsons hosted a book launch party for several hundred guests at Carnton when "The Widow of the South" came out last month.

"We recognize for the novel to be a success, it has to have many fictional elements," said Roderick Heller, an attorney in Washington, D.C.

His brother, Hanes Heller, appreciated seeing an ancestor he'd always known as a dour widow as a younger, more vibrant woman. "Robert made a real woman out of Carrie," he said.

Prisoners of War

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

For the most part, soldiers who were taken prisoner by both sides were relatively well treated. This was the Victorian era, after all, and chivalry still had its place during wartime. More importantly, however, the soldiers of the North and South weren't fighting some unknown, foreign enemy; they were fighting people who spoke their language and had been their own countrymen. To abuse another American — even a rebellious one — wasn't in the nature of most men, though there were exceptions. In addition, every soldier knew there was a strong possibility he could be taken prisoner, so it behooved all to act with kindness toward captured enemy forces — today it was them; tomorrow it could be you.

Paroles and Exchanges
At the beginning of the war, captured soldiers were expected to “give parole,” or promise not to escape. Paroled soldiers could expect to be sent back to their own lines under a flag of truce, at which time they would be sent home until an exchange was effected. Union and Confederate military officials reached an agreement in 1862 that stipulated that all prisoners were to be exchanged within ten days of capture. The fact that promises were made and kept demonstrates the gentlemanly nature of the Civil War during its first years — a man's word was his honor. However, if a soldier broke his promise by returning to the field unexchanged, he ran the risk of being shot or hanged.

The value of a prisoner depended on his rank. A general was worth up to sixty privates; a major general was worth up to forty privates. At the bottom end, a noncommissioned officer was worth two privates, and privates were traded one for one. Approximately 200,000 soldiers from both sides were freed through prisoner exchanges.

In 1864, the Union ceased prisoner exchanges altogether in an attempt to bring the Confederacy down by attrition. Union officials finally realized that every Confederate soldier in a POW camp was one less rifle aimed at Union soldiers. The policy had a devastating effect on the South, where manpower shortages were rampant. Unfortunately, many POWs also suffered greatly as a result of the no-exchange policy.

The conditions at POW camps varied greatly. At the beginning of the war, when prisoner exchanges helped keep prisons relatively empty, conditions were fairly good on both sides. Prisoners were usually well treated, well fed, and adequately clothed. This remained true for most prisons in the North throughout the war, but the conditions of POW camps in the South deteriorated greatly as the Confederacy gradually found itself unable to feed and clothe even its own citizens and soldiers. Most prison officials did their best to maintain humane conditions, but they had less and less to work with during the final year of the war.

Northern POW Camp Conditions
The North had its share of less-than-ideal facilities. Point Lookout in Maryland, for example, was designed to house 10,000 men in tents, but it often contained 20,000 or more. Fort Jefferson in the Dry Tortugas, off the Florida Keys, was another prison known for its brutal conditions. An old fort converted into a military prison in 1861, Fort Jefferson housed Union army criminals. The tropical climate at Fort Jefferson was stifling, and the work conditions unmerciful. Worse, unsanitary conditions promoted the spread of disease among the prison population, killing many.

Probably the worst Union POW camp was located in the town of Elmira, New York. More than 2,960 Confederate soldiers died there — almost a quarter of the prison population. According to government records, the death rate at Elmira was only slightly less than that of Andersonville, and it was more than double that of other Union prisons. The most common cause of death was disease exacerbated by starvation and filthy living conditions. Many prisoners, denied warm clothing and even blankets, froze to death during the harsh winter months. Those who survived the camp referred to it as “Hellmira.” It remains an indelible black mark on the conduct of the Union army.

No prisoner of war camp was more reviled than the Confederate prison constructed near the village of Andersonville in Sumter County, Georgia. Its name has become synonymous with barbarism and ill treatment.

Andersonville, officially known as Camp Sumter, was opened in February 1864 after the high number of Northern prisoners started taking a heavy toll on the food supplies in Richmond, where prisoners had previously been housed. When the first prisoners arrived at the new camp, they were greeted by sixteen acres of open land surrounded by a fifteen-foot-tall stock-ade. Originally designed to house 10,000 men, the facility soon contained more than three times that number and was expanded to twenty-six acres. Nearly 400 new prisoners arrived each day, straining the prison's meager resources to the breaking point.

Almost from the start, rations were scarce and of poor quality, and few prisoners had adequate shelter from the summer sun and the winter cold. The only fresh water came from Stockade Creek, a small stream that flowed through the prison yard. Waste was often dumped into the water, and downstream it was used as a latrine for all prisoners. The entire region was soon contaminated, but prisoners continued to drink from it. Health care was nonexistent.

The first commander of Andersonville was John Henry Winder, who oversaw all Confederate prisons. Winder died from exhaustion in February 1865 and was succeeded by Henry Wirz, a Swiss-born Confederate officer known for his hatred of the Union. According to reports, Wirz did little to alleviate the suffering of his inmates, and the prison's increasingly poor conditions took a heavy toll — approximately 13,000 prisoners died there, a mortality rate of about 29 percent.

At the end of the war, Henry Wirz became the only Confederate officer to be tried and convicted for war crimes. Numerous prisoners who suffered under his sadistic command testified against him, as did Clara Barton, who was outraged when she visited the prison site at the war's end to identify the dead and missing and see that they received a proper burial. Wirz was held accountable for the conditions at Andersonville, found guilty, and summarily executed. Wirz claimed he simply didn't have food, clothing, or medical supplies to give the prisoners and that his own staff suffered equally as the Confederacy began to crumble.

Acts of Kindness and Respect
In contrast to the brutality and horrifying conditions of some POW camps in the North and South are numerous reports of gallantry and kindness at others. For the most part, officers were especially well treated on both sides. They occasionally dined with the commanding officers of the camp and were often given new uniforms (minus their military buttons) when exchanged. In one example of unexpected chivalry, Union general Benjamin Butler, who was not particularly well known for his generosity, went to astounding lengths to find a special horse belonging to Confederate cavalry brigadier William H. F. Lee, the son of Robert E. Lee. The horse had been stolen during the younger Lee's capture in 1863.


Maggots: Friend or Foe?

by Janet King, RN, BSN, CCRN.

Surgeon C.S. Wood of the 66th NY Volunteers wrote of the problems his amputation patients had with flies and the maggots they produced in the hospital wards - "In 12 hours the wound is literally covered with maggots and in 24 hours the stump looks as though a swarm of bees had settled into it." Another surgeon recorded - "The maggot does damage in the wound, not by attacking living tissue, but by the annoyance created by the continued sensation of crawling."

The Union doctors and care givers tried their best to eradicate the flies through the use of netting and injections of chloroform onto the stumps of amputees. The Confederate doctors, while tending gangrene cases in a prison stockade at Chattanooga and denied such "luxuries" made a startling discovery. They found that the Confederate wounds healed quickly, while those of the "well cared for" Union troops (without maggots) became gangrenous or otherwise infected, and the Union soldiers died in great numbers. After this discovery the Confederate surgeons welcomed their new found "friends" - though the Yankee doctors never seemed to learn such a valuable lesson.

The reason the maggots worked was the fact that they eat dead or diseased tissue. They may have been awful to see and feel crawling about in a wound, but they got rid of the infection locally and left the remainder of the wound clean and healthy. Today maggots have been bred for special uses and perhaps they may once again be seen as our "friends."


About Treating Wounds in the Civil War

By Peggy Deland

The American Civil War had a tremendous death toll--nearly 620,000 soldiers died as a direct result of the war. Most of these soldiers died as a result of illness, rather than injury. Those who died of their injuries usually succumbed to infection, made far worse by the lack of cleanliness in camps. Although the care given to wounded soldiers was primitive by today's standards, the loss of life would have been much higher without treatment.

The Civil War lasted four years, from April 1861 through April 1865. This was long before the discovery of antibiotics, and medicine remained focused on balancing the body's "humors." Most doctors trained as apprentices under experienced physicians rather than attend medical school. Formal education for doctors was woefully inadequate, consisting of only one year of lectures before the students were sent out into the world as physicians and surgeons.

Wounded soldiers underwent triage to determine the extent of their injuries and in what order they would be treated. Gunshot wounds to the extremities were treated first, by amputating the affected limb. Surgeons often worked through the night, performing an amputation every 10 minutes. If there was time, minor injuries were treated by removing any foreign objects, packing with lint, and wrapping the wound in a wet bandage. Wounds to the head, neck, chest and abdomen were treated last, if at all. There was little that Civil War physicians could do for these patients, so most were given pain medication and left to die.

Although movies about the Civil War often depict amputations being performed without anesthesia, this was almost never the case. Chloroform was the most common anesthetic used; a rag soaked in the drug was held over the soldier's nose and mouth until he was unconscious. Injected morphine was used when chloroform was unavailable, and in the rare case that neither drug was available, soldiers were given copious amounts of liquor prior to treatment.

Infection was a near-universal complication of wounds treated during the Civil War. No attempts were made to maintain cleanliness, let alone sterility, by physicians of the time. Instruments and hands were not washed between procedures, and filthy rags were used as bandages. The appearance of pus draining from the wound was believed to be part of the healing process and was considered a good sign. Surprisingly, an estimated 75 percent of soldiers who underwent amputation during the Civil War survived.

Due to the sheer number of amputations that were performed during the Civil War, techniques improved significantly. Early in the war, most amputations were performed using the circular technique, in which the cut was made straight through the limb and then the blood flow staunched. The flap technique, in which skin is left attached to be sewn over the end of the stump, gained in popularity; by the end of the war it had nearly replaced circular amputation. The flap technique is still used today, in the rare cases where modern physicians must amputate a limb.


History of PTSD


Before PTSD was conceptualized in the United States, Swiss, German, French, and Spanish physicians identified the disorder. Bentley (2005) noted that the symptoms of PTSD were first named by Swiss military physicians in 1678. “‘Nostalgia’ was the term they used to define a condition characterized by melancholy, incessant thinking of home, disturbed sleep or insomnia, weakness, loss of appetite, anxiety, cardiac palpitations, stupor, and fever”. Around the same time, German doctors termed these symptoms “heimweh,” or “homesickness”. Later, French doctors termed the symptoms, “maladie du pays,” and the Spanish termed it, “estar roto,” or “to be broken”.

By the 1700s, physicians began to have clearer conceptualizations of the disorder which would eventually be known as PTSD. Dominique Jean Larrey, a prominent French surgeon, described the disorder as having three stages: 1) “heightened excitement and imagination,” 2) “period of fever and prominent gastrointestinal symptoms,” and 3) “frustration and depression”.

In the United States, Dorothea Dix advocated for the humane treatment of the mentally ill, and prompted the establishment of the Government Hospital for the Insane in Washington, D.C. in 1855 (U.S. National Library of Medicine, n.d.). Shortly thereafter, military physicians in the United States began documenting the occurrence of fears and stresses related to the military duties of Civil War soldiers. Jacob Mendez Da Costa, a cardiologist, described this constellation of symptoms as  “soldier’s heart,”or “irritable heart,” due to his observation that afflicted soldiers differed in their higher blood pressure and heart rate. His findings from a clinical study about irritable heart were published in 1871 (Da Costa.

The sharp increase in PTSD symptomology during the Civil War years has been attributed to the advent of modern warfare, the horrifying results of which left many soldiers with psychological wounds which physicians were unsure of how to treat (Bentley, 2005). Thus, the role of the Government Hospital for the Insane expanded during the war (D.C. Department of Mental Health, n.d.).

Unfortunately, soldiers who suffered from the PTSD during this time were often seen as weak for succumbing to what was seen as the precursor of the disorder– homesickness. In fact, Robert C. Wood, the assistant surgeon general in 1864, stated, “It is by lack of discipline, confidence, and respect that many a young soldier has become discouraged and made to feel the bitter pangs of homesickness, which is usually the precursor of more serious ailments”. That soldiers suffering from PTSD were merely weak or malingering remained in the American public sentiment for years to come (Bentley. Indeed, soldiers being treated at the Government Hospital for the Insane were ashamed of being treated there, and thus referred to it instead as “Saint Elizabeth’s Hospital” (U.S. National Library of Medicine, n.d.).

Yet elsewhere, the disorder was beginning to gain some legitimacy. By 1905, PTSD, then known as “battle shock,” was regarded as a legitimate medical condition by the Russian Army.

IMAGE: Inside St. Elizabeth's Hospital

Civil War Dressings

by Janet King, RN, BSN, CCRN.

After the wounds had been assessed by the surgeon, cleaned and surgery performed if needed, some type of dressing was applied. These dressings were meant to protect the wound against "contamination" but in reality, probably hurt more than helped.

Lint was a common dressing material. It was obtained from supposedly clean cloth. The lint was often applied wet, then covered with a piece of gauze muslin and held in place by an adhesive plaster. The dressing would then be kept wet as some felt it essential to keep the wound "clean and sweet." Neither the lint nor the water nor the caregiver's hands were sterile and many infections no doubt resulted from this. The "cool" water and ice that was often used in conjunction with these dressings no doubt had some soothing effect and would have decreased swelling to some extent - at least initially.

Poultices were sometimes used, especially when the surgeon felt there would be a value in "encouraging suppuration." Wounds were expected to produce pus. The doctors termed this "laudable pus."

Dressings were reused in some cases, greatly increasing the spread of infections. Doctors, nurses and other attendants, i.e. laundry workers, were sometimes infected as well by coming into contact with infected dressings and linens.

Changing dressings frequently in hospitals crowded with wounded soldiers proved impossible and this sad fact also greatly increased the infection rates of surgical cases, as well as leading to worsening of infections.


Civil War Bloodletting

By Glenna R. Schroeder-Lein

A patient suffering from an infectious illness characterized by a high fever, a rapid pulse, and delirium was considered to have an inflammation caused by congestion of the blood vessels and excited tissues. In the terminology of the time this was called a "sthenic" disease. The category included such illnesses as typhoid fever and pneumonia.

Doctors believed that the way to reduce the inflammation was by depleting the fluids. This could be done through bloodletting by cutting a vein or an artery or, less drastically, by using leeches to suck a smaller amount of blood. Bleeding was practiced infrequently by the time of the Civil War. Only four instances were recorded in "The Medical and Surgical History of the War of the Rebellion".

Depletion could also be achieved by the use of "counter-irritants". These substances and procedures were supposed to provide a sort of distraction for the body by drawing blood to the surface of the skin and thus relieving the inflammation. Cupping consisted of heating a glass or metal cup and placing it on the skin--for example, on the chest or back of a pneumonia patient. As the glass or metal cooled, it pulled the patient's skin into the cup, creating a painful irritation. Blistering could be achieved by mustard plasters, poultices, or specific substances applied to the part to be irritated.

Although counter-irritants did not cure any illnesses, they continued to be used into the twentieth century.

From: "The Encyclopedia of Civil War Medicine"

"Medicines for the Union Army: The United States Army Laboratories During the Civil War" by George Winston Smith

(Book Review)

It wasn't only combat that killed during the Civil War!

Among white Federalist troops alone, there were 1,213,685 cases of malaria, 139,638 cases of typhoid fever, 67,762 cases of measles, 61,202 cases of pneumonia, 73,382 cases of syphilis, and 109,202 cases of gonorrhea between May 1, 1861 and June 30, 1866. (Statistics for Negro troops covered less than three years of the Civil War period.)

Preventative medicine at the time had little more to offer than quinine and a few disinfectants. There was no real understanding of the germ theory of disease.

But "Medicines for the Union Army: The United States Army Laboratories During the Civil War" shows that in the evolution of the army's Medical Department from incompetence to general efficiency during this time, and in the vastly improved organization and supply system designed by William A. Hammond, Jonathan Letterman, the medical purveyors, and others working under the Surgeon General, there was evidence of a great achievement.

In "Medicines for the Union Army" you will come to understand the medical purveying system of the time and its problems, and you will witness the birth, growth, and remarkable achievements of the Federal government's pharmaceutical laboratories at Astoria, New York, and Philadelphia, Pennsylvania.

"Medicines for the Union Army" will inform and enlighten you about the these laboratories, including:

  • the funding and transportation obstacles faced at the Astoria lab
  • the processes by which raw materials became drugs ready for distribution
  • drug testing and inspection methods
  • the bottling of “medicinal whiskey” and wine at the labs
  • the people whose work laid the foundation for modern drug production and distribution methods
  • the contents of the medical supply cases (panniers) and wagons in use at the time . . . and much more!

"Medicines for the Union Army: The United States Army Laboratories During the Civil War" brings to light the groundbreaking achievements of unsung American heroes working to preserve life while the country was in bloody turmoil. No Civil War historian should be without this volume!


Dr. Jacob Mendes Da Costa and "Irritable Heart"


Jacob Mendes Da Costa’s research, writings, and teaching were influential in the development of internal medicine as a specialty. However, his greatest contribution to American medicine lay in his clinical instruction at various Philadelphia institutions. Born 7 February 1833 on the Island of St. Thomas in the West Indies, Jacob Mendes Da Costa received his early education in Dresden, Germany, before coming to Jefferson Medical College. A graduate of the class of 1852, Da Costa received postgraduate education in Europe - mainly Paris but also Vienna.

Upon his return from Europe, Da Costa began his practice in Philadelphia and his private teaching at the Moyamensing Dispensary (1853-1861). During the Civil War, Da Costa served as assistant surgeon in the U.S. Army and at Turner’s Lane Hospital, Philadelphia. Here, he undertook research on "irritable heart" (neurocirculatory asthenia) in soldiers, research that was of landmark importance in clinical medicine. After the Civil War, Da Costa continued his teaching at the Pennsylvania Hospital (1865-1900). He began at Jefferson Medical College as a lecturer on clinical medicine (1866-1872), then professor of theory and practice of medicine (1872-1891), and finally professor emeritus (1891-1900). While Da Costa retired in 1891, he continued his medical efforts as a consultant and supporter for medical education reform and served as a trustee of the University of Pennsylvania in 1899.

Of Da Costa’s writings, his most well known include his "Clinical lecture on spurious or "phantom" tumors of the abdomen," Philadelphia Medical Times (1871) and his monograph Medical Diagnosis (1864).  Medical Diagnosis went through nine editions during his lifetime and served as the first complete guide of its kind.

Jacob Mendes Da Costa died in Villanova, Pennsylvania on 11 September 1900.

Bloodletting (Venesection) During the Civil War

By Dr. Michael Echols

After reviewing an inventory list of medical supplies from a N.Y. military hospital at the end of the War, the presence of scarificators in the inventory lead to this investigation of evidence in the military literature of bloodletting being in use during the War.   From examination of the literature gathered from the Medical and Surgical History citations, venesection was indeed practiced during the Civil War, but was rapidly being abandoned as the War years progressed and knowledge of medicine and bleeding wounds increased.

In eighteenth- and nineteenth-century America, many symptoms of illness were believed to be caused by an excess of blood: the removal of some was therefore thought to alleviate the condition. There were two main methods of bloodletting: using leeches and venesection (i.e. cutting open a vein).  Bloodletting is achieved by fleams, scarificators, cupping glasses, leeches, and assorted instruments.

Venesection (or phlebotomy) was the technique of lancing open a vein to remove blood, which could be drained into a bowl. It could also be removed by suction using a bloodletting cup in which was burned a small amount of alcohol to create a vacuum.   Leeches are annelid worms that inhabit fresh water. They are injurious to animals and people from whom they suck blood. They attach themselves by means of their strong mouth adapted to sucking. The medicinal leech, Hirudo medicinalis, was employed on "bleeding" patients. It is still used for some medical purposes and is a source of the anticoagulant, hirudin.

If you search for 'bloodletting' in the Medical and Surgical History of the War of the Rebellion not that much shows up.  However if you search for 'venesection', then many citations pro and con as well as actual cases are found.

There is abundant evidence reported of the earlier use of bloodletting and bleeding in the History, but only two cases of actual "bloodletting".  The problem is with the term: bloodletting.  The term used by surgeons at the time was 'venesection', not the older term 'bloodletting'.  Most of the information is in defense or rebuke of the process, not the actually use nor which instruments were used unless reference was made to a specific procedure like cupping or leeches.

Examples in the defense of bloodletting or venesection is found thorough out the various medical reports, much of which is from pre-War literature.  Of note is the adamant advice from the Confederate medical leaders that bloodletting should be avoided for various treatments.

The bottom-line is bloodletting or venesection was practiced through out the Civil War, because when the War started, bleeding was an accepted practice in the medical community.  As the war progressed, evidence based treatment was leaning against the use of bleeding for various medical or surgical problems as reported in the Medical and Surgical History.

Edited from the medical text book Handbook of Surgical Operations, 1863, (in this collection)  written during the Civil War by Stephen Smith, M.D.:

BLOODLETTING: The abstraction of blood is divided into general and local bleeding.

General Bleeding.—In general bleeding, blood may be drawn from the veins, when the operation is called venesection; or from the arteries, when it is known as arteriotomy.

Lancets differ as to their points; some are very blunt, others are very acute- the more obtuse are generally used when the vessel is superficial, and the more acute when it is deeply seated.

Venesection.—Blood may be taken from any of the superficial veins, but those of the neck, the bend of the arm, and at the ankle, are generally selected. The patient may be seated or recumbent, but in general the position should be chosen which most enlarges the vessels. The operation should commence by stopping the flow of blood to the heart by a ligature applied around the part on the proximal side of the point selected for the operation, sufficiently firm to close the veins and still leave the arteries unobstructed. The veins now become prominent unless the person is very fleshy, when the position of the vein must be determined by its corded feel. The operation is performed by placing the thumb of the left hand firmly on the vein (Fig. 40), a little to the distal side, to prevent the vessel from rolling aside on the attempt to puncture it. The lancet, held-between the thumb and index finger of the right hand, the blade at an obtuse angle with the hand, is plunged into the vein obliquely to its transverse diameter, and the hand being fixed, the point of the lancet is elevated so as to cut its way out.

The success of the operation is determined by the flow; if this should be slight, it may be due to too small an orifice, which should then be enlarged; or to a mass of protruding fat, which may be pushed aside. If an increased flow is required the patient should be directed to grasp repeatedly the staff, or the operator may rub the limb from the wrist towards the elbow.

When the proper amount of blood is drawn the band should be removed, and a small compress being placed over the wound, a figure-of-eight bandage is applied;. to prevent air entering the circulation in bleeding from the jugular, pressure on the wound should be made before the compress is removed.

Venesection is generally performed either on the external jugular, the median basilic or cephalic, or the internal saphena.

External Jugular.—A compress is placed over the vein in the supra-clavicular fossa, and firmly retained by a bandage passed over it and under the opposite axilla; the index finger of the left hand is placed upon the vein above, and the incision is made upwards and outwards across the platysma myoides.

Median Basilic and Cephalic.—The cephalic vein may be selected on account of its isolation. The basilic is the largest, but the brachial artery passing directly under it is in danger of being wounded. The position of the artery must first be determined. A band is then passed firmly around the arm, above the elbow, and with his band the patient grasps a staff. The operator, standing in front of the patient, grasps the arm with the left hand, placing the thumb on the distended vein, and the fingers on the back of the elbow, and holding the lancet in the right, opens the vessel.

Internal Saphena.—The foot is first placed in a vessel of warm water to distend the veins; a band is then passed around the leg, just above the malleoli; the thumb being placed on the vein it is opened just above the inner ankle, with an oblique incision.

Arteriotomy.—The temporal artery is that on which this operation is practised. It may be opened just over the zygoma, in front of the tragus, before its division into the anterior .and posterior branches, but the anterior branch is generally selected. The position of the artery is determined by its pulsations; the skin being made tense a straight incision is made with a scalpel, involving a part of the caliber of the vessel; when a sufficient amount of blood has been withdrawn the artery should be completely divided, and compression made on either side of the incision with small graduated compresses, firmly retained with a bandage.

Local Bleeding.—The local abstraction of blood is effected by leeching, cupping, scarification, and punctures.

Leeching.—Leeches should not be applied to parts liable to infiltration of blood, and discoloration, as the eyelids, scrotum, prepuce, or where a wound would disfigure, as their bites sometimes leave scars, nor over the track of a superficial vein. They are best applied by placing them in a small glass vessel, and inverting it over the inflamed part; blood, or sweetened milk, is often put on the skin. A single leech can take about an ounce of blood. When removed, the parts may be fomented to increase the flow; if it is desired to stop the blood the bites may be sprinkled with flour, starch, or other absorbent material; if the flow of blood continues astringents are used, of which the best is the persulphate of iron.

Cupping.—Cupping requires a scarificator and cupping-glass. The scarificator is an instrument containing eight or twelve blades, moved by a single spring, and so arranged as to be readily graduated as to the depth which they shall penetrate. They cover but the small space of an inch and a half or two inches square, and make eight, twelve, or more parallel cuts. The cupping-glass .may be simple tin or glass, of the proper size and shape, and applied by exhausting  air within by burning a few drops of alcohol; or it may have an exhausting pump attached to the top ; or, finally, it may have an india-rubber top, which requires only to be squeezed to produce a vacuum. The latter cups have but lately come into use, and are preferable to any other.

Scarification.—In making scarifications, the lancet, scalpel, or bistoury should be used, and the cuts should be made only partially or entirely through the skin, as may be necessary to promote the local abstraction of blood. The incisions should generally be made the entire length of the inflamed part, and within an inch of each other. The flow of blood may be greatly increased by warm fomentations.

Puncturing.—Punctures are made with a straight sharp-pointed bistoury, or a common lancet. The instrument is thrust into the inflamed tissues, to a depth varying from an eighth of an inch to an inch, carefully avoiding vessels and nerves. They should' be repeated until the entire surface is relieved of tension. Warm fomentations will increase the depleting effect.

IMAGE: Cupping & lancet instruments shown in the c.1867 Tiemann catalogue


Thursday, February 6, 2014

Civil War Pharmacy: A History of Drugs, Drug Supply and Provision, and Therapeutics for the Union and Confederacy by Michael Flannery

Review by Gregory Higby

In lieu of an abstract, here is a brief excerpt of the content:
As is often the case today, a work's subtitle tells the full story of its contents. While Michael Flannery gives attention to the traditional aspects of pharmacy—the making of medicines—he focuses on the drugs themselves and their use. Forty years ago, when George Winston Smith wrote Medicines for the Union Army, history of pharmacy, like the discipline it studied, was limited to the production and distribution of medicines. Today the field of pharmacy includes pharmacology, therapeutics, and drug utilization, an expansion reflected in Civil War Pharmacy. Flannery has written a valuable book for both buffs and historians. For the lover of Civil War lore, the text yields useful details and captivating stories. For the professional, the author provides a solid narrative, cogent interpretation, and good documentation. Not one to shy away from controversy, Flannery tackles a few "old chestnuts," including the court martial of Surgeon General Hammond and the debatable efficacy of Civil War therapeutics.

The narrative of Civil War Pharmacy is divided into three parts, followed by a set of exceptionally useful appendices that include the Union and Confederate standard supply tables for medicines, a long excerpt from The Hospital Steward's Manual, and the text of Hammond's famous Circular No. 6. In part 1, Flannery "sets the stage" with three chapters—one largely historiographic, another on the "State of Pharmacy in America, 1861," and a third examining women and Civil War pharmacy. Readers knowledgeable about Civil War medicine should resist the temptation to skip the first chapter, because mixed in with the expected references to Doctors in Blue and laudable pus is a solid argument for the importance of medicines in the conflict: because of the high rate of treated diseases—malaria, respiratory ailments, and digestive disorders—"the medical context for the Civil War . . . was not one principally of saws and sutures but of mortar and pestle" (p. 23).

In part 2, Flannery concentrates on pharmacy in the Union with chapters on purveyors, manufacturing, and therapeutics. This is the strongest section of the book. An entire chapter is devoted to calomel and quinine, two favorites of allopathic physicians of both armies. While the calomel story, wrapped up with the downfall of William Hammond, might be more sensational, Flannery's discussion of quinine as drug and commodity is enlightening. After this, part 3 on the Confederacy is a bit of a disappointment. Flannery bears little blame for this: Many of the records of the South were lost. More importantly, there was much less pharmacy in the South—almost no significant medicine manufacturing existed there before the war, and the Union's naval blockade hampered the importation of drugs. (The vast majority of botanical drugs came from abroad.) Instead, Flannery's story shifts from laboratories and tons of output in the North to the South's blockade runners and the valiant attempt of Southerners to find substitutes for foreign drugs.

Flannery concludes his book with a short epilogue arguing persuasively that the Civil War had sweeping influences on the development of the American pharmaceutical trade in the late 1800s. Forced by an incredible increase in demand, companies like Squibb, Wyeth, and Sharp and Dohme industrialized their operations—ending the era when the drug business was a cottage industry.

Because this is a work on the Civil War, its nearly inevitable popularity should elicit a second edition. If so, I encourage the author to consider the following suggestions: First, insist on better production values from your publisher: the uninteresting typography and murky photographic reproduction detract from the work; also, add a few maps showing laboratory locations and other sites of interest. Second, avoid "pharmaceutical care," a loaded term that carries a specific meaning for today's pharmacists that is not equivalent to "medical care." Third, carefully go over the quinine/cinchona sections: in some places, cinchona is called a derivative of quinine (pp. 99 and 131), while the opposite is true.

Until the second edition arrives, those interested in the American Civil War and nineteenth-century pharmacy will be well served by Flannery's first version.

From: Bulletin of the History of Medicine
Volume 80, Number 4, Winter 2006
pp. 774-775 | 10.1353/bhm.2006.0129


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