Late-Nineteenth and Early-Twentieth Century Pediatrics: The Development of a Specialty

By Cynthia Connolly, PhD, RN, FAAN

A Nineteenth Century Innovation: Hospitals for Children
In early 1879, a concerned citizen using the name “Fireside” penned an impassioned letter to the editors of Boston’s Evening Transcript. The paper published the heartfelt appeal to the citizens of Boston on behalf of the city’s Children’s Hospital on January 22.

Fireside wrote of the poverty observed on Boston’s streets by the casual onlooker:

"Men whose brutal faces made me shiver, women from whom every grace of womanhood had departed; and oh! More pitiful than all, the child faces that looked at me as I passed---the poor, wan faces, so pinched and pale with want and sickness, yet with a childlike innocence in their eyes . . ." (“Fireside”, 1879).

Fireside begged those who could afford it to send money to Children’s Hospital. Donations were a necessity, since the institution received financial support wholly through private funds. The writer may have also wanted to publicize the hospital’s existence since the idea of an institution devoted to the needs of children was a new concept. Until the mid-nineteenth century, there were no facilities dedicated to the care of sick children in the United States. If they could not be cared for at home, children, like their parents, went to municipal almshouses, also known as poorhouses. Orphaned or abandoned babies often ended up in infant asylums, which had been patterned after similar British institutions where the mortality rate approached 100 percent. By the 1860s in the United States, special hospitals for children were becoming a necessity, since many of the newly founded general hospitals simply refused to admit them (King, 1993).

The earliest children's hospitals admitted indigent or abandoned children, some of whom—but by no means all—were also ill. Many people during this era believed that immortality and poor character caused poverty. Since sickness and poverty often appeared together, providing spiritual guidance and moral uplift to the ill, in addition to offering food, clothing, and whatever other material provisions were needed, was supposed to help the poor rise above their condition and facilitate better health. Stratifying the needy into “deserving” versus “undeserving” categories helped charitable organizations and hospitals decide which individuals to aid. Because indigent children were considered the innocent victims of their parents’ bad choices or unsuitable lifestyles, they were, by definition, always deserving of assistance, and aiding them engendered little controversy (Katz, 1986).

Hospitalized children often resided at the institutions for months, and beyond fresh air and food, they were given few therapeutics, at least according to today’s standards. Those in charge of children’s institutions considered one of the most important interventions for the children to be their exposure to the wealthy trustees who ran the institutions. These individuals, usually socially prominent, were presumed to have better characters than the children's indigent parents, and they hired staff who they felt could help imbue the children with the qualities the trustees felt were important. Staff and trustees often discouraged or made it difficult for parents to visit their children, hoping that prolonged contact with staff would facilitate Americanization in immigrant children, and inculcate middle class behaviors and health practices among the native-born (Brosco, 1994; Vogel, 1980).

Fireside's description of the hospital’s environment, illustrated this practice:

"While there, in addition to their medical treatment and nursing, they are carefully taught cleanliness of habit, purity of thought and word, and as much regard is paid to their moral training as can be found in any cultivated family. Think what a widespread influence this becomes when the children return to their homes . . ." (“Fireside”, 1879).

Inventing Pediatric Medicine and Nursing
Physician Abraham Jacobi, considered by most to be founder of modern pediatrics, offered the first medical lectures on the diseases of childhood in 1860. Until the Civil War, pediatrics was considered part of obstetrics in the United States. Before Jacobi, medical specialties centered on a particular organ or technology. Jacobi felt that pediatrics should have a broader, more conceptual, focus. His vision was that pediatricians should concern themselves with child health well beyond mere disease. He advocated for the involvement of doctors who treated children in all aspects of child health including infant feeding, child hygiene, and disease prevention in well children. The pediatrician, he argued, could also use his talents to facilitate the Americanization of immigrants. Jacobi articulated a model for pediatrics with a focus well beyond specific diseases, one that involved disease prevention in healthy children, educating parents about child rearing, and social activism for children's rights.

In 1880, Jacobi and a few other interested physicians founded the American Medical Association’s section on the diseases of children. In 1888, they formed a new organization, the American Pediatric Society, which helped to solidify pediatrics as a distinct branch of medicine. Jacobi served as the first president of both groups. Framers of the American Pediatric Society recruited prominent physicians into their ranks to advance pediatrics’ acceptance. Early pediatricians such as Jacobi wrote prolifically in new journals and textbooks that focused exclusively on childhood diseases. They stressed the need for more children’s hospitals, and for the expansion of pediatric content in medical school curricula. By 1900, ten schools of medicine had full-time pediatricians (Halpern, 1988; Meckel, 1990; Viner, 2002).

Changing notions of disease causation synergized the development of pediatrics in the United States.  In the 1870s and 1880s, Robert Koch, Louis Pasteur, Joseph Lister, and others forged the germ theory of disease causation. These changes altered the role of the hospital in American life (Rosenberg, 1987) and reshaped pediatric nursing and medical care in the ensuing decades. By 1900, the organisms responsible for typhoid, leprosy, malaria, tuberculosis, cholera, diphtheria, and a host of other conditions were identified. Illness—at least infectious illness—left the realm of morality and religion. It gradually evolved, at least for infectious diseases, to receive its identity in the laboratory (Rosen 1958/1993).

An understanding of the bacterial origins of infectious diseases encouraged such advances as the use of surgical gloves and sterilization. When coupled with anesthesia, these interventions made pediatric surgery safer. Better surgical therapeutics helped make hospitals more medically oriented. As early as the 1870s, physicians at the Children's Hospital of Philadelphia, for example, pressured the lay trustees who managed the hospital to increase patient turnover and accept more acutely ill children, especially orthopedic surgical patients who had something to offer physician education and on whom new surgical techniques and therapies could be tried. This new emphasis on the medical needs of patients and the experimental needs of doctors and nurses conflicted with the social welfare role children's hospitals saw themselves as performing (CHOP, 1870-1880).

Children’s hospitals were highly visible in the communities in which they were founded. The individuals who worked there deservedly prided themselves for providing a social safety net for the ill or abandoned child who needed care. Moreover, children’s hospitals were also good for the burgeoning specialties of pediatric nursing and medicine (Brodie, 1998; Golden, 1989). The development of children’s hospitals helped pediatrics to evolve more quickly into a specialty branch of medicine and nursing because of the opportunities it afforded for training, the feeling of shared identity and unity it fostered in its staff, and the research opportunities indigent hospitalized children provided in an era in which no ethical guidelines governed research.

Over time, the proportion of children admitted for social welfare reasons began to fall while the number of those suffering from chronic medical conditions or requiring surgery rose. More hospitals also began to accept children with infectious diseases for the first time. For example, until the 1890s when the Children’s Hospital of Philadelphia developed accommodations to isolate potentially infectious children, the institution avoided admitting children with contagious diseases as well as infants for any reason (CHOP, 1893). As the hospital began to admit sicker patients, hospital trustees and physicians understood that trained nurses were essential for children to benefit from the burgeoning diagnostic and therapeutic modalities. The ongoing need for more and better-trained nurses resulted in the long anticipated inauguration of a nurse training school at the hospital in 1895, an advance that the Board noted answered  "a want, long felt" (CHOP, 1895).

Though the first pediatric nursing textbook was not published until 1923, articles addressing the needs of children appeared in nursing journals much earlier. (Farrar, 1906; Pierce, Cutler, & Bancroft, 1923). Florence Nightingale herself emphasized children's nursing care needs in her seminal 1859 book, Notes on Nursing, writing: "It is the real test of a nurse whether she can nurse a sick infant" (Nightingale, 1859/1992). Early publications highlighted such practices as infant feeding techniques and pediatric nursing procedures. Pioneering pediatric nurses such as Anna Haswell (1908) also stressed the special personality type required for children’s nursing asserting that:

The nursing of young children stands out as a division of our work needing special study. We have no branch that is more important . . . Let us be willing to do anything which will accomplish the greatest good for the child, and honor our profession by becoming more and more efficient in our ability to care for sick children (p 115).

Just what skills were necessary to ‘efficiently care for sick children’ in those days? Though the early nursing literature recognized that nurses needed educational preparation, the form that training took was different from today's. Until the twentieth century, nurses who specialized in children’s health trained in much the same way as their adult-oriented counterparts. Hospitals usually paid student nurses small allowances in addition to room and board, and in return these students worked, often largely unsupervised, on the wards caring for patients.

Students usually toiled twelve hours a day, six days a week for fifty weeks a year. The length of training was variable, ranging anywhere from eighteen months to three years. Nurses who wanted to specialize in child health tried to get their training either at a hospital with a children’s ward or at one of the few children’s hospitals. Once graduated, a few nurses assumed leadership positions in hospitals, but most sought private-duty positions in middle-and upper-class homes. The pay was poor and the hours irregular (Reverby, 1987).

Over the course of the twentieth century, hospital care for sick children of all classes became more commonplace, especially as new technologies and advances such as antibiotics made it possible to save the lives of more children. After World War II, an increasing number of subspecialties in children’s health care, such as neonatology and pediatric critical care, emerged from the rapidly expanding body of knowledge being generated.

Public Health Nursing and Children’s Health
Although institutions were central to the development of children’s health care, many advances arose from the early twentieth century public health movement and reformers efforts to publicize the plight of poor children. When Jacob Riis, New York City police reporter turned social reformer, wrote his 1890 book, How the Other Half Lives, his descriptions of the poor, especially the children, appalled people: “Seventy-two dead babies were picked up on the streets last year. Some of them doubtless were put out by very poor parents to save funeral expenses . . . bodies of drowned children turn up in the rivers right along in summer whom no one seems to know anything about” (Riis, 1890, p 180). Riis’s tales of children dying from starvation and disease, exhausted from overwork, and fending for themselves on the streets, galvanized reformers and helped stimulate the reforms that created our modern child labor laws and systems of juvenile justice, foster care, and government aid to poor families.

These reforms were needed because the United States was experiencing profound social and cultural changes wrought by industrialization, urbanization, economic growth, and population increase. Moreover, people poured into American cities from overseas. Many of these new immigrants, arriving mostly from Eastern and Southern Europe, were poor, spoke little or no English, and engaged in cultural practices foreign to earlier arrivals and the native-born. Masses of immigrants ended up in the ghettos of large cities where they faced even more awful conditions than did American migrants to the same urban areas. Living conditions were usually squalid, and immigrants often were forced to accept jobs so arduous or unsafe that native-born Americans shunned them. Their language and cultural practices were frequently objects of ridicule and suspicion.

The incidence of urban poverty exploded as immigrants and native born migrants crammed into tenements. Inadequate living conditions led to overcrowding, poor sanitation, disease, and increased crime (Cravens, 1985). For reformers such as Riis, “child-saving” represented a meaningful venue through which to cure these ills. Child-savers argued that children were impressionable, possessing the capacity to be uplifted, to rehabilitate their morally questionable parents and other family members, and to be easily Americanized if they were immigrants (Katz, 1986). As one prominent physician noted: "Anyone who has had practical experience recognizes only too well the almost hopeless task of trying to train and educate in the rules of hygiene and right living, ignorant, stupid people from the slums . . . Children, however, are easily trained" (Hawes, 1910, p 904).

Because of the writing and photography of reformers such as Riis, the plight of vulnerable children became more difficult to ignore in the late nineteenth century. Poor children and those orphaned or abandoned, were highly visible in cities. Children played in the streets, increasingly becoming victims of accidents. Contagious diseases and hunger were rampant. Poor maternal nutrition helped keep infant mortality high. Record keeping was sporadic until the 1920s and '30s, but what records that do exist indicate that at the dawn of the twentieth century one in every seven babies died. In some New England industrial towns, the infant death rate was as high as 30 percent. (Klaus, 1993; Meckel, 1990).

A New York City nurse, Lillian Wald, pioneered the new nursing specialty of public health nursing, an important engine of child-saving. In 1893, she and a colleague merged the concepts underlying district nursing and settlement houses by creating the nurse-managed Henry Street Settlement. Wald believed that bringing subsidized nursing care to the poor in their homes—care similar to that which the middle and upper classes could afford for themselves—both heightened the chances for its success and made treatment more humane. Wald also strove to improve the daily living experiences of children. Many Henry Street ventures focused on children health plays, train rides, summer camps, organized sports, music classes, playground for children to be outside. Wald (1915) evocatively brought turn of the century children’s health risks to life:

"One night during my first month on the East Side, [which would have been 1893] sleepless because of the heat, I leaned out of the window and looked down on Rivington Street. . . Sitting on the curb directly under my window, with her feet in the gutter, was a woman, drooping from exhaustion, a baby at her breast. The fire-escapes, considered the most desirable sleeping-places, were crowded with the youngest and the oldest; children were asleep on the sidewalks, on the steps of the houses and in the empty push-carts;. . . I looked at my watch. It was two o’clock in the morning (p 69-79)!"

One of Wald’s most significant accomplishments for children was her idea for school nurses. In 1902, Wald convinced the Board of Education to hire a Henry Street nurse to work in the school system. New York City had begun having physicians inspect school children for acute or infectious diseases in 1897. However, the children physicians identified as “sickly” were simply barred from attending school. Wald argued that this practice was inhumane and arranged for Lina Rogers, a Henry Street Settlement nurse to provide follow-up and home care to children (Wald, 1915).

Wald's activism helped spur the creation of the Children’s Bureau, the first government agency to be dedicated solely to children’s welfare, which was established in 1912 (Markel and Golden, 2005). Wald and other public health nurses throughout the nation worked at health departments to implement Children’s Bureau initiatives such as those aimed at preventing infant mortality. They also worked through private agencies to secure such health benefits as pure milk for children and families. Their efforts established nurses as a critical societal resource for children’s health.

When, a few years later, Congress enacted the first federal legislation for children’s health and welfare, the 1921 Sheppard-Towner Act, nurses coordinated many of its educational and health-screening efforts (Sealander, 2003). At the height of the 1930s Depression, nurses again sprung into action, providing health care to children through the Child Health Recovery Program and later through the Social Security Act (Markel and Golden, 2005). The importance of nurses to the success of child health programs became clear again in the 1960s through their participation in Medicaid-funded programs and in the new infrastructure needed to support the 1975 legislation that guaranteed a quality education for all children, even those with mental and physical disabilities. Today, an essential site for children’s health care delivery is the school-based health clinic, where school nurses and pediatric nurse practitioners address epidemics of child obesity, asthma, and mental health and behavioral problems (Halfon, 2007).

Image: Student nurse and children, Jewish Hospital, Philadelphia, PA c. 1900
                     

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Battlefield Orthopaedics: Civil War Style

By Elaine Fiedler

John M. Rathgeb, MD, brings history alive

Imagine being a doctor in the midst of the American Civil War. You might find yourself at a field station near the battlefield or at a general hospital treating the men in your charge. You are overwhelmed with shocking numbers of casualties, but you do your best to help others survive.

John M. Rathgeb, MD, dons the garb of a Civil War surgeon to give visitors to the National Museum of Civil War Medicine a sense of what surgeons faced during the conflict.

Although many of the soldiers die from disease, an endless array of battle injuries confront you. Soldiers hit in the head, chest, or abdomen have little or no chance of survival. Those with extremity injuries might survive, even though some may be crippled for the rest of their lives.

You put all your knowledge and experience into practice. Each day, you learn something new from your observations and from listening to the other doctors. Some things seem to work, but other attempts fail, and you are not sure why. Although you are not called an orthopaedic surgeon, more often than not, you are practicing as one—treating extremity injuries.

This is the world that AAOS fellow John M. Rathgeb, MD, strives to bring alive for audiences and visitors to the National Museum of Civil War Medicine (NMCWM) in Frederick, Md. A student of the Civil War for most of his life, Dr. Rathgeb’s interest in Civil War medicine may be his true passion.

“At the start, I got interested in the Civil War because my great-grandfather was in the 4th Pennsylvania Cavalry. So there was that connection and of course my own medical interest. Several years ago, I toured the NMCWM and was hooked,” recalls Dr. Rathgeb. “I started volunteering at the museum and did more research on Civil War medicine.”

A turning point in medicine
From a medical perspective, the conflict proved to be a major turning point, according to Dr. Rathgeb. “The Civil War is really the beginning of modern medicine in the United States. Before the war, German and French surgeons were considered the best in the world, but afterward, American surgeons were considered on a par with their European counterparts.”

Just as today’s wars in Iraq and Afghanistan are revolutionizing the treatment of extremity injuries with advances in combat casualty care, the American Civil War introduced a host of orthopaedic and surgical advances. Even though the dire consequences of bacteria and infection were not realized until after the war’s end, many modern medical practices originated on the battlefields and in the hospitals, including the use of pulleys and weights to realign lower extremity fractures (Buck’s traction).

Dr. Rathgeb points out that Jonathan Letterman, known as the “Father of Battlefield Medicine,” organized the Union Army’s medical service and first used triage. He established field hospitals and an ambulance corps. The huge Union medical encampment that served Union and Confederate soldiers at Gettysburg after the battle was even named Camp Letterman.

“The war was a turning point for medicine,” Dr. Rathgeb says. “Many of the surgeons who came out of the war were the movers and shakers of the late nineteenth and early twentieth centuries.”

Bringing the past to life
Since he first became involved with the museum 5 years ago, Dr. Rathgeb has developed into an engaging public speaker, who appears in period costume. “I give presentations on Civil War medicine on a regular basis. One talk focused on orthopaedic surgery during the war; another one featured a profile of a Civil War soldier, with a review of his medical history. My next talk will focus on four soldiers and compare their wounds.

“Civil War researchers are lucky,” he continues. “We have voluminous records of the soldiers, their injuries, and their treatment. When Richmond burned, Confederate records were lost, but we can still rely on the diaries of the Confederate surgeons. During the war, doctors from both sides exchanged ideas and medical information. They treated many cases of orthopaedic injuries, and tried different things, and did a lot of observation and saw what worked, even if they didn’t know why it worked. In many instances, they even published their findings.”

The period is filled with revelations for researchers, says Dr. Rathgeb. The term 4F, for example, came about as a shorthand description of men who were missing four front teeth. Without teeth, the men couldn’t bite off the powder cartridge needed to load a rifle and were rejected as unfit to serve.

“We’ve also learned that anywhere from 400 to 1,000 women enlisted in the war,” notes Dr. Rathgeb. “Information about the military hospitals is also plentiful. The museum’s annual conference in October 2009 will include a presentation on Civil War hospitals that will provide a lot of information on how they were set up.”

From surgeon to innkeeper
As rich as he finds Civil War history, Dr. Rathgeb also inhabits another rewarding world—the Victorian-style bed-and-breakfast (B&B) he and his wife run in Oakland, Md.

“It’s a wonderful place not far from Baltimore, Washington D.C., and Pittsburgh,” he says. “We can enjoy downhill skiing, cross country skiing, hunting, fishing, and whitewater rafting.”

The Rathgebs moved to Oakland in 2006, and he works in the office of a local orthopaedist two days a week. This is the third year they have operated their B & B, The Oak & Apple. “My wife and I dreamed of having a B & B for as long as we can remember,” says Dr. Rathgeb. “It’s similar to medicine because it’s people oriented. I’ve always liked talking to my patients and it’s the same with the B&B. I enjoy talking to the diverse guests we have.”

Although open year-round, “it’s busiest in the summer, of course,” says Dr. Rathgeb. “But the Oakland fall color festival—the Autumn Glory Festival, which MSN.com voted the top fall festival in the world—also brings lots of visitors. After the holidays, people come for the snow.”

About your host
Born in Greensburg, Pa., Dr. Rathgeb graduated from Georgetown University School of Medicine, did his internship and a year of general surgery residence at Mercy Hospital in Pittsburgh, and an orthopaedic residency at the Geisinger Medical Center and The Alfred I. duPont Institute.

Dr. Rathgeb was in solo practice before becoming chief of surgery for Kaiser Permanente and chief of orthopaedics at the Greater Baltimore Medical Center. He retired from Kaiser in 2004, and worked with Johns Hopkins Orthopaedics at the Good Samaritan Hospital. He has volunteered at The Hospital Albert Schweitzer in Haiti and Volunteers in Medicine on Hilton Head Island.

For most of his life, Dr. Rathgeb has done just what he wants to do. His professional life, interests, personality, and family (5 children and 10 grandchildren) make him a happy man. He chuckles as he says, “In my other life I probably would have been a history teacher.”

Elaine Fiedler is a freelance writer. She can be reached at aaoscomm@aaos.org

From: aaos.org

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Cesarean Sections

From: historyengine.richmond.edu

On January 29th, 1822, Dr. Ebenezer Basset who was the town physician of Nassau, New York was abruptly interrupted by his medical assistant Jacob Kipp, who notified the doctor of their servant girl who was terribly ill. Braving the cold, Dr. Basset attended to the black servant girl who was lying in the snow with an unusually large cut on her abdomen and right next to her was a razor blade that was covered in blood. Upon further examining the youth of fourteen, Dr. Basset noticed and began to uncover a fetus hidden underneath the snow. Dr. Basset was in complete shock at what he had just witnessed. To his amazement, the youth of fourteen had just conducted a cesarean section on herself. After Dr. Basset recovered from his shock he sent Jacob Kipp to a neighboring town to retrieve Doctors Francis and Beck to help assess the situation.

Upon their arrival to the city of Nassau, Dr. Basset explained to his colleagues what had occurred. The three physicians began to treat the African American servant girl while making detailed notes of the procedure. The physician’s amazement is understandable given that cesarean sections were known about, but not widely used. Even more amazing, the procedure was a self-administered one. How could a black youth of fourteen perform such a complicated procedure on herself?

Historians have always claimed that cesarean sections had been performed by slaves who came from Africa to America. In fact, the first recorded successful cesarean section was performed in Colonial America. There is an account of a doctor in Virginia by the name of Dr. Jesse Bennett who on January 14th, 1794 performed the first cesarean section on his wife with the help and guidance of their slave who was well versed in the procedure of cesarean section. According to author Herbert M. Morais who wrote, The history of the Negro in medicine, African Americans had prior knowledge and used cesarean sections in Africa and brought that knowledge with them to the early colonies of America. Although the procedure was amazing to these white doctors, it would have not been foreign to black females in this era.

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Did Stonewall Jackson Have Hypochondria?

From: uselectionatlas.org

General Thomas “Stonewall” Jackson was one of the most gifted commanders in U.S. History. But he has a dubious distinction that had haunted his legacy since the 1850’s; Jackson has been accused of being a hypochondriac.

Jackson had some strange distinctions:

1 He thought he was “out of balance” in battle if he didn’t raise one arm while on his horse. He said he wanted to, “Keep the blood balanced.”

2.He refused to have pepper on his food, stating it made his left leg weak.

3.Despite wartime shortage, Jackson would constantly suck on lemons because he felt it helped his “dyspepsia.”

4.His staff noticed his strange diet, some of his meals consisted of only raspberries, bread, and milk.

5.Jackson was only comfortable when he was in an upright position, and I mean standing straight up. He felt it helped his organs stand “naturally” one atop each other. For this reason he had no chairs in his study at Lexington, Virginia. He spent long hours reading the Bible or memorizing Virginia’s laws.

6.While on honeymoon with his second wife (seeing how his first wife had died) he took her to Eastern America so he could bath in the mineral spas to “improve my sagging bad health.”

7.Even while he was a plebe West Point, first classman Ulysses S. Grant called him a “fanatic” whose “delusions took strange forms- hypochondria, fancies that evil spirits had taken possession of him.”

8.Jackson offered some dietary advice to his sister Laura, “If you commence on this diet, remember it is like a man joining a temperance society, if he afterwards tastes liquor he is gone.”

9.His complaints listed almost endlessly through his young manhood: rheumatism, chilblains, poor eyesight (witch he treated by dipping his head in a vat of cold water, eyes open, for as long as he could hold his breath), cold feet, nervousness, neuralgia, impaired hearing, tonsillitis (which required surgery), biliousness and “slight distortion of the spine” as Jackson stated in the late 1840’s.

Because of these things it is now said Jackson was a hypochondriac. But modern physicians have stated that Jackson may have suffered from the fairly common and most uncomfortable diaphragmatic hernia. This is the theory of Dr. E.R. MacLennan of Opp, Alabama. He states that this hernia caused Jackson to suffer from his many body ailments.

Ironically Jackson’s habit of draping his abdomen with cold towels to heal his “dyspepsia” may have caused his death. Soon after the amputation of his left arm at Chancellorsville, cold towels were laid on his abdomen as Jackson did everyday. This may have led to his contraction of pneumonia that killed him.

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Was Stonewall Jackson a Hypochondriac?

By Usha Hari

Stonewall Jackson, the Confederate general, was thought to be a hypochondriac. Even when his hand got wounded by a bullet during the First Battle of Bull Run, he kept his arm raised so that the blood might flow into his body. He avoided pepper in his food as he had a strange notion that it made his left leg weak. He was most comfortable in an upright standing posture so that all of his organs were aligned "naturally." He tried to cure his poor eyesight by keeping his head dipped into a basin of cold water with eyes open!

From: au.ibtimes.com

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“King Alcohol is More Formidable than Tyrant Lincoln”

From: historyengine.richmond.edu

In 1862, throughout the war-ravaged Confederacy, the thoughts of all were turned to the War that tore apart the country.  The death and destruction that had already occurred seemed to foretell a conflict that would not soon be resolved.  In the midst of the fighting, soldiers struggled to remain vigilant and confident.  Romanticized visions of passionate soldiers, Confederates in particular, were created to motivate future as well as current soldiers to continue fighting “the good fight.”  An ideal soldier was one who fought bravely for a cause he believed in, and these beliefs were strengthened when God was on his side.  Thus religion and the strength of a soldier’s faith were often tied directly to his ability to prevail in battle.

An article in The Confederate Baptist entitled “Temperance in the Army” stated that there was evidence that the reason that battles had been lost was because of the drunkenness of the commanders.  Subsequent articles in the paper had already declared that God was on the side of the Confederacy; the postulation of a possible explanation of recent defeats looked to the soldiers themselves and their behavior while fighting for the Confederacy.  The author J.L. Reynolds looked to the experiences of other countries to teach a valuable lesson.  He cited the Madras Presidency, a part of present-day India, and the proportion of temperate men who died in battle to the number of drinkers who died in battle.  The number of temperate soldiers who died numbered 2,315.   The number of drinkers who died was 4,458.  According to Reynolds, “this proves that soldiers will be healthy in proportion to their temperance”.   Alcohol was “the bane of our soldiery,” and if use was not curbed immediately, the Confederacy, despite being divinely-ordained, would surely fall.

To bring these soldiers back to morality, religious revivals were often held in which missionaries traveled to soldiers’ camps to instill a renewed sense of faith.  These revivals also served to inspire the citizen morale that waned as the war dragged on and the death toll rose.  The temperance movement as a whole, however, was not an issue of great national or regional importance during the Civil War.  The Temperance Societies that had emerged in the decades prior had claimed millions of members but receded into the background as the nation faced a crisis of unprecedented proportions.

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The Day in the Life of a Union Prisoner of War: Disease and Deprivation

From: historyengine.richmond.edu

The United States Sanitary Commission conducted a series of interviews following the conclusion of the Civil War. The Commission focused on the details of Union soldier's imprisonment during their service. The soldiers gave testimony as to their experience as a prisoner of war. The compilation of accounts details the suffering and privations of different soldiers both commissioned and non-commissioned officers.

Private Joseph Grider was sworn in and examined in Virginia by the Commission. He detailed his survival from both the Libby and Danville Prisons operated by the Confederate States of America. The main discussion elaborated on the health of Private Grider and the conditions in which he was held. Grider detailed the rations allotted to himself and his fellow prisoners of war; the main storyline revolved around the bread ration, a staple in the diet of Civil War soldiers. The bread was rough with whole grains; when he was moved to Danville he received black bread made of cane seed. Grider discussed the deterioration of his health as a result of the food rations and inadequate housing. The prisoners suffered from diarrhea and other ailments. One other area of interest from Grider's testimony involves the severity of punishment enforced by the Confederate guards; during his stay at Danville seven men were shot for out the window. Other punishments involved the holding of men in chambers until they 'fouled on the floor.'

Another testimony from Private Robert Morrison detailed the differences between Richmond, Pemberton, and Danville Confederate Prisons. Similar to Grider, he discussed the loss of personal items and the deprivation of clean and warm shelter during his early experiences in the prisons. The deprivation of healthy and clean food was another problem for Private Morrison. He noted the decline in his health as coinciding with his entrance into the prisoner of war encampments. Prior to his capture he did not have problems with diarrhea or fever; sickness did not take hold upon Morrison until he began eating the rations given to him by Confederate guards. Unlike Grider's testimony, Morrison detailed his final living quarters as warm, spacey with endless amounts of food and also access to a 'privy.'

The similarities between these two privates testimony is parallel when it comes to their experiences with food rationing. In many instances they expressed their opinion that it was contaminated or perhaps undercooked. Private Morrison stated, "I got a chunk of corn bread daily...sometimes it was about half baked." Dr. Joseph Jones, a witness in trial against Henry Wirz, 'formerly the commandant of the interior of the Confederate States military prison at Andersonville', shared this hypothesis stating, "As far as my experience extends, no person who had been reared on wheat bread, and who was held in captivity for any length of time, could retain his health and escape either scurvy or diarrhea, if confined to the Confederate ration (issued to the soldier in the field and hospital) of unbolted corn meal and bacon."

Interestingly enough, Confederate law decreed that all prisoners should have access to the same privilege and food rations as the Confederate Soldiers; this act was acknowledged by General Robert E. Lee himself in a letter to a relative stating, "The laws of the Confederate Congress and the orders of the War Department directed that the rations furnished prisoners of war should be the same in quantity and quality as those furnished enlisted men in the army of the Confederacy, and that the hospitals for prisoners should be placed on the same footing as other Confederate States hospitals in all respects." Whether this was an act of forbearance or an act of compassion it is easy to see, Union soldier in Confederate prisons suffered through disease and desperation similarly. Although this was an act in effect, prisons in the South failed to comply with all its' standards and requirements. William Best Hesseltine pointed out that the closing of the summer of 1863 brought about the halt of a cartel in which prisoners from both sides of the war were exchanged; this halt increased the number of mouths to feed and also the growing debt of the Confederacy. Prisoners in southern camps suffered the consequences of this halt. Hesseltine remarked that the quality and quantity of rations for prisoners especially at Libby prison decreased markedly as the days passed by and yet the officers continued to enjoy luxuries such as apples, sugar, eggs, molasses, and corn.

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State-Supported Schools for the Blind for African-American Children

From: aph.org

The first school for blind children in the United States was chartered in 1829, in Boston. It was quickly followed by schools in New York, Pennsylvania, and Ohio. In these cities, as well as other Northern cities in which schools for the blind were established, black and white children attended the same classes.

In the South, however, racial attitudes, complicated by the institution of slavery, were much different. Slowly, after the close of the Civil War in 1865, the states in which slavery had been well established began to open departments or divisions for African-American children, usually in facilities separate from the school for white children. By the middle of the twentieth century, there were fifteen residential schools for African-American children who were blind: North Carolina, founded in 1869; Maryland, 1872; Tennessee, 1882; Georgia, 1882; South Carolina, 1883; Kentucky, 1884; Texas, 1887; Arkansas, 1889; Alabama, 1892; Florida, 1895; Oklahoma, 1909; Virginia, 1910; Louisiana, 1892; West Virginia, 1929; and Mississippi, 1951. Thus, as one Southern legislator remarked, "color was distinguished where no color was seen."

Ironically, in nineteenth century, separate schools for African-American children who were blind were viewed as a positive social reform and were encouraged as much by African- American leaders as by whites. Separate but equal education had been established as the law, and, for a while, it seemed to promise two flourishing societies, one white, one black, in the same country. The author of the entry on "blindness" in the 1918 Encyclopedia Americana observed:

In northern schools the colored blind are educated with the white; in Southern schools it is best for the colored to have schools of their own. Both the whites and they prefer this arrangement.

In the two decades following the Civil War, African-American leaders generally left unchallenged the existence of segregation in social programs. When they felt denied certain benefits, such as education for blind children, they demanded the establishment of separate programs. The Georgia Academy for the Blind responded to petitions from black churches when it proposed the "Negro Division" of the Georgia School for the Blind in 1881. A black legislator, Thomas A. Sykes, introduced the bill that provided the "Colored Department" for the Tennessee School for the Blind in Nashville, and in West Virginia, three black legislators pushed for the creation of a school to serve both the deaf and blind. In both Tennessee and Texas, where African-American women had taken on the task of teaching blind children in their own homes, the state formalized what already existing by making the women the matrons, or housemothers, of the new schools.

The ten schools founded in the nineteenth century were created as departments of the already-established schools for white children and were under the nominal rule of the white superintendent. Students were housed in separate campuses or separate buildings on the same campus. The five schools founded after the twentieth century--Oklahoma, Virginia, Louisiana, West Virginia, and Mississippi--had no ties with the white school.

As was true throughout the South, in the public schools, equipment, materials and facilities provided for African-American children who were blind were generally, although not always, inferior, and their education suffered, despite the efforts of excellent teachers and supportive families. In 1945, Charles Buell pointed out that the annual reports issued by the various schools "suggest to the reader that the education of the Negro is similar to that for the white students." Buell's exhaustive study of the curriculum of the schools for African-American blind children indicated "this theory is not put into practice." He found that the "colored departments," as a whole, spent more time on manual training, that science classes suffered for lack of laboratory equipment, that texts were outdated and inadequate, and that instruction was formal and not practical.

Buildings housing African-American students were sometimes unsafe and their furnishings bare, with "worn furniture, chipped crockery, and faded towels." A teacher at the Negro Department of the Florida School for the Deaf and Blind recalled, somewhat bitterly, "When a typewriter or a sewing machine got too old or broke on North Campus, they'd send it over to us." Margaret Johnson, who attended the whites-only school for the blind in Arkansas in the 1950s, remembers, even as a child, being appalled by the conditions at the black school, where the white students were bused for a Christmas concert. Their auditorium "had no stage and only straight-backed chairs." She also remembered feeling bad that the white school's worn-out books were sent to the Colored Department; "Why, the dots were so worn they could scarcely be read," she said.

In general, teacher-pupil ratios were higher in the African-American schools and teachers' salaries were lower. African-American teachers could not attend training courses offered at segregated universities, nor could they afford to attend similar institutions in the North. Enrolling children was also a problem. Not all African-American children who were blind attended the state schools, despite compulsory education laws. To identify students, an African-American superintendent would have had to visit places throughout the state, asking questions and checking public records--not a safe undertaking in the Jim Crow South.

In the 1940s, Helen Keller emphasized the needs of African-American children who were blind to a committee studying the public and private aid given to physically disabled students.

"In my travels up and down the continent I have visited their shabby school buildings . . . I have been shocked by the meagerness of their education . . . I feel it is a disgrace that in this great wealthy land, each injustice should exist to men and women of a different race--and blind at that!"

Her words were instrumental in prodding the state of Mississippi to establish a state school for African-American students who were blind. However, the battle for legislative support was intense, and the Mississippi School for the Negro Blind didn't open its doors to students until 1951—only three years before the ruling of the U.S. Supreme Court in Brown v. Board of Education signaled the end of segregated schools in the United States.

It was more the beginning of the end than the end itself. The process of integration took nearly twenty-five years and varied considerably by state. Some schools integrated peacefully, with little fanfare, whereas others dealt with lawsuits and threats, just as schools for sighted children. Some schools did not integrate until after the passage of the Civil Rights Act, in 1964. Other schools delayed integration into the 1970s. Among the first schools, sighted or blind, to be integrated in the United States were the Kentucky School for the Blind and the West Virginia School for the Blind, both in the summer of 1955. One of the last schools in the South to be integrated, sighted or blind, was the Louisiana School for the Blind, in 1978.

Even though classrooms were integrated in the North, some dormitories were not. In the 1940s, the Missouri School for the Blind had separate dormitories for white and blacks.

Change is slow. In a 1945 study of the "Education of the Negro Blind" in the United States, Charles Buell notes that an earlier study, done in the 1920s, "assumed that all Negroes desire segregated schools, but many leaders among the colored people have expressed the opposite point of view".

In Mississippi, African-American children who were blind could attend the Piney Woods Country Life School, a private boarding school for African-American Youth. A department for deaf and blind children was established in 1929, and the school did receive some money for the students' room and board from the state of Mississippi at the outset.

Image: Museum at the Perkins Institution for the Blind

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