Posted in American Civil War, American Civil War Medicine

American Civil War – Kindness of Strangers, The Cooper Shop Volunteer Refreshment Saloon and The Cooper Shop Hospital, Philadelphia

Food provisions for the war-weary Union Soldier. Exhibition by So.Sk.An.

Amidst all the disease, suffering and death that occurred during the American Civil War, I was heartened to come across an extraordinary act of compassion shown by the citizens of Philadelphia.  The Cooper Shop Volunteer Refreshment Saloon was a 2 storey brick building, 50 yards from Washington Avenue, on Otsego Street.  Philadelphia was the main travel intersection between the East and the seat of rebellion.  Large numbers of troops marched along Washington Avenue before boarding the railroad cars, of the Philadelphia, Wilmington and Baltimore Railroad Company, for onward transportation. Before the War, Messrs. Cooper & Pearce, owners of The Cooper Shop as it was then known, were involved in the manufacture of shooks for the sugar planters of the West Indies.  

The Saloon operated between 26th May 1861 and 28th August 1865 and served approximately 600,000 patriots. During this period a committee of women, assisted by the generosity of friends and neighbours, took over The Saloon’s organisation.   The committee consisted of: Mrs William Cooper, Mrs Grace Nickels, Mrs Sarah Ewing, Mrs Elizabeth Vansdale, Miss Catherine Vansdale, Mrs Jane Coward, Mrs Susan Turner, Mrs Sarah Mellen, Miss Catherine Alexander, Mrs Mary Plant, Mrs Captain Weston, Mrs Thomas D. Grover and Mrs James M. Moore.  Day and night the team tended to the sick and wounded Union troops, mended and washed clothes and offered all the comforts of home to any soldier who turned-up. The Saloon remained open around the clock and the public were also welcome to visit.  Women from the “neck”, which was the garden area of Philadelphia, came to The Saloon daily with wagons laden with fresh milk.  At one point, 100 gallons of coffee was being made every hour in the shop’s large fireplace. 

Soldiers presenting themselves at The Saloon were in a truly terrible state.  Nearly all were starving, exhausted, badly sunburned (particularly on their faces), wearing filthy, tattered and lice-ridden clothing.  All got a warm welcome from the Saloon team.   Each soldier would be thoroughly washed, supplied with a fresh set of clothes including underwear, socks and mittens and given cup of coffee and some food.  The ladies took care of letter writing requests from the soldiers and attended to their every need with warmth and compassion. 

In December 1861, a private, non-military hospital was established above the main Saloon. The aim of The Cooper Hospital being to create a safe, pleasant ‘home from home’ environment for the sick and convalescing soldier with no strict military discipline or regime imposed. Dr Andrew Nebinger was in charge assisted by Dr George W. Nebinger, both worked tirelessly night and day without pay. In February 1862, Robert Nebinger began work as the Hospital’s dispensing pharmacist. The Hospital also had its own apothecary shop. Originally there were 11 beds and by 1st March 1862 bed capacity had increased to 27. Miss Anna M. Ross was the Lady Principal of the Hospital and oversaw the women who volunteered to nurse the sick and wounded.  Sadly, on 22nd December 1863 aged 50, Miss Ross died. The Hospital entered a 30 day period of mourning and the Manager’s Room remained draped in mourning paraphernalia for 6 months.  Following her death, Mrs Abigail Horner became the Lady Principal.

Conditions in the Hospital were excellent.  The rooms were clean, well-ventilated and brightly lit. In March 1862 the Philadelphia Associates of the US Sanitary Commission visited the Hospital and its Chairman Dr Francis G. Smith stated that he was ‘…impressed with the comfortable and home-like appearance of the Hospital, and with the kindly ministrations of those having it in charge.’  Mrs Dorothea Dix visited the Hospital and her sentiments echoed those of Dr Smith.  She was extremely pleased with what she had seen and gave the venture her highest commendations, fully endorsing its usefulness.  In fact, she was so impressed that after her visit she sent The Hospital a donation of books.  The Hospital closed in the autumn of 1865 and out of the 854 patients treated there, only 14 died.

Posted in American Civil War, American Civil War Medicine, History, History of Medicine

American Civil War Medicine Part 6. Female Surgeons – Defiance in the Face of Adversity.

The Southern Skirmish Association, Bath 2011.

A few words upon a very important aspect of this question – the right of women to compete with men in any occupation by which they can earn a livelihood.  A woman has to pay like a man, she has neither mercy nor favour shown her because she is a woman, therefore she should have the same chance as a man, and the same pay if she can render as good work.  Why should not women enter the legal and medical profession…..During a four years’ sojourn in America I had the pleasure of knowing Dr Mary Walker, Dr Elizabeth Blackwell and hundreds of others who are doing the noblest work that is being done in the United States at the present time.  The medical profession is one particularly adapted to women.’

Ada Campbell, Liverpool, 21st September 1891

Ada Campbell wrote the above letter, on equal rights for women in the professions, 26 years after the end of The American Civil War (1861-1865).   Nearly 1,000 women disguised themselves as men and served as soldiers during the campaign, 3,000 white women became nurses and a handful of women served as physicians.  Dr Mary Edwards Walker, Dr Elizabeth Blackwell, Dr Esther Hill Hawks and Dr Sarah Ann Chadwick Clapp were among a pioneering group of medical professionals who broke with social conventions by offering their services for frontline duty.  They received a hostile reception from their male counterparts, who firmly believed that field medicine was a male environment and no place for women.  Undeterred, the feisty females continued to flout the accepted norm and all 4 demonstrated defiance in the face of adversity.

Dr Blackwell (1821-1920) was the first female MD in the US, graduating from Geneva Medical College in 1849.  During the War she trained the nurses that were sent to the Union Army.  Dr Clapp was appointed assistant surgeon of the 7th Illinois Volunteer Cavalry and served in post between 15th November 1861 and 25th August 1862.  She also served as assistant surgeon/surgeon in general hospitals in Cairo, Illinois and aboard transport ships.  However, the medical examining board refused to give her an examination and she never received a commission or pay for her War work.  Dr Hawks (1833-1906) graduated from the New England Female Medical College in 1857.  At the start of the War she followed her husband, John Milton Hawks a regimental doctor with the U.S. Coloured Troops, to the South Carolina Sea Islands and Florida.  She treated the wounded from the attack on Fort Wagner and the Battle of Olustee.

Dr Walker (1832-1919) graduated from Syracuse Medical College in 1855.  At the outbreak of War she applied for a surgeon’s contract, a request which was flatly refused by the Medical Department.  She did not give-up and remained in Washington serving as a nurse in a number of camps and hospitals for Indiana troops.  Whilst working at the Indiana Hospital, Washington she met Dorothea Lynde Dix.  Dix had been appointed on 10th June 1861 by the Secretary of War as Superintendent of Female Nurses.  She was a formidable character and insisted that her nurses were over 30 and plain, lest they should incite sexual desire in the surgeons.  Dix’s nurses wore brown/black dresses, no bows, no curls, no jewelry and no hooped skirts.

Mary made repeated attempts to secure the allusive surgeon’s contract and was abused for her demands.  After proving her worth during the battles of Fredericksburg (1862) and Chickamauga (1863) where she worked, unpaid, as a field surgeon, General Ambrose Burnside declared his confidence in her medical skills and recommended her for a commission.   In September 1863, Major General Thomas appointed her an assistant surgeon in the Army of the Cumberland and she was assigned to the 52nd Ohio Volunteer Infantry serving in Chattanooga.  Finally, in October 1864, she was officially commissioned as a Contract Surgeon and received the rank of First Lieutenant.

Although a talented and competent surgeon, Dr Walker’s temperament was described by her fellow surgeons as being cantankerous, abrasive, harassing, a professional scold and some thought her insane.  Always outspoken and never afraid to challenge her colleagues and their decisions. She was appalled that the battlefield surgeons were performing amputations with such regularity and in her view many were unnecessary.   She would undermine her colleagues by conspiring with the wounded soldier to challenge the Surgeon’s decision to remove a damaged limb.  She was equally horrified at the heavy doses of mercuric compounds that were being given to patients.

Dr Walker was a beautiful woman, with raven hair which she kept long and curled so that no one would think that she was a man.  The reason that she may have been mistaken for a man, was due to her unusual attire, for which she was famed and criticised for throughout her life.   Beginning at medical school she wore bloomers, much to the disgust of her lecturers.  Bloomers were the outfit of choice for radical feminists of the day and were first invented by Amelia Jenks Bloomer (1818-1894), who spearheaded the movement.  When Dr Walker began her medical career she abandoned the bloomers and wore instead a modified version of male dress, a calf-length skirt worn over trousers, teamed with an Army uniform jacket.  Whilst on front-line duty she would always carry 2 pistols about her person.

On 10th April 1864, following a battle, Mary had stayed behind to tend Confederate wounded upon retirement of the Union Army.  She had taken a wrong turn in the camp and was captured by Confederate troops and charged with being a spy.   The Confederates believed that her male attire was a deliberate attempt to don a disguise and infiltrate the encampment.  She spent 4 months in prison and continued to be abused for the manner in which she dressed.  Eventually in August she was exchanged for a Confederate surgeon whom the Union Army had captured.  She was proud of the fact that the price on her head was that equal to a male surgeon and often boasted about it throughout her life.

In 1866, she became President of the National Dress Reform Association which urged women to discard their corsets on health grounds and adopt dress reform.  The Association sought to pioneer a movement which necessitated a change of style in the dress of American women.   In July 1866 she was arrested in New York for the crime of impersonating a man.  The Dundee Courier & Argus reported the incident:

Miss Dr Mary E. Walker who indulges in the Bloomer costume, appeared one day in Broadway with a very long train of boys.  A policeman arrested her, and took her before the justice in question, on charge of being dressed in the attire of a man.  It was alleged that the crowd which followed Dr Mary sufficiently proved that no deception was attempted with regard to her sex.  A lawyer of the Police Court declared that “any man or woman who should dress in a way that would attract attention was violating the law.”  To this it was replied triumphantly that the great majority of New Yorker’s dressed for the purpose of attracting attention.  We say triumphantly, for the justice decided that no case was made out against the fair physician, who thereupon returned to Broadway, where she has since appeared in her “Bloomer” at her pleasure.’

Mary always wore male dress and even in her final years, she could be seen about town wearing a wing collar, bow tie, top hat and carrying  a cane.  She was awarded the Medal of Honor in November 1865 for her services at the First Battle of Bull Run (Manassas).

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Surgical instruments from The American Civil War, owned by members of So.Sk.An.
Posted in American Civil War, American Civil War Medicine, History of Medicine

American Civil War Medicine – Part 5 – The Scourge of “Yellow Jack”

Medicines of The American Civil War. Exhibition by So.Sk.An.

‘The Federal army may soon have to contend with a more deadly foe than the Southerners.  The yellow fever season is fast approaching, and, if the Vomito stalk through its ranks, he will slay more than the sword has done; and it is possible that the Confederacy have calculated on the reinforcement.’

(New York State, 14th July 1862)

The yellow fever is raging with unabating fury at Wilmington, N.C.  Letters from the  scourged city are many, calling for help from abroad.  Its rapid spread and malignity arises from utter ignorance of the physicians and others in their treatment of the disease.’

(The Sheffield & Rotherham Independent, 18th October 1862)

I recently came across the above in contemporary British and American newspapers.  There are many other examples of media reports on the devastation caused by the scourge of yellow fever or “Yellow Jack” as it was referred to in everyday parlance.  The disease was a particular problem in the South, killing over 10,000 people and, like malaria, epidemics occurred mainly during the summer and autumn months.  Outbreaks were reported in Charleston, Galveston, Mobile, New Orleans, Norfolk, Savannah and many more cities besides.  Wilmington’s epidemic, which killed 15% of its population, was traced to the arrival of the blockade runner Kate.   If you did manage to survive yellow fever, which was rare as mortality rates were over 50%, then you would acquire lifelong immunity.  

Yellow fever is transmitted from person-to-person by the Aedes aegypti mosquito.  This type of mosquito lived in the Southern States and laid its eggs in hollow logs and other receptacles that contained fresh water.  Horse troughs, clogged gutters and rubbish lining the streets, that had been filled with rainwater, were popular incubators for the Aedes aegypti’s eggs.  During the winter, the heavy frosts helped to curb the mosquito population.   The mid 19th century American physician was ignorant to the causes of this disease.  It was the popular held belief that yellow fever was a mysterious filth that lived in certain types of clothing and travelled aboard ships.  

Drugs and therapies for its treatment were based upon antebellum practices of inducing vomiting, sweating and purging of the bowels or bladder to release toxins from the body.  Once the toxins had been expelled, then the diseased body could be brought back into balance.  The most popular medication administered by the Army Surgeon was calomel, containing a mix of alcohol, opium, honey, chalk and mercury.   A typical treatment regime for a Civil War soldier suffering from yellow fever would have been:

  • mix of spirits of ether and whiskey;
  • calomel and 15 grains of rhubarb;
  • acid drinks;
  • liquid potasse citrate;
  • 1 ounce of castor oil;
  • 30 drops of laudanum;
  • 6 drops of oil of turpentine.

In the advanced stages of the disease you bleed from the nose and mouth, suffer crippling headaches, fever, jaundice and vomit a substance that resembles coffee grounds.  This blackened, grainy substance is in fact half-digested blood, caused by internal hemorrhaging.  Army Surgeons in the Civil War were accused of prescribing calomel too readily to their patients.   In the Spring of 1863 an ambitious young Surgeon General, Dr William A. Hammond (1828-1900), ruffled more than a few feathers amongst his colleagues.   Hammond believed calomel was indeed being overused and he decided to do something about it.  He issued the infamous, Circular No. 6, insisting that the medication be removed from all the Union Army Surgeons’ supply tables.  Hammond believed that its overuse was the cause of a range of nasty side effects amongst the soldiers.  Examples of the side effects that Hammond cited include:  melancholy, hypersalivation and gangrene of the mouth.  His colleagues were angry at this dictate and at what they thought to be interference in matters that were not of his concern.  The situation escalated resulting in Hammond’s eventual court-martial.  It wasn’t until 1878 that he was finally exonerated of the charges brought against him.

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Posted in American Civil War, American Civil War Medicine, History of Medicine

American Civil War Medicine – Part 4 – Malaria

Medicines used in the American Civil War, from a Medical Exhibition owned by members of So.Sk.An.

Between 1861 and 1866 over 1 million Union soldiers  were diagnosed with malaria.  Malaria is a parasite transmitted by the Anopheles mosquitoes.   The mosquito breeds in stagnant, sunlit pools of fresh water and the adult female requires a blood meal in order to be able to ovulate and lays somewhere between 100-300 eggs at any one time.  Symptoms of the disease are chills, shakes, nausea, headache, an enlarged spleen and most notably, a fever that spikes every 1 to 3 days depending on the type of malaria and its parasitic cycle.  There are 4 species of malarial parasite that commonly infect humans:

  • Plasmodium falciparum –  Common type that was found in the United States during The American Civil War. Results in a congestive and malignant fever.  A pernicious malaria which left untreated is fatal;
  • Plasmodium Vivax – not often fatal and commonly referred to as an “intermittent fever”;
  • Plasmodium Malariae;
  • Plasmodium Ovale.

Malaria is categorised according to how often the fever spikes or paroxysms occur:

  • quotidian fever – every 24 hours;
  • tertian fever – every 48 hours;
  • quartan fever – every 72 hours.

The further south you travelled, the more prevalent malaria was.  The South’s “Sickly Season”, as it was referred to, took place during the months of summer and autumn.  The impact of malaria upon military campaigns in The American Civil War cannot be underestimated.  Examining the causal links between human health in general and developments in military history is extremely complex and lies outside the confines of this blog.  But there is no doubt that military operations are affected by epidemics and seasonal outbreaks.  For example, when the “Sickly Season” was in full swing, major offensives were less likely to be initiated by the Union army in certain areas of the Confederacy.

Pilulae Quinlae Sulphatis used for treating malaria.

The treatment options available in 1860s America were pretty good.  Quinine, which occurs naturally in the bark of the cinchona tree, was the most effective in controlling symptoms of the disease.  The cinchona bark was known for its febrifugal properties and continued to be used in anti-malarial drugs until the 1940s.   The Pilulae Quinlae Sulphatis treatment (pictured above) was standard issue in the Army Surgeon’s medicine chest.  The recommended dosage would be 3 grams of Sulphate of Quinia.  A fatal dose of quinine is 8 grams and many soldiers were given high doses of the drug.  Side effects of overdosing included ringing in the ears, headaches, nausea and blurred vision.  There were two large pharmaceutical companies whose headquarters were in Philadelphia,  Rosengarten & Sons and Powers & Weightman both of whom cornered the market in quinine based medications.

Union blockades meant stock piles of quinine in the South dwindled with each year of the war.  When quinine supplies did sometimes get through the blockade, Confederate soldiers hijacked it for themselves, leaving many civilians to suffer, untreated, the disease’s terrible side effects.  Quinine was also used to treat gout and dyspepsia.  Quinine substitutes were created by the Southerners to try to counter the shortages.  Constituents of these preparations included 30% dogwood bark, an equal portion of poplar bark, 40% willow bark all mixed with whiskey.  Alternative remedies were also tried by the desperate civilian.  Some believed that rubbing turpentine on the stomach prevented paroxysms and others tried putting red pepper in their tea.  All substitutes proved  ineffective.   Throughout the War, travel restrictions were in place in the South which meant that white Southerners, who would have normally fled their plantations during “Sickly Season”,  had to stay put and face the ravages of the disease.

Union Surgeons issued more than 19 tons of quinine throughout the War.  The daily ‘quinine call’ queues were a familiar sight in Union encampments.  Soldiers taking part in The Siege of Vicksburg (18th May – 4th July 1863) exploded powder cartridges in their tents to smoke-out the mosquitoes.  Many soldiers were most vulnerable from being attacked by Anopheles mosquitoes whilst performing picket duty.

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Posted in American Civil War, American Civil War Medicine, History of Medicine

American Civil War Medicine – Part 3 – Minié Ball Injuries

click here.Southern Skirmish Association (So.Sk.An) – Skirmish at The American Museum in Britain, Bath 2011

The standard Civil War issue rifle, was the Springfield Model 1861, a musket shoulder arm that used the percussion lock system.  Weighing approximately 9 pounds, sporting a 40 inch long barrel,  muzzle-loading, .58 Caliber, shooting a 480 grain conical, soft lead Minié ball.  The Minié ball bullet derives its name from the gentleman who invented it, French gunsmith Claude Etienne Minié (1804-1879).   The Springfield rifle was an extremely powerful weapon and the Minié ball had a greater range than the traditional round musket ball.  The Minié was effective at 1,000 yards, deadly at 300.  Introduced into The American Civil War in 1862 by the North and carried by the Union Infantry in the eastern theatre.  Confederate soldiers in the South also used the weapon later on in the conflict, initially as a result of seizing the rifles and ammunitions as spoils of war, but in time they began to manufacture the Minié ball bullet themselves.

Ammunition Display owned by members of So.Sk.An. Examples of the deadly Minié ball bullet are shown

The Minié ball inflicted horrendous injuries, challenging even the most experienced Army Surgeon.  Upon impact the conoidal balls lost their shape, penetrating the victim’s body causing extensive fissuring, splintering of bone, lacerations and destruction of internal organs.  The velocity of the Minié was such that it would carry with it pieces of skin and clothing into the wound itself.  Death from an untreated infected entry wound was often inevitable.  A direct hit to the chest, torso, head and stomach was seen as the soldier’s death sentence.

The Minié ball was responsible for the high number of amputations in The American Civil War.  The removal of the shattered limb was counter to contemporary guidelines practiced by non-battlefield Surgeons in mid 19th-century America.   Physicians were taught to follow the principles of ‘conservative therapeutics’ when faced with severely damaged limbs.  Conservative therapeutics meant preservation of the body at all costs and saving diseased limbs whenever possible, only performing mutilation as a last resort.  However, the Minié ball ignited infection from the moment of impact, with bacterium immediately transported into the wound by way of the torn pieces of skin and clothing.  The battlefield Surgeon had no choice but remove the limb to prevent certain death.  The mindset of the Army Surgeon became ‘life is better than a limb’.

Left of the image the deadly Minié ball bullet, on the right the round musket ball. Part of an exhibition of medical instruments by So.Sk.An.

One of the reasons why bullet injuries to the upper part of the solider’s torso were common is as a result of battlefield formations.  Traditional formations meant that soldiers would stand shoulder-to-shoulder, many suffered multiple wounds as their line of defense met attack.  Gunshot wounds to the face – particularly the eyelids – neck and head were commonplace.  Reviewing contemporary medical journals has revealed the extent of the devastation inflicted by the Minié ball.  In 1864, a 29-year-old soldier was wounded in the head, the bullet entered half an inch above the frontoparietal suture, and two inches to the right of the median line, penetrating the brain and lodging there.  The brain began to ooze mass in a haphazard manner.  The patient was so distressed he could not take food or medicine and become very weak, listless, shouting in pain whilst at the same time his eyes were open and staring,  4 days later he began to  experience frequent and violent convulsions.  Cold applications were applied to the wound, and half a grain of Calomel mixed with a quarter grain of opium were administered.  He subsequently became incontinent, delirious and paralysed down one side.  On the 8th day his symptoms improved but 6 days later he passed away.  The autopsy revealed that a bullet had torn its way through the right lobe of the cerebrum and remained lodged against the meninges for the duration of what must have been a harrowing and excruciatingly slow death.  It was also discovered that the skull had sustained a fracture, 6 inches in length and nearly 2 inches wide, the right cerebrum was decomposed and the middle meniugeal artery sloughed through.

In another case, the Minié ball had entered the mouth of a soldier, passed through the tongue and no exit wound could be found.  The patient appeared fine for 6 days but on the 7th suffered a fatal haemorrhage.  The autopsy revealed that the bullet had lodged in the upper surface of the transverse process of the atlas, having perforated in its course the external and internal carotid arteries.

On a lighter note, I cannot write about the Minié ball without addressing the legend of the ‘Minié ball pregnancy’.  In the American Medical Weekly (7th November 1874) a doctor recounts a most unusual tale from over 10 years ago when  a Confederate soldier, during the Battle of Raymond Mississippi in 1863, had received a Minié ball hit directly into his tibia.  The bullet had ricocheted through his scrotum and subsequently penetrated the abdomen of a 17-year-old girl living in a nearby farmhouse.  The young girl had been treated by the doctor who noticed in the coming weeks that her stomach begun to swell.  A medical examination by him confirmed that although her virginity had not been compromised she was indeed pregnant.  She later gave birth to a baby boy and the doctor concluded that the young maiden must have been impregnated by sperm on the stray Minié ball bullet.  In order to hush the doubters he also claimed that he had gone on to surgically remove said bullet, from the baby boy’s own scrotum following the birth.   However, on 21st November 1874 the same doctor printed a retraction of his story claiming that it had all been just a little bit of ‘contemplated fun’.  The devastation caused by the Minié ball bullet, as you can see from the case studies cited above, was certainly nothing to joke about and the doctor in question was quite rightly chastised for his japers.

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Posted in American Civil War, American Civil War Medicine, History, History of Medicine

American Civil War Medicine – Part 2 – Amputations and Plaster Splints

American Civil War medical instruments owned by members of the UK Re-enactment Group, So.Sk.An

 ******WARNING ABOUT TEXT IN THIS POSTING********

This posting contains some detailed descriptions of medical procedures that a few of my regular followers may find a tad gruesome.  If this topic is not for you, then please check back again in a few days time, when there will be some lovely postings on Victorian actress Lillie Langtry, the 1940s Make Do and Mend Campaign and of course, more cooking with Mrs Beeton.  If you like your history of medicine straight-up, then please read on….

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As you know if you have read my previous posting on American Civil War Medicine, I am researching the career and life of Civil War Surgeon Dr Mary Edwards Walker (1832-1919).   In the course of this research I have come across some great material on medical practices and procedures used by Surgeons during this time which I thought would be of interest to those of you who are keen to find-out more about this fascinating topic.

Amputation was the stock-in-trade of every Civil War Surgeon.   The procedure was used to treat bullet wounds and infections.  The most skilled Surgeon could amputate a leg at the thigh in about 40 seconds.  Reporting on ‘Amputation at the Ankle-Joint’ in The British Medical Journal in August 1869, Prof. George H. B. Macleod, M.D., F.R.S.E., a Professor of Surgery in the Andersonian University, Glasgow, said that ‘..Essentials of any good method of amputation is the removal of the whole disease or injured parts to be removed with as little mutilation as possible and with as great a saving of the body (especially the bone) as can be.’  Macleod’s own research into mortality rates post ankle-amputation in the Crimean War (22.2%) and the American Civil War (8%), demonstrate that even in the few short years that had elapsed between the two campaigns, the Surgeon’s skill at perfecting this procedure had probably reached a high level.   These mortality figures are quite incredible when you think how insanitary the conditions in the Field Hospitals actually were.  The large volume of amputations performed by Surgeons would have ensured that the skill was being practiced on a regular basis.

What is unclear from Macleod’s statistics is whether the amputations were flap or circular.  There were several methods of ankle-amputation available to the Surgeon:   Syme’s, Postero (internal flap), Soupart’s, Sédillot’s and Pirogoff.   Flap method amputations were dangerous in the battlefield as they were particularly prone to gangrene.  However, the flap method was quicker to perform than the circular and would have been popular where speed was of the essence. Macleod believed that the best method was Syme’s flap method which he describes as follows:

  • ‘The knife best fitted for amputation at the ankle is a short, strong bladed one. That the covering retained for the ends of the bones should be ample in amount, healthy and firm in quality, so as to make it capable of withstanding pressure and attrition; that the blood-vessels and nerves should be placed out of the way of pressure, and that they should be well-covered and protected; that the flap or flaps should be well supplied with blood, and fall easily together, and be capable of easy retention; that secretions should have easy exit; that the resulting cicatrix should be out of the line of pressure; and, lastly, that the stump should be one to which the mechanist can with greatest facility adjust a substitute for the removed part.’   

Macleod offers plenty of advice on aseptic surgery, which was not practiced during the Civil War.   It wasn’t until 1867 that the benefits of a sterile operating theatre began to be accepted across Europe.    America did not adopt aseptic surgery practices until the end of the 19th century.  Macleod, writing in 1869 advocates its use but the last couple of sentences on dealing with wound dressings would horrify us today:-

  • ‘I have employed various disinfectants and antiseptics in the after-treatment of these and other wounds, and am strongly impressed with their advantages in lessening discharge and destroying smell. Carbolic acid dissolved in water (1 to 30) or Condy’s fluid or Chloride of zinc (gr 15 or 20 to the ounce), are very useful indeed, when used to wash over the flaps at the time of the operation; and carbolic acid or Condy’s fluid should always be mingled with the water used for syringing out the stump (which I always do at each dressing, so long as pus lodges in its interior).  I am a strong advocate for dressing as seldom as possible.  Unless the suppuration is very profuse, and the drainage bad, it is not necessary to interfere oftener than every second day; and in fact, if the dressings applied be of the simplest and lightest kind, very little meddling will be required.  I rarely make my first dressing till the third or fourth day.’

Many Surgeons during the Civil War reported on the neurological phenomena known as ‘the phantom limb’.  Contemporary researchers on the topic included physicians, S. Weir Mitchell, W.W. Keen and George Morehouse.  They had all experienced reports of this phenomena amongst their patients.  Many   amputees reported feeling a sensation from the amputated portion of limb.

Conditions in the Civil War field hospitals were basic and grim.  Field hospitals were converted schools, hotels, churches, barns, private homes and even boats.  The injured soldier did not recuperate on sprung mattresses in clean, tidy wards but instead would find himself lying on makeshift beds.  These beds were boards on top of church pews or on the ground and if they were lucky they might be given a mattress made of sacks of straw or corn husks.  The operating table would have been a wooden bench often set-up underneath a tree.  Drugs and medical supplies were in short supply and in emergencies corn husks were sometimes used as a substitute for bandages on patients injured on the frontline.  Suppurating wounds were treated by applying an ointment consisting of 2 parts fresh lard and one part white wax. (For more on this particular topic, see Agatha Young’s, The Women and the Crisis: Women of the North in the Civil War, published by Thomas Yoseloff: New York, 1959).

Apart from amputation skills, the Civil War Surgeon developed relatively sophisticated techniques in the use of plaster splints.  I came across an article, ‘Plaster Splints in the American Civil War’ published 1943 in the December issue of The British Medical Journal by an author just referred to as ‘S.W.’  S.W. had discovered a series of essays, titled ‘A-T’, that had been published between 1862-4 by The United States Sanitary Commissioner and intended for distribution amongst Army Surgeons.  The essays covered a wide ranges of topics on battlefield medicine, including techniques for creating plaster splints which can be found in Volume ‘T’.  The Army Surgeons were recommended to use the Maisonneuve technique and A.W.’s article details this procedure:

  • ‘Shave or oil the skin.  Make a paper pattern of the area to be covered and cut to it two thicknesses of Canton flannel or old muslin, devising windows if wounds are present; the sides of the flannel should remain about one inch apart when in position.  Sprinkle plaster into equal quantity of water to a creamy consistence.  Immerse cloth till thoroughly saturated, lay it on a flat surface and smooth with hand.  Apply flannel to limb and put snugly over it a roller bandage.  The limb is then held for a few minutes, extension being made if necessary until the plaster sets, when the roller bandage is removed.  If it is necessary to delay the “setting” of the plaster this maybe achieved by adding a small quantity of carpenters’ glue.’

S.W. goes on to discuss the importance role that the use of plaster splints played in improving survival rates of Civil War soldiers:

  • ‘..a patient with a much swollen elbow-joint wounded at the Battle of Cross-Keys.  The joint had been entered by a round bullet, which was removed two weeks later, when free incisions around the joint were found to be necessary.  At this stage a plaster splint was applied to the anterior surface of the arm and retained by a transverse band above the wrist and another at the middle of the humerus, the arm being flexed.  This splint was worn for a month and then renewed.  The head of the radius came away and the patient recovered with some degree of motion in the joint.  Dr Swan employed the plaster splints in several cases of fracture after the seven days’ fighting before Richmond, during M’Clellan’s campaign, and the patients were comfortable transported to Washington.’

I hope that you have found the above interesting.  I will post further on this topic in the future.  For further resources please see my previous posting.

Posted in American Civil War, American Civil War Medicine, History, History of Medicine

American Civil War Medicine – Part 1 – Field Medicine

US Medical Company (Union Regiment), Southern Skirmish Association (So.Sk.An).

‘The Northern men are not only of stronger bone and muscle than the men of the South, but a very large proportion of them are mechanics and agriculturists, who are inured to labour and fatigue; whereas few, or none of the Southern men have been brought-up to bodily exertion or fatigue.’

(Extract from a ‘Letter from New York’, by J. Outram, dated 23rd April 1861 and published in The Glasgow Herald, Tuesday 7th May 1861)

One of several research projects I am working on at present is a study of the career of Dr Mary Edwards Walker (1832-1919), a female Surgeon in The American Civil War.   During the course of my research I have become increasingly interested in the broader topic of American Civil War medicine, so I thought I would share with you a few basic details of this incredibly interesting subject.

The American Civil began at Fort Sumter in South Carolina on April 12th 1861 and ended on 9th April 1865, with the final shot being fired on 22nd June.  The Surgeons and Assistant Surgeons in the US Medical Army faced a daily struggle on the battlefield to keep their soldiers alive.  There has been much written about the manner in which Surgeons often ‘mangled to death’ the wounded soldiers,  earning them the less than flattering nickname of ‘Sawbones’.  Although this did happen in certain cases, it is pretty much a distortion of the truth.  The Surgeons were highly skilled and found themselves working in unimaginable conditions on the battlefield with limited resources.  The growing number of casualties simply overwhelmed a lot of the Surgeons and facilities in the field hospitals were pretty rudimentary.   Knowledge of germ theory was not yet fully developed and it wasn’t until after the Civil War had ended that the germ theory of disease was discovered by Louis Pasteur.   Then in 1867 Joseph Lister proved his theory on the importance of aseptic surgery.   If more had been known about these two important discoveries at the time of the American Civil War, then many, many thousands of lives could have been saved. The Surgeons were simply unaware that holding bloody instruments in their unwashed hands and performing amputations on one soldier then wiping the blood off onto their apron and gown before moving on to the next procedure, was the cause of cross-contamination and infection.   However, even with the advent of aseptic surgery, physicians simply sprayed an antiseptic solution in the operating room prior to procedure believing this would kill all germs.  Many Surgeons still carried on performing operations with dirty aprons and unsterilised instruments, a practice that continued in many places  throughout the rest of the nineteenth century.

Surgeon’s on both sides in the American Civil War faced a daily battle with disease, the silent but deadly ‘third army’.   Approximately two thirds (63%) of fatalities among Union troops were from disease rather than  battle wounds.  Surgeon General William A. Hammond of the Union Medical Corps kept excellent records and his statistics support this fact.  In J. Outram’s ‘Letter from New York’, an extract of which is quoted above, he states that soldiers from the North were likely to be physically stronger than the ones from the South.  Medically speaking the statistics blow Outram’s theory clear out of the water.  Physical strength may equate to a  developed immune system but if you are living and fighting in insanitary conditions you are just as susceptible to disease as any soldier would be whether from the North or the South.  Soldiers often urinated and defecated near to the water source and would then bathe or drink from the same source, unaware of the implication of their actions.

Scurvy was also common due to the Scorbutic effect of a limited diet.  The solder’s daily ration consisted of salt pork which was often rancid, stale crackers (hardtack) and coffee.   Typhus infection and lack of sleep affected a majority of soldiers at some point too.  The nights were often freezing and to keep themselves warm the soldiers would sleep with all of their changes of clothes on and as you might imagine body lice was very common.

Malaria was rife in the South and hospital staff tried everything to control its spread.  One method involved placing heated irons into bowls of vinegar in the hope that the vapours would deter the lethal, ‘Anopheles’ mosquito.  Emetics were readily prescribed to cure diarrhea, dysentery and jaundice, a popular prescription was simply warm water and honey.   Not all prescribing was so mild, blue mass (a mix of mercury, honey and licorice)  lead acetate and silver nitrate were also  popular remedies.  Blue mass was extremely dangerous and resulted in mercurial gangrene, tooth loss and gum damage.   The South suffered quite a bit with shortages of medical supplies due to the Union naval blockade.  Desperate for ligatures for sewing-up wounds, one Southern doctor improvised by using the hair from a horse’s tail which was softened by boiling it in water.  Statistics detailing cause of death amongst soldiers of the Confederacy are much trickier to come by.   Many of the Surgeon General’s office records were destroyed during the burning of Richmond at the end of the War.

American Civil War medical instruments owned by members of the UK Re-enactment Group So.Sk.An.

Further Resources

There are too many books and resources on this topic to list them all here.  However, here are a selection that you may find useful if you wish to read further on this topic:-

The UK based Re-enactment Group,  The Southern Skirmish Association (So.Sk.An), have a US Medical Company in their Union Regiment.

The National Museum of Civil War Medicine in Frederick, Maryland, USA.

Alfred Jay Bollet M.D., (2001) Civil War Medicine: Challenges and Triumphs (Galen Press)

H. H. Cunningham, (1993), Doctors in Gray: The Confederate Medical Service (Baton Rouge: Louisiana State University Press)

George Worthington Adams, (1996), Doctors in Blue: The Medical History of the Union Army in the Civil War (Baton Rouge: Louisiana State University Press)