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.

Sunday, December 6, 2015

The Impact of Disease on the Civil War (Excerpt)

By Intisar K. Hamidullah

Background
In 1967 the Surgeon General of the United States announced that it was time to close the book on infectious diseases. Unfortunately, this statement was premature. Although our society may not experience epidemics as often as in the past, the epidemics of the present are still a menace to humankind. This unit will focus on four diseases: Measles, Small-pox, Tuberculosis, and Syphilis. These diseases caused a great deal of the deaths before, during, and after the Civil War. Additionally the lack of known treatments and lack of unawareness of prevention had detrimental effects on how these diseases spread throughout the world. Consequently with the advancement of medicine, treatment, prevention, and vaccinations the impacts of these diseases are not as harmful today as during the Civil War.

The invention of the microscope in 1660 enabled Robert Hooke and Antonie van Leeuwenhoek to study cells and other microorganisms that caused diseases. Robert Hooke looked at a cork taken from an oak tree and saw tiny cell-like compartments. The microscope helped him to see the layer of cork thirty times its original size, and thus details of a cell. Much of life is made up of cellular organisms: unicellular life or larger multi-cellular life. Cell Theory describes how living things are made of one or multiple cells, that cells carry out functions needed to support life and that cells come from other living cells.

There are two different kinds of cellular life: eukaryotes and prokaryotes. One major difference between the two types is that a eukaryote cells has a nucleus and a prokaryote cell does not. The nucleus is the largest organelle in a eukaryote cell and contains the DNA. In contrast, prokaryote cells simply contain DNA in their cytoplasm. Many other organelles are essential to the life and functioning of the eukaryote cell. These include ribosomes, endoplasmic reticulum, mitochondrion, and the Golgi apparatus.

In addition to inventing pasteurization to kill bacteria and keep foods such as milk fresh, Louis Pasteur is famous for having studied the causes of sickness in humans and animals. In 1856 he used the microscope to study microorganisms found in the blood of animals and people who were sick. These microorganisms are generally called germs, and Pasteur tried to better understand germs to help in prevention of disease. Studies like these led to the Germ Theory, which states that microorganisms too small to be seen without a microscope can invade the body and cause certain diseases. Prior to confirming the Germ Theory, most people believed that certain diseases had unnatural causes, such as a punishment for evil behavior, demonic possession, etc. Pasteur widely popularized the idea that many diseases were caused by bacteria, the most ancient type of cellular life on earth. Bacteria are found literally everywhere, except where humans have purposefully used chemicals or sterilization to prevent their growth. Thus, although many types of bacteria are useful, such as those living in the human gut which aid our digestion; we have developed antibiotics and other therapies to kill bacteria viewed as harmful.

But germs other than bacteria can cause infectious disease too. In particular viruses are extremely tiny (smaller than cells), but cause some of the most deadly diseases known. All viruses need to reproduce by attacking cells; they use the host cell's metabolism (life properties) to instruct the cell to make copies of viruses which then leave the cell to infect further cells. In this way, cells of human tissues and organs such as lungs can be infected and destroyed by bacteria and especially by viruses. Bacteria and viruses can be passed between humans in many different ways, including via sneezing, talking, coughing, singing, ingesting contaminated food and water and through sexual activity. The poor health conditions of war thus often make it easier for transmission of bacteria and viruses between humans.

One would naturally anticipate that the highest number of causalities during a war is from gunfire. However, this was not true during the Civil War; three out of five Union troops died of disease, whereas, two out of three Confederate troops similarly died. 1 More men died throughout this four year period than in any other war experienced by the United States. The cause for the disproportionate number of deaths was attributed to filthy living conditions in army camps, nonexistent surgical equipment, spoiled and poorly prepared foods, unwashed surgeon's hands, and other poor health conditions.

The Civil War was a breeding ground for diseases caused by bacteria and viruses. At the time little was known about what caused diseases. Surgical techniques ranged from barbaric to nonexistent. As a result a soldier had a 1 in 4 chance of surviving war because of poor medical care. During the early 1800's physicians had minimal training, in fact Harvard University did not own a stethoscope until after the war ended 2. At the beginning of the war the North had 98 doctors whereas the Confederate had 24 doctors. At the end of the war in 1865, the North had 13,000 medical doctors and the Confederates had 4,000 doctors. Since women were not allowed to fight, they often volunteered as nurses. Due to the efforts of Clara Barton, the Red Cross was established to improve medical conditions for soldiers and citizens. According to Walt Whitman, surgeons were butchers because limbs would be amputated in an effort to minimize pain and prevent further spread of infections to other soldiers, but these surgeons did little to minimize pain. At times death or infection set in because the two and four wheeled carts used as ambulances were unreliable and overcrowded. If events that preceded the Civil War had been resolved differently, then this dreadful chapter in US history might have been avoided.

Whether it was the Abolitionist movement in the 1820's and 1830's,the publishing of Uncle Tom's Cabin in 1852, the Dred Scott decision in 1857, the raid on Harper's Ferry in 1859, or William Lloyd Garrison's Anti-Slavery Society, the North was making it clear that they were not in favor of slavery. Then the decision of slave versus freed states was an issue during the Missouri Compromise of 1820, Compromise of 1850 and the Kansas-Nebraska Act of 1854. The aforementioned were all coupled with other differences between the North and the South. The North wanted federally sponsored improvements of roads, railways and canals and the South did not. The North wanted a high tariff for manufactured goods, whereas the South thought it would interfere with the established foreign trade for cotton. The North wanted a currency system, whereas the Confederates did not think the currency would benefit them. Of course, the largest issue was slavery with the North being against it and the Confederate being a proponent for it. Finally Abraham Lincoln who was against slavery was inaugurated President on March 4, 1861. The culmination of the aforementioned events was the start of the Civil War on April 12, 1861.

In addition to the Battle of Antietam, Battle of Bull Run, Battle of Gettysburg, Battle of Fort Sumter, etc. history was also taking place off the battlefield. On January 1, 1863 the Emancipation Proclamation was instated by President Lincoln. With this decree most African Americans hurried to enlist in the Northern Army. In spite of being free they still experienced discrimination, evidenced by substandard supplies, rations and payment inequities. They were given seven dollars per month plus a three dollar clothing allowance. Their white counterparts were given thirteen dollars plus a three dollar and fifty cent clothing allowance 3. The differences were enough for some to refuse to enlist; however, others were eager to be a part of all black regiments, like the Fifty Fourth Regiment of Massachusetts. Two years later, on April 18, 1865 the South surrendered and the Civil War was over. Along with the end of the Civil War, the 13 th Amendment was passed abolishing slavery.

Although the purpose of war can be to repair political conflicts, to obtain territory or to defend against invaders, war has always involved disease. During the Civil War not only did soldiers have to withstand bullets, shells, and bombs they also had to worry about infections. Additionally, not only was this war difficult to deal with physically, the ramifications emotionally were lifelong. The circumstances soldiers found themselves in were unimaginable and ranged from imprisonment, family separation, death, and watching fellow injured soldiers. Consequently, dealing with these circumstances one tends to develop anxiety, depression, post traumatic stress disorder, drug abuse, alcoholism and nightmares that do not fade. Although these emotional side effects of war are devastating, so are the diseases that can often be incurable. The seven most common diseases in army camps were typhoid fever, smallpox, measles, diarrhea, pneumonia, malaria, and tuberculosis. 4 For this unit we will focus on the history of measles, small pox, tuberculosis, diarrhea and syphilis. An English Professor stated that nothing could be more ridiculous than to contend that disease is always the primary cause of great historical change 5. But it is important to examine the episodes that influence disease.

From: teachers.yale.edu

The Founding of the American Medical Association

Fom: ama-assn.org

Scientific advancement, standards for medical education, launching a program of medical ethics, improved public health — these were the goals of the American Medical Association (AMA). Two hundred fifty delegates from twenty-eight states attended the founding meeting and were seated among exhibit cases and before ancient bones of a mastodon, "Mammut Amercanum," in the hall of The Academy of Natural Sciences of Philadelphia, Pennsylvania.

This painting by artist Robert A. Thom captures the moment on the evening of May 7, 1847, when the delegates to the national medical convention had just approved a resolution to establish the AMA and elect Dr. Nathaniel Chapman as its first president.

Convention Chairman Dr. Jonathan Knight welcomed Dr. Nathaniel Chapman, first AMA president (right foreground). Pictured between Dr. Knight and Dr. Chapman where their hands meet is young Dr. Nathan S. Davis, known as the founder of the AMA because his 1845 resolution to the New York Medical Association calling for a national medical convention led to the forming of the AMA.

At the founding meeting the delegates adopted the first code of medical ethics, and established the first nationwide standards for preliminary medical education and the degree of MD.

Those attending the founding meeting of the AMA launched what has become the largest medical association in America, whose work for over a century and a half has remained focused on the founding principles. The AMA represents the best of American medicine and today continues to serve as an advocate for the profession, physician and patient.

Image: "Founding of the American Medical Association" by artist Robert A. Thom, 1961, was part of a series commissioned by Parke-Davis on the "History of Medicine".

Rheumatic Fever (Excerpt)

Lowell A. Rantz, M.D.

Rheumatic fever has been a problem to the U.S. Army in all of its wars for which historical data are available, although it attracted little attention before World War II. Enteric infection and malaria in earlier wars, and influenza and its complications in World War I, overshadowed all other acute diseases. Inadequate diagnosis also prevented the recognition of the military importance of this disorder.

The recorded experience of the U.S. Army in the American Civil War1 reveals that acute rheumatism occurred with remarkable frequency. In 5.2 years, 146,000 cases were reported among white troops at a rate of 61 per 1,000 per annum. Certainly, not all of these were acute rheumatic fever, but examination of the case records that have been preserved in the history of that war indicates that a substantial number of them was certainly this disease. This impression is confirmed by 642 deaths caused by rheumatism, endocarditis, and pericarditis. Furthermore, the disease occurred principally in the winter among fresh levies of troops, an epidemiological pattern which resembles that of rheumatic fever during World War II. In retrospect, it is impossible to define the magnitude of the problem of rheumatic fever in the Civil War, but it must have been great.

From: history.amedd.army.mil

The Remarkable Annie Etheridge

By LTC Peter L. Platteborze, Brooke Army Medical Center

Few people today know the story of Annie Etheridge who was once nationally acclaimed as the iconic nurse of the North. Various accounts indicate that she served admirably, without pay, through the entire four bloody years of the American Civil War functioning in a role that we consider today as a combat medic. One national newspaper commented “that if England can boast of the achievements of Florence Nightingale, we of America can present a still higher example of female heroism in the person of Annie Etheridge.”

She was born Lorinda Anna Blair on 3 May 1839 in Detroit, Michigan. Little is known about her youth other than she spent considerable time aiding her sick father and had worked in a hospital with a poor reputation for patient care. At the age of 21, she married James Etheridge and shortly after the April 1861 outbreak of the Civil War they both patriotically enlisted in the 2nd Michigan Volunteer Infantry Regiment. She signed on with 19 other women to serve as a vivandiere, or daughter of the regiment, with duties to serve as a nurse as well as a cook and laundress. Prior to the Civil War, American women did not officially serve in the military; most vivandiere were outfitted in a feminine version of the regimental uniforms.

In June 1861, the 2nd Michigan marched to Washington D.C. to join the Army of the Potomac. Within a month, Annie was the lone vivandiere remaining in the regiment. Unlike her peers, she seemed to thrive in the constant hardships of field service and military camp life. In mid-July, the regiment skirmished with the enemy at Blackburn’s Ford, which subsequently developed into the battle of First Bull Run. On the battlefield, Annie selflessly moved to the wounded exhibiting great courage under fire as well as an amazing silent focus upon her mission of mercy. Thus began her reputation for being found on the front lines caring for the wounded where many surgeons wouldn’t dare venture. After the battle, her husband deserted yet Annie stayed having found her calling earning her the nickname “Michigan Annie.” Her regiment then helped defend the capitol until the spring of 1862 when they supported General McClellan’s Peninsular Campaign designed to capture the Confederate  capitol of Richmond. She participated in the battle of Williamsburg and was then temporarily transferred to duty aboard hospital transport ships operated by the U.S. Sanitary Commission. These steamboats were designated to carry wounded soldiers back to major city hospitals along the East Coast.

In August 1862, Annie returned to the front lines with her regiment at the battle of Second Bull Run. While giving aid to a wounded soldier of the 7th New York, an artillery shell burst nearby immediately killing him. Upon observing this Major General Philip Kearny rode up to her saying “I am glad to see you caring for these poor fellows. When this is over I shall recommend that you be given a horse and rank of sergeant.” Unfortunately for Annie he was killed two days later at the rear guard action of Chantilly and she received neither rank nor pay. This earned her even greater respect and affection from the fighting men, who now began calling her their ‘sergeant in petticoats.’ Thankfully she did receive a horse which allowed her to move to the front much quicker and with more medical supplies and water, and also provided her the ability to transport the wounded back to a field hospital.

In November, the 2nd Michigan was reassigned to the Union’s Army of Tennessee while Annie decided to remain with the Army of the Potomac by transferring to the 3rd Michigan. The following month Annie had another near-fatal incident at the battle of Fredericksburg. She was binding a soldier’s wounds when an artillery shell exploded nearby, mortally wounding him and removing a large portion of her skirt.

She received the greatest notoriety for her role in the May 1863 battle of Chancellorsville. Here, at the front lines (and on her 24th birthday) she received her only wound of the war when a Minie ball grazed her hand.

This bullet struck her horse which frantically bolted out of thick woods with her holding on. Fortunately, it ran into the Union reserve and was quickly subdued. Later that day Annie conspicuously cheered on a heavily wounded and demoralized unit of artillerymen causing them to not abandon their battery, and they subsequently played a pivotal role in the battle. For this noble sacrifice and heroic service on 27 May 1863, she was awarded the Kearny Cross, a decoration given to only two women in the entire Civil War.

Being wounded did not impede her efforts on the battlefield. Multiple reports indicate that she was at the heavily contested Peach Orchard area of Gettysburg during the brutal fighting on 2 July 1863. Following this battle, Annie travelled with the remnants of her regiment to New York City to assist in suppressing violent draft riots.

During this time she received many public visitors in camp to include Hannibal Hamlin, the Vice President of the United States.

In April 1864, the new commanding General of the Army, Ulysses S. Grant directed that all women leave the front. Despite this order, Annie remained in the heat of several battles that spring and summer. In June the three year enlistment expired for the men of the 3rd so Annie and the soldiers who re-enlisted were transferred into the 5th Michigan Infantry. Around this time, Annie was specifically ordered by General Grant to stay away from the front. Soldiers in her division, from privates to the general, signed a petition asking for special dispensation for her to continue serving with them. General Grant did not concur and Annie was forced to report to the large hospital at City Point where she remained until the end of hostilities.

After the war Annie marched with the 5th Michigan in the Army’s Grand Review parade in Washington and was mustered out with them in July 1865. By the end of the war, she had served in an amazing 32 engagements and had directly tended to the soldiers of the 2nd, 3rd, and 5th Michigan Volunteers. The lives of many soldiers in the Army of the Potomac were saved due to her tireless efforts.

In 1870 she married Charles Hooks, a Union veteran of the 7th Connecticut Infantry, and settled into work for the U.S. Treasury Department in Washington, D.C. In 1887 she finally began receiving a small pension for her noteworthy services to the Union Army. She died in 1913 and was buried with veteran’s honors in Arlington National Cemetery next to her husband. In 1915 the state of Michigan had a white marble headstone erected on her grave site as a monument to this remarkable nurse who embodied the ideal daughter of the Union Army.

From: history.amedd.army.mil/newsletters

Collidge Field Case or Surgeon's Companion

From: medicalantiques.com

(The following are the personal edited research notes of Michael Echols, the source of which may or may not be completely documented)

In the early part of 1863 Medical Inspector R. H. Coolidge, U. S. A.. arranged a field case or companion  (FIG. 1) to take the place of the knapsack. It was based on the plan of the one used in the British service, and was intended to be carried by the Surgeon himself, if necessary.   The Surgeon's Field Companion is one variation used during the Civil War.

The "companion" is a leather case 13 inches long, 6 inches wide, and 7½ inches deep; it is supported by a strap passing over the shoulder, and is provided with a waist strap to steady it when carried.

The hospital medicine chest, mess-chest, and bulky hospital supplies were transported in wagons of the supply train and were often inaccessible when required. To obviate this, the contents of the knapsack were:

One piece of white wax, 8 oz. simple cerate, 12 oz. chloroform, 5 yds. adhesive plaster, 2 yds. isinglass plaster, 1 oz. persulphate of iron, 100 compound cathartic pills, 150 blue mass pills, 150 opium pills, 100 opium and camphor pills, 150 quinine pills, 8 oz. aromatic spirit of ammonia, 16 oz. brandy, 4 oz. laudanum, 10 bandages, 10 binder's boards, 4 oz. charpie, 2 medicine glasses, 1 (spirit) lamp, 12 oz. lint, 1 box matches, 1 paper of pins, 1 spool of surgeons' silk, 4 pieces of sponge, 4 (Dunton's) field tourniquets. 2 spiral tourniquets, 1 piece of tape, 1 spool of lead wire, 1 spool of silver wire, and 1 spatula.

The contents of the Surgeon's Companion were;

6½ oz. chloroform, 2 oz. fluid extract of ipecacuanha. 2 oz. fluid extract of ginger. 2 oz. solution of persulphate of iron, 24 oz. of whiskey, 2 oz. tincture of opium, 144 compound cathartic pills, 144 colocynth and ipecacuanha pills, 144 sulphate of quinine pills, 144 opium pills, 1 yard isinglass plaster, a medicine cup, scissors, teaspoon, pins, thread, 4 oz. lint, a towel, 2 doz. bandages, muslin, and corks.

At the beginning of the war each regimental Surgeon was furnished with suitable equipment for his regiment for field service, consisting of medicines, stores, instruments, and dressings, in quantities regulated by the Standard Supply Table.

(See Standard Supply Table for Field Service, in Revised Regulations for the Army of the United States, 1861, p. 304.)

In action he was accompanied by a hospital orderly, who carried a knapsack containing a limited supply of anaesthetics, styptics, stimulants, and anodynes, and material for primary dressings. This hospital knapsack had been recommended for adoption by an army board in 1859; it was made of light wood, 18 inches in height, 15 inches wide, and 7½ inches deep, but subsequently wicker-work, covered with canvas or enamelled cloth, was substituted for the wood; its weight when filled was 18 pounds. This knapsack (FIG. 425) was in general use in the first year of the way and served an excellent purpose. In 1862 it was changed for what was known as the new regulation knapsack, in which the arrangement and character of the supplies were modified. The new pattern was 16 inches high, 12½ inches wide, and 6 inches deep; the contents were packed in drawers, which were more accessible than in the old style and less liable to become disarranged or broken.(1) The weight when packed was nearly 20 pounds. (FIG. 2). Not withstanding its convenience and general adaptability it was too heavy and cumbrous to be carried by the Surgeon himself, and, when entrusted to other hands, was liable, in the vicissitudes of battle, to be lost.
     
Apparently  there were four military field medicine carrying cases used by the Union army during the Civil War.  In 1861, a large wicker and tarred-cloth knapsack was the regulation case (Fig. 2).   This was superseded by a heavy wood-framed and leather-covered backpack (Fig. 2) 1862.   In 1863, the Coolidge Field, or Surgeon’s Companion, which was worn on the hip became the regulation case.  There was a final version, also worn on the hip, but it is not shown in the illustrations of the Medical and Surgical History data.

Image: Fig. 2  Hospital Knapsack of Wicker-Work, Covered With Enamelled Cloth.

Image: Fig. 3 Regulation Hospital Knapsack of 1862

(Note: in the drawings, all tins and bottles are shown with corks and not metal screw tops.)

Monday, November 30, 2015

Louisa Cheairs McKenny Sheppard: A Confederate Girlhood

From: ozarkscivilwar.org

Louisa Cheairs McKenny Sheppard, “Lou” or “Lulu,” was the fourth child of Talitha and E.D. McKenny. Talitha died during Louisa’s birth in 1848, and she was raised by her grandmother Louisa “Lucy” Terrell Cheairs Campbell after her father moved to Texas. Lulu was twelve when the War began, and she recalled the impact it had on Springfield.
'
The day before the Battle of Wilson’s Creek, Mother (was told) General Lyon and some of his staff (were coming) to dinner. She agreed and at once saw to the preparation of one of those dinners for which she was famous. General Lyon was a rough looking man with good manners. He sat at Mother’s right and opposite to me. During dinner he raised his wine glass to Mother, and said, “Madam, you wish us success?” “Sir,” she answered with grave dignity, “I am a Southern woman.” He looked at her with utter amazement, then said, “And you have sons in the Confederacy?” … “Four,”(she replied) and then with a sudden flash of spirit, “and I wish they were fifty and I were leading them.”…General Lyon arose and took her hand as he said, “I hope no trouble is at hand for so brave a woman.” He was killed the next day…'
Louisa Cheairs McKenny Sheppard – A Confederate Girlhood

Lucy prepared another feast in celebration of the Confederate victory; however, the festivities soon faced the reality of war as the Campbell home was converted into a hospital.

"Our house was now a hospital. I don’t know how many men we had, but there were cots and pallets everywhere, filled with Union and Confederate men, many of whom were past all aid."
Louisa Cheairs McKenny Sheppard – A Confederate Girlhood

The family’s Southern ties necessitated their flight from the Ozarks. Lucy remained in Springfield, while Lulu and others began the treacherous journey to her Uncle Jack’s plantation in Mississippi. In the spring of 1863, the Yazoo, Tallahatchie and Mississippi Rivers flooded bringing diseases and destruction to the family’s plantation. Lulu wrote of federal gunboats approaching through floating livestock carcasses, uprooted trees and buildings. Eventually the family left the plantation, and headed for Arkansas. Lulu briefly visited her father in Texas, but ultimately returned to Lucy in Arkansas. Lulu’s cousins were also stationed in Arkansas, and she commented on the condition of the men.

"The army in Arkansas was in terrible shape. They lacked for every necessity, but their most crying need was for quinine, for nearly all of them had malaria…"
Louisa Cheairs McKenny Sheppard – A Confederate Girlhood

Lucy sought to assist both the Confederate cause and her sons, as she traveled to St. Louis to procure medicine. Her son Junius, the lone Union man in the family, lived in St. Louis and helped her acquire the quinine. Lucy sewed the medicine into her petticoats, and arrived back in Arkansas in January 1865. While Lucy ventured to St. Louis, Lulu made socks, bandages, and supply “bundles” to support the army. Her efforts were honorable and courageous as supplies of all kinds were limited.

"We had not cloth of any kind, except our homespuns. …There were no shoes…We never suffered for food, though there were no luxuries. Coffee had been gone for a long time, and we used various substitutes of parched and ground grain, or squares of dried sweet potato. We had wheat flour but it was coarse and poorly ground, so that it had to be bolted through muslin cloths to make…bread or cake…. molasses sufficed for 'sweetening'."
Louisa Cheairs McKenny Sheppard – A Confederate Girlhood

Certainly, the hardships Lulu and her family faced were not nearly as difficult as those encountered by families with lesser means. Her story, however, is indicative of the resilient spirit exemplified by so many “Rebel women.” At the War’s end, Lucy was determined to return home; however, Springfield in 1865 was very different from when she left.

"(The Campbell home) was overrun with all sorts of riff-raff who had dribbled into town during the war and who had, in our absence, taken possession of the house. Of course everything was in a fearful state of dirt and disrepair. Our taxes had been paid every year by our Union friends, one of them my future father-in-law. While the Big House was being put in order, Mother lived in one of the servant’s houses… Mother had worked, as always, with all her strength, on the task of reclaiming her property, living in discomfort in that poor little house…"
Louisa Cheairs McKenny Sheppard – A Confederate Girlhood

Eventually Lucy became ill and succumbed to pneumonia. Lulu did not return to Springfield until 1869. There, she met a friend of her young uncle, and they were married within the year. Louisa Cheairs McKenny Sheppard wrote A Confederate Girlhood as a recollection of her youthful adventures and a tribute to her beloved grandmother.

Financing Volunteers and their Dependents

(text adapted from Rochester History, Vol. IX. April, 1947 Nos. 2 & 3 "Historic Origins of Rochester's Social Welfare Agencies", by Blake McKelvey)
From: libraryweb.org

Wages and Benefits
Within the first week after the attack on Fort Sumter, a Volunteer Relief Committee was established and a fund of $36,000 subscribed to aid the dependents of volunteers. Weekly benefits, ranging up to four dollars per family, were distributed in the early months from the first payments on these pledges. However, as the call for new regiments arrived and the long-range character of the war became evident, the Relief Committee was forced to recognize its inadequacy for the big task of supplementing the eleven dollar monthly wages of privates. The task was accordingly turned over to the city which continued throughout the war to pay special benefits, not exceeding two dollars a week, to the needy families of volunteers. The high point in these payments was reached in November, 1864, when 900 such families registered for assistance.

Introduction of Bounties
The community's determination to rely on volunteers introduced a new type of subsidy in the form of bounties. Private bounties appeared in the first months, and before the close of the first year the city likewise assumed this function. Starting with $100 for each enlistee in the fall of 1861, Rochester was paying $300 for each man a year later. The county took over the bounty payments for a time in 1863, but when a draft was threatened the next year, the city re-entered the field; $600 bounties were paid that fall, as well as a few private bounties ranging as high as $1,500. Although these payments were in no sense charity payments, the expenditure of an estimated $700,000, widely distributed among the 5,000 recruits raised in Rochester, considerably affected the relief problem. As most of the bounties were paid in lump sums, the recipients tended to spend them on equipment or other immediate uses, thus contributing to price inflation and reducing the real value of the weekly benefits that were to follow.

New emergency appeals, the Ladies Hospital Relief Association and the Christmas Bazaar
One tragic result of the frightful battles along the Potomac and elsewhere during the war was the multiplication of widows and orphans-a long-term problem of sober significance. Moreover, the hardships of famine sufferers in Kansas and especially those in Ireland, and the victims of a fire in Troy, stirred a response in Rochester which resulted in contributions totaling $7,000 during war years. But of course the most generous response was to the call of the Soldier's Aid Society for hospital supplies to alleviate the suffering of sick and wounded soldiers. The city's first great bazaar was held during Christmas week in 1863 for the benefit of the wounded. More than $10,000 was collected in its numerous booths, and this sum, together with the shipments of clothing, bandages and medical supplies sent off at various periods throughout the war, was placed at the disposal of the United States Sanitary Commission for use in battle areas.

Local Hospitals
It was during the war that the utility of local hospitals finally became apparent in Rochester. When the Federal Government began in 1862 to send small detachments of wounded to St. Mary's Hospital, those who had opposed the City Hospital as a useless extravagance were silenced, and its friends, led by the Female Charitable Society, were able to rush its completion at a cost of $14,000, raised largely from charitable sources. The ladies of various Protestant churches undertook to furnish the several wards with a total of 200 beds, and the hospital was finally ready for use in January, 1864. St. Mary's had meanwhile received community-wide support in its drive for funds to erect a new wing, increasing its bed capacity to 400. By May, that year, 400 wounded were receiving care in the two Rochester hospitals, and 2,000 sick and wounded soldiers were thus accommodated before the close of the Civil War.

History of AMA Ethics

From: ama-assn.org

In 1847 the American Medical Association revolutionized medicine in the United States. Members of the newly formed organization, meeting in Philadelphia as the first national professional medical organization in the world, dedicated themselves to establishing uniform standards for professional education, training, and conduct. They unanimously adopted the world's first national code of professional ethics in medicine. For the more than 160 years since, the AMA's Code of Medical Ethics has been the authoritative ethics guide for practicing physicians.

The Code articulates the enduring values of medicine as a profession. As a statement of the values to which physicians commit themselves individually and collectively, the Code is a touchstone for medicine as a professional community. It defines medicine’s integrity and the source of the profession’s authority to self-regulate.

At the same time, the Code of Medical Ethics is a living document, evolving as changes in medicine and the delivery of health care raise new questions about how the profession's core values apply in physicians' day to day practice. The Code links theory and practice, ethical principles and real world dilemmas in the care of patients.

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