From: telegraph.co.uk
In this exclusive extract from his new book, our foremost military historian, John Keegan, exposes the gruesome suffering endured by soldiers during the American Civil War, and the role of poet Walt Whitman in easing their pain.
The likelihood of death or disfigurement on the battlefield was remote from the minds of the men of 1861 as they marched away. It became an all too urgent reality once the first shots were exchanged. The first battle of Bull Run left 1,000 wounded on the field. By 1862, Union regiments were becoming accustomed to casualties of 30 per cent in any engagement.
As quickly as Civil War soldiers learnt of the probabilities of death and wounding in action, however, they learnt to avoid, as far as possible, treatment by regimental doctors, who acquired a reputation early on for incompetence and laziness. It was not understated; the staff of the pre-war medical department was ill-trained, rule-bound and rarely abreast of modern methods. They were also poorly supplied with drugs or equipment. The first hospitals were improvised, often simply a few tents pitched on the outskirts of camp, attended by untrained men who acquired the reputation of shirkers.
The Union army had entered the war with entirely inadequate medical resources. The senior medical officer was 80 years old and his knowledge of medical practice was of equal antiquity. The US Medical Service possessed only 20 thermometers and lacked almost all other medical equipment. Surgeons were posted to regiments on a scale of one per unit, with an assistant surgeon as the only other trained man. In the field they took charge of the regimental musicians, who acted as litter-bearers. They were quite without medical training and earned a reputation as rough, incompetent and often uncaring.
The delay in evacuating the wounded was often extreme. After the second battle of Bull Run, 3,000 wounded still lay where they had fallen three days after the fighting ceased; 600 were found still alive five days after the battle. It was a week before the last survivors were got to hospital in Washington. It was often preferable to remain in a barn or private house, as many did, than be taken to hospital, which were frequently sinks of infection; dirty, untidy, and overrun with parasites. Because of the prevalence of gangrene, amputation was the preferred surgical procedure. Many eyewitnesses recorded the sight of piles of severed arms and legs outside, and sometimes inside, hospitals.
The Civil War occurred at a point of transition in scientific development, so that the armies had the use of some weapons of the future, such as breech-loading rifles, but not others, such as machine guns. Military medicine was also at a point of transition. Doctors could administer anaesthetics, but they did not yet understand the germ theory of infection and so did not practise antisepsis. Surgeons commonly operated in old clothes stiff with blood or pus, dressing wounds with torn-up rags. They did not clean, let alone sterilise, their instruments and did not keep wards or operating theatres free of disease-carrying insects. Blood transfusion was unknown, as was blood-typing, and they would remain so until the end of the First World War.
In the circumstances, it was remarkable that as many wounded survived as did. The minié ball, fired from the Springfield and Enfield rifles – the main cause of wounds – was a conical lump of lead the size of a man's upper thumb joint and weighing two ounces. It penetrated the human body with ease, producing a comparatively benign injury unless it hit a blood vessel. But it frequently hit bone, which it tended to shatter, often a cause of amputation. Even worse was the wound caused by a fragment of artillery shell, which could remove a foot or a hand, or smash the rib cage. Worst of all was a round shot, which could decapitate. A direct hit from a cannonball almost always meant death.
The surgeon of a Kentucky regiment wrote to his wife after the battle of Kennesaw Mountain in 1864: "Citizens at home can never know one fourth part of the misery brought about by this terrible rebellion."
During 1862, the North urgently put in hand an effort to improve the quality of medical care. As with other Civil War developments, the battle of Antietam, with its huge casualty list, was the spur. A new director of medical services, the young, energetic well-educated William Hammond, was supported by the United States Sanitary Commission, a voluntary organisation that became a power in the land. It collected medical supplies, recruited several thousand nurses, and provided welfare facilities for soldiers, both sick and healthy, all over the Northern states.
Hammond was responsible for widespread reform and for choosing able men to fill surgical and medical appointments throughout the Union army. One, Dr Jonathan Letterman, appointed chief of medical services in the Army of the Potomac, expanded and reorganised the ambulance corps. The first results were seen after Antietam, when the wounded were moved from the battlefields according to a rational and disciplined schedule. Letterman, who insisted on strict standards of hygiene, introduced prefabricated hospitals, properly ventilated and heated, with single-storey wards grouped around a central complex of operating theatres and dressing stations.
Walt Whitman, a New Yorker trying to set up as a professional writer, was an early visitor to the dozens of Letterman hospitals that began to spring up all over Washington. Though he did not serve in the army and was never present at a battle, the war was to possess him. After finding his brother, George, who had been evacuated from the field of Fredericksburg, Whitman devoted himself to the welfare of the wounded. He took a clerical job in the army paymaster's office and spent his small salary on tobacco and other comforts for the patients.
By his own reckoning, he attended the bedsides of 80,000 casualties. He recorded: "The doctors tell me I supply the patients with a medicine which all their drugs and bottles and powders are helpless to yield." That medicine was kindness and cheerful attention.
Whitman was to become America's leading 19th-century poet. His poem Come Up from the Fields, Father, is one of the greatest works of literature the war was to inspire and it came from his experiences as an army hospital visitor. What makes it so heart-rending is that everything in it is entirely genuine.
Whitman knew what happened to boys shot in the chest; he knew how such news affected families since he often met them on their visits to the hospitals; he knew what terrible truths the consoling letters sent to families concealed, since he had often written such letters himself. Whitman was a great poet of the Civil War because he understood the nature and purpose of the war, which was to inflict suffering on the American imagination.
The suffering was equally distributed between the two sides, and was felt particularly by those not present. The whole point of the war was to hold mothers, fathers, sisters and wives in a state of tortured apprehension, waiting for the terrible letter from hospital that spoke of wounds and which all too often presaged the death of a dear son, husband, or father. It was a particular cruelty of the Civil War that because neither side had targets of strategic value to be attacked, its effect had to be directed principally at the man in the field and at the emotions of those who waited at home.
Torturing the apprehensions of the non-combatants was a new development in warfare, produced by the rise of an efficient postal service. Before the days of rapid and reasonably certain postal communication, the only certain news of a soldier on campaign came by default, when he did not return.
Whitman caught at the truth in an entry in one of his notebooks. "The expression of American personality through this war is not to be looked for in the great campaign and the battle-fights. It is to be looked for… in the hospitals, among the wounded."
Image: Wounded soldiers in an improvised Union hospital during the American Civil War
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