Medical
treatment during the American Civil War
was extremely poor. It has been estimated that 64,582 died of their
battle wounds. Thousands of men
had to have limbs amputated. Where possible chloroform was used but
in many cases the patient had to rely on whisky while being operated
on.
At the beginning of the war the Union Army
provided one assistant surgeon to every regiment of 1,200 men. These
were not always qualified men and there were many examples of people
who had previously earned their living by selling quack medicines
being appointed. Individual states later took over the responsibility
of employing doctors for their volunteer armies. Some appointments
were based on political factors, but some states such as Ohio, Massachusetts
and Vermont, developed a reputation for recruiting good doctors.
Soon after the war started Dorothea Dix
was appointed as superintendent of women nurses for the federal government.
Over the next four years she was responsible for the recruitment,
training and placement of 2,000 nurses treating members of the Union
Army. Later Elizabeth Blackwell
organized the Women's Central Association of Relief. This involved
the selection and training of nurses for service in the war. Blackwell,
along with Emily Blackwell and Mary
Livermore, played an important role in the development of the
United States Sanitary Commission. Other important nurses during the
war included Clara Barton, Mary
Stafford, and Mary Ann Bickerdyke.
The Confederate Army was slow to organize
a system of medical treatment. In 1861 the Confederate Congress decided
to allocate only $50,000 for the establishment and operation of military
hospitals. This sum was increased and by the end of 1863 they had
a large network of hospitals in Virginia (39), North Carolina (21),
South Carolina (12), Georgia (50), Alabama (23), Mississippi (3),
Florida (4) and Tennessee (2).
The South had a real problem with obtaining medicine after the U.S.
naval blockade began to work successfully in 1862. The Confederacy
published a pamphlet giving a list of herbs and plants that could
be used to treat patients when manufactured medicines were not available.
This included snakeroot, partridgeberry, sassafras, lavender, tulip
tree, dogwood, and the leaves and bark of white oak.
The greatest danger facing soldiers during the war was not bullets
but disease. It is believed that 186,216 soldiers died of a variety
of different illnesses during the conflict. Large numbers of the soldiers
came from rural areas and had not been exposed to common diseases
such as chicken pox and mumps. Living in unhealthy conditions and
often denied properly medical treatment, soldiers sometimes died of
the these diseases. For example, 5,177 soldiers in the Union
Army died of measles during the war.
The main killer diseases were those that resulted from living in unsanitary
conditions. In 1861 typhoid caused 17
per cent of all military deaths, whereas dysentery
and diarrhea caused a sick rate of 64
per cent of all the troops in the first year of the war. The following
year this figure reached 99.5 per cent.
Union Army records show that a large
number of its soldiers died from diseases caused by contaminated food
and water. This included diarrhea (35,127),
typhoid (29,336) and dysentery
(9,431). Drinking from streams occupied by by dead bodies or human
waste and eating uncooked meat were the cause of large numbers of
deaths. Regular soldiers who had been trained to be more careful about
the food and water they consumed, were far less likely to suffer from
intestinal disease that volunteer soldiers.
A mixture of mercury and chalk called blue powder was given to soldiers
with intestinal complaints. Opium, morphine, and quinine were also
used by camp doctors and nurses to deal with a wide variety of different
medical problems. It was commonly believed that wearing a flannel
bans around the waist under the shirt would prevent disease. Large
numbers of soldiers died from tuberculosis
(consumption). Official records show 6,497 soldiers died of the disease
in the Union Army. However, a much larger
number were discharged because of poor health and died later.
It is estimated that smallpox killed
7,058 Union Soldiers. Another 14,379 died of malaria.
Although the exact number of Confederate
Army deaths from malaria is not known, there were 41,539 cases
in an 18 month period (January, 1862-July, 1863) in South Carolina,
Georgia and Florida. The cause of the disease was not known and soldiers
often slept without the protection of mosquito nets. Once contracted,
doctors and nurses often prescribed whiskey and the bark of dogwood,
poplar and willow. Other substances used to combat fever included
cod-liver oil, cinnamon and the syrup of wild cherry.
Large numbers of soldiers suffered from combat fatigue. Caused by
extreme stress, symptoms include muteness, deafness and difficulty
in controlling movement of the limbs. Unrecognized as an illness in
the 19th century, soldiers were often diagnosed as suffering from
mania or dementia, and sent home to recover. During the First
World War combat fatigue was known as shellshock.
(1)
Elizabeth Blackwell,
Pioneer Work in Opening the Medical Profession to Women (1895)
The first shot at Fort Sumter aroused the whole North, and the assassination
of Lincoln enlisted the indignant energy of
every Northern woman in the tremendous struggle. As the deadly contest
proceeded, and every town and village sent
forth its volunteers to the fearful slaughter of civil war, the concentration
of thought and action on the war dwarfed every other effort.
On the
outbreak of the war, an informal meeting of the lady managers was
called at the infirmary to see what could be done towards supplying
the want of trained nurses so widely felt after the first battles.
A notice of this meeting to be held at the infirmary having accidentally
found its way into the New York Times, the parlours of the
infirmary were crowded with ladies, to the surprise of the little
group of managers.
The Rev.
Dr. Bellows and Dr. Elisha Harris being present, a formal meeting
was organised. Whilst the great and urgent need of a supply of nurses
was fully recognised, it was also felt that the movement would be
too vast to be carried on by so small an institution. A letter was
therefore drafted on this occasion, calling for a public meeting at
the Cooper Institute, and a committee of the ladies present was appointed
to obtain signatures to this call.
The meeting
at the Cooper Institute was crowded to overflowing. The National Sanitary
Aid Association was then formed, in order to organise the energetic
efforts to help that were being made all over the country.
The Ladies'
Sanitary Aid Association, of which we were active members, was also
formed. This branch worked daily
at the Cooper Institute during the whole of the war. It received and
forwarded contributions of comforts for the soldiers, zealously sent
from the country; but its special work was the forwarding of nurses
to the seat of war. All that could be done in the extreme urgency
of the need was to sift out the most promising women from the multitudes
that applied to be sent on as nurses, put them for a month in training
at the great Bellevue Hospital of New York, which consented to receive
relays of volunteers, provide them with a small outfit, and send them
on for distribution to Miss Dix, who was appointed superintendent
of nurses at Washington.
(2)
After being badly wounded at Fair Oaks,
General Oliver Howard
was taken to a large house that had been converted into a Union Army
hospital.
Dr. Hammond, my personal friend, met me near the house, saw the
blood, touched my arm, and said: "General, your arm is broken."
The last ball had passed through the elbow joint and crushed the bones
into small fragments. He led me to a negro hut, large enough only
for a double bed. Here I lay down, alarming an aged negro couple who
feared at first that some of us might discover and seize hidden treasure
which was in that bed.
My brigade surgeon, Dr. Palmer, and several others soon stood by my
bedside in consultation. At last Dr. Palmer, with serious face, kindly
told me that my arm had better come off. "All right, go ahead,"
I said.
"Not before 5 p.m., general." "Why not?" "Reaction
must set in." So I had to wait six hours. I had received the
second wound about half-past ten. I had reached the house about eleven,
and in some weakness and discomfort occupied the negro cabin till
the hour appointed. At that time Dr. Palmer came with four stout soldiers
and a significant stretcher. The doctor put around the arm close to
the shoulder the tourniquet, screwing it tighter and tighter above
the wound. They then bore me to the amputating room, a place a little
gruesome with arms, legs, and hands not yet all carried off, and poor
fellows with anxious eyes waiting their turn.
On the long table I was nicely bolstered; Dr. Grant, who had come
from the front, relieved the too-tight tourniquet. A mixture of chloroform
and gas was administered and I slept quietly. Dr. Palmer amputated
the arm above the elbow. When I awoke I was surprised to find the
heavy burden was gone.
(3)
In 1863 Jane Swisshelm
visited Campbell Hospital in Washington.
She wrote about the experience in her autobiography, Half a Century
(1880)
I had sat by him but a few moments when I noticed a green shade on
his face. It darkened, and his breathing grew labored - then ceased.
I think it was not more than twenty minutes from the time I observed
the green tinge until he was gone. I called the nurse, who brought
the large man I had seen at the door of the bad ward, and now I knew
he was a surgeon, knew also, by the sudden shadow on his face when
he saw the corpse, that he was alarmed; and when he had given minute
directions for the removal of the bed and its contents, the washing
of the floor and sprinkling with chloride of lime, I went close to
his side, and said in a low voice:
"Doctor,
is not this hospital gangrene?"
He looked
down at me, seemed to take my measure and answered:
"I
am very sorry to say, madam, that it is."
"Then
you want lemons!"
"We
would be glad to have them!"
"Glad
to have them?" I repeated, in profound astonishment, why, you
must have them!"
He seemed
surprised at my earnestness, and set about explaining:
"We
sent to the Sanitary Commission last week, and got half a box.
"Sanitary
Commission, and half a box of lemons? How many wounded have you?"
"Seven
hundred and fifty."
"Seven
hundred and fifty wounded men! Hospital gangrene, and half a box of
lemons!"
"Well,
that was all we could get; Government provides none; but our Chaplain
is from Boston - his wife has written
to friends there and expects a box next week"
"To
Boston for a box of lemons!"
I went
to the head nurse who gave me writing materials, and I wrote a short
note to the New York Tribune:
"Hospital
gangrene has broken out in Washington, and we want lemons! lemons!
lemons! lemons! No man or woman in health, has a right to a glass
of lemonade until these men have all they need; send us lemons!"
I signed
my name and mailed it immediately, and it appeared next morning. That
day Schuyler Colfax sent a box to my lodgings, and five dollars in
a note, bidding me send to him if more were wanting; but that day
lemons began to pour into Washington, and soon, I think, into every
hospital in the land. Governor Andrews sent two hundred boxes to the
Surgeon General. I received so many, that at one time there were twenty
ladies, several of them with ambulances, distributing those which
came to my address, and if there was any more hospital gangrene that
season I neither saw nor heard of it.
The officers
in Campbell Hospital knew of the letter, and were glad of the supplies
it brought, but some, time passed before they identified the writer
as the little sister in the bad ward, who had won the reputation of
being the "best wound-dresser in Washington."
(4)
Army surgeons normally used chloroform to send soldiers asleep while
they amputated their limbs. James Winchell, a soldier in the Army
of the Potomac, recorded after the war how he had his arm amputated
while he was fully conscious.
Surgeon White came to me and said: "Young man, are you going
to have your arm taken off or are you going to lie here and let the
maggots eat you up?" I asked if he had any chloroform or quinine
or whisky, to which he replied "No, and I have no time to dilly-dally
with you." I said it was hard, but to go ahead and take it off.
He got hold of my arm, pulled the bandage off, pushed his thumb through
the wound and told me to "come on", and helping me up we
walked to the amputation table. They put me on the table, cut off
blouse and shirt sleeves filled with maggots, and after a lot of preliminary
poking and careless feeling around my arm and shoulder they made me
sit up in a chair, and wanted to hold my legs, but I said "No,
I won't kick you." I set my teeth together and clinched my hand
into my hair, and told them to go on. After cutting the top part of
my arm and taking out the bone, they wanted me to rest an hour or
so; to which I refused. I wanted but one job to it. Then they finished
it, while I grasped for breath and the lower jaw dropped in spite
of my firm clinch. I was then led away a short distance and left to
lie on the hot sand.
(5)
In her
book, My Story of the War, Mary
Livermore described the work
of Mary Ann Bickerdyke on the hospital
boat
After the battle of Donelson, Mother Bickerdyke went from Cairo
in the first hospital boat, and assisted in the removal of the wounded
to Cairo, St. Louis and Louisville, and in nursing those too badly
wounded to be moved. On the way to the battlefield, she systematized
matters perfectly. The beds were ready for the occupants, tea, coffee,
soup and gruel, milk punch, and ice water were prepared in large quantities,
under her supervision, and sometimes her own hand.
When the wounded were brought on board, mangled almost out of human
shape; the frozen ground from which they had been cut adhering to
them; chilled with the intense cold in which some had lain for twenty-four
hours; faint with loss of blood, physical agony, and lack of nourishment;
racked with a terrible five-mile ride over frozen roads, in ambulances,
in common Tennessee farm wagons, without springs; burning with fever;
raving in delirium, or in the faintness of death, Mother Bickerdyke's
boat was in readiness for them.
(6)
Sarah E. Edmonds, Nurse and Spy
in the Union Army (1865)
Typhoid fever began to make its appearance in camp, as the burning
sun of June came pouring down on us, and the hospitals were soon crowded
with its victims. Along each side of the tent the sick are laid, on
blankets or cots, leaving room to pass between the beds. The hospital
corps consists of a surgeon, an assistant surgeon, a hospital steward,
a ward master, four nurses, two cooks, and a man of all work to carry
water, cut wood, and make himself generally useful.
(7)
After the war a surgeon working with Mary
Ann Bickerdyke wrote about her achievements working on the Union
Army hospital ship.
I never saw anybody like her. There was really nothing for us
surgeons to do but dress wounds and administer medicines. She drew
out clean shirts or drawers from some corner, whenever they were needed.
Nourishment was ready for every man as soon as he was brought on board.
Everyone was sponged from blood and frozen mire of the battlefield,
as far as his condition allowed. His blood-stiffened, and sometimes
horribly filthy uniform, was exchanged for soft and clean hospital
garments. Incessant cries of "Mother! Mother! Mother!" rang
through the boat, in every note of beseeching and anguish. And to
every man she turned with a heavenly tenderness, as if he were indeed
her son.
(8)
Mary Livermore,
The Story of My Life:
The Sunshine and Shadow of Seventy Years (1897)
On one
occasion, when going from ward to ward of a hospital, in Helena, Arkansas,
I came upon a poor fellow evidently near death. He accepted my offer
to write a letter to his mother, but, pointing to a comrade in the
next bed, said,
"
Write for him first; I can wait."
I doubted
if he could wait, for already the pallor of death was overshadowing
his face, and I urged him again saying:
"Speak
as rapidly as you can, and I will write rapidly; there is time for
both letters."
But he
persisted; "Take him first!" and I was obliged to obey.
Writing as rapidly as possible, I watched the brave fellow who had
given up his last earthly comfort to his comrade, and who was failing
fast. Noticing that my eyes sought him constantly, he beckoned feebly
to one of the nurses, who turned him in bed that I might not be disturbed
by his whitening face and shortening breath. And when I moved to his
bedside to receive his dictation, he had passed beyond the need of
my services.
(9)
Walt Whitman
worked in a Union Army camp hospital
during the battle of Fredericksburg
in December, 1862.
21st December, 1862: Spend a good part of the day in a large brick
mansion on the banks of the Rappahannock, used as a hospital since
the battle - seems to have received only the worst cases. Out doors,
at the foot of a tree, within ten yards of the front of the house,
I noticed a heap of amputated feet, legs, arms, hands, etc., a full
load for one-horse cart. Several dead bodies lie near, each covered
with its brown woolen blanket. In the door-yard, towards the river,
are fresh graves, mostly of officers, their names on pieces of barrel-staves
or broken boards, stuck in the dirt.
23 December, 1862: The results of the late battle are exhibited everywhere
about here in thousands of cases. Hundreds die every day, in the camp,
brigade and division hospitals. These are merely tents, and sometimes
very poor ones, the wounded lying on the ground, lucky if the blankets
are spread on layers of pine or hemlock twigs, or small leaves. No
cots; seldom even a mattress. Once in a while some youngster holds
on to me convulsively, and I do what I can for him; at any rate, stop
with him and sit near him for hours, if he wishes it.
(10)
In his diary Walt
Whitman
recorded his visits to wounded soldiers in Washington
(18th June, 1863)
In one of the hospitals I find Thomas
Haley, company M, 4th New York cavalry. A regular Irish boy, a fine
specimen of youthful physical manliness, shot through the legs, inevitably
dying. Came over to this country from Ireland to enlist. Is sleeping
soundly at this moment (but it is the sleep of death). Has a bullet-hole
through the lung. I saw Tom when first brought here, three days since,
and didn't suppose he could live twelve hours. Much of the time he
sleeps, or half sleeps. I often come and sit by him in perfect silence;
he will breathe for ten minutes as softly and evenly as a young babe
asleep. Poor youth, so handsome, athletic, with profuse beautiful
shining hair. One time as I sat looking at him while he lay asleep,
he suddenly, without the least start, awakened, opened his eyes, gave
me a long steady look, turning his face very slightly to gaze easier,
one long, clear, silent look, a slight sigh, then turned back and
went into his doze again.
In one bed a young man, Marcus Small, company K, 7th Maine. Sick with
dysentery and typhoid fever. Pretty critical case, I talk with him
often. He thinks he will die, looks like it indeed. I write a letter
for him to East Livermore, Maine. I let him talk to me a little, but
not much, advise him to keep very quiet. Do most of the talking myself,
stay quite a while with him, as he holds on to my hand.
Opposite, an old Quaker lady sits by the side of her son, Amer Moore,
2nd U.S. Artillery. Shot in the head two weeks since, very low, quite
rational, from hips down paralyzed, he will surely die. I speak a
very words to him every day and evening. He answers pleasantly, wants
nothing. He told me soon after he came about his home affairs, his
mother had been an invalid, and he feared to let her know his condition.
He died soon after she came.
(11)
Mary Livermore,
My Story of the War (1887)
At last it was believed that all the wounded had been removed
from the field, and the relief parties discontinued their work. Looking
from his tent at midnight, "Blind Jack" Logan, then a colonel,
observed a faint light flitting hither and thither on the abandoned
battlefield, and, and after puzzling over it for some time, decided
it was someone robbing the dead. He sent his orderly to bring the
rascal in. It was Mother Bickerdyke, with a lantern, groping among
the dead. Stopping down, and turning their cold faces toward her,
she scrutinized them searchingly, uneasy lest some might be left to
die uncared for. She couldn't rest while she thought any were overlooked
who were yet living.
(12)
Jane Swisshelm,
Half a Century (1880)
I was called at midnight to a death-bed. It was a case of flesh-wound
in the thigh, and the whole limb was swollen almost to bursting, so
cold as to startle by the touch, and almost as transparent as glass.
I knew this was piemia and that for it medical science had no cure;
but I wanted to warm that cold limb, to call circulation back to that
inert mass. The first thought was warm, wet compresses, hot bricks,
hot flannel; but the kitchen was locked, and it was little I could
do without fire, except to receive and write down his dying messages
to parents, and the girl who was waiting to be his wife.
When the
surgeon's morning hour came he still lived; and at my suggestion the
warm compresses were applied. He said, "they feel so good,"
and was quite comforted by them, but died about ten o'clock. I was
greatly grieved to think he had suffered from cold the last night
of life, but how avoid any number of similar occurrences? There was
no artificial
heat in any of the wards. A basin of warm water was only to be obtained
by special favor of the cooks.
I decided
to lay my trouble before the cooks, who gathered to hear me tell the
story of that death and of my sorrow that I could not drive away the
cold on that last, sad night.
They all
wiped their eyes on their aprons; head cook went to a cupboard, brought
a key and handed it to me, saying:
"There,
mother, is a key of this kitchen; come in here whenever you please.
We will always find room on the ranges for your bricks, and I'll have
something nice in the cupboard every night for you and the nurses."
This proved
to be the key to the situation, and after I received that bit of metal
from cook, there was not one death from piemia in any ward where I
was free to work, although I have had as many, I think, as sixty men
struck with the premonitory chill, in one night. I concluded that
"piemia" was French for neglect, and that the antidote was
warmth, nourishing food, stimulants, friction, fresh air and cheerfulness,
and did not hesitate to say that if death wanted to get a man out
of my hands, he must send some other agent than piemia. I do not believe
in the medical theory concerning it; do not believe pus ever gets
into the veins, or that there is any poison about it, except that
of ignorance and indifference on the part of doctors and nurses.
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