As gunshots ravaged the bodies of tens of thousands of soldiers at the Battle of Gettysburg, military doctors responded with a method of treatment that is still the foundation of combat medicine today.
Union Army Maj. Dr. Jonathan Letterman is remembered as the father of battlefield medicine for his Civil War innovations. He realized that organizing the medical corps was a key for any battle.
“For military medicine, in particular, the lessons that Letterman gave us are as true today as they were then,” said retired Lt. Gen. Ronald Ray Blanck, the former surgeon general for the U.S. Army.
Before the war, medical supplies were handled by regular quartermaster wagons, Blanck said, meaning they had to compete with “beans and bullets.”
The situation was so bad that, in some early Civil War battles, the wounded were left on the field for days, subject to the mercy of untrained troops and civilians.
In 1862, Letterman began to create an ambulance corps and three tiers of field hospitals: at the battlefield for simple wound dressing, nearby for emergency surgery and behind the battle lines for long-term care and recovery.
Dale Smith, a professor of military history at the Uniformed Services University in Bethesda, Md., said Letterman’s innovations were so successful that Prussian and English observers wrote home to praise the system.
“There’s never been any question that he changed military medicine internationally,” Smith said.
But the Battle of Gettysburg was 150 years ago, and some have wondered how that could possibly be relevant for doctors in Iraq and Afghanistan, said George Wunderlich, director of the National Museum of Civil War Medicine in Frederick, Md.
Wunderlich recalled that about 10 years ago, a military member remarked that it was a shame the Civil War “has nothing to do with what we do today” with battlefield medicine.
But after Wunderlich told him how Civil War doctors resolved problems with transportation, training and even corruption, the man asked Wunderlich if those topics could be turned into a one-day course.
Another man who complained that the Civil War training sessions were “unrealistic” called Wunderlich later after responding to Hurricane Katrina, where moving supplies was slow and difficult and even some cell towers were down.
“He says, ‘I’m so sorry. I’m in 1862 down here and now I get it,'” Wunderlich recalled.
Now, more than 5,500 military members and emergency responders have attended history courses run by the Museum of Civil War Medicine. The classes are designed to get people to think about how decisions get made in combat or crisis, and some are taught on battlefields at Gettysburg and Antietam. The courses include topics such as courage and innovation; artillery and its effects; evacuation; and stress and fatigue.
“Our job is to use history to save the lives of people” today, Wunderlich said.
Some of the lessons are subtle. For example, instead of just inspecting hospitals and his staff, Letterman sat beside Union General George McClellan during pre-battle meetings to better predict where to station ambulances and doctors.
“These are the kinds of things that come out from thinking about history,” Blanck said. “The battles are won or lost on the creativity of the medical officer and the support of the commander.”
Wunderlich said the museum also works to dispel many myths about Civil War medicine. The battles and wounds were certainly horrible, but anesthesia using chloroform or ether was involved in more than 95 percent of all major operations, he said.
And while doctors didn’t yet understand exactly what germs were, they had noticed that patients did better when certain folklore was practiced. So while military camps were known for being filthy, hospitals followed strict rules for washing bed sheets and letting in plenty of fresh air and sunlight.
“They didn’t know why, but they knew it worked and they put it to use,” Wunderlich said.
But the biggest benefits of Civil War medicine may have come in the decades after the war, Wunderlich said. The young doctors and medics who had witnessed so much horror and saved so many lives went on to become leaders in many communities, pushing for public health reforms in major cities.
“Those people never stopped practicing medicine,” Wunderlich said. “The benefit to the public was immediate.”
Posts Tagged With: wounds
When the war began, the United States Army medical staff consisted of
only the surgeon general, thirty surgeons, and eighty-three assistant surgeons.
Of these, twenty-four resigned to “go South,” and three other assistant surgeons
were promptly dropped for “disloyalty.” Thus the medical corps began its war
service with only eighty seven men. When the war ended in 1865, more than eleven
thousand doctors had served or were serving, many of these as acting assistant
surgeons, uncommissioned and working under contract, often on a part-time basis.
They could wear uniforms if they wished and were usually restricted to general
hospitals away from the fighting front.
The Confederate Army began by
taking the several state militias into service, each regiment equipped with a
surgeon and an assistant surgeon, appointed by the state governors. The
Confederate Medical Department started with the appointment on May 4 of Daniel
De Leon, one of three resigned United States surgeons, as acting surgeon
general. After a few weeks he was replaced by another acting surgeon general,
who on July 1,1861, was succeeded by Samuel Preston Moore. He took the rank of
colonel and stayed on duty until the collapse of the Confederacy.
Moore, originally a Charlestonian, had served twenty seven years in the United
States Army. He has been described as brusque and autocratic, a martinet. He was
also very hard working and determined, and he was progressive in his
military-medical thinking. Dissatisfied with the quality of many of the surgeons
of the state troops, he insisted that to hold a Confederate commission, every
medical officer must pass examinations set by one of his examining boards. He
disliked filthy camps and hospitals. He believed in “pavilion” hospitals-long,
wooden buildings with ample ventilation and sufficient bed space for eighty to
one hundred patients. Moore, with the compliance of the Confederate Congress and
President Jefferson Davis, began the construction of many such hospitals when
field activities demonstrated that the casualties would be high and the war
long. Dr. Moore maintained a cooperative relationship with Congress, successive
secretaries of war, and President Davis, always subject to the availability of
funds from the Confederate Treasury.
In that era of “heroic dosing”
Moore foresaw shortages in drugs, surgical instruments, and hospital supplies.
He established laboratories for drug manufacture and took prompt steps to
purchase needed supplies from Europe. In the course of time, capture of Union
warehouses and hospitals played an increasing role in the Confederate supply. As
an additional precaution he procured and distributed widely a book on native
herbs and other plants that grew wild in the South and were believed to possess
curative qualities. As a result, despite frequent shortages of some drugs, the
Confederate record was a good one.
Meanwhile, in the old Union,
Surgeon General Thomas Lawson, an octogenarian, obligingly died only weeks after
Fort Sumter. He was replaced by Clement A. Finley, the sexagenarian senior
surgeon who had served since 1818 and was thoroughly imbued with Lawson’s
parsimonious values. Lawson had wanted to keep the Army Medical Department much
as it had been throughout his career, which meant that the eighty-seven
surviving members of the medical corps had not had the kind of experience that
would be needed in a major war. Yet now they were the senior surgeons of a
rapidly expanding army.
Fortunately, immediately after the outbreak
of war there was a swarming of humanitarians of both sexes who wanted to be of
help to the citizen soldiers. Among the most clamorous was the Women’s Central
Association for Relief, of New York, all of whose officers were men. Soon there
was a strong demand for the creation of a United States sanitary commission,
patterned on the British Sanitary Commission, which had been formed to clean up
the filth of the Crimean War. The tentative United States commission elected
officers; the two most important were the president, Henry W. Bellows, a
prominent Unitarian minister, and the executive secretary, Frederick Law
Olmsted, superintendent of Central Park. The commission asked for official
recognition by the War Department stating that its purpose was to “advise and
assist” that department.
Surgeon General Finley, just beginning his
incumbency, had no desire for a sanitary commission, but when that body promised
to confine its activities to the volunteer regiments and to leave the regular
army alone, he withdrew his objections, Secretary of War Simon Cameron then
named a commission of twelve members, of whom three were army doctors.
The United States Sanitary Commission quickly extended itself to
2,500 communities throughout the North, the Chicago branch being especially
proficient. The St. Louis people accomplished great things but insisted on
remaining independent under the name of the Western Sanitary Commission. The
women of the local branches kept busy making bandages, scraping lint, and
sending culinary delicacies to army hospitals. The national organization
maintained a traveling outpost with the Army of the Potomac to speed sanitary
supplies to the field hospitals of that army. In 1862 and again in 1864 the
commission provided and manned hospital ships to evacuate Army of the Potomac
sick and wounded to general hospitals as far from the front as New York City.
Early in the war, and later when it seemed appropriate, the
commission persuaded highly respected doctors to write pamphlets on sanitation
and hygiene. These were widely circulated among both medical and line officers.
Although often erroneous, these pamphlets presented the best thought of that
pre-bacteriological era and did some good where surgeons could persuade their
colonels to take the advice. In the absence of any medical inspectors, the
commission induced a number of esteemed doctors to examine recruit camps and to
report on cleanliness and on the professional adequacy of surgeons to hold their
Although the Southerners had some local and state relief
organizations, they enjoyed nothing similar to the Sanitary Commission in scope
or efficiency; yet in the effects of camp disease and unsanitary conditions, the
Confederacy and the Union shared common experiences indeed. The two armies had
similar experiences as their forces were being trained, usually in an
instruction camp as a gathering place for the troops of each state. Medical
officers did not know how to requisition drugs and medical supplies.
Commissaries did not know how to requisition rations. It has been said that “the
Americans are a warlike but unmilitary people,” and the first months of the
Civil War proved the adage. Too many men, when entering the army after a
lifetime of being cared for by mothers and wives, had a tendency to “go native”
to ignore washing themselves or their clothing and, worst of all, to ignore all
regulations about camp sanitation, Each company was supposed to have a sink, a
trench eight feet deep and two feet wide, onto which six inches of earth were to
be put each evening. Some regiments, at first, dug no sinks. In other cases the
men, disgusted by the sights and odors around the sinks, went off into open
spaces around the edge of the camp. The infestation of flies that followed was
inevitable, as were the diseases and bacteria they spread to the men and their
Soon long lines of soldiers began coming to sick call with
complaints of loose bowels accompanied by various kinds and varying degrees of
internal discomfort. The medical officer would make a slapdash diagnosis of
diarrhea or dysentery an prescribe an astringent. He usually ascribed this
sickness to the eating of bad or badly cooked food. Union Army surgeons were to
come to use the term “diarrhea-dysentery,” lumping all the cases together as one
disease. In fact, in many cases it was only a symptom of tuberculosis or
malaria, though amoebic and bacillary dysentery, introduced into the South by
slaves brought from Africa, was certainly present as well. It caused enormous
sickness and many deaths. The Union Army alone blamed the disease for 50,000
deaths, a sum larger than that ascribed to “killed in action.” It was even more
lethal in the Confederate Army.
The diets of both armies did not help
and were deplorably high in calories and low in vitamins. Fruits and fresh
vegetables were notable by their absence, and especially so when the army was in
the field. The food part of the ration was fresh or preserved beef, salt pork,
navy beans, coffee, and hardtack, large, thick crackers, usually stale and often
inhabited by weevils. When troops were not fighting, many created funds to buy
fruits and vegetables in the open market. More often they foraged in the
countryside, with fresh food a valuable part of the booty. In late 1864, when
Major General W. T. Sherman made foraging his official policy on his march from
Atlanta to Savannah, his army was never healthier. As the war went on,
Confederate soldiers were increasingly asked to subsist on field corn and peas.
And the preparation of the food was as bad as the food itself, hasty,
undercooked, and almost always fried.
No wonder, then, that at sick
call, shortly after reveille, many men who claimed to be sick were marched by
the first sergeant to the regimental hospital, usually a wall tent. There the
assistant surgeon examined them, then assigned some to cots in the hospital
tent, instructed others to be sick in quarters, and restored a few to light duty
or to full duty. The less sick and slightly wounded would be expected to nurse,
clean, and feed the patients and to see to the disposal of bedpans and urinals.
In the event of an engagement, the assistant surgeon and one or more
detailed men, laden with lint, bandages, opium pills and morphine, whiskey and
brandy, would establish an “advance” or dressing station just beyond musket fire
from the battle. Stretcher-bearers went forward to find the wounded and, if the
latter could not walk, to carry them to the dressing station. The assistant
surgeon gave the wounded man a stout drink of liquor, expecting it to counteract
shock, and then perhaps gave him an opium pill or dust or rubbed morphine into
the wound. Later in the war the advantages of a syringe to inject morphine
became apparent. The assistant surgeon examined the wound, with special
attention to staunching or diminishing bleeding. After removing foreign bodies,
he packed the wound with lint, bandaged it, and applied a splint if it seemed
advisable. The walking wounded then started for the field hospital, officially
the regiment hospital tent, although in 1862 and onward there was an increasing
tendency to take over a farmhouse, school, or church if such was available. The
recumbent went by ambulances, if there were any, for the ride to the field
hospital, usually anywhere from three to five miles from enemy artillery and
sometimes much farther.
There, lying on clumps of hay or bare ground,
the wounded awaited their turn on the operating table. There was usually little
shouting, groaning, or clamor because the wounded were quieted by shock and the
combination of liquor and opiate. It was an eerie scene, with a mounting pile of
amputated limbs, perhaps five feet high, the surgeon and the assistant
surgeon-after a few months both Union and Confederate authorities decided that
two assistant surgeons were necessary in a regiment -cutting, sawing, making
repairs, and tying ligatures on arteries. The scene was especially awesome at
night, with the surgeons working by candlelight on an assignment that might
sometimes go on for three or four days with hardly a respite. And there was
always the smell of gore.
The surgeons tried to ignore both the
slightly wounded and the mortally wounded in the interest of saving as many
lives as possible. This meant special attention to arm and leg wounds. Union
statistics showed that 71 percent of all gunshot wounds were in the extremities,
probably because of fighting from cover behind trees and breastworks. Wounds of
the head, neck, chest, and abdomen were most likely to be mortal, so the
amputation cases went first on the operating table. The bullet or piece of shell
had to be removed, often with the operator using his fingers for a probe.
Between the extensive damage done by the Minnie bullets used to inflict wounds,
and the haste and frequent ignorance in treating them, amputation was all too
often the “treatment” prescribed.
Everything about the operation was
septic. The surgeon operated in a blood- and often pus-stained coat. He might
hold his lancet in his mouth. If he dropped an instrument or sponge, he picked
it up, rinsed it in cold water, and continue work. When loose pieces of bone and
tissue had been removed, the wound would be packed with moist lint or raw
cotton, unsterilized, and bandaged with wet, unsterilized bandages. The bandages
were to be kept wet, the patient was to be kept as quiet as possible, and he was
to be given small but frequent doses of whiskey and possibly quinine. This was a
The urgency of operating during the primary
period–the first twenty-four hours was to avoid the irritative period–when
infection showed itself. The surgeon seldom had to wait more than three or four
days for “laudable pus” to appear. This was believed to be the lining of the
wound, being expelled so that clean tissue could replace it and the wound could
heal. In the rare cases when no pus appeared, it was called “healing by first
intention” and was a complete mystery. Actually the pus was the sign that
Staphylococcus aureus had invaded and was destroying tissue.
As to technique, the amputating surgeons had a choice of the “flap”
operation or the “circular,” both quite old. The former was quicker but enlarged
the wound; the latter, when properly done, opened up a small area to infection.
By the end of the war a small majority preferred the flap. The frequency of
amputations was much questioned at the time. Yet, considering the condition of
the patients, the difficulties of transportation, and the septic condition of
the hospitals, amputations probably saved lives rather than limbs.
Men wounded in the abdomen by gunshot frequently died of peritonitis
if they had not already bled to death from serious arterial injuries. Wounds of
the head and the neck were frequently mortal. Some surgeons in both armies
experimented for a while in sealing chest wounds. They would plug the wound with
collodion, relieving the dreadful dyspnea, breathlessness, of the patient, but
sealing in such infections as entered with the bullet. These cases were likely
to be mortal, but the operator seldom knew because the patient was soon
evacuated to a general hospital. As for the frightful looking sabers and
bayonets, they inflicted barely 2 percent of the wounds, most of which usually
Surgical fevers disheartened the doctors. Four or five days
after a wound operation, the patient would be recovering well, producing copious
pus. Then suddenly the pus stopped, the wound dried, and the patient ran a
terrific fever. Despite drugs, the patient would very likely be dead in three or
four days. The diagnosis was blood poisoning. Erysipelas also affected both
armies. With a case mortality of 40 percent, it received serious attention. It
was recognized by a characteristic rash, and it was thought by some to be
airborne, with the result that both Unionists and Confederates took steps to
isolate erysipelas patients in separated tents or wards. The surgeons were in
the dark as to how to treat this affliction, but it was noted that if iodine was
painted on the edges of a wound, its further extension was stopped.
Civil War surgeons had not only iodine but carbolic acid as well, and
a long list of “disinfectants” such as bichloride of mercury, sodium
hypochlorite, and other agents. The trouble was that the wound was allowed to
become a raging inferno before disinfectants were tried. However, one of the
good features of Civil War surgery was that anesthetics were almost always used
in operations or the dressing of painful wounds. It was practically universal in
the Union, and despite mythology, anesthetics were very seldom unavailable in
the Confederacy. The almost universal favorite was chloroform, probably because
ether’s explosive quality made it dangerous at a field hospital operating table,
where there was always the possibility of enemy gunfire.
coming of the big battles of 1862, both armies more or less simultaneously
evolved larger and better field hospitals. First, regimental hospitals clustered
together as brigade hospitals with some differentiation of duty for the various
medical officers and with the chief surgeon of the brigade in charge. Soon
brigade hospitals clustered into division hospitals, and by 1864 in most field
armies there were corps hospitals. There the best surgeons would operate; one
surgeon would be in charge of records, another of drugs, another of supplies,
and yet another would direct and treat the sick and lightly wounded who were the
In time for Antietam, the Army of the Potomac, under its
medical director Jonathan Letterman, developed the Letterman Ambulance Plan. In
this system the ambulances of a division moved together, under a mounted line
sergeant, with two stretcher-bearers and one driver per ambulance, to collect
the wounded from the field, bring them to the dressing stations, and then take
them to the field hospital. It was a vast improvement over the earlier “system,”
wherein bandsmen in the Union command, and men randomly specified in the
Confederacy, were simply appointed to drive the ambulances and carry the
litters. Frequently the most unfit soldiers were detailed, which often meant
that, not being good fighters, they were little better as medical assistants.
Often in the first year of the war they got drunk on medicinal liquor and
ignored their wounded comrades in order to hide themselves from enemy fire.
Such improved organization was copied or approximated in the other
field armies despite loud opposition from the Quartermaster Corps, which wanted
to keep control of ambulances and drivers, and from some field commanders, of
whom Major General Don Carlos Buell of the Army of the Ohio was notable for
In general, the Union forces in the West were spared
battlefield relief scandals by the fact that major battles were fought on the
banks of rivers, whence wounded arid sick could be evacuated by river boats to
Mound City, Illinois, St. Louis, and other cities with general hospitals in the
safety and secure supply of the North. After the relatively prompt fall of
Memphis, that city became the site of several general hospitals. The evacuating
boats, however, might I be maintained by individual states or by the United
States Sanitary Commission or the Western Sanitary Commission, which led to
confusion. The state boats, especially those from Ohio and Indiana, were so
persistent in their “raiding” the evacuation hospitals for Buckeyes and Hoosiers
that General Grant had to forbid their removing any patients.
losing control of their rivers, the Confederates made considerable use of
railroads in evacuating men from field hospitals to general hospitals. They had
no special hospital cars and felt fortunate when they could use passenger rather
than freight cars. They became adept at maintaining dressing and supply stations
where wounds could be tended and the patients fed. The Union Army, too,
increasingly used railroads for evacuating men north. After the Battle of
Chattanooga, a real hospital train was regularly used to move the sick and
wounded from Chattanooga to Louisville. Some of the cars were equipped with two
tiers of bunks, suspended on hard-rubber tugs. At the ends of such cars would be
a room for supplies and food preparation. The locomotive assigned to this train
was painted scarlet, and at night a string of three red lanterns burned on the
front. Confederate cavalrymen never bothered this train.
was that the military commanders, both Confederate and Union, hated to see
fighting soldiers separated from the army; the fear was they would never return.
The South was well aware it was fighting a much larger people. The Union
generals were well aware that as the invaders, on the offensive, they needed a
majority of the men on the battlefield. They also realized that the deeper they
penetrated the South, the greater the number of men needed to garrison important
points and to guard ever-longer supply lines. And so there was never an actual
separately enlisted and separately trained hospital corps in either army.
When Edwin M. Stanton took over as Lincoln’s Secretary of War
early in 1862, he realized that Dr. Finley, now a brevet brigadier general,
would have to be replaced as surgeon general. Taking the advice of the Sanitary
Commission, he appointed William A. Hammond, then a junior assistant surgeon. A
Marylander, Hammond had served eleven years as an assistant surgeon before he
resigned and became a professor in the University of Maryland Medical School. He
was to accomplish many good things and to make many good suggestions during the
fourteen months he served as surgeon general. It was obvious to him and to his
supporters in the Sanitary Commission that the army needed a group of medical
inspectors, chosen for merit and possessing enough rank to give orders to
hospital commanders. It was obvious that the makeshift general
hospitals–hotels, warehouses, schools, churches–should be rapidly replaced by
pavilion hospitals designed for their function. It was obvious that corps and
division hospitals should become official and that something like the Letterman
Ambulance Plan should be extended throughout the army. It was obvious that the
quartermaster should not be able to remove ambulances nor line officers be able
to remove experienced attendants from the medical field details.
Eager to educate his department in the best ideas of the time,
General Hammond wrote a full length textbook on military hygiene. He brought
about the writing of Joseph J. Woodward’s admirable The Hospital Steward’s
Manual. He gave every encouragement to the many medical societies that had
sprung up in the army, ordering that interesting scientific specimens should be
forwarded to Washington for inclusion in an Army Medical Museum. He began the
collection of what has become the world’s largest medical library.
Finley and Hammond secured Congressional authority to augment the
regular Army Medical Department by several hundred men, first called brigade
surgeons, later surgeons of volunteers, a group that contained unusually
prestigious doctors. They were used chiefly as staff assistants. As for the
increase in regimental surgeons and assistant surgeons, the Medical Department
was to have little say. Higher authority had found it desirable to increase the
army by a persistent raising of new regiments rather than by filling up the
depleted ranks of the old ones. This maintained the state governors in their
unfortunate practices of selecting and commissioning the surgeons and assistant
surgeons. The surgeon general could only attempt to reject unfit professionals
by extensive use of reexaminations and “plucking” boards.
Hammond felt frustrated. Secretary Stanton leaned heavily on General Henry
Halleck for military advice, and this usually supported the ideas of the old
regular army medics who were jealous of Hammond, the interloper who had been
promoted over their heads from captain to brigadier general. In addition,
Hammond won the enmity of a large proportion of the American medical profession
through his banning of the two mercurials, calomel and tartar emetic, from the
army drug table. He may have been correct in his idea that these drugs were
being overused, but this seemingly arrogant action lost him the sympathy of many
As a result, Hammond was effectively replaced by
Joseph K. Barnes, of the surgeon general’s office, in September 1863. It was
almost a year before a court-martial of docile surgeons, although finding him
“not guilty” on other counts, did vote Hammond guilty of, “conduct unbecoming an
officer and a gentleman.” He had to leave the army.
successful, Hammond was only partially so. After the medical inspector bill
passed, Secretary Stanton decreed that half the inspectors were to be
“political” appointees. When the ambulance corps bill of 1864 became law, what
was essentially the Letterman Ambulance Plan was extended to all the armies. The
Army Medical Department was to have the privilege of choosing the enlisted men
to be put on ambulance and stretcher-bearer detail, and they could not be
withdrawn, but there was still no ambulance corps per se.
Medical Department organization was very much what Surgeon General Moore thought
it should be. Congress gave him a considerable body of medical inspectors and
hospital inspectors, the former operating within the field armies and the latter
in the general hospitals of each state, with the medical director of each state
responsible for its hospitals. There was some debate with the quartermaster
general about ambulances, but this was generally over the lack of them. Farm
wagons most often constituted the ambulances of the Confederacy. Although Moore
had much the same “arrogant” personality traits as did Hammond, he usually
obtained prompt obedience to orders rather than conflict.
experimented with “special” hospitals, with admission limited to patients with
the same disorders. The Confederates established several venereal hospitals and
some ophthalmic hospitals. The Unionists began a venereal hospital at Nashville
and the famed neurological hospital, Turner’s Lane, at Philadelphia, where W. W.
Keen is believed by some to have founded neurology in America.
contrast, a “general” hospital did not limit its admissions. The sick and the
wounded were evacuated to general hospitals so that empty beds could be made
available in field installations when a new rush of wounded was expected.
Buildings adapted for use as general hospitals were usually considered
unsatisfactory because of the inadequate plumbing, the bad ventilation, and the
“crowd poisoning” and “mephfluvia” which that generation thought bred and spread
disease. Moore and Hammond believed a large building program of pavilion
hospitals in 1862 was the answer. To the best of their abilities both sides
carried this out, and followed it by still bigger construction programs in 1863
and 1864. The Union pavilions were longer than their Confederate counterparts.
Some were as long as 120 feet, with a width of 14 or 15 feet, with a
longitudinal ventilator along the 12- to 14-foot roof. This, along with floor
ventilation, made the patients too cold and was later closed by wooden slats.
At the inner end, each pavilion, North and South, had toilets,
sometimes flush and sometimes, seats over a sloping zinc trough in which water
was supposed to run continuously. Reports show that often the water supply was
insufficient and that toilets were flushed only after many usings.
Frequently the pavilions were built as though they were spokes
spreading from a hub. The buildings at the hub were operating rooms, kitchens,
offices, pharmacies and supplies, “dead house,” ice house, and other services.
The grounds were usually joined by a wooden roadway on which food could be
hauled or the wash taken up and delivered by a steam-powered vehicle.
The staff, aside from the medical officers and hospital stewards, was
mostly made up of the convalescents. They were frequently weak and weary, often
snappish and irritable. They did not like the dirty work they performed. They
wanted to go home. The surgeon-in-charge, as the hospital commander was titled,
was often in a dilemma. If he returned the patient to his regiment too soon, the
man might relapse or die on the road to his unit. If he tried to hold on to the
man too long, he might be forcibly returned to his regiment; and if he prevailed
upon an inspector to give a medical discharge, he would be losing an attendant
who had learned something about his work, and would be forced to rely on a new
man who knew nothing. Union and Confederate surgeons-in-charge faced the same
problem, although occasionally in Southern hospitals there were hired blacks of
both sexes. These people were considered only marginally successful. Some
attempts in the North to use cheap male labor as hospital attendants proved
unsatisfactory, the men being undisciplined, a “saucy lot” who even stole from
The brilliant results of Florence Nightingale in
cleaning up the Crimean hospitals had been widely noted, with the result that
early on it was decided that a corps of female nurses should be added to the
army, with Dorothea Dix their superintendent. Miss Dix was widely known as a
reformer of jails and as the “founder” of several state mental hospitals.
Devoted and hard working, she was disorganized, unyielding in controversy, and
deeply in the grip of Victorian ideals of propriety. Allowed to choose the
nurses and to set the rules, she announced that her appointees must be at least
thirty and plain in appearance, and must always dress in plain, drab dresses and
never wear bright-colored ribbons. They could not associate with either surgeons
or patients socially, and they must always insist upon their rights as the
senior attendants in the wards.
It was not long before outraged
surgeons virtually went to war with Miss Dix’s nurses, frustrating them,
insulting them, trying to drive them from the hospitals. These were
strong-minded middle-class American women, accustomed to ruling within the home
and to receiving the respectful attention of their husbands and male
acquaintances. For the most part they had no nursing training. The surgeons
complained that they often substituted their own nostrums for the drugs
prescribed and that they sometimes were loud and interfering when attempting to
As time passed, younger and less self-righteous
nurses began to appear in the army, furnished by the Western Sanitary Commission
or some other relief agency. Some surgeons learned to suppress their
male-chauvinist behavior. In September 1863, the War Department approved a new
nurse policy that, although ostensibly a victory for Miss Dix, really defeated
her. Under this edict, hospital commanders could send away Dix appointed nurses
but were forced to accept Dix appointed replacements unless the surgeon general
authorized the appointment of someone the surgeon-in-charge preferred. The
surgeon general was always willing.
In fact, the female nurses were
much liked by the patients and were not so much nurses as mother-substitutes.
They wrote letters for their “boys,” read to them, decorated the wards with
handsome garlands, and sometimes sang. Both armies used small contingents of
Catholic nuns in certain general hospitals. They came from the Sisters of
Charity, the Sisters of St. Joseph, the Sisters of Mercy, and the Sisters of the
Holy Cross. Having been teachers, some lacked previous hospital experience, but
surgeons liked them because they had been bred to discipline. The patients liked
them too, but called them all Sisters of Charity.
improved perceptively when women matrons took over the supervision of kitchens.
These women came from various sources, many supplied by the United States
Christian Commission, a large organization that donated delicacies to hospitals
but considered the saving of souls, by passing out religious tracts, its
Because of the great fame of Clara Barton, and
some women like her, an impression prevailed that women functioned in hospitals
in the field. This was seldom the case. Miss Barton might best be described as a
one-woman relief agency. However, the strong-minded but winning “Mother” Mary
Ann Bickerdyke became so popular that in 1864 General W. T. Sherman officially
appointed her to his own corps hospital.
Women could be found serving
in various ways in Confederate hospitals, too, but the bulk of them were hired
black cooks and washerwomen. In the conservative South there was a widespread
feeling that a military hospital was no place for a lady, Only in Richmond were
there significant numbers of women working in the city’s many hospitals.
Richmond was indeed the hospital center of the Confederacy, with
twenty hospitals in 1864 after many of the makeshift type had been closed and
replaced by pavilion structures. The queen of them was Chimborazo, which had
beds for 8,000 men and was often called the largest hospital on the continent.
It was organized into four divisions, each with thirty pavilions. There were
also five soup houses, five ice houses, “Russian” baths, a 10,000-loaf per day
bakery, and a 400-keg brewery. On an adjacent farm the hospital grew food and
grazed three hundred cows and several hundred goats. Almost as amazing was
Jackson Hospital, which could care for 6,000 patients in similar ways. Elsewhere
than Richmond, general hospitals were neither so large nor so grand, but there
were many of which the Confederates were proud. By late 1864 there was a total
of 154 hospitals, most located close to the southern Atlantic coast. They began
to close down, often because of enemy action, early in 1865.
Washington and its environs was the natural hospital center of the
Union Army because of its proximity to major battlefields. This proved
unfortunate because the city had always been considered a sickly place, chiefly
because of the large open canal that stretched across town and into which much
sewage was dumped. Also, the metropolitan community had many standing pools in
which anopheles mosquitoes bred. The intestinal disease and malarial rate of the
hospitals were a natural result.
At the end of 1861 Washington had
only 2,000 general hospital beds. The great slaughters of the Peninsular
campaign, with the Second Battle of Bull Run immediately after, followed shortly
by Antietam, flooded the hospitals of the Washington area and Baltimore and
Philadelphia as well. Adaptation went so far as converting the halls of the
Pension Office, with cots among the exhibitions, the Georgetown jail, and the
House and Senate in the Capitol. From August 31 to the end of 1862, 56,050 cases
were treated in Washington. Many of these adaptations were closed in 1863,
replaced by modern pavilion hospitals. At the end of 1864 the city contained
sixteen hospitals, many of them large and fine. There were seven at nearby
Alexandria and one each at Georgetown and Point Lookout, Maryland. Outstanding
was Harewood, said to resemble an English nobleman’s estate, with professionally
landscaped grounds, flower gardens, and a large vegetable garden. Its building
consisted of fifteen large pavilions with appropriate service buildings and some
The Western showpiece was Jefferson Hospital at
Jeffersonville, Indiana, just across the river from Louisville. Built in the
winter of 1863-64 with 2,000 beds, later increased to 2,600, at war’s end it had
plans for 5,000 beds. Its most interesting architectural feature was a circular
corridor 2,000 feet long from which projected twenty-four pavilions, each 175
By the last year of the war there were 204 Union general
hospitals with beds for 136,894 patients. This proved to be the maximum. In
February 1865 the United States began closing down its hospitals.
many men and women, North and South, who served in the hospital and sanitary
services during the war were justly proud of their achievements. The morbidity
and mortality rates of both armies showed marked improvement over those of other
nineteenth-century wars, particularly America’s last conflict, the war with
Mexico. In that war 90 percent of the deaths were from nonbattle causes. In
contrast, in the Civil War some 600,000 soldiers died, but in the Union Army
30.5 percent of them died in or from battle, and in the Confederate Army the
percentage ran to 36.4. Clearly, the physicians and sanitarians had held down
the disease mortalities to levels that their generation considered more than
reasonable. Better, they made some few halting strides in treatment and
medication, and considerable leaps in the organization of dealing with masses of
wounded and ailing soldiers. It was a ghastly business for doctors and patients
alike; yet without the medicos in blue and gray, much of the young manhood of
America at mid century might not have survived for the work of rebuilding.
Source: The National
Historical Society’s The Image of War: 1861-1865 Volume IV “Fighting For Time”
article by George W. Adams