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Civil War Medicine
Before the call to arms, the Army Medical Department was headed by 80 year old Colonel Thomas Lawson. His primary goal was to keep the expenses to a minimum, in other words, what we call a bean counter today. He thought medical books were an extravagance and is reported to have had a fit when he learned a post had 2 sets of surgical instruments. The personnel in the Medical Department to serve an army of about 16,000 men, included the Surgeon General (Lawson), 30 surgeons and 83 assistant surgeons. At the onset of hostilities, 3 surgeons and 21 assistant surgeons resigned to go with their home states in the South. Three assistant surgeons were dismissed for disloyalty. The net result was 98 officers with experience in dealing with military health care. By the end of the war 11, 000 doctors would be on the Union Army payroll. That is a fantastic increase in manpower. In the South, the number of doctors serving in the military was somewhere between 3 and 4 thousand. In both armies there were also contract surgeons, who were not given rank as well as lots of volunteers who kindly pitched in during times of crisis. By today’s standards the training and knowledge of the medical practitioner of the 1860’s would score about a negative 3 on a scale of 1-10. There were some medical schools with the curriculum being a set of lectures given over a two year period. The second year was basically the same as the first. I guess if it wasn’t gotten the first time there was the next year. There was no laboratory training. After the second year, additional training was to serve as an assistant to a practicing doctor. In fact, up until about 25 years before the war, the majority of medical training was obtained by working with a practicing doctor. Harvard, considered one of the better medical schools, had no stethoscope until 1868, thirty years after it was invented. They got their first microscope in 1869. All of this was after the war. Now-a-days High School Biology departments have a whole closet full of microscopes. Perhaps the war and its medical needs helped prod schools into improving their course work. Many schools were diploma factories, since there were no State licensing systems to guarantee a certain level of skills. In other words, almost anyone could be a doctor.
In the beginning, the organizational structure was not very well defined. The military knew there was a need to have an organized medical department. The wheels of such organizations turn very slowly. In the North, several civilian organizations sprang into life to keep an eye on medical affairs and to make recommendations to the powers that be on how to make things better. One of these organizations was the U. S. Sanitary Commission. Established in New York by prominent physicians and ministers. They set out to collect supplies and hold fund-raisers. Upon presenting themselves to the federal authorities, they were more or less sent packing as the medical department could take care of itself. They were persistent and proposed reforms so as to prevent what had happened in the Crimean War. Some of their proposals include the better examination of recruits, the training of cooks, the use of women nurses in hospitals, and the hiring of young medical men to dress wounds and perform similar services. These may sound like common sense now, but, back then they were revolutionary ideas. They finally got the attention of acting Surgeon General Wood who was replacing Lawson because he was dying. So the Sanitary Commission got going, it had no legal powers, only the right to investigate and advise. Meanwhile Lawson died only weeks after Fort Sumter. He was replaced by Clement A. Finley, the sexagenarian senior surgeon who had served since 1818 and was thoroughly imbued with Lawson's parsimonious values. He is not a big fan, but reluctantly agrees to allow the Commission to go forward. The U.S. Sanitary Commission was approved by Secretary of War Cameron on June 9 and approved by Lincoln on June 13 of 1861. Their executive secretary was Frederick Law Olmstead known as the architect of New York’s Central Park. Through the war the commission furnished vast quantities of medical and health care supplies.
In the West, they operated a fleet of boats to transport the sick and wounded to centralized hospitals. At their insistence, a hospital system was established that only had a mortality rate of 8% in caring for over a million white soldiers. For whatever reason the black soldier had a slightly higher mortality rate. This was far better than any previous statistic for military hospitals and even bettered some civilian hospitals. They helped establish hospital gardens, To raise badly needed produce for the hospital patients diets. Convalescent soldiers were given the duty of tending these gardens, which had good therapeutic value. By 1864, the army had caught up to the commission in the ability to inspect hospitals and so the Commission abandoned that part of its program.
One other large group in the North was the Christian Commission. More into the supply and care department than inspection. In addition there were many more groups that existed on a local or regional domain. The Christian Commission is credited with the introduction of a "kitchen on wheels". It was simply some boilers mounted on a pair of wheels connected to a provision cart much like a cannon and caisson. It came about in 1865, a little late to be of much service, but shows some of the improvements that came about as a result of the war. In the South, there were no nation wide civilian commissions except for the establishment, in 1864, of the Association for the Relief of Maimed Soldiers. There were many very effective local and state associations that provided much in the way of relief of the southern fighting man. The most needed item seems to be clothing. I think the lack of wide spreading relief organizations in the South is, of course, due to the feeling of greater allegiance to ones state rather than the confederate nation. The end result of all of these organizations was better health care, sanitation, and hospitals for the soldiers of the war. It was far better than the military was originally willing to provide. After the war, these groups were the basis for the founding of The American Red Cross and similar organizations. The founder of the American Red Cross, Clara Barton, is credited with having done a lot of nursing when she really was more into the gathering and distribution of medical supplies. The closest she came to providing aid and comfort was while having an affair with a Major from the union army. The initial plan was to have a regimental surgeon appointed by the colonel of the regiment at its formation. This naturally opened the door for the medical care of a regiment to become congruent to its head. There was a definite need for standards to be established and examining boards to be established. So, in the beginning the medical care was just as messed up as the armies themselves. Over time, with the concerns of Surgeon Generals and the gadfly associations, appointments to the medical positions did result in more competent individuals. Originally, the game plan was to have the regimental surgeon take care of the needs of that particular regiment, as he was most familiar with those men. This would need a lot of tweaking as time wore on. The large numbers of wounded required more and larger care facilities at division and army levels. This also required more surgeons as you may remember by the large numbers mentioned earlier.
Let's go through a little of what went on with the medical people with regard to a battle. Once it appears a battle is eminent, surgeons are directed to locate a site for a regimental field hospital. The site chosen should be beyond the range of artillery, which was usually a mile or two behind the battle lines. A detail of about 10 men and the regimental band would be divided up, some to work in the field hospital and the rest to accompany the assistant surgeons and the troops. They would establish a "primary station" outside of musket range. The group of ten men from the regiment was the chosen method of assigning men to the care of the injured. The previous method was that some friend or friends of the injured would leave the fighting and take the injured party to the rear. This took good fighting men from the lines. The helping of ones friend to safety was never stopped, but it was decreased somewhat and the file closers could help in keeping sound bodies in the fighting. One story has it that when General Dan Sickles was injured, 50 men accompanied him off the field. That probably represented the effective strength of a company at the time. Sickles is the one who would go to visit his amputated limb after the war. By selecting ten men from the regiment, training could be done on how to effectively get the injured gathered up and removed for care. A word about the bandsmen, they were never considered to be of much service to the medical people as they were prone to disappear in times of greatest need. Some commanders, later in the war, would send the bandsmen to the front lines. I expect they were as effective there as with the medical staff.
Ambulances were supposed to carry the injured from the "primary station" to the field hospital and then on to general hospitals. The ambulances were under the control of the quartermasters and were more often than not given over for other tasks. They were originally driven by civilian teamsters. As a result, they were often not available for transporting wounded, or if available the driver had taken off. Some of the medical supplies included liquor, very tempting for civilian drivers. The quartermasters also had control of the food provisions. The need was there for the medical people to have control over everything related to the medical care of the soldiers. It took a lot of time and urging from the surgeons and sanitary commission to establish better ways to care for the wounded. After the Peninsula Campaign the ambulances were taken away from the regiments and organized under division and corps control, still with the quartermaster in control. They were to be manned by soldiers chosen by the medical department. With good training, improvements in removing injured at Second Manassas were evident. With more equipment and training, at Antietam, all the wounded had been removed from the right wing by two o’clock in the afternoon of the day after the battle and those from the left wing by that night.
It took until 1864 for Congress to legislate an ambulance corps act. Under it the Medical department had the right to choose and examine the men assigned for ambulance duty and removal of injured. The quartermaster still had control of ambulances and horses, but, was forbidden to use them for anything other than transporting injured soldiers and in emergencies, medical supplies. Anyone other than ambulance corps men were forbidden to assist injured from the field of battle. This organization for the ambulance corps was the model for other armies of the world up until World War 1. Even with well laid plans, the huge numbers of wounded in some battles and who controlled the field at the end dictated the quality of care given to the injured. In early battles, the confederate victories left their medical staffs to care for not only their wounded, but also many federals left behind by the retreating army. True, a surgeon might be left along with the injured, but he had no source of supplies other than the generosity of the enemy. The surgeon and his charges were considered prisoners and would have to await exchange or in the latter stages of the war, do time in places like Andersonville or Elmira. I would like to relate a few anecdotes to further illustrate a little more about Civil War health care. At least one individual impersonated a doctor and got away with it. So claims Robert Arthurs. He had 2 brothers who had gone to medical school and while all were living at home during that time, some of the knowledge must have been absorbed by Robert. He had tried to enlist as a soldier and had been turned down because of defective lungs. After Cold Harbor a call went out for volunteer doctors and one of Roberts brothers answered the call. Robert took off after him to bring him back as he also was of poor health. On the train headed to Washington, Robert fell in with a "real" surgeon and asked his approval to tag along. They quickly passed through the interviews and were contract surgeons headed to the army’s base at White House. He found his brother and set to assisting him. After a few days they were shifted to City Point.
He relates several incidents that are of interest and show his skills at the medical trade. In one he is walking through the surgical area when he comes upon a man that has been shot through the chest. The man has been left by the surgeons on duty to die as the wound is considered fatal. The injured man is an acquaintance from Pittsburgh. Robert says that he sees determination to live in the man’s eyes. He dresses the wound, administers kind words and whiskey. The man recovers, returns to duty, and serves the war out. On another occasion, he came on a man ticketed for amputation of a leg. In conversation with him on the chances of recovery from the amputation or no amputation, the decision was that it was about the same either way. The man preferred no amputation. With the injured's help, Robert straightened the leg and splinted it with cracker box boards. Upon discharge, the man came by Roberts house and thanked him for saving his leg even though he had to use crutches. I guess the feeling that he still had the leg was of some comfort to the soldier. Robert was on ‘’duty" for about 2 months. He did not apply for pay feeling that he had been well compensated by the satisfaction of having done some good in tough times. If his episode is true, it is probably well that he did not leave a paper trail.
A doctor Joseph Alison enlists in the Alabama Mounted Rifles as a private, not as doctor. He is stationed in the Pensacola area from May 1861 to around March of the next year when his unit is transferred to the Corinth area. In Pensacola his unit is involved mostly with self preservation from the insects and other creepy crawlys. At Corinth, his profession is put to use in establishing a facility to care for the sick. He is undersupplied and over worked. The following is several days account from his diary. April 5th-The battle line is formed by dark and the soldiers sleep on their arms. We can hear the enemy’s drums distinctly. We must fight tomorrow. April 6th-About one o’clock we marched to the right and then went into the midst of battle, I there saw the dead and the dying lying thick. I saw many more Yankees that our own men. Farther I went the thicker they lay. We have driven the enemy back. The Yankees fought well but could not withstand the impetuous attack of our men. The Alabama Mounted Rifles dismounted and went with an infantry regiment. Drove the enemy back until under cover of their gunboats, which threw shells so thick we were compelled to fall back. Darkness, and so ended the fight of the 6th, the hardest fought battle ever fought on this continent. With night, my work commenced. Dr. Riggs and myself found a tent full of Yankees and we went to work to dress their wounds April 7th-I thought the fight was over and we had won the greatest
victory ever gained on this continent, but alas! the enemy had been largely
reinforced during the night, and came on us in strong force at 8 o’clock, when
the conflict again opened. Our men were exhausted by hard marching and
fighting., many regiments were scattered so as not to get together again, still
we charged them. We drove them back many times, but they returned with fresh
troops to the attack. Overwhelmed by numbers, we had to fall back. Reached
Corinth by night. All the wounded have been carried there.
At the tender age of 22, without having treated a sick person or having lanced a boil, Dr Simon Baruch was appointed assistant surgeon to 500 infantry. His unit was assigned to join Longstreet's Corps just prior to Second Bull Run. He was given the task of finding a site for a field hospital. He was given the opportunity to perform his first surgery. As the army moved across the Potomac into Maryland, he was given the duty to act as surgeon of the rearguard. In this capacity, he examined all the sick. He commented that as the distant boom of cannon commenced, so too did the number of illness cases. Along with the sound of musket fire came many more cases of illness. He called this new disease "Battlesickness". He was left behind at Boonsboro as the army moved across South Mountain. He and his patients were now captives and he was later exchanged. The following year he is at Gettysburg where again he is left behind with the wounded. He spent about 6 weeks treating the wounded before being taken off as a prisoner. In his own words: Early in the morning of the second day I was accosted by a clerical looking gentleman, who introduced himself as Dr. Winslow of the Christian Commission. With benignity beaming from his eyes he said, "Doctor, I came to offer you some of our supplies. Your General Stuart has cut our Communications, but we will divide with you." This was the first and only instance in my life that illustrated the precept "Love thine enemy." On the following day I received from the Christian Commission at Gettysburg a bag of articles, useful for the wounded, but what is more precious was the information that a visit to the U. S. Sanitary Commission might be profitable. Acting upon this suggestion, I applied to that office, where I was treated with unexpected consideration. I was asked the location of my hospital. And the number of wounded, and was turned over to a clerk who treated me as if I were a merchant purchasing goods, so anxious was he to fill my orders. Before he had proceeded far, he said that unless I had a wagon to load my supplies upon he could not proceed, since there was no room for laying out my selected articles: even the sidewalk and part of the street was crowded with barrels and boxes of provisions, and everything that a sick or wounded man could ask for. His suggestion that I might obtain a wagon from the Quartermaster was received with incredulity. What was my surprise, however, when in answer to my request to the polite young officer in charge of the Quartermasters department, I was told, "Take a seat doctor. Here is a New York Herald, from which you can learn what has become of general Lee. Read it until one of our wagons arrives." Here I obtained the first glimpse of the outside world that I had had in three years. The driver of a six-mule wagon was soon under my command. After obtaining commissary and medical supplies, upon requisition approved by medical director letterman, whose courtesy I have never forgotten, my wagon was loaded to its full capacity. Among the articles I received was a barrel of eggs, packed in sawdust, and an ample supply of wines and other delicacies and necessaries to make my wounded and my employees comfortable for a month. Two noble women of the most renowned Maryland ancestry, in charge of an English nurse, took up quarters in our garret, and became "Angels of Mercy" in their ministrations to the wounded in life and in consigning the dead to honored graves. A constant stream of sympathetic visitors surreptitiously brought delicacies to our wounded and cheered them in their sad captivity. One day after I had performed an operation, a physician from Baltimore presented me with a fine case of instruments, with my name engraved on it. End quote He was held captive in Baltimore until exchanged, with others, for Union doctors captured at Chickamauga. He served in Early’s retreat back up the Shenendoah Valley. In February 1865, he was transferred to hospital service in North Carolina, Near his home state South Carolina. Simon Baruch was the father of Bernard Baruch, a person of note in the early 20th century.
Most of the South’s hospitals were in Richmond. One of the most noted was Chimborazo. It overlooked the James River and opened in October 1861. It had a capacity of 8,000 patients. It has been described as the largest military hospital in the history of this continent. Its site commanded an excellent view, an abundant supply of good water was available, and there was natural drainage on 3 sides. Chimborazo may properly be called a hospital center as it consisted of 5 separate hospitals or divisions. Each hospital or division comprised thirty buildings or wards and each building could accommodate from 40 to 60 patients, whose bunks were arranged in several rows. There were about 150 buildings erected on the site. Each was about 150m feet long by 30 feet wide and one story high. There was plenty of doors and windows for ventilation. The surrounding area had tents for convalescent patients. The hospital even had its own cemetery. Five soup houses, five ice houses, Russian bathhouses, a bakery capable of making ten thousand loaves of bread daily, and a brewery in which four hundred kegs of beer were brewed at a time were also part of the Chimborazo establishment. A large farm, "Tree Hill," owned by Franklin Stearns, was used by the hospital for the pasturage of some two hundred cows and from three hundred to five hundred goats. Hospital trading vessels operated between Richmond and Lynchburg and Lexington to obtain needed provisions. The Secretary of War designated Chimborazo and its ground an independent army post. Each division of the hospital had its surgeon in charge, directly responsible to the commandant. The surgeons in charge supervised the work of some fifty assistant surgeons who were in charge of the various wards. Another large hospital in the Richmond area was the Winder hospital with a capacity of about 5,000 patients. It boasted a garden worked by convalescents and 69 cows. It was opened in April, 1862. A third one with a capacity of 2500 patients was the Jackson hospital opened in the summer of 1863. An official from the U.S. Sanitary commission, after the war was over, stated that this hospital was excellent and in some respects was superior to most of the union hospitals. In early 1864 there were some 20 hospitals in Richmond. On duty were 43 surgeons, 65 assistant surgeons, and 18 acting assistant surgeons. Soldiers were assigned to the hospitals by their home state. For example Chimborazo received sick and wounded from Maryland, Virginia, Tennessee, Kentucky, and Missouri. It would appear that the Confederate hospital system operated more efficiently than the government.
* WebMaster Note: The article was recently presented to the Mid Missouri Civil War Round Table by Harold Meiderhoff. Photographs are from the Library of Congress and from the U.S. Army Medical Department.
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n most every Civil War Museum that I have visited, there is a display that
contains a surgical kit. This is to represent the doctors and surgeons and the
service they performed. The display May make some mention of the number of
deaths during the war, several hundred thousand, and the fact that 2 to 3 times
as many died from disease in comparison to the number that actually died as a
result of wounds received in combat. You see very little information in the
displays about the men and women who served to heal and cure those inflicted
with disease or wounds. I will try to provide you with some information so as to
better understand the Medical Staff. A couple of exceptions are the General
Sweeny museum near Wilson's Creek and a museum in Pensacola, Florida. The Sweeny
museum has several displays on medical care. I visited the museum in Pensacola
last week. It has a large collection of artifacts relating to the war (North and
South) with a huge collection of prints by Kuntsler, Triaoni, Gallon, and
several other noted artists. It is well worth the visit if you are in the area.
Most impressive was the collection of medical artifacts. It had artificial
limbs, crutches, splints, an embalming bench, a transport chair, stretchers, a
stomach pump usable from either end, glass eyes, bleeding cups, blister cups,
and syringes. Notable were several enema syringes with a capacity of around a
quart of fluid. Can you imagine the smile on the face of a private who is
serving as a medical attendant when his sergeant is brought in for a flushing.
