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.

Wednesday, February 22, 2017

Discharged Emaciated from Libby Prison

By Kayla, 11-11-11

“He then looked very sick, pale, and emaciated. He was hardly able to get about. He was afflicted chronic diarrhea, and complained of severe griping pain in his stomach.”  That’s how Patrick Creen described James H. Phalan when he saw him working at the Washington Navy Yard.

Phalan was among the Union soldiers imprisoned in the harsh, unsanitary and overcrowded conditions at Libby Prison during the Civil War.  After his release in 1863, he lived with his Aunt Hannah Griffin and his wife Hanora, and he tried to work at the Navy Yard.  His aunt said, “He tried to do a little easy work in the Navy Yard but was troubled continually with cramps and chills and under treatment all the time. He had to give up this position a few weeks from inability to continue on account of his illness.”

After two years, he and his wife moved a few streets away, but his affliction carried on, and he began to work making feather brushes.  Phalan died in 1870 from the lasting, painful complications due to his time spent in Libby Prison.

Image 1: Libby Prison for Union soldiers in Richmond, Virginia

Image 2: Patrick Creen writes of Phalan's afflictions

Image 3: Hannah Griffin explains the conditions of her nephew


Chisolm’s Manual of Military Surgery


“In putting forth this Manual of Military Surgery for the use of Surgeons in the Confederate service, I have been led by the desire to mitigate, if possible, the horrors of war, as seen in its most frightful phase in military hospitals.”
Julian J. Chisolm
Preface to First Edition.

“When the war suddenly broke upon us, followed immediately by the blockading of our ports, all communication was cut off with Europe, which was the expected source of our surgical information. As there had been no previous demand for works on military surgery, there were none to be had in the country, and our physicians were compelled to follow the army to the battle without instruction. No work on military surgery could be purchased in the Confederate States. As military surgery, which is one of expediency, differs so much from civil practice, the want of proper information has already made itself seriously felt. In times of war, where invasion threatens, every citizen is expected to do his duty to his state. I saw no better means of showing my willingness to enlist in the cause than by preparing a manual of instruction for the use of the army, which might be the means of saving the lives and preventing the mutilation of many friends and countrymen.”
Julian J. Chisolm
Preface to First Edition.

From the outset of the war, Julian John Chisolm (1830-1903) realized that knowledge of military medicine was practically non-existent among doctors in the South. Using the knowledge gained during his time observing the treatment of soldiers wounded in the Second Italian War of Independence (1859) in Milan, Italy, Chisolm wrote and published his book, A Manual of Military Surgery: For the Use of the Surgeons in the Confederate Army With an Appendix of the Rules and Regulations of the Medical Department. First published in July 1861, the manual described how to treat specific types of wounds, construct field hospitals, and manage food, clothing, hygiene and non-surgical diseases. Later editions contained detailed illustrations showing how to perform specific procedures such as amputations. The manual became one of the most popular surgery books published by the Confederates States of America and resulted in the publication of three more editions. These later editions incorporated the knowledge gained from the battlefield to improve the treatments of gunshot wounds.

Four editions of the manual were produced during the course of the war and are now available for research use at the Waring Historical Library:
1861 edition
1862 edition
1864 edition
Or online:
1861 edition:
1862 edition:
1863 edition:
1864 edition:

“After three years of incessant and bloody warfare I have been called upon to embody, in a new edition of “The Manual of Military Surgery,” the large experience of the medical staff of our army. It has been my aim to condense, in a concise, practical form, the improvements in the treatment of gunshot wounds which have been developed during our active campaigns, and repeatedly confirmed upon thousands of wounded.”
Preface to the Third Edition.

Sister-Nurses Honored for Military Service


Memorial Day, observed this year on May 28, commemorates all the men and women who have died in military service for the United States. Flags traditionally fly at half-mast from dawn until noon, and volunteers often will place an American flag on the graves of veterans.

At Saint Mary’s in Notre Dame, Indiana, we remember our deceased sisters who served as nurses in the military. This military service actually began in 1861, six months after the outbreak of the U.S. Civil War, when Holy Cross sisters responded to the request of Indiana Governor Oliver Morton to care for Indiana soldiers then serving in Kentucky. Although they had no training as nurses, six sisters, led by Mother M. Angela (Gillespie), journeyed to Paducah, Kentucky, to tend the sick and the wounded. Many more sisters followed, and others went to hospitals in Illinois, Tennessee, Missouri and Washington, D.C.

On Christmas Eve 1862, three Holy Cross sisters boarded the U.S. Navy’s first hospital ship, the Red Rover, to serve as nurses for the wounded on both sides of the war. They traveled the Mississippi River carrying sick and wounded soldiers to various military hospitals. In so doing they became what U.S. naval history today hails as the forerunners of the United States Navy Nurse Corps. Before the conflict ended, 65 of the 160 Sisters of the Holy Cross in the United States would serve in the Civil War, and another 13 sisters would serve in the Spanish-American War.

Each sister-nurse received a military pension, and the Navy honored these sisters with a special headstone placed on their graves in the congregation’s Our Lady of Peace Cemetery at Saint Mary’s.

The Sisters of the Holy Cross are among 12 congregations of religious women who are depicted on the Nuns of the Battlefield monument, erected in 1924 in Washington, D.C. The inscription reads: “To the memory and in honor of the various orders of sisters who gave their services as nurses on the battlefields and in hospitals during the Civil War. They comforted the dying, nursed the wounded, carried hope to the imprisoned, gave in His name a drink of water to the thirsty.”

Image: Novices Callista Tetteh, Grace Kitinisa and Jessica Brock stand at the headstone of Mother M. Augusta (Anderson), who served as a Navy nurse during the U.S. Civil War.

“I Cannot Leave Them”: Walt Whitman

By Karen, 2-17-14

Walt Whitman was 43 and already a well-known poet in 1862 when word reached his family that his brother George, who’d enlisted in the Union army, had been wounded in a battle at Fredericksburg, Virginia. Whitman immediately left to find George, anxious to see him and discover the extent of his injuries. George, as it turned out, had only received a cheek wound, but Whitman’s experience searching for his brother among the military hospitals had left an impression on him. For the next three years—the remainder of the war and then some—Whitman, who moved to Washington DC for this purpose, visited wounded and sick soldiers almost daily in the capital’s many military hospitals.
While some people today refer to Whitman as a nurse during this time, he wasn’t anything so official. While he did help change bandages and definitely observed many bloody surgeries, his role was more that of a really dedicated and concerned frequent visitor. Funded by his part-time job at the army paymaster’s office and by generous Northern philanthropists, Whitman brought with him on his visits countless little gifts for the soldiers. He brought treats like apples, oranges, figs, crackers, fruit-flavored syrups, and ice cream, and when a soldier requested a specific food—from rice pudding to pickles—Whitman did his best to obtain it for him. Whitman also brought reading materials for the men: magazines, newspapers, and almanacs for individuals, and books to pass around the ward. He also provided the wounded with stamped envelopes and paper to write letters to their loved ones, and when they were too ill or illiterate to write themselves, he wrote the letters for them. In addition to these items, Whitman also passed out small sums of money to the soldiers, since many came to the hospital with no money in their pockets, and Whitman discovered that giving them even small amounts helped raise their spirits. At the end of the war, he estimated he had passed on thousands of dollars of philanthropists’ money to hospitalized soldiers.

But beyond these simple gifts, Whitman felt the best way he could help the wounded was with his cheerful presence. Disregarding whether the man was from North or South, Whitman went around the wards talking to the men and learning not only how they’d been injured but about their families and lives before the war as well. And when the men were too hurt to hold a conversation, Whitman would sit by their bedside and give them comfort in silence. He remarked, “I do not see that I do much good to these wounded and dying; but I cannot leave them. Once in a while some youngster holds on to me convulsively, and I do what I can for him; at any rate, stop with him and sit near him for hours, if he wishes it.” Whitman’s hospital visits lasted anywhere from a couple hours to all day or all night, if a dying soldier needed him that long. By his own estimation, Whitman “made over six hundred visits or tours, and went, as I estimate, counting all, among from eighty thousand to a hundred thousand of the wounded and sick.”

Whitman’s mission of mercy inevitably affected his writing. He wrote many poems about his own and others’ wartime experiences in a collection called Drum-Taps. Those poems captured the quiet, stalwart bravery of common soldiers and the close camaraderie they shared. He would also later compile his hastily jotted down notes and observations from his visits into a book called Specimen Days, which provides keen insight into life in Civil War hospitals and in wartime Washington DC.


A Case of Temporary Insanity

By Karen, 2-25-13

Daniel Sickles, although perhaps best known as a political Civil War general whose disobedience at Gettysburg got his troops killed, is also known for a scandal before the war in which he killed his wife’s lover.

Sickles was a former lawyer of the Tammany Hall political machine who had become a Democratic representative for New York in the House of Representatives. Sickles was a womanizer and had many affairs, most famously with courtesan Fanny White, whom he took with him on his travels to England. At age 33 he courted scandal by marrying Teresa Bagioli—who was 15 and pregnant.

In 1859, when his wife was 23, Sickles discovered that she had been having an affair with 40-year-old Philip Barton Key, a family friend who was also a US district attorney and the son of composer Francis Scott Key. Sickles had apparently been ignorant of the affair until he received an anonymous letter informing him of his wife’s actions. Sickles confronted his wife and she confessed.

The next day, February 27, he saw Key walking by the house, and Sickles ran out shouting, “Key, you scoundrel, you have dishonored my home—you must die!” Sickles cornered Key, assaulting him and shooting him multiple times. Finally, Sickles shot Key point blank in the chest, killing him.

As there had been multiple witnesses, there was no doubt of Sickles’s guilt, but when his case came to trial, his lawyer (Edwin Stanton, later Lincoln’s secretary of war) blamed temporary insanity—the first time that defense had been used in trial. The trial received much attention, and the public—as well as the jury—sided with Sickles, believing that his actions and insanity were totally justified given the situation, and he was acquitted.

Interestingly, public opinion stayed on Sickles side until a few months later, when he reconciled with his wife. Having completely vilified Teresa, the public couldn’t forgive Sickles for returning to her, and they turned against him. It seemed like his political career would never recover, but then the war started and Sickles became a Union general—giving him a chance to start over.

Image 1: Daniel Sickles shooting Philip Barton Key, 1859

Image 2: Teresa Sickles

Part I: "The Lady Nurse of Ward E" watches the Civil War come to Washington, D.C.

By Diane Wendt, 7-31-14

With Confederate troops looming just outside of Washington, D.C., July 1864 was an exciting and scary time to be a nurse in the city. Curator Diane Wendt shares what those daring days were like 150 years ago through the matter-of-fact diary entries of nurse Amanda Akin.

While nurse Amanda Akin's diary is more cursory than poetic, I was drawn to her account because of the proximity of her hospital to the Smithsonian, and because we share, albeit 150 years apart, this common ground. Her original diary is in the collections of the National Library of Medicine and was the centerpiece of a small exhibition I curated a few years ago.

Akin left home to work at Washington's Armory Square Hospital at age 35 and began work in April 1863. By July 1864, she was preparing to end her nursing service and return home to Quaker Hill, New York. We pick up her story on the morning of July 9, when she first heard word of the Confederate advance on Washington:

July 9, 1864. Spent morning in ward framing and changing some of the pictures, etc. Received exciting news of another raid into Maryland. An order came to have every man able to carry a musket ready to leave tomorrow. […] Sang in Miss Merrill's ward my new song, "When Johnny Comes Marching Home," and tried duets with her; then went to my ward and repeated it. The general ward master came in and brought a tenor, and we had quite a musicale.

In order to strengthen the defenses of the city, all able-bodied men were called to duty, including many of the hospitals assistants and clerks—even any patients well enough to serve. Perhaps the excitement of the call to arms inspired Akin to try out her "new song" during the evening entertainment. "When Johnny Comes Marching Home," one of the most enduring Civil War tunes, was first published in 1863, and became popular in both the North and South.

Cover of sheet music for “When Johnny Comes Marching Home” words and music by “Louis Lambert” (Patrick Sarsfield Gilmore), Boston: Henry Tolman & Co., 1863-_Project_Gutenberg_eText_21566
Cover of sheet music for "When Johnny Comes Marching Home." Words and music by "Louis Lambert" (Patrick Sarsfield Gilmore), Boston: Henry Tolman & Co., 1863.
July 11, 1864. Began my packing. Another order for men from the hospital. Found only the ward master, with ward attendants—two for the dining room and bathroom. Johnny Hegeman, my orderly, volunteered, as the orderlies were to be exempt for the present.

Armory Square Hospital had ten wards and usually one female nurse assigned to each. Akin was assigned to "Ward E." Convalescing and disabled soldiers were put to work as orderlies and ward attendants. Johnny Hegeman was serving as Akin's primary assistant—her orderly—when the call to arms came. He had joined the military service underage, but had come down with fever and landed at the hospital before his regiment reached the front. New recruits were particularly susceptible to infectious diseases including typhoid, measles, and smallpox. One can imagine that Johnny Hegeman was excited to finally have the chance to see "action."

The rebels are skirmishing before Fort Stevens, formerly Fort Massachusetts, only five miles from the city. Baltimore is in great excitement. General Lew Wallace was in command, and the fighting going on all day Saturday, but our men were obliged to fall back, as the enemy was superior in numbers. […]

A hospital ward in Washington, D.C. Library of Congress Prints and Photographs Division.
The Confederates under General Jubal Early approached Washington from the northwest. Two days before reaching Fort Stevens, they encountered General Lewis (Lew) Wallace's troops at the Battle of the Monocacy, not far from Frederick, Maryland. Although the Union was defeated, the battle slowed the Confederate advance on the city and allowed Union reinforcements time to reach Washington from the south. Wallace had borne much of the blame for Union losses at Shiloh in 1862, and his actions at Monocacy, dubbed "The Battle that Saved Washington," helped restore his reputation.

[…] After "Taps" sat on the chapel steps with Sisters Merrill and McClellan, in the moonlight. Our nerves were too over-wrought for us to separate, and we were wondering what news the morning would bring. As we were returning we were called out again to hear the band from the Sixth Corps, which passed here to-day on a forced march and returned to treat us, playing most beautiful music for a half hour. Part of the Nineteenth Corps, from New Orleans, also passed; in fact all day troops have been hurriedly massing to protect Washington.

The Confederates reached Fort Stevens on the outskirts of the city on July 11th. The fort was located north of the city on the 7th Street Pike [Georgia Avenue], the major north-south route through the city. Armory Square Hospital also sat on 7th Street, and Akin witnessed the passing of the Union reinforcements as they arrived at the Sixth Street docks to the south and marched north through the city to reach the fort. Akin’s nervousness on the evening of July 11 was indicative of the atmosphere throughout the city, as an anxious population awaited the outcome of the confrontation at the north edge of town.

Stay tuned for Part II, in which I'll continue Amanda's story.

Diane Wendt is a curator in the Division of Medicine and Science at the National Museum of American History. She has previously blogged about what it was like to survive rabies 100 years ago.


Part II: "The Lady Nurse of Ward E" Bids Adieu to Washington, D.C.

By Diane Wendt, 7-31-2014

This post continues the story of Civil War nurse Amanda Akin, which began in Part I.

"July 12, 1864. The bridge over Gunpowder River, sixteen miles from Baltimore toward Philadelphia was burned. The 7.30 A.M. train yesterday was attacked, the passengers ordered out, and the train then run on to the bridge and burned. This afternoon the "extras" say a few miles of double track between this city and Baltimore were torn up, so I am a fixture for the present. […]"

General Jubal Early sent one unit of his Confederate forces around Baltimore to cut supply and communication lines that connected the Capitol to the North. Telegraph lines, track, and bridges were destroyed on the Northern Central Railway and the bridge over the Gunpowder River (near Joppa, Maryland) on the Philadelphia, Wilmington, and Baltimore Railroad was burned. This railroad is now part of Amtrak's Northeast Corridor. Until the railroads were repaired, Akin would be unable to return home.

"[…] After "Taps" went with Sisters Helen and Mac to Smithsonian, where Misses Lowell and Ware had preceded us, to see the shells from the Smithsonian Tower; but as they came down and reported only "signal lights" to be seen, we felt too weary to attempt to climb so many flights. Professor Henry's daughters came to the door and were cordial."

The familiar bugle call for "lights out" known as "Taps" had its origins during the Civil War. The top of the Smithsonian's highest tower afforded a grand view of the city of Washington and the surrounding country, although the climb proved too much for Akin and her companion on the evening of July 12th.

"July 13, 1864. The rebels have retreated, but many precious lives have been sacrificed. Major Jones of the Sixth Maine, just returned to his regiment from a furlough, was killed; his term of service would have expired in two days. […]"

By July 14, the Confederate troops had retreated to Virginia, crossing the Potomac River near White's Ford (just up river from where White's Ferry crosses today). With the threat to the city over, Akin resumed her preparations for leaving. On July 15, Akin visited Mathew Brady's gallery on Pennsylvania Avenue to purchase a picture of Abraham Lincoln and an album for her cartes-de-visite. The next day, she noted in her diary that the trains north were running again but were much too full for her to get through.

"July 16, 1864. Our ward at present is very quiet; only a few of the patients (the most severe cases) still in bed. Captain Constantine Lippe, of the 188 Pa. Vols., who would not consent to have his leg amputated, after weeks of suffering lying on his back, losing flesh and strength, as he knew he must until the crisis was passed, is now gaining. His fine physique and good health have borne the strain. […]"

Constantine Lippe was the son of Adolph Lippe, a prominent American homeopathic physician and teacher at Hahnemann Medical College in Philadelphia. Constantine was also a homeopathic physician and his "irregular" medical training probably influenced his decision to refuse amputation. Although surgeons were often accused of being too eager to amputate limbs, few other options were available to prevent fatal infections and repair shattered limbs. Lippe had received his leg wound at the battle of Cold Harbor on June 3, 1864. He continued to suffer from pain and ill health after the war, and his death in 1885 was judged to be a result of the war wound.

Akin's last entry is dated July 20, 1864. Few were left in her ward to bid her adieu except for Captain Lippe and Captain Newton May Brooks, who had been at the hospital since May after being severely wounded at the Battle of Spotsylvania:

"July 20, 1864. The day has at last arrived to bid adieu to my ward and its absorbing duties, now realizing, reluctantly, how my life has been rounded within it for eight months. So with an inexpressible regret to leave even a few whose watchful eyes and patient smiles would bid me stay, though with an unspeakable longing for home and loved ones there, have given them my hand in good fellowship, and over a glass of native wine made my good wishes to Captain Lippe, my brave Philadelphian, and Captain Brooks of the Twelfth New Jersey Volunteers. WILL I EVER RETURN?"

I do not know if Akin ever returned to Washington, nor do I know much else about the rest of her life. She married Dr. Charles W. Stearns in 1879. He had been a surgeon in the 3rd New York Infantry, but it is doubtful their paths crossed during the war. Akin was widowed in 1887, and apparently had no children. In 1909, at age 81, she published an account of her nursing experience, "The Lady Nurse of Ward E", under her married name of Amanda Akin Stearns. She died in February 1911 and is buried with her husband in Pawling, New York, the town that includes her home at Quaker Hill.

Diane Wendt is a curator in the Division of Medicine and Science at the National Museum of American History. She has previously blogged about the influenza vaccine. Want to learn more about Amanda Akin? Her book "The Lady Nurse of War E" is available online. The Smithsonian Institution Archives has other interesting resources related to the Confederate attack in July 1864.


Image: The chapel for Armory Square Hospital where Akin sat with her fellow nurses on the evening of July 11th. The nurse’s quarters were just to the left of the chapel. The capitol dome can be seen in the distance.

Intersections of Religion and War: Examining a USCC Diary

By Savannah Labbe 9-26-16

While most don’t immediately associate religion with war, there is no doubt that it plays a role in most, the Civil War included. The Civil War brought with it new levels of death and destruction that the government was unprepared to deal with; it didn’t have the resources to adequately care for the influx of wounded soldiers, which was painfully evident after Bull Run when the number of soldiers needing medical care was more than the hospitals could handle. In the wake of the Battle of First Bull Run, the general public as well as the government saw the need for a civilian organization to help care for and comfort wounded soldiers. On November 14, 1861, a few months after the battle, the United States Christian Commission (USCC) was created by representatives of the Young Men’s Christian Association (YMCA) to fill this void. Its headquarters were set up in Philadelphia, and a layman named George Hay Stuart was appointed to head the Commission. The Commission was made up of volunteer delegates who were unpaid, though they were reimbursed for travel costs and other expenses they acquired while in the field. These delegates would go to the field for usually only a few months, during which time they were encouraged to keep a diary; many did just that.

A diary from a delegate that spent a few months in Louisville gives us a glimpse into his everyday life. The diary was issued by the USCC and bears their stamp on the front; the first few pages detail the duties of a delegate and provide other useful information and instructions. A delegate was expected to visit hospitals, camps, and battlefields to distribute supplies and religious materials. He was also supposed to speak to the men individually as well as collectively and hold meetings of prayer. In addition, the Commission provided the delegates with supplies such as stamps, envelopes, paper, clothing, food, and coffee for distribution to the soldiers.

After the instructions section the delegate’s diary entries begin. The entries in the journal I examined date from May 18, 1864 to July 7, 1864. He was in the field for a couple of months, which is reflective of the typical length of time the Commission preferred for its volunteers. In his diary the delegate recorded the smallest details about his life such as the weather conditions and his bathing habits. In addition to this, the reader also learns what duties the delegate performed on a day-to-day basis. Much of what the delegate wrote about involved talking to the men, visiting the hospital, and distributing religious tracts. For example, on May 24 he wrote that he distributed 200 religious tracts and would have distributed more if he had the resources to do so.

In addition to handing out religious tracts, the delegate also performed many other essential tasks. There are accounts of the delegate distributing woolen shirts and cotton drawers to the men as well as envelopes, paper, and stamps. At one point he described helping a wounded soldier write home, a simple task that provided the soldier with the precious ability to communicate with his loved ones. There are other instances in the diary in which the reader can imagine the impact the delegate would have had on the soldiers. In the June 22 and 23 entries he wrote about visiting Rebel prisoners. During this visit one prisoner in particular caught his attention; a Confederate, Holliday, who was wounded and paralyzed. The delegate provided him with a shirt, despite the fact that he was a Confederate. On the 23, he wrote of the death of Holliday and lamented at “what a penalty this nation is paying for its oppressive acts.” In addition to this, the delegate spent a lot of time in the field and in the hospital, comforting and attending to the wounded. For example, on June 19 he wrote that he “prayed with a man wounded in the bowels. He died in an hour.” In this way the delegate was able to do something of which the government and the hospital staff were incapable of: sitting with and comforting a dying soldier.

In this diary we see examples of the many services the USCC provided. These services brought comfort to the soldiers and filled a void that the government was incapable of filling. The earliest forms of dog tags were provided by the Commission, something that the government was unable to do. The USCC’s distribution of religious tracts, if nothing else, provided the men with reading material that was often seriously lacking or even nonexistent in most army camps. In addition, they provided much needed support to hospitals and distributed supplies that the men needed but that the government couldn’t supply. The USCC did many other things like this, and while some may have had an aversion to the religious nature of the organization, there is no question that they provided the soldiers with simple pleasures and comforts in a time of war to which they would not have had access otherwise.


Diary of a Missionary with the U.S. Christian Commission. Civil War Vertical File Manuscripts. Special Collections/Musselman Library, Gettysburg College, Gettysburg, Pennsylvania.

Hovde, David M. “The U.S. Christian Commission’s Library and Literacy Programs for the Union Military Forces in the Civil War.” Libraries & Culture 24, no. 3 (1989): 295-316. Accessed September 10, 2016.

Katcher, Philip. “Union soldiers had a mixed verdict on the effectiveness of the U.S. Christian Commission.” America’s Civil War 15, no. 4 (September 2002): 12. Accessed September 10, 2016.

U.S. Christian Commission Dogtag. Civil War Vertical File Manuscripts. Special Collections/Musselman Library, Gettysburg College, Gettysburg, Pennsylvania.

Image: USCC headquarters in Germantown, VA. Photo via Library of Congress.


Julian John Chisolm: Class of 1850


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

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

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

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

Tuesday, February 14, 2017

Grave’s Anatomy: Abolitionists, Body Snatchers, and the Demise of Winchester Medical College

By Kaylyn Sawyer ’17

GRAVE, n.  A place in which the dead are laid to await the coming of the medical student.

A census in 1890 listed Chris Baker’s occupation as “Anatomical Man.” While the title sounds like that one of today’s superheroes, the nineteenth century existence of this vocation kept people from lingering around medical colleges after dark. By day, Chris Baker worked as a janitor for the Medical College of Virginia in Richmond. By night, he had the darker task of obtaining corpses for the school. He was a “resurrectionist,” and he was not alone in his eerie nocturnal task of preying on the powerless and recently interred with a shovel, bag, and cart close at hand. Until legislation governing the supply of anatomical material in Virginia was passed in 1884, grave robbing and body snatching were primary means of obtaining cadavers for medical school instruction. African American cemeteries and potter’s fields were primary targets, and medical students themselves were often the perpetrators. For students at the Winchester Medical College, this unseemly practice would lead to the destruction of their school.

The College of Physicians of the Valley of Virginia at Winchester was incorporated in December 1825. It closed its doors in 1829 but reopened in 1847 under a new charter as the Winchester Medical College.  Among the faculty was surgeon Hugh H. McGuire, a native of Winchester. His son, Hunter Holmes McGuire, would graduate from the school and teach as a faculty member before commissioning as a surgeon in the Confederate Army, where he served as medical director of the Army of the Shenandoah on General Thomas Jackson’s staff. The College was a red brick structure that contained a surgical amphitheater, two lecture halls, a dissecting room, a chemical laboratory, a museum, and offices.

As abolitionist John Brown and his followers raided the armory and arsenal at nearby Harpers Ferry in October 1859, Winchester’s medical students, goaded by curiosity and sensing opportunity, travelled there by train. As the story goes, they were forced by military authorities to detrain before they reached the station, and they happened upon the body of a man. They put the body into a container and shipped it back to the college, where they later examined his papers and discovered that he was one of John Brown’s sons. The cadaver was dissected, and the skeleton displayed in the college museum. As described by Louis De Caro, Jr., “The remains of Watson Brown…were maliciously stolen away by students of the Winchester Medical College…and ‘the whole hung up as a nice anatomical illustration’.”  The body of Watson Brown would be joined in December by the recently hung, buried, and disinterred bodies of convicted African American co-conspirators John Copeland and Shields Green. As reported in the Richmond Dispatch, “They will be interred tomorrow on the spot where the gallows stand, but there is a party of medical students here from Winchester who will doubtless not allow them to remain there long.” Thus, while John Brown’s body lay “a-mouldering in the grave,” the corpses of his son and two followers had little time to molder before falling prey to the resurrectionists.

For Winchester Medical College, the resurrectionists’ zeal would bring about destruction. The start of the Civil War drew students and faculty away from studying and toward the excitement of battle. The medical college ceased teaching and transformed into a hospital for the wounded. In May of 1862, while Winchester was occupied by Union forces engaged in the Shenandoah Valley Campaign, the college was burned to the ground supposedly on orders of Union General Nathaniel Banks in retaliation for the dissection of Watson Brown’s body. James Monroe of Oberlin College quotes Winchester Medical College graduate D.B. Conrad: “The College was burnt by General Banks’ army in May 1862. He himself regretted it, but his New England doctors and chaplains did it – applied the torch with their own hands.”    It is reported that a surgeon in the Union Army took the remains of Watson Brown back to Indiana with him, where they remained for nearly twenty years. The body was ultimately recovered by the Brown family and reached its final resting place for burial near John Brown in North Elba, New York in 1882. As for the Winchester Medical College, it was never rebuilt. In an ironic twist of grim fate, the Winchester Medical College, like Watson Brown’s body, was ultimately undone by its’ own “anatomical men.”


Bierce, Ambrose. The Devil’s Dictionary.

Blanton, Wyndham Bolling. Medicine in Virginia in the Nineteenth Century. Richmond: Garrett & Massie, Incorporated, 1933.

DeCaro, Louis A. Freedom’s Dawn: The Last Days of John Brown in Virginia. Lanham, MD: Rowman and Littlefield, 2015.

Griset, Rich. “Black Market.” Style Weekly, August 18, 2010.

“John Brown’s Son.” The Weekly Wisconsin (Milwaukee, Wisconsin), November 1, 1882.

Kinney, A. Bentley. “A Skeleton’s Revenge: The Burning of the Winchester Medical College.” Winchester-Frederick County Historical Society Journal 7 (1993): 33-50.

Monroe, James. “James Monroe: A Journey to Virginia in December 1859.” Electronic Oberlin Group. February 11, 2009. Accessed September 30, 2016.

Nudelman, Franny. John Brown’s Body: Slavery, Violence, and the Culture of War. Chapel Hill: University of North Carolina Press, 2004.

“The Executions at Charlestown.” The Richmond Dispatch, December 19, 1859.

Image: Chris Baker (left) with anatomy students at the Medical College of Virginia around 1899. Image courtesy of Special Collections and Archives, Tompkins-McCaw Library, Virginia Commonwealth University.


History of Surgical Treatment of Appendicitis (Article in Serbian)

By Meljnikov I1, Radojcić B, Grebeldinger S, Radojcić N.


Most of the history of appendicitis and appendectomy has been made during the past two centuries. Jacopo Berengario da Carpi gave the first description of this structure in 1522. Gabriele Fallopio, in 1561, appears to have been the first writer to compare the appendix to a worm. 

In1579 Caspar Bauhin proposed the ingenious theory that the appendix served in intrauterine life as a receptacle for the faexes. Many of anatomists added more or less insignificant ideas concerning the structure of the appendix and entered upon useless controversy concerning the name, function, position of the appendix vermiformis. The first successful appendectomy was performed in 1735 by Claudius Amyand. 

Geillaume Dupuytren considered that acute inflammation of the right side of the abdomen arose from disease of the caecum and not the appendix. As surgeons were wary of opening the abdomen for examination, early stages of appendicitis remained unknown. John Parkinson was able to give a good description of fatal appendicitis in 1812. Surgeons began draining localised abscesses which had already formed. 

In 1880 Robert Lawson Tait made the first diagnosis of appendicitis and surgically removed the appendix. In 1886 Reginald Heber Fitz published a study on appendicitis and named the procedure an appendectomy. In 1889, Tait split open and drained an inflamed appendix without removing it. Charles McBurney proposed his original muscle splitting operation in 1893 and this was modified by Robert Fulton Weir in 1900. Today we have a multiplicity of signs and symptoms, helping to diagnose appendicitis, and there are a lot of techniques for operation with little essential difference throughout. Kurt Semm performed the first laparoscopic appendectomy in 1981 which became a new gold standard in surgical treatment of acute and chronic appendicitis.


The Ladies Union Aid Society of St. Louis (LUAS)


We often see photographs of women who were serving with the U. S. Sanitary Commission in the East. Jessie Fremont was the wife of General John C. Fremont and daughter of prominent Missouri Senator Thomas Hart Benton. She urged her husband to set up a separate Western Sanitary Commission in St. Louis to serve the Trans-Mississippi region. Gen. Fremont issued an order that established the Western Sanitary Commission in St. Louis, Order No. 159. A primary purpose was to provide doctors and nurses for the hospitals in the fight in the West. It opened or supplied some 15 hospitals in St. Louis as well as hospital ships and trains that brought the wounded from the battles on the Mississippi to St. Louis. Eventually, the WSC also provided assistance for soldiers in St. Louis who had no funds for lodging, refugees from the South, and newly freed people in the city.

Another organization, the Ladies Union Aid Society of St. Louis (LUAS) actually preceded the WSC in its founding. The LUAS was organized on August 2, 1861 and the WSC on September 10, 1861. Many of the women whose names appear in our thread on Women of Missouri like Mrs. Anna Clapp were members of the Ladies Union Aid Society of St. Louis ( with Mrs. Clapp being the president. They met initially in the founders' homes, but the group soon became too large and they were given a room for meetings in the Military Hospital in downtown St. Louis. The LUAS met each week at 3:00 pm on Friday for reports from hospitals and their other activities.

The Union military authorities weren't prepared for the numbers of the wounded that would be transported to St. Louis, where there were hospitals such as New House of Refuge, Jefferson Barracks, City General, Good Samaritan, Marine, Pacific, Hickory Street, Benton Barracks, Lawson, Eliot, Schofield Barracks, City and Sisters, Invalid Corps Hospital, and the Gratiot Prison Hospital to care for them. LUAS members worked in the hospitals, visited the sick now in St. Louis due to the war, and provided for burial expenses. They also raised considerable amounts of money to support these efforts. Some LUAS members like Adaline Couzins would be injured or suffer frostbite as they went into the field to nurse the wounded. Ms. Couzins had been badly frostbitten early in the war and was later hit by a minie ball at Vicksburg. Arethusa Forbes was also frostbitten attending to soldiers in the field. The deaths of Mrs. Margaret Breckinridge and Mary Palmer were attributed to exhaustion from their work for LUAS.

Sometimes the statements about women's efforts during the Civil War seem to be along the lines of "They rolled bandages and visited the soldiers in the hospital, bringing them flowers and reading to them." I don't know whether the actions of women in Missouri were more than elsewhere, or whether they were just better documented. This passage from the recording Secretary of the LUAS describes the kind of baskets which were delivered to those convalescing in the 14 hospitals that LUAS dealt with:

"Within was a bottle of cream, a home-made loaf, fresh eggs, fruit and oysters;, stowed away in a corner was a flannel shirt; a sling, a pair of spectacles, a flask of cologne; a convalescent had asked for a lively book, and the lively book was in the basket; there was a dressing-gown for one, and a white muslin handkerchief for another; and paper, envelopes for all.” Woman's Work in the Civil War: A Record of Heroism, Patriotism and Patience, Linus Pierpont Brockett, Mrs. Mary C. Vaughan, p. 632.

18thVirginia said: ↑
The Union military authorities weren't prepared for the numbers of the wounded that would be transported to St. Louis, where there were hospitals such as New House of Refuge, Jefferson Barracks, City General, Good Samaritan, Marine, Pacific, Hickory Street, Benton Barracks, Lawson, Eliot, Schofield Barracks, City and Sisters, Invalid Corps Hospital, and the Gratiot Prison Hospital to care for them. LUAS members worked in the hospitals, visited the sick now in St. Louis due to the war, and provided for burial expenses. They also raised considerable amounts of money to support these efforts. Some LUAS members like Adaline Couzins would be injured or suffer frostbite as they went into the field to nurse the wounded. Ms. Couzins had been badly frostbitten early in the war and was later hit by a minie ball at Vicksburg. Arethusa Forbes was also frostbitten attending to soldiers in the field. The deaths of Mrs. Margaret Breckinridge and Mary Palmer were attributed to exhaustion from their work for LUAS.

Thanks for the thread, 18th! Yes, they did indeed lay it all out. What's crazy is how many of these women were lost. It's very tough getting ' the word out ' on them, too. You see their photos, care worn, battered, so faded by the time anyone has asked for a photograph and no one imagines this uninteresting looking female has incredible stories attached to her. Many who died I cannot find, when coming across a mention of them in someone's diary or journal. There will be an entry of a death " Mrs. Reed died today of typhoid after being here for only 6 weeks. She was buried with many tears. " That kind of thing. It's so prevalent, makes me wonder if there are statistics, you know?

No, it's not just Missouri- women from all over, North and South had the same kind of stories. It's just always been extremely hard, knowing how to convey who did what, you know? Some organizations were poorly funded but rich in intent- these lost a lot of workers to disease and over work. Some, the bandage rollers, tended to make a lot of noise over volunteering, maybe had an awful lot of resources but stayed little distant from the action. I wonder if there's a list somewhere?

But then, how do you include women like those in towns post battle? Virginia Wade's sister handed her baby, Lewis McClellan to her mother and walked to the hospitals.

The work accomplished by the Ladies Union Aid Society of St. Louis was very impressive. One quote I read from a Union soldier about the Confederate leaning women of Missouri said they were "spunkier" than some other women. I'd say that went for both Union and Confederate women of Missouri--makes me quite proud to count a great-grandmother from Missouri.

The LUAS went far beyond just carrying baskets to the convalescing soldiers and supplying nurses to the many St. Louis hospitals and the hospital ships. Finding a need for hospital clothing, they received $5,500 from the Western Sanitary Commission to sew 75,000 pieces of clothing. Soldiers' wives who needed to earn extra money were hired to provide the sewing. The Medical Purveyor then gave them a contract for $6,000 to produce 128,000 articles of clothing. Sewing machines were available in the LUAS headquarters for the women to use.

LUAS also received a contract for 261,00 yards of bandages.

In 1864, the Western Sanitary Commission and the Ladies Union Aid Society collaborated on the Mississippi Valley Sanitary Fair of 1864, to raise funds for their hospitals and the many wounded soldiers flowing through St. Louis. Though the men of the Western Sanitary Commission chaired most of the committees, it is generally agreed that the LUAS women did most of the work and personed the booths.

The Fair lasted from May 17 to June 18, 1864 and raised $550,000. Admission to the Fair to view the booth exhibits of sewing machines, hardware, and other knitted, embroidered or quilted crafts by the women of St. Louis started at $2 and went to .50 after the initial days.

The most popular booth at the fair was The Delphic Oracle, a fortune-telling booth.

Civil War Helped Shape Today's Medical Practices

By Carolyn Kimmel for Body & Mind Magazine, 11-13-12

The words "butcher" and "barbaric" may often be used to describe medical practices during the Civil War, but today's soldiers owe a lot to the forefathers who tended to the sick and wounded in Gettysburg and elsewhere.

"There were definitely medical advances that came out of the Civil War that are benefiting soldiers in Iraq and Afghanistan today," said Peter J. D'Onofrio, president of the Society of Civil War Surgeons, based in Ohio. "When I give talks, I say 'if you get nothing else out of tonight's talk, remember we can't look back at the surgeons of the Civil War and judge them in the context of today's medicine.'"

Our ambulatory and evacuation systems that carry wounded soldiers to help, our understanding of sanitization and even our respect for female nurses all trace their roots to the Civil War, historians say.

“One of our slogans here is ‘Civil War medicine — it’s not what you think,’” said George Wunderlich, executive director of the National Museum of Civil War Medicine in Frederick, Md. “Much of our modern neurology, plastic and reconstructive surgery, even occupational therapy — these people were inventing it and what’s amazing to me is how well they were doing, considering they were inventing it as they went along.”

As the battle unfolded around them, major players in the Civil War realized they were woefully unprepared.

“They never anticipated the war lasting that long or that kind of carnage,” D’Onofrio said.
As a result, they were writing medical procedure manuals as they went, inventing protocol and demanding better, more expedient care than was ever seen on the battlefield prior to 1862.

“By today’s standards, people think it was pretty primitive, but there was a lot of progress made during the Civil War,” said John Heiser, historian at the Gettysburg National Military Park.

Today’s soldier’s well-executed journey from battlefield to life-saving medical attention began with a war surgeon named Jonathan Letterman from Washington, Pa., who was medical director of the Army of the Potomac, the major northern army.

“Letterman is considered the father of battlefield medicine. He put all the parts of modern emergency medicine as we know it today into a chain,” Wunderlich said. “The movement of troops from injury to a medic to a field hospital to a general hospital to a bigger hospital is exactly how troops are moved today.”

Prior to this, when a soldier was injured, he would be helped off the field by several fellow soldiers who were not trained to give aid.

Letterman introduced the four-wheeled, horse-drawn wooden ambulance, piloted by trained drivers and carrying stretchers and medical supplies to the field, D’Onofrio said.

“Letterman also set up aid stations about 50 to 100 yards behind the firing line, hopefully in a wooded area or ravine, where basic first aid could be given. Then the soldier could be taken by ambulance to a field hospital, which might be a half mile to a mile away,” he said.

The improvements were readily apparent — at the battle of Antietam, there were only one or two first aid stations whereas at Gettysburg, there were more than 271 such stations, Wunderlich said.

Our triage system — a quick assessment to determine priority for treatment based on severity of injury — also came out of the Civil War.

During the Battle of Gettysburg, nearly every barn, building and home was turned into a makeshift field hospital to care for the more than 23,000 wounded soldiers left behind. Letterman’s new administrative plan assured good communication among field hospitals, and his insistence upon a surgical team composed of the most experienced surgeons in the military division meant better care, Wunderlich said.

“We’re still following Letterman’s plan,” D’Onofrio said. “You usually have a medic with a unit who will patch up the wounded soldiers as best they can and they will be helicoptered out to one of the permanent bases in, say, Afghanistan, or later transported to Germany or to Walter Reed [Army Medical Center] in Washington. That helicopter is the equivalent of that wooden ambulance and that tiered system of evacuation is from Letterman.”

“The concept of moving someone swiftly to a place where they could be better cared for came from the Civil War,” agreed G. Craig Caba, Civil War author and member of the Harrisburg Civil War Round Table.

At the National Museum of Civil War Medicine, which specializes in training military medical professionals, Letterman’s principles of 150 years ago are still taught as best practices, Wunderlich said. “You can have all the technology in the world, but if you can’t get the patient there while he’s still alive, it’s no good,” he said.

Sanitary conditions are standard protocol in medical facilities today, but in Civil War times, scientists Joseph Lister and Louis Pasteur had yet to link bacteria with infection.

“For every one soldier killed outright, two died from disease and infection,” D’Onofrio said. “Doctors knew about these things; they just didn’t know what caused them.”

Consequently, army surgeons amputating limbs — the preferred remedy of the day especially when bone was shattered — in a makeshift field hospital didn’t give a thought to bacteria, Heiser said. They might even use the same instrument on multiple patients.

“The amputation might be successful, but could he survive the possibility of gangrene or infection that might set in?” Heiser said.

An understanding of the correlation between sanitization and diseases and infection came out of the Civil War, historians said.

Some of the advances were stumbled upon, Heiser said. For example, some hospitals that had washed bandages in hot soapy water, out of desperation to reuse them, noted their infection rates were lower than most and realized they had unwittingly been sanitizing bandages, he said.

The medical realities of the Civil War led to a greater interest in the field of medicine, Caba said. He owns an 1864 edition of Samuel D. Gross’s “System of Surgery,” a thick, yellowed directory on everything from gangrene to amputation. Who knows but a Civil War doctor might have referred to this very volume even as shells exploded around his field tent, Caba said.

“You began to see greater numbers at medical schools and greater numbers of females going into nursing,” he said. “This was really the first time that you began to see women respected for the medical care they offered. They were called angels of mercy. Fifty years later, at reunions, men would still be giving them three cheers.”

At the time of the Civil War, there were only 600 trained nurses in the nation and all of them were Catholic nuns, D’Onofrio said. During the war, some 5,000 to 6,000 women came forward to serve as nurses for the North; records for the South were lost in a later fire in Richmond, he said.

“Few of them were formally trained, but remember back then, women took care of the family when they were sick or injured so they had that experience,” he said.

All Americans, soldier or civilian, are benefiting from the medical services introduced during the Civil War, historians said.

“We didn’t have ambulance services and emergency rooms in hospitals until well after the Civil War. Why not? The answer is because of the war,” Wunderlich said. “The Civil War changed the expectations of hundreds of thousands of men who went through a medical system that was changing, and they are ones who instigated these improvements in major cities across the country.”

Image: A field exhibit at The National Civil War Museum in Harrisburg depicts Civil War medical practices.


Confederate Medical Department


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

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

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

The Hospital of the Sisters of Charity


In the late fall of 1828, four members of the Daughters of Charity of St. Vincent De Paul traveled the 1,500 miles from their convent in Emmitsburg, Maryland to St. Louis, Missouri, to found the first hospital west of the Mississippi River and the first Catholic hospital in the United States. The American branch of the Daughters of Charity was founded by St. Elizabeth Ann Seton and stemmed from the religious order founded by St. Vincent De Paul in 1633 in France.

The “Sisters Hospital” was opened in a three-room log cabin, a building that had been donated by St. Louis cotton merchant John Mullanphy. By 1832, the small hospital could no longer accommodate the growing number of patients, and a 3-story brick building was constructed. At the request of the St. Louis mayor, Dr. William Carr Lane, the Sisters’ Hospital operated as the official City Hospital until a municipal hospital was built in 1846. In 1861 Dr. Simon Pollak opened the first eye and ear clinic west of the Mississippi River in the Sisters’ Hospital. He was also the first to hire a woman physician, Dr. Nancy Leavell, as his assistant in the clinic. During the Civil War, the Sisters Hospital staff cared for both Union and Confederate soldiers.

A third and larger hospital was constructed in 1874 at Montgomery and Bacon Streets in north St. Louis. In recognition of the continued financial support of the Mullanphy family, the hospital was called the St. Louis Mullanphy Hospital. In 1894 the hospital opened its Training School for Nurses. The main structure, with its east and west wings, was a 4-story, red-brick building that could accommodate 300 patients.

During World War I, one wing of Mullanphy Hospital was set aside as an isolation ward for treatment of soldiers with influenza. Much of Mullanphy Hospital was destroyed in 1927 when a tornado swept through St. Louis. A new hospital building was constructed on North Kingshighway Blvd. at Wabada Avenue, and opened in 1930. This new hospital was named DePaul Hospital, after the sisters’ founder. Resident training was approved and started in 1931. In 1954 an 8-story nursing school and residence was built adjacent to the hospital. DePaul Hospital became the first hospital to inaugurate rooming-in and family-centered maternity care in 1961. In 1963 an intensive care unit was opened.

As the population of St. Louis shifted out of the city and into the surrounding St. Louis County, DePaul Hospital broke ground in Bridgeton in 1972 for a large, modern medical center, which was opened in 1975. The 450-bed DePaul Health Center continues in operation today as part of the SSM Health Care system.

Image 1: The Hospital of the Sisters of Charity, ca. 1854. At the time the 3-story hospital was located facing Spruce Street, between 3rd and 4th Streets.

Image 2: Mullanphy Hospital, 1874-1927

Under the Knife

By Terry L. Jones, 11-17-12

On Aug. 28, 1862, Maj. Gen. Richard S. Ewell’s Confederate division was fighting desperately in the fields and pine thickets near Groveton, Va., during the Second Bull Run campaign. Heavy fire was coming from unidentified soldiers in a thicket 100 yards in front. To get a better look, Ewell knelt on his left knee to peer under the limbs. Suddenly a 500-grain (about 1.1 ounces) lead Minié ball skimmed the ground and struck him on the left kneecap. Some nearby Alabama soldiers lay down their muskets and hurried over to carry him from the field, but the fiery Ewell barked: “Put me down, and give them hell! I’m no better than any other wounded soldier, to stay on the field.”

The general lay on a pile of rocks while two badly wounded soldiers nearby cried out for help until stretcher bearers finally arrived on the scene. Despite their own painful wounds, the two men insisted Ewell be carried off first, but he instructed the litter bearers to take them away. Hours after being wounded, Ewell was finally placed on a stretcher and taken to the rear. Dr. Hunter McGuire, Gen. Thomas J. “Stonewall” Jackson’s medical director, amputated Ewell’s leg the next day.

Campbell Brown, Ewell’s aide and future stepson, witnessed the operation. McGuire and his assistants sedated Ewell with chloroform and used a scalpel to cut around his leg just above the knee. In his drug-induced fog, Ewell feverishly issued orders to troops, but he did not appear to feel any pain until McGuire applied the bone saw. According to Brown, the general then “stretched both arms upward & said: ‘Oh! My God!’”

McGuire opened up the amputated limb to show the officers in the room that the operation had been necessary. The bullet had “pierced the joint & followed the leg down for some inches,” Brown later wrote. “When the leg was opened, we found the knee-cap split half in two — the head of the tibia knocked into several pieces — & that the ball had followed the marrow of the bone for six inches breaking the bone itself into small splinters & finally had split into two pieces on a sharp edge of bone.” Brown and a slave wrapped the bloody limb in an oilcloth, and the slave “decently buried” it in the garden. Brown kept the two pieces of bullet as souvenirs for his mother, who was engaged to Ewell, although he never told the general he had done so.

Rank was no protection from such brutal operations, and General Ewell was just one of many high-ranking officers to face the surgeon’s knife. In fact, statistically speaking, a Confederate general was more likely to require medical treatment than a private. Almost one out of four died in the war, compared with 1 out of 10 Union generals. Of the 250 Confederate generals who were wounded, 24 underwent amputations. General Ewell was one of the lucky ones who survived and returned to duty many months later with an artificial leg.

Approximately two out of every three Civil War wounds treated by surgeons were to the extremities because few soldiers hit in the head, chest or stomach lived long enough to make it back to a field hospital. From a technical point of view, damaged limb bones presented the greatest challenge to surgeons. The war’s most common projectile, the large, oblong Minié ball, often tumbled when it hit the body and caused much more damage to bone than smoothbore musket balls. One Confederate surgeon observed, “The shattering, splintering, and splitting of a long bone by the impact of a minié or Enfield ball were, in many instances, both remarkable and frightful.” When bone was damaged, surgeons had to decide quickly on one of three possible treatments. If it was a simple fracture, a wooden or plaster splint was applied, but if the bone was shattered the surgeon performed either a resection or an amputation.

Resection involved cutting open the limb, sawing out the damaged bone, and then closing the incision. It was a time-consuming procedure and required considerable surgical skill, but some surgeons became quite proficient at it. After the Battle of Savage’s Station in 1862, one Union surgeon completed 26 resections of the shoulder and elbow in a single day. He was said to be able to eat and drink coffee at the operating table while pieces of bone, muscle and ligaments piled up around him.

Besides being a difficult procedure, resection also carried a high risk of profuse bleeding, infection and postoperative necrosis of the flesh. Successful resections, however, allowed the patient to keep his limb, although it was limp, useful merely to “fill a sleeve.” Because of the time required, resections were not always practical when there were large numbers of patients to treat, but they were used more frequently after surgeons learned that amputations had a much higher mortality rate.

The amputation process was fairly simple. After a circular cut was made completely around the limb, the bone was sawed through, and the blood vessels and arteries sewn shut. To prevent future pain, nerves were then pulled out as far as possible with forceps, cut and released to retract away from the end of the stump. Finally, clippers and a rasp were used to smooth the end of the exposed bone. Sometimes the raw and bloody stump was left untreated to heal gradually, and sometimes excess skin was pulled down and sewn over the wound. Speed was essential in all amputations to lessen blood loss and prevent shock. An amputation at the knee was expected to take just three minutes.

Civil War surgeons almost always had chloroform to anesthetize patients before an amputation. The chloroform was dripped onto a piece of cloth held over the patient’s face until he was unconscious. Although not an exact science, the procedure worked well, and few patients died from overdose. Opium pills, opium dust and injections were also available to control postoperative pain.

The mistaken belief that amputations were routinely performed without anesthetics can be partially attributed to the fact that chloroform did not put patients into a deep unconscious state. Bystanders who saw moaning, writhing patients being held down on the table assumed no anesthetic was being used. As in the case of General Ewell, patients often reacted to the scalpel and bone saw as if in pain, but they did not remember it afterward. After his left arm was amputated (Dr. McGuire also performed that operation), Stonewall Jackson mentioned that he had heard the most beautiful music while under the chloroform. Upon reflection, he said, “I believe it was the sawing of the bone.”

Because surgeons preferred to operate outdoors where lighting and ventilation were better, thousands of soldiers witnessed amputations firsthand. Passers-by and even wounded men waiting their turn watched as surgeons sawed off arms and legs and tossed them onto ever growing piles. The poet Walt Whitman witnessed such a scene when he visited Fredericksburg in search of his wounded brother. “One of the first things that met my eyes in camp,” he wrote, “was a heap of feet, arms, legs, etc., under a tree in front of a hospital.” Indeed, after the December 1862 Battle of Fredericksburg, Union surgeons performed almost 500 amputations.

Early in the war surgeons earned the nickname “Saw-bones” because they seemed eager to amputate. This eagerness stemmed not from overzealousness but from the knowledge that infections developed quickly in mangled flesh, and amputation was the most effective way to prevent it. Those limbs removed within 48 hours of injury were called primary amputations, and those removed after 48 hours were called secondary amputations. The mortality rate for primary amputations was about 25 percent; that for secondary amputations was twice as high, thanks to the fact that most secondary amputations were performed after gangrene or blood poisoning developed in the wound. Surgeons learned that amputating the limb after it became infected actually caused the infection to spread, and patients frequently died. Thus, the patient was much more likely to survive if a primary amputation was performed before infection set in.

Primary amputations were also preferred because it was easier and less painful to transport an amputee than a soldier whose broken bones and inflamed tissue made the slightest jostle sheer torture. One surgeon admitted that an excessive number of amputations may have been performed during the war, but he added, “I have no hesitation in saying that far more lives were lost from refusal to amputate than by amputation.”

Where the amputation was made on the limb was as vital to survival as when it was done. Generally, the higher up the amputation was made, the higher the mortality rate. This was especially true for thigh wounds. More than half of all soldiers who suffered a femur wound died, and amputations at or near the hip joint had a 66 percent mortality rate in the Confederate Army.

Nonetheless, it is estimated that approximately three out of four soldiers survived amputations. Amazingly, some, like Confederate Brig. Gen. Francis T. Nicholls, endured more than one. His lower left arm was amputated after he was shot at the First Battle of Winchester and his left foot was taken off when he was wounded at Chancellorsville. After the war, Nicholls was a popular Louisiana governor who was said to ask people to vote for “all that’s left of General Nicholls” and to support him for governor because he was “too one sided to be a judge.”

Often, surviving an amputation seemed to be completely random. While some, like Ewell and Nicholls, seemed unhindered by the surgery, others died from what appeared to be rather minor wounds. Two members of Company B, 19th Michigan Infantry, were shot in the index finger in the same battle during the Atlanta campaign. One man treated himself by cutting off the mangled finger with his pocket knife. He wrapped the stub in a handkerchief and waited until the battle was over to have the wound dressed at the field hospital. The other soldier went immediately to the surgeon for a proper amputation. Gangrene set in within days, and the surgeon was later forced to amputate his arm at the shoulder. The soldier died soon afterward. The man who treated himself made a full recovery and lived to a ripe old age.

Taking care of amputees put a significant strain on both wartime governments. The Union provided its disabled soldiers with prosthetic limbs made from cork wood, metal or rubber and gave amputees $8 a month as a pension. The Confederacy was unable to be so generous and by 1864 was providing just 10 percent of the needed prostheses. Incredibly, Mississippi’s single greatest state expenditure a year after the war ended was the purchase of artificial limbs for its veterans, which consumed 20 percent of the state’s budget. Some amputee veterans were forced to look after themselves and paired up to form “shoe exchanges” where they chipped in to buy a pair of shoes and each man took the one he needed.

Amputation was the most common Civil War surgical procedure. Union surgeons performed approximately 30,000 compared to just over 16,000 by American surgeons in World War II. One postwar British traveler noted that amputees were “everywhere in town and farm communities through the South.” The men who had survived the surgeon’s knife were a visible reminder of the Civil War for decades.

Sources: Terry L. Jones, “The American Civil War”; Terry L. Jones, ed., “Campbell Brown’s Civil War”; Donald C. Pfanz, “Richard S. Ewell”; Ira M. Rutkow, “Bleeding Blue and Gray”; Robert E. Denny, “Civil War Medicine”; Frank Vandiver, “Mighty Stonewall.”

Terry L. Jones is a professor of history at the University of Louisiana, Monroe and the author of six books on the Civil War.

Image: Unidentified soldier with both arms amputated.


Civil War Surgeries: The Truth Behind the Myth

By Karen, 3-3-14

You may have seen it in a film or read it in a book: a bloody Civil War surgery consisting of an incompetent surgeon, overeager to amputate, chopping off limbs unnecessarily and without anesthesia in a chaotic hospital tent. However, despite its prevalence, this traditional view of Civil War surgeries is mostly myth.

Myth 1: Surgeons amputated unnecessarily and too often.

The Civil War occurred before x-rays and antibiotics—and basic antiseptics, while used, were not used uniformly due to a lack of understanding of germs. As a result, infection was a deadly problem for the wounded, more deadly in fact than amputation. So when a man came in with a bone shattered by a bullet or artillery shell—especially if the bone was protruding through the skin—amputation was often the surest way to save the man’s life, as it would actually reduce the risk of fatal infection. If the surgeon didn’t amputate right away but waited instead, often until infection set in, the mortality rate rose from around 25 percent to twice that. In the Northern hospitals, after late 1862, if there was any doubt about whether a limb should be amputated, three surgeons were consulted; if the majority decided amputation was the right course, a fourth doctor would do the surgery. While there were certainly individual surgeons, especially early in the war, who amputated unnecessarily, surgeons in general were more likely to be criticized by other medical professionals for actually not amputating often enough.

Myth 2: Surgery was performed without anesthesia.

In reality, around 95 percent of operations, at least in the North, were done with anesthesia, often ether or chloroform. The rumor that the surgeries were done without anesthesia, a misconception widespread even at the time, was probably a result of the fact that the anesthesia didn’t always render the patient fully unconscious. Some patients under anesthesia were awake but numbed to the pain; others weren’t conscious of what was going on around them, but their bodies still reacted. Since many surgeries were performed outside—and even when they were done inside there were still bystanders—many soldiers saw the anesthetized patient thrashing around and yelling and assumed that meant he hadn’t been given anesthesia.

Myth 3: Military hospitals and their systems for operating were unorganized.

At the beginning of the war, this was generally true. The Northern military medical system wasn’t prepared for an extended war or for the number of casualties. But after 1862, when Jonathan Letterman was appointed medical director for the Army of the Potomac, things rapidly improved, at least in the North. Among the many changes he made, Letterman required the use of triage, reorganized how surgeons obtained their supplies, developed and unified the ambulance system, and hired hospital administrators.

Because of these and other misconceptions, Civil War surgeons were underappreciated then as well as today. While there were of course exceptions, as a whole the surgeons did the best they could with the knowledge and supplies they had. Walt Whitman—who spent countless hours visiting Civil War hospitals—perhaps summed it up best when he wrote, “I must bear my most emphatic testimony to the zeal, manliness, and professional spirit and capacity, generally prevailing among the surgeons, many of them young men, in the hospitals and the army. […] I never ceas’d to find the best men, and the hardest and most disinterested workers, among the surgeons in the hospitals. They are full of genius, too. I have seen many hundreds of them and this is my testimony.”

Image: Wounded soldiers in Armory Square Hospital, Washington DC; man with amputated arm at left and man with amputated leg at center



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