Care of the sick and wounded in the Union army, 1861 to 1865

Item Type text; Thesis-Reproduction (electronic)

Authors Robbins, Lucia Greenman Allyn, 1913-

Publisher The University of Arizona.

Rights Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.

Download date 28/09/2021 00:46:08

Link to Item http://hdl.handle.net/10150/317943 CARE OF THE SICK AND WOUNDED IN THE UNION ARMY

1861 to 1865

by

Lucia Allyn Robbins

A Thesis Submitted to the Faculty of the

DEPARTMENT OF HISTORY

In Partial Fulfillment of the Requirements For the Degree of

MASTER OF ARTS

In the Graduate College

; THE UNIVERSITY OF ARIZONA

1 9 6 6. STATEMENT BY AUTHOR

This thesis has been submitted in partial fulfillment of requirements for an advanced degree at The University of Arizona and is deposited in the University Library to be made available to borrowers under rules of the Library.

Brief quotations from this thesis are allowable without special permission, provided that accurate acknowledgment of source is made. Requests for permission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the head of the major department or the Dean of the Graduate College when in his judgment the proposed use of the material is in the interests of scholarship. In all other instances, however, permission must be obtained from the author.

SIGNED 4i.it* t- I^A^Xlnxy

APPROVAL BY THESIS DIRECTOR

This thesis has been approved on the date shown below: TABLE OF CONTENTS

Page

ABSTRACT ...... iv

NEW DEMANDS ON AN OLD SYSTEM ...... 1

AMERICAN MEDICINE IN TRANSITION ...... 23

THE NATION'S CONCERN WITH THE ARMY'S HEALTH ..... 44

BULLETS AND FEVER ALONG THE RIVERS ...... 68

The Tennessee ...... 68

The Chickahominy ...... 84

DUTY WEARS A CHANGING F A C E ...... 98

THE HARSH LESSON OF REALITY ...... 128

REFERENCES ...... 150

ill ABSTRACT

The Civil War began with a lack of military preparation that was nowhere more evident than in the medical department of the army.

In peace time , this small group of doctors had been directly respon­ sible to the Surgeon General and assigned by him to the scattered military posts as needed. They had never been responsible for more than the care of a regiment and there were no regulations or procedures to guide them when they were made medical directors of the new volun­ teer armies.

In the first year of the war it quickly became evident that the simple organization for medical care that existed was completely in­ adequate to preserve the health and care for the wounds of an army of half a million men. Among the recruits, ignorant of the measures needed to maintain healthy camps, and frequently commanded by incompetent officers the sick rate became so great as to seriously impair the fight­ ing strength of the Union. In the early battles care of the wounded was improvised on the spot. There was no organized personnel to care for them on the field, means to evacuate them to the rear, suitable hospital facilities to receive them, or adequate medical supplies for treatment.

Most of the experiences of the sick and wounded in the Civil

War were dismal ones. Most basic of the reasons for this was the level

iv of medical practice of the period. Scientific medicine was in its infancy,

progress in the understanding of the causes of disease and an enlight­

ened approach to treatment had largely been made in Europe, and few

American doctors belonged to what was known as the "new school of . medicine." In the United States the status of the doctor was at its low­ est point in the history of American medicine. The public health move­ ment which had begun to develop in the mid-century as a part of the philanthropic effort toward human improvement was interrupted by the war before much progress had been made. But many of the men and women who had been active in this movement became leaders in the civilian Sanitary Commission which gave inestimable aid to the medi­ cal corps throughout the conflict. An acquaintance with the medical

concepts of the period is so important in understanding the problems

of the Civil War doctor that I have devoted a chapter to this subject, using as sources such eminent historians of medicine and public health as Richard H. Shryock, M. G. Seelig, George Rosen, and C.-E. A.

Winslow. I have given less attention to the work of the Sanitary Com­

mission which has been so thoroughly covered in George Worthington

Adam's study published under the title Doctors in Blue (New York:

Henry Schumah, 1952).

The other basic factor in the failure to provide adequate care

for the sick and wounded of this war was the lack of strong centralized

direction of the total war effort. From both doctors and civilians, men of foresight and genius appeared upon the medical scene and worked out plans and methods for field hospital care, organization of medical per­ sonnel, evacuation of wounded to the rear, and the maintenance of medical supplies. However, authorization of the systematized care pror- posed was not secured until the war was nearly over and they were only able to implement their new ideas in spotty instances. Individualism was a dominant characteristic of the Civil War. Troops, nurses, doc­ tors, officers, and congressmen each had his own ideas. Personal antagonism, political preference, the independent attitude of the states, old-line army attitudes all conspired to deprive the soldier of the care it would have been possible to give him.

The great contribution to army medicine of the Civil War was the record of the suffering, the trials and the errors compiled in The

Medical and Surgical History of the War of the Rebellion upon which I have relied for so much of my information. The British experience in the

Crimea and the American in the Civil War were the first histories of war­ time medicine ever to be compiled. While their medical data became only of historical interest on the advent of the sciences of bacteriology, immunology, and epidemiology the Civil War experience in camp sanita­ tion and hygiene, military health hazards, hospital construction and management, the organization of field hospitals and dressing stations was preserved for use and implementation in both World Wars I and II. Only in these later wars did the.work of the great Civil War medical administrators gain recognition. NEW DEMANDS ON AN OLD SYSTEM

Surgeon William King, Medical Director, rode with the Others

of General McDowell1 s staff on the road from Centreville to Manassas ■

Junction Virginia on a hot July twenty-first in 1861. A Union army of

some thirty thousand men marched behind them, a conglomeration of volunteer state militia only slightly leavened by a scattering of regular

I ' , army units. The volunteers marched in a recrudescence of the war hys­ teria with which they had answered President Lincoln1 s call for troops

in April. The boredom and discomfort of four months in makeshift camps

lay behind. They were on the offensive in Confederate territory and ahead,

so they believed, lay a glorious victory which would quickly end the re­

bellion of the seceded southern states against the Union.

The brash optimism of the volunteer troops was not shared by

the staff officers of the regular army. General McDowell was well aware

of the army's deplorable unpreparedness for battle, the inadequate staff,

the lack of all kinds of supplies, the troops' ignorance of battlefield

deployment. But in what Catton calls the nation's "bright innocence" 2

1. W. S. King, "Report of Events Connected with the First Bull Run Campaign," in J. j. Woodward et al (eds.), The Medical and Surgi­ cal History of the War of the Rebellion (6 vols., Washington, 1870-1888), Medical, I, Appendix, p. 2. Hereafter cited as Woodward et al (eds.), The Medical and Surgical History .. . Rebellion.

2. Bruce Catton, This Hallowed Ground (New York, 1956), p. 21. public and political pressure was forcing an engagement the outcome of which was viewed as entirely unpredictable by professional military O judgm ent.

The Civil War, though long foreseen and feared, was undertaken with the same lack of preparation with which the previous wars, in the 4 nation's military history had begun. At the beginning of 1861 the regu­ lar army of the United States numbered some. 15,000 officers and men

scattered across the country as meagre.garrisons for coastal defense

installations and for the Indian outposts of the west. Despite the dis­ persal of troops over great areas the Medical Corps was limited to a

Surgeon General and one hundred and eleven d octor s - - thirty surgeons and eighty-three assistant"surgeons—all, of necessity, attached to the

general staff and moved from post to post as needed. The defection of twenty-four surgeons to the Confederacy left the Medical Corps of the

Union army with eighty-nine doctors experienced in the procedures of

army medicine

The volunteer state militia which responded to the call of April

15 carried one surgeon on the roster of each regiment. The presidential

proclamation of May 3, calling for forty regiments for two years of

3. Ibid. p. 44.

4. Francis R. Packard > History of Medicine in the United States (2 vols. . New York, 1931), I, p . 637

5. Harvey F. drown. The Medical Department of the United States Army from 1775 to 1873 (Washington, 1873) , p. 215. federal service, authorized the addition of one assistant surgeon per regiment. Almost none of these men had had any experience of military life and, as appointees of state governors, felt only responsible for their respective state troops. They exhibited little realization of the need for coordination and organization, either of health measures in the camps or care of the wounded in an engagement. On the outbreak of hos­ tilities the Surgeon General had called all medical officers of the regular corps back from their posts to provide administrative personnel, assign­ ing them as medical directors for divisions and armies. In the early months of 1861 they struggled to organize the medical care of an army of half a million men under regulations designed for an army of nineteen regiments.® They were further hampered by the fact that none of them had ever held Targe commands. Even those who had served in the Mexi­ can War had only regimental experience on which to rely as the field organization in that war had been entirely on a regimental basis. 7 ■

Behind Surgeon King was twenty-five years of such service, in O only the last five of which had he held the rank of major. The man's

6. Ibid, pp. 214, 217. Woodward et al feds.). The Medical and Surgical History .. . Rebellion, Surgical, III, p. 899.

7. Charles Lynch et al (eds.). The Medical Department of the United States Army in the World War (15 vols., Washington, 1921-1925), I, p. 37. Hereafter cited as Lynch et al (eds.), Medical Department .. . World W ar.

8. Thomas H. S. Hammerslev (ed.) . Complete Army Register of the United States for One Hundred Years, 1779-1829 (third edition; Washington, 1881), p. 561. • nervousness shows through his report. He wrote that he "was painfully impressed with his job" and "anxious that nothing should be wanting on his part to the fulfillment of the just expectation of the country." He rode with the general staff believing in that position he would experience the fiercest contest and would be able to give comprehensive supervision to the regimental officers. In the three months since he had returned from a frontier post to become a Medical Director in the Department of

North East Virginia the medical organization of the swollen army had taken no more than skeletal form. No plan of indoctrination or training had been devised for medical officers but to those who had sought his help he had given advice as to camp life and the channels for obtaining medical supplies

The troops were in good health and carried three days cooked rations in their haversacks, but they were raw and inexperienced and had not been toughened by drill for a grueling march in the heat. Com­ manders as inexperienced as they pushed them at the double quick along the dusty roads and they soon began to discard their gear, blankets, coats, and haversacks and then to drop out along the way from exhaus­ tion and sunstroke.

Surgeon King had distributed through the army the limited num­ ber of ambulances which were available. No other transport vehicles

9 . King/ "Report," in Woodward et al (eds.), Medical and Surgical History .. . Rebellion, Medical, I, Appendix, pp. 1, 3. had been furnished to the medical corps so that only such supplies as

the ambulances could carry were available. Regimental surgeons carried

field kits of instruments and simple dressings. Some were supplied with

stretchers, a wall tent, extra blankets, the items varying according to how much the individual Officer had learned about the channels Of army procurement. ^® On the eighteenth of July, when General Tyler's division

suffered some casualties at Blackburn's Ford, King had sent Assistant

Surgeon Magruder, one of his few regular officers, to select buildings

suitable for hospitals at Centreville. There, in a few empty dwellings

and a hotel, about thirty wounded were cared for and in a period of two days evacuated back to Alexandria by ambulance and railroad.

The engagement of the twenty-first of July beyond Bull Run

Creek abruptly changed the nation's view of the war. The realities of artillery and musketry fire were revealed as the army streamed back to

Washington in confused retreat leaving hundreds of wounded as prisoners

of the Confederate forces. Near the scene of action Surgeon Magruder had set up another hospital in Sedley Church, removing the seats,

covering the floor with hay and whatever blankets were available, dis-

tributing buckets of water and improvising an operating table. 11 The

10. King, "Report," in Woodward et al (eds.), Medical and Surgical History ... Rebellion, Medical, I, Appendix, p. 3.

11. D. S. Magruder to W. S. King, July 25 , 1861, in ibid p . 5» 6 wounded filled the church and three other houses in the vicinity „ Some were laid under the trees, or remained where they had fallen. They ar­ rived in such numbers that work had to be suspended until more medical officers of disorganized regiments, regular and volunteer, found their way to the hospitals and coordinated their efforts. Taken prisoners by a group of Gonfederate cavalry late in the afternoon, the medical officers were allowed to continue their care of the wounded through Monday. It had begun to rain and a shelter of abandoned rubber blankets was erected over the wounded left in the open. ^ While there was a plentiful water supply the only food that first day was the rationsci. that could be col­ lected from abandoned haversacks. Later, people of the community I o brought in soup, chickens, eggs, milk, and butter. °

On Monday evening the medical officers centered at Sedley

Church Hospital were suddenly ordered to M anassas. Considerable con­ fusion existed concerning the status of non-combatant prisoners. The first order directed that they must sign a parole for the duration of the

12. G. M. Sternberg, "Extract from a Report in the Duties As­ signed to Him, from the Outbreak of the Rebellion till May 1st, 1863," in ibid, p. 8. George Sternberg, a graduate of the College of Physicians and Surgeons, New York City, left private practice and became an army surgeon at the outbreak of the war. He remained in the army and became Surgeon General in 1.893 . A pioneer bacteriologist and authority on sani­ tation and disinfection he wrote the first textbook on bacteriology by an American author and founded the Army School of Medicine in Washington.

13. C. S. DeGraw, "Extract from a Narrative of Services," in ibid, p. 8. war in order to return to the care of the wounded. When all refused, some were offered a five day parole which was accepted. Their instru­ ments were confiscated, however, and on returning to Sedley Church they could do little but provide shelter, nourishment, and dressings to those wounded who were selected as having a chance of survival.. The

Union request to remove the wounded to Washington was refused and during the following week they were taken to Manassas in "Virginia wagons," described as "eminently adapted for an instrument of torture."

From Manassas medical officers and wounded were sent to Richmond in freight cars, neither food, water, or medicine being provided on the two day trip. There was extreme suffering and an unrecorded number of • d e a th s .

The record of wounded and missing from First Bull Run is not accurate; the reports made at the time varied widely. In the confusion of the retreat many who first were reported as killed or wounded later strag­ gled back to their commands. There was no count of the number who died on the way to Richmond. Nevertheless, the official medical returns of

481 killed, 1,911 wounded, and 2,952 missing were of a magnitude to 15 quicken public recognition of the serious state of affairs. The Bull

14. C. C. Gray, "Extract from a Report of Services at the First Battle of Bull Run," in ibid, p. 7. 15. Frederick Phisterer, Statistical Record of the Armies of the United States (New York, 1883), p. 213. Phisterer is a convenient source for statistics as they were compiled from the records of the Provost Marshal, the Adjutant General, and the Surgeon General. Run debacle, actually witnessed by members of the administration and citizens of Washington, shocked the nation into an awareness that the war should be directed by professional military ? judgment, not by popular clamor. ^^ It was obviously not going to be quickly or easily won.

The military measures taken up to this time had been autho­ rized by presidential proclamation based on extant laws and army regu­ lations passed many years before. The Thirty-seventh Congress went * into session on July 4, 1861 and during the summer numerous measures to increase the effectiveness of the army were introduced . Prolonged debates took place between those congressmen favoring an increase in the regular army and those who believed that the nation should rely on volunteer forces recruited for a specified length of time. 17 Legislation was needed for a command organization which would coordinate regular and volunteer troops. Peacetime army appropriations were completely in­ adequate for the forces now under arms. Expenditures for the fiscal year which had ended July 1 already were in arrears to the amount of over seven million dollars. 18 As jealous of its prerogatives as any congress, committees were appointed to investigate new types of guns, armored

16. Harper's Weekly, V (August 10, 1861), p. 499.

17. Cong. Globe, 37 Cong. , 1 Sessi, Appendix, pp. 113-115, 123-127, 219-221, 228, 248.

18. House Mis. Docs., 37 Cong. > 1 Sess., Doc. 6, pp. 12- 13. ships, and other matters which might better have been the duty of profes­

sional soldiers. The problem of expediting the war was further hindered by the tactics of congressmen from the uncommitted border states and

other peace Democrats. This multiplicity of pressures explains in some degree the relatively slight progress made in modernizing the medical care of the army through the first two years of the war.

Improvements in the medical branch of the army were also hampered by a succession of changes in the Surgeon General’s office.

At a time when the exigencies of the situation demanded new regulations and services the medical staff was headed by old men. Shortly after the fall of Fort Sumter, Surgeon General Lawson, then eighty years old,

suffered a stroke and was retired. Until hi s. death on May 15 the office was filled by the senior ranking surgeon Robert C. Wood, who had been in service thirty-six years. Wood was succeeded by Clement A. Finley, an army surgeon since 1818.

Colonel Lawson, who had been Surgeon General since 1836, had served on the field as .Medical Director of Scott’s Army in the Mexi­ can War. He was a positive character who, had he lived, might have exerted more positive leadership than his immediate successors. Lawson had obtained military rank for the medical staff, had added enlisted

stewards for regiments, had twice secured an increase in the number of

19. The first retirement provision for officers of the United States Army was authorized by Congress in August of 1861. See ibid. Doc. 38, p. 44. 10 regular surgeons, and had put military surgeons in uniform. A good doc­ tor by the standards of his day, he was a careful observer, described several disease entities, and published the first statistical reports on sickness and mortality in the United States Army. Surgeon Finley had served during the Indian Wars and as Medical Director of the hospitals at Monterey during the Mexican War. He was apparently a man of lim- 20 ited vision who could not grasp the size of the problem facing him .

The executive secretary of the newly formed civilian Sanitary Commis- sion described him as complacent, self-satisfied, and incompetent. 21

His only recommendations for the improvement of the department were 22 additional staff and higher rank for medical officers.

The provision of supplies and equipment for the three months militia had been a terrible mess. An articles in Harper1 s Weekly com­ mented that the want of all preparation for a sudden call to arms was nowhere more evident than in the unarmed, ill-clad condition of the

20. Allen Johnson and Dumas Malone (eds.), Dictionary of American Biography (22 vo ls., New York, 1928-1944, including a gen- ' eral index and a supplementary volume), XI, p. 59; Brown, The Medical Department of the United States Army from 1775 to 1873, pp. 215-217; Packard, History of Medicine in the United States, I, p. 640.

21. P.M. Ashburn, A History of the Medical Department of United States Army (Boston, 1929), p. 68 ff;

22. Annual Report of the Surgeon General in Senate Ex. Docs ., 37 Cong., 2 Sess., II, pp. 60-63. 23 Pennsylvania volunteers mustering at the state capital „ Medical

stores and hospital equipment held a low priority. Provisions in the camps for the two year recruits called up in May were little better. It is apparent, however, that not only did;recruits from states with greater resources fare better than others but that the administrative capacities of their commanding officers had much to do with the facilities provided.

At Camp Defiance, Cairo, Brigadier General Benjamin Curtis saw to it that the volunteers were thoroughly disciplined, established in good quarters, and amply supplied , and that a suitable hospital was erected under the supervision of the brigade surgeon.^ The medical director of the Department of the Ohio commanded by Major General George B.

McClellan reported that the new regiments were rapidly provided with 95 hospital outfits by the "efficient purveyor" at New York.

Supplies remained a problem throughout the war but the diffi­ culty was less in production than in distribution. Early in the war many supply depots were set up in addition to the old centers at New York and

Baltimore and purveyors of medical supplies were attached to each. But

23. Harper's Weekly. V (May 25, 1861), p. 331.

24. Harper's Weekly, V (Tune 1,1861), p. 351.

25. J. J. B. Wright/ "Extract from Reports Relative to the Oper­ ations of the Medical Department in the Campaigns in West Virginia," in Woodward, et al (eds.), Medical and Surgical History ... Rebellion, Medical, I, Appendix, pp. 13-14. even so, land transportation from the depots to the moving armies, was hampered by poor roads and rough terrain. The variety of railroad gauges and insufficient rolling stock were factors as the army moved west and south. Medical items were mixed in with other supplies and it often took many days to find them. Even when shipped in carload lots it was not uncommon for hospital stores to be switched to a siding to clear the line for needs that were deemed more urgent. Volunteer medical officers were confused by the requisition channels for items needed in care of the sick and wounded. Professional items such as drugs, surgical instruments, bandages and lint, splints, stretchers, and hospital basins were issued by the medical purveyor. Equally necessary items, woolen and rubber blankets, ambulances, tents, supply wagons, and hospital furniture were.issued by the quartermaster. The quartermaster service was also responsible for hospital construction, hospital ships and trains. 26

While the old systems faltered under stresses for which they were not designed, the welfare of the sick and wounded depended largely . on the energy, ingenuity, and responsibility of individual medical offi­ cers. There was no medical director for General Lyon's army in Missouri and a volunteer surgeon was. in charge of distributing to the regiments the medical supplies accumulated at Springfield. A regular surgeon re­ ported a lack of surgical instruments but a sufficiency of drugs and

26. Revised Regulations for the Army of the United States, 1861 (Philadelphia, 1861), pp. 159-241, 281-239. 11 stores" if the officers were efficient enough to procure them. 2 A7 volun­ teer surgeon claimed that he received only a few drugs stored in a dry goods box, was allowed one wagon, no tents, and used his own instru­ ments . ^ The one officer responsible for both the Fifth and Third Mis­ souri regiments "personally" secured wagons and stores, one can only surmise how .^

At the Battle of W ilson's Greek on August 10 practical meas­ ures were taken for the care of the wounded despite the lack of central direction. A field hospital was established in a ravine near a supply of water and there the wounded walked or were carried by their fellows.

One volunteer surgeon had his wounded brought back of the lines and laid in a triangle about which he made rounds, applying temporary dressings and checking hemorrhage. 30

Basically such arrangements were the same as the aid stations of modern warfare, the great difference , of course, being the surgical knowledge of the two eras. To the majority of Civil War surgeons the

27. H. M. Sprague, "Extract from Observations on the Battle of W ilson's Creek, " in Woodward et al (eds.), Medical and Surgical History ... Rebellion, Medical, I, Appendix, p. 16.

28. W. Hi White, "Extract from a Report on the Regimental Hospital of the 22nd Iowa Volunteers," in ibid,1 p. 17.

29. S. H. Melcher, "Extract from a Report of.his Services at . Wilson's Creek," in ibid, p. 17.

30. W hite, "Extract from a Report on the Regimental Hospital of the 22nd Iowa Volunteers," in ibid, p. 17. 14 orthodox treatment of a bone- shattering wound of an extremity was im­ mediate amputation and he considered himself seriously hampered if his instruments were captured, ^ ^ or the conditions were such that the pro­ cedure could not be done. There, was no satisfactory treatment for penetrating wounds of the head, chest, or abdomen. These were regarded as inevitably fatal. Bacteria were unknown and it had yet to be recog­ nized that pus was not laudable but a sign of infection. Lister's demonstration, that sterile technique prevented wound infection was not made until 1864 and not accepted in the United States until some years later. While surgical shock was recognized, its nature was not well understood, the only treatment being administration of hot drinks, soup and stimulants.

At W ilson's Greek as at Bull Run the Union defeat resulted in the capture of many wounded. The senior surgeon present blamed the want of centralized medical direction but it is clear that lack of trans­ portation to evacuate the wounded was equally responsible. Wishing to make a surprise attack. General Lyon had refused to take along the heavy 32 six-mule spring ambulances because of the noise they made. The wounded jolted back to the unfinished courthouse that served as a

31. Melcher, "Extract from a Report of His Services at Wil­ son’s Creek,” in ibid, p. 17.

32. Sprague, "Extract from Observations on the Battle of Wilson's Creek." in ibid, p. 16. 15 hospital in Springfield in baggage wagons and on gun caissons. The same situation prevailed w h e n the Union troops abandoned Springfield and fell back to Rolla. It was reported that the wounded were taken out on every kind of conveyance that could be found. .

At Belmont, Missouri, where the field hospital of Grant's army was a log hut on the river bank, as soon as they were dressed the wounded were evacuated to Cairo by transport steamers. Nevertheless, as no ambulances or spring wagons were available at the Belmont.depot, the wounded were brought from field to hospital on horseback, stretchers, and blankets fastened to poles and muskets. When the Confederate forces overran the field many wounded who had not reached the river bank were captured. When these were removed under truce the next day, it was found that their clothes had been stolen, no nourishment given, and their wounds not dressed. At the hospital depot there was sufficient morphine, chloroform, instruments, and dressings, but no food or soup.

Reports from this battle comment on the shattering effect of .the new conoidal balls. All cases of fractured skulls and penetrating wounds of the lungs and intestines died. 33

. At the BalUs Bluff engagement in Virginia, it was again reported that the round balls of the old type smooth bore muskets did far less

33 . John Brinton, "Account of the Operations of the Medical Department at the Battle of Belmont, M issouri," in ibid-.' pp. 18-22* H. P. Stearns, "Second Extract from a Narrative of Services from the . Commencement of the Rebellion till July 18th, 1863," in ibid, pp. 22—23. 16 damage than the conoidal Minie ball which would be increasingly used in the war with shattering effect. Here removal of the wounded from the

Virginia to the Maryland side of the Potomac was hampered by the two swift running channels formed by Harrison's Island and the bordering canal on the Maryland side. The canal was the greater obstacle, as all boats had been taken to the river. An enterprising surgeon of volunteers found a supporting archway so that the ambulances were able to pass beneath the canal to the wounded on the river bank. 34 Surgeon Charles

Tripler, U .S.A ., who had become Medical Director of the newly formed

Army of the Potomac in July, had instituted, regular drill for the members of the band who constituted the ambulance corps. The advantage of a trained corps was demonstrated in this engagement, the wounded being all under care by nightfall.35

The disastrous results of these engagements of 1861 presented to the administration leaders in Congress the problem of legislating for the more effective prosecution of the war. The existing laws under which

President Lincoln had first acted had limited federal service of militia to three months. On July 22 an act was passed authorizing the President to ask for no more than.500,000 volunteers for no more than three years of

■;34= A. B. Crosby,- "Extract from Reports of the Wounded at the Engagement at Ball's Bluff, Virginia," in ibid, pp. 10-11.

35. John A. Lidell, "Extract from a Narrative of the Surgery at Ball's Bluff, Virginia and a Report of the Wounded of General Baker's Brigade at the Affair of Oct. 21,• 1861," in ibid, p. 11. 17 service or to the end of the war if earlier „ ^® These regiments were to be raised by the states and, when accepted into federal service, to be or­ ganized into brigades of four or more regiments and divisions of three or more brigades. Ten companies each of cavalry and artillery were author­ ized , to be attached to the infantry regiments at presidential direction.

Despite the consolidation of troops into larger commands the provision for medical officers continued in essence the old system of regimental organization. The allowance of one surgeon, one assistant surgeon, and one hospital steward per regiment was continued . No medi­ cal officers were provided for cavalry or artillery. The single innovation in the medical staff structure was the introduction of the position of . brigade surgeon, appointment to be made by the President with the ad­ vice and consent of the Senate. Either regular or volunteer officers could be appointed, the object being, as congressional.debates on the measure showed, to fill the positions with competent officers. Regimen­ tal medical officers continued to be appointed by state governors. How­ ever, the War Department's right to review such commissions often " • i made on the basis of political and social pressure was secured by that section of the act which empowered commanders of departments and armies to appoint examining boards to inquire into the capacity, quali­ fications, conduct, and efficiency of any commissioned volunteers

36. House M is. Docs., 37 Cong., 1 Sess., Doc. 23, pp. 21-24. 18 reported to it. 37 • An adverse report of the Board, if approved by the Pres­ ident, was to result in dismissal. The Medical Department was thus able to enforce its departmental regulation that surgeons be passed by a medical examining board before receiving a commission. The states had frequently ignored this regulation in the medical appointments made . in April and May with the result that many physically incapacitated and incompetent doctors had been brought into service. Under the stronger legislation the calibre of medical officers among the three year volun­ teers was greatly improved and the incompetents with the two year regi- On ments could be dismissed.

On July 29, 1861 Congress authorized an increase in the strength of the regular army by nine regiments of infantry and one each of cavalry and artillery, the medical personnel, allotted to each being

on . one hospital steward. On August 3, the Act for Better Organization of the Military Establishment added ten surgeons, twenty assistant sur­ geons and a corps of medical cadets to the regular staff . ^ The cadets, not to exceed fifty in number, were to serve as dressers in hospitals and ambulance attendants in the field under the control of medical

37. H arper's W eekly, V (Aug. 10, 1861) , p. 499.

38. Brown, The Medical Department of the United States Army from 1775 to 1873, p. 218.

39. House Mis. Docs., 37 Cong., 1 Sess., Doc. 23, pp. 31-32. 40. Ibid, pp. 42-44. . ■ ' ■ 19

officers alone „ They were to be students of medicine between eighteen and twenty-three who "had read medicine for two years" and attended at least one course of lectures in a medical college. Their rank and pay was to be that of West Point cadets and they were to serve for one year.

It was further enacted that in general or permanent hospitals female nurses might be substituted for soldiers when considered expedient by the Surgeon General or medical director. They were to be paid forty cents a day. This provision for female nurses, stemmed from the situa­ tion in Washington hospitals during First Bull Run when soldiers detached; to hospitals as nurses and cooks had been called back to their regiments leaving the hospital sick completely unattended.

The needs of the sick were further recognized in a section re­ lated to hospital food. At the direction of.the Surgeon General, approved by the Secretary of War, hospitals might be provided with fresh or pre­

served fruits, milk, butter, and eggs as necessary for the proper diet

of the sick. Prior to this legislation the soldier's ration, set by act of

Congress, had been the same whether he was sick or well:—flour,

bread, or hardtack, salt or fresh beef, beans, rice or hominy, potatoes

or their equivalent, tea or coffee The Medical Bureau, in an effort

to secure items more suitable for the sick, had devised the "hospital .

fund." To this fund the Commissary Department credited the purchase

41. Ibid. 20 value of a soldier's daily ration when he was absent from his regiment in hospital. The amount of such "commutation" varied with the purchase and transportation cost of food in different localities, and hence had never provided a dependable or adequate amount of funds on which hos­ pitals could draw.

From the point of view of twentieth century military medical care the above provisions seem superficial and negligent. By 1862 the astute and practical among both civilian and military held the same opinion.N ot long after the war a veteran wrote, "It seemed impos­ sible for the public authorities to appreciate the necessity of ample preparation for the wounded and sick, their attention seemed constantly directed to the increase of the army by new enlistments. The importance of providing for its health was but slowly admitted and hardly admitted at all until it became evident that the ranks could only be kept up by such provisions. However, in perspective of one hundred years, the impartial historian recognizes factors other than congressional neg­ ligence: the lack of leadership exercised by Surgeons General grown old in service, the limited scope of biological knowledge, the primitive character of military medicine practiced at the time, and the 'strict:'... ..

42. Lynch et al (eds.), Medical Department . . . World War, I, p . 38.

43. Charles Lanman, The Red Badge of Michigan; a Civil, Military and Biographical History (Detroit, 1871), p. 198. 21 economy under which the army had been forced to operate during the long years of peace.

The sudden fiscal demands alone were tremendous . Government expenditures had risen from $84.5 million, in the year ending June 1861 to an expected $543 million in the fiscal year ending June 1862. $339 million of the total was needed by the War and Navy Departments.44

The appropriations to the medical bureau, two and a half.million dollars, seem very small in relation to the whole and to other departments but again, an unbiased evaluation of the value given to its services will compare the increases in the departmental appropriations during the war, and will take into account that funds allocated to' other departments facilitated medical services. For example, the pay of regular and volun­ teer, surgeons, though not of contract surgeons, was part of the total pay appropriation and not included in the medical budget. Supplies fur­ nished by the Quartermaster and Commissary departments came out of their departmental appropriations. The increase in the funds allowed the medical department for the first two years of the war are shown in the following figures.

Appropriation to June, 1861 $ 76,225.50 Amount left from 1860 50 ,054.65 Appropriation of March, 1861 ' ______115 ,000.00

. 1861 $ 241,306.31 .

44. House Mis. Docs., 37 Cong., 1 Sess., Doc. 24, Expended to June, 1861 to contract surgeons 20,088.89 for supplies, hospital cooks and nurses 174.037.88

.1861 Total 194,026.77 Remaining 47,179.54

Appropriation of July, 1861 1,271,841.00 Appropriation of February, 1862 1, 000, 000.00 Appropriation for deficiency 125,000.00 Amount left from 1861 47,179.54 Stores sold at auction 1.874.35

1862 Total 2,445,894.89

Expended to June, 1862 to contract surgeons 121,650.67 for medicine, instruments, hospital stores, bedding 2,249,462.52 in hands of disbursing agents .74.781.70

1862 Total 2,445,894.8945

In these figures for 1862 we see that the economy practices of his pre­ decessor were not continued by the new Surgeon General, William A.

Hammond, appointed in that year. It is said of him that he spent more for ice in one year of his administration that had been spent for the whole medical service in a year of peace.^

While Surgeon General Finley, in face of the medical needs already exhibited wherever fighting had occurred , could think of no

46. S. Wier Mitchel, "Medical Department in the Civil War, in The Journal of the American M edical A ssociation, LXII (May 9, 1914) pp. 1445-1450. other recommendations in his annual report of 1861 than an insignificant increase in personnel and the usual request for greater equality of rank for army surgeons, civilians over the country were concerned about the care of the sick and wounded. 47 The Sanitary Commission's recommen­ dation that William Hammond would be a Surgeon General competent to initiate the obvious reforms resulted in his appointment in April 1862.

From that time the old ways of the Army Medical Corps began to give - way to the new .

1 47. Senate Ex. Docs., 37 Cong., 2 Sess., II, Doc. 1, pp. 60-63. AMERICAN MEDICINE. IN TRANSITION

The high rate of disease which drastically reduced the combat

effectiveness of the Civil War armies, both Union and Confederate, be­

gan to show as soon as the first volunteer troops assembled in training camps. The diseases were those which had always attacked the armies of the world to that time—measles, dysentery, pneumonia, typhoid, and typhus. They were accepted as the unavoidable consequence of large troop aggregations and of the rigors of military field service. Sur­

geon General Hammond held the most enlightened medical views of his day, but even he shared the attitude of inevitability and expressed, it in his report for the year ending July 1862. The health of the troops had been excellent, wrote Hammond, with no severe epidemics. The abso­ lute number of sick, 90,000 at the time of writing, was large because the army was so large. The belief in a fixed ratio of sickness to total

strength was also expressed by the Medical Director of the Army of the

Potomac, Charles Triplet, when he opposed sending regimental sick to

general hospitals on the grounds that "the constant quantity of sick in

2 a regiment would be increased by malingerers."

1. House Ex. Docs., 37Cong., 3 Sess., IV, Doc. i, pp. 50-58 . 2. Charles Triplet to Surgeon General Clement Finley, in R. N. Scott etal .(eds.), The War of the Rebellion; a Compilation of the Union and Confederate Armies (30 vols., Washington, 1880-1901), Series I, Vol. V, p. 7. Hereafter cited as Official Records . .. Armies. This military attitude so wasteful of manpower.had been inherited from Europe. Absolutist governments with their conscripted armies gener­ ally had abandoned their sick as no longer soldiers and concerned them­ selves only with the men who took the field. Only in the surgical care of the Wounded had any advances been made in military medicine up to the time of the Crimean War. The soldier owed to the French barber- s urge on, Ambrose Pare (1510-1590) the first advance in the care of wounds received in battle. Serving in the armies of all the French kings from Francis I to Henry of Navarre, he had discarded the practice of treating wounds with boiling oil for more humane and efficacious methods, had introduced ligation in place of cauterization in amputations, written a book The Method of Treating Wounds Made by Arquebuses which be­ came the standard reference of surgeons in the French, Italian, German and Spanish armies, and as surgeon-in-ordinary to his monarchs influ- 3 eneed the acceptance of military responsibility for care of the wounded.

In the Swedish army, Gustavus Adolphus had introduced personnel spe­ cifically to care for the wounded on the field and transportation for their removal. Frederick of Prussia had personally inspected the military sur­ gery conducted on the field and in hospital. The great Baron Larrey,

Napoleon's chief medical officer, is famous for his "flying ambulances" and for his improvement, of surgical procedures related to wounds. But

3. Ralph H. Major, A History of Medicine (2 vols, Springfield, Illinois, 1954), I, pp. 425-431. the lack of attention to disease is well illustrated by Napoleon's failure

in Russia, which is now believed to have been mainly due to typhus

fever, to which the Russian soldier was immune but to which the French 4 soldier was not.

In the previous wars on the American continent, the Revolution,

the War of 1812, and the War with Mexico, there had never been suffi­

cient surgeons and supplies or adequate appropriations for care of either the sick or the wounded. Most of the little attention the disabled soldier received had been through voluntary civilian efforts. But the size of the

army in the Civil War, the greatest in military history to that time, and the actualities of disease and death which were presented to the eyes

of the civilian population, brought an awareness of its responsibilities to a nation already touched by the concern for human welfare which had

stemmed from the Enlightenment.

In the Civil War deaths from disease were some 202,000 while C those from wounds were 50,000. These figures are even more horrifying when compared with the wars of the twentieth century: 6

4. Edgar Erskine Hume, "Introduction to Military Medicine," in The Military Surgeon, CII (fan. 1948), pp. 17-20.

5. Woodward et al (eds.), Medical and Surgical History ... Rebellion, Medical, III, pp. 1-3.

6. Ibid; Hume, "Introduction to Military Medicine, " in The Military Surgeon, CII (ftm, 1948), p. 22. 27

Deaths from disease Civil War 278 per thousand World War I 16.5 per thousand World War II 1 per thousand

Deaths from wounds Civil War 142 per thousand > World War I 83 per thousand World War II 45 per thousand

Since an army exists to go to war, the disease incidence rate is equal in military importance to mortality rate because of its bearing on the combat effectiveness of an army. Today we judge the success or failure of the military medical department on its ability to keep the rate of disease to

n its minimum. While Civil War medical records were not kept with the accuracy which obtained in later conflicts there were 6,029,564 reported cases of disease. 8 From May 1, 1861 to June 30, 1866 there were some

12,579 cases of disease to every 1000 of mean strength among white troops and 17,044 among colored.® The official figures give the annual disease rates per thousand. These show that each white soldier was sick about two and a half times per year and each colored soldier three and a half times. The death rate of the colored was three times that of the w hite.

7. E. E. Hume> "M edicine and W ar. The 1948 Kaber Lecture at Georgetown University," in The Military Surgeon, CHI (Sept. 1948), p . 178.

8. Woodward et al (eds.), Medical and Surgical History ... . Rebellion, Medical, III, p. 6.

. 9. Since the statistics for colored troops only covered the years 1864-1866 the rate for colored troops is a corrected figure for the total war period. 28

White Troops Colored Troops Year C ases Deaths Cases Deaths

1861 3,822 10.8 1862 2,983 49 1863 2,696 63 1864 2,210 48 4,092 251 1865 2,273 56 3,205 ■ 140 1866 . 2,797 94

The Civil War occurred at a tragic place in time for the survival

of the sick and wounded. While modern medicine as we know it had be­

gun to emerge in the years from 1800 to 1850, no rational approach to

disease prevention and cure was possible untiTthe science of bacteri­

ology emerged. In 1858 Louis Pasteur was able to demonstrate that living

organisms were the cause, not the by-products, of fermentation in wine.

The analogy between the bacterial cause of fermentation and putrefac-

tion on the one hand and of infection on the other then became obvious. 10

This clue was seized upon and tested by practicing physicians and sur­

geons. In 1864 Joseph Lister conclusively demonstrated that the intro­

duction of bacteria into wounds caused infection. Using carbolic acid

as a counter-a gent he initiated the antiseptic and aseptic procedures

that made surgical intervention practical for the first time, although

twenty years elapsed before these measures were adopted in the United

States .11

10. R. H. Shrvock, The Development of Modern Medicine: An Interpretation of the Social and Scientific Factors Involved. (Phila- delphia, 1936), pp. 273-279. 11. Ibid, p. 281. 29

The new science of bacteriology made rapid strides with the •

advent of the achromatic microscope, and techniques of isolating and identifying specific bacteria were developed. In 1876 Koch and Pasteur demonstrated beyond doubt that a specific bacterium caused a specific I O disease. Following the postulates which Koch formulated, there were identified between 1873 and 1905 the pathogenic organisms which caused tuberculosis, typhoid, tetanus, bubonic plague, syphilis, malaria, typhus , and yellow fever. ^ Also identified were such patho­

genic protozoa as the amoeba which caused dysentery and various fungi which caused skin infections.

The science of entomology emerged as bacteriology developed, with tremendous implications for the public health movement. The old arguments over contagion were finally resolved in the decade of the turn of the century when, the role of insects as carrier agents was discovered: the mosquito in malaria and yellow fever, the fly in typhoid, the body louse in typhus. Public health control learned to discriminate between the need for quarantine, where transmission of disease result from direct contact, and the need for sanitation and improved personal hygiene.

The preventive medical practices of immunology and the use of antitoxins are of such recent origin that they need not be discussed here.

12. Ibid, pp. 281-283.

13. Ibid, pp. 286-290. 30

The medical tragedy for the Civil War soldier lay in the fact

that barely twenty years meant the difference between life and death for

so many. Although in the next American war, the Spanish.American,

deaths from disease were still greater than the small number wounded,

2,565 to 350,14 nevertheless that war made a significant contribution

to medicine. The commission sent to Cuba by Surgeon General G. M.

SternberglS discovered the aegypti mosquito to be the vector in yellow

fever and thus ended the epidemic danger of that disease. Not until

World War I were the losses from disease, for the first time in history,

•I £■ less than the losses from enemy action.

The medical officer of the Civil War not only was denied the

professional achievements of the near future but he had inherited from

the past a welter of conflicting theories of disease. He worked in a

. transitional period where certain advances made by the scientists in the

medical profession were colliding with the systematic concepts upheld

by traditionalist practitioners. Medical men in the United States were

still in opposition as to whether medicine was a science or an art. In

the materialist philosophy of the rapidly expanding United States many

doctors regarded their practice primarily as a lucrative business.

14. Hume, ,lMedicine and War," in The Military Surgeon, CHI (Sept. 1948), p. 184.

15. Seeff 12, p. 6.

16. Ibid. p. 184. There was great variety in the calibre and training of American practitioners in the nineteenth century. Much of the medicine practiced

1 n in the United States to 1900.was provincial and mediocre. The great strides were being made in Europe where the clinical material for study was available in the hospitals of large cities. The scientific investiga­ tion of disease, which had begun in the Enlightenment, was publicly supported in England, France, and Germany where American doctors interested in investigation and research were obliged to go for such study. The United States was still a largely rural nation with few large cities and few large hospitals. Only in Boston, Philadelphia, . and New York were there Medical schools which merited the name and where critical ingest!gation was pursued by such men as Oliver

Wendell Holmes, ^ William Gerhard, ^ Samuel Gross, and ■

17. Shryock, The Development of Modern Medicine, pp. 183- 186.

18. Major, A History of Medicine, II, pp. 756-759. Hdmes's epochal essay on the Contagiousness of Puerperal Fever was published in 1843 . He was professor of anatomy and physiology at Harvard Medical School from 1847 to 1882.

19. Ibid, p. 759. Gerhard was assistant professor of medicine at the University of Pennsylvania. A contemporary of Holmes, he pub­ lished On the Typhus Fever and On the Diagnosis of Diseases of the C h e st.

20. Ibid, pp. 762-764. Known as the greatest American surgeon of his time. Gross was professor pf pathology and anatomy at Cincinnati Medical College and professor of surgery at Jefferson. His published works on anatomy, pathology and surgery were widely used in England and the United States, 1805-1884. 32

Alfred Stille. ^ The few American names which appear in the medical history of this period reveal how small was the group ambitious enough to abandon traditional theory and search for the true nature and cause of disease through use of the natural sciences.

The public was equally responsible for the American medical lag of the nineteenth century. Opposition to dissection prevented most states from legalizing this form of research until after the Civil War, the one exception being Massachusetts where it was legalized in 1831. 22

The antivivisectionists likewise opposed experimentation in physiology.

Individual physicians tested the effectivness of therapeutics in a trial and error method generally not known to the patient. The public's fear of hospitals was partly based on the belief that in them patients would be "experimented on," a belief not wholly dead to this day. Respect for the fashionable practitioner, usually the conservative type who clung to the old nostrums and panaceas, was far greater than for the man inter­ ested in investigative work. It was thought.he neglected his practice and lacked concern for his patients' welfare. Shryock believes that in

21. Ibid, p. 770. Stille, who.was an active member of the U.S. Sanitary Commission, was professor of medicine at the University of Pennsylvania after the war. He was an early president of the American Medical Association and wrote works on general pathology, cerebrospinal meningitis, and cholera.

22. Shrvock. The Development of Modern Medicine, p. 39. its commercial-mindedness the American people valued science only

0.0 when they could see its usefulness .

It is true that the initial work of the modern school, if I may call it that, had led to the abandonment of many of the old theories and practices. In discarding the old remedies it had almost reached a state of therapeutic nihilism. Oliver Wendel Holmes spoke for this school when he wrote that the largest number of diseases a physician was called upon to treat would get well anyway and that while drugs now and then saved life or removed symptoms they were secondary to hygi­ enic influences.^ But the public liked panaceas. As scientific medicine abandoned bloodletting and condemned excessive purging as not only useless but dangerous all kinds of therapeutic schools of thought be­ came popular—mesmerism, homeopathy, the use of patent medicines.

A cult called the Grahamites opposed all mineral drugs and advocated only cereal and vegetable products. The Thompsonians claimed a mys­ terious power for an extract of the wild hellebore which would cure all 25 fevers. Shortly before 1850 Christian Science was born. -

23. Ibid, p. 183.

24. Oliver Wendell Holmes, The Writings of .. . (Revised ed., 13 vols., Cambridge, 1891), p. 233.

25 . M. G. Seelig, Medicine; An Historical Outline (Baltimore, 1925), pp. 157-160. The provincial school of medical practitioners encompassed two groups. The older doctors,. trained early in the century, found it easier and more acceptable to continue the. tradition of nosologies based on symptoms only. In their largely rural practice it was impossible to do post-mortem pathological examinations and relate the findings to the symptoms observed at the bedside. Therefore, the notion that the great variety of symptoms they observed were merely various manifestations of three or four basic diseases lasted for many years although French pathologists had demonstrated early in the century that definite symp­ tom complexes were due to pathological changes in specific tissues.

The whole attitude toward fevers is an example of this notion. In the

1770's Benjamin Rush had fathered the dogma that there was one dis­ ease—fever—with various manifestations, this fever being caused by a hypertension of the whole circulatory s y s t e m . ^ 6 a, modification of this dogma lingered through the nineteenth century as can be seen in the disease classification table of the Civil War army which listed as

"diseases," simple continuous fevers, common intermittent fever's, remittent fevers, and eruptive fevers.

The other group in the provincial school was composed of the graduates of the small private medical colleges which sprang up in the

United States as the population rapidly expanded over a wide area.

26. Shryock, The Development of Modern Medicine, pp. 29- 30. 35

Limited in equipment and faculty, by 1850 such schools were granting medical degrees to men who had attended lectures for one winter. '27

Some augmented the course of lectures by "reading medicine" under some established physician, accompanying him on his rounds, and taking care of his night calls.

It is obvious that such training produced doctors with little or no knowledge of pathology or rational treatment to say nothing of pre­ vention. While the modern school of the profession tried to improve the standards of.training and practice through state medical societies and through the American Medical Association which was organized in 1847 their efforts were largely fruitless. Evidence of the generally low level which American medicine had reached by 1850 is seen in the abandon­ ment by the states of restrictions against.irregular practices. The medi­ cal licensing laws up to 1830 were credible, but with the increase in health cults and quackery ten states had repealed their licensing restric- 28 tions by 1845 and only three made any pretense of enforcing them.

Only in New York, M assachusetts, and Pennsylvania did the influence of the established medical schools maintain a reasonable level of com­ petence in the profession. At the same time the public supported the health cults, its respect for the poorly trained doctor decreased.

27. Ibid, p. 258.

28. Ibid, p. 221. 36

Public confidence in professional medicine reached a very low ebb.

Despite this generally gloomy picture contributions to medical knowledge were made. Certain symptom complexes had been related to tissue and organ pathology and identified as disease entities—measles, dysentery, syphilis, gout, pulmonary tuberculosis, and rickets. Others are familiar today through the names of the men who described them—; .

Bright, Addison, Hodgkin, Parkinson, Graves—all Englishmen. In

Vienna, Rokitansky recognized that fever was not a disease but a symp­ tom . Independently, Holmes in Boston in 1843 and Semelweiss in

Vienna in 1861 published their conclusions on the contagiousness of puerperal fever. In 1837 the American army surgeon, William Beaumont, studied the physiology of gastric digestion in the stomach of Alexis

Martin. Jenner1 s method of vaccination against smallpox was introduced 30 into the United States by another army surgeon Banjamin Waterhouse.

In 1837 Gerhardt in Pennsylvania differentiated typhoid from typhus al­ though the distinction was not widely understood and during the Civil

War the introduction of the term typho-malaria further confused the clinical picture. Gross, also at Philadelphia, wrote a famous textbook

29. Seelig, Medicine, an Historical Outline, p. 175.

30. Hume, "Medicine and W ar," in The Military Surgeon, CII1 (Sept. 1948), p. 184. on pathology. A classic of geographic pathology. The Diseases of the

M ississippi Valley, was produced by another American, Daniel Drake,

in 1850.

Various diagnostic aids were developed in Europe although they

were slowly adopted in the United States. The use of percussion was

demonstrated as early as 1808. Laennec invented a stethoscope before

1826 and wrote a treatise relating the signs determined by auscultation

Q -I and percussion to chest diseases. There are.no stethoscopes listed

in the army medical supply table of 1861, but many of the reports of

chest conditions in the Medical Surgical History of the Rebellion refer

to rales and the suppression of chest sounds which indicate that the

instrument was available. Pulse taking was generally practice in the .

United States by 1850 but the clinical thermometer, a practical model

of which was in use in European clinics, was a rarity„ Shryock claims

that not half a dozen were used in the largest Union army during the

. w a r .32 The supply table allowed one per regiment. Dr. Hugh Smith

believes that not more than fifty thermometers a year were imported by

the United States as late as 1867. They were bought in London at a cost

of $3.00.to $4.00 a piece.^ Hypodermic needles., the otoscope, and

31. Seelig, Medicine, an Historical Outline, pp. 171-172.

32. Shryock, The Development of Modern Medicine, p. 23.

.33. Hugh H. Smith, "Notes on the History of Clinical Ther­ mometry, " in Arizona Medicine, XIV (Sept. 1957), p. 574 ophthalmoscope had been introduced before 1850 but they likewise do not appear in the supply table „

Some valuable drugs had been discovered. The use of digitalis and cinchona had long been known „ In the first half of the century chem­ ists discovered crystalline morphine and an Irish physician introduced the practice of giving it under the- skin. Strychnine, quinine, epsom salts likewise had come into use. Emetine had been found to be a specif- 0 4 ic in the treatment of dysentery and potassium iodide in syphilis 6

Surgeons who had studied in France during the Napoleonic ■ regime had been impressed by the work of Baron.Larrey, chief medical officer of the French army.. Larrey introduced what was known as the

"flying ambulance," a corps which picked up the wounded during a battle. Before his time the wounded had been left on the field until com­ bat had ended.^ In the light of the localized pathology demonstrated in

France / American surgeons devised procedures for the removal of dis­ eased parts, such as the appendectomy, and made improvements in the ligation of blood vessels, disarticulation of the. hip joint> and amputa­ tion methods. ^ In the 1840's several Americans showed that surgical anesthesia could be induced by nitrous oxide and ether. Not long after chloroform also came into use. The relief of suffering brought about by

34. Shryock, The Development of Modern Medicine,pp. 161-169.

35. Major, A History of Medicine,- II. p. 647 . anesthesia gave great impetus to the practice of surgery. In the pre-

Listerian era this impetus was of mixed value < How many patients died from, the infection that inevitably "followed the knife" will never be known but in the Civil War the general use of anesthesia undoubtedly promoted the performance of many more surgical procedures, especially amputations, that if it had not been available.

The nineteenth century also saw a resurgence of scientific investigation into the transmission of disease. Europe had taken the lead in professional and lay efforts to control the epidemics,which peri­ odically swept her crowded urban centers. The practical fact of conta­ gion in regard to certain diseases had been recognized since antiquity.

Primitive procedures of isolation and quarantine were employed not only against plague but also against measles, diphtheria, and smallpox.

However the: idea of animate organisms played no part in the measures taken, the "contagion" being thought of as a chemical miasm emanating from the infected individual. In 1831 when Asiatic cholera became pan­ demic it was observed that unsanitary conditions were connected with the spread of the disease although how was not clear. Quarantine and the clean-up of filth were both advocated, but while quarantine proved . a failure> sanitation seemed to help. In both cholera and typhoid it was observed that transmission was not related to person-to-person contact as it was in measles and smallpox. Hence arose the "filth theory," based on the assumption that decay or other organic decomposition generated a miasm which caused the disease. Until well after the Civil

War it was taught that the feces of cholera and typhoid cases only be­ came dangerous when their decomposition in the soil released the deadly miasms. However, there was enough truth in the filth theory so.-that in areas that were cleaned up the incidence of the related diseases was markedly reduced .

The filth theory produced an interest in public.hygiene and sanitation. Coupled with a growing appreciation of the effects of dis­ ease on society and on national strength, public-spirited citizens sought ways to ameliorate disease producing conditions . In Germany the government took action instituting the "medical police." In England and the United States private individual and cooperative group's made certain piecemeal accomplishments , but there was little corporate re­ sponsibility taken. Following the British example "sanitary associations" were formed in many American'cities between 1840 and 1860. Including both lay and medical members they sought to arouse public awareness of the dangers of an unsanitary environment, to popularize the findings of their investigations, to stimulate direct action in the construction of model housing, public baths, water and sewage systems, and to encour­ age the formation of local boards of health and of a national health council.

The move to collect health statistics had grown ever since

LaPlace, in 1786, had introduced the calculus of probabilities. A comprehensive survey of health conditions in England had been made in

1842. The newly formed American Medical Association failed to persuade the United States government to organize such a survey but several of the larger cities were surveyed by the Association. Their death rate was found to be higher than in the cities of England. The state of Massa­ chusetts was surveyed under the leadership of Lemuel Shattuck, a schoolteacher who had become interested in vital statistics. The cor­ relation between the incidence of fevers and filth and overcrowding was so convincing that the state instituted regular statistical health reports.

Until 1840 the census of the United States gave no cause of death. In

1843 Massachusetts required this information and between 1850 and

1860 eight more states followed her lead. However there was opposition in other areas, explained by Shryock as due to the extreme individualism and real ignorance of their democratic assemblies. The Georgia legisla­ ture, for example, opposed reporting the cause of death as "a trick of the doctors. 1

The private sanitary associations of the United States had a high moral purpose. As a part of the great philanthropic movement of the thirties and forties they attracted the same members who were active in other areas of reform—?prisons, insane asylums, foundling homes,

37. George Rosen, A.History of Public Health, (New York, 1958), passim; G.E. A. Winslow, Man and Epidemics (Princeton, 1952), pp. 8-16; Shryock, The Development of Modern Medicine, pp. 212-240. and hospitals. In these associations originated the idea that cleanliness

was next to godliness. The emphasis on personal hygiene and environ­

mental improvement especially appealed to women„ Between 1857 and

1860 local medical societies and sanitary associations met in a series

of conventions. The first, at Philadelphia, considered the subjects of

sanitation and quarantine. The next year at Baltimore they met as The

Great American Congress for Hygiene Reform. Following the Boston

meeting in 1860 they were about to resolve themselves into the first 38 American Public Health Association when the Civil War intervened.

While organization of this association had to be deferred, in the sum­

mer of 1861 a joint committee of delegates from sanitary associations

and the early soldiers' aid societies secured authorization from the

government to organize a Commission of Inquiry and Advice, in respect on of the Sanitary Interests of the United States Forces. The Sanitary

Commission, as it came to be known, made a tremendous contribution

to improving the health of the armies and providing care to the sick and

wounded throughout the war.

Despite the advances discussed above, the sad fact remains

that there were few in American medicine, curative or preventive, who

were independent enough to combat authoritarianism and place their

38. Shryock, The Development of Modern Medicine, pp. 235- 236. 39. The Sanitary Commission of the United States Army. A Succinct Narrative of Its Works and Purposes (New York, 1864), pp. 6-7. 43 trust in experience. As Dr. Hugh Smith has cogently stated "The true rate of advance in medicine is, ... , not to be measured by the work of

single men, but by the practical capacity of the masses. . .. There is a certain sadness in these stories of the failure of long neglected inven­ tions or discoveries to make on their time any permanent impression of their real usefulness.

40. Smith, "Notes on the History of Clinical Thermometry,11 in Arizona Medicine. XIV (Sept. 1957) , p. 570. THE NATION'S CONCERN WITH THE ARMY'S HEALTH

By August of 1861 the new two and three year levies were assembled in camps across the northern states to the M ississippi. In the hot summer wedther sickness broke out and spread. Camp sites were often located in lowy damp areas where water was accessible. The troops were ignorant of the police measures necessary to maintain health in large groups of men living in close quarters and resentful of the work in­ volved in camp housekeeping, work which the women of families per­ formed in private life. Many regimental medical officers were profes­ sionally incompetent and heedless of their responsibilities in supervis­ ing the camp environment. Facilities for care of the sick were improvised and crude. In the Atlantic and Central Regions, where the greatest num­ ber of the Army was massed, diarrhea, dysentery, and malaria produced in that month the highest disease rate of the war, 364 sick per 1000 tro o p s. ^

In the Army of the Potomac, encamped on the mosquito-ridden lowlands of the Potomac Basin, thirty-three percent were sick, chiefly

o ' ' from malaria. Surgeon Charles Tripler> who arrived as Medical Director

1. Woodward et al (eds.), The Medical and Surgical History .. . .Rebellion, Medical, III, p. 20. ■

2. Tripler, "Report on Operations" in Woodward et al feds.), The Medical and Surgical History.. .Rebellion, Medical, I, Appendix,p.51. to General George B. McClellen, found medical conditions in the city of

Washington in a state of incredible confusion. While general hospitals had been improvised in hotels, halls, churches and other unsuitable buildings there was no system for admissions or discharges. Sick sol­ diers from the camps wandered the streets seeking care; others who had left the hospitals, sought a meal, the location of their regiments, and some means of transportation to get back to camp. 3 Surgeon Tfipler had no information as to the number of regiments on the scene and whether or not they had medical officers. His first act was to secure an.;i order from General McClellan directing all regimental medical officers to re­ port to him that he might determine the priority of needs in organizing a medical program.

The state of affairs revealed was far from encouraging. First of the problems was the incompetence of many doctors. Despite General

Order 25 many regimental surgeons had not been passed by state medi­ cal examining boards. Some colonels of independent regiments had rejected the surgeon legally appointed and instead brought along an old friend. Some medical officers had not yet joined their regiments . That

Surgeon Tripler was too harassed to exercise much tact is shown in the letter he sent to the Surgeon General of Pennsylvania concerning one absentee. "The surgeons of regiments in the field are intended for

3. Tripler, "Report" in Official Records .. . Armies, Series I, V, p . 77. , 46 service not ornament. The government cannot await the convenience of

Dr. Harlan Tripler wrote. To weed out the incompetents and to select men who were qualified to serve as brigade surgeons, Tripler convened a medical examining board. For many years the qualifications of doctors appointed to the regular army had been passed on by such boards and it appears that the standards were high for that day The number of doctors recommended for discharge by this board is not given in his report but 107 were found qualified to take over brigades. Since the congressional act authorizing brigade surgeons had said nothing as to their duties, Tripler decided to use them as a training corps for "the new regimental doctors, and drew up orders defining such a program.

Director Tripler next discovered that many of the volunteer country doctors were having great difficulty in adapting their customary C treatment to' the army drug supply table. He attempted to provide them with the medications they were accustomed to using but the medical purveyor during the regime of Surgeon General Finley would provide no item not listed on the supply table, and despite Tripler®s efforts the non-regulation requisitions were countermanded by the Surgeon General personally.

4. Brown, The Medical Department of the United States Army from 1775 to 1873, p. 218.

5. Revised Regulations for the Army of the United States, 1861 (Philadelphia, 1861), pp. 304-306. 42

On examination, the army medical supply table 1861 would seem to have provided a choice of drugs that would have satisfied any . of the numerous isms into which medicine was then divided. There were mineral drugs and vegetable drugs. But as a true pharmacopeia it did not offer the compounded patent medicines popular at the time nor the vege­ table and cereal mixtures promoted by such groups as the Thompsonians and the Grahamites. One interesting item was Tincture of Veratrim Viri- dis, made from the bulb and roots of the swamp hellebore, which the

Thompsonian eclectics had introduced about the middle of the century in opposition to the dangerously free use of calomel, bichloride of mer­ cury. Believing it to have a mysterious power to relieve local congestion, eclectics used it for all kinds of inflammatory diseases with high fevers

—pneumonia, peritonitis, and typhoid—not recognizing that the desired response of sweating was due to a dangerous lowering of the blood pres­ sure . G Whether the Board which approved the Army drug issue regarded

Tincture of Veratrim as an experimental drug is not known but it is per­ haps significant that the allowance was eight ounces per regiment for three months while that of calomel was two pounds.

The seventy-seven items in the 1861 drug table of course in­ cluded the substances which doctors of that day needed in compounding their own pills and syrups—alcohol, wax, sugar, and flavorings. There

6. Horatio C. Wood, Arthur Osol et al (eds.), The Dispensa­ tory of the United States (23rd ed. , Philadelphia, 1943), p. 1219. 48 were seven different purgatives and cathartics, including, besides the notorious calomel, others equally dangerous such as the drastic Extract of Colocynthidis. 7 Castor oil must have been popular for twelve quarts per regiment were allowed: also, two pounds of senna and sixteen ounces of the Blue Pill, another mercury cathartic. Other drugs for gastrointestinal disorders were ammonium bicarbonate, extract of rhu­ barb, oil of peppermint, turpentine, and capsicum, a variety of Mexican hot pepper.

Numerous drugs had multiple uses. Acetic acid was used as a wash for skin ailments and internally to control gastric, hemorrhage.

Tartar emetic was given to those with sick headaches and upset stomachs and also used for chest conditions because of its expectorant action.

Eight quarts of oil of turpentine were allowed, for use as an expectorant, a diuretic, a carminative, and in treating hemoptysis and worms. There were various liniments for rheumatism, neuralgia, and lumbago, such as croton oil and lead acetate. Twelve pounds of black mustard were al­ lowed for the making of poultices . Both quinine, and potassium acetate were issued for malaria, copaiba for gonorrhea and inflammatory skin conditions, potassium, iodide for syphilis, creosote for tuberculosis.

Tincture of iron chloride was believed to have curative properties

7. Made from the dried pulp of the wild cucumber, this dras­ tic purgative produced inflammation and hemorrhage of the bowel in large doses. While 1/2 gr. of the extract was the recommended dose, deaths were reported from 1 l/2 tsps. of the powder. See Ibid, pp. 34l f 433. . against diphtheria and erysipelas „ There were styptic acids and pastes for use in external hemorrhage and skin ulcers. Curiously enough, al­ though the drug was well known, there was no digitalis listed in the drug table. The only cardiac stimulant provided was ammonia. The whiskey ration was 24 bottles every three months per regiment. This cursory sur­ vey reveals the almost complete lack of specific medications as we know them today. One preparation was apparently regarded as about as useful as another. The Sixteenth Maine Volunteers learned that its doc­ tor gave prescriptions numbered six, nine, and eleven in turn regardless of the complaint, and the wily soldier counted off the line at sick call to see that he was in place for Vinum and not for Blue Pill or Quinine.®

Returning to Surgeon Tripler—following his immediate steps to

get his medical staff in action, he turned his attention to the problems

of disease, first of all malaria. Throughout the war years the disease rate continued to peak in the late summer as:the armies were progressive­ ly exposed to the malarious regions of Virginia, North Carolina, and the

Gulf.® While fever and ague and swarms of mosquitoes made camp life miserable the relationship of the two discomforts was not realized. The

symptoms were believed due to "miasmatic influences" which rose from

8. Abher R. Small, The Road to Richmond (Berkley, 1939), p. 188. The memoirs of a private who became a major in the Sixteenth' Maine Volunteers.

9 ^ Woodward et al (eds.), The Medical and Surgical History .. .Rebellion, Medical, III, pp. 20-24. swamps and low country. There were differences of opinion over locating

. camps on low ground or high ground which today seem absurd. Advocates

of low ground claimed that the winds carrying the miasms would blow

oyer the camps, whereas were they to be located on hillsides the full

force of the dangerous air current would be received. Ignoring the dis­

advantage of the labor involved in locating a camp at a distance from

its water supply. Surgeon Tripler recommended that camps be located

on the leeward slopes of hills „ 10 The army would learn in time and

through experience the type of location that would be most healthful.

Groping for other antidotes to the miasmatic influence Tripler had

reveille advanced to sunrise and hot coffee served to the men at that

time. He also instituted a daily prophylactic dose of quinine and whis­

key despite his own doubt as to its efficacy and his knowledge of the

prejudice he would have to overcome until the measure proved effec­

tive . A century later in the South Pacific an American army would

exhibit a similar prejudice against prophylactic doses of atabrine.

Other diseases affected the armies . Whenever new troops

were brought into camps measles, against which no prevention was

known, became epidemic. Sporadic cases of smallpox occurred among

troops coming from areas where that disease was active. But because

10. Tripler, "Report" in Official Records ... Armies, Series I, Vol. V, p . 81. 51 the order that all:troops be vaccinated was consistently enforced, no large number of troops was ever infected. A lad in a New York regiment wrote that he had been vaccinated so many times his arm looked as though a hen had pecked him .^ The other Complaint that ranked with fever and ague in reducing the number of effective troops was diarrhea or dysentery. It is impossible today to differentiate between them as the diagnosis at the time was made only on the basis of symptoms. Most cases showing "bloody flux" were called dysentery.

Whether due to the pressure to fill state quotas or to decep­ tions practiced by the men themselves the number of recruits accepted with physical disabilities was a distinct problem.. Surgeon Tripl.er re- . ported that the Sixty-first New York regiment contained men sixty to seventy years of age with hernias, ulcers, and epilepsy, and the Fifth

New York Cavalry had eighty men with hernias and epilepsy. 13 Surgeon

Cuyler at Fortress Monroe reported the discharge of forty men with her­ nias. Surgeon Goodman, assigned to the Twenty-eighth Pennsylvania discovered that not a man in the regiment had been examined. In the

Twenty-seventh Ohio over one hundred had to be discharged as physi­ cally unfit. The First Brigade of New Jersey contained men disabled with

12. Lawrence Van Alstyne > Diary of an Enlisted Man (New Haven, 1910), p. 84. .

13. Triplet, "Report" in Official Records ... Armies, Series I, Vol. V, p. 82. 52

fistulas, hernias, and blindness. ^ In October; November, and Decem­

ber of 1861, 3,939 men were discharged from the Army of the Potomac for

disabilities. Of these 2,881 had the disability prior to enlistment. Sur­

geon Tripler estimated that these men cost the government $200 each.

Attention or lack of attention to physical fitness at the time of

induction was noticed by the soldiers themselves. Young Van Alstyne in

the One Hundred Twenty-eighth New York wrote that the men were exam­

ined like horses. Their teeth were carefully looked at, they were felt all

over for unsound ness, put through gymnastic performances, weighed,

measured, and their hair, eye color and complexion noted. Watching

the doctor examine replacements in Louisiana a year later he observed 17 . that they were not so particular. As a veteran soldier, gnawing his

government-issue hardtack:that was tough as wood, he understood why

his regimental surgeon had been so particular about the men's teeth. 18

Private Woodward of the Second Pennsylvania Reserves reported that

applicants to this outfit went through the most severe medical examina­

tion, every man being stripped and examined and all with the least

14. Woodward et al feds.), The Medical and Surgical History . . .Rebellion, Medical, III, p. 25.

15. Tripler, "Report" in Official Records ... Armies, Series I, Vol. V, p . 82.

. 16. Van Alstvne, Diary of ah Enlisted Man. p. 3.

17. Ibid, p. 209.

18. Ibid, pp. 160-161. 53 blemish or defect being rejected. ^ On the ether hand, Sergeant Small, recruiting for the Sixteenth Maine, said that despite orders some inva- lids and misfits were accepted. 20 Leter in the war he saw hospitalized sick who as their hair and. whisker dye faded were revealed as much too old for field service.F ifteen year old Elisha Stockwell was helped to lie about his age by the captain recruiting the Fourteenth Wisconsin. The officer estimated his height with a glance, and he was inducted. 22

Since few doctors of the period had stethoscopes or a machine to mea­ sure blood pressure, much internal pathology without overt symptoms such as heart diseases and chest conditions was overlooked. But the . burdening of the already makeshift army with obvious defectives is main­ ly explained by the prevalence of the fatuous notion that anyone who wanted to could play soldier.

Undoubtedly the most important factor in the high disease rate of 1861-1862 was the army's lack of knowledge of how to take care of itself in camp. Not even the medical ignorance of the times superseded that factor as is seen in the annual decline of the sick rate as the army

19. E„. M. Woodward. Our Campaigns (Philadelphia, 1865), p. 30. An account of the marches, bivouacs, battles, and incidents of camp life of the Second Pennsylvania Reserves by its adjutant.

20. Small, The Road to Richmond, p. 39.

21. Ibid, pp. 186-187.

22. Byron R. Abernathy (ed.), Private Elisha Stockwell Sees the Civil War (Norman, 1958), p. 6. was toughened by experience. The decline in the ratio of sick per thou- ^ q sand troops was:

August, 1861 364 July, 1862 279 August, 1863 256 August, 1864 265

The slight rise in the last year was due to increased exposure to malaria in Virginia and North Carolina and the induction of raw troops as the term of service of the first three-year men expired.

Health conditions in the camps of 1861 and the apparent inability of the military to correct the situation had been instrumental in the organ­ ization of the civilian corps, the United States Sanitary Commission, which served as an accredited co-worker of the War Department and the

Army Medical Bureau. One of its first activities had been to send Sani­ tary Inspectors into the field to investigate some two hundred practical questions relating to the hygienic conditions in the camps and to conduct a training program for men and officers on such matters as the art of pre­ paring army rations, the policing of tents and streets, drainage, the proper disposal of garbage and excreta. 24 George Worthington Adams,

23. Woodward et^al (eds.), The Medical and Surgical History ... Rebellion. Medical, III, pp. 23-24.

24. The Sanitary Commission of the United States Army .. . , pp. 16-19. in his excellent study, quotes the reports of various Sanitary Commis­ sion inspectors in describing conditions that prevailed in some camps. ^

\ Where water was difficult to obtain the men did not wash and their per­ sons and clothing were dirty. Garbage and refuse accumulated in tents and the company streets. Horse manure accumulated indefinitely. The men objected to using the army latrines which in those days were called

"sinks," a straddle trench into which fresh earth was supposed to be thrown daily but frequently was not. What with the stench and the fouled edges the men would refuse to use them despite orders and would relieve themselves anywhere they chose, not infrequently contaminating the watersheds of their drinking supply. A Commission report on the army as a whole stated that twenty percent of the units had poor latrine arrange­ ments, thirty-two percent had ineffective regulations for their use and in thirty-five percent the men were permitted to urinate in the company streets at night.

The relation of sanitation to the disease rate was understood by professional army men who were acquainted with the comparative statistics of the British and French in the Crimea and with the reforms

25 . Georae Worthington Adams , Doctors in Blue (New York, 1952), pp. 18-23. 56.

■ in m ilitary hygiene that had been made in the British Army . ^ y . S . Army

regulations.included a good deal about hygiene and cleanliness, as

cleanliness was understood in that day. Company commanders were

directed to pay the "utmost attention" to the cleanliness of the men,

their persons, clothing, quarters, and tents. Dirty clothes were to be

kept in an appropriate part of the knapsack, not under the beds. Cooking

utensils and table equipment were to be cleaned and kept in closets i On

Saturdays bunks and bedding were to be overhauled, barracks1 floors

"dry-rubbed," and tables and benches scoured. Where there were con­

veniences for bathing the men were to take "one or two baths a week,"

wash their feet twice a week, and wash face and hands dally. The non­

commissioned officers were to see that these regulations were carried

out. ^

These regulations were designed for troops at permanent posts

and, as any veteran will realize, there were certain practical difficul­

ties to carrying them out in the field. Civil War army camps depended

on natural water supplies—ponds, streams, and rivers—in which to

bathe and from which to drink. In the soldiers' accounts of the w ar.

2 6. Ashburn > A History of the Medical Department of the United States Army, p. 72. In the first year of the Crimean War the British losses had been two and a half greater than those of the French. After the reforms in military hygiene initiated by Florence Nightingale the British losses became one-thirteenth those of the French.

27. Revised Army Regulations, 1861, Article XIII, pp. 21-23. ST

2 Q there is occasionally found a reference to digging a well, but the usual accounts of the availability or absence of water speak of the natural sources. Company field equipment included sheet iron pails which were used to cook in, but I have never found a reference to bathing or washing clothes in anything but a stream or river. Awash basin, if one were used, was improvised from any kind of available container, as was the coffee pot. The helmet, in later wars valued as bucket as much as protector, was not yet part of army gear.

The army regulations about bathing were considerably in ad­ vance of the habits of most rural Americans in the 1860's. In an article

on on "The Human Body and Its Management" Oliver Wendell Holmes discusses bathing as a convenience of city life not equally available in the country. With the invention of the iron pipe and the steam pump cities had built municipal water systems and water was being piped into the homes of the affluent, but families in small towns and on farms de­ pended on water hand-drawn from w ells. But to city and country boy alike the problem of keeping clean in an army camp was a new responsi­ bility, the one lacking the conveniences of city plumbing, the other his mother's insistence. To many men personal cleanliness had never been the custom and continued to be ignored.

28. Oscar Osburn Winther (ed.), With Sherman to the Sea (Baton Rouge, 19 43), p . 48 . The Civil War letters and diaries of Theodore U pson. 29.. Van Alstvne, Diary of an Enlisted Man, -p. 30. 30. Holmes, The Writings of . . . , VIII, pp. 189-235. 58

Army regulations in regard to the arrangement of camps care­ fully designated the placement of tents, by paces, of corrals, black­ smith and stables. But except for stating where the sinks should be dug,

"the last line before the prisoners" for the men and at the opposite end of the rectangle for officers, the only Other direction was that the dirt dug out should "occasionally" be thrown back. There was no direction whatsoever as to the choice of a pure water supply.^ In the years just before the war there had been rapid progress in the installation of water systems in major cities over the country, but sewage disposal facilities had lagged behind. That most drinking water supplies were badly con­ taminated was not recognized. The common concepts of pollution held that grossly polluted water was unhealthy, as was a still pond with no • outlet, but that running water was safe. There was a vague concept of the value of sand and gravel filtration but before bacteria became known the true nature of pollution was given many explanations. •

By December of 1861 the Sanitary Commission had fourteen qualified physicians in the field as Sanitary Inspectors. Their reports pointed out the improvement which had resulted from merely pointing out to new officers their duty to enforce sanitary regulations, from the example that a good regiment set to one less well regulated, and from the pamphlets on preserving health which had been distributed. 32 The

31. Revised Army Regulations. 1861, Article XXXV, p. 74.

32. United States Sanitary Commission, pp. 19-20. Commission also expressed in no uncertain terms its conviction that the first sanitary law in camp and among soldiers was military discipline. A series of resolutions published in the proceedings of the Commission on

July 29 , 1861 included such statements as

... it is our profound conviction that any special relaxation of military discipline in favor of volunteer troops, based either upon their supposed unwillingness or inability to endure, it, or upon the alleged expectation of the public, is a fallacious pol­ icy, and fraught with peril to the lives of the men and the success of the national cause; .... the health and comfort and . efficiency of the men is mainly dependent.on the uninterrupted presence, the personal watchfulness, and the rigid authority of the regimental and company officers; and that all the great defects, whether in the commissariat or in the police of camps, are radically due to the absence of officers from their posts and to the laxity of disciplines . . . —a laxity which would never be tolerated among regulars, and which, while tolerated among our soldiers, will make a mob of armed men rather than an army. . . .that the. soldiers themselves, in their painful ex­ perience of want of leaders and protectors would heartily wel­ come a rigid discipline exerted over their officers and them- selves;33

The organization of the volunteer.army was not conducive to . . / ' discipline. It was the custom to recruit an entire company from one com­ munity. Men who had known each Other all their lives, frequently on a first name basis, found it equally difficult to give or take orders,. espe­ cially in regards to personal habits. The first commanders of the new units were rarely appointed on the basis of ability. They could be popular fellows who had independently recruited a company, or they could be elected by the company after the regiment was formed. Regimental BO commanders were appointed by state governors on the basis of political preferment or personal friendship, or they could be elected by the com­ pany officers. Some regiments were commanded by men with previous military experience or by officers of the regular army who had joined the volunteers from their state for the duration. But the majority of vol­ unteer officers knew as little about running a clean camp as they did about giving marching orders. Furthermore, they not infrequently re­ garded such mundane duties as inspecting cooking pots and latrines as considerably beneath their new dignity as officers.

In the Sixteenth Maine the captains and lieutenants elected . the field officers to the dismay of the men who had. preferred another candidate for colonel "one whom they supposed would give them a good 04 time with a minimum of discipline." Working on the defences of Wash­ ington they were a miserable bunch, lacking Confidence in their officers and refusing to take for granted the proficiencies of their superiors. A change in command did not improve their circumstances . The regimental equipment was lost on the way to Antietam. With no tents, no overcoats, and only the clothes they wore the regiment camped outside Sharpsburg.

They sheltered themselves from the cold fall nights in huts of fence rails , cornstalks, and boughs. Wrapped in their blankets in place of the lost overcoats they were derisively called the "Blanket Brigade" by

34. Small, The Road to Richmond, p. 9. other regiments. As they became more despondent, wrote Small, they

sank into unclean ways, filthy habits, and sickness. A college graduate

became so. filthy that his comrades forcibly washed him in a brook with a

corn broom. The medical officers did their best but there was no proper housing for the sick and few medicines. Only half the regiment was able to muster for a review by President Lincoln and General Reynolds / their corps commander. A new brigade commander obtained a partial supply of

shoes and tents but the regiment then ran out of food. Marching some­ how to Rappahannock Station they arrived with only 200 able for duty.

An investigation by the divisional medical director must have improved conditions, for while Small, as usual, had nothing good to say about this officer, from then on his account has little reference to sickness and privation.

On the other hand the Second Pennsylvania, the same whose men had gone through a rigorous physical examination, described their

colonel as assiduous in attention to the welfare of the men, examining their rations, visiting quarters and hospital daily, and "tempering the discipline necessary to the formation of a soldier with fatherly care.” 35

In their first recruit camp, details daily raked up the straw, rubbish,

and old bones which were carted away in wagons. The whole regiment

bathed weekly in a nearby river. A hospital was built with a laboratory,

35. Woodward, Our Campaigns, p. 69. 62

kitchen, washing and dining room. On reaching the Potomac they too were

without rations but a fund was raised to purchase them. In camp near

Hyattstown, on high wooded ground, they dug sinks and cut paths. When

some 600 malcontents stirred up trouble the colonel summarily sent them

home and combined the below strength companies. By the time they

marched into Virginia they had learned to travel with two axes, a hatchet,

five mess pans, and two kettles per twenty men and to sleep six men to

a tent. Their winter quarters were snug and warmed by sheet iron stoves.

The men on picket were sheltered by structures of boughs and relieved

every hour on cold nights. The only appreciable amount of sickness in

the Second Pennsylvania occurred in recruit camp and was blamed on the

high limestone content of the water to which they were not accustomed.

The demoralization of a regiment which could be caused by

suspicion of all officialdom, by insufficient food and clothing, by appar­

ent lack of leadership, and by sickness has no better example than the

Sixteenth Maine. While the men undoubtedly brought much of their hard­

ship on themselves, by comparison with other regiments little initiative

or concern for the welfare of the troops was demonstrated by their com­

m anders.

Surgeon Tripler was faced with the problems of many regiments

in as poor condition as the Sixteenth Maine . To his brigade surgeons he.

delegated the task of educating medical and line officers alike in their

. responsibilities for the care of their citizen troops. As winter approached other problems demanded his attention „ Malaria declined but respiratory

and gastrointestinal diseases took its place. The Quartermaster's De­

partment was unable to supply blankets and clothing for 60,000 men at

once. There was the problem of sufficient tents and of means of warm­

ing them. The heavy labor on fortifications, the exposure when on picket duty, and the incessant drill took their toll of the many unfit who had

been inducted. Three hospital tents for thirty men each was the standard

allotment per regiment but there were not that many available and as the

units moved into Virginia they were frequently used for other purposes .

Believing as he did that the sick should be kept with their commands yet hampered by insufficient regimental equipment Tripler organized bri­

gade hospitals where equipment could be centralized. There was no pro­ vision for such by law and hence no authorized staff, but by setting them up as an aggregation of regimental hospitals, he was able to use regimental personnel.,

In planning for general hospitals in the Washington area, where

the sick could be left when the army went on the offensive in the spring,

Tripler recognized that those improvised in public buildings were quite

inadequate. A Sanitary Commission document described such a hospital, 07 set up in an old seminary in Alexandria. It was an irregular structure

36. Tripler, "Report" in Official Records ... Armies, Series I, Vol. V, p. 90.

37. Quoted in Bell Irvin Wiley, The Life of Billy Yank (Indian- . apolis, 1951), p. 141. . 64 with abrupt and narrow halls and stairways. Many of the wards were small and difficult of access. The immediate precincts were damp. The woodwork of its piazzas and sheds was decaying. Ventilation was very defective and an unhealthy odor pervaded the building from the filth which troops recently quartered there had left in upper rooms and in the cellars. There were no indoor waterclosets or baths, and no dead house. .

General Rosecrans had had erected for the Army of West.Vir­ ginia , on the recommendation of William Hammond and Jonathan Letter- man, three of the pavilion type hospitals that had been used by the 30 British in the Crimea. These proved so satisfactory that Tripler recom­ mended that the same type be erected in the Washington area. On con­ sultation with the Quartermaster General it was determined that these one story pavilions could be erected at a cost of $25.00 a bed.^ In

February when a brigade surgeon reported the " scandalous" condition of

General Lander's division, where 1200 sick were abandoned in towns over a 40 mile area, several of these pavilions were quickly erected near the division headquarters. With the help of eight Sisters of Charity who were secured as nurses, in two weeks the patients had been col­ lected, classified and treated, a commissary Fund established, and stores and ambulances secured. 40

38. Ashburn, A History of the Medical Department of the United States Army, p. 79. 39. Tripler, "Report" in Official Records .. . Armies, Series I, Vol. V, Pi 90. 40. Ibid, p. 86 . 65.

Triplet further recommended that these-buildings be arranged as

"hospital towns," located on well-drained sites, and with their own wells. He proposed that each "town" be organized under a surgeon super­ intendent with an assistant commisary of subsistence, an assistant quartermaster, and a guard of troops. ^ At "the time, however, the recommendations came to naught because of another architectural plan proposed by the Sanitary Commission, based on a French model. Con­ struction costs proved to be twice as high as the Tripler-Hammond model and only two buildings were erected for use by the time of the Peninsular campaign. However, not only was Tripler's basic plan adopted by the

Union Army before the war was over but. it is the basic plan which has been used by the military establishment to the present day.

The role of the Sanitary Commission in the Civil War was of tremendous significance and can never be deprecated. As a lobby group, it persuaded Congress to pass most of the measures for the better organ­ ization of the care of the sick and wounded, something which the military themselves could probably not have accomplished. It did much to cen­ tralize, and control civilian efforts in aid of the soldier. It provided medical supplies, hospital stores, hospital ships, sanitary inspectors, and doctors, especially in the first two years when government agencies struggled to revise inadequate systems. But in a war in which everyone

41. Ibid, pp. 104-105. 66

wanted to get into the act as he saw best, the Commission at times

appeared.to the military professional as just another amateur group which did more to obstruct than to promote the business at hand.

Surgeon Tripler welcomed the three sanitary inspectors which

the Commission furnished him. Their efforts augmented his overworked

brigade surgeons in the job of cleaning up the filthy camps and teach­

ing the men to take care of themselves in the field. As the faults re­

ported by the two groups were ordered to be corrected by the Adjutant

General the monthly sick rate for regiments dropped from 126 to 74.

This chain of command through the Adjutant General explains what otherwise would seem a querulous carping about rank in the medi­

cal reports and recommendations of the early war years. As long as the head of the medical department was only a colonel, the brigade sur­

geons and medical directors only majors, and other medical officers

captains and lieutenants, they were all outranked by the command with which they had to deal and hence could give them no orders. Where

relationships were good between regimental, brigade, division, or

corps commander and the assigned doctor the command was apt to take

medical advice. The reverse could also be the case. Such relationships

were, undoubtedly significant in the contrast of conditions seen in the

regiments and armies. This difference in rank affected the organization

of an ambulance corps, the control of hospitals, and the securing of

supplies. Although it took nearly four years to correct the situation. the final achievement of equality of rank by the medical department was one of the Civil War contributions to care for the sick and wounded.

By the spring of 1862 the health of the army was greatly im­ proved. Many of the unfit and chronically ill had been weeded out. The men had learned that soldiering consisted as much in covering sinks, burying garbage, and raking up trash as in cleaning a musket and mas­ tering drill tactics. They were not veterans yet, but they had learned how to build log shelters when they had no tents, to shelter themselves from the weather when on picket, to forage when rations did not.arrive, and, in general, to survive an incredibly confused and irrational system of logistics. The government was waking to the fact that the purpose of an army was to go to war, not to the hospital, and to its responsibility for providing the means to keep the men well. While neither the admini­ stration nor the war department were yet clear as to the meant to employ, the shift from apathy to concern for the soldier's health was a step for­ ward . BULLETS AND FEVER ALONG THE RIVERS

— The Tennessee —

With the coming of spring in 1862 the first serious campaigns of the war got under way. During the winter there had.been changes in the top echelon of the military organization. In January Edwin M. Stanton had replaced Simon Cameron as Secretary of War. A few months before

Winfield Scott had retired and General George B. McClelland had been appointed to the post of Commander-in-Chief. Despite Stanton's dedica­ tion to the Union cause and McClellan's youth, vigor, and organizational ability, the direction of over-all strategy continued to be weak and con­ fused. At that time the military was. organized in eleven geographic departments, each of which had from one to three armies . The commanders of these armies functioned almost independently, while in Washington the President, the Secretary of War , the General-in-Chief and the Con­ gressional Committee on the Conduct of the War"*- separately propounded their ideas of the strategy to be pursued. While McClellan trained and equipped the Army of the Potomac with a deliberation that finally drove

Lincoln personally to order the advance into Virginia in February, the

Army of the Ohio under General Don C arlos Buell, .the Army of the

1. The eight members of this formidable committee came from the radical wing of the Republican party and constantly agitated for vigorpus prosecution of the war.

68 Tennessee under General Ulysses S. Grant, and the Army of the Mis­ sissippi under General John,Pope went on the offensive against the

Confederate western defense line which stretched across Kentucky from

Columbus to Bowling Green.

The armies of the west were still seriously limited in supplies.

"Irregularities" in the quartermaster department at Cairo, the wild and uncultivated nature of the country, the few towns, and the great dis­ tances made logistics a problem, especially in the care of the sick and wounded. At the beginning of the war the main medical purveyor's depot was in New York City with subsidiary depots at New Orleans., San

Antonio, Gamp Floyd Utah, and Albuquerque. By 1862 other had been established at Washington, St. Louis, and Cairo and a medical officer, attached to each army as a field purveyor. The Western depots were chiefly distributing points as most purchases were made at the source of their manufacture in the cities of the eastern seaboard, mainly New.

York and Philadelphia. When heavy casualties occurred, medical stores at the depots were rapidly depleted and at times several weeks elapsed before stores could be replenished. Transportation of all army supplies was under the control of the quartermaster and medical supplies were mixed with munitions, forage, rations, and baggage. Time and again the wounded were in need while hospital stores sat on a railroad siding miles away or were buried under other equipment at a receiving depot. As: the Union forces gained control of the M ississippi River/ transporta­ tion by boat eased the supply problem in the west.

Grant's Army of the Tennessee won the first victories of the war and also suffered the largest number of casualties to that time in its ex­ pedition up the Tennessee River. The army was first moved by transport to Fort Henry which had surrendered to Admiral Foote of the Navy. With limited equipment the troops then marched overland to the siege of Fort

Donelson on the Cumberland while the transports went back around by water with most of the supplies.

Weather conditions were miserable. Surgeon Brinton reported that the Tennessee was in flood forty feet.over its normal level, an al­ most unprecedented height, and on the army's arrival before Donelson. on February 14 it was greeted by a sleet storm and freezing temperatures.

In preparation for the campaign two general hospitals had been estab­ lished, one at Mound City of 170,0 beds and another at Paducah. The many cases of typhoid and pneumonia that developed while the men waited at Fort Henry were sent back to these hospitals on the transports.

Those who became sick on the march across to Donelson were dependent on the one or two two-wheeled and four-wheeled ambulances allowed per regiment. The two-wheeled vehicles only carried three men and,be­ ing too lightly constructed, quickly broke down on the rough roads. The medical equipment allowed each regiment was a field knapsack, a medicine chest, a mess chest, two to three stretchers and twenty extra b lan k e ts. ^

At Fort Donelson, Surgeon H. S. Hewitt,^ Medical Director of the expedition,, organized the regimental medical officers under one sys­ tem. Each regiment was allowed one surgeon to go forward with it into action. The other surgeons were grouped in four field hospitals extem­ porized in log huts and stables around the perimeter of the fighting. The ambulances were collected in trains, one for each hospital, under the command of a non-commissioned officer whose duty it was to keep them constantly moving between field and hospital. During the three days of the engagement the field.hospital accommodations became insufficient and other shelters had to be improvised from the canvas covers of the quartermaster wagons.

On the forced march to Donelson the troops typically had dis­ carded their cumbersome equipment, such as blankets and overcoats and in the sleet storm which came up that night they suffered severely from exposure. Confederate sharpshodters made recovery of the wounded from

2. John Brinton, "Account of the Campaign of the Army of the Tennessee from February to June, 1862, Including the Capture of Forts Henry and Donelson and the Battles of Corinth and Shiloh,” in Wood­ ward et al (eds). The Medical and Surgical History ... Rebellion, Medical, I, Appendix, p. 27.

3. Surgeon Hewitt is probably better known as the officer to whom the doughty C. F. Smith said/ as his line wavered, " . . .my God, my friend , if you love me, go back and bring up another regiment of thos damned volunteers. You'll find them behind the bushes." the abatis in front of the fort very difficult and their suffering from the cold was extreme. In McClernand's division alone 144 cases of frost bite were reported. ^ Camp fires had at first been allowed in the hospital areas for warmth and to cook soup made from slaughtered bullocks, but at night the fires presented such a target that they had to be extinguished.

Primary surgery was done although there is no record of the actual num­ ber of cases. It was reported that there were no deaths from surgery . among the 1,735 wounded but that exposure to the excessive cold caused "typhoid pneumonia, " diarrhea, and dysentery which later

"materially thinned the ranks. It is of interest that the surgeons were on the lookout for tetanus and relieved that none appeared. ® An en­ lightened approach to surgery is evident in some reports of efforts to save the limb in cases of compound fracture rather than the traditional amputation.

4. H. P. Stearns, "Extract from a Narrative," in Woodward etal feds.). The Medical and Surgical History .. . Rebellion. Medical, I, Appendix, p. 34.

5. Brinton, "Account of the Campaign of the Army of the Tennessee from February to June, 1862, Including the Capture of Forts Henry and Donelson and the Battles of Corinth and Shiloh," in Wood­ ward etal feds .) , The Medical and Surgical History ... Rebellion, Medical, I, Appendix, p. 28.

6. While tetanus was clinically recognized, the spore of the causative bacillus, with an incubation period of five days to five weeks, was as yet unknown. In view of the extensive use of barns and stables for hospitals it is surprising that more cases were not reported later from the general hospitals. 73

Following the surrender of Fort Donelson evacuation of the sick

and wounded by water transport.was begun. During the two weeks the

army rested thousands were taken to hospitals as far away as Gincinnatti,

St. Louis, and Louisville. The river steamers which were used were not

equipped as hospitals. The men were simply laid on the bare decks and

in the staterooms and facilities for providing nourishment or dressing

wounds were almost non-existent.7 A plan for a river fleet of hospital

ships had been presented to the military authorities by Dr. Aigner of the O Sanitary Commission shortly after the battle of Belmont. Recognizing

the practicality of this plan General Grant had leased one vessel, the

City of Memphis, the Sanitary Commission had equipped it with hospital

supplies, and at both Fort Henry and Fort Donelson it was used as a

receiving ship where surgery was done and cases selected to be evacu­

ated on the steamers. In the obvious need for more such ships at Fort

Donelson Grant sent his medical director, John Brinton, back to St.

Louis to arrange for their procurement and equipment.

With the fall of Fort Donelson the Cumberland River was open

all the way to Nashville. By February 25, General Buell had established

his headquarters there, while Grant, his. sick and wounded evacuated

7. Woodward et al (eds.). The Medical and Surgical History . ... Rebellion, Surgical, III, p. 973.

8. The Sanitary Commission of the United States Army. A Succint Narrative of Its Works and Purposes, p. 79. and his army augmented by fresh troops to a strength of 30,000, loaded his transports and advanced 120 miles up the Tennessee to Savannah.

The boats were badly crowded, holding about a thousand men each, and for some reason on arrival the troops were held on board for several days. Overcrowding and exposure to night air were given as the reasons for another disastrous wave of sickness which then attacked the troops— an epidemic typhoid of the most severe form. Since the City of Memphis was still the only hospital ship at hand the town of Savannah became one vast hospital. Supplies were short and the overworked doctors began to fall sick themselves. The small dwellings in which the sick were housed were miserably ventilated and hard to police. It was observed that the sick placed in the few available tents recovered much more rapidly than those in houses, an observation which supported the medical belief that through-and-through ventilation was necessary to dispel the Q miasmatic influences. At Nashville Buell,1 s army was in better shape.

Although twelve percent of his strength was sick with the measles, facilities for their care were better. The captured Confederate stores included many tents and the buildings of an asylum and a school on a . in nearby hill provided more suitable hospital accommodations,

• 9. Stearns, "Extract from a Narrative," in Woodward et al feds.), The Medical and Surgical History .. . Rebellion, Medical, I, Appendix, p. 42. 10. John Murray, "Reports on the Battle at Mill Springs and the Hospitals at Nashville,” in Woodward et al feds.), The Medical and . Surgical History ... Rebellion, Medical, I, Appendix, p. 23. 75

The physical condition of the army which Grant brought into

Pittsburg .Landing was "unpromising in the extreme." 11 Malaria and chronic diarrhea were the cause of "a great lassitude" among the troops „

The doctors had finally decided that the diarrhea was caused by the great amount of decomposing animal matter on the mussel shoals of the

Tennessee river. Men could only be cured by sending them out of the area which at the time was impossible. The poor physical shape of the

Union forces was undoubtedly a factor in the Confederate success on the first day of the battle of Shiloh.

Probably in no battle of equal magnitude where the number of wounded was so great was the medical department so destitute as at

10 the battle of Shiloh. Grant had miscalculated in not preparing for an enemy offensive and no preparation for the care of possible wounded had been made. Requisitioned medical supplies had not yet arrived from

St. Louis because, the medical director reported, "the medical depart­ ment had not yet freed itself from the system of blind routine which, serving well enough the needs of a small army in times of peace, yet 1 o failed utterly to meet the necessities of gigantic war." The sick were

11. Brinton, "Account of the Campaign of the Army of the Tennessee from February to June, 1862, Including the Capture of Forts Henry and Donelsdn and the Battles of Corinth and Shiloh, in Woodward ^t al (eds.), The Medical and Surgical History ... Rebellion. Medical, I, Appendix, p. 29.' 12. Ibid, p. 32.

1,3. Ibid, p. 31. 76

in camp in tents, under the care of at least two women volunteersthe

famous Mary Ann Bickerdyke and Lucy Campbell Kaiser. Lucy Kaiser

recalled that when the musket balls began to whistle through the camp

a lieutenant told her of a ravine where she must try to move the sick

men. Those who could not walk they carried on poles, all but one delir-

ious old man who would neither walk nor be carried.14 By Sunday night

the rebel forces had captured the camp area, taking the few supplies,

instruments, and stretchers which it contained. The wounded who wgre .

able got to the river landing where there was a fifteen by thirty log hut

and the City of Memphis moored to the bank. While the official repotts

claim that no men could be spared to assist the wounded, personal

reminiscences tell of the men helping each o t h e r . Throughout the

night an incessant rain poured down on a wild disorder of wounded men,

stragglers, mules, horses, tents, and blankets in which Surgeon Hewitt

attempted to direct the most severely wounded onto the boat.

The only care given on shore that night was the staunching of

hemorrhage with strips of clothing and blankets. The two women went

14. Mary A. Gardner Holland (compiler), Our Army Nurses, . (Boston,; 1895), p. 184. This book is a collection of the experiences of nearly one hundred women who served in hospitals and on battle­ fields during the Civil War. Those reminiscences written by the women themselves are valuable sources for the. conditions and attitudes which prevailed in care of the wounded.

15. Abernathy (ed.), Private Elisha Stockwell Sees the Civil War, p. 21. to the field to give such aid as was possible. An effort to make soup from a killed bullock was hampered by the rain and a lack of cooking pots. Miss Kaiser went on board the Memphis and stirred up the kitchen crew to provide coffee and hardtack. The Memphis was staffed by vol­ unteer attendants who, it was said, had come along for the surgical operating experience they might secure. The army surgeon in charge reported that despite his efforts to prevent unwarranted surgery, many unnecessary amputations were performed.^

By Monday morning reinforcements under Buell and Lew Wallace had come up and during that day the rebel forces were driven back on

Corinth. The heavy rain and mud delayed Buell's supply train and ambu­ lances but his medical officers came on ahead with their instruments , hospital knapsacks, and such stimulants and important medications as they could carry on horseback. Men of initiative used whatever means were at hand. Two medical inspectors appropriated the tent a of regiments which were engaged or captured and set up what was probably the first

•tent field hospital in history. ^ Surgeon Hewitt organized his surgeons along the lines he had used at Fort Donelson, assigning some in operat­ ing teams, others to command the six steamers which were turned over

1,6., N. R. Derby, "Extract from a.Narrative of His Services in the Medical Staff," in Woodward et'al (eds.), The Medical and Surgical H istory __ Rebellion, Medical, I, Appendix, p. 40. .

17. Surgeon G. H. Hubbard, Medical Inspector to General W allace, and Surgeon B. J. D. Irwin, of the Fourth Division. 78 to the medical corps, and a third group to select the wounded to be evacuated. Surgeon Robert Murray, Buell’s Medical Director, ranked

Surgeon Hewitt and therefore took nominal command of the combined forces when he arrived but the two men apparently worked together with­ out friction for Surgeon Hewitt's arrangements were continued and

Surgeon Murray took charge of affairs on the steamers and the four government hospital ships which arrived from St. Louis at the end of the w eek.

The whole plan of ship transport for the wounded was so new that confusion reigned supreme. The six steamers turned over to the medical corps were supply ships which had to be unloaded before they could take on wounded. The government hospital ship Louisiana carried

Dr. Douglas of the Western Sanitary Commission and a corps of .sixty volunteer surgeons and attendants. While the army medical directors gave high praise to this group the same could not be said of boats sent by state governors and local soldier's aide committees. Not only did such boats attempt to refuse wounded from other states, but their staffs used no discrimination in the physical condition of those taken aboard, left no record of those they took away, and in their treatment exercised

"free use of the knife." The medical directors estimated that several 79- thousand malingerers left on the state boats during May and never re- I O turned to their commands.

In addition to the Louisiana, Surgeon Brinton had procured the

D. A. Jamieson, the Empress and the Imperial for government hospital service and fitted them with at least basic equipment. The arrival of the supply train of the Army of the Ohio, its Store ship and medical purveyor, and the Sanitary Commission's store ship Polar Star alleviated the supply problem. One gathers that in the emergency supplies were not distributed in any systematic manner. Surgeon Smith, assigned to the steam freighter

Crescent City, prowled through the mixed loads of freight dumped on the shore and appropriated mattresses, sheets and pillows, twenty bales of hay, and 350 bed sacks. Coming upon the medical supplies assigned to a regiment he made a deal dividing the items with them. He took seven days rations for 350 men and persuaded the ship's captain to let him use the crew as cooks and attendants in return for feeding them. With his ship equipped he turned to the operating table still in the muddy clothes he had worn for nine days . ®

18. Brinton, "Account of the Campaign of the Army of the Tennessee from February to June, 1862, Including the Capture of Forts Henry and Donelson and the Battles of Corinth and Shiloh," in Wood­ ward _et al (eds.), The Medical and Surgical History .... Rebellion, Medical, I, Appendix, p. 33. !

19. David P. Smith, "Extract from a Narrative of Services in the Medical Staff from July, 1861, to May 28, 1863," in Woodward et al (eds.). The Medical and Surgical History ..; Rebellion, Medical, I, Appendix, p. 43. The casualties in the wilderness of Shiloh were as great as those at Waterloo. Of the 90,000 troops engaged, 1,735 were killed,

7,882 wounded, and 3,956 missing. 20 Because of the confusion and the rapid removal of the wounded the medical records are scanty and there is no way to determine the proportion of serious to minor wounds.

The available evidence does indicate that the results of the surgery per­ formed were poor. Exposure, lack of nourishment, and the long trip out on overcrowded boats favored death from pyemia and exhaustion, today known as surgical shock. Uncontrolled surgery according to the most heterodox and various theories undoubtedly contributed to the death. to ll.T h e official reports state that there was every kind of wound from every kind of fire—grape, canister, spherical case, eonoidal ball, and ball and buck. The large proportion of wounds were in the lower . extremities. Those hit in the head or abdomen were usually killed. The shattering affect of the Minie ball drove bone fragments deep into the muscle but under the circumstances few wound excisions, or what we today call debridement, were done in the field hospitals and profuse

20. Phisterer, Statistical Record of the Armies of the United States, p. 213.

21. Smith, "Extract from a Narrative, of Services in the Medi­ cal Staff from July, 1861 to .May 28, 1863," in Woodward et al (eds.), The Medical and Surgical History .. . Rebellion, Medical, I, Appendix, p. 43.. suppuration had developed by the time such wounded reached the hos­

pital ships. ^

The bruised armies rested at Shiloh until the middle of May,

reorganizing, reequipping, and treating their sick and wounded, while

the medical command again played musical chairs. On General Halleck's

assumption of active field command, his senior surgeon, James Simons,

succeeded Surgeon Murray as medical director for a short time and was

in turn replaced by Surgeon Charles McDougal. Such frequent changes

must have impeded medical reorganization although no hint of lack of

cooperation between the men of the regular corps ever appears in the

. official medical history.

Once more diarrhea and camp fever of "more or less a typhoid

form" flared at the unhealthy campsite oh the river. While the diarrhea

was generally recognized as due to the river water, the fever was as­

cribed to any number of causes--a full diet and inactivity or a lack of

fresh meat and vegetables, impure water or the disagreeable "effluvia" ,

which rose from the shallow graves of the many bodies. When Surgeon

McDougal arrived he found the purveyor’s storehouses empty and the

regimental hospitals, on damp ground in the woods, scantily supplied

and staffed. With full authority from Halleck to secure supplies and

22. Charles McDougal, "Extracts from Letters to the Surgeon General Relative to Operations Subsequent to the Battle of Shiloh," in Woodward et al (eds.), The Medical and Surgical History ... Rebellion, Medical, I, Appendix, p. 40. organize the hospitals as he saw fit. Surgeon McDougal set.up three general hospitals at Savannah, Hamburg, and Pittsburg Landing„ Appeal­ ing directly to William Hammond, the new Surgeon General at Washing­ ton, he secured the needed tents, cots, and bedsacks from the east and additional medical officers. His intention was to use the general hos­ pitals for minor ailments and convalescehts and send the seriously ill to the hospital ships. But in daily expectation of the order to advance on Corinth regimental officers indiscriminately sent their unfit to the

Landing where, due to a lack of guards, they filled the ships, both government and private * With the appointment of four medical inspec­ tors to control assignment some order was achieved. Of the recorded sick some1 8,000 were sent off to Indiana, Missouri, Kentucky, and

Ohio and 2,500 kept at Hamburg. The inability to cure the cases of persistent diarrhea as long as the men stayed in the area led to the creation of a three-man board to examine and recommend for further hospitalization or discharge those unfit for field service. Another 11,000 o o were reported sent off by this board.

By May 5 the regiments were completely resupplied and divi­ sion field hospitals to care for the army at Cofinth organized. While an adequate supply of Sibley, wall, and regulation hospital tents had

23. Charles McDougal, "Extracts from Letters to the Surgeon General Relative to Operations Subsequent to the Battle of Shiloh" in Woodward et al fed si) . The Medical and Surgical History .. .Rebellion, Medical, I, Appendix, p. 40. ' arrived the problem of attendants to care for the patients remained un­ solved. To a hospital of 400 tents at Monterey near Corinth the division command sent a detail of the weak and disabled to serve as attendants . 24

That, out of forty, only fifteen were able to work was typical of the details customarily assigned to hospital duty. The other great hospital need, that of suitable food, could not be filled from the surrounding countryside which the rebels had stripped of food-stuffs, so that the diet consisted of regular rations augmented by a small amount of dried and canned fruit. While there were no battle wounds at Corinth, the rebels having abandoned the city> the sick filled the division hospitals.

The hospital at Monterey received 1,792 in a month with a 9.76 mortality rate and reported that many others died while being transported.

The medical officers who reported the campaigns of the Cumber­ land and the Tennessee were specific in the criticism of the deficiencies in the care of the sick and wounded. The armies were hurried into action leaving their supplies behind. No men were assigned or could be re­ leased for hospital duty, either as nurses, guards, ambulance men, or as details to bury the dead. One experienced surgeon per boat could not control the volunteer doctors who wanted to operate. The great needs for were for sufficient medical purveyors, who could also act as quarter­ masters and commissary officers for the medical department, and for

24. Derby, "Extract from a Narrative of His Services in the Medical Staff," in Woodward et al (eds.), The Medical and Surgical History ... Rebellion, Medical, I, Appendix,.p. 41. ambulance and hospital attendants with no other duties. It is strange that General Halleck, while he recognized the need to give Surgeon

McDougal full powers to set up and equip division hospitals, remained blind to the need of a designated non-combatant corps to staff these hospitals. Later> when general-in-chief, he continued to oppose Sur­ geon General Hammond's pleas for a separate ambulance corps. While one can understand the military attitude toward the uncontrolled civilian groups that flocked to each battlefield to aid the wounded>’ 25 less com­ prehensible was the nonrecognition of the depletion in fighting strength that resulted when it was left up to the soldiers to help each Other.

— The Chickahominy —

The medical experience of the Army of the Potomac on the pen­ insula between the James and the York rivers generally paralleled that

. . , ■ of the armies on the Tennessee. In the marshy lowlands, cut by streams that flooded with every rain, the troOps were immediately attacked by malaria and typhoid and the supply trains, bogged down in mud, moved at a snail's pace. The adjutant of the Second Pennsylvania Reserves reported that it took thirty-six hours for his wagon train to move five m iles.^G Water transportation was used to supply the bases at Fortress

25. To be discussed below.

26. E. M . W oodward, Our C am paigns, p . 105 „ . Monroe, White House at the mouth of Pamunky Greek, and Harrison's

Landing on the James River and a fleet of hospital ships was ready for service by the middle of Aprilx .

Medical preparations had been more carefully made for the

Peninsula campaign than for that on the Tennessee. Surgeon Tripler was close to the procurement'centers in New York and Philadelphia and an old army friend of Quartermaster Meigs and Medical Purveyor Satterlee.

In spite of, or perhaps because of, his constant carping about supplies, his brigade surgeons were completely supplied when the army moved to

Alexandria and issues were again made at Fortress Monroe to replace items wastefully left behind on the move to the peninsula. Triplet was constantly aggrieved by the wastefulness of regimental surgeons who, 27 he said, expected fresh supplies to be waiting at each new post. On the other hand he recognized the difficulties they met—-the outdated and rigid requisition forms, the lack of any medical control.over the transportation system. He succeeded in securing simplification of the chain of approvals required for requisitions so that only the signature of the corps medical director was required. When William Hammond replaced Clement Finely as Surgeon General in the summer other changes which Triplet had been recommending were approved. Greater latitude

27. Tripler, "Report," in Official Records . .. Armies, Series I, XI, Part 1, p. 181. in drugs and medical stores were allowed and a simple list of the articles required replaced the old requisition forms „ A circular from the Surgeon

General's office stated further that drug and supply tables were to serve only as a guide in ordering and that variations could be approved by any medical director. Medical control of its own transportation, however, was not secured until the last year of the war .

Tripler had also devoted much attention to providing adequate ambulance transportation for the Army of the Potomac. To understand what seems to be an inordinate effort to secure sufficient ambulances, it must be remembered that no such vehicles were in used in the United

States army prior to the Civil War.. In 1859 a medical board composed of

Surgeons Finely, Satterlee, Tripler, Cuyler, and Coolidge had recom­ mended the adoption of ambulance transportation for forty men per thousand troops. Two models had been accepted, a two-wheeled vehicle, designed by Finley, and a.four-wheeled, designed by Tripler. The four- wheeled vehicle had been tested in New Mexico, and while cumbersome and heavy, was extensively used in the first two years of the war. The two-wheeled had never been tested and its light contruction and intol- erable motion made it the bane of both doctors and patients. 2 8 It was found that the commands commonly used them as pleasure vehicles and baggage, wagons. After a serious attempt to estimate the number of

, 28. Woodward et al feds.). The Medical and Surgical History ... Rebellion, Surgical> III, pp. 946-948. wounded which a division could be expected to sustain from the new

higher velocity weapons, the number of ambulances per division was

set at twelve four-wheeled and twenty-two two-wheeled ambulances

each and 177 were assigned to the medical director's headquarters. 29

In the campaign on the Peninsula were also used a few horse cacolets which had been designed by the French 30 but efforts to train enough horses or mules to carry them was never successful and there is no record that they were used after this time. 31-

The number of hospital beds which would be needed was an­

other question on which the medical staff had little experience on which

to base their estimates. They believed that the experience of the Mexi­

can War would be drastically altered by the greater destructive power

of the rifled muskets and cannon which the Confederacy was known to

possess. It turned out that the anticipated figure of 60,000 wounded with

20,000 needing hospitalization^2 was greatly exaggerated, the actual

29. Triplet> "Report," in Official Records ... Armies, Series I, XI, Part I, p. 179.

30. J. F. Hammond, "Extract from a Letter to the Surgeon General's Office Relative to the Hospital Arrangements of the Second Corps in the Peninsular Campaign," in Woodward et al (eds.), The Medical and Surgical History ... Rebellion, Medical, I, Appendix, p. 64.

31. Woodward et al (eds.), The Medical and Surgical History . .. Rebellion, Surgical, III, p. 932.

32. Triplet * " Report," in Official Records . .. Armies , Series I, V, p . 103. - " . figure from. Williams burg. Seven Pines, and the Seven Days being

12,736.33 Since about 6,000 beds were all that had been arranged for

in Washington, Philadelphia, Annapolis, Baltimore, and New York it was

well that the casualties were no higher. There were no estimates made

on the number of sick that might require evacuation to rear areas.

While the army was in training at Washington Tripler had pre­

pared a directive on the duties of brigade surgeons which was published

as General Order No. 20, Army of the Potomac. 34 While specific as to

'their responsibilities in sanitation, medical supplies, the drill of the

ambulance teams (the band), the placement of medical teams in an

engagement, and reports, nevertheless brigade and regimental surgeons

were too inexperienced not to need additional help. Part of the work of

the medical inspectors had been to instruct these men in their responsi­

bilities and supervise their arrangements. Shortly before the army em­

barked for Fortress Monroe President Lincoln, without General Mc­

Clellan's knowledge, issued an order organizing the twelve divisions of

the army into four corps of three divisions each. If McClellan was dis­

mayed, Tripler was more seriously discommoded. Since the corps had

been provided with no medical, directors, he had to put his medical in­

spectors in those positions, which left him with no staff assistants. Had

33. Phisterer, Statistical Records of the Armies of the United States, pp. 213-214.

34. Tripler, "Report.11 in Official Records . .. Armies , Series I, V, p . 93. it not been for the very able civilian surgeons sent him by the states of

M assachusetts, New York, and Pennsylvania he would have had no one

to put in charge of the general hospitals established at Yorktown,

Williamsburg, and White House, or of evacuation to the hospital ships.

The first wounds on the Peninsula were the 1,400 received in

the rear guard action near Williamsburg. A "model hospital" had been fitted up at Ship's Point by the Massachusetts doctors, Cabot, Hodges,

Gay, Park, Hartwell, and Homans where the field surgery was done„ The wounded were then evacuated oh the Commodore equipped by and in .

charge of Professor Henry Smith of Pennsylvania, The Daniel Webster

No. 1, a Sanitary Commission boat in the charge of Mr. Olmstead, and

the quartermaster ship Ocean Queen. Professor Smith, it may be noted,

not only was placed in charge of embarkation, but also, having brought

along the means of embalming bodies, " cheerfully performed /this kind

service/ for numbers of men from other states .

Leaving those too critical to be moved in the care of Dr. D. L.

Rogers of New York, the army advanced from Yorktown in rain and mud with no shelter or rations, the exhausted straggling back to the embark­

ation point at Queen's Creek. On arrival at White House a general hos­

pital in tents was set up by a reluctant and inefficient detail, which

35. Tripler, "Report," in Official Records . . . Armies, Series I, XI, Part I, p. 181. spent four days erecting 100 tents By #ie eiid'pf May, White House was a bustling area with tremendous supply dumps, a hospital town of several hundred tents with board floors and beds, and an establishment for embalming the dead. 37 An efficient housekeeper. Miss Dix, had ar­ rived at the hospital at Yorktown, which was reported as a neat estab­ lishment with ample bedding and hospital clothing, and staffed by nineteen contract surgeons sent by the surgeon general of M assachusetts.

The worst problem of the general hospitals was the. horde of stragglers which came back to them from the moving army without their papers, without nurses or subsistence „ Some were sick and exhausted but others were out and out malingerers. Of 1,020 who had come into the White House Hospital by the end of May, 900 were reported to have trifling ailments. The practice at first had been to send the sick north by ship in order to keep beds available for the wounded frpm the antici­ pated engagements. When it became apparent, not only to Tripler but to the authorities in Washington, that this was the objective of the strag­ glers Tripler put his foot down. No more sick would go out. To Surgeon

J. B. Brown of the Fourth Corps Tripler wrote,

.... Army regulations make it the duty of the quartermaster to transport the sick on a march when called upon to do so by the medical officer ... the practice that has prevailed .. . may save trouble to the regimental surgeons and the quartermaster

: £ 36. Ibid, p. 186.

37. E, J. Woodward, Our Campaigns, p. 104. department, but it will destroy this army ... If men are sure of being sent home by being thrown on the hands of the Medical Director the contagion of homesickness will spread till not a sound man is left to carry a musket.38

That may have been well and good for Tripler but to Surgeon

Brown, whose corps was by now at the flooded Chickahominy, matters appeared in a different light. The offending divisions under General

Casey and General Smith had not been instructed in sanitary measures by their medical officers nor given prophylactic quinine and the troops became sick by scores. One thousand four hundred were sent to York- town. A division of inexperienced recruits j oined the corps with few medicines and no ambulances or hospital tents. The terrible roads re­ stricted the use of ambulances and made the replacement of medical supplies almost impossible. Quinine was secured by sending messen­ gers to White House on horseback.^

J. F. Hammond, Medical Director of the Second Corps, wrote that as soon as a general field hospital was set up in tents at Fair Oaks it was filled with deserters from Casey’s division. Thereafter he reverted to the regimental hospital plan where the men stayed with their own

38. Tripler to J. B. Brown, in Official Records ... Armies, Series I, XI, Part I, p. 204.

39. J. B. Brown, "Extract from a Narrative of Services in the Medical Staff,11 in Woodward et al (eds.), The Medical and Surgical History .... Rebellion, Medical, I, Appendix, p. 66. command. ^0 Surgeon O'Leary of the Sixth Corps also wrote of the de­ moralization of Casey's division. He reported that lack of ambulances made transportation of the wounded to a collecting point difficult and that because the brigade and corps organization existed only on paper the regimental surgeons spent half their time searching for their own m en. ■

Collection of the wounded from the Peninsula, until the Seven

Days, was facilitated by the Richmond and York Railroad over which the men were brought back to White House within a day or two . A receiving hospital at Savages Station was staffed by a Dr. Swinburne of New York and Surgeon Milhau. A Mr. Brunot of Pittsburgh brought a party of well qualified nurses to the Hospital at White House. Both of these men. volunteered to stay with the wounded who were left behind when the army's base was moved to Harrison's Landing on the James River.

The retreat to the James River, which is known as the Seven

Days, resulted in 7,709 wounded and 5,958 missingThe last wounded

Byemgitfctat®iwchite House came from Gaines's Mill on June 28 and all but those unable to be moved were taken out on ships. The wounded from

40. Hammond> "Extract from a Letter to the Surgeon General's Office Relative to the Hospital Arrangements of the Second Corps in the Peninsular Campaign, " in Woodward et _al (eds,), The Medical and Surgical History ... Rebellion, Medical, I, Appendix, p. 66.

41. Phisterer. A Statistical Record of the Armies of the United States, p. 214. the successive engagements at White Oaks, Savage's Station, and

Malvern Hill found their way as best they could to Harrison's Landing and Haxall or were taken prisoner. The troops were allowed to take what they wanted from the immense stores at Savage's Station and the wounded were provided with food, improvised crutches, and money. Woodward's account of the treatment received by the captured wounded tells a varied story. Some Confederate soldiers collected the Union wounded and shared water and rations with them. A Dr. Carter offered his house as a hospital and helped with their care. He also relates that rebel officers would provide no medicines, liquor, or food, and that one stole the surgeon's, instrument case, that inquisitive citizens from Richmond came out to view the battlefield but offered no aid and on the contrary stole

42 , canteens and cups from the prisoners.

The army which began to come into Harrison's Landing on July

1 was exhausted, shaking with malarial chills, and ulcerated with scurvy. On the forced march through the. muddy country and in the con­ stant fighting, tents and ambulances had been worn out or abandoned, and rations long since consumed. A great effort had been made to for­ ward supplies to the Landing. The commissary wagons had been sent in advance of the supply train which hdd gotten away from White House and coffee, soup, and hardtack was ready on the troops' arrival. On

42. E. M. Woodward, Our Campaigns, p. 156. 91

.the transports which came up the James River the Surgeon General had

sent stores of antiscorbutics, potatoes, onions, cabbages, and 1,5000 boxes of lemons. The Second Pennsylvania went into camp on a plain above a brook and was issued full rations plus cabbages, beets, and

onions. The brook provided good bathing and the men began the process of ridding themselves of the body lice; 11 gray backs11 in army lingo, with which everyone was infested. Good drinking water was scarce so this

AO outfit dug a deep well.

Surgeon Tripler's replacement, Jonathan Letterman, was await­ ing him.at.Harrison’s Landing with a medical purveyor and a medical director of transportation. The new medical director, who was to effect the complete reorganization of the medical.field service of the United

States army, found his organizational ability taxed to the utmost in his new assignment. The walking wounded arrived in increasing numbers, through July 2-3 and, of course, it rained. The only facilities available for a hospital were the Harrison House and a few wall tents so that only the most serious cases could be given shelter. The surgeons worked in relays around the clock. On July 2, transports sent by the Surgeon

General arrived completely equipped as hospital ships and staffed with

surgeons> stewards, and nurses. As quickly as they could be selected

6,000 acutely .sick and wounded were sent north and 2,000 to the

43. Ibid, p. 163. hospital aj Fortress Monroe. Because the needed hospital tents were not

. ready Letterman had to send away many less serious cases who ordinarily

would have been cared for in the camp. 44

The longer the army stayed on the unhealthy peninsula the higher

the sick rate rose from "privation and the poisonous exhalation of the

streams.Malaria of the "typhoid type”^ produced a disease mor­

tality rate which was the.highest of the entire war. Surgeon Letterman

agreed with Tripler in the desirability of caring for the sick in their own

command area but for a different reason. Letterman thought that troops

became disheartened and homesick when sent away from their buddies,

an observation which would be supported by most army nurses. While

300 hospital tents arrived on July 18 and the sick now had shelter it

was obvious that the disease rate would not drop as long as the army

stayed on the James River, just as it had been obvious on the Tennessee.

In Washington the military high command had also decided that

the Army of the Potomac should come back to northern Virginia, but there

is no evidence that the decision was influenced by the morbidity rate.

. In reply to McClellan's continuous requests for reinforcements,

44. Letterman to S, Williams, in Official Records ... Armies , Series I, XI, Part I, pp. 210-214.

45. Ibid. p. 215.

46. The general infestation with body lice coupled with the clinical description of "typhomalaria" indicates that the disease was typhus, the diagnosis of which was greatly confused at.this time. Stanton and Lincoln referred him to the paper strength of his divisions.

Stanton and Lincoln had also decided to entrust the direction of the war to a new general-in-chief, Halleck, and the scattered forces in Virginia to a new general, Pope. On July 29 McClellan was ordered to send away his sick and on August 3 to move his army to Acquia. Creek and join forces with Pope. .

The high command of the Civil War was prone to issue orders when there were insurmountable. obstacles in the way of their execution.

The hospital; transports which had been assigned to the medical staff at

Harrison”s Landing were removed from medical jurisdiction from.July 15 to August 3, first to bring exchanged prisoners from Richmond, and then to return Confederate wounded. On being returned from this last trip they were so filthy that it required a great effort and time to make them useable again.^ A side note of interest here is that a supply of lemons, brandy, and lint sent for the care of wounded Union prisoners at Rich­ mond was refused by the Confederates. On August 3, shipment of

McClellan's sick was begun again with a reduced fleet, numbers of vessels having been taken to move General Burnside's troops. General

Halleck had refused to enlarge the hospital.facilities at Fortress Monroe, as recommended by Letterman and Colonel Ingals of the quartermaster corps, so that 3,000 needed beds were not available and the army's

47. Letterman to S. Williams, in Official Records .. . Armies, Series I, XL, Part I, p. 216. removal was further slowed. Its first elements did not reach Pope until

August 23—and again, under pressure of a forced move, supplies and ambulances had been left behind. DUTY" WEARS A CHANGING FACE

The appointment of William Hammond, a thirty-seven year old

lieutenant, to the surgeon generalship had been a triumph of the Sanitary

Commission over the old guard of the regular army. In the summer of.

1862 the medical department was quivfering under the impact of its ener­

getic, picturesque, and able though visionary new head. ■*"

Before the war. Dr . Hammond had served for several years as

an army surgeon in the west, but in 1860 had resigned to become Profes­

sor of Anatomy and Physiology at the University of Maryland. On the

outbreak of hostilities he passed the army medical board examinations

and was appointed an assistant surgeon in Rosecrans8 Army of West

Virginia where he became medical, inspector of camps and hospitals. Dr.

Hamrnond was highly regarded by the "modern school" of medicine. His

studies on nutrition and on arrow poisons, the latter done in collabora­

tion with Wier Mitchell, and the publication of his official Reports of

Inspection in Hospitals and Gamps brought him to the attention of the

Sanitary Commission which, was looking for a candidate to replace Sur­

geon General Finely. The influence of the Commission on the military

1.. Ashburn, A History of the Medical Department of the United States Army, p. 74. committees of Congress., resulted in his appointment over many who O were his seniors in rank.

The resentment of the old guard, who had been passed over, and his relationships with Secretary Stanton and General Halleck did not make Hammond's term of office easy. While the Surgeon General and the. Secretary had a common objective of providing the Union soldier with everything he needed, they were equally arbitrary and strong- minded as to the measures to be employed. Halleck, who was himself one of the old guard, was happy to back Stanton when Hammond and

Stanton clashed, as they did on the question of an independent ambu­ lance corps. Nevertheless, although Hammond's active term of office lasted only fifteen months, in that time he was able to initiate changes of such value to the medical department that his successors in office continued and implemented them.

Hammond came, into office on a wave of national criticism of the care provided for the sick and wounded. The military hospitals were overwhelmed with the tide which the moving armies had left in their wake.

The victories at Mill Spring, Fort Donelson, Pittsburg Landing, Island

No. 10, Hilton Head, Fort Pulaski, Roanoke Island, New Bern, and

New Orleans had not only overdrawn the resources of the medical de­ partment but had increased the sick rate as. troops moved into unfamiliar

2. Ibid ; The Sanitary Commission of the United States Army, p. 25; Packard, History of Medicine in the United States, p. 642. 100 geographic areas and met diseases to which they were not immune.

This situation led to the introduction of numerous bills in Con­ gress, variously designed to meet special interests. However, the bill to increase the efficiency of the medical departments which became law on April 16, 1862, was largely the work of the Sanitary Commission.^

The Act gave to the surgeon general the rank, pay, and emoluments of a brigadier and created the position of assistant surgeon general with the rank of colonel of <5avalry. Robert C . Wood, who had been acting surgeon general in the interim after Lawson' s stroke, was appointed to this position. The Act also created a medical inspection section of eight medical inspectors, lieutenant colonels, headed by a medical inspector general, colonel of cavalry. These officers were to be ap­ pointed by the President, with the advice and consent of the Senate, from either the regular or volunteer medical corps, on the basis of qualifications without regard to rank. Hammond recommended a list of eight medical inspectors, including Jonathan Letterman, but various senators exerted pressure for their own candidates and in the end only four of Hammond's choices were approved. Thomas F. Perley, who was appointed Medical Inspector General, was not known in either medical

3. Brown, The Medical Department of the United States Army from 1775 to 1873, p. 221; Woodward et al fed s .), The Medical and Surgical History .. . Rebellion, Surgical, HI, p. 899. 101 or military circles and his administration was criticized for its. political rather than its professional orientation.^

Other provisions of the Act added ten surgeons and ten assis­ tant surgeons to the regular army and as many hospital stewards as the

Surgeon General should consider necessary; it broadened the function of the medical purveyors, charging them with the selection and purchase of all medical supplies—drugs, instruments, furniture, and hospital stores—and allowed a simple list of the articles required to be honored as requisitions. In May, six additional purveyors were authorized, who were appointed after an examination in pharmacy, materia medica, and basic English. They were required to post a bond of $40,000.

The Sanitary Commission had particularly supported the Act's provision for medical inspectors, hoping that its own agents in the sanitary field could be relieved for other activities. While it was now the legal duty of the medical department to supervise all that pertained to sanitary conditions in quarters, transports, and camps, and to the hygiene, police, discipline, and efficiency of field and general hospi­ tals, and while increased rank put the department in a better position to enforce its orders, the additional duties which Congress shortly ) assigned to the inspectors limited the attention they could give to any of their functions.

4. Adams, Doctors in Blue, p. 40 . 102

The overcrowding of the general hospitals in Washington and the large number of men with chronic disease and physical disability who occupied beds and still drew their pay led to the Act of May 15 which added to the duties of the inspectors responsibility for facili­ tating the discharge of such s o l d i e r s . ^ Under Army General Order Num­ ber 36, chief medical officers of general hospitals were supposed to keep the hospital population moving, either by discharge if unfit for further field service or by return to their regiments. However , since they were also allowed to employ convalescents and "the feeble" as cooks, nurses, and attendants, the hospital population was not de­ creased by any large number of disability discharges. It was thought that by making the inspectors responsible for discharge of the unfit the bottleneck would be alleviated but, unfortunately, the law. required that certification for discharge be based on the personal inspection of each man and specify, not only the nature of, but also the origin of his disability. Since regimental officers were very lax about sending with a soldier what, in those days, was called his "descriptive list," a medical history was often difficult to ascertain. Furthermore, the very idea that eight doctors could personally examine the 10,000 Soldiers estimated unfit for further military service was completely unrealistic.

The malingering reported by Tripler and Brinton continued to be a major

5. Brown, The Medical Department of the United States Army from 1775 to 1873. p. 224. 103 problem, particularly in the winters of 1862 and 1863, and the jurisdic­ tion of hospitals was so confused, until it was given exclusively to the medical department in December 1864, that there was little effective control of admissions or discharges.

The concept of medical practice which was prevalent among many citizens was evident in the Senate debate on a bill to increase the number of inspectors to sixteen, introduced in December by the Military

Affairs Committee. As Senator Wilson, chairman of the committee, pointed out the previous authorization of eight medical inspectors did . not even provide one for each military department despite the respon­ sibility placed on them for the health standards of both camps and hospitals. The additional duty of examining for discharge the 60,000 patients in the fifty general hospitals by then established made it mandatory to increase their number.® The bill also proposed qualify­ ing the previous "personal inspection" feature to read "designate to the medical officers of hospitals and camps" those who should be.dis­ charged. Senator Hale of New Hampshire, who was always anti-doctor in any debate on the medical department, wished to delete the provision that inspectors should be members of the medical corps and let the

President appoint "men who could do the job best." Senator Grimes of '

Iowa was of the opinion that no more inspectors were needed if the ones

6. Senator Wilson’s figure was not correct. Report of the Surgeon General in November 1862 listed 151 general hospitals. already appointed were held accountable for their duties. There was no reason, said Grimes, why a doctor should not be able to examine 1,000 men a day. ^ Why were not the medical officers in the hospitals and camps doing this duty, asked Senator Trumbull. Senator Wilson was forced to admit "that of the four to five thousand doctors in federal ser­ vice, fifteen hundred were contract surgeons, "all of whom do not have the same sense of public duty." and some of whom, it was known, is­ sued discharge certificates only for compensation. The army was not getting the best and ablest doctors, he added, because they were not O willing to make the sacrifices required by military service.

In the end, the Committee's argument that four million dollars would be saved, should the 10,000 estimated unfit be discharged, won enough votes to pass the bill increasing the number of inspectors to sixteen, but the addition of a second inspector general was deleted.

Had sufficient qualified inspectors been provided in the Civil War, bad spots like Falmouth after Fredericksburg, the transports that took Bank's troops to the Gulf, Camp Chalmette, Louisiana, and other would not have' continued to mar the over-all progress in army medical care. How­ ever, the office of medical inspector,. introduced into the military organ­ ization for the first time in this war, proved of such value that it became a permanent fixture in the medical corps.

7. Italics mine.

8. Congressional Globe, 37 Cong., 3 Sess., pp. 116-212. 1Q5

While the argument over medical inspectors was going on,

Hammond was initiating improvements in Other functions of the depart­ ment . Recognizing the enormous opportunity for the collection of statis­ tics on military medicine, surgery, and hygiene which the war effort offered, he at once took steps to improve army medical reports. ® Prior to this time medical officers had been guided only by general army regulations in making their reports. The surgeon in charge of each post hospital, regiment, and detachment had sent a monthly report of the number of sick, wounded, dead, and discharged to his medical director and a quarterly consolidation of these figures to the Surgeon General.

Difficulties in securing these reports from the volunteer regimental sur­ geons had led Medical Director Tripler to take over.the quarterly consol­ idation himself. Hammond made the consolidated report the duty of medi­ cal directors throughout the service and issued a printed form to be used.

His Circular Number 2 also directed the making of. fuller monthly reports: fractures, gunshot wounds, amputations, and "exsections" were to be recorded as to date received, description, treatment and result: the character and symptoms of medical diseases were to be described and certain specific information given under the different disease categories

--the. location and sanitary conditions of camps and quarters under fevers, the character of the rations and the modes of cooking under

9. Woodward et al (eds.), The Medical and Surgical History . .. Rebellion. Surgical, III, pp. iii-iv. 106 diarrhea and dysentery , observations on causation and curative mea­ sures under the scorbutic diseases, and shelter and atmospheric condi- 1 n tions under respiratory diseases.

This circular also annouoed the department's intention of com­ piling a medical and surgical history of the war and asked that important cases and autopsy findings be fully described and contributed. This. decision was apparently influenced by the British account of the medical experiences in the war with Russia, published in 1858 as the first such record of this kind. Like the British, the medical officers of the United

States army had been unable to find in any records of previous wars data which would guide them in the care of the sick and wounded and

Hammond was determined that the record of the Civil War should be pre­ served for the future. * ■*" The compilation of material was continued by

Hammond's successor, Joseph K. Barnes, and was published in six volumes between 1870 and 1888. It contained the pioneer accounts of gunshot injuries of nerves, the "irritable heart" of soldiers, trench nephritis, the ipecac treatment of dysentery, venereal disease preven­ tion, and the organization of a field ambulance service.V irchow , the great German pathologist, praised the exact detail, the careful

10. Brown, The Medical Department of the United States Army from 1775 to 1873, p. 226.

11. Lynch et al (eds .), Medical Department ... World War, P. 13. 1 12. Ibid, p. 16. 107 statistics, and the scholarly statements of The Medical and Surgical

History and, although it is now only of historical interest, until the acceptance of the germ theory of disease it was widely used as a ref­ erence by military and civilian doctors, and as a text by medical 11 stu d e n ts.

Improvement in the adequacy and accuracy of medical reports made under the stress of battle conditions received further attention under Hammond's successor. Surgeon General Barnes, who detailed to certain medical officers in each army the duty of collecting and trans­ mitting medical statistics and recording the disposition of the wounded who were evacuated. Thus some system of keeping track of the soldier as he was moved from field to rear area hospital was achieved. In Janu­ ary of 1864 a new compact and portable Register of Sick and Wounded was introduced, together with a bed-card record of treatment and prog­ ress which was sent with the soldier when he was moved, from one facility to another. In February 1864 the reports on the sick were separated from I ' those on the wounded as were reports on prisoners, white troops and colored troops. The attempt to determine what factors affected physical condition lay behind this move. Disease morbidity and recovery from wounds were analyzed in relation to previous living conditions, race, present environment, nutrition, atmospheric conditions, and so forth.

13. Shryock, The Development of Modern Medicine, p. 182. In March, the Report of Surgical Operations was instituted, which pro­ vided for a notation of any secondary hemorrhage, pyemia, or tetanus that occurred „ The last of the forms introduced in the war was the

Classified Returns of Wounds and Injuries Received in Action which went to corps and division commanders as well as the surgeon gen­ eral. While it took three years for . the medical department to achieve anything approaching an accurate record system, the war department as a whole was not better. It could forget where it had sent a whole divi­ sion for six weeks ^ and Senator Rice claimed no one in the military forces could provide any exact d ata.^

It is difficult at best to change the procedures under which any large number of people work. The headquarters staff of the medicM de­ partment, consisting of one Surgeon General, one Assistant Surgeon

General, one Medical Inspector General, and a few clerks / was depen­ dent upon some 139 army and corps medical directors, and 85 contract staff surgeons of varying tours of duty to implement any change in pro­ cedure to be followed by 5,991 volunteer regimental surgeons and 5,532

14. Woodward et al (eds.), The Medical and Surgical History ... Rebellion, Surgical, III, pp. iv-v.

15 . Blanker" s division which was sent from Virginia to Fremont in the Shenandoah.

16. C ongressional G lobe, 37 C o n g ., 3 S e s s . , p. 447., 17 acting assistant surgeons under contract. The fact that no system of

instruction (basic training as the modern soldier knows it) was ever insti­ tuted was one of the great weaknesses in the conduct of the Civil War.

The efforts of Tripler and others showed that the need was recognized and reported in The Medical and Surgical History. The leaders of future wars took note. In the Civil War, it was a real achievement that any progress in medical organization took place.

The need for an independent ambulance corps, trained in its duties, and responsible to medical officers alone, had been apparent to medical leaders from the first engagements of the war. It was the old army custom to detail members of the band to accompany the ambulances, and to assist the wounded from the field. The ambulances themselves were driven by the quartermaster corps. The results of such a disorgan­ ized effort were evident in the engagements already described. As early as May 1861, a plan for ambulance organization had been presented to

General Scott who had referred it to Acting Surgeon General Wood who had responded with s ile n c e .In September of that year, the Surgeon

General of Pennsylvania had offered the Army of the Potomac an organi­

zation of forty-five ambulances, fifteen transport parts, and sixty-seven men under two line officers. Surgeon Tripler had refused the offer

17 . Woodward et al (eds.), The Medical and Surgical History ... Rebellion, Surgical, III, p. 901.

. 18. Packard, History of Medicine in the United States, p. 640 . 110 because his regimental surgeons had no authority to direct the line officers in charge. A similar offer by a group of French citizens in this country had also been refused because he could see no way of fitting it into the army table of organization.

But Jonathan Letterman, faced with the problem of transporting thousands of sick from Harrison's Landing, had somehow managed to organize an ambulance corps from the depleted divisions of the Army of the Potomac. This plan he had presented to Surgeon General Hammond who had in turn recommended its adoption to Secretary Stanton. Unfor­ tunately, Stanton at this time was greatly concerned with the snail' s pace at which the armies, east and west, moved when on the offensive.

Halleck convinced him that the reason for their slow progress was the size of the accompanying supply trains and that the addition of the recommended number of ambulances and medical supply wagons would only fufthere impede military movement and increase the enemy's advan­ tage. The use of a group designated as non-combatants, solemnly opined Halleck, would only cause stampedes and panic. Furthermore, 20 there was the touchy question of the additional expense .

19. Ibid, p. 641; Letterman, "Report" in Official Records ... Armies, Series I, Vol. II, p. 89.

20. Fletcher Pratt, Stanton, Lincoln's Secretary of War (New York, 1953), p. 234; Ashburn, A History of the Medical Department of the United States Army, p. 71. In the last days of August, with McClellan and Letterman i) temporarily shelved, General Pope led elements of the three armies of the eastern theatre to the Second Battle of Bull Run with no more prepa­ ration for the care of casualties than had been made at the same scene the year before. When news of the repeated disaster reached Washington

Secretary Stanton attempted to prove his contention that a trained ambu­ lance service was unnecessary by calling for volunteer surgeons and male nurses to go to the battlefield. In Washington the provost-marshal seized a collection of "omnibuses, cabs, market wagons, old coaches, hay wagons, dog carts, sulkies, and gigs, " ^ filled them with the raf­ fish , drunken mob which volunteered, and sent them off to care for the w ounded.

The performance of these volunteers is too well known to repeat here. They would not lift the wounded, or feed or give them water. They stole the subsistence stores and loaded their vehicles with them. Most made one trip from the field to the Fairfax Station hospital and did not r e t u r n .22 Hammond had, on his part, rounded up thirty-seven wagons of medical supplies and sent them to Centreville. with Medical Inspector

R. H. Coolidge. General Pope always made sure that his supplies were kept well in the rear away from any danger of being capture by the enemy

21. Quoted in Pratt, ibid.

22. R. H„ Coolidae to W. F. Hammond in Official Records .. Armies, Series I, Vol. XDC, Part II, p. 260. iM

So there was no food at Centreville where the wounded were arriving by rail . Pope shortly retreated from that place taking his medical director

McParlin with him. But Coolidge remained and was given complete co­ operation in care of the wounded by Surgeon Gild, medical director to general Lee, one of the rare fine instances of Confederate consideration of wounded prisoners in the war. Lee allowed the Union ambulances and subsistence wagons to pass through his lines and the two directors worked together collecting the 4,000 wounded in twenty-one field hos­ pitals over a ten mile area. While the wounded remained in the field hospitals for a week, Coolidge reported that all were given medical attention, were wrapped in blankets, and were fed. While there were few nurses, citizens offered their help and augmented the fresh beef OO x and bread sent from Washington with other food.

The evacuation of the wounded which Lee allowed at the end of the week was graphically described by Alonzo Quint, chaplain of the

Second M assachusetts. Jack son's interruption of the railway back to

Washington was responsible for much shuttling of cars , their floors and roofs covered with wounded, between breaks in the line and way stations.

At Warrenton and Fairfax the by now familiar scene was repeated, churches and dwellings crowded, and acres of ground strewn with the injured. Viewing the catastrophic incompetence seen all about him the

23. Ibid, pp. 259-263. 113

outspoken. Quint, who always seems to have been well aware of what

was going on at headquarters, bluntly wrote> "let civilians attend their

civil duties ... /b ut/ in a republic political leaders cannot willingly

keep their fingers out "of military affairs."

With the complete and utter failure of his volunteer service,

Stanton ceased to obstruct Hammond’s and Letterman's development of

a trained ambulance corps in the Army of the Potomac. Letterman returned

to the position of medical director September 2 when McClellan was re­

appointed to the command and remained with that army through the bat­

tle of Chancellorsville. During that time he not only organized ah

ambulance service for the evacuation of the wounded but reorganized

the field service of supply and created an effective mobile hospital

organization. Sherman was the next to adopt Letterman's organization

in his corps and in March 1863, Grant instituted the system in. the army

advancing on Vicksburg. However, it was not until March 16, 1864 that

Congress passed an act which established a uniform system of ambu­

lances in the army of the United States. ^

Letterman's system, which was promulgated in General Order

147 of the Army of the Potomac, established an ambulance organization

24.. Alonzo Quint, The Potomac and the Rapidan (Boston., 1864), p. 174, pp. 203-209. An account of the war experiences of the chaplain, .. Second M assachusetts.

25. Woodward et al (eds.), The Medical and Surgical History . .. Rebellion, Surgical, III, pp. 938-942. . 114

O (2 for each army corps . A captain was in over-all command of each such group, responsible for the condition and maintenance of vehicles, horses, harness > supplies, for training the men to lift and carry the wounded with gentleness, for situating the ambulances before each engagement, and for making a detailed report following the battle. As­ signed to the captain was a first lieutenant from each division who acted as, quartermaster, responsible for the vehicles, horses, and harness.

He was supplied with a forge, a blacksmith> and a saddler and was to inspect the equipment and animals in each brigade weekly. A second lieutenant carried the responsibility for a brigade. A sergeant from each regiment was detailed to conduct the drills. All the officers and non- coms were mounted.

The allowance of vehicles was one 4-horse and two 2-horse ambulances and one transport cart per regiment, one 2-horse ambulance per battery of artillery, and two 2-horse ambulances for headquarters.

Each ambulance carried two stretchers, water kegs, a chest of drugs and stimulants, and was staffed with two privates and a driver. The

Tripler 4-horse ambulance was a heavy, cumbersome vehicle and by this time had been augmented by a lighter model which could be drawn by two horses and was called the Wheeling or Rosecrans ambulance.

Like the Tripler model, the Rosecrans ambulance had platform springs

26. Official Records ... Armies, Series I, Vol. XIX, Part I, pp. 217-219. and a duck cover but the interior was differently arranged with benches which could be made into beds and it could carry eleven or twelve pa­ tients. Later in the war an improved model called: the Rucker was intro- 2 7 duced, which model was still used in World War I.

On the march each division was accompanied by its ambulances and carts placed at the head of the baggage train, under the direction of two medical officers and a hospital steward who had complete control of which men were allowed to ride. Regulations stated that the troops were not to be allowed to suffer and according to Quint the arrangement was later modified to allow one ambulance to accompany each regiment, where it was more accessible to those who became exhausted on long m a r c h e s . On the march to Atlanta, where hospitals were miles away i and the sick had to stay with their commands, it was the custom to excuse the sick from morning camp details and send them on foot ahead of the main body, their guns and knapsacks being taken in the wagons.

When they could walk no further they lay down by the road and waited for the ambulances to pick them up. Private Stockwell wrote of being assigned to the care of a typhoid patient in an ambulance for two days

, 27. Woodward et al (eds.), The Medical and Surgical History ... Rebellion, Surgical, HI, pp. 947-9:56: Nick Eggehhofer, Wagons, Mules, and Men (New York, 1961), p. 122.

28. Quint, The Potomac and the Rapidan, p. 229, ffp. 253. , 116

on the way to Rome > Georgia. Regulations limited the use of ambu^

lances to the. transportation of the sick and of medicines, and any other

items were to be left behind if there was not room for them in the baggage

wagons. The same provision applied to ambulances in camp and any

officer who attempted to commandeer them for other purposes was liable

to trial for disobedience of orders. This was a distinct change from the

practice of the first years when regimental officers commandeered ambu­

lances to carry everything from ammunition to personal baggage.

Ambulance regulations also provided that the horses were to

be serviceable and used for nothing else, that the corps would be armed

with revolvers and identified by a green arm band, and that no person

was to carry wounded from the field but this corps, By 1863 cavalry

guards were posted in the rear of battlefields to enforce this order and

prevent the straggling which had previously gone on under the ruse of

helping the wounded. The regulations in the general order of 1864 dif­

fered from Letterman' s original plan only in increasing the allotment of

ambulances and the staff of eadh. ■

Letterman's ambulance organization was first .tried at Antietam

. in the corps of the Army of the Potomac. Although all of the ambulances

required had not yet been constructed, the wounded of the right wing

were removed from the field to hospitals at Keedysville by two in the

29. Abernathy fed.), Private Elisha Stockwell Sees the Civil War, p. 76, 104. 117: 30 afternoon of the next day. There had been little time for training prior to Antietam and there was confusion in Franklin's corps which went in to relieve Sumner. The senior surgeon was killed and there was delay in getting the litter men and ambulances into action.^ But after

Fredericksburg in December, Surgeon H. S. Schell could write, "In no previous battle witnessed by me were the wounded so promptly and well cared for throughout the army as at Fredericksburg due to the uniformity of action. Every surgeon, hospital steward, nurse, cook and ambulance attendant was assigned to his position and knew it.The system , when adopted by the entire army, proved itself at the Wilderness,

Spottsylvania, Cold Harbor, and in Georgia and the Carolinas. Casual­ ties greater than the world had ever seen resulted from these engagements:

at Antietam 9,416 wounded at Fredericksburg 9,028 at Gettysburg 13,709 at the Wilderness 21,463 at Spottsylvania 19,687 at Cold Harbor; . ■ 10,57033

30. Letterman, "Report” in Official Records .. . Armies, Series I, Vol. XDC, Part I, p. 110. 31. John T. Reilly, "Second Extract from a Narrative of Services," in Woodward et al (eds .) . The Medical and Surgical History .., Rebellion, Medical, 1, Appendix, p. 105. 32. H. S. Schell, "Second Extract from a Narrative of Services in the Medical Staff, " in Woodward et al (eds .), The Medical and Sur­ gical History ... Rebellion, Medical, I, Appendix, pp. 131-132.

33. Phisterer, Statistical Record of the Armies of the United States, pp. 21.4-215. While the death rate of the wounded was very high it was due to the primitive surgical procedures of this era. How much higher it would have been had the wounded suffered the exposure of many days untended on the battlefield, one shudders to think.

After Antietam Surgeon Letterman also changed the medical supply system for units in the field. It has been previously noted that the medical corps was plagued throughout the war by lack of control over the transportation of medical supplies. When Lee cross the Poto­ mac and the Union armies were on forced march looking for him only ammunition wagons accompanied the troops . Not until an engagement was underway and its location known were rations and medical supplies dispatched from Washington. This was true at both Antietam and Gettys­ burg. Previous to Antietam the bridges across the Monocacy River had been destroyed so that supplies sent up by railroad from Washington were dumped at Frederick City. To secure medical supplies surgeons from the various units had to be sent there to procure them and for several days such supplies west of the river were very scanty. There­ fore, in October of 1862, a system of supplying by brigades was insti­ tuted which made available at least basic medical items, made them more easily transportable, and avoided much of the loss previously experienced.^ Medical purveyors issued to each brigade surgeon one

34. Letterman, "Report" in Official Records ... Armies, Series I, Vol. XIX, Part I, p . 114. 119 hospital wagon, one medicine chest for each regiment, and one hospital knapsack for each regimental surgeon. These were equipped with sup­ plies to last one month and regimental surgeons needed only to requisi­ tion the brigade surgeon for replacements. The medicine chest and knapsacks could be stored in an ambulance and thus the three wagons previously needed for each regiment eliminated. The brigade hospital wagon carried hospital tents, an operating table, a hospital mess chest, blankets, bed sacks, instruments, and other basic equipment. These supplies were often combined in one division hospital.

. At the end of October 1862, the organization of the division field hospital was clarified.T hese hospitals were to be set up before an action and were to be staffed by a surgeon in charge with two assis­ tants, an operating team of six, and the necessary stewards and nurses.

One assistant was responsible for the erection of tents or preparation of suitable buildings, for a supply of water and hay, and for the organiza­ tion of a kitchen to provide beef stock, tea, arrowroot, and bread. The other assistant was responsible for the hospital records, interment of the dead, and the proper marking of graves. The command was to supply a guard to keep stragglers away and no medical officer was to leave his assignment without permission. One of Tripler*s great problems on the peninsula had been the vacating of their posts by both volunteer and contract surgeons.

35. Ibid. pp. 114-116. 12,0

Letterman’s total program of supply, removal of the wounded, and field hospitals was put into action at Fredericksburg on December

13, 1863.36 Between October and December the medical corps of the

Army of the Potomac had been supplied with

74 wagons of general supplies 14 wagons of hospital supplies 7 complete hospital wagons 207 medicine chests 256 surgical field knapsacks.

In addition, vehicles specially constructed to carry drugs and stimu­ lants, Autenrieth wagons, had been distributed, although there were not yet enough for each brigade. In preparation for the engagement, the medical purveyor had brought into Acquia Greek a steamer stocked with drugs, instruments, stimulants, anesthetics, beef stock, milk, coffee, tea, blankets, and underclothing. From there, replacements were brought up to the Rappahannock. The quartermaster had supplied 500 hospital tents and these were set up as division hospitals on the east side of the river in protected sites, each with its assignment of officers and detailed attendants. According to the strict discipline which Letterman exercised over his medical officers, each surgeon responsible for a unit was required to report when his arrangements were complete and by the morning of the twelfth all four corps had complied.

36. Letterman, "Report" in Woodward et al (eds .) . The Medical and Surgical History ... Rebellion, Medical, I, Appendix, pp. 98-104.' - 12:1

Once a part of the city of Fredericks burg had been occupied by the Union forces on the twelfth, aid stations were set up in various buildings and the stretcher bearers were notified of their location„ In the terrible battle of the'thirteenth, in front of the stone wall and the sunken road under the guns bn Marye's Heights, it was impossible to bring the wounded off the field. During the daylight hours it was im­ possible to move on the field without being shot and several medical officers were killed. Not until night fell could the ambulances go for­ ward , and then stretcher bearers were fired upon if they showed a light of a lantern as they searched for the wounded among the piles of dead.

By dawn, the wounded that could be found within the Federal lines had been taken to the aid stations where the surgeons had operated through­ out the night . While blankets had been hung before every door and window in a black-out precaution, some stations were shelled although no one was reported hurt.

On the night of the fourteenth the Union army was pulled back across the river and on the fifteenth the wounded were carried back to the division hospitals. In this engagement there was not the dispersion of units that occurred in so many others and the casualties of each regiment fell in one area. Woodward wrote that all the wounded of his regiment were taken to the same house in Fredericksburg and were 1:2:2 07 cared for by their own surgeon. Hence, surgeons did not waste so

much time looking for the wounded of their own regiments, for the sense

of regimental responsibility persisted. Letterman himself believed in

keeping the men of a unit together even in hospital and his system of

division hospitals enabled this to be done. It was relatively simple to

move the wounded of a regiment from its aid station to the hospital area

of its division. In battles where units were pushed back, separated,

and scattered, a pattern such as Letterman envisioned could not be

. follow ed.

There was only a single track railroad running back to Acguia

Greek from the Rappahannock. The rolling stock was mostly platform

cars without covering. Since it was mid-winter and cold this fact un­

doubtedly influenced Letterman1 s decision to serid only the slightly

wounded back to the Alexandria and Washington hospitals and keep the

seriously wounded in the hospitals at Falmouth. A time table was set.

up with Colonel Ingalls, the quartermaster, by which the cdrs of

wounded would go straight through to Ac quia Creek where transports

would meet them and take them on to Washington. Despite the g'iiards

assigned to the loading point, on the first day of the evacuation about

a thousand men who were very slightly injured, if at all, jumped on the

cars and rode to Ac quia where there were no facilities for their care and

37 . E. M. Woodward. Our Campaigns, p. 245 . where the transports would not accept them. Letterman described them as "those who in all battles run to the rear .. . and raise the cry of inhumanity and want of attention on the part of surgeons, whom they sedulously avoid.11 The cars assigned to the wounded had been spread with hay and straw and to each was assigned a surgeon and an atten­ dant with an emergency supply of instruments, dressings, and stimu-

j ■ ' ' . ' . lants. In January, however, when Burnside, preparing for his mud-march, directed that the serious cases be sent to the rear, there was not time for similar preparations to be made. The surgeon in charge of this train reported that there was no straw for beds and many of the cars were

3 8 : uncovered, although there were ample rations, attendants, and nurses.

The last battle of Letterman” s tour of duty with the Army of the

Potomac was Chancellorsville. Because General Hooker1 s strategy in­ volved a rapid, secret march through the Wilderness to the open ground southwest of Fredericksburg, the army moved with only the indispensable ammunition loads, two ambulances to a division, and some pack mules.

When it was learned that another disaster had befallen the Union forces, division hospitals were set up at Ac quia Creek.

In the days before an international agreement respecting the wounded and medical personnel, the greatest suffering endured by the

38, DeWitt Peters, "Extract from a Narrative of Services" in Woodward et al (eds.), The Medical and Surgical History .. .Rebellion, Medical, I, Appendix, p. 135. wounded was when they were left in an area captured by the enemy. As the Federal Army retreated back across the Rappahannock, many of its wounded had to be left behind > although Quint says that they were later brought across the Rappanhannock under truce. ^ As in the later Wilder­ ness, Wounded who fell in the heavy underbrush set afire by exploding shells often were not found and many burned to death. John Shaw

Billings,. who at that time was with the Fifth Corps, described the wild confusion at the Chancellor House, where the wounded were laid every­ where and the kitchen and outbuildings were filled with teamsters, orderlies, contraband, and stragglers As Lee's army advanced, the clearings where the wounded had been brought for care were shelled by artillery and the men were killed where they lay,.. A doctor with the

Twelfth Corps was killed as he attempted to move his men across the river and a surgeon who stayed at the Chancellor House was shot when he stepped out on the porch. The shell fire inflicted the most extensive wounds that Billings said he had ever seen, many of the chest and abdo­ men. Care of the wounded, which the Confederates had allowed at Bull

Run, was not repeated here. Surgeon Bacon, who, with a cook, steward, and nurse, stayed with the wounded of one division, buried his whiskey,

39. Quint, The Potomac and the Rapidan, p. 305.

40. J. S. Billings, “Extract from a Narrative of Services" in Woodward et al (eds.), The Medical and Surgical History ... Rebellion, Medical, I, Appendix, p. 135. 125 chloroform, and morphine to keep it out of rebel hands. Surgeon Holt of

A. P. Hill's division took his other stores and would leave the Federal wounded no bedding or blankets. Gangrene spread even to minor wounds

"because the vital powers of the men were exhausted. "41 when Surgeon

Bacon was paroled the attendants who had stayed with him were not and his instruments and field knapsack were confiscated.

The defeat at Chancellorsville produced another upheaval in the upper echelon. "It is no wonder the Army, of the Potomac is not in the best condition when its command is changed so often" wrote Chap- lain Quint.42 In one year his brigade had been in four different armies with five different generals. This time the upheaval affected the medical corps. The Hammond-Stanton feud had steadily been growing more bitter.

Now the Secretary sent the Surgeon General south "to investigate con­ ditions." Shortly, Letterman left—or was removed from the Army of the

Potomac, it is not certain which—to become Inspector of hospitals in the Department of the Susquehanna. Inspector General Perley resigned in August and was succeeded by Joseph K. Barnes. In September, Stanton made Barnes Acting Surgeon General „

41. Ibid. p. 137.

42. Quint, The Potomac and the Rapidan, p. 272, 172. 126

In the Senate, an acrid debate was going on over another bill to promote the efficiency of the medical corps . ^ The medical depart­ ment had spent eleven and a half million dollars in the fiscal year 1862-

1863 and Senator Fessenden wanted to know what the Surgeon General had done with all that money. One of the provisions of the new bill was to increase the commutation rates of rations in order to provide a more suitable diet for patients in hospitals. To this Senator Grimes objected because "men were making large estates from, the food the sick were not e a tin g." Another provision, to increase the number of surgeons for hospital staffs, confused Senator Fessenden who thought the regimental surgeons staffed hospitals. A section which would give the rank of colonel to medical directors of armies and hospitals drew the retort that a man in this position was a clerk and did not need a horse—a perquisite of the rank of colonel. Fessenden was particularly irate over the proposal to amend the law which as it stood required a medical lieutenant to serve for five years before he could be promoted. The constant demand for increased rank and pay by young fellows who,

' r \ if not for the state of things, would not expect a captaincy for twenty years, is evil, said the Senator. Increases in rank should go to the volunteers and the regulars should not object to being over-ranked .

Senator Harlan of Iowa objected to the medical cadets who were in the

43. Congressional Globe, 37 Cong., 3 Sess., pp. 370, 427, 446, 468. See p. 19 on "commutation" of rations. service just for experience. He stated the he personally knew of a soldier from his state whom one of them had killed. Conditions at the convalescent camp at Alexandria were severely criticized, although the medical department had no control over this camp which was com­ manded by General Heintzelman, who hired his own contract surgeons.

While a much deleted version of this bill passed the Senate it was lost in the House. As the Senate prepared to adjourn. Military Affairs Chair­ man Wilson told them, "my heart is made sick by the stories we hear from all quarters during this war ... it seems that we are living in an age, if not of total depravity, at least of universal slander." THE HARSH LESSON OF REALITY

In August of 1864 Surgeon General William Hammond was courtmartialed, convicted of improper conduct, and dismissed from the service. He was so destitute of funds that friends loaned him the money to establish a private practice in New York City. The story of the Stanton-Hammond feud which culminated in the courtmartial of the

Surgeon General is not a clear one. Whether or not the details have been preserved in the files of the Surgeon General's or Provost Mar­ shall's offices remains to be investigated. Stanton's suspension of

Hammond was apprently triggered by a medical inspector1 s reports of the bad conditions in the regimental hospitals at Falmouth in the winter and spring of 1864. Hammond would not accept the suspension without a courtmartial. In its first sitting the court acquitted, him of the charges brought but Stanton ordered it to reconvene and for months the Secretary's staff, it is said, presented'testimony of involved accounting and contract procedures in which the court finally judged the Surgeon General guilty of improper practices.

In 1878 when Hammond was vindicated by Congress and put on the army retired list as a brigadier general, the House and Senate

1. Ashburn, A History of the Medical Department of the United States Army, pp. 83-86: Pratt, Stanton, Lincoln's Secretary of War, p. 278. 129

Military Affairs Committee reported that "he had been the victim of a series of antagonisms, the jealousy of those passed over in rank, the rapacity of contractors, and bickerings among civil surgeons ." ^

Joseph Barnes, the next Surgeon General, had been with the corps since 1840, had served in the Seminole War and with Scott in

Mexico. Not only was he acquainted with the old guard, but since 1862 he had been in Washington as attending surgeon to the military command, and to Lincoln, Stanton, and Seward . Held in respect by the high com­ mand, he had the wisdom to continue the progressive efforts begun by

Hammond and Letterman. Perhaps because bitter experience had finally taught some lessons, perhaps because there was less tension when

Lincoln and Stanton finally found a general to run a winning war for them,

Barnes was able to achieve what Hammond had not. By Congressional

Act and General Order, Letterman8 s ambulance system was made uniform throughout the army. In December of 1864 the exclusive control of gen­ eral hospitals was given to the Surgeon General. In February of i.865 transports assigned to the medical department for hospital ships came exclusively under its control and could not be commandeered by officers of other staffs.^

2. Quoted in Ashburn, ibid.

3. Brown, The Medical Department of the United States Army from-1775 to 1873. pp. 239-244. 130

Barnes gathered a brilliant group of men around him. The authority he secured for the department, the publication of the Medical and Surgical History, the establishment of the Surgeon General's Library and the Army Medical Museum have given to him a place in medical history which has generally been denied to Tripler, Hewitt, Murray,

McDougal, Letterman, and Hammond. But it was these men, and others like them, who discarded in adequate measures and first initiated the procedures which in later wars would produce the finest system of mili­ tary medicine in the world.

Army medical care of the Civil War never became systematically organized even under Surgeon General Barnes. Not only was four years not long enough to build an organization such as had never existed be­ fore with the inexperienced and often incompetent surgeons of an impro­ vised army but the attitudes of the period were against it. The federal government was not the strong, central authority it is today, especially in time of war. States had surgeon generals who interjected their author­ ity. Governors wanted their wounded in hospitals within their own borders.

They restricted supplies and facilities to their own troops. They com­ missioned regimental surgeons and even assigned women as nurses.

Doctors were not held in high repute by either soldiers or nurses, and the latter, untrained as they were, frequently gave whatever old-wives treatment they fancied. 131

It is hard to remember that trained nursing, like safe hospi­ talization, is barely one hundred years old. When the Civil War began there was immense civilian enthusiasm to nurse the wounded but a total lack of experience. Much of the saga of the Rebellion, in both the south and the north deals with the volunteer citizens who went into hospitals and onto the battlefield to give nourishment and care to the sick and ' wounded. Principally remembered because of the widely read accounts of "their own experiences are Oliver Wendell Holmes, Louisa May

Alcott and Walt Whitman. But there can still be found long out of print little volumes on the wartime experiences of many others whose names are now forgotten.4

Trained nursing developed along with the organization and improved reputation of hospital care for the sick, which did not occur until the twentieth century. In civilian life of the Civil War period only the poor and destitute went to hospitals, most sick were cared for in the home. The war experiences in the construction and management of general hospitals actually gave the stimulus to improved civilian prac­ tices. But at the time the only nurses with any training or discipline were in the religious orders, and these promptly volunteered for military service. Sisters of Charity, Sisters of the Poor, Sisters of Saint Joseph,

4. Mary Gardner Holland (compiler), Our Army Nurses, 1895. William Howell Read, Hospital Life in the Army of the Potomac, 1866. Cornelia Hancock, South After Gettysburg (edited by Henrietta Stratton Jaquette), 1937. .132

Sisters of Mercy, representing nearly every state, not only staffed hospitals but went on the battlefields .^ Private Stockwell met two sisters accompanying the;troops on the road to Atlanta.®

Since there were not enough nurses in the Catholic orders to meet the need, it became the custom for Protestant ministers to ask for volunteers from their congregations > or for notices to be published in newspapers when heavy casualties occurred. Women who were active in the various reform movements were particularly apt to go into sol­ diers' work, combining their private relief ventures with nursing care.

Mary Livermore, wife of the editor of a religious periodical in Chicago, an active worker for abolition and temperance , took charge of nurse assignment in the west under the Sanitary Commission..7 Elida and John

Fowle, who "devoted all their spare time to philanthropic enterprises," held prayer meetings in Washington hospitals, ran a soldier's library which, in addition to books, supplied medicines, socks, shirts, and crutches, and after the second Battle of Bull Run took an ambulance, load of supplies to the field and established a hospital in a negro cabin.® Lucy Campbell Kaiser turned up at camps from St. Louis to

5. Josephine A. Dolan. Goodnow's History of Nursing (revised edition, Philadelphia, 1963), pp. 233-234.

6„. Abernathy (ed.). Private Elisha Stockwell Sees the Civil War, p. 89. 7.. Holland (compiler). Our Army Nurses, p. 38.

8. Ibid, pp. 175-187. im

Pittsburg Landing, distributing articles from her basket, "supervising" the scrubbing of dirty hospital wards, badgering her way onto trans­

ports of wounded, and finally securing a nurse commission from Mr.

Yeatman of the Sanitary Commission.®

In the summer of 1861 Secretary Cameron appointed Dorothea

Dix, known for her organizational zeal in care of the insane, to give

all necessary aid in organizing military hospitals, to aid the chief sur­

geons in supplying nurses, and to receive and bestow supplies from

individuals or associations. Miss Dix wished to discourage young

and flighty volunteers with romantic notions , and required that her

nurses be over thirty, plain looking, and dressed in brown or black with no hoop, bows, curls, or jewelry. Miss Dix's accomplishments

are somewhat controversial. She seems to have spent less time on

organization .than in chaperoning her charges. But she may have felt

that strict oversight was necessary to overcome the prejudice against women nurses held by the regular army. Surgeon Tripler expressed his

preference for Sisters because "they were better disciplined, more 1 ] discreet, judicious and reliable.” Cornelia Hancock wrote from

Gettysburg, "Miss Dix was in camp today and stuck her head in the

9. Ibid, pp. 175-187.

10. Dolan. Goodnow"s History of Nursing, pp. 235-236.

11. Tripler, "Report" in Official Records . .. Armies. Series I, Vol. V, p. 103. 134 tent but she does not work at all, and her nurses are being superseded very fast."^

Military regimental and post hospitals prior to the war were directly managed by stewards, the only authorized assistants to the surgeons. They were responsible for rations, medicines, and equip­ ment. When more help was needed enlisted men were assigned as cooks and nurses . But the establishment of general hospitals demanded a fixed non-combatant corps to run them. The failure of the military to establish such a group produced the great civilian effort to provide nursing care.

Nurses came into the army in many ways, with and without authorization. The Sanitary Commission and the Christian Commission recruited and assigned both men and women. In the first years of the war state governors commissioned women in regiments as "matrons."

Ruth Sinotte held such a commission in an Illinois regiment and at the request of the colonel accompanied the troops on the Tulahoma Raid.

Secretary Stanton discontinued such a commission in 1863 but regimen­ tal commanders frequently overlooked their presence. Private individuals of means would recruit and pay the expenses of a group of volunteers and would forward foody dressings, and bedding to them for distribution

12. Henrietta S. Jaquette (ed.). South after Gettysburg (New York, 1937) > p. 21. The letters of Cornelia Hancock.

13. Holland (compiler). Our Army Nurses, p. 129. 135 to hospitals and camps. ^ Indeed, one of the reasons for the organiza­ tion of the Sanitary Commission was the need to regulate the well meant but often foolish flood of private donations and activities „ Par­ ticularly in the west it was not unusual for a woman to accompany her husband into the service. Mary Loomis entered the service with her husband in 1861 under no other authorization than that of the regimental surgeon. Remaining with the regiment until her husband was killed at

Chickamauga in 1863, she worked at hospitals in Nashville, Murfrees­ boro, and Huntsville for about a year and the rest of the time was in 15 camp or on the march with the troops. Other women were sent for by their husbands when they were wounded and stayed to continue hospital duty. Elizabeth Nichols went to her husband at Camp Douglas , Chicago where she was put on the hospital staff as was he when he became con­ valescent. They accompanied the regiment to Washington and cared for the sick at Fairfax Seminary and in camp at The Stockade where she slept in the same hospital tent that sheltered typhoid patients and eighteen cases of smallpox. ® Hospital surgeons, stewards and cooks sent for their wives or other capable women who could help them. Julia Tompkins took her little boy along when she went to help her husband who was in

14. Ibid, p. 19.

15. Ibid, p. 87.

16. Ibid, pp. 95-97. 136 charge of the kitchen at Benton BarracksSt. Louis. The soldiers added their entreaties that the child be allowed to stay because "he enlivened

so many of /their/ lonely hours .

The Dix and Sanitary Commission nurses were customarily sent to the two model hospitals, Armory Square in Washington or Benton Bar­ racks in St. Louis to learn their duties. They were first assigned to the laundry room or diet kitchen of a hospital and in their free time helped with patient care. With experience they would be given charge of a ward. These nurses held valid commissions, received a small salary, and were pensioned following the war.

The status of the independent nurses was less well established.

They either learned their duties by observation or were instructed by the ward stewards and surgeons. Mrs. M. J. Boston was asked by a surgeon

J - . at Gettysburg if she could " wash wounds." When she admitted her ignor­ ance, he gave instructions as to the amount of blue stone to drop in a bucket and she set about her unfamiliar task.M an y of these women were never formally commissioned, worked only for a brief time, moved from place to place at their own volition, or became sick and went home.

For years after the war Congress received petitions for pensions from these nurses who were never registered on the army rolls.

17/ Ibid, p. 107.

18. Ibid, p. 427. 13 7

The women exercised great independence in "their activities.

The idea that the military could never provide and keep in operation an adequate medical service prevailed throughout the war and influenced women to take matters into their own hands. Cornelia Hancock's letters continually relate the privation suffered by the wounded in the days immediately following a battle, hard bread and salt pork the only rations , lack of dressings and bedding and shelter. In almost every letter she urged her friends to support the Sanitary Commission and send the much desired soft bread, jellies, preserves, butter and tea and linens. The famous Mary Ann Bickerdyke, holder of a degree in botanic medicine from Dr. Hahneman0s short course in homeopathy at Philadelphia, col­ lected one hundred cows and a thousand chickens on an island in the 19 Mississippi near Memphis to supply the hospitals in the area. Walt

Whitman found that the greatest pleasure he could bring to the wounded in the Washington hospitals was the iced drinks of blackberry and cherry syrup which he prepared and administered himself , and the small jars of jelly which he distributed. The lack of sugar provided in the hospital diet is quite apparent from these reports.

Perhaps less called for than their independence in the matter of diet was the complete freedom felt by the civilian volunteers to criticize surgical and medical practice and to use home remedies of their . :

19. Ibid, p. 526. 138 own choice. Letterman wrote of the difficulty experienced by the doctors in persuading volunteers that the wounded did better in barns and tents where there was free circulation of air than in the stuffy, unventilated houses of that era. Not understanding that the prevalent wound gangrene was spread by using the same sponge and bucket from patient to patient, nor having any sound explanation of the causes of typhoid and malaria, nevertheless, observant army doctors learned from their experience with thousands that fevers and wound infections did do better in the open air.

Nevertheless, it was common practice for families and townspeople to personally take wounded men from battlefields in their vicinity and care for them in their own homes. This practice was a significant factor in the inaccuracy of the figures as to wounds and deaths in Civil War sta­ tistics. And the belief that wounded were not well cared for unless they were "housed" lay behind much of the criticism of army medical practice.

The personal reminiscences of both soldiers a:nd nurses are rich sources of information for the home medical practices of that day. On the hospital ship Imperial Ruth Sinnotte proceeded to treat a typhoid patient by binding compresses of brandy and red pepper to the soles of his feet, palms of his hands, and breastbone. By modern standards her treatment of dehydration by patiently trickling chicken broth and brandy 20 down his throat would be considered the more effective treatment.

20. Ibid. p. 129. 139

Elisha Stockwell had no use for his regimental surgeon. The only time he ever went to him was when his pants had been torn to pieces in the cane brakes of Bayou Macon and he needed a good pair of cotton flannel pants to protect his legs.21 Otherwise, from Shiloh to Atlanta his various ailments received self treatment: skin rash from poison oak was washed with a solution of saleratus made by an old soldier, diarrhea was dosed with a tea made of hazelbrush and blackberry roots made up by the

"country boys."2 2

There were no separate operating rooms in either the front line or general hospitals of the Civil War. On the field, operating tables, used almost exclusively for amputations, were set up in the open. In the hospitals, secondary procedures were performed in the open wards.

Particularly criticized as "barbarous" by the volunteer nurses was the procedure of probing for retracted blood vessels and ligaments, which from a surgical point of view was mandatory. One group of nurses staunched the hemorrhage from a shoulder artery with manual pressure until the soldier was baptized and then let go rather than call a surgeon to ligate the vessel.Granted, it took a strong stomach to witness the crude procedures of the period with no understanding of the necessity for them .

21. Abernathy fed.)-. Private Elisha Stockwell Sees the Civil War, p. 61.

22. Ibid, pp. 28, 79-85. 23. Ibid, p. 136. Until 1864 the volunteers not only did much that they wanted

to but went where they wished. Sufficient influence could secure a pass

from Secretary Stanton, Surgeon General Barnes, or a corps commander.

However, when Grant crossed the Rapidan his order excluding women

from the army was strictly enforced. Not even his favorite, Mrs.

Bickerdyke could accompany the troops from then on although they con­

tinued to provide the principal nursing force in the general hospitals set

up in the rear of the advancing army.

By 1864 there were 190 general hospitals established in the 24 north, with 120,521 beds. The first of these hospitals were impro­ vised in colleges, hotels, warehouses, government buildings, and

private homes. Such buildings required a great deal of remodeling to

make them suitable for the care of bed patients. The remodeling that

was done considered ventilation, water supply, bathrooms and lava­

tories, kitchens, the transportation of patients to upper floors, and

storage space. It was believed that not only a specified amount of air

space should be provided each patient but that the air must be moving,

not stagnant, to prevent gangrene, erysipelas, and pyemia. Blocks of

wood were nailed in the sashes so that patients could not close the

windows and air ducts were built from ceilings to roof. Since the rooms

or wards were heated by coal stoves the men often complained of the

24. J. K. Barnes, "Annual Report" in Official Records ... Armies, Series III, Vol. IV, pp. 790-792. I ll cold drafts along the w alls, Where at least one bathroom and lavatory were not adjacent to a ward/ one was installed, the water being brought in through lead pipes under pressure from steam pumps. Hotels were favored as hospital buildings because they had water closets. Factory buildings which had a toilet on each floor were occasionally used. In some instances» the facilities reported were wooden seats on barrels sunk in the ground „ It was necessary to construct outdoor sinks in all in sta n c e s„25

As troops were trained and took the field, barracks became available for hospital use, but few of them were satisfactory. The buildings were too narrow for two rows of beds, the floors were imper­ fectly joined and had no air space beneath, the window arrangements did not provide cross ventilation, they usually lacked a sufficient water supply or disposal facilities, the arrangement of the buildings was not convenient. At Camp Dennison, for instance, the buildings stretched for a mile in a straight line. From the grounds taken over for the Clifburn Hospital in Washington, 1500 load of offal had to be re­ moved.

The ridge ventilated wooden sheds which Letterman had designed at Parkersburg were fine in summer, but the unbattened rough board sides

25. Woodward et al (eds.), The Medical and Surgical History Rebellion, Medical, III, pp. 899-903.

26. Ib id , ■ 142 and the fact that the roof ventilators could not be closed made them un­ bearably cold in winter„ However, from the basic idea, the pavilion-

' ' . - type hospital was enlarged upon and experimented with throughout the war years. Photographs of the aggregation of units which evolved in the

Civil War could easily be mistaken for a hospital of World War II. The great difference lay in the interiors and in the plumbing.

Domestic sewage systems had not developed very far when the Civil War began. In the Judiciary Square and Mt. Pleasant Hospitals, built in Washington according to Sanitary Commission plans, privies were constructed between each pavilion, the pavilions extending from each side of a central corridor in parallel rows. To save money, the partitions were not carried to the ceilings and the stench, soon pervaded the entire hospital. While this situation was corrected by installing vents and finishing the partitions, the plan of putting pavilions on both sides of the central corridor fell into disfavor. But there was no objection to parallel corridors with pavilions on the outer edge and service rooms in the middle, and various modifications were built. At the McClellan hospital in Germantown the corridors connected at the ends, where kit­ chens and storehouses were located. A car track laid on the corridors facilitated the distribution of food and supplies. The Mowrer Hospital at Chesnut Hill was built in a square with service rooms and administra­ tion offices in the center, Harewood was V-shaped, and Hammond at

Point Lookout was round, the pavilions radiating from a central core. 143

The scarcity of water in the Washington area was a problem in sewage construction. At Carver, Mt„ Pleasant; and Columbia College Hospitals, box sinks were in use to the end of the war . The Campbell was so (Situ­ ated that it could use Potomac River water. There was a water closet for every other ward and the sinks for convalescents were cleaned by a running stream. At Hilton Head the sinks were built out over the beach so they could be cleaned by the tide. The Chester Hospital in Philadel­ phia was the worst. Five parallel buildings, three wards long, were connected at the ends by kitchens and dining rooms. The spaces be­ tween were occupied by the latrines which had water-filled vaults but no drains. Even with the addition of drains the conditions were unsatis- . factory. 27 The knowledge gained in these numerous constructions was not ignored, however, and finally the Secretary of War directed that the quartermaster would build only from plans that were, presented by the medical division and approved by a medical inspector. In the meantime, architects with no knowledge of the practical needs of illness, sold the government on structures that could hardly be called facilities.

The staff organization of these hospitals generally followed that proposed by Tripler in 1861: a surgeon in charge; an executive officer; ward physicians—-one to seventy-five patients; wardmasters—responsible for diet, medication, the performance of nurses, and general police; stewards—one acting as quartermaster sergeant, one as subsistence

27. Ibid. . 144

sergeant, one as chief wardmaster. In addition, there were medical

cadets; nurses—women volunteers, convalescent and disabled soldiers;

hired civilians—cooks>. clerks, and bakers; guards and police—-the

Veteran Reserve Corps „2ft

It is impossible to determine how effective these hospital

staffs were. The mortality in various hospitals at various times resulted

more from the character of the cases received than from the care that

was given. For what did they know to do? The surgeons amputated and

28% of the cases died. 29 Despite the emphasis on ventilation erysipelas

and gangrene spread. While cases of smallpox were isolated in the

general hospitals, other fevers lay in the same wards with the uninfected.

In the sovereign treatment of "washing wounds," the same sponge and

the same bucket went from bed to bed, carrying infection from man to

man. Lacking any specific remedies, a concerned citizenry stroked

fevered brows, washed the shattered bodies, sang, distributed Bibles,

wrote letters by the score, and prayed.

How many Union soldiers were wounded between First Manassas

and Appomatox will never be known. Incomplete records in the Surgeon

General"s office list 253,142 wounds treated by army surgeons, of which

28. Ibid, p. 955.

29. Mitchell, "The Medical Department in the Civil War, " in ... Journal of the American,Medical Association, LXII (May 9, 1914), p. 1447. 145 seven to ten percent, died . 30 In 1865 the war was over, but in that year the hospital population was at its greatest with old and current cases.

Walt Whitman wrote the testimony of the American public, its . bright innocence long since taught the harsh lessons of reality

„ „ „ the Government ... is always full of anxiety and liberality toward the sick and wounded. The system in operation in the permanent hospitals is good, and the money flows without stint. But the details'have to be left to hundreds and thousands of subordinates and officials. Among these, laziness, heartless­ ness, gouging, and incompetency are more or less prevalent.

I have seen many battles, their results, but never one where there was not, during the first few days, an unaccountable and almost total deficiency of everything for the wounded— appropriate sustenance, nursing, cleaning, medicines. Stores .. . No thorough preparation, no system, no foresight, no genius .32

Quick to blame as always when its emotions are deeply Stirred, the American public would not pass judgment on itself . The least amen­ able of all people to preparation, system, and discipline, it ignored the foresight and genius that appeared here and there in the care of the in­ jured but failed because neither leaders nor workers were willing to yield their own independence of action to another authority. It was an age in which the individual was more influential than the group, In the general

30 . Richard M . Buck _et al (eds.), The Complete Writings of Walt Whitman (10 vols., New York, 1881), Vol. I, ff p. 117.

31. Walter Lowenfels fed.). Walt Whitman" s Civil War (New York, 1960), p. 107.

32. Ibid, p. 103. .

< r 146 level of provincial ignorance the professional, be he military or medical, was granted little stature.

Certain conditions of war are inevitable. Agressive action into enemy country cannot choose the terrain on which it must fight. The ex­ perience of Grant's army in the Mississippi bayous—slogging through water ankle to armpit deep, cutting through jungle growth, living in booths of boughs, their sleep disturbed by night alarms, their diet ex­ clusively salt meat and hard bread > depleted by the " malignant form of remittent fever," negro huts and boat docks their only hospitals^— was paralleled eighty years later by the American army on Guadalcanal.

And a similar public cry of unnecessary hardship and neglect was raised.

Even the advent of the airplane has not solved all logistical problems.

The provision of medical aid to troops under fire was no less a problem on the beaches of Saipan and Iwo Jima than it was on the plain under Marye's Height. The great difference was the medical knowledge and technology which had been gained through the years.

The medical facilities of the Civil War were an improvised m ess. The program of aid to the sick and wounded, both government and voluntary, was confused, overlapping, inadequate when needed, and wasteful. The loose organization of the entire military effort did not hold individuals properly accountable or exercise a systematic

33. Woodward et al (eds.), The Medical and Surgical History ... Rebellion, Medical, III, p. 154. 147:

discipline which could control the normal but damaging weaknesses of human nature. But it was the lot of the United States to fight the first

great modern war. No army before had put so many troops on the field

or suffered such casualties. Yet the 27,000 wounded at Gettysburg were all under some kind of shelter within twenty-four hours, while at Waterloo the wounded lay on the field for ten days

The medical experiences of a war were for the first time chronicled by the British after the Crimea and the Americans after the

Rebellion. Yet it took the development of a strong federal authority to establish and support a permanent military medical organization which would be effective. As soon as the Civil War was over the nation's armed forces were disbanded as quickly as possible By the end of

October 1865, one hundred seventy of the 205 general hospitals had been discontinued and their patients discharged. The 5,991 volunteer surgeons and the 5,532 contract surgeons had been musteredo u t .35

From January to July 1866, the Congress debated and amended the bill to regulate the size of the peacetime medical department. As final­ ly passed the Act allowed a Surgeon General, an Assistant Surgeon

General, a Chief Medical Purveyor with four assistants , five medical

34. Mitchell, "The Medical Department in the Civil War, " in Journal of the American Medical Association, LXII (May 9, 1914) , p. 1447.

35. Brown, History of the Medical Department of the United States Army from 1775 to 1873, p. 245. 148

storekeepers, seventy surgeons, and one hundred forty assistant sur­

geons for the regular army. The act specified that the Surgeon General

should hereafter be appointed from the regular medical corps.This

staff was immediately called upon to serve the widely dispersed forces

engaged in the Indian Wars in the west. The medical story of these out­ posts continued to be one of lack of supplies and facilities. The great

military medical endeavor returned almost to its level of 1861.

By the time of World War I bacteriology, epidemiology, and immunology had completely changed the practice of medicine . While the Medical and Surgical History of the Rebellion no longer had medi­ cal scientific value, the value of its data on military health hazards,

ambulance and field hospital service, and the construction and organi­

zation of general hospitals was recognized, and finally used in organ- o 7 izing the finest permanent military medical organization in the world.

In preserving the practical facts of their experiences for the future, Tripler and Letterman, Brinton, Hewitt and all the others whose reports appear in the History's pages were not writing for their own

glory, for their experiences in the most had been dismal ones. But as professionals and realists they were less confident than most that the

country would continue to walk the "broad, majestic days of peace."

36. Ibid, pp. 248-250.

37 .. See the Introduction in Lynch et al feds.), Medical Department .... World War. . 148

As American pioneers in the science of hygiene and medicine they en­ visioned the realities which the future would disclose.

Now thou stridest on, yet perhaps in time toward denser wars, Perhaps to engage in time in still more dreadful contest, dangers, Longer campaigns and crises, labors beyond all others .-38

In those more dreadful contests which did come the nation finally recog­ nized the founders of military medicine in the great army hospitals which today bear many of their names.

38. Walt Whitman, "As I Walk These Broad Majestic Days,” in Lowenfels (ed.). Walt Whitman's Civil War, pp. 107-108. REFERENCES

ABERNATHYe BYRON R„ , ed. Private Elisha Stockwell Sees the Civil W ar. Norman: University of Oklahoma Press, 1958.

ADAMS*. GEORGE WORTHINGTON . Doctors in Blue. New York: Henry Schuman, 1952.

ASH BURN* P.M . A History of the Medical Department of the United States Army. Boston: The Houghton Mifflin Company, 1929.

BROWN* HARVEY, E. The Medical Department of the United States Army from 1775 to 1873. Washington: Government Printing Office, 1873.

CATTON* BRUCE. This Hallowed Ground. Garden City: Doubleday, 1956.

Congressional Globe, 37 Cong., 1 Sess.; 37 Cong., 3 Sess.

DOLAN* JOSEPHINE A. Goodnow1 s H istory of N ursing. Revised edition. Philadelphia: W. B. Saunders Company, 1963.

HAMMERSLEY* THOMAS H0S., ed. Complete Army Register of the United States for One Hundred Years. 1779-1879. Third edition. Washington: Thomas H. S. Hammersley, 1881.

JAQUETTE, HENRIETTA STRATTON, ed. South after G ettysburg. Letters of Cornelia H ancock. 1863-1868. New York: Thomas Y. Crowell Company, 1937.

Harper's Weekly, V (July 1, 1860-June 30, 1861).

HOLLAND* MARY A. GARDNER, com piler. Our Army N u rses. Boston: B. W ilkins and Company, 1895 .

HOLMES, OLIVER WENDELL. The Complete W ritings. Revised edition. 13 vols. Cambridge: The Riverside Press, 1891.

House Executive Documents, 37 Cong., 2 Sess., IV; 37 Cong., 3 Sess., IV, Doc. 1.

ISO' House Miscellaneous Documents, 37 Cong., 1 Sess „, Doc. 6, Doc. 38, Doc. 23.

HUME, EDGAR ERSKINE. "Introduction to Military Medicine, " The Mili­ tary Surgeon, CII January 1948).

.______. "Medicine and War." The Military Surgeon, CIII (September 1948).

. JOHNSON, ALLEN and MALONE,, DUMAS, eds. Dictionary of American Biography. 22 vols., including a general index and a supple­ mentary volume. New York: Charles Scribner's Sons, 1928- 1944.

LAMMAN, CHARLES. The Red Badge of M ichigan; a C iv il, M ilitary and Biographical History. Detroit: E. B. Swift and Company, 1871.

LOWENEELS, WALTER, ed. W alt W hitm an's C ivil W ar. New York: Alfred A. Knopf, 1960.

LYNCH, CHARLES et al. eds. The Medical Department of the United States Army in the World War. 15 vols. Washington: Govern­ ment Printing Office, 1921-1925.

MAJOR, RALPH H. A History of M edicine. 2 vols. Springfield, 111.: Charles C Thomas, 1954.

MITCHEL, S. WIER. "Medical Department in the Civil War, " The Tournal of the American Medical Association, LXH (May 9, 1914).

PACKARD, FRANCIS R. History of Medicine in the United States. 2 vols. New York: Hafner Publishing Company, 1931.

PHISTERER,' FREDERICK. Statistical Record of the Armies of the United States. New York: Charles Scribner's Sons, 1883.

PRATT, FLETCHER .. Stanton, Lincoln8 s Secretary of W ar. New York: / W. W. Norton and Company, 1953.

. QUINT, ALONZO. The Potomac and the Rapidan. Boston: Crosby and Nichols, 1864.

Revised Regulations for the Army of the United States, 1861. Philadelphia, 1861. 152

SCOTT, R.No al, eds„ The War of the Rebellion: a Compilation of the Official Records of the Union and Confederate Armies „ 70 vols „ Washington: Government Printing Office, 1880-1901.

Senate Executive Documents. 37 Cong., 2 Sess.

SHRYOCK, RICHARD H. The Development of Modern Medicine: An Inter­ pretation of the Social and Scientific Factors Involved. Phila­ delphia: Knopf, 1936.

SMALL* ABNER R. The Road to Richmond. Edited by H. A. Small. Berkeley: The University of California Press, 1939.

SMITH, HUGH H. "Notes on the History of Clinical Thermometry." Arizona M edicine, XIV (September 1957).

UPSON, THEODORE. W ith Sherman to the S ea. Edited by O scar Osburn Winther. Baton Rouge: Louisiana State University Press, 1943.

VAN ALSTYNE, LAWRENCE. Diary of ah Enlisted Man. New Haven: Tuttle, Morehouse and Taylor, 1910 .

WHITMAN, WALT. The Complete W ritings. Edited by Richard M. Buck ^etjal. 10 vols. New York: Henry W. Knight, 1881.

WILEY, BELL IRWIN. The Life of Billy Yank. Indianapolis: The Bobbs- Merrill Company, 1951.

WINSLOW, C.-E. A. Man and Epidemics. Princeton: Princeton Univer­ sity Press, 1952.

WOOD, HORATIO C. et al, eds. The Dispensatory of the United States. 23 ed. Philadelphia: J. B. Lippincott Company, 1943.

WOODWARD, E. M. Our Campaigns. Philadelphia: J. E. Potter, 1865.

WOODWARD, J. J. e t a l , e d s . The M edical and Surgical H istory of the War of the Rebellion. 6 vols. Washington: Government Printing Office, 1870-1888.