Tuesday, August 28, 2007


At the beginning of the war, the US Military Medical Department consisted of one Colonel, the Surgeon General, thirty Majors, Surgeons, and 84 Captains and below, the Assistant Surgeons. This was not even close to being adequate for the massive army that was needed to put down the rebellion. Add to this the fact that several doctors were from the South and therefore going with their seceded states, and the US Army had a problem operating a Medical Department at first. Of course, the CS Medical Department had to start from scratch.

The Union’s doctors was led at the beginning by Thomas Lawson, a veteran of the War of 1812, and one that had a reputation of being a martinet. He also was dying of cancer, so the Surgeon General position became vacant very fast.

As far as appointing doctors were concerned, it was left to the states to commission those who wanted to be in the Medical Service.

The thing was, many of these doctors had just graduated from medical school, at the time not the eight-year course of study, complete with grueling exams and several years residency to top it off with. These medical students had two, three, and maybe four years worth of education.

It also did not help that many medicines used at the time were just as likely to kill as heal. Medicines such as blue mass and calomel contained mercury, a toxic metal.

Medical science was not complete; people knew that there was a connection between sanitation and health, but did not know why. Doctors knew that a clean camp had healthier troops in it rather than a dirty camp. It was that the discovery of bacteria laid years in the future. Doctors also had to put up with regular outbreaks of malaria and yellow fever, but could not figure how it was spread or that there seemed that there was a “season” for these diseases. That would not be discovered until the Spanish-American War and the discovery by Army Surgeon Walter Reed that mosquitoes were the ones spreading the disease.

Another thing that could have been considered was water sources, which were mainly streams and rivers. There were no clean water sources, other than wells, and filtration and boiling water were know, but seldom practiced.

As a matter of fact, the basic health advice of the 1860’s seemed to be thus:

1. Avoid use of ardent spirits (alcoholic beverages).

2. Do not drink very cold water. Cool water is best.

3. Tea, coffee and chocolate are best at meals.

4. Do not overeat and limit between meal eating.

5. Wear flannel in all weather conditions.

6. Wash clothes regularly or hang them in the sun.

7. Have a bed of hay, straw, or other such material for sleeping on. Avoid bare ground.

8. Sleep as much as possible.

9. Make sure there is a fire after rain and damp weather.

10. Wash entire body whenever possible with soap and water.

11. Wear a white flannel around the bowels if disease prevails (the book never said which disease).

12. Keep in open air but not in direct sunlight.

13. Wear shoes with thick soles.

14. Wear a silk handkerchief in your hat in order to prevent sun stroke.

15. Never eat a heavy meal before a march or a battle.

16. Coffee is a great restorative after a march or battle.

17. Never sleep without a cover.

18. If you must drink brandy, do so after a march or battle.

19. Drink as little as possible, even water.

20. If a wound is jetting blood, that means an artery is cut. Tie a handkerchief between the wound and the heart or else the wounded man will die. Use a stick or other thin device to tighten the handkerchief.

21. For a wound in the abdomen, make the wounded man comfortable, for this is fatal.

22. A full beard will give protection against dust and cold. Also will aid perspiration.

23. Avoid fats.

24. Keep your hair cut short and wash the scalp every morning.

25. Wear wool socks and loose shoes.

26. Keep toe and finger nails cut.

27. Wash feet in the evening and the hands and face in the mornings. This will keep the skin soft.

28. When hurt, the best position is on the back with the head elevated.

29. Put a coat on after a march to avoid a cold.

30. Get water to an injured person immediately. If you have no vessel, tie your shirt into a bag and use that.

31. If you are wet, keep moving and you will be all right.

32. If your cooking water comes from a pond or a sluggish stream, boil it, let it cool, and then stir it to get oxygen into it.

33. If you wear garish clothes in battle, you will be more likely to be hit.

34. Envelop a canteen with a wet woolen cloth to chill the water.

35. During a rest stop in the march, lie down. You will get more rest.

36. A tablespoon of cornmeal in a glass of water will aid in “evacuation of the bowels.”

37. Loose bowels is the first step toward cholera and the remedy is a diet of boiled rice. If it’s an advanced case, wrap the abdomen tightly in flannel.

Some of these “cures” and advice often contributed to killing the patient. For example: Confederate General Thomas Jackson was recovering from having his left arm amputated following his being wounded at the Battle of Chancellorsville. He had a stomach complaint that was remedied by wrapping the abdomen with cold, wet towels. This caused the pneumonia that killed him.

The other thing to consider was the advancement of military hardware. Thirty years previous, the US Army’s main long arm was a smoothbore musket that took a ball slightly smaller than the barrel, resulting in low accuracy over long ranges. A French officer named Claude Minie developed a bullet that was cone shaped with a base that expanded to fit the barrel when the powder charge was fired. This, plus the addition of rifling and a percussion ignition system, and the accuracy and lethality of the long arm increased dramatically. A charging column of infantry could now be hit at longer ranges with relative ease.

When a Minie ball struck a person, the damage was horrific. The bullet did not have a metal jacket around it, so the lead cone turned into a mushroom upon entering the body, causing more damage. This round also traveled at speeds slowed than sound, so heat was not generated as in today’s supersonic bullets. The slow, tumbling, lead mushrooms smashed organs and tore blood vessels, making death almost certain.
When the round struck bone, it was really bad; the bone did not break, but shattered laterally. This is why most led and arm wounds resulted in amputation.

A head shot was almost instantly fatal.

Unless an arm or leg wound was in the muscle, the limb was usually lost.

A hit in either the upper or lower torso meant death, but slow and very painful. It was possible to survive that, but it would not have been easy.

Another thing to consider was infection, foreign objects, such as the cloth of a uniform, was dragged into the wound, causing complications. This happened to Union Major General Winfield Hancock. On Day Three of the Battle of Gettysburg, he was on a horse overseeing the defenses at Cemetery Ridge and observing the approaching Pickett-Pettigrew-Trimble charge. During the exchange of musket fire, a Minie bullet struck the pommel of his saddle, tearing off a small nail and a bit of the leather, and drove the mess into Hancock’s right hip. The wound became infected and the resulting fever almost killed him. To get him on the road to recovery, an ingenious doctor placed a saddle on a sawhorse, and then he placed Hancock on the saddle. After figuring out the angle of the bullet’s trajectory, he was able to probe the wound with a small hook, finding and extracting the nail, which allowed the wound to be drained. Even with that help, Hancock never fully recovered from the wound.

As the war went on, a system of getting the wounded to medical attention was developed. For this, an Ambulance Corps was established so patients could be moved quickly from the battlefield to the field hospital. More often than not, the wounded soldier was either carried by friends, or stretcher bearers who were made up of musicians. There was a position where the ambulance could be found, but the usual case was that the wounded soldier was carried all the way. Sadly, causality collection was not as efficient as claimed, resulting in wounded soldiers lying on the battlefield for as many as 48 hours, many of dying from wounds that would have been survivable if the soldier was taken to the field hospital.

Upon arrival at the field hospital, the wounded was subjected to a triage method that divided them into at least three categories:

Those with minor wounds who could wait on treatment.

Those with wounds that are survival with treatment (this was usually the amputations).

Those with wounds that ware mortal. No treatment was prescribed but to make the patient comfortable as possible.

These hospitals were set up in farmhouses, barns, or any shelter that came to hand. The conditions on such places were not ideal, with surgeries being performed on planks laid over sawhorses, or even a door. The surgery “table” might be washed between operations, but that was not guaranteed. The surgeon’s instruments, the scalpels, bone saws, and probes, were usually not sterilized, so infections were passed on from patient to patient. The surgeon’s collection of instruments more resembled a carpenter’s toolbox than a doctor’s kit. Ether and chloroform was used to put the patient to sleep, but if that was in short supply, that did not stop the doctor. A skilled physician could complete an amputation within 15 minutes, and then be ready for the next one. The limbs were supposed to be burned, but more often than not, they were piled outside. One Union soldier’s account told of pigs eating the amputated limbs.

After treatment, the patient could either be returned to duty (minor wounds), or sent out of the area to a regional military hospital. If possible, the soldier could be sent home to fully recover (called recovery leave).

Both sides organized large scale hospitals in order to care for the wounded. Union hospitals were established in Washington D.C. as well as Nashville, TN, Jefferson, IN, and many other cities in the North. Washington alone boasted 25 hospitals, both military and private. Add to this the convalescent camps, and the Union had a somewhat decent system in order to treat the wounded.

One innovation that resulted was a Nursing Corps that was staffed by females. Women were already working as government clerks, but wanted to do more.

Louisa May Alcott, who would write Little Women, worked in a hospital.

Dorothea Dix, a social activist, was instrumental in recruiting women for the Nursing Corps. She did have some rather peculiar qualifications, no women under 30 and they could not be pretty.

Clara Barton did not qualify to work with Dix, but that did not stop her from attaining a position at another hospital. She would go on to create the American Red Cross. She worked with another nurse, Susie King Taylor, who became the only African-American to publish a memoir of her war experiences.

Mary Ann “Mother” Bickerdyke was so successful in the Western Theatre that by order of Major General William Sherman, she was the only woman allowed in his hospitals.

Another nurse, this one male, was the writer Walt Whitman, who worked in several hospitals after nursing his wounded brother back to health.

Not only there were women nurses, but at least one woman doctor, Dr. Mary Walker.

The Confederates were not without their own system of helping their wounded. They were hampered with lack of supplies and facilities. They did manage to create a model hospital, Chimborazo, at Richmond, VA.

Southern nurses included Kate Cummings, who defied Southern attitudes towards women to become a nurse, as well as Sally Louisa Tomkins, who was commissioned a Captain in the Confederate Army for her work.

With resources being stretched, it soon fell on private organizations to pitch in and help. The U.S. Sanitary Commission and the U.S. Christian Commission brought food, clothing, and comfort to troops in the field and in the hospital, even running several private hospitals. Several states also formed organizations so that their troops could be helped.

Sadly, beyond a few private organizations, there were no Sanitary Commissions in the CSA.

Of course with remedies such as these, it was a wonder anybody survived:

1. Thieves Vinegar: Take a handful each of rue, sage, mint, rosemary, wormwood, and lavender and out into a gallon of vinegar to infuse. Let sit in a warm place for four days. Strain the mixture and then add one ounce of camphor. Wash the face and hands with it before exposure in a hospital or sick room. It is called Thieves Vinegar because of a legend of thieves using this liquid to protect them as they plundered the houses of people sick with Bubonic Plague at Marseilles, France.

2. Prevention of Mosquito Bites: Mix oil of pennyroyal with olive oil and spread on the skin to repel mosquitoes.

3. Sprains and Bruises: mix one pint of train oil, ½ pound of stone pitch, ½ pound of resin, ½ pound of beeswax, and ½ pound of stale tallow. Boil for ½ an hour and skin off any scum. Pour liquid into cups to cool. When needed, spread it on a cloth and apply it to the sprain or bruise.

In Paris, the treatment for a sprain was to have the doctor grease his thumbs and press them on the sprain for ½ hour. Within one day, the patient was relieved.

A specific treatment for a sprained ankle was to wash the ankle with salted water and keep the foot as cold as possible. Elevate the foot, don’t eat too much, and take a “cooling medicine” until the sprain is cured.

Another cure for a bruise was to bath the area with water and apply a paper or cloth spread with treacle.

4. Stings: Take a wine glass of vinegar and mix in common (baking) soda. Apply it to the affected areas.

Another treatment was to apply a plaster of moistened salt. This was to draw out the venom of a bee or wasp sting.

5. Blisters on the feet: Rub the feed with spirits mixed with tallow from a candle.

6. Dirt in the Eye: Place a finger on the affected patients cheek and slightly pull down, exposing the area under the eye. For over the eye, use a knitting needle over the eyelid to hold it up. Use a silk handkerchief to remove the dirt. Bathe the eye and have the patient stay out of the sun for the day. If there is any inflammation, have the patient take a purgative and apply a cooling lotion.

7. Frostbite: For the feet, apply deer’s marrow to the affected area.

For other areas, take chrome yellow and hog’s lard and mix them into an ointment. Apply to affected areas after warming the ointment.

8. Coughs: Take one teacup of molasses, add two tablespoons of vinegar and bring to a simmer. Then add three teaspoons of paregoric and as much refined niter as you can place on a breakfast knife. Take two or three teaspoons before bed and one of two during the day to dispel coughs.

9. Nosebleed: Blow powdered gum Arabic or alum up the nose with a quill to stop the bleeding.

10. Headaches: Use epodeldoe, spirits of wine, and sal ammoniac applied as a lotion to the forehead.

11. Bleeding Wounds: Apply flour and lint to the wound.

12. Infectious wounds: Apply sugar to the wound. Another procedure is to wash the wound with wine, then apply sugar.

13. Warts: Wet the wart with tobacco juice and apply chalk. Another method is to rub the area with fresh beef.

14. Corns: Mix and melt together two ounces of beeswax and two ounces of ammonia. Then add ½ ounce of verdigris. Spread on linen and apply it to the corn.

15. Bunions: If caught early, bind the foot tightly to prevent bunion growth. If inflames, a poultice of twelve grains of iodine and a ½ ounce of lard can be applied. This should be done two to three times daily. If the bunion is enlarged, apply salad oil. Wear lose shoes or slippers.

16. Boils: Treatment is a poultice of molasses or honey mixed with flour. Apply until it disappears. If the boil is painful, a poultice of bread, milk, volatile liniment and laudanum should be used.

Or, when one was sick, these nutritional tidbits:

1. Panada: Take some bread slices, cut off the crust, and boil then in water. After five minutes, take out the bread and pound it in a bowl, adding a little of the water it was boiled in. Mix in butter, sugar, and nutmeg to taste.

2. Toast Water: Take one slice of bread and toast it. Lay the toast in a bowl and pour on boiling water. Cover bowl with a saucer and let cool.

3. Beef Tea: Take one pound of beef and slice it into thin strips. Add salt and boil it in water for an hour. Pour through a strainer into a cup and serve.

4. Broth: Take meat (chicken, beef, or veal), add two tablespoons of rice and boil it until tender. If needed, serve the broth fifteen minutes after boiling, otherwise cover and keep overnight.

5. Water Gruel: Start with two tablespoons of cornmeal or oatmeal with three tablespoons of water. Mix a pint and a half of boiling water slowly to the mixture. Once everything is mixed, put the whole mixture in a skillet and boil it for thirty minutes. Skim the mixture and season with salt. Sugar and nutmeg can also be used.

6. Rice Gruel: Mix one tablespoon of rice, one and a half pints of water, and either a cinnamon stick or a lemon peel. Boil it until soft and add a pint of milk. Strain the mixture and add salt, sugar, nutmeg, and butter to taste.

7. Milk Porridge: Same as the gruel but with equal parts of flour, cornmeal, milk and water. The flour, cornmeal and water is cooked first. Then the milk is added prior to boiling.

8. Mutton Custard for Bowel complaints: Take two ounces of mutton suet and shred it. Add cinnamon and nutmeg and boil it in a pint of milk. Skim off any scum that rises. Take a half teacup of this three or four times a day.

9. Bread Jelly: Boil a quart of water and set it aside. Take a 1/3 loaf of bread, cut off the crust, and toast it. Pot the toast into the water and boil it slowly until the liquid turns into jelly. Strain the mixture and set it aside. When used, sweeten it with sugar and a little lemon peel.

10. Wine Whey: Boil a ½ pint of milk. Add two glasses of wine and a teaspoon of sugar. After the mixture boils, take it off the fire and set aside. Curds (solids) will form and sink to the bottom of the pot. Pour the whey (liquid) into another pot and add boiling water. Add sugar to taste. Use in cases of typhus.

11. Calves Feet Broth: Take two calves feet and boil them in three quarts of water. When water is half boiled away, take off the fat, season with salt, and serve in a teacup with a spoonful of wine.

12. Rice Jelly: Take ¼ pound of rice, mix in ½ pound of sugar, and add enough water to cover it. Boil until it becomes glutinous. Strain it and set it aside. Season to taste.

13. Hot Lemonade: Cut up a whole lemon, add a teacup of sugar and boiling water. Great for colds.

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