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.

Tuesday, February 24, 2015

The Plot to Kill Jeff Davis

By Ronald S. Coddington, 3-8-14

Samuel Kingston, a Union soldier and prisoner of war, languished in a dungeon on a late winter’s day in March 1864. The cell was in the basement of infamous Libby Prison in Richmond, Va., the capital of the Confederacy. A severe cough and cold racked his body. His cellmates were similarly affected. Ten in all, they were crammed into a dank, drafty cell not much larger than a common tent. Rebel guards provided Kingston and the others with nothing more than scraps of food for subsistence and an open bucket for a toilet. If some of the guards had had their way, the prisoners would be left to rot in the filth and cold of the converted brick warehouse.

Four of the cellmates were enlisted men of color, who were often abused, if not executed, by their Southern captors. But in the minds of the guards, the other six, including Kingston, had done something even more heinous: They were implicated in an alleged assassination attempt against the Confederate president, Jefferson Davis and members of his cabinet.

The mysterious plot to take out the senior leadership of the South was uncovered in papers found during a Union cavalry raid on Richmond. The stated purpose of the coup de main was to free federal troops held in Libby Prison and the nearby Belle Isle camp.

The raid began on the evening of Feb. 28, 1864. A column of handpicked troopers, 3,584 sabers strong, crossed the Rapidan River at Ely’s Ford, about 65 miles north of Richmond. A half-dozen artillery pieces and a few supply wagons and ambulances accompanied the cavalrymen.

The brain behind the audacious operation was a junior cavalry commander in the Army of the Potomac who worked back channels to sell the plan to the Lincoln administration. Hugh Judson Kilpatrick, a West Point-educated brigadier driven by reckless personal ambition, had a penchant for suicidal charges and pushing his troopers to exhaustion. “Kill Cavalry,” as he became known, had started his career as a horse soldier in the summer of 1861 when he was named lieutenant colonel of the Second New York Cavalry. An amalgamated regiment composed of recruits from New York, New Jersey, Connecticut and Indiana, six of the 10 companies hailed from the Empire State.

Kingston was a latecomer to the regiment. A meticulous bachelor who worked as physician in the bustling community of Oswego, N.Y., he joined the Second as an assistant surgeon in May 1863. He had his baptism to war during the seven-week-long Gettysburg Campaign, although the regiment did not fight in the eponymous three-day battle that broke an unprecedented streak of victories by Confederate Gen. Robert E. Lee and his Army of Northern Virginia.

Half a year later, Kingston mounted his horse and joined his comrades on Kilpatrick’s Raid. Word of the incursion arrived in lightly defended Richmond before the Yankees. The Confederate War Department mobilized an irregular force of soldiers, government workers and volunteers to resist the invaders.

On Feb. 29, during the first full day of the raid, Kilpatrick divided his troops into two columns. He rode hard with the main body of about 3,000 men south to Richmond, while a second, smaller column of 500 men headed to Goochland, northwest of the capital.

Kingston and the rest of the Second were part of the smaller column. It was under the command of Ulric Dahlgren, a 21-year-old colonel and son of a career Navy officer, John Dahlgren. “Ully” spent his boyhood steeped in all things military, and distinguished himself in Union blue. He had led a successful reconnaissance raid into Confederate-held Fredericksburg on Nov. 9, 1862; later, at Gettysburg, he had suffered a severe wound in the foot that resulted in the amputation of a leg below the knee. Still, he soldiered on.

Kilpatrick and his men encountered Richmond’s outermost defenses on March 1 and found them stronger than anticipated. “Kill Cavalry” balked. He turned east and skirmished with Confederates while he waited for Dahlgren’s column to arrive.

Dahlgren, unaware of Kilpatrick’s withdrawal, continued on to Goochland and made a dash for Richmond. According to Lt. Col. Mortimer B. Birdseye of the Second, “This regiment has the honor of being the only Union regiment that passed the outer line of defenses surrounding Richmond during its occupation by Confederate forces.” But Dahlgren and his men ran into stiff resistance as they closed in on the capital. Casualties mounted, and Kingston went to work to save as many men as he could.

Dahlgren pressed to within two-and-a-half miles of the heart of the capital when the defenders finally broke their momentum. Dahlgren acted to save his command. “It soon got too hot, and he sounded the retreat, leaving forty men on the field” stated one of Dahlgren’s aides, 2nd Lt. Reuben Bartley. Kingston, who was uninjured, remained with the wounded as Dahlgren and the survivors fled.

Dahlgren continued on. By now night had fallen, and in the confusion caused by the darkness and enemy activity the column became separated. One section eventually made its way back to Kilpatrick. The other section, under the command of Dahlgren, rode into an ambush arranged by about 150 Confederate cavalrymen and other local volunteers. They descended on the Yankee raiders. Dahlgren was struck and killed by four bullets, and the rest of his troopers were dispersed or captured.

Victorious Confederates found Dahlgren’s lifeless body and stripped it of clothing and valuables, including his wooden artificial leg. One man hacked off one of Dahlgren’s fingers to take a ring. Another, 13-year-old William Littlepage, came away with a cigar case, a memorandum book and a few papers.

Littlepage and his comrades read one of the papers with fascination. “Special Orders and Instructions” provided details about the raid. One statement stood out among the rest: “The men must be kept together and well in hand, and, once in the city, it must be destroyed and Jeff Davis and his cabinet killed.”

The papers were forwarded through military and political chains of command and ultimately to Davis. Publication of the contents days after they were discovered rocked Richmond. Calls for retribution and retaliation rippled across the South. The North promptly denied any assassination plans and declared the documents to be forgeries.

Dahlgren’s body, which had been unceremoniously dumped in a muddy grave near the place he fell, was disinterred and put on display in Richmond. “Large numbers of persons went to see it. It was in a pine box, clothed in Confederate shirt and pants, and shrouded in a Confederate blanket,” reported The Richmond Whig on March 8, 1864.

While this circus played out on the streets of the capital, Kingston and his white cellmates were informed that they had been condemned to death as felons for their role in the alleged assassination attempt. “This news appeared to have a very depressing effect on Dr. Kingston,” noted Lieutenant Bartley, a fellow prisoner.

Kingston’s cough and cold worsened, and he lost his appetite. On March 21, as he lay near death, the Confederates removed him from his cell and sent him North. He survived the trip home, and with good food and care came back to life. He eventually returned to the regiment, was promoted to full surgeon, and served in this capacity until the end of the war.

The Confederates never followed through on their promise to execute the prisoners, which was most likely an idle threat by overzealous guards. But their ill treatment exacted a grim toll. According to Bartley, of the six officers imprisoned in the dungeon at Libby Prison, only three survived. He did not mention the fate of the four black soldiers.

Kingston was forever damaged by the ordeal. Back home in Oswego, he was frequently incapacitated by illness, and often doctored himself. His mental health appears to have suffered as well. An acquaintance described him as “a very odd & peculiar person.” Still, he managed to practice medicine and work as a druggist. A cerebral hemorrhage ended his life in 1889, at age 53. His wife, Anne, whom he had married in 1875, and two daughters survived him.

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Sources: Samuel T. Kingston military service record, National Archives and Records Administration; New York Monuments Commission, “Final Report on the Battlefield at Gettysburg”; John Dahlgren, “Memoir of Ulric Dahlgren”; Philadelphia Inquirer, March 4, 1864; Frank Moore, “The Rebellion Record: A Diary of American Events”; Richmond Whig, March 8, 1864; The New York Times, March 10, 1864; The War of the Rebellion: A Compilation of the Official Records of the Union and Confederate Armies; Anne E. Kingston pension record, National Archives and Records Administration.

Ronald S. Coddington is the author of “Faces of the Civil War” and “Faces of the Confederacy.” His most recent book is “African American Faces of the Civil War.” He writes “Faces of War,” a column for the Civil War News.

Image: Artist Edwin Forbes sketched Kilpatrick's Raid to Richmond, circa Feb. 28 to Mar. 11, 1864.Credit Library of Congress

Photo: Samuel Kingston sat for this portrait in the photographer Mathew Brady’s New York City studio, circa 1863.


Wounded Warriors: Civil War Amputation

Compiled by Laura June Davis

In the heat of battle, Civil War doctors often had to make quick diagnoses of soldiers’ injuries. According to The Medical and Surgical History of the War of the Rebellion, 1861-65, 70% of all wounds were to the extremities—35.6% to the upper extremities and 35.2% to the lower extremities. These statistics help explain why surgeons performed so many battlefield amputations; if they couldn't save the limb, they wanted at least to save the soldier’s life.

When deciding whether or not to amputate a limb, a cursory probe of a wound was often the only examination a doctor had the time (or the ability) to conduct before beginning surgery. The high frequency of amputation was often attributed to the damage created by minié balls, which shattered bones and mangled tissue, but the high risk of bleeding, infection, and gangrene were deciding factors as well. By war’s end, Union and Confederate surgeons had performed an estimated 60,000 amputations.

Image: Though staged after the war, this image is one of the few existing photographs of a Civil War era amputation surgery. This "surgery" was staged outside of a Gettysburg hospital tent. (Image credit: Library of Congress.)


The Dangers of Amputation Surgery


This drawing of Union soldier Milton E. Wallen highlights the dangers of amputation surgery. After having his arm removed by Confederate doctors, Wallen headed toward Union lines for medical attention. While recuperating at the Navy School Hospital in Annapolis, Wallen’s stump became infected with gangrene. “Hospital gangrene” was a chronic problem during the war. A small black spot would appear in the wound and slowly expand, resulting in loosened skin, necrosis of body tissue, and corresponding putrid smells. The likelihood of gangrene increased the longer an amputation surgery was delayed—thereby increasing the likelihood of death post-surgery. However, by 1864, Union surgeons learned to control gangrene by pouring carbolic acid—a painful but effective antiseptic—over the infection. (Image Credit: National Museum of Health and Medicine.)

Andersonville Amputation


This photograph of Corporal Calvin Bates of Co. E, 20th Maine Infantry, reminds us that not all amputations resulted from bullet wounds. A prisoner at Andersonville, Bates suffered inhumane treatment at the hands of his prison guards. His maltreatment resulted in illness, decay, and ultimately the amputation of his feet.

Learn more about Civil War prison conditions at

The Civil War and P.T.S.D.

By Dillon Carroll, 5-21-14

Edson Bemis was a hard man to kill. Rebel soldiers tried three times, and three times they failed. At the Battle of Antietam, a musket ball ripped through his left arm. Two years later, in the horrible fighting in the Wilderness, he was shot in the abdomen, just above the groin. The ball was never extracted, remaining in his body until the day he died.

The Confederates came the closest to killing Bemis in February 1865. At Hatcher’s Run, Va., a Minié ball struck him in the head. He lay near death for several days, his skull cracked and leaking brain matter. Most passed him off for dead. Dr. Albert VanDevour, however, did not, and instead performed a risky surgery to remove the bullet from his skull. Bemis improved immediately, eventually recovering, much to the shock of everyone.

The war was finally over for Bemis. He moved to Suffield, Conn., with his wife, Jane, where they hoped to start a new life. He began working for W.W. Cooper’s, a local merchant house, but very quickly it became clear to everyone that Bemis was not right. One of his colleagues at W.W. Cooper’s, George N. Kendall, described his health as “never very good,” and Bemis began to suffer from “spells of vertigo” or “something that afflicted his head” so much so that he frequently could not work.

Kendall noticed that Edson was also “very forgetful.” He had wild mood swings, and Kendall wrote “any little thing irritates him.” He was increasingly subject to memory loss. Sometimes, for several hours each day, he had no memory of where he had been or what he had done. Eventually he had to stop working at W.W. Cooper’s because of his condition.

In 1890, Bemis suffered what appeared to be a stroke, and his condition, which was already bad, got exponentially worse. A pension official came to Suffield to interview the Bemis family and friends, and immediately noticed that although Bemis was only 55 in 1895, he walked “like a man of 80!” His wife had to assist him in dressing, she had to “cut his meat and wash his potatoes” and she described him as being “like a child.” The pension official wrote that Bemis’s only job each day was to go to the post office “right below here for the mail and to a few houses above for a pail of milk every day this is all he can do.”

In 1900, Jane had apparently had enough, and Bemis was examined and institutionalized in Westboro Insane Hospital in Westboro, Mass. By this time, his condition had spiraled even further. A doctor at Westboro, Lewis Bryant, wrote that Bemis believed he was “thirty years old” but he could not recall the present “year month or day of the week.” Bemis believed that “the civil war is still going on” and, occasionally, would “see dogs in the room.” Bryant described him as “silly, emotional, crying and laughing without apparent cause” and having “little memory confusing the present with the past…soils his clothing has had delusions and false sights, and at times requires the care and attentions usually given a child.”

Celestia Bemis, his sister, who coincidentally married a man with the last name Bemis, came to Westboro and took charge of Edson, taking him to her farm in North Brookfield. Celestia and Jane did not get along, and their feud spilled over into the notes of the pension official who occasionally checked up on Bemis. Jane claimed that Celestia ordered her to stay away from him, because her presence excited him too much, while Celestia claimed that Jane had never once tried to visit Bemis, and was content to keep cashing his pension checks without ever seeing him. Jane last saw her husband in August of 1900; he died two months later. She continued collecting a pension until her death in 1917.

Bemis’s story was not an uncommon one among Civil War veterans. Historians are beginning to uncover what was a virtual epidemic of emotional, psychological and neurological trauma that afflicted soldiers after the war. Veterans labored under emotional and psychological stress in ways that are disturbingly similar to the present. Alcoholism was rampant, as was unemployment. Suicide was endemic. Civil War veterans dotted the wards of insane asylums across the country.

Modern science would most likely have given Bemis a diagnosis of traumatic brain injury, caused by a blow to the head or a penetrating injury of the skull. Such injuries are all too common among veterans of Iraq and Afghanistan today. Symptoms of T.B.I. range from headaches, confusion, lightheadedness and dizziness to fatigue, mood changes, depression, changes in sleep patterns, restlessness and agitation. That seems to be consistent with Bemis’s litany of postwar complaints.

If so many Civil War veterans were troubled with emotional and psychological trauma, why has it taken us so long to discover them? Veterans were loath to admit they were traumatized. In the 19th century, mental illness carried a tremendous stigma, and most veterans fought a private battle rather than disclose their trauma.

Additionally, most families preferred to care for mentally ill loved ones at home. Bemis’s care as his mental health declined became a community project. Jane certainly performed the lion’s share of the work. She dressed him, fed him, and sometimes had to help him in the bathroom. But she could not watch him all the time. A.P. Sherwin, a local doctor, later testified that everyone “in town knows soldier to be mentally afflicted” and all the people in Suffield near the Bemis household “watch him closely.” Jane Bemis testified that she did not watch him “on the street” because “everybody knows him” and that he only “goes a short way from home.”

Finally, the relationship between warfare and psychological trauma has only recently become better understood. War trauma has distressed veterans in nearly every war, but the whispers of shell shock and combat fatigue never really entered the public consciousness. It was not until after Vietnam that veterans’ groups successfully lobbied the American Psychiatric Association to include post-traumatic stress disorder in the Diagnostic and Statistics Manual of Mental Disorders. Since then, our understanding and empathy for veterans afflicted with psychological trauma has grown rapidly. Bemis’s life demonstrates that combat has been damaging to the human brain and the human psyche long before we were willing and able to give the maladies a name.

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Sources: Soldier’s Certificate No. 59,267, Cpl. Edson D. Bemis, Company K, 20th Massachusetts Volunteer Infantry, National Archives; Case Files of Approved Pension Applications of Veterans Who Served in the Army and Navy Mainly in the Civil War and the War with Spain, 1861-1934, National Archives; Steven T. DeKosky, “Traumatic Brain Injury: Football, Warfare, and Long-Term Effects,” in the New England Journal of Medicine 363, No. 14 (Sept. 30, 2010); Rebecca J. Anderson, “Shell Shock: An Old Injury with New Weapons,” Molecular Interventions 8, No. 5 (Oct. 2008); Emily Singer, “Brain Trauma in Iraq,” Technology Review 111, No. 3 (May–June 2008); Jeanne Marie Laskas, “Game Brain,” GQ, Oct. 2009; Ben McGrath, “Does Football Have a Future?” New Yorker, Jan. 31, 2011.

Dillon Carroll is a graduate student in history at the University of Georgia.


Disabled Soldiers


Many soldiers, like Private William Sargent of Co. E, 53rd Pennsylvania Infantry (above), continued to don their uniforms after their amputations. Federals and Confederates alike worried about the immoral and idle behavior that would arise if disabled soldiers did not return to work and provide for themselves. The creation of the Invalid Corps (later renamed the Veteran Reserve Corps) allowed amputees and other wounded soldiers to serve as aides to the army—cooks, nurses, or prison guards—or to return to combat if their injuries were not too severe.

Dr. Thomas Fearn

By Taylor M. Polites, 2-28-13
Excerpted from: The Bloody Occupation of Northern Alabama

On Jan. 16, 1863, Dr. Thomas Fearn died of pneumonia at his home in the northern Alabama city of Huntsville. Fearn had studied medicine in London, Paris and Philadelphia, and was the first doctor to treat malaria patients with quinine. He was also a businessman and slaveholder. He had served at the February 1861 Constitutional Convention and in the first Confederate Congress in Montgomery, Ala.

Fearn’s illness was reportedly of long duration, having begun when he was imprisoned for supporting guerrilla activity after the Third Division of the Union’s Army of the Ohio had swept into the area the previous spring.

Excerpted from:

Counting the Costs of the Civil War

By Jeffrey Allen Smith and B. Christopher Frueh, 11-7-13

While the desire to document military exploits and wars is as old as writing itself, the recording of military medical data is a relatively modern phenomenon. Although some initial attempts to chronicle the health of troops occurred in the first half of the 19th century, the first large-scale, wartime medical and behavioral health surveillance effort was conducted during the American Civil War.

This is partly a reflection on the dismal state of the medical profession before the mid-19th century. By the Civil War era, medical practice had improved markedly over the previous century, but it had yet to shake free of all the fetters of its lingering superstitions and misconceptions. For example, with the germ theory of disease still a generation away, it was commonly held that a variety of fevers and diseases, like cholera, were caused by miasma or the foul-smelling “bad” air that emanated from swamps and decomposing matter. On the other hand, medical sophistry notwithstanding, bloodletting had fallen out of fashion and belief in the prophylactic powers of cleanliness and proper hygiene were more widespread thanks in part to the hard work of Florence Nightingale during the Crimean War in bringing sanitation to British war hospitals. One ward’s mortality rate fell over 30 percent because of her efforts.

Thus, with medical advancements showing tangible results in lowering mortality rates and sickness, placing greater effort and funding into a larger systematic wartime recording of military medical data began to seem sensible, and feasible.

The United States Army Medical Department entered the Civil War understaffed and underfunded. This was partially the result of Surgeon General Thomas Lawson, an ossified War of 1812 sawbones, who infamously considered updated medical textbooks a superfluous use of funds. After Lawson died a month into the war, President Lincoln replaced him with Clement Finley, who soon ran afoul of Secretary of War Edwin Stanton in a fiery disagreement.

The choice of Finley’s replacement, William Alexander Hammond, was a stroke of good fortune for the department. Hammond, who had military experience and previously was the chair of anatomy and physiology at the University of Maryland Medical School, set about updating and modernizing the Medical Department. He is credited with increasing standards for army surgeons, reorganizing the ambulance service, founding the Army Medical Museum, expanding support to field and general hospitals and helping to establish the Army Nurse Corps.

Hammond also recognized that the medical record-keeping system for sick and wounded soldiers was “insufficient and defective” and in June 1862, barely a month into his tenure, his office announced a plan to compile the Medical and Surgical History of the Rebellion.

Still, it was not until Nov. 4, 1863, that the War Department issued General Orders No. 355, directing “Medical Directors of Armies in the field [to] forward, direct to the Surgeon General at Washington, duplicates of their reports… after every engagement.” A week later, the Surgeon General’s Office requested “all obtainable statistics and data in connection with past and future operations” and drew “particular attention” to a list of medical topics of elevated importance, the first on the list being “morale and sanitary condition of the troops.”

By January 1864, the scope and focus of the data collected expanded from the battlefield to include general hospitals. “Medical officers in charge of wards” were issued a “Register of Sick and Wounded” and a “Register of Surgical Operations” in which they kept “minutely and in detail, the particulars of all operations performed, or treated in [the] hospital.” These two registers later served as the foundation for the organizational structure of Medical and Surgical History of the Rebellion. A month later, the military began explicitly requesting medical reports for “Sick and Wounded Rebel Prisoners of War” and “White and Colored Troops.” With the inclusion of these medical reports, and a slight modification of a few others, the Surgeon General’s Office had in place a comprehensive system for tracking the medical condition of Civil War combatants by the spring of 1864.

Yet another year would pass before the office started to focus on medical reporting efficiency as well as effectiveness, but Hammond would not be around to see it. Apparently, in his zeal to modernize, Hammond fell victim to the “Calomel Rebellion.” After he banned the medicinal use of mercurial poisons like calomel, army physicians – who stood by these drugs as lifesavers – successfully ousted him from his post.

With Hammond gone, Secretary of War Stanton chose Joseph K. Barnes to serve as the fourth surgeon general in four years. Barnes studied medicine at Harvard University and the University of Pennsylvania before joining the military as an assistant surgeon in 1840. Unlike the previous surgeon generals, Stanton got along well with Barnes, and it showed in the War Department’s increased support of the Medical Department’s activities.

One of these endeavors was the organization of medical records. Bureaucratic delay, ineffectiveness and struggles to conceptualize and implement a final medical recording system notwithstanding, the unprecedented size and scope of the military medical data collected is truly impressive. Still, the struggle to organize the mountains of reports, analyze the data and effectively share it with the world would last longer than the war itself.

In June 1868, as the nation began to come to terms with the significance of the war, Congress commissioned Secretary of War Stanton to prepare for publication “five thousand copies of the First Part of the Medical and Surgical history of the Rebellion, [as] complied by the Surgeon General.”

A decade later the resulting tome, “The Medical and Surgical History of the War of Rebellion, 1861-65,” appeared, consisting of six volumes and totaling approximately 3,000 pages. Based exclusively on military and government medical records, it included statistical data on Union and colored troops broken down into a variety of subcategories. More than 100 separate tables organized by region and army group tracked 150 “diseases,” including “serpent bite,” gunshot wounds, dysentery, diabetes, “dropsy from heart disease” and even alcoholism and suicide. In addition, many of the “diseases” listed in the tables were in subsequent volumes given general descriptions, selective case studies, accounts of treatments and sometimes even illustrative photographs or color plates to further aid in contextualizing their effects on the health of the Civil War soldier.

Newspapers, photographs, diaries and soldiers’ letters all had the ability to create a visceral and real connection to the horrors and heroism of the Civil War. However, these sources could also prove selective and occasionally obscure the larger war. The “Medical and Surgical History” provides something else: an extremely detailed examination of the medical condition and toll taken on soldiers during the Civil War. Here, almost uniquely for the time, there is no euphemism, no soft focus, no attempt to diminish that cold, dispassionate arithmetic reality of the terrible cost borne by Civil War soldiers, both during the war and for decades after.

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Sources: B. Christopher Frueh and Jeffrey A. Smith, “ Suicide, Alcoholism, and Psychiatric Illness Among Union Forces During the U.S. Civil War,” in the Journal of Anxiety Disorders, vol. 26 (2012).

Jeffrey Allen Smith is an assistant professor of history at the University of Hawaii, Hilo.

B. Christopher Frueh is a professor of psychology at the University of Hawaii, Hilo, a McNair Scholar, the director of research programs at the Menninger Clinic in Houston and, writing as Christopher Bartley, the author of “They Die Alone.”


A Prosthetic


Private George W. Lemon (above) was among the soldiers who elected to use a prosthesis. As early as 1862, the Union government began allocating resources for wounded veterans to purchase an artificial arm or leg. Several Confederate states followed suit in 1864. Payments of $50-$75 covered the cost of the prosthesis as well as any required travel to have the soldier outfitted with his new limb. (Image Credit: National Library of Medicine.)

The Empty Sleeve


The empty sleeve became a symbol of the postwar era. By pinning up a shirt sleeve or trouser leg, war veterans emphasized their sacrifices, mettle, and manhood. Some amputees—like Lucius Fairchild of Wisconsin and Francis R. T. Nichols of Louisiana—even utilized their injuries to garner votes and gain political office.

The above drawing by Winslow Homer uses the image of the empty sleeve to symbolize the great changes ushered in by the Civil War: distorted bodies, altered gender relations, and newfound freedoms. (Image Credit: Harper’s Weekly.)  

Sunday, February 8, 2015

The Numbers Illustrated: Civil War Battle Casualties


New military technology combined with old-fashioned tactical doctrine to produce a scale of battle casualties unprecedented in American history.

The Scholarly Challenge


Compiling casualty figures for Civil War soldiers is a complex process. Indeed, it is so complex that even 150 years later no one has, and perhaps no one will, assemble a specific, accurate set of numbers, especially on the Confederate side.

A true accounting of the number of men in the armies can be approached through a review of three primary documents: enlistment rolls, muster rolls, and casualty lists. Following any of these investigative methods one will encounter countless flaws and inconsistencies--the records in question are little sheets of paper generated and compiled 150 years ago by human beings in one of the most stressful and confusing environments to ever exist. Enlistment stations were set up in towns and cities across the country, but for the most part only those stations in major northern cities can be relied upon to have preserved records. Confederate enlistment rolls are virtually non-existent.

Muster rolls, generated every few months by commanding officers, list soldiers in their respective units as "present" or "absent." This gives a kind of snapshot of the unit's composition in a specific time and place. Overlooking the common misspelling of names and general lack of specificity concerning the condition of a "present" or "absent" soldier, muster rolls provide a valuable look into the past. Unfortunately, these little pieces of paper were usually transported by mule in the rear of a fighting army. Their preservation was adversely affected by rain, river crossings, clerical errors, and cavalry raids.

Casualty lists gives the number of men in a unit who were killed, wounded, or went missing in an engagement. However, combat threw armies into administrative chaos and the accounting done in the hours or days immediately following a battle often raises as many questions as it answers. For example: Who are the missing? Weren't many of these soldiers killed and not found? What, exactly, qualifies a wound and did armies account for this the same way? What became of wounded soldiers? Did they rejoin their unit; did they return home; did they die?

A wholly accurate count will almost certainly never be made.  The effects of this devastating conflict are still felt today.

"Fondly do we hope, fervently do we pray, that this mighty scourge of war may speedily pass away. Yet, if God wills that it continue until all the wealth piled by the bondsman’s two hundred and fifty years of unrequited toil shall be sunk, and until every drop of blood drawn with the lash shall be paid by another drawn with the sword, as was said three thousand years ago, so still it must be said “the judgments of the Lord are true and righteous altogether.”

--Abraham Lincoln, 2nd Inaugural Address

Image: Union Soldier: The average Civil War soldier was 26 years old, weighing 143 pounds and standing 5'8" tall. (Library of Congress)



Approximately one in four soldiers that went to war never returned home.  At the outset of the war, neither army had mechanisms in place to handle the amount of death that the nation was about to experience.  There were no national cemeteries, no burial details, and no messengers of loss.  The largest human catastrophe in American history, the Civil War forced the young nation to confront death and destruction in a way that has not been equaled before or since.

Recruitment was highly localized throughout the war.  Regiments of approximately one thousand men, the building block of the armies, would often be raised from the population of a few adjacent counties.  Soldiers went to war with their neighbors and their kin.  The nature of recruitment meant that a battlefield disaster could wreak havoc on the home community.

The 26th North Carolina, hailing from seven counties in the western part of the state, suffered 714 casualties out of 800 men during the Battle of Gettysburg.

The 24th Michigan squared off against the 26th North Carolina at Gettysburg and lost 362 out of 496 men.  Nearly the entire student body of Ole Miss--135 out 139--enlisted in Company A of the 11th Mississippi.  Company A, also known as the "University Greys" suffered 100% casualties in Pickett's Charge.

Eighteen members of the Christian family of Christianburg, Virginia were killed during the war.  It is estimated that one in three Southern households lost at least one family member.

One in thirteen surviving Civil War soldiers returned home missing one or more limbs.  Pre-war jobs on farms or in factories became impossible or nearly so.

This led to a rise in awareness of veterans' needs as well as increased responsibility and social power for women.  For many, however, there was no solution.  Tens of thousands of families slipped into destitution.

Image: The Battle of Gettysburg left approximately 7,000 corpses in the fields around the town. Family members had to come to the battlefield to find their loved ones in the carnage. (Library of Congress)

Casualties of War


There were an estimated 1.5 million casualties reported during the Civil War.

A "casualty" is a military person lost through death, wounds, injury, sickness, internment, capture, or through being missing in action.  "Casualty" and "fatality" are not interchangeable terms--death is only one of the ways that a soldier can become a casualty.  In practice, officers would usually be responsible for recording casualties that occurred within their commands.  If a soldier was unable to perform basic duties due to one of the above conditions, the soldier would be considered a casualty.  This means that one soldier could be marked as a casualty several times throughout the course of the war.

Most casualties and deaths in the Civil War were the result of non-combat-related disease.  For every three soldiers killed in battle, five more died of disease.  The primitive nature of Civil War medicine, both in its intellectual underpinnings and in its practice in the armies, meant that many wounds and illnesses were unnecessarily fatal.

Our modern conception of casualties includes those who have been psychologically damaged by warfare.  This distinction did not exist during the Civil War.  Soldiers suffering from what we would now recognize as post-traumatic stress disorder were uncatalogued and uncared for.

Medicine in the Civil War


The doctor of a regiment in the Civil War was called a surgeon. These men were responsible for treating the sick and wounded of their regiment. Often there were so many wounded that they treated wounded men from many other regiments. This was especially true at Gettysburg where so many soldiers were injured.

Surgeons in both armies were taxed to the limits of their endurance and treated the most severe cases first. The remaining soldiers languished in the open air, waiting their turn on the surgeon's table. For the wounded, the horrors of the battlefield were only equaled by the horrors they experienced in a field hospital.

Most wounds during the Civil War were caused by gunshot. The Minie ball, which was the standard bullet of the war, was made from very soft lead. When it struck human tissue, it would create a very ragged wounded and could splinter once inside. This led to infection which could be fatal. The large bullets could also shatter bones.

Shell fragments from artillery were the next most common cause of wounds. An exploding shell sent large fragments of iron sailing into the air and would cause terrible wounds as well. Bayonet wounds were rare. Only about 2% of all wounds during the war were caused by the bayonet. Soldiers were not always inclined to use them and close fighting usually called for clubs or swinging rifles like clubs, though Colonel Harrison Jeffords of the 4th Michigan Infantry was mortally wounded by a bayonet thrust at Gettysburg.

Even when wounds were treated with great care, infection could easily set in. Medical knowledge in the 1860's did not understand bacteria and germs and how they could be transmitted. They did not properly sterilize the tools and equipment, and bacteria could easily spread from patient to patient during a days worth of operations. This lack of understanding of germs and bacteria led to the spread of disease that killed more soldiers than enemy bullets during the entire war.

This surgeon's operating kit is typical of those used by army doctors. Though they seem ancient by today's standards, the instruments were made of the finest metals with precision and encased in beautiful walnut cases. Confederate instruments were not as fine as those made in northern factories or in Europe, so captured instruments and medical supplies were highly prized.

Radical surgery took place in the crudest conditions. A typical "operating room" was in the open air where the surgeon had plenty of light. Otherwise, it was the room of a farmhouse, the center of a barn, or under a tree. Assistants held lamps over the surgeon to provide light. Patients were placed on a door removed from its hinges and set on sawhorses. With little more than a rag to wipe his hands, the surgeon then began the examination of the wounded soldier and then decided on what course to take.

Over 30,000 soldiers of both armies lay wounded in temporary field hospitals at the close of the Battle of Gettysburg. In every sense of the word, these were not real hospitals at all, but private homes and buildings which afforded some shelter and a nearby source of water. Every barn, church, warehouse, and outbuilding within a ten mile radius of Gettysburg was filled with suffering men, so many that they could not all be attended to at once.

Surgeons from the various regiments worked for days without rest to treat the wounded and medical supplies were hurried to the scene as rapidly as possible.

Still, many soldiers went without care or treatment for several days. "Houses and barns, but chiefly the woods were used as hospitals and the wounded, necessarily endured much suffering," wrote Dr. Jonathan Letterman. As the Medical Director of the Army of the Potomac, Dr. Letterman and his staff had an overwhelming job ahead of them. Before the battle ended, Dr. Letterman ordered more medical supplies to be brought to Gettysburg and he sent his ambulance corps over the field to move the wounded into a more central medical stations called corps hospitals. Dr. Letterman was forced to leave Gettysburg with the army in the pursuit of the Confederates, but he assigned Surgeon Henry James to the task of supervising the gathering and treatment of all the wounded in the area.

The first task was gathering all of the wounded into central field hospitals where adequate water supplies could be found, treatment could be rendered and wounds dressed. Further surgery could also be performed at these hospitals until the wounded could be taken to Gettysburg where they could be transported by railroad to hospitals in Philadelphia, Baltimore and Washington.

A central hospital was established on the York Pike east of Gettysburg and near the railroad and named Camp Letterman after Dr. Letterman. Wounded soldiers were taken from the field hospitals by horse-drawn ambulances to the new camp where they were housed in large canvas tents. Unlike the rigors of a field hospital, the new camp had cots with clean sheets and pillows. Nurses were assigned to each of the tents and surgeons stayed busy around the clock treating the more serious cases. Food was plentiful and the camp was remarkable for its sanitation. Cases considered too serious to move remained at the camp while an average of 800 men per day were shipped by rail to hospitals in northern cities.

Many of the nurses at Camp Letterman were women who were members of the U.S. Sanitary Commission and U.S. Christian Commission, organizations formed in the north for the benefit of Union soldiers wounded in battle. Clara Barton, who later founded the American Red Cross, was not at Gettysburg, but many women like her were. They put in long hours in the hospital wards, aiding the sick and injured soldiers, both Union and Confederate.

Surgical operations continued on the most serious cases at Camp Letterman. A visitor to the hospital witnessed the most gruesome of treatments in a surgeon's tent:

"In the operating tent, the amputation of a very bad looking leg was witnessed. The surgeons had been laboring since the battle to save the leg, but it was impossible. The patient, a delicate looking man, was put under the influence of chloroform, and the amputation was performed with great skill by a surgeon who appeared to be quite accustomed to the use of his instruments. After the arteries were tied, the amputator scraped the end and edge of the bone until they were quite smooth. While the scraping was going on, an attendant asked: 'How do you feel, Thompson?' 'Awful!' was the distinct and emphatic reply. This answer was returned, although the man was far more sensible of the effects of the chloroform than he was of the amputation."
(excerpt from A Strange and Blighted Land, Gettysburg: The Aftermath of a Battle, by Gregory Coco, Thomas Publications, Gettysburg, 1995.)

By August 7, 1863 all of the corps and field hospitals were closed and Camp Letterman was the only hospital remaining with over 3,000 patients. Union and Confederate wounded were both treated at the camp by army doctors and personnel of the United States Christian Commission and the United States Sanitary Commission. Still, not all of those wounded men could be saved and many died from the results of their wounds or infection. A cemetery was established near the camp and burials took place every day. The camp remained at Gettysburg until November 1863 when the last remaining patients left, the tents were packed, and the doctors and nurses left for other battlefield hospitals.

Amputation Procedures Used In Civil War Medicine

by Kevin Thompson

Before the Civil War, amputations were used for many many years and provided data for the surgeons that used amputations in the War. Amputations were not only used in military practice but also in civil practice to treat injuries sustained in accidents as well as other issues such as tumors of the bone. The data used was supplied to the United States surgeons by texts written by doctors such as Tavernier, Sir Astley Cooper, G.J. Guthrie, Paul Eve, Fergusson, and many others. Much of the data used came from the War of the Crimea which took place from 1853-56 and was considered to be the 1st modern war.

There were 2 main methods used to amputate large limbs during the War: Flap and Circular Amputations. In the field the flap method was more widely used where time was a factor. With this method the bone was dissected and flaps of deep muscle and skin were used to close the operation. When implementing the flap method it was imperative to cut the bone away a few inches above the place where the flaps were brought together.

The flap method presented a problem when the patient was to be transported long distances soon or directly after the surgery. The muscles that are used in the flaps to cover became gangrenous when moving the patient about. G.J. Guthrie recommended the circular method because the coverings were made primarily of skin and surface muscle. In military surgery, the flap procedure brought about more sloughing and secondary hemorrhages than that of circular amputation. This was especially noticed after severe battles.


The Numbers Illustrated: Military Deaths in American Wars


The human cost of the Civil War was beyond anybody's expectations.  The young nation experienced bloodshed of a magnitude that has not been equaled since by any other American conflict.

The numbers of Civil War dead were not equaled by the combined toll of other American conflicts until the War in Vietnam.  Some believe the number is as high as 850,000.  The Civil War Trust does not agree with this claim.

The Call For Amputations During The Civil War

by Kevin Thompson

Medicine on the battlefield during the Civil War was crude at times and good at best. With only a surgeon or two with an assistant surgeon to a regiment there was a good chance the wounded would severely overwhelm the medical personnel. The problem was compounded by the type of injuries suffered on the battlefield: gunshot and explosive wounds. These type wounds carried many types of injuries with them, none more severe than, comminuted fractures, compound fractures, and wounds of the joints. The goal of the surgeon in all cases of amputation was to leave as much of the limb intact as possible while giving the patient the best chance of survival.

Comminuted fractures are those fractures where the bone is either broken, splintered, or crushed into a number of different pieces. It does not take long to understand how a projectile, such as the minie ball, could produce such an injury, The minie ball, and other related projectiles that were fired from a rifle, were relatively slow moving and large. When the human body was struck at the bone the velocity of the projectile did not allow a “clean exit.” This produced a shattering effect at the point of impact. In general when a comminuted fracture occurred with rupturing of the principal artery or nerve of a large limb it demanded amputation. It is interesting that Hamilton states that fractures involving contusions demanded amputations more often than those that created a laceration. Also when a fracture injury occurs with a laceration of a main artery, amputation is not always necessary if the artery can be tied.

Compound Fractures are those fractures that produce the bone protruding from the skin. As in injuries producing a comminuted fracture the compound fracture may require amputation if sustained in a large limb, such as the leg, thigh, the arm, or forearm. Amputation during the Civil War was almost always performed if the large limb had severed principal arterial damage or nervous trunk damage.

Wounds to the joints almost always needed amputation during the Civil War. Those wounds include injuries sustained to the knee joint, elbow joint, shoulder joint, wrist, ankle, and hip joint. Amputations made at these joints are also referred to as disarticulations. When an injury was taken to the arm below the forearm, that required amputation, it was common to amputate through the elbow joint even though it was thought better by some to leave some of the radius and ulna. This was also the line of thinking when an amputation was required of the upper arm, leaving a few inches below the humerus. To prevent exposing the patient to inflammation and spread of trouble upwards the road more traveled was disarticulation. Wounds of the hand and feet are more complicated because of small bones and will not be discussed in this article. I will note however that disarticulations took place at the smallest of joints of the toes and fingers. Amputation at the knee joint was normally carried out rather than at the thigh. Baudens comments on this procedure in the text, On Military and Camp Hospitals, which describes the War in the Crimea. The preference for him was to amputate in the knee joint rather than below the joint or the thigh.


The Numbers Illustrated: Military Deaths by State


This chart and the one below are based on research done by Provost Marshal General James Fry in 1866.  His estimates for Southern states were based on Confederate muster rolls--many of which were destroyed before he began his study--and many historians have disputed the results.  The estimates for Virginia, North Carolina, Alabama, South Carolina, and Arkansas have been updated to reflect more recent scholarship.

Given the relatively complete preservation of Northern records, Fry's examination of Union deaths is far more accurate than his work in the South. Note the mortal threat that soldiers faced from disease.

Civil War Medicine: A Turning Point


The American Civil War was known for its brutality – its harsh weapons and tactics produced the highest causality rates in any American conflict. Over 600,000 Americans were killed in the conflict. At the Battle of Antietam, 23,000 were killed or wounded in a single day. In spite of these conditions, medicine in the Civil War has taken its share of hard knocks. In reality, for soldiers, life in a field hospital during the Civil War was grim. However, the Civil War actually marked a turning point in medicine – not only on the battlefield, but in the country as well.

What made medicine in the Civil War extremely deadly were three factors.

1. The Minie Ball
This 56 caliber bullet made any field surgeon’s job over before it could begin. The bullet shattered bones and tore through muscles leaving amputation as the only choice. In fact, 3/4 out of all surgeries in the Civil War were amputations. At the Battle of Gettysburg, doctors created separate piles for the hundreds of legs and arms outside the makeshift field hospital. Aside from the size of the minie ball, it was also known for accuracy. This combination created large numbers of casualties in the conflict.

2. The Tactics
While advances in weaponry took place in the 1800s, advances in tactics did not, and would not, until near the end of the war. The Generals used methods going back to the Revolution of marching in formation and alternating fire between rows of soldiers. The advances in the minie ball changed the distance a weapon could fire accurately making the column obsolete. In addition, artillery advanced to the point where it shred marching armies exposed on open ground. As a result, casualties flooded the field  hospitals.

3. Conditions
The conditions in most field hospitals were notoriously filthy. Contrary to popular opinion, 75% of the soldiers receiving an amputation survived. However, water-borne diseases and intestinal disorders killed twice as many soldiers as bullets ever did. The large number of people in small areas created conditions that the viruses Staphylococcus aureus and Streptococcus pyogenes were able to spread quickly. The problem was not a lack of knowledge about sterilization and cleanliness, it was the ability to stay sterile and have clean water for drinking, laundry, bandages, and sterilizing hands and instruments. Water, or the lack of clean water, was the main culprit. There just was not much clean water to be found. Also, Antibiotics and antiseptics did not exist yet. The Union Army reported that 99.5% of all Union soldiers contracted some sort of bowel disorder at one point during their enlistment. Despite the formation of the Sanitary Commission in 1861, the conditions failed to meet recommendations.

As a result of these three factors, the state of medicine had to change if soldiers were going to survive.

The Civil War changed many  things about medicine.

1. Chloroform – Most movie accounts of th2e war show patients taking a swig of Whiskey or biting a belt or strap while doctors did their business. In fact, chloroform was standard issue for every doctor. The use of chloroform allowed for doctors to successfully amputate with the patient unconscious.

2. Triage – Union Medical Director Jonathan Letterman created a system of diagnosis and care that still exists today. Letterman’s system called for triage near the battlefield followed by ambulance care to a field hospital, a regular hospital, and then post operative care (if they survived infection and disease). This type of diagnosis is still in effect in the military and in modern society.

In addition, Letterman took copious notes on his craft. Letterman details an amputation here:

"The surgery of these battle-fields has been pronounced butchery. Gross misrepresentations of the conduct of medical officers have been made and scattered broadcast over the country, causing deep and heart-rending anxiety to those who had friends or relatives in the army, who might at any moment require the services of a surgeon."

It is not to be supposed that there were no incompetent surgeons in the army. It is certainly true that there were; but these sweeping denunciations against a class of men who will favorably compare with the military surgeons of any country, because of the incompetency and short-comings of a few, are wrong, and do injustice to a body of men who have labored faithfully and well.

It is easy to magnify an existing evil until it is beyond the bounds of truth. It is equally easy to pass by the good that has been done on the other side. Some medical officers lost their lives in their devotion to duty in the battle of Antietam, and others sickened from excessive labor which they conscientiously and skillfully performed. If any objection could be urged against the surgery of those fields, it would be the efforts on the part of surgeons to practice “conservative surgery” to too great an extent.

3. Specialization – The large number of wounded from the civil war created a need in medicine. That need was for prosthetics and the new field of plastic surgery. After  the war, these two fields had huge advances in usability and availability. What once was for soldiers was now used in the general population.

4. Ambulances – Much like baseball spread after the Civil War when soldiers brought home the game, the use of ambulances did the same albeit with horses and wagons. Stretcher bearers and ambulances have not changed much since.

5. Embalming – While many soldiers were buried where they died, many others requested to be sent back home. To do so, new methods for embalming evolved to make sure the body could make the journey home.

6. Standardization of supplies and training – By 1863, every doctor in the Union had to take an exam, do an apprenticeship, and receive a standard set of supplies including a kit that included all the tools needed to amputate and perform a variety of tasks. In addition, each doctor received what amounted to barrels (kegs) for storing water for sanitary purposes.

7. Knowledge – By doing a large number of surgeries, doctors gained a lot of experience not only in dealing with war wounds, but also in their knowledge about the human body – mainly the vertebrae, spine, and head.

8. The Role of Women – While men were needed in battle, women filled the need for bodies in the hospitals. It is estimated that 3200 women served as nurses. They risked their lives leaving home to work in the cesspools of infection. They lived separately from the soldiers and only made $12 a month. While many women are nurses today, their service in the war began their integration into the work force over the next 100 years. But in medicine, women nurses soon became commonplace.

George Wunderlich, executive director of the National Museum of Civil War Medicine, called the conflict, “a watershed that really changed all medicine to the point where it could never completely go back to the way it was before.” Unfortunately, the demise of any soldier in the Civil War was a sad affair. But the large numbers of casualties necessitated the need for more advanced medicine and forms of care to help the soldiers survive their wounds. Most did survive the wounds but not the infection.

Image: What a minie ball did to a leg bone

The Numbers Illustrated: Civil War Service by Population


Even with close to total conscription, the South could not match the North's numerical strength. Southerners also stood a significantly greater chance of being killed, wounded, or captured.

Frank Hastings Hamilton, Surgeon


HAMILTON, Frank Hastings, surgeon, born in Wilmington, Vermont, 10 September, 1813; died in New York city, 11 August, 1886.

He was graduated at Union in 1830, after which he entered the office of Dr John G. Morgan, and in 1831 attended a full course of lectures in the Western college of physicians and surgeons in Fairfield, New York In 1833 he was licensed to practice by the Cayuga county medical censors, and two years later received his medical degree from the University of Pennsylvania. Soon afterward he began to give a course of lectures in anatomy and surgery in his office in Auburn, which he continued until 1838.

In 1839 he was appointed professor of surgery in the Western college of physicians and surgeons, and a year later was called to the medical college of Geneva. During 1843-'4 he visited Europe, and contributed a record of his experiences to the "Buffalo Medical Journal." In 1846 he became professor of surgery in the Buffalo medical college, subsequently becoming dean, and also surgeon to the Buffalo charity hospital. Two years later he left his chair in Geneva and removed to Buffalo, in order to attend to his practice, which was rapidly increasing.

On the organization of the Long Island college hospital in 1859 he was called to fill the chair of principles and practice of surgery, and was also chosen surgeon-in-chief of the hospital. In May, 1861, he was appointed professor of military surgery, a chair which at that time existed in no other college in the United States.

At the beginning of the Civil War, he accompanied the 31st New York regiment to the front, and had charge of the general field hospital in Centreville during the first battle of Bull Run. In July, 1861, he was made brigade surgeon, and later medical director, and in 1862 organized the United States general hospital in Central park, New York. in February, 1863, he was appointed a medical inspector in the United States army, ranking as lieutenant-colonel, but resigned in September and returned to his duties in Bellevue hospital medical college, where in 1861 he had been appointed professor of military surgery and attending surgeon to the hospital.

In 1868-'75 he was professor of the principles and practice of surgery in the college, and remained surgeon to the hospital until his death. He was also consulting surgeon to other hospitals and to various city dispensaries, and in that capacity Dr. Hamilton had few equals.  On the assassination of President Garfield he was called in consultation, and remained associated with the case until the death of the president.

His notable operations were many, and his descriptions of improved processes are numerous. He invented a bone-drill and an apparatus for broken jaw, and invented or modified appliances for nearly every fracture of long bones, with various instruments in military and general surgery He was the first to introduce the use of gutta-percha as a splint where irregular joint surfaces require support, and the closing of old ulcers by the transplanting of new skin has been repeatedly attributed to him by French and German physicians. He was a member of various medical associations, and was president of the New York state medical society in 1855, of the New York pathological society in 1866, of the New York medico-legal society in 1875-'6, of the American academy of medicine in 1878, and of the New York society of medical jurisprudence in 1878 and 1885. In 1869 he received the degree of EL. D. from Union college.

Dr. Hamilton was a large contributor to medical journals, and many of his special memoirs are accepted as authorities. His works in book-form include "Treatise on Strabismus" (Buffalo, 1844): "Treatise on Fractures and Dislocations" (Philadelphia, 1860; 7th ed., 1884, French and German translations); "Practical Treatise on Military Surgery " (New York, 1861); and "The Principles and Practice of Surgery " (1872; 2d ed., 1873). He edited a translation of Amussat on the "Use of Water in Surgery" (1861), and "The Surgical Memoirs of the War of the Rebellion," published under the direction of the United States sanitary commission (Washington, 1871).

from: Appleton's Cyclopedia of American Biography, edited by James Grant Wilson, John Fiske and Stanley L. Klos. Six volumes, New York: D. Appleton and Company, 1887-1889 and 1999.  Retrieved from on 28 February 2007.


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