Medical treatment during the American Civil War was extremely poor. It has been estimated that 64,582 died of their battle wounds. Thousands of men had to have limbs amputated. Where possible chloroform was used but in many cases the patient had to rely on whisky while being operated on.
At the beginning of the war the Union Army provided one assistant surgeon to every regiment of 1,200 men. These were not always qualified men and there were many examples of people who had previously earned their living by selling quack medicines being appointed. Individual states later took over the responsibility of employing doctors for their volunteer armies. Some appointments were based on political factors, but some states such as Ohio, Massachusetts and Vermont, developed a reputation for recruiting good doctors.
Soon after the war started Dorothea Dix was appointed as superintendent of women nurses for the federal government. Over the next four years she was responsible for the recruitment, training and placement of 2,000 nurses treating members of the Union Army. Later Elizabeth Blackwell organized the Women's Central Association of Relief. This involved the selection and training of nurses for service in the war. Blackwell, along with Emily Blackwell and Mary Livermore, played an important role in the development of the United States Sanitary Commission. Other important nurses during the war included Clara Barton, Mary Stafford, and Mary Ann Bickerdyke.
The Confederate Army was slow to organize a system of medical treatment. In 1861 the Confederate Congress decided to allocate only $50,000 for the establishment and operation of military hospitals. This sum was increased and by the end of 1863 they had a large network of hospitals in Virginia (39), North Carolina (21), South Carolina (12), Georgia (50), Alabama (23), Mississippi (3), Florida (4) and Tennessee (2).
The South had a real problem with obtaining medicine after the U.S. naval blockade began to work successfully in 1862. The Confederacy published a pamphlet giving a list of herbs and plants that could be used to treat patients when manufactured medicines were not available. This included snakeroot, partridgeberry, sassafras, lavender, tulip tree, dogwood, and the leaves and bark of white oak.
The greatest danger facing soldiers during the war was not bullets but disease. It is believed that 186,216 soldiers died of a variety of different illnesses during the conflict. Large numbers of the soldiers came from rural areas and had not been exposed to common diseases such as chicken pox and mumps. Living in unhealthy conditions and often denied properly medical treatment, soldiers sometimes died of the these diseases. For example, 5,177 soldiers in the Union Army died of measles during the war.
The main killer diseases were those that resulted from living in unsanitary conditions. In 1861 typhoid caused 17 per cent of all military deaths, whereas dysentery and diarrhea caused a sick rate of 64 per cent of all the troops in the first year of the war. The following year this figure reached 99.5 per cent.
Union Army records show that a large number of its soldiers died from diseases caused by contaminated food and water. This included diarrhea (35,127), typhoid (29,336) and dysentery (9,431). Drinking from streams occupied by by dead bodies or human waste and eating uncooked meat were the cause of large numbers of deaths. Regular soldiers who had been trained to be more careful about the food and water they consumed, were far less likely to suffer from intestinal disease that volunteer soldiers.
A mixture of mercury and chalk called blue powder was given to soldiers with intestinal complaints. Opium, morphine, and quinine were also used by camp doctors and nurses to deal with a wide variety of different medical problems. It was commonly believed that wearing a flannel bans around the waist under the shirt would prevent disease. Large numbers of soldiers died from tuberculosis (consumption). Official records show 6,497 soldiers died of the disease in the Union Army. However, a much larger number were discharged because of poor health and died later.
It is estimated that smallpox killed 7,058 Union Soldiers. Another 14,379 died of malaria. Although the exact number of Confederate Army deaths from malaria is not known, there were 41,539 cases in an 18 month period (January, 1862-July, 1863) in South Carolina, Georgia and Florida. The cause of the disease was not known and soldiers often slept without the protection of mosquito nets. Once contracted, doctors and nurses often prescribed whiskey and the bark of dogwood, poplar and willow. Other substances used to combat fever included cod-liver oil, cinnamon and the syrup of wild cherry.
Large numbers of soldiers suffered from combat fatigue. Caused by extreme stress, symptoms include muteness, deafness and difficulty in controlling movement of the limbs. Unrecognized as an illness in the 19th century, soldiers were often diagnosed as suffering from mania or dementia, and sent home to recover. During the First World War combat fatigue was known as shellshock.
The first shot at Fort Sumter aroused the whole North, and the assassination of Lincoln enlisted the indignant energy of
every Northern woman in the tremendous struggle. As the deadly contest proceeded, and every town and village sent
forth its volunteers to the fearful slaughter of civil war, the concentration of thought and action on the war dwarfed every other effort.
On the outbreak of the war, an informal meeting of the lady managers was called at the infirmary to see what could be done towards supplying the want of trained nurses so widely felt after the first battles. A notice of this meeting to be held at the infirmary having accidentally found its way into the New York Times, the parlours of the infirmary were crowded with ladies, to the surprise of the little group of managers.
The Rev. Dr. Bellows and Dr. Elisha Harris being present, a formal meeting was organised. Whilst the great and urgent need of a supply of nurses was fully recognised, it was also felt that the movement would be too vast to be carried on by so small an institution. A letter was therefore drafted on this occasion, calling for a public meeting at the Cooper Institute, and a committee of the ladies present was appointed to obtain signatures to this call.
The meeting at the Cooper Institute was crowded to overflowing. The National Sanitary Aid Association was then formed, in order to organise the energetic efforts to help that were being made all over the country.
The Ladies' Sanitary Aid Association, of which we were active members, was also formed. This branch worked daily
at the Cooper Institute during the whole of the war. It received and forwarded contributions of comforts for the soldiers, zealously sent from the country; but its special work was the forwarding of nurses to the seat of war. All that could be done in the extreme urgency of the need was to sift out the most promising women from the multitudes that applied to be sent on as nurses, put them for a month in training at the great Bellevue Hospital of New York, which consented to receive relays of volunteers, provide them with a small outfit, and send them on for distribution to Miss Dix, who was appointed superintendent of nurses at Washington.
Dr. Hammond, my personal friend, met me near the house, saw the blood, touched my arm, and said: "General, your arm is broken." The last ball had passed through the elbow joint and crushed the bones into small fragments. He led me to a negro hut, large enough only for a double bed. Here I lay down, alarming an aged negro couple who feared at first that some of us might discover and seize hidden treasure which was in that bed.
My brigade surgeon, Dr. Palmer, and several others soon stood by my bedside in consultation. At last Dr. Palmer, with serious face, kindly told me that my arm had better come off. "All right, go ahead," I said.
"Not before 5 p.m., general." "Why not?" "Reaction must set in." So I had to wait six hours. I had received the second wound about half-past ten. I had reached the house about eleven, and in some weakness and discomfort occupied the negro cabin till the hour appointed. At that time Dr. Palmer came with four stout soldiers and a significant stretcher. The doctor put around the arm close to the shoulder the tourniquet, screwing it tighter and tighter above the wound. They then bore me to the amputating room, a place a little gruesome with arms, legs, and hands not yet all carried off, and poor fellows with anxious eyes waiting their turn.
On the long table I was nicely bolstered; Dr. Grant, who had come from the front, relieved the too-tight tourniquet. A mixture of chloroform and gas was administered and I slept quietly. Dr. Palmer amputated the arm above the elbow. When I awoke I was surprised to find the heavy burden was gone.
I had sat by him but a few moments when I noticed a green shade on his face. It darkened, and his breathing grew labored - then ceased. I think it was not more than twenty minutes from the time I observed the green tinge until he was gone. I called the nurse, who brought the large man I had seen at the door of the bad ward, and now I knew he was a surgeon, knew also, by the sudden shadow on his face when he saw the corpse, that he was alarmed; and when he had given minute directions for the removal of the bed and its contents, the washing of the floor and sprinkling with chloride of lime, I went close to his side, and said in a low voice:
"Doctor, is not this hospital gangrene?"
He looked down at me, seemed to take my measure and answered:
"I am very sorry to say, madam, that it is."
"Then you want lemons!"
"We would be glad to have them!"
"Glad to have them?" I repeated, in profound astonishment, why, you must have them!"
He seemed surprised at my earnestness, and set about explaining:
"We sent to the Sanitary Commission last week, and got half a box.
"Sanitary Commission, and half a box of lemons? How many wounded have you?"
"Seven hundred and fifty."
"Seven hundred and fifty wounded men! Hospital gangrene, and half a box of lemons!"
"Well, that was all we could get; Government provides none; but our Chaplain is from Boston - his wife has written
to friends there and expects a box next week"
"To Boston for a box of lemons!"
I went to the head nurse who gave me writing materials, and I wrote a short note to the New York Tribune:
"Hospital gangrene has broken out in Washington, and we want lemons! lemons! lemons! lemons! No man or woman in health, has a right to a glass of lemonade until these men have all they need; send us lemons!"
I signed my name and mailed it immediately, and it appeared next morning. That day Schuyler Colfax sent a box to my lodgings, and five dollars in a note, bidding me send to him if more were wanting; but that day lemons began to pour into Washington, and soon, I think, into every hospital in the land. Governor Andrews sent two hundred boxes to the Surgeon General. I received so many, that at one time there were twenty ladies, several of them with ambulances, distributing those which came to my address, and if there was any more hospital gangrene that season I neither saw nor heard of it.
The officers in Campbell Hospital knew of the letter, and were glad of the supplies it brought, but some, time passed before they identified the writer as the little sister in the bad ward, who had won the reputation of being the "best wound-dresser in Washington."
Surgeon White came to me and said: "Young man, are you going to have your arm taken off or are you going to lie here and let the maggots eat you up?" I asked if he had any chloroform or quinine or whisky, to which he replied "No, and I have no time to dilly-dally with you." I said it was hard, but to go ahead and take it off. He got hold of my arm, pulled the bandage off, pushed his thumb through the wound and told me to "come on", and helping me up we walked to the amputation table. They put me on the table, cut off blouse and shirt sleeves filled with maggots, and after a lot of preliminary poking and careless feeling around my arm and shoulder they made me sit up in a chair, and wanted to hold my legs, but I said "No, I won't kick you." I set my teeth together and clinched my hand into my hair, and told them to go on. After cutting the top part of my arm and taking out the bone, they wanted me to rest an hour or so; to which I refused. I wanted but one job to it. Then they finished it, while I grasped for breath and the lower jaw dropped in spite of my firm clinch. I was then led away a short distance and left to lie on the hot sand.
After the battle of Donelson, Mother Bickerdyke went from Cairo in the first hospital boat, and assisted in the removal of the wounded to Cairo, St. Louis and Louisville, and in nursing those too badly wounded to be moved. On the way to the battlefield, she systematized matters perfectly. The beds were ready for the occupants, tea, coffee, soup and gruel, milk punch, and ice water were prepared in large quantities, under her supervision, and sometimes her own hand.
When the wounded were brought on board, mangled almost out of human shape; the frozen ground from which they had been cut adhering to them; chilled with the intense cold in which some had lain for twenty-four hours; faint with loss of blood, physical agony, and lack of nourishment; racked with a terrible five-mile ride over frozen roads, in ambulances, in common Tennessee farm wagons, without springs; burning with fever; raving in delirium, or in the faintness of death, Mother Bickerdyke's boat was in readiness for them.
Typhoid fever began to make its appearance in camp, as the burning sun of June came pouring down on us, and the hospitals were soon crowded with its victims. Along each side of the tent the sick are laid, on blankets or cots, leaving room to pass between the beds. The hospital corps consists of a surgeon, an assistant surgeon, a hospital steward, a ward master, four nurses, two cooks, and a man of all work to carry water, cut wood, and make himself generally useful.
I never saw anybody like her. There was really nothing for us surgeons to do but dress wounds and administer medicines. She drew out clean shirts or drawers from some corner, whenever they were needed. Nourishment was ready for every man as soon as he was brought on board. Everyone was sponged from blood and frozen mire of the battlefield, as far as his condition allowed. His blood-stiffened, and sometimes horribly filthy uniform, was exchanged for soft and clean hospital garments. Incessant cries of "Mother! Mother! Mother!" rang through the boat, in every note of beseeching and anguish. And to every man she turned with a heavenly tenderness, as if he were indeed her son.
On one occasion, when going from ward to ward of a hospital, in Helena, Arkansas, I came upon a poor fellow evidently near death. He accepted my offer to write a letter to his mother, but, pointing to a comrade in the next bed, said,
" Write for him first; I can wait."
I doubted if he could wait, for already the pallor of death was overshadowing his face, and I urged him again saying:
"Speak as rapidly as you can, and I will write rapidly; there is time for both letters."
But he persisted; "Take him first!" and I was obliged to obey. Writing as rapidly as possible, I watched the brave fellow who had given up his last earthly comfort to his comrade, and who was failing fast. Noticing that my eyes sought him constantly, he beckoned feebly to one of the nurses, who turned him in bed that I might not be disturbed by his whitening face and shortening breath. And when I moved to his bedside to receive his dictation, he had passed beyond the need of my services.
21st December, 1862: Spend a good part of the day in a large brick mansion on the banks of the Rappahannock, used as a hospital since the battle - seems to have received only the worst cases. Out doors, at the foot of a tree, within ten yards of the front of the house, I noticed a heap of amputated feet, legs, arms, hands, etc., a full load for one-horse cart. Several dead bodies lie near, each covered with its brown woolen blanket. In the door-yard, towards the river, are fresh graves, mostly of officers, their names on pieces of barrel-staves or broken boards, stuck in the dirt.
23 December, 1862: The results of the late battle are exhibited everywhere about here in thousands of cases. Hundreds die every day, in the camp, brigade and division hospitals. These are merely tents, and sometimes very poor ones, the wounded lying on the ground, lucky if the blankets are spread on layers of pine or hemlock twigs, or small leaves. No cots; seldom even a mattress. Once in a while some youngster holds on to me convulsively, and I do what I can for him; at any rate, stop with him and sit near him for hours, if he wishes it.
In one of the hospitals I find Thomas Haley, company M, 4th New York cavalry. A regular Irish boy, a fine specimen of youthful physical manliness, shot through the legs, inevitably dying. Came over to this country from Ireland to enlist. Is sleeping soundly at this moment (but it is the sleep of death). Has a bullet-hole through the lung. I saw Tom when first brought here, three days since, and didn't suppose he could live twelve hours. Much of the time he sleeps, or half sleeps. I often come and sit by him in perfect silence; he will breathe for ten minutes as softly and evenly as a young babe asleep. Poor youth, so handsome, athletic, with profuse beautiful shining hair. One time as I sat looking at him while he lay asleep, he suddenly, without the least start, awakened, opened his eyes, gave me a long steady look, turning his face very slightly to gaze easier, one long, clear, silent look, a slight sigh, then turned back and went into his doze again.
In one bed a young man, Marcus Small, company K, 7th Maine. Sick with dysentery and typhoid fever. Pretty critical case, I talk with him often. He thinks he will die, looks like it indeed. I write a letter for him to East Livermore, Maine. I let him talk to me a little, but not much, advise him to keep very quiet. Do most of the talking myself, stay quite a while with him, as he holds on to my hand.
Opposite, an old Quaker lady sits by the side of her son, Amer Moore, 2nd U.S. Artillery. Shot in the head two weeks since, very low, quite rational, from hips down paralyzed, he will surely die. I speak a very words to him every day and evening. He answers pleasantly, wants nothing. He told me soon after he came about his home affairs, his mother had been an invalid, and he feared to let her know his condition. He died soon after she came.
At last it was believed that all the wounded had been removed from the field, and the relief parties discontinued their work. Looking from his tent at midnight, "Blind Jack" Logan, then a colonel, observed a faint light flitting hither and thither on the abandoned battlefield, and, and after puzzling over it for some time, decided it was someone robbing the dead. He sent his orderly to bring the rascal in. It was Mother Bickerdyke, with a lantern, groping among the dead. Stopping down, and turning their cold faces toward her, she scrutinized them searchingly, uneasy lest some might be left to die uncared for. She couldn't rest while she thought any were overlooked who were yet living.
I was called at midnight to a death-bed. It was a case of flesh-wound in the thigh, and the whole limb was swollen almost to bursting, so cold as to startle by the touch, and almost as transparent as glass. I knew this was piemia and that for it medical science had no cure; but I wanted to warm that cold limb, to call circulation back to that inert mass. The first thought was warm, wet compresses, hot bricks, hot flannel; but the kitchen was locked, and it was little I could do without fire, except to receive and write down his dying messages to parents, and the girl who was waiting to be his wife.
When the surgeon's morning hour came he still lived; and at my suggestion the warm compresses were applied. He said, "they feel so good," and was quite comforted by them, but died about ten o'clock. I was greatly grieved to think he had suffered from cold the last night of life, but how avoid any number of similar occurrences? There was no artificial
heat in any of the wards. A basin of warm water was only to be obtained by special favor of the cooks.
I decided to lay my trouble before the cooks, who gathered to hear me tell the story of that death and of my sorrow that I could not drive away the cold on that last, sad night.
They all wiped their eyes on their aprons; head cook went to a cupboard, brought a key and handed it to me, saying:
"There, mother, is a key of this kitchen; come in here whenever you please. We will always find room on the ranges for your bricks, and I'll have something nice in the cupboard every night for you and the nurses."
This proved to be the key to the situation, and after I received that bit of metal from cook, there was not one death from piemia in any ward where I was free to work, although I have had as many, I think, as sixty men struck with the premonitory chill, in one night. I concluded that "piemia" was French for neglect, and that the antidote was warmth, nourishing food, stimulants, friction, fresh air and cheerfulness, and did not hesitate to say that if death wanted to get a man out of my hands, he must send some other agent than piemia. I do not believe in the medical theory concerning it; do not believe pus ever gets into the veins, or that there is any poison about it, except that of ignorance and indifference on the part of doctors and nurses.