Field Hospitals
Field Hospitals
FIELD HOSPITALS: AN OVERVIEW
Jeffrey William Hunt
COMRADES AND THE AMBULANCE CORPS
Jeffrey William Hunt
TRIAGE AND SURGERY
Anurag Biswas
EVACUATION HOSPITALS
J. Douglas Tyson and Jenny Lagergren
Field Hospitals: An Overview
No other part of the battlefield represented such an odd mixture of hope and terror as the field hospital. The writings of veterans almost universally picture it as a place to be feared and avoided if at all possible. To the men who survived the conflict, hospitals presented a gruesome compendium of the horrors of the war, second only to the sight of torn, bloated, lifeless bodies on the field of battle. Yet the field hospital's staff, medicines, facilities, and surgeons were the only hope desperately wounded men had to save life and limb.
It was predictable that there would be contradictory views of the hospital. Only there could wounded soldiers find relief from their pain, comfort and assistance in their weakened and helpless condition, and life-saving surgery and medical care. At the same time, however, the hospital was a site of agony and misery—the place where men with mangled limbs, bleeding bodies, torn flesh, blinded eyes, and worse, were brought together. It was the spot where overworked doctors hurriedly examined and probed painful wounds; where, all too often, surgeons used their instruments to amputate shattered and infected limbs. Field hospitals were facilities where mortally wounded men were given a few comforts and set aside to die. They were in short a concentration of the vilest aftereffects of battle.
The common perception of Civil War hospitals and surgeons was generally quite negative during the conflict. Time did little to alter that point of view and, in fact, did much to reinforce it. The disorganized and grossly inadequate efforts made by both Union and Confederate medical departments at the start of the war were widely reported in newspapers of the day. However, both sides were able to rapidly improve the standard of care delivered to sick and wounded soldiers alike. This remarkable advance in battlefield medical practices saved many lives before the war was over (Bollet 2002, p. xiii).
Hospital Trains
The Civil War was the first railroad war. Both sides used trains to move troops and supplies to the front and transport sick and wounded men to general hospitals located throughout the North and South. Initially, ordinary boxcars were used to haul patients. These cars had no provisions for the feeding, care, or comfort of wounded soldiers, who endured journeys lasting hours, and sometimes days, without medical attention or basic necessities. The agony and misery such trips entailed was extreme, provoking demands for change.
The industry-poor Confederacy could do little to remedy such problems. The North, with facilities for building locomotives and railway cars, developed hospital trains. Specially designed "ambulance cars" were built, each containing space for thirty hospital litters, suspended three high from stanchions by rubber straps. The litters, complete with mattresses and pillows, swung gently, preventing the pain previously caused by any movement of the trains. Each car had a seating area and a fully stocked pantry. A stove heated the cabin. Kitchen and dining cars accompanied the ambulance cars, as did sleeping cars for doctors and nurses staffing the train. The locomotive and tender were painted bright red, and U.S. Hospital Train was emblazoned in large red letters on every car. These trains provided all the facilities of an efficient and well-regulated hospital. Sick and injured troops were never without food, water, comfort, or medical care while being carried to their destination.
jeffrey william hunt
SOURCE: Bollet, Alfred Jay. Civil War Medicine: Challenges and Triumphs. Tucson, AZ: Galen Press, 2002.
But improvements and innovations seldom made headlines and largely went unnoticed. The horror, fear, and sadness surrounding even an efficiently run and effective field hospital kept most veterans from seeing or understanding the vast change for the better made by dedicated doctors, surgeons, officers, and administrators. Postwar memoirs and regimental histories are full of stories of needless amputations conducted without anesthesia. Also prevalent are tales of incompetent surgeons, indifferent doctors, callous nurses or stretcher-bearers, and half-trained medical students conducting unnecessary surgery on injured soldiers simply to gain experience (Bollet 2002, p. xiii).
Perception vs. Reality
The attitude of many soldiers toward the men who worked in field hospitals, and toward what went on in them, is abundantly clear in an account given by a Union officer wounded during the May 23 to July 9, 1863, siege of Port Hudson, Louisiana:
The surgeons used a large Cotton Press for the butchering room & when I was carried into the building and looked around I could not help comparing the surgeons to fiends…. [A]ll around on the ground lay wounded men; some of them shrieking, some cursing & swearing & some praying; in the middle of the room was some 10 or 12 tables just large enough to lay a man on; these were used as dissecting tables & they were covered with blood; near & around the tables stood the surgeons with blood all over them & by the side of the tables was a heap of feet, legs & arms. (Wiley 1952, p. 148)
The bloody mass of waiting wounded, the tables, the appearance of the surgeons, and the agony of the injured were, of course, very real. But the words this injured soldier used to describe what he saw—"butchering," "fiends," "dissecting"—reveal all too well how he perceived those who were about to save his life. His point of view was hardly unusual. For people unaccustomed to the sight of mass casualties gathered together, or the instruments and operations of surgeons, revulsion and horror were common reactions. Wounds, after all, are horrific to look at; suffering is difficult to hear or see, and the methods used by doctors and surgeons to treat major wounds must, of necessity, sometimes cause pain. The very tools used to repair and heal—probes, saws, scalpels, needles—were enough to make most witnesses shudder, especially if they did not fully understand what was being done or why. Any modern person who has felt ill at ease while staring at medical instruments in a doctor or dentist's office has had a similar, although certainly less intense, experience.
Furthermore, field hospitals posed dangers that were unrecognized at the time. The Civil War was fought just prior to the discovery of bacteria and their role in causing infections, and the development of methods of sterilization used to prevent the transmission of disease from cross-contamination.
One Federal surgeon, looking back on the war from the vantage point of 1918, was amazed at the ignorant practices employed between 1861 and 1865:
We operated in old blood-stained and often pus-stained coats…. We used un-disinfected instruments from un-disinfected plush-lined cases, and still worse, used marine sponges which had been used in prior pus cases and had been only washed in tap water. If a sponge or an instrument fell on the floor it was washed and squeezed in a basin of tap water and used as if it were clean. Our silk to tie blood vessels was un-disinfected…The silk with which we sewed up all woulds was undisinfected. If there was any difficulty threading the needle we moistened it with…bacteria-laden saliva, and rolled it between bacteria-infected fingers. We dressed wounds with clean but undisinfected sheets, shirts, tablecloths, or other old soft linen rescued from the family ragbag. We had no sterilized gauze dressing, no gauze sponges…. We knew nothing about antiseptics and therefore used none. (Wiley 1952, p. 148)
Little wonder then, that wounds frequently became infected even after successful operations. Very often, injured men who survived the trip from the battlefield to the field hospital and underwent life-saving procedures died weeks or months later from the unrecognized bacteria that caused gangrene, tetanus, and other complications.
Nonetheless, field hospitals saved many more lives than they took. Fortunate to be working, for the most part, on healthy young men, inured to hardship by a soldier's life, surgeons and doctors ministered to a population with a better than average likelihood of healing and recovering. If infection could be avoided, and the wound was at all survivable, medical personnel usually managed to save life, if not limb.
Supplies
At the war's outset, the typical surgeon used his own personal instruments, usually brought into service from prewar private practice. He was authorized by the government to purchase and use whatever medicines or supplies he thought appropriate. Hospital stewards in every regiment carried a medical knapsack, which was similar in shape and size to the pack carried by infantrymen and worn in identical fashion. Union hospital steward Charles Johnson recalled that this knapsack contained such emergency supplies as "bandages, adhesive plaster, needles, artery forceps, scalpels, spirits of ammonia, brandy, chloroform and ether" (Commager 1973 [1950], pp. 195–196).
The type and quantity of supplies and medicines at the field hospital was constrained by the necessity of mobility. The number of wagons and ambulances assigned to a hospital was finite, and care had to be taken not to overload vehicles that would be pulled by mules or horses over rough and difficult roads. The standard stock of medicines in a field hospital consisted of "opium, morphine, Dover's powder, quinine, rhubarb, Rochelle salts, castor oil, sugar of lead, tannin, sulphate of copper, sulphate of zinc, camphor, tincture of opium, tincture of iron, tincture opii, camphorate, syrup of squills, simple syrup" and a wide variety of alcohol (Commager 1973 [1950], p. 195). Most medicines were compounded in liquid or powdered form. Few pills were available, so powders were typically mixed with water and drunk by the patient. Precise measurements were not made and surgeons simply apportioned the amount of medicine they thought necessary (Commager 1973 [1950], p. 195).
The resulting lack of uniformity in supplies, instruments, and medicines proved a logistical nightmare. Combined with the widely varying levels of experience and skill found among surgeons and stewards, it also frequently resulted in poor or indifferent care for the sick and wounded. By late 1862, however, changes born of experience and good leadership began to address these concerns.
Among the many vital improvements made by Jonathan Letterman, medical director of the Army of the Potomac from July 1862 to January 1864, was standardization of equipment and medicines for field hospitals. Letterman developed a thoroughly modern system of evacuating wounded from the battlefield, totally reformed the organization and staffing of field hospitals, and established standardization in the army's Medical Department.
Letterman introduced a standard medical kit for each doctor, equipped with exactly the same instruments, arranged in precisely the same fashion (Freemon 2001, p. 75). He also oversaw the adoption of the Autenrieth Wagon—a specially designed supply wagon that carried a standard set of surgical instruments and medicines, arranged to provide immediate and unfettered access in time of need. Because every wagon was identically organized, packed, and equipped, any surgeon could find exactly what he needed from any such wagon, regardless of the unit to which it belonged (Bol-let 2002, pp. 244–245). These reforms, first instituted in the Army of the Potomac, were later extended to all Union armies and replicated as much as possible by the Confederates.
Organization
One of the greatest challenges facing Union and Confederate medical departments was the problem of how best to utilize their resources. Every regiment was entitled to a surgeon, an assistant surgeon, and one hospital steward. The latter carried out the same function as the military medic or corpsman of the twentieth and twenty-first centuries. Surgeons held officer's commissions, while the steward was equivalent in rank to a sergeant. Special duty men, drawn from regimental ranks, would do the odd jobs—cooking, drawing water, and so on—necessary for the hospital to function. All were responsible to the regimental commander. The titles of these men were sometimes deceptive, however. The term surgeon was applied to any officer assigned medical duties, even if he did not have surgical experience. Many "surgeons" were simply doctors, of varying educational background and experience, and some were mere med-ical students (Freemon 2001, p. 41).
Nonetheless, the medical personnel assigned to a regiment were the primary source of care in camp and aid on the battlefield. As their unit moved toward battle, they selected a sheltered spot behind the lines on which to establish the regimental field hospital. If at all possible, the site chosen was near a source of water—either a stream or well—and beyond the range of small arms fire, if not always artillery fire. Houses or barns, if available, were often requisitioned for use by the surgeons. Such structures supplemented the meager four tents allotted to reach regimental hospital by army regulations: two small tents for the officers, one small kitchen tent, and one hospital tent capable of holding eight cots (Commager 1973 [1950], p. 194).
At the beginning of the conflict every hospital was marked by a red flag. By early 1864, however, a yellow flag with a large green H painted or sewn on it was the standard banner used to designate the presence of a field hospital. These flags helped walking wounded, ambulances, and litter-bearers find the facility, and hopefully kept the enemy from firing on it (Bollet 2002, p. 218).
The assistant surgeon, accompanied by the steward with his knapsack, followed closely behind the battle line. Their job was to establish a field dressing station as near to the firing line as practicable, where they would provide first aid and immediate emergency care. Here wounded men received initial treatment to stop bleeding, splint fractures, and relieve pain, usually through the administration of opiates.
The assistant surgeon was also responsible for making initial triage decisions—determining the order by which wounded were taken to the regimental hospital, based on the severity of their wounds. Lightly wounded men had their injuries dressed and were either sent back to the firing line or ordered rearward under their own power. Badly hurt men whose lives might be saved by immediate surgery were assigned first priority for transportation by ambulance or stretcher-bearers. Those believed to have mortal wounds were made comfortable and set aside to die. If they did not die, they would be sent to the hospital when resources and time allowed (Bollet 2002, pp. 100–101).
The regimental hospital system, used by both sides in the first year of the war, proved wasteful and inefficient. It required great redundancy in supplies and equipment and proved problematic on the battlefield. Even in a large engagement, a significant number of surgeons and stewards would be idle when their unit was not involved in combat, even as the small staffs of other hospitals were being overwhelmed by a flood of casualties. The wide range of skill levels among surgeons meant that the quality of care provided was uneven at best. Some regimental hospitals refused to treat wounded not from their own command, and there was an almost total lack of coordination among the field hospitals, as well as between the field hospitals and the large general hospitals in rear areas.
Once again it was Jonathan Letterman who developed the answer to seemingly intractable problems. His solution was to concentrate medical supplies and personnel in division hospitals. The elimination of regimental hospitals allowed for the pooling of surgeons and doctors (Freemon 2001, p. 75). The division hospitals were better staffed and equipped and became the primary field unit of the medical departments of North and South, although there were a few brigade-level hospitals, especially in the Rebel armies. The typical division hospital was run by a surgeon-in-chief, who was one of the most experienced surgeons at the facility. He directed the activities of three operating surgeons and nine assistant surgeons. There was also an officer who oversaw the provision of food and shelter for staff and patients; he worked under the direction of the surgeon-in-chief, as did the enlisted men assigned duty as nurses (Bollet 2002, pp. 106–107).
The best surgeons were attached to division or brigade hospitals, where they were tasked with performing surgical procedures assigned on the basis of skill and experience. Military rank was irrelevant in these assignments. As a result, a soldier would have the services of the man best suited to deal with his particular injury. Surgeons of lesser abilities staffed the dressing stations behind the battle lines, administering emergency aid and conducting first-level triage. Almost all surgery, however, was performed at the brigade or division level (Freemon 2001, p. 46).
Medical equipment and supplies were also issued on the brigade or division level. The average Union division hospital was issued eighteen wagons, including four Autenrieth wagons, twenty-two hospital tents, and sufficient surgical instruments, equipment, medicines, and other supplies to care for 7,000 to 8,000 casualties at one time (Coggins 1962, p. 116).
This equipment was in addition to the emergency medical supplies maintained at the regimental level, as well as the regimental ambulances. When the Medical Corps' Ambulance Service was created by the U.S. Congress on March 11, 1864, the number of ambulances assigned to each regiment was fixed according to the unit's strength. A regiment with 500 or more troops would be allowed three ambulances; a command of 200 men or less was worthy of a single vehicle. Additional ambulances were assigned to corps headquarters and would be sent to whatever divisional field hospital needed them most (Bollet 2002, p. 105).
The hallmark of Letterman's organizational system was concentration of resources and flexibility. Letterman's system began in the Army of the Potomac and soon spread to all Federal forces. To the extent possible given the South's lack of industrial capacity—which created shortages of purpose-built ambulances, Autenrieth wagons, tents, medicines, surgical instruments, and so on—Confederate armies also copied Letterman's design. As might be expected, many of the ambulances and much of the equipment used by the Rebel medical services was captured from the enemy (Coggins 1962, p. 117).
Hospital Ships
Both North and South used waterways to evacuate sick and wounded during the Civil War. Early in the conflict, efforts to utilize ships for medical purposes proved chaotic and haphazard. Civilian craft, under contract to each army's quartermaster corps, were used to evacuate patients. Often captains commanding these vessels, and the quartermasters who controlled them, made medical duties a low priority. Injured men were sometimes left to languish on vessels for days before beginning their journey to a hospital. Ships used to transport casualties lacked medical staff, military discipline, organization, adequate food, supplies, and facilities of any kind to care for or treat their patients.
Public outcry in response to these facts produced rapid change. The U.S. Army and U.S. Navy both purchased vessels to act solely as hospital ships. The United States Sanitary Commission and the Western Sanitary Commission did the same. Even the Confederacy managed to designate some of its limited floating stock for a hospital role. By 1863, specially designed hospital ships were in operation in every theater of war.
The biggest and best ships were literally floating hospitals, outfitted with hundreds of regular hospital beds organized into wards; operating rooms; and quarters for a full complement of surgeons, doctors and nurses. They also came equipped with bathrooms, laundries, steam-powered fans to circulate air below decks, elevators for moving patients between decks, gauze blinds to protect passengers from smoke or embers spewed by a ship's stacks, and even cold water produced by passing water in pipes through ice chests to faucets located conveniently about the vessel. These ships saved many lives and alleviated much suffering wherever they sailed.
jeffrey william hunt
BIBLIOGRAPHY
Bollet, Alfred Jay. Civil War Medicine: Challenges and Triumphs. Tucson, AZ: Galen Press, 2002.
Freemon, Frank R. Gangrene and Glory: Medical Care during the American Civil War. Madison, NJ: Fairleigh Dickinson University Press, 2001.
Letterman's reforms made a world of difference and vastly improved both the quality and speed of battlefield medical care. Combined with the development of specialized military vehicles and a well-organized system to evacuate wounded from the front lines to the dressing stations, then to the field hospital and finally rearward to general hospitals, the reorganization of medical services and the development of brigade and division field hospitals made for a revolution in military medicine. European armies were quick to take note and soon copied these American innovations. The system of battlefield medical care developed between 1862 and 1865 remained standard both in the United Sates and Europe until after World War II (Bollet 2002, p. 107).
No matter how helpful in saving lives Letterman's innovations were, however, they could not erase the damage caused by ignorance of bacteria and of the importance of sterilizing medical instruments, bandages, dressings, sheets, and hands. Such ignorance cost hundreds, if not thousands of men their lives. No amount of organization could have prevented the heart-rending agony, fear, courage, stoicism, and sadness that were all too often seen at field hospitals. Despite this, the tireless efforts of overworked surgeons and medical staff, who scarcely took a moment to eat or sleep so long as injured men suffered, made the field hospital an example of inspiring selflessness and the highest devotion to duty.
BIBLIOGRAPHY
Bollet, Alfred Jay. Civil War Medicine: Challenges and Triumphs. Tucson, AZ: Galen Press, 2002.
Coggins, Jack. Arms and Equipment of the Civil War. Garden City, NY: Doubleday, 1962.
Commager, Henry Steele. From the Battle of Gettysburg to Appomattox. Vol. 2 of The Blue and the Gray. Indianapolis, IN: Bobbs-Merrill, 1950. Reprint, New York: Mentor, 1973.
Freemon, Frank R. Gangrene and Glory: Medical Care during the American Civil War. Madison, NJ: Fairleigh Dickinson University Press, 2001.
Wiley, Bell Irvin. The Life of Billy Yank: The Common Soldier of the Union. Indianapolis, IN: Bobbs-Merrill, 1952.
Comrades and the Ambulance Corps
Civil War battles were incredibly bloody affairs. Every large engagement produced tens of thousands of casualties in the span of one to three days. Wounded numbering in the thousands presented a challenge of enormous proportions to both Union and Confederate Armies. The dictates of humanity as well as military necessity required the prompt evacuation and medical treatment of wounded soldiers. From the medical standpoint, the motivation was to save life and limb, as well as to ease pain and suffering. From a military perspective, maintenance of morale and manpower were the critical factors. Troops fought better if they believed prompt and adequate care would be delivered to them if wounded. The evacuation of stricken soldiers removed an unnerving distraction for men still locked in combat. In addition, men whose lives were saved and bodies repaired by hospitals could be sent back to the ranks once their wounds healed.
Both North and South entered the war utterly unprepared to deal with the flood of wounded men streaming from the battlefield. Previous conflicts provided little guidance, as they had produced nothing like the scale of casualties typical of the Civil War. The frontier experience of the small regular army provided even less preparation for officers faced with the need to evacuate and care for large numbers of wounded.
An Inadequate Approach
Past experience, however, was the only guide available. As Frank Freemon points out in his 2001 book, Gangrene and Glory: Medical Care during the American Civil War, the initial medical organization of Northern and Southern armies was based on regulations of the prewar United States military (p. 28). Control of ambulances and medical evacuation fell under the authority of the Quartermaster Corps. The ambulances, of which there were only a few, were used to haul supplies to the battlefield and were driven by civilian contractors. Once emptied of cargo, they would be available to carry wounded.
Each regiment was responsible for providing its own stretcher-bearers. In his 1988 book Soldiers Blue and Gray, James Robertson observes that commanders were unlikely to assign their best men to such duties. The standard pool from which stretcher-bearers were drawn was the regimental band. Generally, there were not enough musicians available, so various men deemed poor soldiers would be called on to round out details. Stretchers were not supplied to regiments, and thus makeshifts of every sort—from blankets to house doors—were pressed into service (Robertson 1988, 160).
In his book Civil War Medicine (2002), Dr. Alfred Bollet explains that the shortcomings of this system were apparent as early as the battle of First Bull Run (First Manassas) on July 21, 1861. Civilian drivers, exhibiting little desire to risk their lives, fled the field or stayed far to the rear. Quartermasters often commandeered ambulances to move ammunition or other equipment, making them unavailable to evacuate the wounded (Bollet 2002, pp. 103, 117). The relative handful of stretcher-bearers available were quickly overwhelmed or failed to do their duty (Robertson 1988, p. 160).
Injured soldiers had only limited options if no ambulance or stretcher-bearers reached them. If still mobile, they could leave the field under their own power and attempt to reach a field hospital. Such attempts were risky, however. Unaided movement could aggravate wounds or cause additional injury. Loss of blood or shock could quickly overcome the victim, leading to his collapse, sometimes in a spot where he might remain unnoticed for hours or days, if he were noticed at all—a situation that could prove fatal.
The second option was to be helped from the field by unwounded or lightly wounded comrades. This was a much safer method of evacuation, as it ensured assistance and care (no matter how minimal) all the way to a field hospital. Helping a wounded friend was a natural impulse. Soldiers often served alongside members of their family or prewar community, and shared emotional connections borne of common sacrifice and service. Men were inclined to go to the aid of a friend in distress—and doing so, incidentally, also provided them with an honorable excuse for leaving the zone of danger. From a military standpoint, however, this form of assistance was the worst system imaginable, as it removed healthy men from the firing line, thus significantly multiplying the effect of casualties.
The final option for men too badly hurt to move on their own, and unlucky enough to fall out of reach or view of comrades, was to lie on the field until the fighting ended. In this circumstance an injured man had no one to provide aid, except, perhaps, a nearby soldier who shared his fate. For soldiers without food, medical aid, or sometimes even water, the odds of survival grew worse with each passing hour on the battlefield.
The experience of Major John Haskell during the battle of Gaines' Mill, on June 27, 1862, provides a graphic example of the difficulties wounded men faced early in the war. Haskell was leading an attack when an artillery projectile smashed his right shoulder and virtually ripped off his arm. Unconscious for an unknown length of time, Haskell awakened to find his arm "wrapped around" the blade of his sword in a "most remarkable manner" (Haskell 1960, p. 34). On sitting up, Haskell passed out. Awakening a second time, he managed to separate the remnant of his arm from his sword. Stuffing the injured limb into the breast of his coat, Haskell got up and started for the rear, using a flagstaff as a crutch.
On his way, the major heard a close friend crying for help. Finding the man lying in a ravine and shot through the lungs, Haskell held up his shattered arm, explaining he could not help. Seeing a nearby soldier, the major ordered him to aid his friend. Accomplishing this, Haskell continued rearward, but did not get far before falling down. Weak from loss of blood, he was unable to get back up. Luckily, a fellow officer saw his distress, dismounted, put Haskell on his horse, and took him to a surgeon who provided first aid and sent Haskell to a field hospital via ambulance (Haskell 1960, pp. 34–36).
Encapsulated in this account are all the perils a wounded man faced early in the war. No stretcher-bearers were present to evacuate Haskell or his wounded comrade. One man was too badly wounded to move on his own, while Haskell's efforts to reach the rear alone ultimately failed. Stragglers and friends provided the only assistance. The ambulance that finally evacuated the major was found well to the rear of the firing line. In all likelihood, Haskell would not have survived if he had fallen somewhere outside the view of his passing comrade.
The Father of Battlefield Medicine
Jonathan Letterman (1824-1872) was born in Canonsburg, Pennsylvania, the son of a local surgeon. He graduated from Jefferson Medical College in 1849 and became an assistant surgeon in the Army Medical Department that same year.
In the 1850s Letterman was assigned to various military campaigns in Florida (against the Seminole Indians), New Mexico Territory (against the Apaches), and California (against the Utes). Letterman returned East at the beginning of the Civil War. He was named medical director of the Department of West Virginia in May 1862 and medical director of the entire Army of the Potomac just one month later. General George McClellan (1826-1885) gave Letterman, now a major, full permission to reorganize the army's medical service as seemed best to him. Letterman introduced a series of forward first aid stations at the battle of Anti-etam in 1862 as well as the practice of triage (sorting the wounded into categories in order to focus treatment on those most likely to survive). At the battle of Gettysburg in July 1863 Letterman created a large field hospital on the grounds of a local farmer to treat Confederate as well as Union wounded left behind after the three-day battle. The hospital was named Camp Letterman in his honor. Members of the U.S. Sanitary Commission visited Camp Letterman to bring supplies and help transport the more severely wounded to permanent hospitals elsewhere. One member of the commission reported that Letterman gave soldiers from both armies the best care he could: "The surgeon in charge of our camp, with his faithful dresser and attendants, looked after all their wounds, which were often in a most shocking state, particularly among the rebels. Every evening and morning they were dressed. Often the men would say, 'That feels good, I haven't had my wound so well dressed since I was hurt" (Camp Letterman General Hospital). Letterman's system was so successful that it was established by an act of Congress in March 1864 for all Union armies in the field.
Letterman moved to San Francisco after the war and worked in the veterans' hospital at the Presidio. Saddened by the death of his wife in 1867, he died a few years later at the relatively young age of 48. In 1911 the hospital at the Presidio was named Letterman General Hospital to commemorate his work. Letterman was buried in Arlington National Cemetery; his epitaph reads, "Medical Director of the Army of the Potomac, June 23, 1862 to December 30, 1863, who brought order and efficiency into the Medical Service and who was the originator of modern methods of medical organization in armies" ("Jonathan K. Letterman").
rebecca j. frey
BIBLIOGRAPHY
"Camp Letterman General Hospital." Voice of Battle: Gettysburg National Military Park Virtual Tour. Available from http://www.nps.gov/.
"Jonathan K. Letterman." Arlington National Cemetery. http://www.arlingtoncemetery.net/.
The inadequacy of this haphazard system was obvious. Nonetheless, it continued in the eastern Union Army until the late summer of 1862, and in the western Federal army until early 1863. Fortunately for the hundreds of thousands of men destined to be wounded in the middle and latter stages of the conflict, change eventually came.
The Letterman System
By mid-1862, voices advocating change and modernization of medical evacuation services were heard in both the North and South. The man who brought about those changes for the Union was Jonathan Letterman, who became the medical director of the Army of the Potomac in late June 1862. Letterman urged the creation of a dedicated ambulance corps, equipped with its own wagons, ambulances, tents, and supplies, and staffed by personnel specifically detailed and trained for the job of evacuating and caring for the wounded. Vehicles, equipment, and personnel would be under the sole authority of medical officers and could not be interfered with by anyone. Major General George B. McClellan, commander of the Army of the Potomac, instantly saw merit in Letterman's proposal and ordered its implementation (Bollet 2002, pp.103-105).
By the battle of Antietam (Sharpsburg) on September 17, 1862, Letterman's ambulance corps had begun to take the field. Although not fully staffed, equipped, or trained, it performed well. The battle of Fredericksburg, on December 13, 1862, was the first full test of the "Letterman System." In a single day of combat, 9,028 Union soldiers were wounded. Within just twenty-four hours of the end of the fighting, virtually every wounded man had been removed from the battlefield and taken to a field hospital (Bollet 2002, p. 125).
So effective was the new method of evacuation that Surgeon General William Hammond urged its adoption by all Union armies. Inexplicably, the War Department and General-in-Chief's office rejected the proposal. The logic of what Letterman was doing, however, could not be denied, and commanders of other Northern armies replicated his system. At the same time, Confederate armies, urged on by Dr. Hunter McGuire of the Army of Northern Virginia, were putting in place a system virtually identical to Letterman's. On March 11, 1864, the U.S. Congress passed legislation creating the Medical Corps' Ambulance Service, and requiring the army to adopt Letterman's system everywhere (Bollet 2002, pp. 105–106).
Inevitable Horrors
Although the new ambulance corps made an enormous difference, it could not solve all the problems or prevent all the terrors associated with removing injured soldiers from the battleground. Even trained stretcher-bearers were not always able or eager to evacuate wounded from a battlefield swept by enemy fire. Generally in a hurry to get out of danger, they tended to move quickly, which did little for the comfort or safety of an injured man on a litter. Major battles producing heavy casualties in short periods of time could still overwhelm the ability of stretcher-bearers to promptly remove or even find wounded men, especially in the hilly, heavily wooded terrain typical of most engagements.
At the beginning of the war the only ambulances available were two-wheeled carts or ordinary wagons. Lacking springs, these vehicles, often moving over unpaved and rutted country roads, provided a jarring and extraordinarily painful ride for wounded men. New four-wheeled ambulances with springs came into use by late 1862. They provided greater comfort but were always in short supply. In the aftermath of any large engagement, there were never enough purpose-built vehicles to transport the wounded and anything that rolled was pressed into service. The results were often heart-rending, especially for an army forced into a lengthy retreat.
No better example of this sad reality can be found than in the aftermath of the battle of Gettysburg. During its retreat, the Army of Northern Virginia was forced to transport 8,500 badly wounded soldiers over a hundred miles back to Virginia. There were not enough ambulances to do the job, so every available vehicle was utilized. The resulting misery endured by the wounded was grimly predictable and altogether too common in the annals of Civil War battles.
Brigadier General John Imboden was given the job of protecting the fifteen-mile-long procession of wagons and ambulances carrying the wounded southward. His vivid description of what the injured endured is one of the most memorable accounts of the horrors associated with the evacuation of the wounded:
From almost every wagon for many miles issued heart-rending wails of agony. For four hours I hurried forward… and in all that time I was never out of hearing of the groans and cries of the wounded and dying. Scarcely one in a hundred had received adequate surgical aid, owing to the demands on the hard-working surgeons from still worse cases that had to be left behind. Many of the wounded… had been without food for thirty-six hours. Their torn and bloody clothing, matted and hardened, was rasping the tender, inflamed, and still oozing wounds. Very few of the wagons had even a layer of straw in them, and all were without springs. The road was rough and rocky…. The jolting was enough to have killed strong men…. From nearly every wagon as the teams trotted on, urged by whip and shout, came such cries and shrieks as these: "O God! Why can't I die?" "My God! Will no one have mercy and kill me?" "Stop! Oh! For God's sake stop just for one minute; take me out and leave me to die on the roadside." "I am dying! I am dying! My poor wife, my dear children, what will become of you?"
Some were simply moaning; some were praying, and others uttering the most fearful oaths and execrations that despair and agony could wring from them; while the majority, with a stoicism sustained by sublime devotion to the cause they fought for, endured without complaint unspeakable tortures, and even spoke words of cheer and comfort to their unhappy comrades of less will or more acute nerves…. No help could be rendered to any of the sufferers. No heed could be given to any of their appeals. Mercy and duty to the many forbade the loss of a moment in the vain effort then and there to comply with the prayers of the few. On! On! We must move on…. There was no time even to fill a canteen of water for a dying man; for, except the drivers and the guards, all were wounded and utterly helpless in that vast procession of misery. (McDonald 1907, pp. 318–319)
It was a scene that no witness could ever forget. "During this one night," Imboden wrote, "I realized more of the horrors of war than I had in all the preceding years" (McDonald 1907, p. 319).
BIBLIOGRAPHY
Bollet, Alfred Jay. Civil War Medicine: Challenges and Triumphs. Tucson, AZ: Galen Press, 2002.
Freemon, Frank R. Gangrene and Glory: Medical Care during the American Civil War. Madison, NJ: Fairleigh Dickinson University Press, 2001.
Haskell, John Cheves. The Haskell Memoirs, ed. Gilbert E. Govan and James W. Livingood. New York: Putnam, 1960.
McDonald, James Joseph. Life in Old Virginia, ed. J. A. C. Chandler. Norfolk, VA: The Old Virginia Publishing Co. (Inc.), 1907.
Robertson, James I., Jr. Soldiers Blue and Gray. Columbia: University of South Carolina Press, 1988.
Jeffrey William Hunt
Triage and Surgery
Brigadier-General Gladden of South Carolina, at the Battle of Shiloh in 1863, had his left arm shattered by a cannon ball. As William Stevenson, a volunteer for the Confederacy, recalled in his 1862 book Thirteen Months in the Rebel Army: Being a Narrative of Personal Adventures in the Infantry, Ordnance, Cavalry, Courier, and Hospital Services…:
Amputation was performed hastily by his staff-surgeon on the field; and then, instead of being taken to the rear for quiet and nursing, he mounted his horse, against the most earnest remonstrances of all his staff, and continued to command. On Monday, he was again in the saddle, and kept it during the day; on Tuesday, he rode on horseback to Corinth, twenty miles from the scene of action, and continued to discharge the duties of an officer. On Wednesday, a second amputation, near the shoulder, was necessary. Against the remonstrances of personal friends, and the positive injunctions of the surgeons, he persisted in sitting up in his chair… till Wednesday afternoon, when lockjaw seized him, and he died in a few moments. (pp. 179–180)
Albeit heroic, death often befell those who survived surgery in the Civil War. Initially, both sides of the conflict were ill-prepared to handle mass casualties, and at the onset of the war there were 113 surgeons in the U.S. Army, of which twenty-four joined the Confederate army and three were dismissed for disloyalty. By the end of the war more than 12,000 surgeons had served in the Union army and nearly 3,200 in the Confederate army.
Triage
Although infection was yet to be understood, battlefield surgical conditions were far from primitive. Medical staff assessed the wounded in a system of triage. Soldiers brought in with head, chest, or stomach wounds were considered the least likely to survive; they were given morphine and water to ease their pain as they waited to die. This allowed doctors who were stretched to their limits (after the Battle of Gettysburg on July 1, 1863, the ratio of patients to doctors was nearly 300 to 1), to attend to the soldiers who could be saved. As a result, those slightly wounded and considered beyond help were set aside.
Amputation
Even in the early twenty-first century, many misconceptions persist about battlefield surgery during the Civil War. It is often thought that the injured soldier received inadequate treatment, an untrained surgeon giving him a doubtful glance before concluding amputation was the only solution—without anesthetic—only to have the patient die after surgery from "surgical fevers," such as deadly septicemia or gangrene. Contrary to this popular belief, however, amputation was not the first course of action. Surgeons took great care not to amputate, oftentimes causing greater harm than good. George Worthington Adams quotes William Williams Keen, a renowned surgeon of the war and West Point military cadet, in his 1985 book Doctors in Blue: The Medical History of the Union Army in the Civil War, where Keen stated, "I have no hesitation in saying that far more lives were lost in refusal to amputate than by amputation" (p. 163).
British and American civilian surgeon observers also felt that too few amputations were done, resulting in deaths that could have been prevented if amputation was chosen. William M. Caniff, professor of surgery at the University of Victoria College in Toronto, published in the British medical journal Lancet on February 28, 1863, and reprinted by Alfred J. Bollet in his 2004 article "The Truth About Civil War Surgery" that, "Although a strong advocate of conservative surgery… I became convinced that upon the field amputation was less frequently resorted to than it should be; that while in a few cases the operation was unnecessarily performed, in many cases it was omitted when it afforded the only chance of recovery" (p. 27).
When amputation was the chosen course of action, surgeons had a choice of performing a "flap" operation (which was the preferred method by the end of the war) or the circular procedure that left a small area open, prone to infection. The "operator," wielding his bone saw (thus the moniker of "Sawbones" attributed to Civil War doctors) would saw through the bone of the limb to be amputated. The arteries were then tied off using sutures of horsehair, silk, or cotton threads. After the bleeding was controlled, the surgeon scraped the freshly cut bone smooth so it would not damage the skin to be sewn shut. In the "flap" procedure, the extra skin would then be sewn shut and a small hole would be left for drainage. Finally, the appendage would be set in isinglass plaster and bandaged.
As an alternative to amputation, surgeons on both sides of the war tried using a medical technique called excision, or resection. Wherever bone was damaged, the broken pieces were removed from the limb in the hopes that the healthy bone would reattach itself. Many soldiers, however, preferred to have prosthetics attached to an amputated limb rather than have a poorly functioning limb that was shortened. Excisions also resulted in higher mortality rates than did amputations.
Infection
Infection ran rampant under the poor sanitary conditions of the camps. Hospital gangrene threatened to infect even the simplest cut and resulted in severe pain and fever for the patient, and the formation of pus at the wound site—the foul smell that pervaded the hospitals of the time. Where amputation was afforded, the threat of infection persisted. Often soldiers would not make it to the surgical theater for many days after being wounded. Surgeons at the time thought it was imperative to operate within the first day of receiving the wound to avoid the period during which infection could set in. Within a few days "laudable pus" would often appear, which doctors at the time believed was how clean tissue replaced itself within the body; in actuality, healthy tissue was already undergoing decomposition. William Stevenson noted in his 1862 book Thirteen Months in the Rebel Army: "On account of exposures, many wounds were gangrenous when the patients reach the hospital. In these cases delay was fatal, and an operation almost equally so, as tetanus often followed speedily. Where amputation was performed, eight out of ten died" (p. 177).
Operations at the time were disease-ridden from beginning to end. Everything the surgeons used was unsanitary. The operating table, tools—literally everything—was pus-and blood-laden. Between surgeries, tools were cleansed in nothing more than cold water; if surgical forceps or an incision knife was dropped on the floor, it too would be cleaned in the same water. Wounds were often wrapped in unsterilized, wet bandages. Although germs were not fully understood at the time, medical staff did have sterilizers such as bichloride of mercury, sodium hypochlorite, and carbolic acid. The error in reasoning occurred when disinfectant was used after infection had already set in.
Anesthesia
Anesthesia was introduced to the medical community in 1846. Thus, most surgeries during the Civil War were carried out under anesthesia. There is a record in the United States Surgeon-General's Office 1879 publication Medical and Surgical History of the War of the Rebellion, however, in which, at the Battle of Iuka in September 1862, 254 casualties were operated on without the use of anesthetic, the single largest such documented case. Chloroform and ether were the types of anesthetics used. Usually a cloth was placed over the face of the patient and a few drops were placed on the cloth as the patient breathed in the fumes. Chloroform was usually preferred to ether because of ether's explosive chemical properties.
By War's End
Despite the lack of preparation, Union surgeons treated more than 400,000 wounded men—about 245,000 of them for gunshot or artillery wounds—and performed at least 40,000 operations. Less complete Confederate records show that fewer surgeons treated a similar number of patients. Oftentimes, soldiers were operated on by surgeons of the opposing forces. Thomas Ellis, a Union surgeon, gives an account of a Confederate major from a North Carolina regiment in his 1863 book Leaves from the Diary of an Army Surgeon; or, Incidents of Field, Camp, and Hospital Life: "The major was shot in the thigh, fracturing the bone very badly and rendering amputation necessary, he thanked us for our attention stating that he had not expected such kind treatment at our hands" (p. 76). In the 1862 article "Surgeon at Work," Harper's Weekly reported, "Arteries are tied, ligatures and tourniquets applied, flesh wounds hastily dressed, broken limbs set, and sometimes, where haste is essential, amputations performed within sight and sound of the cannon. Of all officers the surgeon is often the one who requires most nerve and most courage" (p. 439).
According to the United States Sanitary Commission's 1869 work Sanitary Memoirs of the War of the Rebellion, "The whole number of casualties during the forty-eight months of the war, among 2,480,000 white soldiers, was 858,000. The total number of deaths in the same service was about 250,000, making the ratio of deaths to the whole number of casualties as 100 to 343" (p. 9). The surgeons on both sides did well to keep the men of the nation alive for without them, untold numbers would have perished, making Reconstruction for a war-weary nation nearly impossible.
BIBLIOGRAPHY
Adams, George Worthington. Doctors in Blue: The Medical History of the Union Army in the Civil War. Dayton, OH: Press of Morningside, 1985.
Bollet, Alfred J. "The Truth About Civil War Surgery." Civil War Times 43, no. 4 (2004): 27-33, 56.
Coco, Gregory A. Gettysburg, The Aftermath of a Battle. Gettysburg, PA: Thomas Publications, 1995.
Ellis, Thomas T. Leaves from the Diary of an Army Surgeon; or, Incidents of Field, Camp, and Hospital Life. New York: J. Bradburn, 1863.
Stevenson, William G. Thirteen Months in the Rebel Army: Being a Narrative of Personal Adventures in the Infantry, Ordnance, Cavalry, Courier, and Hospital Services…. New York: A. S. Barnes and Burr, 1862.
"Surgeon at Work." Harper's Weekly 6, no. 289 (1862): 439.
United States Sanitary Commission. Sanitary Memoirs of the War of the Rebellion, v. 2, Investigations in the Military and Anthropological Statistics of American Soldiers. Cambridge, MA: Riverside Press, 1869.
United States Surgeon-General's Office. The Medical and Surgical History of the War of the Rebellion, 1861-1865. Washington. U.S. Government Printing Office, 1870.
Anurag Biswas
Evacuation Hospital
During the Civil War years, 1861 through 1865, hundreds of hospitals, including evacuation hospitals—those situated far from the battlefields, often in larger cities—became important scenes for dealing with the thousands of injured or ill soldiers. In addition to the common problems soldiers endured, like bullet wounds and gangrene, many people fell ill with infectious diseases unrelated to battlefield wounds, such as typhoid fever or dysentery, and required hospitalization. In the early 1860s, links between health and sanitation were poorly understood, and there was not yet knowledge of antiseptic principles or an understanding of the spread of bacteria and germs. Also, anesthesia was becoming widely used, but still largely experimental. The emerging role of hospitals and health care professionals in dealing with large numbers of people requiring treatment, pushed the hospital system forward during this historical military and medical period. In April 1861 the people of the United States and the new Confederate States of America found themselves unprepared for the fierce and bloody struggle that awaited them. The shocking realization that the war would not be short was accompanied by another epiphany: The wounded were piling up, and the hospitals of the time were severely inadequate.
The medical system as it existed, including the establishment of hospitals, faced a myriad of challenges, including the accommodation of thousands of wounded soldiers. Before the war, most people who became ill had been accustomed to home care. With home care more common, hospital buildings were rare before the war. In fact, the early causalities of the war during the fall and winter of 1861, created the need for several buildings to be used as hospitals, as there were not adequate numbers already established; churches, courthouses, barns, stores, warehouses, and multiple other buildings became interim hospitals (Cunningham 1958, p. 45). One account from Private David Holt of the Sixteenth Mississippi Regiment, details the early limitations of these temporary hospitals from his observations in Bedford County, Virginia:
This old one-story freight station had been converted into the receiving room of a temporary hospital, and the ward for the wounded and very sick was a long shack about ten feet high at the eaves with a shingle roof and the ground for a floor. I never went into the ward, but Milton [a hospital worker] said there were not enough cots and some of the sick and wounded lay on the floor. He also said it was hotter than the hinges of hell. (Cockrell and Ballard 1995, p. 106)
Also contributing to the problems was the common medical doctrine of the time that recovery from disease or injury in large hospitals tended to take longer than in the preferred small private hospitals. Large public hospitals were thought to be full of "tainted air which fills the wards and… enfeebles the nervous system," leading to new diseases and slower healing of wounds ("Military Hygiene," November 5, 1861, n.p.). The notion that mortality rates were higher inside hospitals than outside them meant that there were very few large hospitals built at the time. Soldiers often preferred to be treated at camp at the temporary or mobile field hospitals. They feared the unfamiliarity of the hospitals that were located far from the battlegrounds in the cities. Rumors and first-hand accounts from patients, frequently reported lack of organization in hospitals, crowded corridors, shortages of medical supplies, and minimal individualized attention for patients. (Rutkow 2005, p. 152). Private houses were thought to be more hygienic.
An "Ancient and Fossilized" Medical System
After the Battle of Bull Run (known as the First Battle of Manassas by the Confederate forces) on July 21, 1861 the casualties began to mount. Because existing hospitals could not deal with the numbers, military evacuation hospitals were set up in buildings intended for other purposes: "[P]ublic buildings, school-houses, churches, hotels, warehouses, factories, and private dwellings" became the treatment centers for sick and wounded soldiers from all over the country (Otis 1865, p. 152). On August 3, 1861, there were 945 sick and wounded soldiers in the five hospitals in Washington, DC; many were divided among the hospitals improvised at Miss English's Seminary and the Columbia College buildings, not to mention the House and Senate Chambers in the Capitol Building ("Sick and Wounded Soldiers," August 8, 1861). However, these buildings were still insufficient in size, supplies, toilet facilities, ventilation, and heating. The New York Times (July 27, 1861) noted less than a week after the Battle of Bull Run that "we are inexpressibly pained to learn from Washington that very inadequate provision has been made by the regular authorities, for the proper care of the wounded in the late battle…. [S]ome of our gallant soldiers, for want of hospital garments, even yet lie sweltering in their bloody uniforms, festering with fever and maddened with thirst." The Medical Department's preparations were "ancient and fossilized" and only adequate for a force of "less than fifteen thousand men" (n.p.). Clearly, new measures had to be taken. Plans on both sides varied widely over time and place.
Confederate Hospitals
In the South, soldiers were not always sent to division hospitals. According to Confederate medical department regulations, the sick and wounded were to be "sent to the hospitals representing their respective states," unless their sickness or wounds were too severe and another hospital was closer (Confederate States of America War Department 1863, p. 56).
By 1862, more hospitals were being built, but there were still too few to take care of the soldiers needing treatment and long-term care. However, positive changes persisted throughout the years of the Civil War; by 1863, many more hospitals had been created. Hospitals in Richmond, Virginia had the best reputation and were thought of as the medical center for the Confederacy (Cunningham 1958, p. 50).
On October 11, 1861, Chimborazo, the most well-known Confederate hospital, opened in Richmond, Virginia. The hospital was located on the edge of Richmond, which allowed convenient access to York River Railroad. Chimborazo had room for approximately 8,000 patients, and it eventually became regarded as the best hospital in the North and the South. Chimborazo Hospital grew its own food, and even had around two hundred cows and a herd of goats on its hospital farm.
Union Hospitals
The Saterlee Hospital in Philadelphia, developed by William Hammond after he became the Surgeon General in April of 1862, exemplified the grand visions held for a nationwide military hospital system. The structure had twenty-eight pavilions, with room for well over a thousand patients. "With barbershops, laundries, a pharmacy, and smoking rooms, the complex was a city unto itself, and following further additions, by war's end bed capacity reached an amazing 3,519" (Rutkow 2005, p. 157). Another Union hospital, Mower U.S. General Hospital, was constructed by architect John McArthur Jr. in Philadelphia, in the city's Chestnut Hill area. Named after an Army surgeon, Thomas Mower, the hospital was in operation from 1863 to 1865. During those years, it treated over 20,000 patients, most of whom were Union soldiers. Saterlee and Mower U.S. General were two of several hospitals that became established in Philadelphia. In fact, by 1865, there were twenty-seven hospitals in the city (Adams 1958, p. 155). Like the city of Washington, Philadelphia played a key role in the development of the hospital system.
In both the North and the South, a directory was created to present organized information about patients in over two hundred hospitals (Denney 1994, p. 12). The public was gaining both a familiarity with the hospital system, and experiencing the advancement of the American hospital system. By the end of the war in 1865, the United States' hospital system had undergone significant changes in the architecture, organization, and administration of hospitals, and laid the foundation for a better hospital system across the country.
New Plans, New Hospitals
Medical treatment of injured soldiers took place in a series of locations. After being stabilized, or if further care not available at the field hospital was needed, a wounded soldier was transported to a hospital camp or a division or regimental hospital (though this step was often skipped). From there the surviving soldier would be transported to a general hospital for extended care and convalescence. In 1864 the Union soldier Henry Meacham was wounded in the arm and underwent an amputation in a battlefield hospital before being taken to City Point Hospital for extensive care and convalescence: "We were treated well and had all the comforts that could be expected. Never but once while at City Point did I have occasion to find fault with my treatment… I had good care." After leaving City Point, Meacham was transferred to the Third Division Hospital near Alexandria, Virginia, and found it "very pleasant…; the ground was kept neat and clean, and everything was neat about the building and tents. We were treated kindly" (Meacham 1869?, pp. 28–29).
In order to establish hospitals that were both sufficient in size and properly ventilated, many facilities were built according to the new "pavilion" model. Adelaide Smith described one of these, Fort Schuyler Hospital along the East River in New York, as being "formed like a wheel, the hub being headquarters and spokes extending into wards for patients" (Smith 1911, p. 31). Other pavilions were triangular in design, such as Lincoln Hospital in Washington, DC. The pavilion plan allowed the assignment of different medical problems to separate buildings, which were no more than two stories in most cases.
With the larger buildings, design was an important consideration, and structures were created to foster more hygienic practices. For instance, there was an emphasis on incorporating fewer ninety-degree angles to prevent the accumulation of hard to clean dirt. These hospitals also featured ventilation refinements in the form of ridge-ventilated ceilings, which could be closed off during the winter, when shaft ventilation would substitute. According to the New York Times, the "ventilation of these buildings is their triumphant singularity, and, properly arranged, completely ignores contagion." The construction was such that each building "admits of the freshest circulation of air," allowing the wards to be cool and comfortable in the summer—forming a "seductive place for convalescing patients to lounge" (April 9, 1862, n.p.). These pavilion hospitals were commissioned in both the North and South—some with the wards directly connected to the central building, others with free-standing buildings. In July 1864, the Union Secretary of War, Edwin Stanton, issued official orders that all new military hospitals were to be built in the detached pavilion style with sixty beds per ward, and that no other buildings were to be used as hospitals unless inspected by the Medical Corps. These pavilion hospitals would feature dining rooms, kitchens, laundry facilities, quartermaster offices, storage areas for patients' effects, guardhouses, dead houses, housing for female nurses, operating rooms, stables, and a chapel (Otis 1865, pp. 153–154).
The new hospitals were built quickly and cheaply. They were supplied primarily through donations from citizens, without which the majority of hospitals would not have lasted. Throughout the summer of 1861 Northern and Southern newspapers published letters from military staff, war department officials, and private citizens calling for contributions and volunteers. Lists of contributed items were also printed in these newspapers. The war departments, the Northern Sanitary Commission, volunteer organizations, and independent hospitals also directly solicited more donations. This practice was especially commonplace in the South, where hospital supplies often ran low. However, the North was not without its needs. In October 1861, acknowledging the poor quality of hospital care in the North, the federal government made an appeal "to the loyal women of America." The authorities admitted that "lives [were] lost because the government cannot put the right thing in the right place at the right time." While the U.S. Sanitary Commission had been created to solve the problems, the commission still had to rely on voluntary contributions, which at that point numbered around sixty thousand articles (United States Sanitary Commission 1861, pp. 1–2).
Under the supervision of the Sanitary Commission, Northern hospitals underwent required inspections that examined "theoretically and practically all questions of diet and cooking [,]… climate, malaria and contagions, [and] ventilation" (New York Times, June 25, 1861). A questionnaire of 179 items was filled out by inspectors regarding the health of the patients and the environment of the hospital, with consideration given to such things as the latrines, soldiers' diets, the laundry, and hygiene (Bollet 2002, p. 225). After inspections, unfit hospitals would be reformed, "careless or ignorant officials" would be chastised or removed, and every hospital was made to adhere to the "uniformity of plans and harmony of action between the States" (New York Times, June 25, 1861).
General hospitals were built across the nation, both near the front lines and far away. By June 1865 the Union had 204 hospitals and the Confederates had created about 154. The majority of Northern hospitals were in and around Washington, DC, whereas in the South, though Richmond had many, hospitals were concentrated in several areas, as nearly all the fighting took place throughout the Southern states (Bollet 2002, p. 221-223).
Hospital Services
The evacuation or general hospitals, as well as the soldiers' homes, were intended to be places where sick and wounded soldiers could rest, recuperate, receive any needed medical attention, and prepare to return to either their regiment or, in the case of disabled soldiers, to their homes.
Over the course of the war, women became the backbone of Union and Confederate hospitals—as matrons, nurses, volunteers, or simply by making donations. Certainly, these women did not lack for patriotic fervor. A New York woman wrote directly to President Lincoln: "[W]ere I a man I would…fight in a moment…. [Being unable to,] I offer my services to nurse our wounded soldiers. I do not wish any pay for my services, but only to nurse the sick and wounded soldiers who are fighting for the rights of our glorious country" (New York Herald, April 22, 1861). In the South, many women were moved by the desire to contribute "to the comfort of the men who had been wounded in protecting their homes" (Stevenson 1862, p. 190). They volunteered for hospital duty in droves, and their effect on soldiers in hospitals was profound. William Stevenson, a Confederate wounded at Shiloh, found the hospital nearby to be in a state of chaos, with men going untreated, unskilled young surgeons wreaking havoc on bodies, and disease spreading—until the nurses arrived: "Their presence worked like a charm. Order emerged from chaos, and in a few hours all looked cleaner and really felt better, from the skill and industry of a few devoted women" (Stevenson 1862, pp. 178).
In her book Hospital Days (1870), Jane Stuart Woolsey noted that women nurses were of all sorts: "volunteers paid or unpaid; soldiers' wives or sisters who had come to see their friends, and remained without any clear commission or duties;… [and others] sent by state agencies or societies… [and] set adrift… without training or discipline… or officers" (p. 43). Despite this lack of oversight, the air and tone of a hospital, according to Woolsey, would invariably improve within only a few days of the women's arrival. The character of many nurses was so stubborn that they would "gaily starve… [themselves] to feed a sick soldier… [and] cheerfully sacrifice time, ease and health, to the wants or whims of a wounded man" (Woolsey 1870, pp. 43–44).
At most general hospitals the first order of business was recuperation. Wounds and diseases were cared for by nurses and surgeons, who generally made rounds once a day. Volunteers read and wrote letters for the infirm. Many hospitals featured extensive grounds for walking, which aided in both physical and mental recovery. Meals were provided daily, as well as medicine, depending on availability. When it was time for a sick or wounded soldier to leave the hospital, either to return to his regiment or to return home, most hospitals offered assistance in procuring papers, pensions, transportation, and back pay. Some hospitals had cemeteries for those who did not recover.
In addition to general hospitals, specialty hospitals were created. Philadelphia's Turner's Lane Hospital catered to nerve injuries and neurological disorders. A Nashville hospital dealt with venereal diseases. A specialty hospital in Washington, DC, which was named the Desmarres Hospital after it was moved to Chicago in 1864, dealt with both eye and throat injuries and diseases, while the Confederacy opened an eye hospital in Athens, Georgia. Both sides responded to the immense need for orthopedic hospitals for soldiers with wounds or injuries to the extremities, as well as those who had lost limbs and needed prostheses (Bollet 2002, pp. 227–229).
Results
In a few short years, the medical situation on both sides had drastically improved. "Never before, in the history of the world," declared the Union medical officer George Alexander Otis, "was so vast a system of hospitals brought into existence in so short a time… [or] has the mortality rate in military hospitals been so small" (Otis 1865, p. 152). By 1865 it was realized that "the ill-ventilated barracks and private edifices… occupied as hospitals during the earlier part of the war" (Otis 1865, p. 87) were indeed only contributing to disease. The creation of the Sanitary Commission and the reforms it enacted, especially mandatory hospital inspections, helped pave the way for a new era of expectations for public hospitals. The designs of the pavilion hospitals influenced hospital architecture, and the creation of specialty hospitals continued beyond the war. While the majority of general hospitals closed after the war, the very idea of what a hospital is and what it should be had been forever altered in America.
BIBLIOGRAPHY
Adams, G.W. Doctors in Blue. Baton Rouge: Louisiana State University Press, 1958.
"The Army Hospitals at Washington." New York Times, August 13, 1861.
Bollet, Alfred J. Civil War Medicine: Challenges and Triumphs. Tucson, AZ: Galen Press, 2002.
Cockrell, T. D. and M. B. Ballard, eds. A Mississippi Rebel in the Army of Northern Virginia: The Civil War Memoirs of Private David Holt. Baton Rouge: Louisiana State University Press, 1995.
"Condition of Our Wounded." New York Times, July 27, 1861.
Confederate States of America. War Department. Regulations for the Medical Department of the C.S. Army. Richmond, VA: Ritchie & Dunnavant, 1863.
Cunningham, H. H. Doctors in Gray, The Confederate Medical Service. Baton Rouge: Louisiana State University Press, 1958.
Denney, R. E. Civil War Medicine: Care & Comfort of the Wounded. New York: Sterling Publishing Co., Inc., 1994.
"Health of the Army: The Sanitation Commission." New York Times, June 25, 1861.
"Local Military Matters." New York Times, July 10,1861.
Meacham, Henry H. The Empty Sleeve; or, The Life and Hardships of Henry H. Meacham, in the Union Army. Springfield, MA: Author, 1869?.
"Military Hygiene." North American and United States Gazette, November 5, 1861.
Otis, George Alexander. Reports on the Extent and Nature of the Materials Available for the Preparation of a Medical and Surgical History of the Rebellion. Philadelphia: J. B. Lippincott, 1865.
"A Patriotic Lady Offers Her Services to Nurse the Wounded." New York Herald, April 22, 1861.
Rutkow, I. M. Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine. New York: Random House, 2005.
"Sick and Wounded Soldiers." (Letter to the editor.) Washington, DC, Daily National Intelligencer, August 8, 1861.
Smith, Adelaide W. Reminiscences of an Army Nurse during the Civil War. New York: Greaves Publishing Company, 1911.
Stevenson, William G. Thirteen Months in the Rebel Army: Being a Narrative of Personal Adventures in the Infantry, Ordnance, Cavalry, Courier, and Hospital Services. New York: A. S. Barnes & Burr, 1862.
United States Sanitary Commission. General Aid Society for the Army (Buffalo, NY). Report of Delegates from the General Aid Society for the Army at Buffalo, N.Y.: To Visit the Government Hospitals, and the Agencies of the United States. Buffalo, NY: Franklin Steam, 1862.
United States Sanitary Commission. To the Loyal Women of America. Washington, DC: Author, 1861.
"Ward's Island." New York Times, April 9, 1862.
Woolsey, Jane Stuart. Hospital Days. New York: D. Van Nostrand, 1870.
J. Douglas Tyson
Jenny Lagergren