Hospital Conditions and Care for the Wounded
(Article submitted by John Bowen to the Union Standard)
We as reenactors tend not to re-create the gorier side of the Civil War, and that is the pain and misery inflicted upon the participants of the battles we reenact. Part of the reason is that we are certainly reluctant to 'assault' the spectators' senses with a show that may become too unseemly, and that is a consideration. Aside from the bloodied bandage that you may find among the ranks at the end of a battle, little is displayed to the public about the aftermath of the battle except in the instance of units like the 173rd who do a fine job of educating the public about the horrid conditions the soldiers endured who were unfortunate enough not to immediately succumb to the effects of a battlefield injury. Even during the battle, our portrayals of the wounded are somewhat misleading. A
typical hit consists of the soldier dying on the spot whereas you would actually suspect many of those hit were actually 'walking wounded.' We should see more of our 'fallen' brothers on the field trying to find and 'patch' their wounds or at least more movement, crawling, limping back, crying out, etc. Comrades helping the wounded to the rear would also be appropriate if it weren't for the fact that we rarely have the numbers in our ranks to justify losing men from the line. Brook has mentioned that we could assist the 173rd after the battle with their living history presentations of field hospital conditions and I would recommend those of you so inclined to give it a try. This type of activity usually draws a good crowd and would 'bring home' the actual sacrifices our ancestors endured.
I've copied some excerpts from a book about Walt Whitman's life working in hospitals in Washington, D.C. from 1862 to 1865. At the time, he was already a known writer for "Leaves of Grass" but his life was in turmoil and he was suffering with some depression when he heard his brother George was wounded at Fredricksburg. He found his brother in D.C. (who was recovering) and got interested in visiting the wounded in hospitals to help where he could. The following quotes from the book will give you a better understanding of those conditions and maybe inspire some to create some 'living
history' along with members of the 173rd.
From "The Better Angel, Walt Whitman in the Civil War,"
by Roy Morris, Jr., Oxford University Press, 2000
…the sights, the sounds, and the smells of the army hospitals-they were literally a world unto themselves. At the end of 1862 there were approximately thirty-five hospitals in and around Washington, accommodating some thirteen thousand suffering soldiers. Despite the recent influx of wounded from Fredericksburg, the winter of 1862-63 actually represented something of a downtime for the hospitals after the extended bloodletting that followed Major General George McClellan's Peninsula campaign, the Seven Days battles, Second Manassas, South Mountain, and Antietam, when a grand total of 56,050 cases had been treated in Washington during the last four months of the year. (p88-89)
Whatever their design, the hospitals in Washington were places to be feared and despised by any soldier. Medical care in the early 1860s was not much advanced from the Middle Ages. The great discoveries in bacteriology and antisepsis by such European medical pioneers as Louis Pasteur, Robert Koch, and Joseph Lister were still a few years in the future. American doctors, by and large, were poorly trained and woefully under-equipped. (Harvard Medical School, for example, did not even own a microscope until 1869.) The cause and prevention of disease were unknown. Typhoid fever, malaria, and diarrhea, the three most prevalent and deadly killers of the Civil War, tore through every
hospital and camp, spread by infected drinking water, fecally contaminated food and
disease-transmitting mosquitoes. Meanwhile, attending physicians ascribed the ills to such
imaginative and fantastical causes as "malarial miasms," "mephitic effluvia," "crowd poisoning," " sewer emanations," "depressing mental agencies," " lack of nerve force," " exhalations," " night air," " sleeping in damp blankets," "choleric temperament," "decay of wood," "odor of horse manure," "effluvia of putrefying corpses," and "poisonous fungi in the atmosphere."
Given such thinking, together with the endemic over-crowding and poor sanitary practices common to both armies, it is no wonder that Civil War soldiers were four times as likely to fall ill as civilians- and five times as likely to die if they did. It was not that the hometown doctors were dramatically better at their work- most of the eleven thousand physicians who served in the Union Army in camp, field, or hospital were volunteers drawn from the same pool of peacetime practitioners-the problem lay in the system itself. In 1860, one year before the start of the Civil War, there were forty existing medical schools in the United States, three-fourths of them in the North, with a total enrollment of approximately five thousand students. The demand for doctors far outstripped the number of schools, and students characteristically rushed through their classes in a year or less and then were free to hang out their shingles without (as was still common in Europe) serving a professional apprenticeship. Low standards of education, combined with a dismaying ignorance of European medical advances, meant that all Americans-soldiers and civilians-received less than satisfactory medical treatment during the war. And the sheer volume of cases-more than four hundred thousand wounded and six million sick in the Union Army alone during the four years of war-insured that even the most competent doctors were swamped with more cases than they could effectively handle.
Once ill, the soldiers could expect little in the way of practical help from their doctors. Indeed, many of the physicians' favorite remedies made matters worse by violating the most basic of all medical tenets: first, do no harm. Civil War-era doctors were apt to prescribe a bewildering and generally ineffective array of drugs at the first sign of illness. Diarrhea was treated with laxatives, opium, Epsom salts, castor oil, ipecac, quinine, strychnine, turpentine, camphor oil, laudanum, blue mass, bella-donna, lead acetate, silver nitrate, red pepper, and whiskey. Malarial symptoms called for large doses of quinine-one unfortunate patient received 120 grams in seventeen hours-whiskey, opium, Epsom salts, iodide of potassium, sulphuric acid, wild cherry syrup, morphine, ammonia, cod liver oil, spirits of nitre, cream of tartar, barley water, and cinnamon. Typhoid sufferers were dosed with quinine, blue mass, carbonate of ammonia, turpentine, opium, and brandy. When all else failed, as it frequently did, doctors harkened back to more primitive methods of treatment: bleeding, cupping, blistering, leeching, binding, and chafing. Flannel belly bands were also widely if ineffectively used.
By far the most widely prescribed and damaging drug was calomel, or mercurous chloride. Dissolved in a chalky, bitter-tasting liquid, calomel was administered in massive doses for virtually every disease that Civil War physicians encountered. This was the era of "heroic dosing," when patients were virtually drenched in medicines, on the seemingly unassailable theory that any drug worth taking in moderation was doubly worth taking in excess. Unfortunately, it did not require much calomel to induce chronic mercury poisoning, with horrific short-term and insidious long-term aftereffects. Some patients were given a dram of calomel every hour, causing their faces to swell, their tongues to jut out of their mouths, and their saliva to gush forth at the rate of anywhere from a pint to a quart every twenty-four hours. Heavy doses caused the victims' teeth and hair to fall out, and in extreme cases they developed mercurial gangrene, a particularly loathsome disease that rotted the soft tissue in the inside of the mouth and caused it to slough off in a putrid mass.
Abuses were so widespread that in May 1863 Union Surgeon General William A. Hammond felt compelled to issue a directive banning the use of calomel and a related mercury-based compound, tartar emetic, in all army hospitals. "No doubt can exist," said Hammond, "that more harm has resulted from the misuse of these agents…than benefit from their administration." Hammond's farsighted order was widely ignored, and its unpopularity among other physicians contributed greatly to his removal from office a few months later. At any rate, the directive came too late to help Northern author Louisa May Alcott, who had come to Washington not long before Whitman to serve as a nurse in the hospitals. Contracting typhoid fever after only three weeks at Union Hotel Hospital, Alcott was heroically dosed with
calomel, lost most of her hair and teeth, and suffered from shooting pains in her arms and back for the rest of her life.
Sharing hospital space with the ill were soldiers who had been wounded in combat. Frequently, this meant that they were recuperating from amputations of their arms or legs and, more often than not, were also battling some sort of postoperative fever caused by the incredibly filthy conditions of Civil War surgery. Antisepsis was almost entirely unknown during the war, and the rough nature of field hospitals precluded even minimal standards of cleanliness, much less sterility. The common image of the Civil War "butcher" at work in a charnel house of severed limbs and screaming victims has some basis of truth, but with important qualifications. The popular notion of a wounded soldier biting down on a bullet while a drunken surgeon sawed away clumsily at his ruined arm is a romantic-or antiromantic-figment of the screenwriter's imagination. To begin with, most wounded soldiers were effectively anesthetized before surgery, chloroform being the overwhelming agent of choice. Soldiers were often given a drink of whiskey upon their arrival at field hospitals, but this was done erroneously to combat symptoms of shock, not for anesthetic reasons.
Amputations were performed at a staggering rate after a major battle, not out of callousness or stupidity but as accepted medical practice stemming from the experience of British surgeons during the Crimean War. The number of amputated limbs was high because the number of wounds to
soldiers' extremities was also high-71 percent of all Civil War wounds were to the arms, legs, hands, or feet. The wounding agent was almost always a bullet-surprisingly, only 6 percent of wounds were caused by artillery fire-and three-fourths of all bullet wounds were inflicted by .58 caliber Minie bullets, wrongly called balls. The damage done to the human body by such a lethal projectile, fired from a
rifled musket with great accuracy at a range of upwards of one thousand yards, is difficult to exaggerate. The relatively slow muzzle speed of Civil War muskets, coupled with the heavy weight of the cone-shaped lead bullet, resulted in large, jagged wounds, copious bleeding, and catastrophically shattered bones. (By comparison, the modern steel-jacketed, .30-caliber bullet, traveling at a much faster speed, is effectively sterilized by the sheer heat of its velocity and typically makes a smaller, neater, utterly aseptic hole while passing completely through the victim's body.)
More often than not, it was this shattering of bones that compelled immediate amputation during the Civil War. As one wartime surgeon described it, "The shattering, splintering, and splitting of a long bone by impact of the minie or Enfield ball were, in many instances, both remarkable and frightful, and early experience taught surgeons that amputation was the only means of saving life." Furthermore, it was accepted practice that operations should take place within twenty-four hours of the patient's wounding, before the "irritative," or infected, stage of the injury took place in rough field hospitals, not in
better-equipped surgeries farther to the rear.
It was not so much the amputations themselves that caused such traumatic medical aftereffects in Civil War soldiers but the frightful and literally ignorant way in which they were carried out. No modern description of the procedure can equal the eyewitness account of Union surgeon W.W. Keen, a young Philadelphia physician who went through the war with the Army of the Potomac and later became one of the country's most respected neurologists. Writing in 1918, half a century removed from the horrors he had witnessed at Bull Run, Gettysburg, and Spotsylvania, Keen could not suppress an almost perceptible shudder. "We
operated in old blood-stained and often pus-stained coats," he wrote. "We used undisinfected instruments from undisinfected 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….The silk with which we sewed up all wounds was undisinfected. If there was any difficulty in threading the needle we moistened it with…bacteria-laden saliva, and rolled it between bacteria-infested fingers. We dressed the wounds with clean but undisinfected sheets, shirts, tablecloths, or other 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."
The predictable result of such hurried and horrific operations was postoperative infections, of which there was no shortage of dreadful candidates. Pyemia, septicemia, erysipelas, osteomyelitis, tetanus, gangrene-the very names of the so-called "surgical fevers" are terrifying, and with good reason. Caused by the ever teeming streptococcus or staphylococcus bacteria, the fevers routinely followed invasive surgery (erysipelas was the exception, often occurring idiopathically, or spontaneously, without the necessity of an open wound). Pyemia, or "pus in the blood," was the most dreaded of all, with a mortality rate of 97.4 percent. Sufferers experienced profuse sweating, high fevers, chills, jaundice, and the affliction's mordant trademark, multiple abscesses, before being carried off within a few days of its onset.
One Union surgeon graphically charted the fever's course: "Many a time I have the following experience: A poor fellow whose leg or arm I have amputated a few days before would be getting on as well as we then expected-that is to say, he had pain, high fever, was thirsty and restless, but was gradually improving….Suddenly, over night, I would find that his fever had become markedly greater; his tongue dry, his pain and restlessness increased; sleep had deserted his eyelids, his cheeks were flushed; and on removing the dressings I would find the secretions from the wound dried up, and what there were watery, thin, and foul smelling, and what union of the flaps had taken place had melted away. Pyemia was the verdict, and death the usual result within a few days."
Less deadly than pyemia, but perhaps more distressing to both victims and onlookers because of their hideous outward manifestations, were tetanus, and hospital gangrene. Tetanus, or lockjaw, is caused by the bacillus tetani, found frequently in the very soil the soldiers fought over. It was easily spread by horse manure (horses being a popular host of the germ), and the largest single outbreak of the disease during the war came after the Battle of Antietam, when many of the Union wounded were treated at a field hospital located in a stable that was ankle deep in manure. Once securing a foothold in a deep puncture wound-the bacillus cannot survive in the open air- tetanus releases a variety of toxins that grotesquely affect the central nervous system, causing the familiar fixed smile and frozen jaws of the terminal victim. There was no effective treatment at the time, and the mortality rate was a fearsome 89 percent. Doctors tried large doses of brandy and opium, administered through stomach tubes or enemas, but without noticeable effect. "To enumerate the means used for the relief of tetanus would require a volume," a surgical manual explained, "but to record those entitled to confidence does not demand a line." Few who saw a tetanus victim thrashing his life away on a hospital cot, held down by half a dozen straining attendants, ever forgot the hideous sight.
Hospital gangrene, now mercifully extinct, was even more terrible to behold. The infection typically began with a small black spot the size of a dime appearing on the surface of the wound. Within a few days' time, the spot would grow into a rotten-smelling mass of decayed tissue, gray, blue, green, or black in color. Because its characteristic odor and repulsive appearance were upsetting to fellow patients, doctors, and staff, gangrene cases were sometimes kept in isolation wards or separate hospitals, such as the Confederate's Empire Hospital in Macon, Georgia. Treatment
included surgically removing the dead tissue or burning it off with corrosive chemicals such as nitric acid, chlorine, or bromine. Charcoal, yeast, turpentine, and carrot poultices were also frequently applied to the wounds, with predictably low rates of success.
Understandably, if wrongly, confusing the cause of the disease with its most noticeable symptom, doctors attributed hospital gangrene to the catchall culprit "sewer effluvia." Pails of bromine were scattered about the wards to combat the smell, although one Confederate surgeon actually opposed the practice on the grounds that it was "like removing the beacon that warns the watchful mariner of the certain death that lurks beneath the surface." Patients trapped in nearby beds no doubt disputed that nautical reasoning. (Pp.90-98)
Whitman was far from the only visitor in the hospitals. Indeed, one signal characteristic of Civil War-era hospitals was the easy access that the general public had to the men. This access was not always an unalloyed blessing, as one disgusted Indiana soldier recalled later, remembering the "broken-down, short-winded, long-faced, seedy preachers of all denominations" who prayed regularly over the men "without having smiled on a single soldier or dropped a word of comfort or cheer," and the "batch of sightseers, do-nothings, idlers, time-killers, fops, and butterflies [who] skip through the
hospital, and the summer shadows, leave no trace behind." (pp. 107-8)
In light of such unorthodox views, it was inevitable that Whitman would soon part ways with the Christian Commission, although he continued to hold its members in high regard for their selfless (and unpaid) devotion to duty. He had considerably less use for the salaried members of the United States Sanitary Commission, a quasi-military organization whose cool, clinical approach to aiding the soldiers was summed up by one female volunteer who recommended that hospital nurses "put away all feelings. Do all you can and be a machine-that's the way to act; the only way." (p. 110)
In April 1863 the Army came up with a new organization, the Invalid Corps, to help the hard-pressed hospital administrators. In theory the Invalid Corps was to be a "Corps of Honor" comprised of "meritorious and deserving" individuals whose physical handicaps precluded them from returning to the battlefield. In practice, however, its ranks filled with a volatile combination of unwilling soldiers who wanted to get back to the front, unhealthy soldiers who wanted to get home, and unvalorous soldiers who wanted to get out of active duty. To a man, the members of the Invalid Corps loathed
their new, eye-catching sky-blue uniforms and Corps insignia-"I.C.-which unfortunately duplicated the governmental stamp on broken-down horses and inferior material: "Inspected and Condemned." In time the name was changed to the more dignified Veteran Reserve Corps, but the quality of care it provided to those confined to the hospitals remained conspicuously poor and grudging. (pp. 113-4)
In the aftermath of Chancellorsville, Whitman suffered a temporary crisis of faith. One evening he went down to the Sixth Street Wharf to see the arriving flood of wounded, and was profoundly disheartened by what he saw. "The men in charge of them told me the bad cases were yet to come," he wrote. "If that is so I pity them, for these are bad enough. You ought to see the scene of the wounded arriving at the landing here….Two boat loads came up at about half-past seven last night. A little after eight it
rain'd a long and violent shower. The poor, pale, helpless soldiers had been debark'd, and lay around on the wharf and neighborhood anywhere. The rain was, probably, grateful to them; at any rate they were exposed to it…All around-on the wharf, on the ground, out on side places-the men are lying on blankets, old quilts, &c., with bloody rags bound round heads, arms, legs….The men generally make little or no ado, whatever their sufferings. A few groans that cannot be suppress'd, and occasionally a scream of pain as they lift a man into the ambulance." The wounded were arriving at the rate of
nearly one thousand per day. ( Pp. 117-8)