Field and temporary hospitals: the surgeon in the field
Prayer with the wounded after Spotsylvania
The photographer of May, 1864, preserved a moment breathing the devout spirit of Millets ‘Angelus.’
the Surgeon's assistants, heads bared, and the nurse stand in reverent attitudes; the wounded lie listening on the ground; while a chaplain pours out a prayer to the Almighty that the lives of the stricken soldiers before him may be spared.|
Rough surgery in the field: Federal wounded on Marye's heights
This is war. The man in the foreground will never use his right arm again.
Never again will the man on the litter jump or run. It is sudden, the transition from marching bravely at morning on two sound legs, grasping your rifle in two sturdy arms, to lying at nightfall under a tree with a member forever gone.
But it is war. The usual treatment of an ordinary wound during the Civil War consisted in shaving the part if necessary and washing it with warm water and a sponge.
Asepsis was not yet understood.
The sponge, used on any and all cases indiscriminately, soon became infected.
Gross foreign bodies were removed and<
the wound probed by instruments which were never sterilized and usually remained continuing sources of infection.
The wound was usually protected by dressings of lint, the scrapings of which from cotton cloth by hand rendered its infection certain.
Cloth or cotton compresses dipped in cold water were often used as dressings.
Some surgeons used ointments spread on muslin.
Flaxseed or bread poultices were often employed.
In fact nearly every measure taken for the relief of the wounded was, through the irony of Fate and ignorance of infection, largely contributory in increasing the very suffering it was desired to prevent.|
Red men who suffered in silence
In modern warfare the American Indian seems somehow to be entirely out of place.
We think of him with the tomahawk and scalping-knife and have difficulty in conceiving him in the ranks, drilling, doing police duty, and so on. Yet more than three thousand Indians were enlisted in the Federal army.
The Confederates enlisted many more in Missouri, Arkansas, and Texas.
In the Federal army the red men were used as advance sharpshooters and rendered meritorious service.
This photograph shows some of the wounded Indian sharpshooters on Marye's Heights after the second battle of Fredericksburg.
A hospital orderly is attending to the wants of the one on the left-hand page, and the wounds of the others have been dressed.
In the entry of John L. Marye's handsome mansion close by lay a group of four Indian sharpshooters, each with the loss of a limb—of an arm at the shoulder, of a leg at the knee, or with an amputation at the thigh.
They neither spoke nor moaned, but suffered and died, mute in their agony.
During the campaign of 1864, from the Wilderness to Appomattox, Captain Ely S. Parker, a gigantic Indian, became one of Grant's favorite aids.
Before the close of the war he had been promoted to the rank of colonel, and it was he who drafted in a beautiful handwriting the terms of Lee's surrender.
He stood over six feet in height and was a conspicuous figure on Grant's staff.
The Southwestern Indians engaged in some of the earliest battles under General Albert Pike, a Northerner by birth, but a Southern sympathizer.|
Helpless wounded during the action at Spotsylvania
Written on the back of this print the editors of the Photographic history found the words: ‘On the battlefield of Spotsylvania, in the rear during the action.’
The place has been identified by comparison with many other photographs as Marye's Heights.
Much of the battlefield surgery during the war was, in all probability, not only unnecessary but harmful.
The rate of mortality after operation, 14.2 per cent., though shocking to the present generation, was inevitable, owing to the defective knowledge at the time as to surgical cleanliness.
While the same number of operations could probably be performed by modern military surgeons with a small fraction of the Civil War death-rates, it is now recognized that most gunshot cases do better under surgical cleanliness, antiseptic and expectant treatment than by operation.
The advantage of this conservative procedure was well illustrated by the war in Manchuria of 1903, where it is claimed that one-third of the Japanese wounded were able to return to the firing-line within thirty days.|
[The two articles which follow supply interesting personal reminiscences of hospital conditions within the Confederate
On the accompanying illustration pages will be found many examples of the hospitals and medical service in the Union
armies, together with extensive description of Federal institutions and practice.
The Appendices at the end of this volume supply some account of the system and organization, both Federal and Confederate, much of the latter appearing for the first time.—the editors.]
As the records of the Confederate
hospitals were burned in the surgeon-general
's office at the fall of Richmond
, it is difficult at this date to write of their work.
But, from the writer's own experience and the accounts of others engaged in the work, it is possible to show something of what was attempted and accomplished in the face of difficulties which seemed insurmountable.
After some preliminary hospital experience at Hot Springs
, and Bath Alum Springs, Virginia, I reported, in March, 1862, to Doctor S. H. Stout
, who was just beginning his invaluable services as medical director of the hospitals of the Department and Army of Tennessee.
Preferring active service, I was assigned to the Twentieth Regiment, Tennessee Infantry, with which I remained until paroled, after General J. E. Johnston
On the morning of December 1, 1864, I received orders to go to Franklin, Tennessee
, and make arrangements for the wounded of General Bate
I did so, taking with me my hospital steward, a detail of ten men, and two wagons.
I found an old carriage-and wagon-shop about sixty by one hundred feet, two stories high.
It had a good roof, plenty of windows above and below, an incline leading up to the upper floor on the outside, and a good well.
This I immediately placarded as ‘Bate's Division Hospital,’ and put part of the detail to work cleaning out the work-benches, old lumber, and other debris.
Further up the same street, I found an unoccupied brick store, two stories high, eighty by twenty feet, and, on the corner of the square, the Chancery Court
room, about forty feet square, both of which I took possession of, and put the remainder of the detail at work cleaning out the counters, shelving, empty boxes, and barrels from the one, and the desk, or rostrum, and benches from the other, sending the wagons into the country for clean straw.
Two assistant surgeons
with additional detailed men reported to me and all worked diligently, so that, by the middle of the afternoon, the buildings were fairly well cleaned.
The wagons did not have to go far afield, and each floor was soon covered with clean wheat-straw ten or twelve inches deep; and before midnight all the wounded were transferred from the field-hospital.
The provisional Army of Tennessee
was at first, to some extent, supplied with spring vehicles as ambulances: but as the war progressed, hard usage and rough roads caused them to break down, and they were abandoned.
Their places were supplied by ordinary wagons drawn by two mules and without springs.
Staples on the sides of the body secured white-oak bows, covered with heavy cotton-duck cloth, with the name of the regiment, brigade, division, and corps painted on the sides of the white cover.
While such ambulances afforded somewhat rough riding for sick and wounded men, they were the best that could be supplied.
Now and then, one or more well-built and equipped ambulances were captured; in which case it did not take long
to convert the ‘U’ into a ‘C,’ leaving the ‘S’ and ‘A’ painted on it in some Northern city, still on duty; but these were generally taken possession of by brigade, division, or corps headquarters, leaving the regiments to rely on the two-horse wagons.
I had kept with me my regimental medicine chest, amputating and pocket-case
instruments, and the assistant surgeons
had their own pocket instruments.
The division commissary left us three days rations of beef and meal per man, but I had no further occasion to call on our commissariat for supplies, as the good people of Franklin
and vicinity brought in an abundance of everything that sick, wounded, and attendants could desire from day to day-well-cooked bread, beef, mutton, chickens, turkeys, milk, butter, eggs, and other food.
Several carpenters in my detail were put to work constructing rough bunks of such lumber as could be found, placing in them the more severely wounded.
By the end of my first week's service, I had permitted about one-third of the wounded to take up their quarters in the residences of willing citizens of the town and immediate vicinity.
Those who could do so were required to report at the hospital every day, or on alternate days, and one of the assistant surgeons
or myself visited, from time to time, such as could not walk to the hospital.
Nearly all of these ‘out-patients,’ as well as some others in my hospital, went south with Hood
's battered battalions as they retreated beyond the Tennessee River
in the days following December 17, 1864.
In my hospital, while at Franklin
, only seven men died; two from abdominal wounds, three from gunshot wounds in the head, one with amputation of thigh, and one who refused to submit to amputation—I never amputated a limb without consent of the wounded man—after the nature of his case had been fully explained to him. Despite all arguments and reasoning, this man refused amputation, was greatly depressed and despondent from the first, and died on December 23d, as
I had expected, from gunshot injury to forearm, complicated by nostalgia and despondency in an old man.
Largely predominating on both sides were the wounds inflicted by the rifled musket, carrying its conical ball of an ounce or more in weight.
These wounds differed in some important and very material characteristics from all gunshot wounds in preceding wars, including that with Mexico
; as well as those in our later experience with Spain
, and those inflicted by the improved army-gun of the present day. The old round ball, of low velocity, caused many fractures in bones of the extremities.
But it never produced such shattering, comminution, and amount of bone destruction and injury as did the heavy conical ball of increased velocity—both differing in character from the Mauser and Martini of the present day with their still greater increase of velocity—and its hardened or steel-jacketed projectile of smaller caliber, which often makes an almost clean-cut perforation, even through the shaft of a long bone.
The shattering, splintering, and splitting of a long bone by the impact of the minie or Enfield
ball were, in many instances, both remarkable and frightful, and early experience taught surgeons that amputation was the only means of saving life.
In the vicinity of a joint, the ends of the bone being more spongy, softer, and less brittle, the damage to the shaft of the bone was not so great, and the expedient of resection, largely resorted to and greatly developed by the surgeons, in many instances afforded a comparatively, if not perfectly, restored limb.
Resections of the upper extremity afforded better results than those of the lower, although fairly good results were sometimes obtained in the case of the latter.
In some instances, I deemed it imperatively necessary to resort to a second, or even a third resection of the limb, even after the end of the bone had been sawn through, and while the patient was still under the influence of the anesthetic, the primary section furnishing the information that the bone had
been shattered, splintered, or split higher up than could be ascertained at first.
Conservative surgery was, I might say, almost, if not entirely, a universal principle with the Confederate
surgeon; conservatism, first, as to the life of the wounded soldier, secondly, as to his future comfort and usefulness.
Conical-ball wounds in the abdomen were nearly always fatal, far more so than those produced by the round hall with lower velocity.
The intestines, in the former case, were generally perforated; in the latter, they often escaped this injury by being pushed aside by the slower moving round ball fired from the smooth-bore gun. The reverse of this was the case in wounds of the chest, since the round ball bruised and lacerated a large area of lung tissue, while the more swiftly moving conical ball often produced a clean-cut wound.
On December 25, 1864, my associates and myself, with the wounded of Bate
's division, were all moved to Nashville
, and placed in the large building on South College Street, built in the summer of 1861 for a gun-factory, where I, as the ranking surgeon, assumed charge of the twelve hundred wounded there assembled from the battlefields of Franklin
, assisted by nine other Confederate surgeons and assistant surgeons.
On January 10, 1865, all the Confederate
surgeons in Nashville
were relieved by Federal surgeons, and we were sent by way of Louisville
, Fortress Monroe
, and City Point
, reaching the capital, January 28th.
Remaining three days in Richmond
, I visited every morning some part of Chimborazo Hospital, and other hospitals in the city.
Leaving the capital, I went to Montgomery, Alabama
, having thirty days leave, and while waiting for the Army of Tennessee en route to the Carolinas, frequently visited a hospital there in charge of Doctor John Scott
, an Englishman.
He had been commissioned surgeon in 1861, assigned to duty at Pensacola
until it was evacuated, and subsequently was stationed in Montgomery
The hospital was in a large
cotton-warehouse near the river, commodious, thoroughly clean, and well arranged in every way. The had here about two hundred and fifty patients, mostly chronic cases, two assistant surgeons
, a hospital steward, a one-armed hospital clerk, about twenty convalescents as nurses, and a matron—the wife of one of the assistant surgeons
After the battle of Chickamauga
, to revert to an earlier period of the war, the Confederate
wounded were treated for weeks in the field-hospitals, in the immediate vicinity of the battlefield, about one-half of the regimental surgeons
and assistant surgeons remaining in charge of them until relieved by surgeons sent from the rear; while the other half of the regimental medical officers went with their commands to the vicinity of Chattanooga
Having accompanied my regiment on its advance movement, about fifteen days after the battle, I was ordered by General Bate
to go to the field-hospitals and make a thorough inspection of the condition of the wounded men of his command.
I do not remember to have seen, at any time, wounded men doing so well, two weeks after injury.
The weather was mild and dry, and nearly all were treated in the open air. It was about five weeks before all were removed from the field-hospitals, and then fully three-fourths were convalescent or able for duty.
During the Dalton
of 1864, I was sent at different times by General Bate
to make unofficial inspections of the wounded of his command at Catoosa Springs
, and Marietta, Georgia
At each place a surgeon was in charge, with other surgeons, assistant surgeons
, and contract, or acting assistant surgeons under him, with a post quartermaster and commissary.
The nurses and attendants consisted of enlisted men detailed for the purpose when the hospitals were first established.
Later, these were ordered to their respective commands, and their places taken by convalescents.
By practical experience, during the Dalton
, the various hospitals organized at Chattanooga
A sanitary-commission nurse and her patients at Fredericksburg, May, 1864
More of the awful toll of 36,000 taken from the Union army during the terrible Wilderness campaign.
The Sanitary Commission is visiting the field hospital established near the Rappahannock River, a mile or so from the heights, where lay at the same time the wounded appearing on the opposite page.
Although the work of this Commission was only supplementary after 1862, they continued to supply many delicacies, and luxuries such as crutches, which did not form part of the regular medical corps paraphernalia.
The effect of their work can be seen here, and also the appearance of men after the Shock of gunshot wounds.
All injuries during the war practically fell under three headings: incised and punctured wounds, comprising saber cuts, bayonet stabs, and sword thrusts; miscellaneous, from falls, blows from blunt weapons, and various accidents; lastly, and chiefly, gunshot wounds.
The war came prior to the demonstration of the fact that the causes of disease and suppurative conditions are living organisms of microscopic size.
Septicemia, erysipelas, lockjaw, and gangrene were variously attributed to dampness and a multitude of other conditions.|
With the wounded of Spotsylvania Court House, May, 1864
Examining the lawn closely, one perceives belts and bandages strewn everywhere.
These recumbent figures tell more plainly than words what has been going on here.
The stirring of the breeze in the leaves of the great oak which shades the wounded too often marks the sigh of a soul that is passing to its reward.
The scene is Marye's Heights after the battle of Spotsylvania, May 11, 1864.
The glory of the battle, the glitter of arms, the crash of artillery and musketry, and the paeans of victory echoing over the land after a great battle has been won are not all of war. The maimed and wounded soldiers who have fallen before the hail of shells and canister and grape realize at what price these paeans are bought.
With limbs torn and bodies lacerated, they sometimes lay suffering excruciating torments for hours or even days after the battle had been fought.
An insensible soldier passed over for dead by the ambulance corps, or lying unseen in a thicket, might recover consciousness to be tortured with thirst and driven frantic with the fear that he would be permanently forgotten and left there to die. Incongruous, but of interest to posterity, is the photographer's tripod on the right of the picture in front of the wounded lying in the shade of the house.|
In the wake of Grant's advance: a warehouse used as a hospital after Spotsylvania, May, 1864
This picture shows a warehouse on the banks of the Rappahannock to which wounded have been conveyed after the slaughter in the Wilderness.
Grant had attempted to oust the Army of Northern Virginia from its position by a flank movement on Spotsylvania.
Lee succeeded in anticipating the movement, and once again Grant hurled the long-suffering Army of the Potomac upon the unbroken gray lines of the Army of Northern Virginia. Two assaults were made on the evening of May 11th, but the position could not be carried even at a loss of five or six thousand men. The neighboring buildings were filled with the Federal and Confederate wounded.
Around the factory above are the tents of a division hospital corps which have been found inadequate to care for so many wounded.
They can be seen on every floor of the big structure.
The hospital orderlies are hurrying about.
At first tentage was not used by these field hospitals, but they were established in any existing buildings, such as churches, mills, and dwelling-houses.
were not always convenient, but the first tent hospital was not used until the battle of Shiloh, April, 1862.
The value of such shelter on this occasion was so manifest that hospital tents were soon after issued and ultimately used with troops almost exclusively in campaign as well as in periods of inactivity.
These division or field hospitals, as finally developed in the war, proved to be thoroughly practicable and of the greatest value to the wounded in battle, while in Camp they were set up and acted as temporary receiving hospitals to which sick were sent for more extended treatment or to determine the necessity for their removal to the fixed hospitals in the rear.
Large in resources, they cared for wounded by the hundreds; always in hand and mobile, they could be sent forward without undue delay to where the needs of battle demanded and wheeled vehicles could penetrate.
They embodied a new idea, developed by our surgeons, which was promptly adopted by all military nations with modifications to meet the demands of their respective services.|
become quite adept in changing position, keeping in touch with, but in the rear of, the army, occupying the towns and villages with which there was reasonable railway connection, and finally a number of them were carried over to the eastern part of Mississippi
at the time of Hood
's last sad and disastrous advance.
The chaplains attached to regiments had the rank, emolument, and allowances of a captain of cavalry, and they not only aided in caring for the sick in Camp and on the march, but were exceedingly efficient on the battlefield in many instances.
As a rule, they accompanied the assistant surgeons
in the immediate rear of the center of their respective commands.
The writer cannot refrain from mentioning a few of these men who were so faithful, so earnest, and so fearless in their efforts.
The Reverend Charles Quintard Todd
, afterward bishop of Tennessee
and chancellor of the University of the South, had, previous to the war, relinquished a professorship in the Memphis
Medical College to be ordained a priest in the Protestant Episcopal Church.
He followed the fortunes of the First Regiment, Tennessee Volunteer Infantry, during the whole war. The Reverend J. H. McNeilly
, one of the most prominent ministers of the Presbyterian Church in Nashville
never failed to be on the firing-line with the assistant surgeon
in the infirmary detail.
The Reverend John B. McFerrin
. who stood high in the councils of the Methodist Episcopal Church, South, held a commission as chaplain, though not assigned to any particular regiment, and was of invaluable service to the medical staff.
, a young Irishman, served as chaplain of the consolidated Tenth and Fifteenth Tennessee regiments, and also of Slocum
's battery, Washington Artillery.
He was killed on the field of battle while administering the last rites of his church to a dying artilleryman.
These personal experiences will indicate the manner and method of caring for the wounded in the field or in improvised hospitals.
The Confederate surgeons used all of the resources at their command and their success was surprisingly great.