Civil War Medicine
by Janet King, RN, BSN, CCRN.
IV. From the Battlefield to the Hospital:Care of the Soldier After Wounding
"I felt a terrible blow on the left side, as though someone had struck me with a club and I was knocked half way round. I leaned upon my musket for support but soon became insensible and fell. When I regained consciousness a comrade was leaning over me..." Andrew Roy, Pvt, 10th Pennsylvania Reserves, at Gaines Mill, VA 1862.
"There was a sharp electric pain in the lower part of the body - then a sinking sensation of the earth - and falling, all things growing dark. The one and last idea passing through the mind was 'This is the last of earth' " W.C. Ward, Pvt, 4th Alabama, Gettysburg, PA 1863
Minie balls, artillery shells, and sabers showed no partiality for soldiers of specific states. The effects of wounds and the suffering of the men who received them were the same for Vermonters as for these men from Pennsylvania and Alabama. Their descriptions illustrate what the soldiers felt at the time of their wounding. For the wounded the suffering was only beginning. They had yet to endure transport from the battlefield to a more rear-ward position, and often the agonies of surgery and a long convalescence. For some the journey would end after months of hospitalization, and for some it would end in death.
In this section we shall follow the wounded soldier from the battlefield and transportation to a field or evacuation hospital. We will also look at Vermonters who experienced and helped treat battlefield injuries.
**My sincere thanks to Gerry Chittick - great, great granddaughter of Surgeon Melvin John Hyde, 2nd Vermont Volunteers - who contributed his letter, which is included in this section.
On the Battlefield
What became of the soldier after he was wounded? If he were fortunate and not too badly injured he might make it to the rear of his regiment and seek help from the medical attendants on his own. If he could not make it to the rear a "buddy" might be able to assist him. At times such help was impossible. Andrew Roy found himself between his regiment's line and the oncoming Confederate troops. "For a few minutes I was lying between the two lines under a terrific fire from both sides. The Rebels were farthest from me and their balls that fell short sometimes threw the dirt over my clothes. I expected to be shot again every moment and was badly frightened." Roy was fortunate in that stretcher bearers bore him to an ambulance and a field hospital in the rear. Not all soldiers were this fortunate, especially in the first two years of the war.
The Ambulance Corps
At the beginning of the Civil War organization of all aspects of the Medical Corps was sadly lacking. The newly commissioned regimental surgeons were not familiar with their duties. They did not yet know how to requisition medical supplies or get men assigned from the ranks to help them with medical duties. The Medical Corps's directors were unprepared and the entire system was in need of reform. No provision had been made for the training of hospital attendants, the Army command believing that wounded soldiers could take care of other wounded soldiers. There were no ambulance personnel and few ambulances. The medical director of each division had authority..."after consultation with the Quartermaster General to dispose his men for battle and set up a field hospital." The medical director only controlled the medical officers, hospital stewards and nurses under his command. He had no control over the ambulances or their crews, which belonged under the control of the Quartermaster Dept. In addition, there were at times conflicts between line officers of a unit and the medical officers. Some medical men were denied requests for details of men to act as nurses and perform other hospital duties, and some suffered the frustration of having ambulance horses requisitioned as cavalry remounts or the ambulances themselves used as vehicles for general officers or for other uses.
At the start of the war the Quartermaster Dept. hired teamsters to drive the ambulances. These ambulances were either two or four wheeled devices. Each regiment would be assigned a certain number of these vehicles. Stretcher bearers consisted of bandsmen: regimental musicians and hospital details: 10 men form the ranks of each regiment.
At first, almost everyone was ill-trained and inexperienced. There were not enough ambulances and problems arose with what was available. Vehicles broke down, or were found to be ill-suited for transporting the wounded. The 2-wheel ambulance at first thought best for the transport of severely wounded soldiers, proved to be the exact opposite and itĄ Ąs bumpy, bone-jarring rides left many men who had broken bones and torn extremities with worse fractures and increased bleeding and pain. Teamsters, believing their pay did not include being fired at or killed, took off - leaving wounded men stranded.
An assistant surgeon describing the chaos of evacuating the wounded at Seven Pines (Fair Oaks), stated: "The bands of the various regiments proved utterly worthless in bringing off the wounded, behaving with the utmost cowardice, and required more persons to watch and see that they did their duty than their services were worth. As a natural consequence of this, when ever a man fell out of the ranks wounded four and sometimes six of his comrades would fall out for the purpose of carrying him away, thus seriously depleting the ranks and affording opportunity to the skulkers and cowards to sneak away."
By the fall of 1862 reforms were underway. Spearheaded by Medical Director of the Army of the Potomac - Dr. Jonathan Letterman, and supported by Surgeon-General William A. Hammond - an effective system of battlefield evacuation was established. It would take time, much "red tape" and literally an act of Congress, but in March 1864 a uniform ambulance system was adopted throughout the Union Army. This plan - known as the Letterman Plan for Field Evacuation - became a model of it's kind. Indeed the principles it outlines are still used by the military today, and civilians involved in "disaster preparedness" will recognize it's principles of triage and transport.
Letterman Plan for Field Evacuation
(From: United States Army Medical Department: A Summary by Andrew H. Rowden (Captain, U.S. Army Medical Department)
Members of the Regimental Band, other musicians, and assigned litter bearers "removed wounded from the front lines to a Battalion Field Aid Station or Collection Station". This station was marked by a red flag and was staffed by an Assistant Surgeon; a Hospital Steward and any other assigned privates.
Battalion Field Aid Station:
Directly behind the front lines and staffed by an Assistant Surgeon, Hospital Steward, and other assigned male personnel. "The chief functions of a Battalion Field Aid Station were to stop bleeding, relieve pain, reduce fractures and dislocations, and stabilize the wounded for evacuation to the Field Hospital."
A Field Hospital was established 3-5 miles behind the lines and safe from any artillery fire. They were staffed by a Surgeon, Assistant Surgeon, additional Hospital Stewards and other assigned male personnel. For larger organizational levels i.e. Brigade or Division Field Hospitals - there would be a Surgeon-in-Charge of the Hospital; and Assistant Surgeon in charge of adjutant duties; an Assistant Surgeon in charge of commissary and quartermaster duties; three surgeons with three assistant surgeons, a chief Hospital Steward; additional medical officers and Hospital Stewards, and other assigned enlisted personnel. "The chief function of the field hospital was to perform emergency surgery and to prepare the wounded for further evacuation."
These were usually established at a rail head, river front, or harbor. Essentially an Evacuation Hospital's function was to perform further surgery and allow recuperation of the wounded before their being sent back to the home front. Recovering soldiers from slight wounds or illness usually rejoined their units from this point. Soldiers needing further convalescence or surgery were sent to the General Hospital.
A General Hospital could be found near a major city. It's purpose was for the recovery of the wounded or performing further surgery that was needed. A soldier was either returned to his unit or was discharged from this point.
Letterman Plan In Action:
At the Battle of Fredericksburg the Letterman Plan received it's first full trial. The wounded were removed more rapidly than ever before by teams of stretcher bearers who had been trained and drilled in this task. These men comprised "division ambulance trains" commanded by a 1rst Lt. and assisted by a 2nd Lt. for each brigade. Each regiment would be assigned one sergeant and 3 privates per ambulance (1 to 3 ambulances were detailed for each regiment), and one private per wagon. In addition, the regiment would be assigned - as part of the brigade - a medicine wagon and 2 or more supply wagons. No longer were non-medical officers in charge of medical wagons or ambulances. These were now under the control of the Surgeon in Chief of the Division, and ultimately the Surgeon-General.
Eye-Witness Accounts: May 1864
A young New Englander - Lt. Barton - of the 51rst Massachusetts, was an officer in the Ambulance Corps in the spring of 1864. Barton's duties included evacuating troops from the battle of the Wilderness on May 4, to Evacuation Hospitals located in Fredericksburg,Virginia. His ambulance trains made numerous round trips along roads crowded with men and the equipment of an Army - from the field hospitals and back to the Evacuation Hospitals. "The field hospitals had been overflowing with bloody, shot up soldiers," and his own crew never seemed to make an impact on the numbers. Describing the scene within Fredericksburg, Captain Anderson - of the 57th Massachusetts - stated, "Here every church in the city was a hospital and every one was full, while all around outside lay wounded men ready to take the places of those who were dying within or being removed to Washington, Alexandria and Baltimore..."
Some 7,000 wounded men were brought to Fredericksburg following the Battle of the Wilderness and only 40 surgeons were available initially, to help them. It took some 24 hours just for the ambulances to get through the clogged roads and bring the wounded soldiers in. Surgeon George Stevens of the 77th New York wrote of the carnage, "We were almost worked to death..I see so many grand men dropping one by one. They are acquaintances and friends. They look to me for help, and I have to turn away heartsick at my want of ability to relieve their sufferings...Oh! Can I ever write anything beside these mournful details? Hundreds of ambulances are coming into town now, and it is almost midnight - so they come every night."
Fellow Surgeon - Melvin John Hyde, native of Isle LaMotte, Vermont - and surgeon of the 2nd Regiment Vermont Volunteers, voiced similar experiences in a letter dated May 18,1864 to his step daughter.
I received yours of May 2nd this evening also your mother's of April 26th. I made my clerk write you the other day. I was so busy that I had no time myself. O Alice we have had one of the most bloody battles this world ever saw lasting several days.
We left camp on the morning I told you we should in my last letter. It was on the 4th and 5th we had a terrible battle. Our Col. Stone of my regiment was shot dead and our Lt.Col, Tyler was shot through the thigh, and nearly all the captains and lieutenants of our regiment were killed, mortally wounded or very seriously wounded. The officers of the 3rd, 4th, 5th, and 6th Vermont were also many of them severely wounded and some killed. The soldiers were cut down by hundreds. Our Brigade numbering 4000 men when it left camp, now numbers about 700! Our Regiment alone numbered nearly 1000 when it went into the fight and now it numbers 140! We had to fight them in the woods the first day. I went with my regiment till it made the charge with the rest of the Brigade, and then was ordered back to the field division hospital where I had to operate all that day and nearly all night. We put up 30 large hospital tents, which were crowded with the wounded while 1500 men lay on the ground around suffering the most heart-rending cries of agony. We numbered but 5 or 6 surgeons and it took us about 3 days to attend them and then many had to be moved in army wagons and ambulances without having their wounds dressed at all! All this time the ambulances continued to bring in the wounded of our Division and the cannonading and musketry was almost deafening. O, it was terrible to hear the poor fellows cry for water or in piteous tones cry out to any surgeon that chanced to pass near him for help. The third night we left this place and moved on about 9 miles and established our hospital on the "Old Chancellorsville" battleground, called Cherry Grove, 3 miles from Chancellorsville. We stayed here one day and a night with about 200 wounded on our hands and Dr. Allen, the Division Director, detailed me to furnish food and shelter for the wounded of the whole division - besides having to perform operations. In the night all our wounded but 300 were sent on to Fredericksburg and all the surgeons were sent on with them but I refused to go, declaring that I would never leave 300 wounded men behind without food or medical aid, to perish, for there were many Vermonters among them. I accordingly remained and rode all night around the field to keep straggling horsemen from trampling on the wounded who lay all over the field without shelter or even a blanket. In the morning I cooked them some coffee which had been left with me for the them and passed it around with some hard tack. I then detailed some of the stragglers to carry 33 of them on stretchers to a house about a quarter of a mile off, as the poor fellows lay with the hot sun streaming into their faces, many of them half naked, their clothes having been torn off to dress their wounds which were now covered with matter and smelled horribly. At this moment about noon some army wagons were sent back for them but could not carry all, about 40 still remaining, including 13 Vermonters. With these I resolved to stay and starve if necessary. Just then General Grant of our Brigade passed in the rear of the 6th Corps and I begged a beef of him which I butchered and kept the men alive 4 days on beef tea. The first day that I was here I sent my man on to Spotsylvania with my two horses. At the same time, the 6th Corps passed, which was the rear of our army. They had not been gone four hours when [Confederate] Gen. Stewar's [ J.E.B. Stuart(?)] Cavalry came along and took me and my wounded prisoners. They did not disturb my hospital - on the contrary they acted like gentleman. They surrounded my hospital and the woods about 50 rods off was full of them. They took many stragglers near my hospital prisoners - pointed revolvers at their heads and robbed them of everything. After I had been a prisoner four days Gen. Stewart [Stuart?] said he would parole me and all my wounded, but fortunately before he could do it, during the night the army [US] Director came for us with a flag of truce and a strong cavalry escort. The rebs happened to be out of sight searching for plunder at this time so we got off all right with our ambulances to Fredericksburg. The Director made a great spread about it."
Eye-Witness Accounts: September 1864
Private Wilbur Fisk of Co. E, 2nd VT, wrote of his experiences following the Battle of Winchester in the Shenandoah Valley to the Montpelier newspaper, the Green Mountain Freeman.
Wed. Sept. 21
"....[D]own by the creek where the train stopped, they put up the division hospitals for our corps. Ambulance loads of wounded men were continually coming in, and the surgeons had all they could attend to, and more too. Wounds of every description; some in the head, some in the body, some in the hands, arms, legs or feet were constantly being brought forward for attention. It was impossible to attend them all at once, and many had to wait and suffer a long time with their savage wounds undressed. Amputations at several tables were being made all the time. As fast as one man was removed from the board another was put on. Many poor fellows had to wait for several hours before their turn came. The surgeons, besmeared with blood, and hardened to their business, looked more like butchers cutting up beef than like professional men, adopting the stern alternative of removing a limb to save the life of a fellow man. A hospital on the battlefield always presents a horrid ghastly sight...
"Among those brought in were several of my own comrades. One man struck in the thigh with a piece of shell, which broke his leg, and bruised it badly, was brought in around noon, and it was not till night that any attention was paid to his wounds, except what we could do ourselves. It was not till night that he had any shelter either, and then it was only a fly tent overhead - a roof without walls. But it was the best they could do and it is not always at such times that they can do as well as that. It was a chilly night, and the men, many of whom had to have their clothing cut from wounds, leaving them in some instances half naked, had but one blanket for two men. I remember I promised to bring my friend a rubber blanket from the train, but the train moved along, and I could not do as I had promised. Yesterday I suppose he, with the rest of the wounded, were removed to a general hospital. It will be a tedious and painful journey over the rough roads for the men with such wounds as his, but I know my friend is a brave man, as indeed they all are, and I know that bodily pain cannot crush his spirit."
"Right by the side of the tent where my friend lay was another soldier, mortally wounded, and left there to die. I couldn't help noticing him in particular, though I never had seen him before. Fair looking and intelligent, too young and too tenderly reared, one would think, to endure the hardships of a soldier's life. Alas, he did not have long to suffer. He was wounded in the head, and died that night. I first noticed him a little past noon. He could not speak, but he appeared conscious. A fellow from his company asked him if he knew him. He signified by a pressure of the hand, that he did. I saw him again at night, he was dying then. Oh what would a brother or sister have given to have been with him then - to have called his name and received back a pressure of recognition? What would his mother give now to drop a tear by his rude grave - a sacred spot that she may never be able to find? And thus have perished thousands since this war began. Verily war is cruel, and none more terribly so than this which the rebellion has forced upon us. God forgive those who started it, they knew not what they did."
[Excerpt from: Hard Marching Every Day: The Civil War Letters of Private Wilbur Fisk, 1861©1865, edited by Emil & Ruth Rosenblatt,, University Press of Kansas, 1992 ]
Following care at the field or evacuation hospital the soldier would be transported to a general hospital. At the general hospital the wounded soldier would begin another, longer journey. A hospital stay of less than 6 weeks was considered rare. For most soldiers- for example those with amputations, or chronic debilitating illness - such as dysentery - the stay could be months or even a year.
In the next section - In The Hospital: General Hospitals In Vermont and Elsewhere, we will look at a day in the lives of the patients, doctors, nurses, and visitors associated with the general hospital. We will explore the duties of the doctors, nurses, stewards and see how the State of Vermont contributed to the care of it's wounded. Volunteer organizations, such as the Sanitary Commission, will also be examined.
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