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XVI. hospitals and ambulances.

The sketch embodied in this chapter is an attempt in a limited space to give the public a more adequate idea of the medical department of the army, what it was, how it grew up, and something of what it accomplished. I enter upon it with a quasi-apology for its incompleteness, understanding fully how inadequate any mere sketch must be regarded by those whose labors in this department made its record one of the most remarkable in the history of the war; yet, like all the other topics treated in this volume, it must undergo abridgment, and I can only hope that what is presented will, in some degree, do justice to this much neglected but very interesting theme in the Rebellion's annals.

At the time of the battle of Bull Run there was no plan in operation by which the wounded in that battle were cared for. Before this engagement took place, while the troops were lying in and around Washington, general hospitals had been established to provide for the sick. For this purpose five or six hotels, seminaries, and infirmaries, in Washington and Georgetown, and two or three in Alexandria, had been taken possession of, and these were all the hospital accommodations to be found at the end of the first three months. So general was the opinion that the war [299] would be speedily ended no one thought of such a thing as building permanent structures for hospital purposes.

But this condition of affairs soon after changed. Preparations for war were made on a grander scale. The Army of the Potomac, under the moulding hands of McClellan, was assuming form, and the appointment by him, Aug. 12, 1861, of Surgeon Charles S. Tripler as medical director of that army indicated a purpose of having a medical department set on foot and put in completeness for active service. Let us pause and glance at the situation as he found it, and we may, perhaps, the better appreciate the full magnitude of the task which he had before him.

Army Regulations were the written law to which it was attempted to have everything conform as far as possible. But when these regulations were drafted, there was no expectation of such a war as finally came upon us, and to attempt to confine so large an army as then existed to them as a guide was as impossible and absurd as for the full-grown man to wear the suit of clothes he cast off at ten years.

“ New times demand new measures and new men,” and so in certain directions Army Regulations had to be ignored. For example, they provided only for the establishment of regimental and general hospitals. A regimental hospital is what its name indicates — the hospital of a particular regiment. But if such a hospital became full or received some patients whose ailments were not likely to submit readily to treatment, such cases were sent to a General Hospital, that is, one into which patients were taken regardless of the regiment to which they belonged. But in these early war times, in the absence of a system, any patient who was able could, at his pleasure, leave one general hospital and go to another for any reason which seemed sufficient to him, or he could desert the service entirely.

By general orders issued from the war department May 25, 1861, governors of States were directed to appoint a [300] surgeon and assistant surgeon for each regiment. The men appointed were for the most part country physicians, many of them with little practice, who, on reaching the field, were, in some respects, as ignorant of their duties under the changed conditions as if they had not been educated to the practice of medicine; and the medical director of the army found his hands more than full in attempting to get them to carry out his wishes. So, to simplify his labors and also to increase the efficiency of his department, brigade hospitals were organized about the beginning of 1862, and by general orders from the war department brigade surgeons were appointed, with the rank of major, and assigned to the staffs of brigadier-generals. These brigade surgeons had supervision of the surgeons of their brigades, and exercised this duty under the instructions of the medical director.

The regimental hospitals in the field were sometimes tents, and sometimes dwellings or barns near camp. It was partly to relieve these that brigade hospitals were established. The latter were located near their brigade or division.

The hospital tent I have already described at some length. I may add here that those in use for hospital purposes before the war were 24 feet long by 14 feet 6 inches wide, and 11 feet 6 inches high, but, owing to their great bulk and weight, and the difficulty of pitching them in windy weather, the size was reduced, in 1860, to 14 feet by 14 feet 6 inches, and 11 feet high in the centre, with the walls 4 feet 6 inches, and a “fly” 21 feet 6 inches by 14 feet. Each of these was designed to accommodate eight patients comfortably. Army Regulations assigned three such tents to a regiment, together with one Sibley and one Wedge or A tent.

The Sibley tent I have likewise quite fully described. I will only add here that, not having a “fly,” it was very hot in warm weather. Then, on account of its centre pole and the absence of walls, it was quite contracted and inconvenient. For these reasons it was little used for hospital purposes, and not used at all after the early part of the war. [301]

The hospital tents in the Army of the Potomac were heated, for the most part, by what was called, for some reason, the California Plan. This consisted of a pit, dug just outside of the hospital door, two and a half feet deep, from which a trench passed through the tent, terminating outside the other end in a chimney, built of barrels, or in such a manner as I have elsewhere described. This trench was covered throughout its entire extent with iron plates, which were issued by the quartermaster's department for that purpose. The radiation of the heat from the plates kept the tent very comfortable.

The honor of organizing the first field hospital in tents is said to belong to Dr. B. J. D. Irwin, U. S. A., of the Army of the Ohio. It occurred at the battle of Shiloh. While establishing a hospital near the camp of Prentiss' division of that army, which had been captured the day before, the abandoned tents still standing suggested themselves to him as a convenient receptacle for his wounded. He at once appropriated the camp for this purpose, and laid it out in systematic form. It was clearly shown by this and succeeding experiences during the war that the wounded treated under canvas did better and recovered more rapidly than those treated in permanent hospitals.

As fast as they could be procured, hospital tents were furnished, three to a regiment, in accordance with the provision of Army Regulations referred to. Each regiment provided its own nurses and cooks. In general hospitals one nurse was allowed to ten patients, and one cook to thirty.

The capacity of a regimental hospital tent, like a stagecoach, varied according to the demand for room. I have said they were designed to accommodate eight. An old army surgeon says, “Only six can be comfortably accommodated in one of them, three on each side.” But when the surgeons were crowded with the wounded, it was a common practice to set two long narrow boards edgewise through the centre [302] of the tent, about twenty inches apart. If boards were wanting, two good-sized poles were cut and used instead. Between these was the passage for the surgeons and nurses. Behind the boards or poles a filling of straw or fine boughs was made and covered with blankets. On these latter could be placed twenty patients, ten on either side; but they were crowded. When six single cots were put in one of these tents, three on each side, ample space was afforded to pass among them.

In the latter part of 1861, the government, realizing its pressing needs, began to build general hospitals for the comfort

A two-wheeled ambulance.

and accommodation of its increasing thousands of sick and wounded, continuing to build, as the needs increased, to the very last year of the war, when they numbered two hundred and five.

Before the civil war, the government had never been supplied with carriages to convey the sick and wounded. Only two years before, a board, appointed by the secretary of war, had adopted for experiment a four-wheeled and a two-wheeled carriage. The four-wheeled vehicle was tried in an expedition sent into New Mexico, and was favorably reported on; the two-wheeled was never tested, but was judged to be the best adapted to badly wounded men [303] (though the contrary proved to be the fact), and so the board reported in favor of adopting these carriages in the ratio of five two-wheeled to one four-wheeled.

When Surgeon Tripler took charge, he found several of these two-wheeled carriages in Washington, but they were used chiefly as pleasure-carriages for officers, or for some other private purpose. This was stopped, for a time at least, and an order was issued, leaving one to a regiment and requiring the rest to be turned over to the quartermaster's department. But the perversion of ambulances from their proper use, I will add in passing, continued, to a greater or less extent, till the end of the war. This very year McClellan issued an order for them not to be used except for the transportation of the sick and wounded, unless by authority of the brigade commander, the medical director, or the quartermaster in charge, and the provost-marshal was ordered to arrest officers and confine non-commissioned officers and privates for violation of the order.

The most important steps taken towards organizing the medical department, and placing it on that thorough basis which distinguished it in the later years of the war, were the result of the foresight, energy, and skilful management of Dr. Jonathan Letterman, who was made medical director of the Army of the Potomac on the 19th of June, 1862. His labor was something enormous. It was during the progress of the Peninsular Campaign. All was confusion. Medical supplies were exhausted. Thousands of sick and wounded men were dying for want of proper care and medicine. Yet this campaign, so disastrous in its results to our army from a military point of view, was a valuable teacher in many respects, and one of its most pointed and practical lessons was the necessity shown of having the ambulances organized and under a competent head. It remained for Dr. Letterman to appreciate this need, and effect an organization which remained practically unchanged till the close of the war. Here is the substance of the plan which he drew up, and [304] which General McClellan approved, and published to the army in orders, Aug. 2, 1862, and which General Meade reissued, with some additions and slight changes, a little more than a year later.

Ambulance Corps.

All of the ambulances belonging to an army corps were to be placed under the control of the medical director of that corps, for now, in addition to a medical director of the army, there was a subordinate medical director for each army corps. Such an ambulance corps was put into the hands of a captain as commandant. This corps was divided and subdivided into division, brigade, and regimental trains, corresponding to the divisions of the army corps to which it belonged, having a first lieutenant in charge of a division, a second lieutenant in charge of a brigade, and a sergeant in charge of a regimental detachment. Besides these, three privates, one of them being the driver, were to accompany each ambulance on the march and in battle. The duties of all these men, both officers and privates, were very carefully defined, as well for camp as for the march and battle. Besides the ambulances, there accompanied each corps one medicinewagon and one army wagon to a brigade, containing the requisite medicines, dressings, instruments, hospital stores, bedding, medical books, small furniture (like tumblers, basins, bed-pans, spoons, vials, etc.).

In addition to the foregoing articles, which were carefully assorted both as to quantity and quality, each ambulance was required to carry in the box beneath the driver's seat, under lock and key, the following articles:--

Three bed-sacks, six 2-pound cans beef-stock, one leather bucket, three camp kettles (assorted sizes), one lantern and candle, six tin plates, six table-spoons, six tin tumblers; and, just before a battle, ten pounds hard bread were required to be put into the box. [305]

There was another scheme, which was conceived and carried into execution by Dr. Letterman, which deserves mention in this connection. This was the establishment of Field Hospitals, “in order that the wounded might receive the most prompt and efficient attention during and after an engagement, and that the necessary operations might be performed by the most skilful and responsible surgeons, at the earliest moment.” Under Surgeon Tripler, there had been rendezvous established in rear of the army, to which all the wounded were taken for immediate attention, before

A four-wheeled ambulance.

being sent to general hospitals. But there was no recognized system and efficiency in regard to it. Just before an engagement, a field hospital for each division was established. It was made by pitching a suitable number of hospital tents. The location of such a hospital was left to the medical director of the corps. Of course, it must be in the rear of the division, out of all danger and in a place easily reached by the ambulances. A division hospital of this description was under the charge of a surgeon, who was selected by the surgeon-in-chief of the division. With him was an assistant surgeon, similarly appointed, whose duty it was to pitch the tents, provide straw, fuel, water, etc., and, in general, make everything ready for the comfort of the wounded. For [306] doing this the hospital stewards and nurses of the division were placed under his charge, and special details made from the regiments to assist. A kitchen or cook-tent must be at once erected and the cooks put in possession of the articles mentioned as carried in the ambulance boxes and hospitalwagons, so that a sufficient amount of nourishing food could be prepared for immediate use.

Another assistant surgeon was detailed to keep a complete record of patients, with name, rank, company, and regiment, the nature of their wound, its treatment, etc. He was also required to see to the proper interment of those who died, and the placing of properly marked head-boards at their graves.

Then, there were in each of these division hospitals three surgeons, selected from the whole division, “without regard to rank, but solely on account of their known prudence, judgment, and skill,” whose duty it was to perform all important operations, or, at least, be responsible for their performance. Three other medical officers were detailed to assist these three. Nor was this all, for the remaining medical officers of the division, except one to a regiment, were also required to report at once to the hospital, to act as dressers of wounds and assistants generally. In addition to these, a proper number of nurses and attendants were detailed to be on hand. The medical officers left with regiments were required to establish themselves during the fighting in the rear of their respective organizations, at such a distance as not to unnecessarily expose themselves, where they could give such temporary aid to the wounded as they should stand in need of.

I have said that these hospitals were to be located out of all danger. That statement needs a little modifying. In case the tide of battle turned against our army and it was compelled to retreat, what was before a safe place might at once be converted into a place of great danger. But a hospital could not be struck and its patients moved at a [307] moment's or even a day's warning, as a rule, and so it was made the duty of the medical director of a corps to select a sufficient number of medical officers, who, in case a retreat was found necessary, should remain in charge of the wounded. When the Rebels captured such a hospital, it was their general practice to parole all the inmates — that is, require them to give their word of honor that they would not bear arms again until they had been properly exchanged

A medicine wagon.

as prisoners of war. Our government established what were known as parole camps, where such prisoners were required to remain until duly exchanged.

I think it can now be readily understood, from even this fragmentary sketch, how the establishment of these field hospitals facilitated the care of the wounded, and, by their systematic workings, saved hundreds of lives. With a skilful, energetic man as medical director of the army, giving his orders to medical directors of corps, and these carefully superintending surgeons-in-chief of divisions, who, in turn, held the surgeons and assistant surgeons and officers of ambulance corps to a strict accountability for a careful performance of their duties, while the latter fortified themselves by judicious oversight of their subordinates, the result [308] was to place this department of the army on a footing which endured, with the most profitable of results to the service, till the close of the war.

I vividly remember my first look into one of these field hospitals. It was, I think, on the 27th of November, 1863, during the Mine Run Campaign, so-called. General French, then commanding the Tiird Corps, was fighting the battle of Locust Grove, and General Warren, with the Second Corps, had also been engaged with the enemy, and had driven him from the neighborhood of Robertson's Tavern, in the vicinity of which the terrific Battle of the Wilderness began the following May. Near this tavern the field hospital of Warren's Second Division had been located, and into this I peered while my battery stood in park not far away, awaiting orders. The surgeon had just completed an operation. It was the amputation of an arm about five inches below the shoulder, the stump being now carefully dressed and bandaged. As soon as the patient recovered from the effects of the ether, the attendants raised him to a sitting posture on the operating-table. At that moment the thought of his wounded arm returned to him, and, turning his eyes towards it, they met only the projecting stub. The awful reality dawned upon him for the first time. An arm had gone forever, and he dropped backwards on the table in a swoon. Many a poor fellow like him brought to the operator's table came to consciousness only to miss an arm or a leg which perhaps he had begged in his last conscious moments to have spared. But the medical officers first mentioned decided all such cases, and the patient had only to submit. At Peach-Tree Creek, Col. Thomas Reynolds of the Western army was shot in the leg, and, while the surgeons were debating the propriety of amputating it, the colonel, who was of Irish birth, begged them to spare it, as it was very valuable, being an imported leg,--a piece of wit which saved the gallant officer his leg, although he became so much of a cripple that he was compelled to leave the service. [309]

It has been charged that limbs and arms were often uselessly sacrificed by the operators; that they were especially fond of amputating, and just as likely to amputate for a flesh-wound as for a fractured bone, on the ground that they could do it more quickly than they could dress the wound;

A Folding Litter.

that it made a neater job, thus gratifying professional pride: but how the victim might feel about it or be affected by it then or thereafter did not seem to enter their thoughts. It was undoubtedly true that many flesh-wounds were so ugly the only safety for the patient lay in amputation. A fine fellow, both as a man and soldier, belonging to my company, lost his arm from a flesh-wound — needlessly, as he and his friends always asserted and believed.

A corporal of the First Massachusetts Heavy Artillery suffered a compound fracture of the left knee-joint from a piece of shell by which he was struck at the battle of

A stretcher.

Hatcher's Run, Oct. 27, 1864. In the course of time he reached the Lincoln Hospitals (well do I remember them as they stood on Capitol Hill where they were erected just before the bloody repulse at Fredericksburg), where a surgeon decided that his leg must come off, and, after instructing the nurse to prepare him for the operating-room, left the ward. But the corporal talked the matter over with a wounded cavalryman (this was a year when cavalrymen were wounded quite generally) and decided that his leg must not [310] come off; so, obtaining the loaded revolver of his comrade, he put it under his pillow and awaited the reappearance of the surgeon. He returned not long after, accompanied by two men with a stretcher, and approached the cot.

“What are you going to do?” asked the corporal.

“My boy, we will have to take your leg off,” was the reply of the surgeon.

“Not if I know myself,” rejoined the corporal, with determination expressed in both looks and language.

For a moment the surgeon was taken aback by the soldier's resolute manner. But directly he turned to the men and said, “Come, boys, take him up carefully,” whereupon the stretcher-bearers advanced to obey the order. At the same instant the corporal drew the revolver from beneath his pillow, cocked it, and, in a voice which carried conviction, exclaimed, “The man that puts a hand on me dies!” At this the men stepped back, and the surgeon tried to reason with the corporal, assuring him that in no other way could his life be saved. But the corporal persisted in declaring that if he died it should be with both legs on.

At that “Sawbones” (as the men used to call them) lost his temper and sought out the surgeon in general charge, with whom he soon returned to the corporal. This head surgeon, first by threats and afterwards by persuasion, tried to secure the revolver, but, failing to do so, turned away, exclaiming, with an oath, “Let the d-- fool keep it and die!” but a moment after, on second thought, said to the first surgeon that, as they wanted a subject to try the water-cure on, he thought the corporal would meet that want. After obtaining a promise from the surgeon that he would not himself take the leg off or allow any one else to, the corporal assented to the proposition.

A can was then arranged over the wounded knee, in such a manner as to drop water on the cloth which enwrapped it day and night, and a cure was finally effected.

This is the substance of the story as I received it from the [311] lips of the corporal himself, who, let me say in passing, was reduced to the rank of private, and mustered out of the service as such, for daring to keep two whole legs under him. His bravery in the hour of peril — to him — deserved better things from his country than that.

But to return, to the field hospital again; on the ground lay one man, wounded in the knee, while another sat near, wounded in the finger. This latter was a suspicious wound. Men of doubtful courage had a way of shooting off the end of the trigger-finger to get out of service. But

Placing A wounded man on A stretcher.

they sometimes did it in such a bungling manner that they were found out. The powder blown into the wound was often the evidence which convicted them. These men must be proud of such scars to-day.

Three wounded Rebels also lay in the tent, waiting for surgical attention. Of course, they would not be put upon the tables until all of our own wounded were attended to; they did not expect it. In one part of the tent lay two or three of our men, who were either lifeless or faint from loss of blood. Only a few rods away from the tent were some freshly made graves enclosing the forms of men whose wounds had proved fatal, either having died on their way to the hospital or soon after their arrival. Among these was the gallant Lieutenant-Colonel Theodore Hesser, who was shot [312] in the head while bravely leading the Seventy-second Pennsylvania Infantry in a charge. The graves were all plainly marked with small head-boards. A drizzling rain added gloom to the scene; and my first call at a field hospital, with its dismal surroundings, was brief.

One regulation made for this department of the service was never enforced. It provided that no one but the proper medical officers or the officers, non-commissioned officers, and privates of the ambulance corps should conduct sick or wounded to the rear, either on the march or in battle,

Carrying A wounded man to the rear.

but as a matter of fact there were probably more wounded men helped off the field by soldiers not members of the ambulance corps than by members of that body. There were always plenty of men who hadn't the interests of the cause so nearly at heart but what they could be induced, without much persuasion, when bullets and shells were flying thick, to leave the front line and escort a suffering comrade to the rear. Very often such a sufferer found a larger body-guard than could well make his needs a pretext for their absence from the line. Then, too, many of these escorts were most unfortunate, and lost their way, so that they did not find their regiment again until after the battle was over. A large number of them would be included among the Shirks and Beats, [313] whom I have already described. But, in truth, it was not possible for the ambulance corps to do much more in a hot fight than to keep their stretchers properly manned. Each ambulance was provided with two of these, and the severely wounded who could not help themselves must be placed on them and cared for first, so that there was often need for a helping hand to be given a comrade who was quite seriously wounded, yet could hobble along with a shoulder to lean on.

The designating mark of members of the ambulance corps was, for sergeants, a green band an inch and a quarter broad around the cap, and inverted chevrons of the same color on each arm, above the elbow; for privates the same kind of band and a half chevron of the same material. By means of this designation they were easily recognized.

By orders of General Meade, issued in August, 1863, three ambulances were allowed to a regiment of infantry; two to a regiment of cavalry, and one to a battery of artillery, with which it was to remain permanently. Owing to this fact, an artillery company furnished its own stretcherbearers when needed. I shall be pardoned the introduction of a personal incident, as it will illustrate in some measure the duties and trials of a stretcher-bearer. It was at the battle of Hatcher's Run, already referred to, or the Boydton Plank Road, as some called it. The guns had been ordered into position near Burgess' Tavern, leaving the caissons and ambulance nearly a half-mile in the rear. Meanwhile, a flank attack of the enemy cut off our communications with the rear for a time, and we thought ourselves sure of an involuntary trip to Richmond; but the way was opened again by some of our advance charging to the rear, and by the destructive fire from our artillery. Soon orders came for the battery to return to the rear. In common with the rest, the writer started to do so when a sergeant asked him to remain and help take off one of our lieutenants, who was lying in a barn near by, severely wounded. So actively had we, been engaged that this was my first [314] knowledge of the sad event. But, alas! what was to be done? Our ambulance with its stretchers was to the rear. That could not now avail us. We must resort to other means. Fortunately, they were at hand. An abandoned army-blanket lay near, and, carefully placing the lieutenant on this, with one man at each corner, we started.

But the wounded officer was heavy, and it was, as can readily be seen, an awkward way of carrying him. Moreover, his wound was a serious one,--mortal as it soon proved,and every movement of ours tortured him so that he begged of us to leave him there to die. Just then we caught sight of a stretcher on which a wounded Rebel was lying. Some Union stretcher-bearers had been taking him to the rear when the flank attack occurred, when they evidently abandoned him to look out for themselves. It was not a time for sentiment; so, with the sergeant at one end of the stretcher and the narrator at the other, our wounded enemy was rolled off, with as much care as time would allow. With the aid of our other comrades we soon put the lieutenant in his place, and, raising the stretcher to our shoulders, started down the road to the rear. We had gone but a few rods, however, before the enemy's sharpshooters or outposts fired on us, driving us to seek safety in the woods. But it was now dusk, and no easy matter to take such a burden through woods, especially as it rapidly grew darker. Suffice it to know, however, that, after more than an hour's wandering and plunging, our burden was delivered at the ambulance, where another of our lieutenants, also mortally wounded, was afterwards to join him. This fragment of personal experience will well illustrate some of the many obstacles which stretcher-bearers had to contend with, and disclose the further truth that in actual combat the chances for severely wounded men to be taken from the field were few indeed, for at such a time stretcherbearers, like the proverbial “good men,” are scarce. [315]

I omitted to say in the proper connection that the men whose wounds were dressed in the field hospitals were transported as rapidly as convenient to the general hospitals, where the best of care and attention could be given them. Such hospitals were located in various places. Whenever it was possible, transportation was by water, in steamers specially fitted up for such a purpose. There may be seen in the National Museum at Washington, the building in which President Lincoln was assassinated, beautiful models of these steamers as well as of hospital railway trains with all their furnishings of ease and comfort, designed to carry patients by rail to any designated place.

Another invention for the transportation of the wounded from the field was the Cacolet or Mule Litter, which was borne either by a mule or a horse, and arranged to carry, some one and some two, wounded men. But although it was at first supposed that they would be a great blessing for this purpose, yet, being strapped tightly to the body of the animal, they felt his every motion, thus making them an intensely uncomfortable carriage for a severely wounded soldier, so that they were used but very little.

The distinguished surgeon Dr. Henry I. Bowditch, whose son, Lieut. Bowditch, was mortally wounded in the cavalry fight at Kelly's Ford, voiced, in his “Plea for an ambulance system,” the general dissatisfaction of the medical profession with the neglect or barbarous treatment of our wounded on the battle-field. This was as late as the spring of 1863. They had petitioned Congress to adopt some system without delay, and a bill to that effect had passed the House, but on Feb. 24, 1863, the Committee on Military Affairs, of which Senator Henry Wilson was chairman, reported against a bill “in relation to Military Hospitals and to organize an Ambulance Corps,” as an impracticable measure at that time, and the Senate adopted the report, and there, I think, it dropped.

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