Then & Now: Caring for War's Dead and Wounded

From: pbs.org

A Civil War burial ground was a profoundly religious place. The circumstances of a person's death was thought to indicate much about the nature of one's afterlife; a "good death" meant passing at home surrounded by the family and friends one hoped to reunite with in heaven. The American Civil War upended these Christian notions of the proper way to die. On the battlefield, most soldiers died alone, anonymous, and without comfort, their families unaware of their fate.

Today, our government provides services for surviving veterans and their families, but it took the mass casualties of the Civil War to bring about this standard. The four-year war that claimed 2.5% of the American population caused the government to recognize the responsibility it owed to its soldiers and citizens, transforming the relationship between the nation and its people forever.

Before the Civil War:

*There was no effective ambulance corps to transport wounded soldiers from the battlefields to aid locations. As late as August 1862, a Union division took the field at the Second Bull Run without a single ambulance. After numerous pleas to the government by public health advocates such as Henry Bowditch, an ambulance corps was finally established in 1864.

*There were no federal hospitals providing comprehensive care. Wounded soldiers lucky enough to be rescued were taken to hastily established field hospitals constructed on an emergency basis. Volunteer relief groups, such as the U.S. Sanitary Commission, organized medical aid, while individual medical professionals such as Clara Barton bravely took to the battlefields to care for the wounded.

*Soldiers did not wear dog tags or have any system of personal records. Hundreds of thousand of bodies remained unidentified, leaving families with no knowledge of how their loved one died, or where they might be buried. When officials did attempt identification, it was often unreliable, resulting in live soldiers being recorded as deceased and dead soldiers being marked as only slightly wounded. By World War I, soldiers were wearing official id badges.

*There was no official system for notifying next of kin. If a body was identified, a fellow soldier might take it upon himself to write to the family of the deceased explaining how their loved one died and offering words of condolence. In the spring of 1865, Clara Barton established the Missing Soldiers Office in Washington, D.C. Her organization eventually helped provide information for about 22,000 soldiers who would have otherwise remained unknown.

*There was limited technology available to preserve the war dead for proper burial. With so many families requesting that the bodies of their deceased loved ones be transported home, preservation methods had to evolve beyond simply keeping a body on ice. When the use of arsenic in embalming fluid became widespread during the Civil War, the Medical Department of the Union Army set up battlefield embalming stations to put this chemical advancement into practice. This allowed bodies to be preserved for the often  long journey home.

*Using refrigerated transportation cases for bodies was not common. In addition to the advancements in embalming fluids, refrigerated transportation cases were greatly improved to preserve the body on its often long, and slow journey back home. The Staunton Transportation Company distributed fliers claiming that its "portable refrigerator" cases preserved the body in perfect condition.

*Federal services for veterans and their families were inadequate. After the war ended, the Nation's veterans assistance program expanded to include benefits and pensions not only for veterans, but also their widows and dependents. The first state veterans homes were also established which provided medical care even for injuries or diseases not acquired through battle. This paved the way for Congress to establish a new system of veteran's benefits when the U.S. entered World War I, which included disability compensation, insurance, and vocational rehabilitation for the disabled. In 1930, a comprehensive Veterans Administration was established, and today the system includes 152 hospitals, 800 outpatient clinics, 126 nursing home care units, and 35 domicillaries as well as numerous mental health and crisis prevention programs.

*There were no national cemeteries at Arlington, Gettysburg, or anywhere. As there were no federal provisions for burying the dead, responsibility for clearing a battlefield of dead bodies fell to individual units, volunteer organizations, and even civilians. It was almost two full years after the end of the Civil War before Congress finally passed formal legislation to establish and protect a vast system of national cemeteries.

*There was no Memorial Day. After the burial of many Union and Confederate soldiers, "decoration day" rituals began to spring up, which included placing fresh flowers on soldiers' graves. In the spring of 1868, General John Logan officially designated May 30th "for the purpose of strewing flowers or otherwise decorating the graves of comrades who died in the defense of their country," and Memorial Day as we know it today was established.

Today, the United States spends hundreds of millions of dollars a year trying to recover servicemen who are missing and presumed dead from World War II, Korea, and Vietnam. And with a $137.6 billion budget the Department of Veterans Affairs now offers dozens of programs, including medical and financial services.

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‘I Am Not Long For This World': An Irish-American Soldier Says Goodbye to His Family

From: irishamericancivilwar.com, 3-11-15

On 23rd February 1864, George Carl of the 7th Ohio Infantry sat by the bed of William Brophy of the 29th Pennsylvania, in the Union General Hospital at Bridgeport, Alabama. William’s end was near, and both men knew it. The soldier was suffering from chronic diarrhea, a cause of death that was listed for thousands of soldiers during the war. Unable to write himself, William dictated a letter to George, addressing his last thoughts to his wife back home in Philadelphia.

Although William Brophy is recorded as being born in England in the 1860 Census, there is little doubt that he was a member of the Irish-American community. Quite a number of pension files demonstrate earlier Irish emigration to England and Scotland prior to the ultimate move to the United States. William’s wife Bridget (née Mulhall) had been born in Ireland, and all the affidavits associated with the pension claim were provided by individuals bearing Irish surnames. The couple had been married at St. James Church, Philadelphia on 14th February 1858. It appears that William had been married previously, as he had two sons whose birth pre-dated the union; Andrew born on 13th July 1851 and Michael born on the 12th March 1854. Bridget gave birth to a daughter, Mary Ann, on the 3rd October 1861. Mary Ann had not yet arrived into the world when 32-year-old William marched off to war. He had enlisted in Company D of the 29th Pennsylvania Infantry on 8th July 1861.

William saw long and arduous service with the regiment over the course of the next few years, surviving a number of engagements. But by February 1864 illness looked certain to have done for him. Here is the letter he dictated to George Carl in Bridgeport during those final days:

Bridgeport, Alabama

February 23th /64

Dear Wife

With a sad heart that I write you this morning as it may be the last you ever will hear from me as I feal that I am not long for this world. but it greaves me much that I am not at home whare I could see all your loving faces once more before I leave this troublesome world but as it is gods will to take me away from you I hope that I may be better of in the better land. I hope that god may spare me a little longer but I thaught that I would write so as to have them ready at any moment if any thing should happen

well Dear Wife in regard to that money that James McMinon [owed?] it will not be long before it is dew and I hope that it will be of youse to you as I dont never expect to be thare again but if not in this world I hope in the next whare we will part no more

Well in regard to my backpay and bounty you can get someone to collect it for you as it will be of some youse to you give my love to my children and tell them of their father and to my brother and all friends and that I did not forget them

But I must close for the presant and maby for the last time in this world but hope that god may spare me a little longer but if not I will bid you all fare well hoping to meat you all in heavan

From your

Dear Husband Wm Brophy

George Carl added the following note to the letter three days later, indicated William’s fate, which had befallen him the previous day:

February the 26 1864

Mrs Brophy

Sory to relate that your husbond Wm Brophy died yesterday and is buried hear at Bridgeport

Any information you may want I will give frely as far as I can

No More

George K. Carl

Writer

If you wish to write to me direct to George K. Carl, Co. G. 7. Ohio Regiment, 1st brigade, 2nd Division, 12th Army Corps, Bridgeport Alabamy

When William died very few men from his unit were nearby. Those soldiers of the 29th Pennsylvania who had elected to re-enlist as veteran volunteers had left Bridgeport the previous December, heading home to enjoy their veteran furlough. As William lay dying in the General Hospital in Bridgeport, the majority of his comrades were back in Philadelphia with their loved ones. George Carl, the good Samaritan who wrote the letter for William and informed Bridget of his death, survived his war service. Bridget, who wasn’t yet 30-years-old when her husband died, re-married in 1867, wedding Irish laborer William Donnelly. William Brophy’s children would be unable to hold on to their father’s final words as a keepsake; the letter was submitted by Bridget to the Pension Office in order to claim a pension based on her husband’s service. After the war William’s body was moved to Chattanooga Military Cemetery, where he lies in Section H, Grave 11006.

Image: A hospital ward in a convalescent camp near Alexandria (Library of Congress)

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Post-Operative Care and Consequences during the American Civil War

By Adrienne Bruce

Surgical techniques became a priority for early medicine because there was such a high prevalence of limb and bodily destruction during the American Civil War. The regimental surgeon at the battlefield frontlines triaged more serious cases to be transported via ambulance to the field hospital in the rear of the battlefield, and here, a medical team would explore the wound and make the decision to resect or amputate, a decision often based on resources. While hemorrhage and loss of blood were common causes of death prior to surgery, infection control, pain management, and rehabilitation of veteran back into society determined post-surgical outcomes.

Of the 29,980 successful and reported amputations between 1861 and 1865, Union medical officials documented that 21,753 amputees survived (Jordan 2011). Despite the seemingly high amount of amputations during the Civil War, early nineteenth century physicians preached and practiced “conservative medicine." Based on this philosophy, they refrained from treating the patient when there was evidence that the disease or injury could have a favorable outcome without active interference (Figg and Farrell-Beck, 1993). While conservative medicine seems to contraindicate the necessity of amputations, surgeons believed that amputation was an end to a means, and that removal of the limb prior to infectious reaction would result in a more favorable outcome for the patient. Primary surgery, federally defined as surgical intervention within forty-eight hours of the injury, intervened prior to the onset of infection, but secondary surgery, intervention following the thirtieth day post-injury, was protocol for all injuries with expected inflammation (Figg and Farrell-Beck, 1993). Those that did not receive amputations by primary surgery were believed to be worse off in terms of morbidity and mortality, and the main source of these complications was infection as a result of operative inference.

Following surgery, soldiers and the medical staff were plagued with a road to recovery that involved pain management, infection control, and rehabilitation. Fortunately for Union troops, the United States Sanitary Commission, composed of laypeople and physicians, was established and approved on June 13, 1861 (Gilchrist 1998). Despite this safeguard to standardize medical treatment for military troops, two-thirds of amputees died during the first week following surgery (Watson 1985). While recurrent hemorrhage, gangrene, and erysipelas were of concerns, septicemia as a result of operative intervention was the worst fear of infections because it had a 100% mortality rate and did not manifest until after surgery (Watson 1985). Lint covering limb stumps was made by scraping woven linen and was then added to a wet compress of old muslin cloth and applied to the wound. However, water that was used to soak these compresses was often tainted with bacteria (Gilchrist 1998). Maggots were used to clean wounds because they ate dead tissue that provided a breeding ground for such bacteria. Additionally, potassium permanganate, sodium hypochlorite and nitric acid were used on wound treatment, particularly for gangrene (Gilchrist 1998). Staphylococcus aureus and Streptococcus pyogenes were the cause of the majority of post-surgical infections, and Streptococcus pyogenes was known to cause specifically hospital gangrene, an infection that was transmitted during the recuperation period following amputation (Gilchrist 1998). Furthermore, hospitals located in stable areas were ideal locations for the transmission of tetanus because Clostridium spores flourished in the manure-covered floors (Gilchrist 1998). Even with these treatment attempts, microbes killed more men during the Civil War than rifles and cannons because of poor sanitation.

Anesthesia use began during the 1840s and, thus, was poised to be a key factor in Civil War medicine. The major anesthetic agents were chloroform and ether administered with the help of a cloth formed into a cone-shape with a small sponge in the apex or with inhalers such as the Morton Ether Inhaler (Albin 2000). Additionally, chloroform and ether were often used in combination to attenuate the cardio-respiratory excitatory effects of chloroform, the decrease in flammability, and the stimulatory responses associated with ether, resulting in a mortality rate of 2.6 out of every 1000 patients (Albin 2000). Only about one-fourth of amputees received anesthesia during their surgery based on the records in the Medical and Surgical History of the War of the Rebellion. Both North and South experienced supply shortages that affected their ability to use anesthetics and distribute pain management. Northern troops had abundant supplies but their chaotic medical organization led to poor distribution of what was available. On the contrary, Southern troops experienced shortages due to Union naval blockages, resulting in less Confederate soldiers receiving anesthesia in comparison to Union soldiers. Additionally, the shortage of sponges in the South led them to use cotton rags and raw cotton as well as horse’s tail hair for surgical procedures. Southern surgeons were forced to boil cotton and the horse’s hair to remove dried blood from rags and make hair pliable for use in ligatures which inevitably reduced the spread of infection during surgery (Gilchrist 1998). Despite being at an increased disadvantage due to supplies shortage, Southern surgeons realized the potential of surgical sterilization prior to its full understanding.

Post-operative pain was controlled with opioids, specifically morphine. Morphine effectively managed pain but also heightened pain sensitivity, aggravated already existing pain problems, particularly in soldiers with previous amputations, and immunosuppressed soldiers creating additional infection control issues (Albin 2000). Despite its effective use, morphine use led to addiction that was known as “Army Disease,” which often led to increased crime, drug addictions, violence and unemployment among veterans (Dean 1991). It is hypothesized that many soldiers masked possible psychiatric and stress conditions related to their amputations under the guise of excessive morphine misuse.

As a result of the rise in amputations during the Civil War, the manufacturing field for prosthetics, artificial limbs, and other supportive devices exploded during the nineteenth century. Between 1846 and 1861, thirty-four patents for new or improved artificial limbs, crutches, and invalid chairs were recorded, and between 1861 and 1873, this number grew to one hundred thirty-three (Figg and Farrell-Beck 1993). While there were one and a half times more men that survived the War with upper extremity amputations than lower extremity amputations, there were more limbs and devices patented for the lower extremities (Figg and Farrell-Beck, 1993). Manufacturers sought to make their products strong, light, and durable for ease of gait and comfort but also quiet, non-corrosive, and realistic to help veterans assimilate into society despite their deformities. Despite such a crude appearance, these devices allowed veterans to return to their normal lives following the War.

Overall, the federal government provided little social or occupational rehab for disabled veterans prior to the War. In 1862 Congress began a general law pension system that allowed pension for soldiers with permanent bodily injury as a direct result of military duty following March 4, 1861 (Figg and Farrell-Beck, 1993). Starting in 1864, invalid veterans received a monthly pension for each disability, and each year this system increased payments and provided additionally for disabilities. Veterans were also eligible for an additional allowance to cover artificial limbs, which ranged in average cost of fifty to seventy-five dollars between 1863 and 1864. The Congressional Acts of 1866 and 1867 provided free transportation to and from artificial limb fittings and guaranteed replacement of these limbs every five years (Figg and Farrell-Beck, 1993). Through these implementations, the federal government sought to help Civil War amputees to assimilate into daily life and demonstrate its appreciation for their service.

Following the Civil War, the sheer volume of Union veterans’ claims led to absorption of substantial amounts of national resources. In fact, the federal government spent more funds on veterans between 1865 and 1870 than it had in the preceding eighty years (Gilchrist 1998). Veterans had to submit evidence and photographs of their injuries from physicians and affidavits of witnesses to the Pension and Records Division. Reviewed evidence was submitted for a decision from the Congressional officials (Gilchrist 1998). By the end of the nineteenth century, veterans received benefits that included incidental medical and hospital treatment for all injuries and benefits that covered their widows and dependents (Figg and Farrell-Beck, 1993). While the federal government’s provisions were vast for Union soldiers, they did not provide for former Confederates. Confederate amputees did not receive artificial limb assistance until 1864 when the Association for Relief of Maimed Soldiers provided them with benefits.

Armed with artificial limbs and support from the government, most soldiers who returned home were praised by both nurses and civilians. Their injury served as a symbol of courage and their survival was perceived as a form of pride (Figg and Farrell-Beck, 1993). While many returned to duty even after amputation, many found it difficult to return to work. Former generals initially found it easier to find occupations outside of the War because of their prestige, but the majority of veterans returned to farmlands. Both North and South government provided land for veterans to encourage farming endeavors. Additionally, the federal government passed Section 1754 in 1865 to grant preference to disabled veterans for civil service jobs. For example, the Lincoln Institute, an early predecessor of the Veteran’s Affairs, trained the disabled in telegraphy, typewriting, and bookkeeping (Figg and Farrell-Beck, 1993). The severely wounded often were used during the War as the Union’s Invalid Corps, men who worked as clerks, watchmen, cooks, and attendants due to the shortage of nurses.

Despite the federal government’s help in returning veterans to society, many veterans struggled psychologically with amputations and surgery on the battlefield. Some surgeons pioneered the idea of “irritable heart” or “trotting heart,” which were conditions that essentially defined stress, such as paralysis, diarrhea, and headaches. Such symptoms were often attributed to overexertion or sunstroke (Dean 1991). In fact, the Union Army did not recognize insanity as grounds for discharge, and surgeons had to send soldiers to the Military Hospital for the Insane in Washington to diagnose them. Even so, symptoms of stress short of total breakdown were still viewed as cowardice in society, and most veterans suffered the stress of warfare and amputation quietly (Dean 1991). Despite having survived the war and the complications of amputation surgery, many veterans still suffered in post-Civil War life. Through the consequences of both Civil War medicine and postoperative care during the Civil War, history suggests that the road to amputation was one of both physical and mental strife.

From: gucivilwarmed.blogspot.com

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A Place of Refuge and Medical Care: Thomasville, North Carolina

From: thomasvilletourism.com

John W. Thomas, who represented the Thomasville area in the State Legislature in the mid-1800s, laid out the town of Thomasville in 1852 on the proposed route of the North Carolina Railroad. Three years later, this line was completed to the new town, and the first train passed through on January 20, 1856. By 1860 Thomasville was thriving with 308 residents, a female seminary and a shoe factory. During the war, two companies, including the renowned “ Thomasville Rifles”(Co. B, 14th NC Infantry), served in Confederate General Robert E. Lees’ Army of Northern Virginia.

In 1864, Gen. James Longstreet’s corps passed through Thomasville on the railroad in route from Georgia to rejoin Lee’s army in Virginia. Many of the soldiers who boarded trains (200 feet from the current Depot) later fell in the Seven Days’ Battles, at Sharpsburg (Antietam), Gettysburg, and in the wilderness. Thomasville grew during the Civil War at first because of the importance of its shoe factories (local factories produced shoes for the Confederate cause) and later because of the hospitals. The Union occupation of North Carolina’s coastal region in 1862 caused the 1st influx of civilian refugees and wounded soldiers. A smallpox hospital was located in Thomasville prior to the war; local churches were turned into makeshift hospitals during the war; and convalescent facilities for soldiers arose during and after the war.

A Place of Refuge and Medical Care: Thomasville provided a refuge for wounded and ill soldiers and civilians fleeing from war-torn eastern North Carolina. Confederate Gen. Joseph E. Johnson established hospitals in a tobacco warehouse and in the local Baptist and Methodist churches in March 1865, as his army of Tennessee retreated north. Confederate Surgeon Simon Baruch led the medical efforts. Local citizens ripped out church pews, gathered pine straw for makeshift beds, gathered food, drink and generally assisted in the care of wounded soldiers, both Northern and Southern.

Thomasville City Cemetery
One of a Kind While hospitals were established in a tobacco warehouse and in the local Baptist and Methodist churches in March 1865, all able bodied men, women and children in town ripped out church pews, gathered pine straw for makeshift beds, gathered food, drink and generally assisted in the care of wounded soldiers, both Northern and Southern. Union and Confederate soldiers who died in the hospitals were interred in Thomasville’s City Cemetery side by side. This is the only such grave site in the world. Three rows of 12 headstones have the names of the soldiers on them with the dates of 1861-1865 with the exception of the markers for unknown soldiers. The 36 soldiers are accounted for as such: Confederate soldiers- 28; Union soldiers- 4; and unknown soldiers- 4.

The City of Thomasville was founded in 1852 as a stop along the fledgling North Carolina railroad, and by 1855 burials were made in this cemetery. The City provided hundreds of soldiers to the Confederacy, and grew during the Civil War in part due to its important industries and later because of the location here of hospitals and convalescent facilities for soldiers. The Union invasion of North Carolina’s coastal region in 1862 caused the first influx of civilian refuges and wounded soldiers.

In March of 1865, Confederate Gen. Joseph E. Johnson established hospitals in a tobacco warehouse and in Thomasville’s Baptist and Methodist churches as his army of Tennessee retreated north. Local citizens ripped out church pews, gathered pine straw for makeshift beds, gathered food, drink and generally assisted in the care of wounded soldiers, both Northern and Southern. (A CWT sign on Main St. where the churches were located, recounts this story.)

Union and Confederate soldiers who died in the hospitals were interred in Thomasville’s City Cemetery side by side. This is the only such grave site in the United States. Three rows of 12 headstones have the names of the soldiers on them with the exception of the markers for four unknown soldiers. (A CWT sign identifies the area within City Cemetery.)

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Convalescent Camp

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

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

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

IMAGE: Convalescent Camp near Alexandria, Virginia

FROM: sites.allegheny.edu

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