The Photographic History of The Civil War: in ten volumes, Thousands of Scenes Photographed 1861-65, with Text by many Special Authorities, Volume 7: Prisons and Hospitals.
Francis Trevelyan Miller, Ed.

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Part 2. hospitals

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Medical and surgical supplies: the army surgeon and his work

Edward L. Munson, M. D., Major, Medical Department, United States Army

Guarding supplies for the surgeons with the armies Washington 1863

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however brilliant the tactics and strategy, it should be remembered that an essential factor in all warfare must be the physical efficiency of the man behind the gun. Despite this fact, historians give but slight attention to the medical men whose ability and self-sacrifice largely make possible the military reputation of others. Although the surgeons are regarded as non-combatants, their efficiency must always have a powerful influence upon military tactics. The Nation selects its popular heroes wholly for service on the battlefield. But it should not be forgotten that it is only through the unwearying and unobtrusive efforts of the surgeons that men and armies are kept in fighting trim and physically able to execute the will of the commanders. In any critical inquiry into battles and campaigns, the careful student will not overlook the fact that the conflict under consideration might not have occurred at all, nor in the place where it actually did occur, nor might the military tactics have been the same, had not one or the other force been weakened by preventable diseases or rendered more or less immobile by the crippling incubus of the wounded, for whose removal and care no adequate provision had been made before the conflict occurred.

At the outbreak of the war, the national army was inadequate to meet military needs, especially those relating to the critical Indian situations west of the Mississippi, which had been developed in large part by the influx of gold-seekers and colonizers into that territory. It is not to be wondered at, then, that the war should have found the military establishment of [219]

[220] the United States deficient as regards its medical organization and equipment.

At the opening of hostilities between the States the personnel of the Medical Department of the regular army was composed of one surgeon-general with the rank of colonel, thirty surgeons with the rank of major, and eighty-four assistant surgeons with the rank of first lieutenant for the first five years of service, and thereafter with the rank of captain, until promoted to the grade of major. There was no hospital corps, but the necessary nursing and other hospital assistance were performed by soldiers temporarily detailed to hospital duty from organizations of the line of the army, and here it may be parenthetically remarked that the qualifications and character of the soldiers so detailed were usually far from satisfactory.

The Medical Department, with the above personnel, formed one of the coordinate branches of the general staff of the army as it existed in 1861. Its members were not permanently attached to any regiment or command, but their services were utilized whenever required. Although a separate regimental medical service still existed in many foreign armies, as it did in our militia, experience had demonstrated that our national system of a separate department was better adapted to the needs of troops when scattered over an immense area, and usually serving in small and isolated commands. The latter requirements explained the unusually large proportion of surgeons necessary at the time, amounting to about one per cent. of the total strength.

This little force of one hundred and fifteen trained medical officers theoretically available at the beginning of the war was, however, materially depleted. Many of its members were of Southern birth and sympathy, and no less than twenty-seven resigned from the army at the outbreak of hostilities. Three who so resigned entered into the practice of their profession, declining to assist either against their Southern kindred or [221]

[222] their friends in the Northern States and former military associates remaining under the old flag. But the remaining twenty-four merely transferred their services to the military forces of the Confederacy, where they were promptly given the positions of responsibility and power which their previous experience and training warranted. These men formed the nucleus about which the Medical Department of the Confederacy was created, building it up along the administrative lines to which they were accustomed, and even adopting the same blank forms and reports, as, for example, that for the sick and wounded, which they had formerly used in the Federal service. In many particulars the organization was identical.

Among these men was Doctor Samuel P. Moore, who had completed a quarter of a century of service as a medical officer of the regular army when he resigned his commission as a major and surgeon, to ally himself with his native State of South Carolina. Shortly after his resignation he accepted the position of surgeon-general of the Confederate forces, which he held during the entire duration of the war. Among his former medical associates in the regular army who became his trusted assistants in the Medical Department of the Confederacy, were such able men as Surgeons De Leon, Madison, Haden, Johns, Langworthy, Potts, Fauntleroy, Ramseur, and others, without whose extensive knowledge, training, and experience in things military, the Confederate medical service might very likely have achieved less high efficiency.

But the Army Medical Department, always a corps daelite, still contained able men after the resignation of Surgeon Moore and his Southern associates. A mere handful in number, it made up in quality what it lacked in quantity, and furnished the germ from which developed the vast medical service which came to be required. It included many men whose natural administrative and military abilities, in many cases developed by the experiences of the war with Mexico, if employed in other than the direction of non-combatants, would [223]

[224] probably have made them national figures in the military history of the United States.

Some of the names on this medical roll of honor from the regular army are those of Finley, Hammond, Barnes, Crane, Murray, Moore, Sutherland, Baxter, Sternberg, and Forwood, all of them surgeons-general during or after the war. Others were Letterman, Smart, Woodward, Huntington, Otis, Woodhull, Smith, Greenleaf, and others whose great services might be mentioned. Many of these men became figures of national importance in a medical and surgical sense. Some in their time were recognized as the highest authorities the world over in respect to the professional subjects with which they had been particularly identified.

Contrary to the usual idea of the general public, army medical officers have many important duties outside the actual professional treatment of sick and wounded. Far-reaching health measures, under the direction of the commander, are in their hands. Vast hospitals must be organized, equipped, supplied, and administered, to which sick and wounded by the hundreds of thousands must be transported and distributed. This latter problem can advantageously be met only in the light of broad knowledge of military organization, methods, and purposes. There are subordinates to be enlisted, equipped, cared for, trained, and disciplined. An elaborate system of records, upon the accuracy of which the whole pension system of the Government rests, must be maintained. And upon the handful of trained regular medical officers the responsibility for efficient direction of the above-mentioned business management of the Medical Department had, at the outset of the Civil War, to devolve. From it, as a nucleus, there developed a scheme of organization of the medical service for war which remains the prototype upon which similar organization in all the armies of the world is now based, while administrative methods were worked out which still remain our standard for the management of similar conditions and emergencies. [225]

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To the support of this little group, insignificant except in ability, the outbreak of the war promptly brought a vast number of the better type of medical men of the Northern States. Some of these physicians and surgeons had already achieved great fame and success in the practice of their profession, and their enrolment for the assistance of their country gave powerful incentive to similar action on the part of others of equal or less prominence. The younger medical men, lately graduated, flocked to the colors almost en masse, not only from motives of patriotism, but also because the practical training to be gained in the vast military hospitals was far more comprehensive and valuable than could be gained in any similar civil institution or walk of life. When, at the conclusion of the war, they undertook the practice of their profession in civil life, they found that their military experience placed them at once among the foremost of the local physicians and surgeons.

To give even brief mention of the self-sacrifice and achievements of the ten thousand medical men who, thus to aid their country, gave up the relative ease and the greater financial rewards of practice in civil life for the dangers and hardships of war, would require volumes. But it would be unfair not to recall the names of a few, whose services may have been of no whit greater value than those of others, who, for lack of space, must remain unmentioned, but whose professional standing during and after the war was such as to render them worthy of selection as representatives of the great volunteer medico-military class to which they belonged. Among such may be mentioned the names of Doctors Agnew, Ashhurst, Bacon, Bartholow, Bowditch, Bryant, Buck, Da Costa, Gouley, Gross, Hamilton, Hodgen, Pancoast, Shrady, Tyson, and Weir.

Under the agreement of the Geneva Convention, medical officers are now officially neutralized. This status cannot free them from the dangers of battle, in which they, of course, must share, but operates to exempt them from retention as prisoners [227]

[228] of war. Such was not the case in the first year of the Civil War, when surgeons were captured and immured in military prisons like combatant officers. Medical officers were thus often forced to make the hard choice of deserting the wounded under their care, often including patients from both sides who were urgently requiring attention, or of remaining and submitting to capture, with all the rigors and sufferings that this implied.

But General Jackson, after the battle of Winchester, in May, 1862, where he had captured the Federal division hospitals, took the ground that as the surgeons did not make war they should not suffer its penalties, and returned them unconditionally to their own forces. The neutral status of the surgeons, thus recognized for the first time, was subsequently formally agreed upon between Generals McClellan and Lee, though later the agreement was for a time interrupted. The idea that those engaged in mitigating the horrors of war should not be treated like those who create them, met with instant popular approval in both North and South, was subsequently advanced in Europe, and the humanitarian idea developed in this country was advocated until officially taken up by the great nations and agreed upon by them under the Geneva Convention.

In connection with the foregoing, the record of the casualties among the regular and volunteer Federal medical officers during the Civil War is of interest. Thirty-two were killed in battle or by guerillas; nine died by accident; eighty-three were wounded in action, of whom ten died; four died in Confederate prisons; seven died of yellow fever, three of cholera, and two hundred and seventy-one of other diseases, most of which were incidental to Camp life or the result of exposure in the field.

The medical and surgical supplies for the Federal hospital establishments not accompanying troops were practically unlimited as to variety and amount. But with the material taken into the field with troops, considerations of transportation [229]

A hospital on the firing-line Confederate Camp in front of Petersburg, captured June 15, 1864 This abandoned Confederate Camp fell into Federal hands June 15, 1864. It was used by the Union troops as a temporary hospital and camp. Three assaults had been made on Petersburg before this photograph was taken, June 24, 1864. The man with his arm in the sling is evidently one of the slightly wounded who was sent to this field hospital. It was not long before these rough shelters gave place to bomb-proofs and burrows. As the siege progressed the soldiers on both sides lived subterranean lives. Nothing was safe above ground within range of musketry fire. Even the resting-camps in which the relieving regiments took turns had to be heavily protected from dropping shells and long-range fire. It was in such exposed positions as this Camp of abandoned winter-huts that some of the surgery had to be performed at the front.

[230] were paramount. Generally speaking, ammunition was forwarded first, rations second, and medical supplies third. Owing to the tremendous number of men engaged, it was early demonstrated that road spaces occupied by marching troops had to be studied so that organizations could be moved and deployed as rapidly as possible. Nothing except the barest necessities could be brought to the front where large armies were contending. In spite of every effort, transportation always tended to increase. For example, when Grant entered upon his Wilderness campaign, it is said that his trains contained between five thousand and six thousand wagons, which, on a single road, would have made a column over fifty miles long. The first tendency of new troops is to overload, and to this neither the Civil War as a whole nor its medical service in particular proved exceptions. All finally came to realize that the nature and degree of sanitary relief which could be provided for troops at the front must partake of a compromise between what might be desirable and what was possible.

At the beginning of the war, each regimental surgeon was furnished with a suitable equipment for his regiment for field service, in quantities regulated by the supply table. This table, which was revised about a year later, seemed to contemplate the medical and surgical outfitting of regiments on the basis of independent service, and when they became brigaded much of the equipment so supplied was found to be not only unduly heavy and cumbrous but also unnecessary.

The medical and surgical material available on the firingline was practically that carried by the surgeon in his case, known as the ‘surgeon's field companion,’ and by his orderly in the ‘hospital knapsack,’ a bulky, cumbersome affair weighing, when filled, about twenty pounds.

Wounds were expected—nay, encouraged—to suppurate, and that they could heal without inflammation was undreamed of by the keenest surgical imagination. Their repair was always expected to be a slow, painful, and exhausting process. [231]

[233] [234] [235] [236] for them. They were contained in four cases, one for major operations, one for minor operations, one a pocket-case, and one a field-case to be carried by the surgeon on his person into action. The instruments were well assorted, but they were used indiscriminately and without more than superficial cleansing upon both flesh and festering wounds, with the result that they habitually conveyed infection.

Under the surgical practice of the time, germs of blood poison, gangrene, and lockjaw were conveyed into the body. Moreover, it was the custom for the surgeons to undertake the most severe operations at the front, often under fire, under conditions in which even a pretense of surgical cleanliness could not have been maintained, even if the knowledge of the time had been sufficient to cause it to be attempted. What we would now term ‘meddlesome surgery’ was not peculiar to the army but was characteristic of general surgical practice of the time. In fact, toward the end of the war the best surgeons in the country were probably those with the military forces, and the admirable results which they frequently achieved bear evidence, not only of their accurate anatomical knowledge and surgical dexterity but of the amount of injury and infection which the human organism can resist.

[For a further discussion of the personnel of the Federal Medical Department and the Surgeons-general and their work, see Appendices B and C.—the editors.]

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The medical service of the Confederacy

Deering J. Roberts, M. D., Surgeon, Confederate States Army

Destruction in Richmond. Why the author of the following chapter must rely on memory and private sources. —destruction in Richmond, April, 1865 reaching almost to the Capitol itself (in the rear of the picture), and consuming medical and other official records.

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in the conflagration in the city of Richmond, Virginia, on the night of April 2, 1865, on its occupation by the Federal army, two houses with their contents were completely destroyed; one occupied by Surgeon-General Samuel P. Moore as his office, and the one adjoining, in which were stored many papers, reports, and records pertaining to his office, and which had accumulated during the preceding four years.

While much has been placed on the printed page during the past forty years, including the numerous octavo volumes under the title of ‘The War of the Rebellion,’ and the larger but less numerous ones entitled ‘The Medical and Surgical History of the War of the Rebellion,’ in which other lines and departments of the Confederate States army, including their organization, acts and deeds, rank and file, field and staff, have place, giving records, reports, and facts, information relating to the Confederate Medical Department is scant and meager indeed. However, during the past few years, through the organization of the Association of Medical Officers of the Army and Navy of the Confederacy, a few material facts have been made accessible to the future historian, from which, with my own personal observations, limited though they were, was obtained the subject matter contained in the following pages.¹

As the war dragged along, there was a greater want of medical, surgical, and hospital supplies among the citizens of the Confederate States in the territory not occupied by the [239]

Samuel Preston Moore surgeon-general of the Confederacy Dr. Samuel Preston Moore served as surgeon in the old army for many years. At the outbreak of hostilities he determined to follow his native State of South Carolina, where he had been born in 1812, and resigned from the army. He was almost immediately appointed surgeon-general of the Confederacy by President Davis, and served in that capacity until the end of the war. Dr. Moore did much with the scanty means to establish the Confederate medical service on a sure foundation. Though occasionally stern toward an offender, his words of encouragement were never lacking. Dr. Moore was a man of commanding presence. During the years after the war he became a noted and much beloved figure in the streets of Richmond, where he died in 1889.

[240] Federal lines than there was in the field and hospital service. The wholesale and retail dealers in drugs and medicines throughout the South usually kept large stocks on hand. The more prudent and far-seeing added to their usual stock in many of the larger cities and towns as the war-cloud darkened. These stocks were largely drawn upon by the medical purveyors, State and Confederate, and were supplemented by supplies from across the Atlantic, notwithstanding the rigid blockade of all Southern ports.

In connection with the ordnance bureau, an agency was established in London, with instructions to purchase and forward much-needed supplies for both Ordnance and Medical departments by every blockade runner, the vessels on their return trips carrying cotton to defray the expense. A separate agency for the Medical Department was established at Nassau. The cotton for the use of the Medical Department was purchased by special agents of the department, who were very active in the discharge of their duties, and supplies were shipped with commendable regularity.

From the time of the occupation of New Orleans by the Federals until the closing of the Mississippi River by the surrender of Vicksburg, considerable amounts of quinine and morphia were brought out of the Crescent City, at night, by fishermen in their small canoes or dugouts. The following incident is quoted from Dr. C. J. Edwards, of Abbeville, Louisiana:

Many and daring were the attempts of the distressed Confederates to obtain medicines during the war. In 1863, when Grant was besieging Vicksburg and his gunboats patrolling the Mississippi had cut the Confederacy in twain, my father was detailed from Wright's Arkansas cavalry, an independent command, to procure some quinine, calomel, and opium. He crossed the Mississippi River at Greenville, Mississippi, and proceeded with a buggy and horse to Canton, where he obtained the supplies. He made the return trip safely to the Mississippi River, only to find a gunboat in close proximity and no means of traversing the mighty stream, then bank-full. After considerable search he found an

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Thomas H. Williams, medical director of the first Confederate army in Virginia Dr. Williams was one of the regular army surgeons whose convictions led him to join the Southern cause. As medical director of the army in Utah under General Albert Sydney Johnston in 1859, he made an enviable record. In April, 1861, he resigned from the United States army, and on June 21st proceeded to Richmond. The following day he offered his services to President Davis, and was appointed surgeon in the Confederate States army. June 24th he was ordered to report to General Beauregard as medical director of the (Confederate) Army of the Potomac. He continued to hold this same position after General Joseph E. Johnston took command of the army. When General Johnston was wounded at the battle of Seven Pines, General Lee succeeded to the command. His medical director ranked Dr. Williams in the old army and therefore relieved him. Dr. Williams was afterward appointed medical director and inspector of hospitals in Virginia, and made his headquarters in Danville. He established nearly all the large hospitals in Virginia except at Richmond and Petersburg, and after a few months he was transferred to Richmond and put in charge of the ‘Medical Purveyors' Department,’ in which position he remained active till the end of the war.

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old disused pirogue, or dugout, with the front end partly knocked out. It was almost useless, but by loading only in the rear end he found the front would ride high enough to clear the water. He accordingly waited until night, when, under the convenient cover of darkness, he carefully loaded his frail craft with the precious burden, and stripping off, he swam the river in safety to the opposite side, pushing the dugout in front, keeping it properly trimmed.²

Supplies were brought into the Trans-Mississippi Department across the Rio Grande, from Mexico, close up to the time of General Richard Taylor's surrender to General Canby. Many petticoats were quilted in the shadow of the dome of the Capitol at Washington and in other Northern cities, worn through the lines by Southern ladies, and relieved of their valuable padding of quinine and morphia in Richmond. While ‘love laughs at locksmiths,’ love of country, inspiring brave hearts and stimulated by dire want, greatly aided in such important work.

In addition, on more than one occasion, valuable and greatly needed medical and surgical supplies were captured from the more bountifully supplied Northerners. Dr. J. B. Cowan, medical director of Forrest's cavalry, stated to the writer, that on one of Forrest's raids into western Tennessee, they captured and brought out a large wagon train, in which were three four-mule army wagons loaded with medical supplies, the remainder of which, after supplying his command very bountifully, were forwarded to Atlanta, Georgia. The value of that was estimated by Dr. George S. Blackie, medical purveyor there, to be fully equivalent to what would have cost the department at least one hundred and fifty thousand dollars in gold.

Finally, these means and measures were supplemented by a careful economy, and a resort to indigenous resources to be found in our hills and dales, fields and forests, mountains and [243]

[244] valleys. There were probably at least three laboratories for the preparation of indigenous drugs established: one in Lincolnton, North Carolina; one at Macon, Georgia, and one west of the Mississippi, in which tinctures and extracts were manufactured to some extent.

One tincture in particular, well remembered and popularly known in field and hospital service as ‘old indig.,’ was used as a substitute for quinine in malarial fevers, a compound tincture of willow, dogwood, and yellow-poplar barks. Efforts were made to cultivate the poppy (Papaver somniferum) in Florida and North Carolina, and the unripe seed-capsules, when incised, yielded or exuded a dark gum, not unlike Turkish opium in its effects. Decoctions and tinctures of Jamestown or common jimson-weed, leaves and seeds (Stramonium), and may pop root (Passiflora incarnata) were employed for the relief of pain, both internally and as a local application. Boneset (Eupatorium perfoliatum) and yellow jasmin (Gelsemium sempervirens), the former used as an antipyretic and the latter to control nervous symptoms in fever; queen's-root (Stillingia), in all conditions of depraved blood; the inner bark and pith of the common alder for making salve for ulcers and chronic suppurating wounds; and fresh slippery-elm bark, the root and leaves of the mauva plant, and the leaves of the prickly pear, or cactus, when shorn of its spines, well pounded and macerated, as an emollient poultice, were among the most prominent of the indigenous remedies.

Many Confederate surgeons reported that at no time did they fail in having an ample supply of three most important drugs, quinine, morphia, and chloroform. Furthermore, in all the writer's service there was not a death from chloroform in field or hospital. Dr. Chaille reported one case, immediately following an amputation just above the knee.

Other surgeons reported good success or ‘luck,’ among whom could be recalled Dr. J. B. Cowan, medical director, Forrest's cavalry; Dr. J. M. Keller, medical director, Trans- [245]

Confederate field-hospital at Cedar Mountain, August, 1862 The Confederate loss at Cedar Mountain, known to the Confederacy as the battle of Cedar Run, was about thirteen hundred men. General Banks, who had the temerity to attack General Jackson with less than half that redoubtable Confederate general's force, suffered a loss of twenty-four hundred men. The medical corps of the Confederate army had not yet run short of medicines, books, surgical instruments, and supplies as it did later in the war. As the fighting dragged on, there was a greater want of medical, surgical, and hospital supplies among the citizens of the Confederate States in the territory not occupied by the Federal lines than there was in their field and hospital service. The Union had not yet developed an efficient cavalry corps, and among the supply wagons that fell prey to the swift-moving Confederate cavalry were some laden with medical supplies. The stocks accumulated by the wholesale and retail dealers in drugs and medicines throughout the South were largely supplemented from time to time by supplies from across the Atlantic.

[246] Mississippi Department; Dr. J. R. Buist, of Nashville; Dr. William Brickell, of New Orleans; Dr. G. B. Thornton, medical director of Stewart's corps, and others. Dr. Hunter McGuire, medical director of General T. J. Jackson's corps, collected fifteen thousand cases of chloroform anesthesia without a single death.

As for dressings, there were a few cotton manufactories in the South that made a fairly good quality of osnaburg from which bandages were made, in some instances rolled by the hands of fair women, or the medical officers and hospital attendants. Many households furnished old sheets and other worn cotton and linen garments, lint being made from the latter by scraping with a knife in some Southern woman's hands. Raw cotton, however, carded by hand, and in some instances separated from its seeds by the fingers of women and children, baked in an oven, in fact almost charred, was often substituted for lint, being rendered aseptic by this means, although we knew little of asepsis and antisepsis in that part of the ‘Sixties.’ When sponges became scarce, old but clean linen or cotton rags were used and then thrown away or burned, another aseptic procedure, although at the time that special designation had not been given it. Occasionally, silk for ligatures and sutures was limited, but it was as easily transmitted by blockade or the ‘underground’ as were quinine and morphia; yet a few times I was forced to use cotton or flax thread of domestic make, and horse hair, boiled, to make it more pliant and soft—again accidental asepsis.

Water dressing for large wounds, amputations, resections, and extensive lacerations, was largely resorted to, by means of wet cloths applied from time to time, the nurse pouring small quantities on, or the automatic siphoning by means of a strip of cotton or linen, one end of which was immersed in a vessel of water suspended over the wound, the other hanging down a little lower than the bottom of the water. In that case a piece of oilcloth or part of an old piano cover was placed beneath the [247]

Mrs. Felicia Grundy Porter president of the women's relief society of the Confederate states In the shadow of the Confederate Monument in the Mount Olivet Cemetery at Nashville, Tennessee, lie the remains of Mrs. Felicia Grundy Porter, who gave her time, devotion, and heart both during and after the war to the physical relief of the boys in gray. She was escorted to her last resting-place by Confederate soldiers riding on each side of the hearse, with many more following in its train. Mrs. Porter was born in Nashville, June 26, 1820. When the war broke out she set about establishing hospitals in Nashville for the wounded Confederate soldiers. She labored without stint as president of the Women's Relief Society, first of Tennessee, and then of the entire Confederate States. She collected a vast fund for this humanitarian purpose. As president of the Benevolent Society of Tennessee, she arranged for a series of concerts and tableaux in its towns and cities, the receipts from which were expended in buying artificial limbs for the disabled Confederate soldiers.

[248] wound, so arranged as to drain the excess of water into another vessel on the floor at the bunk side. In some cases minor amputations, gunshot and incised wounds limited in degree of severity were hermetically sealed by adhesive plaster, or the starch bandage, securing ‘union by first intention.’ But suppuration was largely the rule, and in extensive wounds ‘laudable pus’ was regarded as essential.

Instruments were procured by the medical bureau in the earlier part of the war from stock in the hands of dealers in the larger cities, later by blockade-runners, and by the handiwork of a few skilled workers in metals in the Southern States. Some were somewhat crude and clumsy, and lacked the beautiful polish and finish given by the experienced and well-equipped instrument maker. Occasionally a fortunate surgeon would acquire a good case of instruments by capture; but quite a number of our surgeons brought from their homes both amputating-and pocket-cases, their private property purchased before the coming on of hostilities.

Books were far more scarce than instruments. However, those who so desired could at times provide themselves in a meager way. Some surgeons made a point of calling on village and country practitioners in the vicinity of the army, and on more than one occasion, during such peregrinations, managed to make a purchase of medical works. The author has now in his library a copy of ‘Erichsen's Surgery,’ purchased from a Doctor Johnson in the vicinity of Clinton, Louisiana, just after the battle of Baton Rouge, August, 1862. The price paid was one ounce of ‘P. & W.’ sulphate of quinine, of which I had at the time an ample supply. I have also a copy of Wilson's ‘Dissector,’ 1857 edition, which I had carried with me from home, and managed to bring back with me, it being less cumbersome than the text-book of anatomy by the same author. Other books which I managed to secure from time to time by ‘barter and exchange,’ but was forced to abandon because of their size and weight, were [249]

[250] Druitt's ‘Surgery,’ Bartlett ‘On Fevers,’ Wood's ‘Practice,’ Watson's ‘Practice,’ Tanner's ‘Practice,’ and a copy of the ‘United States Dispensatory,’ by Wood & Bache.

Occasional copies of The Confederate States medical and surgical Journal, reached field and hospital surgeons. It was published in Richmond by Ayres & Wade, with the approval and under the supervision of the Surgeon-General, monthly from January, 1864, until February, 1865. A complete file from which much important historical data can possibly be obtained, is now in the Library of the Surgeon-General's office at Washington. The first number reported a regular meeting of the ‘Association of Army and Navy Surgeons,’ organized in Richmond, August, 1863, with Samuel P. Moore, the Confederate Surgeon-General, as president.

Dr. J. J. Chisolm, who entered the army as a surgeon from Charleston, South Carolina, wrote an excellent little ‘Manual of Military Surgery’ of about four or five hundred 12mo pages; and another manual, about the same size, was prepared by surgeons detailed for that purpose by Surgeon-General Moore, and published in Richmond, in 1862 or 1863. These were supplied to many field and hospital surgeons by the Government.

Another work published at Richmond in order that the medical officers, as well as the public, might be supplied with information, which at that time was greatly needed, was prepared by direction of Surgeon-General Moore, by Francis Peyre Porcher, M. D., formerly surgeon in charge of the city hospital in Charleston, South Carolina, and professor of materia medica and therapeutics in the medical college of that city, and was entitled ‘Resources of the Southern Fields and Forests, Medical, Economical, and Agricultural, being also a Medical Botany of the Southern States, with Practical Information of the Useful Properties of the Trees, Plants, and Shrubs.’ A large number of copies was printed, and the book supplied to the medical officers and all others who made application.

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Field and temporary hospitals: the surgeon in the field

Deering J. Roberts, M. D.,, Surgeon, Confederate States Army

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.

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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< [253] 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.

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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.

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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.

[256]

[The two articles which follow supply interesting personal reminiscences of hospital conditions within the Confederate lines. 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's surrender.

On the morning of December 1, 1864, I received orders to go to Franklin, Tennessee, and make arrangements for the wounded of General Bate's division. I did so, taking with me my hospital steward, a detail of ten men, and two wagons. [257]

[258] 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 [259]

[260] 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 [261]

[262] 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 [263]

[264] 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 and Nashville, 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, Cincinnati, Pittsburg, Philadelphia, Baltimore, Fortress Monroe, and City Point to Richmond, 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 [265]

[266] 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-Atlanta campaign of 1864, I was sent at different times by General Bate to make unofficial inspections of the wounded of his command at Catoosa Springs, Griffin, 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-Atlanta campaign, the various hospitals organized at Chattanooga had [267]

[268]

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.

[269]

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.

[270]

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. These, naturally, [271] 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.

[272] 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. Father Blemiel, 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.

---

[273]

Permanent and General hospitals

Deering J. Roberts, M. D., Surgeon, Confederate States Army

1865—a Presbyterian church turned into a hospital with 41 beds, at Nashville

[274]

A photograph which helps to explain the national pension roll: carver hospital in Washington, September, 1864 The figure farthest to the right, with the white cross on his breast, was recognized as his own portrait, a generation after the war, by Henry W. Knight, of Company B, Seventh Maine Volunteers, one of the veterans associated with the preparation of this Photographic history. The cross is the corps badge of the Sixth Corps. The man on his right is Cephas McKelvey, of the Eleventh Pennsylvania Volunteers, who was wounded in the arm. Both men were convalescent. The personnel of these hospitals consisted of the surgeon in command, assisted by an executive and professional staff, and with the necessary number of stewards, clerks, attendants, cooks, laundry workers, guards, etc. Nursing and similar work was either done by details of soldiers from the line of the army or by civilians hired or volunteering for such duty. the guard, necessary for the maintenance of order restraint of convalescent [275] patients and the protection of property, was usually composed of convalescent patients and members of the Veteran Reserve Corps. The surgeon in command of a general hospital had full military control over all persons and property connected with his institution, reported directly to the War Department and surgeon-general and received his orders therefrom. He usually had one or more assistants. The medical staff ordinarily numbered about one to each seventy-five patients. A medical officer of the day, detailed by roster, was always on duty, performing routine duties in relation to the proper management of the hospital and responding to any emergency in professional, administrative, or disciplinary matters. The ward surgeons had duties almost exclusively professional and similar to those performed by the resident physicians of civil hospitals. Two women are sitting by one of the cots.

[276]

General S. P. Heintzelman and friends at the headquarters of the convalescent camp in Alexandria The photographs on these two pages tell their own pathetic story—the story not of the wounded and suffering soldiers, but of their thrice-suffering womenkind. To this convalescent Camp in Alexandria came the anxious wives and mothers, sweethearts and sisters to find their soldiers whom they had perhaps not seen for months or years. The mourning of the woman on the veranda tells the tale of a soldier-boy that is gone. Perhaps she has come to bring the aid and comfort to others which she was denied the privilege of lavishing on her brother or son. The quaint costumes of the time are very well illustrated in this photograph. Then a woman apparently put on a cap at forty, sometimes before. the little girls wear such [277] voluminous draperies that one wonders how they could get about at all. These were the days of the hoopskirt and the polonaise. In the photograph to the right they have removed their quaint small hats, and look less like premature little women. The little boys, in their ‘cunning’ Kate Greenaway costumes on the left-hand page, have evidently just come up to get into the photograph. The officer lounging in the chair has turned his profile to the camera. A great change in the type of women's faces can be seen since that time. Women have changed more than men. The change is deeper than mere dress, and involves also her outlook upon the world. But she is as ready as ever to relieve distress and suffering in war.

[278]

Though the writer was never on the staff of a general hospital, he visited a large number of them, knew personally many medical officers assigned to duty in them, and was familiar with their general plan of operation. The most valuable information concerning them, however, is to be found in a remarkable series of addresses and papers published in the Southern practitioner, many of which had been delivered before the Association of Medical Officers of the Army and Navy of the Confederacy. This series is an invaluable mine of information, and from it most of the facts given in the following pages are drawn.

It must be remembered, of course, that the men from whom I quote, whose writings are abstracted, or whose success is described, were among the most distinguished officers of the service. Added to professional skill they possessed executive and administrative ability which would have won success under any circumstances. That all the Confederate hospitals were so successful, either upon the medical or upon the administrative side, is, of course, improbable.

The problem confronting the Medical Department and the manner in which it was met is thus stated by the surgeon-general, Doctor Samuel Preston Moore:

The only building in Richmond adapted to hospital purposes, the almshouse (a large brick building, well suited, capable of accommodating say five hundred patients), had been converted into a hospital,

[279]

Hospital ward in convalescent Camp at Alexandria This is where thousands of fortunate soldiers got well from their wounds. When the regiments marched away to the front, their barracks and other available buildings were turned into improvised hospitals. Where the intended capacity was exceeded, tent wards were often pitched to supply the deficiency. Generally, however, other buildings were taken over to provide for the surplus wounded. These offshoots themselves were frequently forced to enlarge and, for facility of administration, were detached from the parent institution. For instance, in the middle of December, 1864, there were sixteen such institutions within the corporate limits of the city of Washington alone, and a total of twenty-five, with an aggregate bed capacity of 21,426, almost within cannon-shot of the Capitol. On this same date there were 187 general hospitals in operation, scattered all over the country from New England to New Orleans and from the Missouri to the Atlantic, and having the enormous total capacity of 118,057 beds, of which but 34,648 were then vacant.

[280]

and occupied by the wounded prisoners of the Northern army from the battle just mentioned [Manassas]. The Confederate wounded from the same battle were treated in private houses, in small, unoccupied wooden buildings, and small tobacco-factories improvised as hospitals. There were serious objections to this method of treatment of the sick and wounded, the principal being the liability of spreading contagious diseases among the inhabitants of the city; the aggregation of so many patients in the necessarily large wards of the factories, thereby contaminating the buildings, rendering them unfit for occupancy; and the impossibility of supplying by these means the further demands of the service.

To meet, as far as practicable, these requirements, the plan was adopted of erecting buildings, each one to be a ward and separate, of undressed planks set upright, calculated for thirty-two beds, with streets running each way, say thirty feet wide. From fifteen to twenty of such wards constituted a division, three or more divisions making a general hospital. Each division was separate and distinct, having all the appliances of a hospital, but under control and supervision of the surgeon in charge of the general hospital. There were five of these hospitals in the suburbs of Richmond, erected in 1861. At a rough estimate, twenty thousand patients were at one time treated at these general hospitals.

The plan proved to be excellent, and the temporary hospital buildings in the city were abandoned as soon as practicable, the larger factories only being retained and used. This segregation of the sick and wounded was highly beneficial. If the condition of a ward, from whatever cause, required its abandonment, it was done without trouble or much cost to the Government. It may be stated that cases of hospital gangrene were, as a rule, removed from wards and treated in tents, with decided benefit. General hospitals, on this plan, were established whenever and wherever deemed necessary. This was sometimes attended with delay; for the Medical Department, instead of being an independent bureau, building and furnishing hospitals, had to depend entirely upon the Quartermaster's and Commissary departments. Hence, much delay was experienced in obtaining proper hospital accommodations, and in such cases blame was attached to the medical bureau, which it never deserved.³

[281] [282]

Doctor John R. Gildersleeve, when president of the Association of Medical Officers of the Army and Navy of the Confederacy, in 1904, delivered an interesting address upon Chimborazo Hospital, Richmond. When the necessity for larger hospital accommodations became evident, SurgeonGen-eral Moore, after consultation with Doctor James B. McCaw, of Richmond, chose Chimborazo Hill, on the outskirts of Richmond, as a site for the new hospital, and Doctor McCaw was placed in charge. Some of the buildings were opened early in 1862, and before the end of the war one hundred and fifty wards had been constructed. They were usually commodious buildings, one hundred feet long, thirty feet wide, and one story high, each ward having a capacity of from forty to sixty patients. The buildings were separated by alleys and streets, and the hospital presented the appearance of a town of considerable size. Five divisions were created, each in charge of a surgeon with the necessary assistants. These divisions were arranged, as far as possible, upon the basis of States. So far as possible troops from the same State were assigned to one division, and were attended by surgeons and attendants from that State.

The celebrated farm, ‘Tree Hill,’ was loaned to the hospital by Mr. Franklin Stearns, and afforded pasturage for a large number of cows and several hundred goats. The meat of young kids was found to be much relished by the soldiers. ‘The hospital trading canal-boat, Chimborazo, with Lawrence Lotier in command, plied between Richmond, Lynchburg, and Lexington, bartering cotton yarn and shoes for provisions. This was only one of the hospital's many resources.’ An additional fact is that the hospital never drew fifty dollars from the Confederate States Government but relied solely upon the money received from commutation of rations.

The total number of patients received and treated at Chimborazo Hospital amounted to seventy-six thousand (out of this number about

[283]

Officers and nurses at seminary hospital, Georgetown, April 1, 1865 The two neat nurses in the window, with their old-fashioned black mittens, may be held responsible for the bird-cage hanging by the door. Neither they nor the chubby little boy sitting on the sidewalk in the foreground suggest war; yet this is a scene of April, 1865, before Lee's surrender. It is well-nigh impossible for a man surrounded by the sights and sounds and scents of every-day civilian life to realize what a touch of femininity meant to a sick soldier far from home after four years of rough campaigning. A chaplain was attached to most of these hospitals; his duties, besides those of a spiritual nature, having to do with correspondence with friends and relatives, supervision over the postal service, reading-room, library, amusements, etc. There was often much trouble in securing adequate nursing attendance, both in respect to the number and character of the personnel. There were female nurses at many hospitals; some were Sisters of Charity, and representatives of women's aid societies often took turns in nursing and assisting in the diet and linen-rooms. The sick were fed from the regular ration, or from articles purchased with the savings made on the unconsumed portions. The latter fund was in some cases scarcely sufficient.

[284]

seventeen thousand were wounded soldiers). . . . It was the first military hospital in point of size in this country and in the world, the next largest hospital in this country being the Lincoln in Washington, D. C., which represented a total number of forty-six thousand patients; and the next largest in the world at large was the Scutari Hospital in the Crimea, which represented a total of thirty to forty thousand patients. The percentage of deaths at Chimborazo was a fraction over nine per cent.⁴

Doctor Alexander G. Lane, surgeon in charge of the Winder Hospital in Richmond, from its organization in April, 1862, until the evacuation of Richmond, has told in an interesting way of the organization of that institution. The grounds covered one hundred and twenty-five acres, and the hospital, composed of six divisions, had a capacity of forty-eight hundred patients. A dairy was organized, an ice-house was built, and there were large gardens, worked by convalescents, on the hospital grounds.

Here, as at the Chimborazo Hospital, it was sometimes difficult to secure food suitable for the sick, and therefore Doctor Lane had two canal-boats constructed, which made regular trips up the Kanawha Canal, bringing back whatever supplies could be found in the country nearer the mountains, as yet undrained by the demands of the armies. The bakery had a capacity somewhat larger than was necessary for the hospital, and at times baked, by contract, a part of the bread for the prisoners in Belle Isle and Libby.

From a series of articles prepared by Doctor Samuel H. Stout, Medical Director of the Army of Tennessee, we learn that the change of climate caused much sickness among the troops drawn from the Gulf States to Tennessee and Kentucky during the winter of 1861-62, and that only by the greatest exertions was Medical Director Yandell able to provide for the care of the sick. Most of these were sent to [285]

[286] Nashville, and there Doctor Stout himself, before his promotion, was placed in charge of the Gordon Hospital, formerly an old warehouse.

This hospital had been in charge of a committee of ladies who had employed civilian physicians to attend the sick, and the hospital attendants were not under military discipline. Through the exercise of considerable tact, Doctor Stout reorganized the hospital and brought it under military rule without offending the sensibilities of the ladies. Doctor Stout was an excellent business man and required frequent statements from the commissary of the amount of money due the hospitals from commutation of rations, and the fund thus obtained was used liberally for the benefit of his patients, procuring for them articles of food to be had in the market. When chickens, butter, and eggs were not brought to the hospital in sufficient quantities, he sent out wagon-loads of cotton yarn purchased from the factories, and exchanged it for the much needed delicacies.

After his promotion to the office of medical director, Doctor Stout was particularly insistent that real coffee should be served the patients in the hospitals under his control, and sent subordinates to Wilmington and Charleston to purchase it from the blockade-runners. A bakery was established at every hospital, and the saving thus made inured to the benefit of the hospital fund.

He even went so far as to purchase at Chattanooga a printing outfit on which the numerous blanks needed for the use of the various hospitals were prepared. This was placed under the charge of privates detailed for the purpose and soon became a source of income.

Seeds were bought for gardens, and, when the number of convalescents was not sufficient to work them, labor was paid from the hospital fund. Cows, horses, and wagons were purchased whenever needed, without waiting for the formal approval of the surgeon-general. ‘I thought that economy of [287]

[288] expenditure was not to be considered urgent. The great undertaking was to find the materials needed.’

At Chattanooga, Doctor Stout caused hospitals to be constructed upon an entirely new plan, which he maintained was far superior to that followed in the building of the Chimborazo Hospital, and which ‘was evidently an imitation of the models of such buildings long in use in the Federal service.’ His objections to the plan of Chimborazo were that its width afforded space for more than two rows of bunks and that, when windows and doors were necessarily closed on account of the weather, ventilation through the roof was not sufficient. He thus describes the new plan:

The pavilion wards erected under my direction, were of such width that only two rows of bunks could be arranged or accommodated in them. The bunks were placed crosswise of the room, the head of each being from one and a half to two feet from the side wall. Thus, an aisle or vacant space of from eight to ten feet in width was left in the middle of the ward throughout its entire length. Sometimes the wards were built one above another. Near the floor, and just under the ceiling overhead, were longitudinal openings with sliding shutters, one foot in width, that could be closed or opened at the will of the surgeon in charge. Overhead, in the ceiling, were also openings with sliding shutters, and latticed structures on the comb and in the gables, which were opened or closed as occasion required.⁵

Doctor Stout also provided a general register at his headquarters for all the hospitals under his direction. The surgeon in charge of every hospital was required to send daily any changes in his register. These were entered upon the general register, and it was therefore possible to find the whereabouts or the fate of any patient in a few seconds.

In addition to the general hospitals established for the treatment of patients until they were convalescent, ‘wayside’ hospitals were established at every important junction-point. [289]

A Federal officer wounded at pine mountain, Georgia—August, 1864 This unusual photograph of an officer still on crutches, emaciated and suffering, was taken in August, 1864, near Pulpit Rock, Lookout Mountain, Tennessee. It is reproduced here through the courtesy of the officer himself—Major (later Colonel) L. R. Stegman, associated with the editors in the preparation of this work. In June, 1864, during Sherman's march to Atlanta, he was shot in the thigh, the shot fracturing the bone. Major Stegman was in command of the Hundred and Second New York, which was attached to the twentieth corps of the Army of the Cumberland. A wound of this character disabled the victim for many months. Colonel Stegman's companion in the photograph is Lieutenant Donner, of an Ohio regiment, also wounded in the thigh and using a cane for support.

[290] In these were treated soldiers taken suddenly ill, convalescents who had overestimated their strength, and wounded whose condition forbade further travel.

Some of the general hospitals established received high praise from Federal sources. For example, the lamented Doctor Stanford E. Chaille, of New Orleans, in a private letter written just before his death, tells of the capture of himself and his hospital at Macon, Georgia, by Wilson's cavalry, and goes on to say that he ‘was treated by General Wilson's medical director with marked consideration and to many favors, . . . and he urged me to continue in charge, on Federal pay, retaining my Confederate inmates, and admitting to separate wards Federal sick and wounded. My feelings were then too bitter to accept his generous offer.’

At the beginning of the war, many private hospitals were established wherever troops were stationed for any length of time. These were generally under the control of a committee of women anxious to do something for the good of the cause, and under the charge of a citizen-surgeon of their own selection. The nursing was almost exclusively volunteer, but rations were furnished in some cases by the Confederate Government. Many of these were well conducted and did good service, particularly during that period before the general hospitals were built and the medical staff thoroughly organized.

When the Medical Department became able to take care of all the sick and wounded, it seemed best, for obvious reasons, that all sick and wounded should be brought under direct supervision of the Medical Department, and a majority of the private hospitals were discontinued. One of them, however, established in Richmond just after the first battle of Manassas (Bull Run) by Miss Sally L. Tompkins, deserves mention. Doctor William Berrien Burroughs says of this hospital:

Ten days after the battle, on July 30, 1861, entirely at her own expense she opened the Robertson Hospital (corner of Main and Third streets) which continued its mission of mercy to July 13, 1865. In

[291] [292]

This Confederate hospital over fourteen hundred soldiers were nursed and received the best of attention.

Private hospitals became so numerous that a law was passed that they be discontinued, and no hospital was allowed except those in charge of a commissioned officer with a rank not lower than that of captain, that being the rank of an assistant surgeon. When this law was being executed and the ambulances were at the hospital door, Miss Sally remonstrated. The Secretary of War was consulted but said he was powerless and that President Davis was the only man that could annul the order. Her hospital register was shown the President. The death-rate was very small. The number of men returned to the army was very large; in fact, her hospital record of deaths was lower than, and her record of soldiers returned to their commands was greater than, that of any other hospital in Richmond. . . . On receipt of this information the President commissioned her captain.⁶

Though the germ theories of Lister and Pasteur had not yet been advanced, mention has already been made of some instances of accidental asepsis. From necessity or experience, surgeons in the hospitals sometimes adopted methods which prevented infection of wounds, so common in all surgery at that time. For example, Doctor C. H. Tebault says:

One blessing we enjoyed, due to the blockade, was the absence of sponges, clean rags being substituted for them with telling advantage. These rags could be thoroughly washed, as was done, and used over and over again. It is next to impossible, easily, if possible at all, to wash an infected sponge. This fact and the unstinted use of a plentiful supply of pure well or spring water, and the pure condition of the air of the hospitals, . . . were not without their wholesome effect.

On the other hand, Doctor J. J. Terrell, in connection with his service at General Hospital No. 1, Lynchburg, Virginia, in 1863, began to treat cases with dried-lint dressing to exclude air from the wound, ‘not upon a germ theory, which was then unknown, but upon the theory of oxygen and moisture causing decomposition.’ [293]

Armory square hospital—where Lincoln walked among the flowers Perhaps it was because of President Lincoln's habit of visiting the Armory Square Hospital in Washington that so much care has been bestowed upon the flowers. The walks are straight and even, and the scene, except for the ambulance standing near the curved walk, seems one of peace and not of war. The Capitol rises majestic in the background, and to the left is the little chapel attached to the hospital. Earnest people entered there to send up a prayer for the soldiers who were wounded in the cause of their country.

[294] [296]

There was no central organization controlling the women nurses as in the North, but there was seldom any lack of feminine attention in the permanent hospitals. The greater part of the service was rendered entirely without remuneration, and, if paid for, the amount was trifling.

The women of the South considered it a privilege to act as nurses and hospital attendants. So many were they and such valuable services did they render, that it is almost an injustice to mention the few and omit the names of hundreds. Miss Emily Mason, niece of James M. Mason, Confederate commissioner to England, was the matron of one of the divisions of the Winder Hospital, while Miss Mary L. Pettigrew, sister of General Pettigrew, served in the same capacity, first at Raleigh, and then at Chimborazo. Mrs. Archibald Cary did effective service at Winder, where she was assisted by her daughter, later Mrs. Burton N. Harrison. The daughters of General Lee, Mrs. G. W. Randolph, and many others were frequent visitors to the Richmond hospitals, where they read to the convalescents, wrote letters for them, and fed them.

Mrs. Felicia Grundy Porter, of Nashville, gave freely of her time and means; Mrs. Gilmer, of Pulaski, Tennessee, served as nurse and matron at various hospitals; Mrs. Ella Newsom, a wealthy young widow, left her home in Arkansas with a number of her own servants and went to the seat of war in the West, serving first at Memphis, then at Belmont, Bowling Green, Nashville, Atlanta, Corinth, and Chattanooga.

Nor must the work of the Roman Catholic sisterhoods be neglected. The nursing in some of the hospitals was entirely under their charge. At others, they worked with nurses appointed by the surgeons, or with volunteers. Every city or town containing a convent had in the inmates willing workers, who went where sickness and suffering were found.

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[297]

With the ambulance corps: transportation of Federal sick and wounded

Edward L. Munson, M. D., Major, Medical Department, United States Army

Well-equipped ambulance bearers of the army of the Potomac, 1862—drill in removing wounded

[298]

Removing the wounded from Marye's heights, May 2, 1864: ambulance corps of the fifty-seventh New York infantry This spirited scene of mercy followed close on the assault and capture of the famous ‘Stone Wall’ at Fredericksburg, May 2, 1863. The ambulances belong to the Fifty-seventh New York, which suffered a terrible loss when it helped, as a part of Sedgwick's Corps, to carry Marye's Heights. Out of one hundred and ninety-two men engaged, eight were killed, seventy-eight were wounded, and one was reported missing, a loss of forty-five per cent. Then the ambulance train was rushed to the front. Within half an hour all the wounded were in the field hospitals. The corps still had many of the short, sharply tilting, jolting two-wheeled ambulances whose [299] rocking motion proved a torment to sufferers. Several four-wheeled ambulances appear, however, and later in the war the two-wheeled ambulances were entirely superseded. The long lines of infantry drawn up in battle array in the background are ready to repel any further assaults while the wounded are being removed on the litters. The one in the foreground (on the left) exhibits a device to elevate the patient's limbs. The medical officer is gazing anxiously at the wounded soldier, and an orderly is hurrying over with some bandaging. Directly behind the orderly, bearers are lifting another sufferer on a litter into the four-wheeled ambulance.

[300]

A few of the wounded at Gettysburg: second corps hospital, Union center, near Meade's headquarters To these rough tents, erected by the Second Federal Army Corps, the wounded have been rushed during the second and third days of the mightiest of all American battles, just decided at a cost of 6,664 dead and 27,206 wounded. Accommodations are simple. But cups hang at the front of the foremost tent wherewith to slake the sufferers' thirst, and at least one woman nurse is present to soothe their fevered brows with the touch of her cool hands. By this time the ambulance organization of the Union armies had been perfected. Such was the efficiency of its administration that on the early morning of the 4th of July, 1863, the day after the battle, not one wounded soldier of the thousands who had fallen was left on the field. The inspector-general of the army himself reported this [301] fact from personal investigation. During the Civil War, the number of battle casualties steadily increased, until in the year 1864 there were no less than 2,000 battles, actions, and skirmishes officially reported, and during the second quarter of that year more than 30,000 wounded were received in the Washington hospitals alone, while the total number of such admitted to all the hospitals during the same period exceeded 80,000. For the war period, May 1, 1861, to June 30, 1865, the cases admitted to hospitals for all surgical causes amounted to 408,072, with 37,531 deaths. Of this great number 235,585 were gunshot wounds, with 33,653 deaths. This gives a case-mortality among the wounded able to secure surgeon's care of 14.2 per cent., a terrible toll of the nation's young men.

[302]

The first removal of helpless wounded from the battlefield was usually effected by hand-litters, of which the number issued during the war exceeded fifty thousand. There were a number of patterns used, of which the best weighed twenty-four pounds, was quickly collapsible when not required, and possessed legs, which made its temporary use as a cot readily possible. Many wounded were also removed by their comrades on extemporized litters made by passing poles or muskets through the sleeves of coats which were then buttoned over them; or these supports were rolled in the edges of blankets, and litters thus formed. Hurdles, gates, window shutters, and ladders, with brush and hay thrown over them, were also used. Poles interlaced with rope or wire were employed. Hammock litters were made by swinging the wounded man in a blanket with its ends lashed to a single pole. The Indian travois, a frame on two long poles dragged after a horse, their front ends being supported by the saddle and tied together with a breast-strap, was also used. The ordinary ‘chair seat,’ as made by children at play, was frequently employed to remove wounded over shorter distances. Mule-litters and cacolets, the latter chairlike affairs swung on each side of the mule's back, were suggested and some were provided, but seem to have been little used. They were specially intended for rough country where wheeled vehicles could not readily go. Wounded able to walk were expected to make their own way back to the surgeon, with or without assistance. [303]

Union hand-stretchers at work at Marye's heights in May, 1864 Over fifty thousand hand-stretchers of various patterns were issued by the Union Government during the war. It was by means of them that the removal of the helpless wounded from the battlefield was effected. The best pattern of hand-stretcher weighed twenty-four pounds, was quickly collapsible when not required, and possessed legs which made its temporary use as a cot readily possible. This photograph shows the wounded on Marye's Heights after the battle at Spotsylvania, May 12, 1864. The wounded man on the stretcher is gazing rather grimly at the camera. His hand is bound up, and his foot showing at the end of the stretcher is bare. The poor fellow in the foreground seems pretty far gone. His face is as pale as the blanket which covers him. The whole group of strong men struck down typifies the awful effects of war.

[304]

But the transportation results achieved in these ways were usually possible only over short distances. The organization of the medical service made no provision for removal of the wounded from the regimental collecting-points to hospital facilities further to the rear. There were no sanitary organizations in reserve, available to assist near the firing-line where their service might be needed, or to bridge with their succor, care, and transportation, the often tremendous gap between the relief stations of the regimental surgeons and the general hospitals, usually far in rear. Frequently surgeons with some regiments in action were overwhelmed by the number of casualties in their organizations, while others might be idly waiting with commands held in reserve. The need for organizations to play the part of intermediaries was obvious, but for some occult reason failed to appeal at first to those who had the direction of general military affairs in charge. The lack of such specially equipped and trained organizations resulted in a vast amount of suffering during the first eighteen months of the war, and gave rise to much criticism of the Medical Department which the latter in nowise deserved.

A carefully matured plan for the organization of a hospital corps, to belong to the Medical Department and take over work which was at that time being inefficiently done by some sixteen thousand enlisted men detailed from the line of the army, was submitted to the Secretary of War on August 21, 1862, but failed of adoption as a result of the opposition of General Halleck, general-in-chief. An appeal was then made as follows:

This letter was returned with an endorsement from General Halleck, reiterating his continued disapproval of the whole plan of medical organization, in the face of which opposition in high places, no further steps at army headquarters could, for the time, be taken.

But in the mean time, medical officers of independent commands had been endeavoring to improve conditions within the immediate jurisdiction of their commanders, and in the Army of the Potomac, Medical Director Letterman had convinced General McClellan, perhaps the ablest organizer in the Northern forces, of the need for some special provision for the first aid and transportation of wounded. On August 2, 1862, General McClellan issued an order embodying Medical Director Letterman's plan, which was not only the first of its kind but so complete and practical as to have since served as the basis for the organization of the medical service in the field in all the armies of the world. The order need not be here further discussed than to mention that it organized an ambulance corps with animals, transportation, personnel, and supplies [307]

[308] complete, to be used for succoring and transporting sick and wounded men, ‘and for nothing else.’

The advantages of this organization became speedily manifest, and at the battle of Antietam, in the following month, it gave admirable service. Of its operation in the battle of Fredericksburg, Surgeon Charles O'Leary, medical director of the Sixth Corps, said in his official report:

‘During the engagements of the 13th, the ambulances being guided and governed with perfect control and with a precision rare even in military organizations, the wounded were brought without any delay or confusion to the hospitals of their respective divisions. Not a single item provided for the organization of the field-hospitals suffered the slightest derangement, and the celerity with which the wounded were treated, and the system pervading the whole Medical Department, from the stations in the field selected by the assistant surgeons with the regiments to the wards where the wounded were transferred from the hands of the surgeons to be attended by the nurses, afforded the most pleasing contrast to what we had hitherto seen during the war. . . .’

In the operations at the time of the battle of Chancellorsville in the following May, the Sixth Corps charged and took Marye's Heights behind the town of Fredericksburg. The medical director of the corps, in his report, says: ‘The charge was made at 1 P. M.; the heights were taken, and in less than half an hour we had over eight hundred wounded. Two hours after the engagement, such was the celerity and system with which the ambulances worked, the whole number of wounded were within the hospitals under the care of nurses.’

In the battle of Gettysburg the ambulance organization was intact, and such was the perfection of its administration, that, on the early morning of the 4th of July, the day after the battle ended, not one wounded man of the great number who had fallen was left on the ground. The inspector-general of the army himself reported this interesting fact from personal examination. [309]

Ambulances going to the front—before the Wilderness campaign In the foreground of this photograph stand seven ambulances and two quartermasters' wagons, being prepared for active service in the field. The scene is the headquarters of Captain Bates, of the Third Army Corps, near Brandy Station. The following month (May, 1864) the Army of the Potomac moved to the front under General Grant in his decisive campaign from the Wilderness onward. A large quantity of stores lie upon the ground near the quartermasters' wagons ready for transportation to the front. As it became evident that any idea of providing each regiment with its individual hospital was impracticable in a large command, efforts were made to afford hospital facilities for each division at the front. As a result, the regimental medical supplies—the wagons containing which had usually been back with the field train when required during or after action—were largely called in and used to equip a single central hospital organization, which could be held intact and at once available to be brought forward in its wagons for use as needed. One of these hospitals was organized for each division, but sometimes the needs of the wounded in a given area would be such that several of these hospitals might be ordered to work near together.

[310]

The success of the plan under McClellan induced Grant to adopt it in the Army of the Tennessee, in an order dated March 30, 1863. Finally, Congress tardily passed an act, approved by the President on March 11, 1864, establishing a uniform system of ambulance service throughout the military forces. After it was once established, the value of this ambulance organization in the saving of life, suffering, and tears cannot be overestimated.

The ambulances were of a number of types, two-and fourwheeled. The former were soon found intolerable from their incessant rocking motion. The four-wheeled type was issued in various forms, successive models designed to avoid the demonstrated defects of their predecessors being issued. The Rucker ambulance was the final development toward the end of the war and gave much satisfaction. In a general way, it was the prototype of the improved ambulance now used in our army. One great fault of all these four-wheeled ambulances was their excessive weight in relation to their transportation capacity. After every great battle, any available supply wagons were used to supplement the ambulances. These were springless, but, with their floors well bedded with brush and hay, were made very comfortable for the wounded placed in them, while their canvas tilts served admirably to screen against rain and sun.

The medical-transport service in battle, as finally perfected, worked about as follows: The medical officers of regiments accompanied their organizations into action and established stations as near the firing-line as possible and usually at a sheltered point, with ready access from both front and rear. Hither the wounded resorted or were conveyed as the situation permitted, had their wounds dressed, and were set aside or started for the field hospital, if able to walk.

As soon as possible the ambulance corps came up and took over the helpless wounded, freeing the regimental surgeons and enabling them to accompany their organizations to [311]

[312] the front or rear. If the ambulance train could not reach the places where the wounded were lying, it was halted at the nearest practicable point, and the ambulance corps went forward and removed the wounded to the ambulances by means of litters.

The ambulance train then removed the wounded to the field-hospitals, the service of which is later discussed and of which there was one to each division, where more elaborate professional treatment was received. These field-hospitals were usually located just beyond the range of artillery fire. Sometimes several of them were established close together, and if tactical conditions permitted, they would be brought up and established on an occupied battlefield, thereby saving the time and suffering incident to removal of the wounded therefrom.

After reaching the field-hospitals and receiving the necessary attention to fit them for further transportation, the wounded were removed as soon as possible to the great base and general hospitals, which at one time aggregated two hundred and five in number.

In continuance of the work of the ambulance service, the railroads and steamships were brought into use. Sometimes conditions permitted trains to be run close to the scene of action and to receive wounded almost on the battlefield itself. This was the first war of great magnitude in which railroads were so employed.

The hospital trains were under the control of the Medical Department. The surgeon in charge was the sole head. Some were made up of passenger-cars which were regularly equipped or constructed by the railroad companies for the better care of wounded; some were hastily improvised at the front from ordinary freight-cars, merely emptied of the supplies which they had brought up and in which the wounded were merely laid on beds of boughs, hay, or straw. Between the two extremes there were all varieties of arrangements. Some cars were fitted with bunks; others with stanchions and supports, [313]

[314] [316] upon which litters were laid or suspended, jarring being taken up by springs or rubber. These trains often included special cars arranged and used as kitchens, storerooms, dispensaries, and surgeries. From the completeness of their resources, the better type of them was practically a hospital on wheels.

Frequently the sick and wounded were easiest and best removed by water, particularly in the vicinity of the Atlantic coast and in sections of the Mississippi watershed. But all transport vessels were under control of the Quartermaster's Department, which ordinarily gave the greatest preference and importance to its own duties, until higher authority, roused by the justice of the appeals, ordered a number of steamers placed under the exclusive control of the medical officers. These varied in type from ordinary freight-boats and transports returning empty, to the finest type of speedy, capacious steamers, completely remodeled into floating hospitals. Some of these hospital boats were planned for the care of four hundred or more patients. One old hulk was fitted up after the battle of Shiloh, with accommodations for a thousand men, and used as a receiving and forwarding hospital for the fleet of river hospital steamers. The latter were kept continually on the move, and a single such steamer is recorded to have removed 12,299 sick and wounded in the space of seventeen months. This steamer hospital service was a new departure in military affairs and was a matter of gradual development to the end of the war, when it had become most complete as to equipment and administrative efficiency. All the boats used for hospital purposes were ultimately assigned officially to the use of the Medical Department, either for the trip or—in the case of specially equipped steamers—indefinitely. The surgeon in charge was in complete control of the boat and its movements, except in respect to the details of navigation. The system worked so successfully as to be continued during the Spanish War, and is part of the regulations at the present time.

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[317]

Private agencies of relief: the sanitary commission and other relief agencies

Holland Thompson

The doctor's gig on the Mississippi, 1864

[318]

[319]

A ‘floating palace’—United States hospital steamer red rover on the Mississippi This steamer was a veritable floating palace for the days of 1861. It had bathrooms, a laundry, an elevator between decks, an amputating room, two kitchens, and the windows were covered with gauze to keep out flies and mosquitoes. When Island No.10 was captured on April 7, 1862, several Confederate boats were taken. Among them was this Red Rover, an old side-wheel steamer which had been purchased in New Orleans for $30,000 the previous November. A shell had gone through her decks and bottom, but she was repaired at Cairo, Ill., and fitted up as a hospital boat by Quartermaster George M. Wise. The Western Sanitary Commission gave $3,500 for the purpose. Dr. George H. Bixby of Cairo was appointed assistant surgeon and placed in charge. Strange to say, the first serious cases placed on board were those of the commander and men of the gunboat Mound City, who had been severely scalded when the boiler was pierced by a shot in the attack on some Confederate batteries. This was the gunboat that had taken possession of the Red Rover when she was abandoned at Island No.10, little more than two months previously. Before the Red Rover was placed in service, the army had chartered the City of Memphis as a hospital boat to take the wounded at Fort Henry to Paducah, St. Louis, and Mound City. There were several other hospital steamers, such as the Louisiana, the D. A. January, the Empress, and the Imperial, in service.

[320]

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[321]

Private agencies of relief.

‘Boxes for the soldiers’ in 1865

[322]

Boxes ready for the boys at the front: the office of the United States Christian commission in Washington. Though not so well known as the Sanitary Commission, the United States Christian Commission did an immense amount of valuable work during the Civil War, and appealed to those who preferred to make their contributions carry with them a positive expression of their faith. Though this organization did much relief work similar to that done by the Sanitary Commission, a large portion of its energies was directed toward improving the mental and moral welfare of the soldiers as well as their physical. Many thousand its energies was directed toward improving the mental and moral welfare of the soldiers as well as their physical. Many thousands copies of Bibles and Testaments were distributed. Millions of tracts were sent out under its auspices. At every prominent camp reading-rooms were established, in which a point was made to secure papers published in all the States represented by the soldiers. [323] Writing materials were furnished free and stamps also; and every effort was made to induce the soldiers to remember the loved ones at home, since the officials believed that a keen remembrance of those left behind was one of the best safeguards against reckless living. Its combinations extended through the Northern States. Volunteers were solicited to contribute their services in the proper distribution of supplies, and a large number of men were regularly employed under salary. Among the volunteers who went to the front were a large number of ministers who afforded great help to the wounded upon the field, and brought encouragement and sympathy to the hospitals where large numbers of ladies acted as nurses to the wounded soldiers. The Government gladly availed itself of their aid.

[324]

Twenty millions for relief the central office of the sanitary commission in Washington From these general offices of the Sanitary Commission the various branches of the work were directed. The Commission was organized for the threefold purpose of inquiry, advice, and relief. During the first two years of the war, while the medical department was gradually increasing in efficiency, the Commission to a large extent cared for the wounded from many battlefields. In addition to the immense sum of money, nearly $5,000,000, expended by the Commission directly, several hundred thousand dollars raised under its auspices was spent directly by the different branches themselves. Supplies to the value of more than $15,000,000 were sent in addition to the money. The Commission also established rest-houses and accommodations for the sick, aided soldiers to correct any irregularities in their papers preventing them from receiving pay, bounties or pensions, and compiled a hospital directory.

[325]

The sanitary commission a success—women in the field, 1864 The creation of the Sanitary Commission was due to the desire of women to be of real, tangible help in the war. The plan at first met with little favor at Washington. The medical corps was indifferent, if not actually hostile, and the War Department was in opposition. But finally the acting surgeon-general was won over, and the plan took definite shape. The idea was to inquire into the recruiting service of the several States, to look into the subjects of diet, clothing, cooks, camping-grounds, in fact everything connected with the prevention of disease; and to discover methods by which private and unofficial interest and money might supplement the appropriations of the Government. During the first two years of the war, the camps of several hundred regiments were examined by inspectors appointed by the Commission, who advised the commanding officer as to proper location and sanitation.

[326]

A link with the folks at home sanitary commission officers and nurses at Fredericksburg, in 1864 After the first enthusiasm of the different communities had passed, and ‘folks at home’ realized that the boxes of edibles and wearing apparel they forwarded often reached, not their own dear ones but the Union soldier at large, speakers and organizers were sent out to stir the flagging interest in the work of the Sanitary Commission. Women who had been at the front, such as those shown sitting before the boxes and barrels in this photograph, told their experiences. Mrs. Mary A. Livermore began her career as public speaker by addressing such gatherings. The standard set was ‘a box a month for the soldiers.’ The presence of these nurses and supplies at the front after Spotsylvania was an incalculable blessing to the thousands of wounded soldiers and to the medical corps.

[327]

Supply wagons of the sanitary commission at Belle Plain, 1864 After the Sanitary Commission proved its worth, it had no more ardent adherents than the medical corps. When a field-surgeon's requisitions were delayed, he would apply to the nearest Sanitary Commission official, who seldom failed to promptly forward the desired medicines. One of its activities was to publish pamphlets on sanitation, some of which were useful no doubt in theory but hardly practical for the soldier on the march. ‘When halting to rest,’ read one of them in substance, ‘never sit upon the ground. First unroll your rubber blanket, then spread on top of it your woolen blanket, and sit on that.’ Aside from the lack of such a plethora of blankets, the usual halt on the march was five minutes, exactly the length of time it took the soldier to roll up his blanket and strap it on his knapsack, ready for the march.

[328]

The object of the Sanitary Commission was to do what the Government could not. The Government undertook, of course, to provide all that was necessary for the soldier, . . . but, from the very nature of things, this was not possible. . . . The methods of the commission were so elastic, and so arranged to meet every emergency, that it was able to make provision for any need, seeking always to supplement, and never to supplant, the Government.—Mary A. Livermore in ‘My Story of the War.’

When the fall of Fort Sumter made war inevitable, a wave of enthusiasm swept over the country, North and South. As always happens in such crises, the women looked about them for something they might do. The first soldiers who went to the front were furnished with every possible bit of equipment which feminine brains could devise. In every village the women met to ‘sew for the soldiers.’

Out of this feeling that there must be something which women could do, even if they could not fight, grew in the North the Sanitary Commission. Its origin may be traced to a meeting of women held in New York, April 25, 1861. Out of this grew the Women's Central Association of Relief. Plan after plan was suggested, only to be discarded by the common sense of the leaders. Finally, Dr. Henry W. Bellows, pastor of All Souls Unitarian Church in New York, advised them to find out first what the Government would and could do, and then to attempt to do only those things which the general Government felt itself unable to do.

Accompanied by several other gentlemen deeply interested [329]

Home workers for the sanitary commission These young women are hardly real nurses, but were thus photographed and the photographs offered for sale to secure money for the cause, in connection with a great fair held in New York. One of the most successful methods of raising money for the various activities of the Sanitary Commission was by means of such fairs in the great cities. Almost every conceivable variety of merchandise was sold. Often the offerings occupied half a dozen different buildings, one of which would perhaps be devoted to serving meals, another to the display of curiosities, another to art objects, another to fancy work, another to machinery, etc. Women gave their whole time for weeks to the preparation of the objects offered for sale, and then to the active work while the fair was open. Young girls acted as waitresses, sold flowers, served at the booths, and exerted all their charms to add to the fund ‘to help the soldiers.’ In New York and Philadelphia the great fairs realized more than a million dollars each, while that in Chicago was proportionately successful.

[330] in the problem, he went to Washington to study the situation. The idea of the Sanitary Commission was a natural outgrowth of what they saw, but the plan at first met with little favor. The medical corps was indifferent if not actually hostile; the War Department was in opposition; President Lincoln feared that it would be a ‘fifth wheel to the coach.’ But finally the acting surgeon-general was won over and recommended the appointment of ‘a commission of inquiry and advice in respect to the sanitary interests of the United States forces,’ to act with the medical bureau. The committee was invited to put into a definite form the powers desired, and on May 23d suggested that an unpaid commission be appointed for the following purposes:

To inquire into the recruiting service in the various States and by advice to bring them to a common standard; second, to inquire into the subjects of diet, clothing, cooks, camping-grounds, in fact everything connected with the prevention of disease among volunteer soldiers not accustomed to the rigid regulations of the regular troops; and third, to discover methods by which private and unofficial interest and money might supplement the appropriations of the Government.

The plan was approved and, on the 9th of June, Henry W. Bellows, D. D.; Professor A. D. Bache, Ll.D.; Professor Jeffries Wyman, M. D.; Professor Wolcott Gibbs, M. D.; W. H. Van Buren, M. D.; Samuel G. Howe, M. D.; R. C. Wood, surgeon of the United States Army; G. W. Cullum, United States Army, and Alexander E. Shiras, United States Army, were appointed by the Secretary of War, and his action was approved by the President on the 13th of the same month. The Government promised to provide a room in Washington for their use. The men at first appointed soon added others to their number, and as the movement spread over the country additional members were appointed until the commissioners numbered twenty-one. Frederick Law Olmsted, the distinguished landscape architect, was chosen general secretary [331]

[332] while Dr. Bellows naturally became president. A general circular asking for contributions amounting to $50,000 for the remaining six months of the year 1861 was issued on June 22d, which amount was considered sufficient to continue the work of inquiry and advice for that period.

Upon the authority thus given, an examination of the condition of the troops both in the East and in the West was undertaken by several members of the commission, with the result that unsanitary conditions were found almost everywhere. At once provision was made for the employment of expert physicians as inspectors of camps. Though the commission could pay only moderate salaries, it was found possible to secure inspectors of an unusually high type, many of whom resigned more remunerative positions to take up the work of the commission. Minute instructions were issued to them. They must not enter a Camp without the approval of the superior officers, which was usually given as a matter of course. In their examination they were instructed to consider the location of the camp, its drainage, ventilation of tents or quarters, the quality of the rations, the methods of cooking, the general cleanliness of the Camp and of the men. Wherever any of these fell short of a satisfactory standard, they were instructed to suggest tactfully to the commanding officers the points of deficiency and also to send their reports to the commission.

Their reports contained an immense number of physiological and hygienic facts, which were tabulated by the actuaries of the commission and digested by the physicians employed for the purpose. The effects of these inspections were almost invariably good. When a commanding officer once had his attention called to defects in the location of the Camp or in drainage or in police, he was usually unlikely to make the same mistakes in the future, and every regiment in which sanitary and hygienic conditions were satisfactory was an example to the regiments with which it might be brigaded in the future.

Through the inspectors, eighteen short treatises prepared [333]

[334] by committees of eminent medical men were distributed to the regimental surgeons and the commanding officers. Since these surgeons had been almost wholly drawn from civil life and as the Medical Department had not issued any such treatises to them, these little books were of inestimable value.

The ideas of the members of the commission, which included some of the best-known physicians in the country as well as men of affairs, were large. The members of the Sanitary Commission felt that only a young man was capable of making the organization effective, and they were successful in so influencing public opinion that a bill was passed destroying to a large extent the system of promotion by seniority and allowing the appointment of William A. Hammond as surgeon-general.

The third phase, that of relief, began with the care of the fugitives of the battle of Bull Run. Many regiments had been scattered, and the men came pouring into Washington, separated from their officers and surgeons, and but for the work of the commission, much more suffering would have resulted. Relief was also sent to the wounded after the battles at Edwards' Ferry, Ball's Bluff, and Dranesville.

The collection of supplies in kind was left largely to the branches, which were made almost entirely independent of the parent organization. In all of these women were prominent. The Women's Central Relief Association of New York was the first one recognized, though the branch in northern Ohio was the first association of women organized. The chief branches in the East were those in New York, Boston, Buffalo, and Philadelphia. There were other branches at Cincinnati, Louisville, Chicago, Troy, Detroit, and elsewhere. Far-off California sent a large contribution in money. These branches were best able to deal with local conditions, as through them were collected such diverse articles as quilts, blankets, pincush-ions, butter, eggs, sauerkraut, cider, chickens, and many other things. The standard set by the branch for the local-aid societies was ‘a box a month for the soldiers.’ [335]

[336] At first, there was much difficulty in establishing the principle of universality of relief. A community was willing to send a box to its own company or to its own regiment, but was less enthusiastic over the question of sending articles to men whom it had never seen. But after it had been shown that, on account of the frequent changes in the position of troops, thousands of such boxes lay in the express offices undelivered until their contents were often spoiled, the wisdom of the provision of a general-relief fund which should send aid wherever needed, came to be recognized.

One great difficulty to be overcome was the widespread belief in some sections that the soldiers did not get the contents of the boxes sent them. Rigid investigation disproved the existence of any considerable misapplication of stores, but the rumor was stubborn, and was believed by many whose zeal naturally was relaxed.

The commission proved its value during the Peninsula campaign of 1862. The transfer of troops to this new and somewhat malarious country soon brought on an amount of sickness with which the Governmental agencies were unable to deal. With the approval of the medical bureau, the commission applied for the use of a number of transports, then lying idle. The Secretary of War ordered boats with a capacity of one thousand persons to be detailed to the commission, which in turn agreed to take care of that number of sick and wounded. The Daniel Webster, assigned to the commission April 25, 1862, was refitted as a hospital and reached the York River on April 30th, with the general secretary, Mr. Olmsted, and a number of surgeons and nurses.

Other ships were detailed, though great inconvenience was suffered from the fact that several were recalled to the transport service, even when they had a load of sick and wounded, who, of course, had to be transferred at the cost, sometimes, of considerable suffering. At the same time, agents of the commission were near the front with the soldiers, offering such [337]

Sanitary–commission wagons leaving Washington for the front in the last days of the war This photograph shows how the Sanitary Commission worked. The four-horse team is harnessed to the covered wagon in which were carried those supplies which would be of most immediate use on the battlefield. It included stimulants of various sorts, chloroform, surgeon's silk, condensed milk, beef-stock, and dozens of other things. The mounted agent is ready to accompany the wagon, and the flag of the Commission is waving in the breeze. By this time the business of helping the soldiers was thoroughly systematized.

Headquarters of the Christian commission in the field, 1864 The following summary of the receipts of the Christian Commission up to January, 1865, will convey some idea of the magnitude of the work which it performed. In 1861 the receipts were $231,256.29; in 1863, $916,837.65; in 1864, $2,882,347.86, making a total of $4,030,441.80. During the year 1864, 47,103 boxes of hospital stores and publications were distributed, valued at $2,185,670.82.

[338] relief as was in their power. Undoubtedly hundreds of lives were saved during this campaign by the efficient work of the commission.

During this campaign another branch of the commission's activity developed. So many letters inquiring about sick, wounded, or dead soldiers were received that a hospital directory was begun, and before the 1st of April, 1863, this directory included the names of the sick and wounded soldiers in every general hospital. At the second battle of Bull Run the supplies sent forward by the surgeon-general were captured by the Confederates, and but for those furnished by the Sanitary Commission, the suffering would have been truly frightful. The work was continued at Antietam, where the supplies were brought to the field two days ahead of those of the Medical Department. The commission was also the main dependence after the battle of Fredericksburg, and not until the battle of Chancellorsville were the supplies of the Medical Department on the battlefield plentiful and accessible.

In the West, an organization in St. Louis, known as the Western Sanitary Commission, though having no connection with the larger body, was very efficient in the work of relief. It established and equipped hospitals, and was able to supply them. Many valuable contributions, however, were sent from the East. The Chicago, or Northwestern branch, also rendered valuable service. Scurvy was prevented by rushing carloads of fresh vegetables to Vicksburg and to the Army of the Cumberland.

After the reorganization of the medical bureau and the resulting increase in efficiency, the work of the commission became, as mentioned above, largely supplementary. And yet, to the end of the war, with every corps was a wagon carrying, among its supplies, chloroform, brandy, and other stimulants; condensed milk, beef-stock, bandages, surgeon's silk, and other articles of pressing need. A telegram from the inspector or relief agent on the spot to the nearest branch, demanding [339]

Clara Barton—a war-time photograph by Brady Before the Civil War was over, Clara Barton's name had come to mean mercy and help for the wounded in war and peace alike. In the Civil War she took part in the relief work on the battlefields, described at length in the last chapter of this volume, and organized the search for missing men, for the carrying on of which Congress voted $15,000. She was active throughout the Franco-Prussian War, in the adoption of the Treaty of Geneva, in the founding of the National Red Cross in the United States, and in the Spanish-American War. Even later, in spite of advancing years, she appeared as a rescuing angel, bringing practical aid with sympathy to sufferers from the calamities of fire, flood, and famine.

[340] articles of food or of clothing, was almost sure to be promptly answered, while Government supplies were to be procured only on requisition, and necessarily passing through several hands, were sometimes much delayed. With the resulting lessening of the burden upon the energies of the commission, its activity was much broadened.

A ‘home’ was established in Washington to give food and lodging and proper care to discharged soldiers. Those in charge were always ready to help soldiers to correct defective papers, to act as agents for those too feeble to present their claims at the pension office or to the paymaster, and to protect them from sharpers and the like. Lodges were established near the railway stations to give temporary shelter. Two nurses' homes were established, but these were largely used as temporary shelter for mothers or wives seeking their wounded sons or husbands.

In the West, a home was established by the Chicago branch at Cairo, Illinois, which was one of the main gateways through which soldiers passed, going toward or returning from the army. Rations were issued by the Government, and the building was furnished for the most part by the commission which assumed the management. It was, in effect, a free hotel for soldiers, and thousands were looked after and kept from harmful associations. Later it was much enlarged by order of General Grant, who instructed the officer commanding the post to construct suitable buildings. Much of the money raised by the Sanitary Commission was by means of fairs, some of which became national events, and lasted for weeks. During its existence the Sanitary Commission received $4,924,480.99 in money and the value of $15,000,000 in supplies.

No such well-organized instrumentality as the Sanitary Commission existed in the South. There were many women's-aid societies, and some of those in the seaport towns performed valuable services. The one in Charleston devoted its energies largely to procuring through the blockade the much needed [341]

Michigan state relief association ministering to wounded at white House, Virginia There were various relief associations besides the Sanitary and Christian Commissions which did extremely efficient work. Here are some women from the West who are not only cooking on their stove in the open air, and broaching their boxes and baskets of delicacies, but seem to have cheered up the wounded soldier boys mightily. The soldier under the flag, with the girl in the white frock and little straw hat nestling close to him, appears far from discontented. The big sign ‘Michigan’ over the entrance to the tent on which one can see the words ‘Michigan Headquarters,’ partially concealed, must have been a beacon of hope to many of the wounded soldiers from the far West of that day. The stoves and pans and kettles show that the inner man was cared for.

[342]

Busy with good works for the soldiers: members of the Christian commission at white House on the Pamunkey In this photograph one gets an actual glimpse of the manifold activities of the Christian Commission, especially as they appeared the first two years of the war. At the left a man with a hatchet is opening a box of such stores for the sick and wounded as the medical department did not supply—special medicines, jellies, chocolates, perfumes, and many others delicacies—which were greatly appreciated by the soldiers. In front of him stands a wounded soldier, his hand bound up and leaning upon a crutch, doubtless supplied by the Christian Commission, looking down gratefully at the woman in the poke-bonnet. Another woman is dipping into a tub, apparently [343] for something liquid, since the men behind her and the boy sitting on the grass in the foreground all have cups in their hands. In front of her is a man busy over a field stove. The men directly behind him seem to be constructing a temporary field oven, and in the background stands one of the Commission's supply wagons. The masts of the boat which has brought the delicacies for the soldiers to White House Landing are visible in the extreme background. This busy scene shows some of the practical good accomplished by the Christian Commission and how enthusiastically the women worked together with the men to alleviate the soldiers' woes.

[344] stimulants and medicines. In Wilmington, much work of the same sort was accomplished. In every town through which soldiers passed, the women were always ready to feed the hungry and nurse the sick without formal invitation.

There were few organized convalescent homes, but their place was taken by almost the universal custom of private families taking convalescent soldiers to their homes. In Richmond, the so-called ambulance committee was very efficient in proportion to its scanty means, but the needs were so great, and the scarcity of men and money so discouraging, that it did not work so like a well-oiled machine as did the Sanitary Commission. Bibles and tracts were distributed by various organizations, and an attempt to furnish other reading matter was made.

Another organization which did good work among the Northern soldiers was the United States Christian Commission, organized by the Young Men's Christian Association. Its purpose was primarily to improve the morals of the soldiers and, incidentally, their physical condition. It distributed thousands of Bibles, millions of copies of religious books, and many millions of religious newspapers and tracts. In addition, it bought many copies of the better class of magazines and sent them to the soldiers. In the permanent camps, free reading-rooms were established, and in a number of these State newspapers were kept on file. Writing-materials and postage-stamps were furnished free to the soldiers, and the agents never ceased to urge the men to write home and to send a considerable part of their pay. This commission set up a number of coffee-wagons in competition with the sutlers, many of whom sold liquor, and also established ‘special diet-kitchens,’ where needed, for the sick and convalescent. The commission estimated that it had expended in money and in supplies more than six and a quarter million dollars.