Battle Field Angels (5 page)

Surgeons sometimes removed the damaged portion of a leg or arm bone if it was short enough so that the remaining undamaged stubs could fuse together. For example, a surgeon would cut open the length of a forearm, exposing the shattered bone. He then threaded a flexible chainsaw under one end of the bone and pulled back and forth, cutting through. He repeated the procedure at the other end of the damaged bone. Once the shattered pieces were removed, the wound was sutured shut and the limb placed in a splint. If the excision had taken place in a leg and the soldier survived, he would need a modified shoe to accommodate his shortened leg. Many soldiers were left with an upper arm or forearm with no internal support when the bones failed to grow together, a limp appendage that hung useless at their side.

Surgery introduced a second enemy to the Civil War wounded: infection. Almost nothing about surgery was antiseptic. The fact that germs caused infection became known only toward the end of the Civil War, too late to help the estimated five hundred thousand men wounded during four years of fighting. Some surgeons sharpened scalpels on the heel of their boots. Sponges were dipped in a bucket of water hauled from a nearby creek and squeezed damp between operations. In the chaos of combat, cleanliness was considered more of a luxury than a necessary medical protocol.

Shortages forced surgeons to use cotton, silk, and even horsehair for sutures, and they often licked the frayed end before threading a needle. If the operation was an amputation, a flap of skin was folded over the stump of an arm or leg and sutured shut, save for a small drainage hole. Almost every phase of a Civil War operation introduced bacteria into a prematurely sealed wound.

Within a day or two, pus began flowing from the wound, which was thought to be a good sign by doctors who failed to recognize it as a potentially deadly infection. Then, by about the fourth day, the wound dried out, the flow of pus ceased, and a raging fever gripped the patient. Typically he was dead four days after the onset of infection. It might have been blood poisoning, which was 90 percent fatal. Or, it could have been hospital gangrene. Thousands of Civil War deaths were protracted and gruesome.

Military hospitalization proved nearly as lethal as battle. Families near Washington, D.C., often took their sons out of understaffed and poorly equipped military hospitals to care for them at home. Although many Washington hospitals had mosquito netting, sanitation was so bad that patients’ unburied excrement and neglected bedpans spawned hordes of flies. Typhoid, dysentery, and malarial outbreaks were frequent. The hospital diet weakened patients further. Men wounded in battle were fed cornmeal and hardtack fried in pork grease. The quality of care wasn’t much better. Walt Whitman spent time in Union hospitals and noted that one patient died from an overdose of opium and another succumbed when a wardmaster gave him lead muriate of ammonia, which was supposed to be a foot wash.

Even the wounded with relatively slight wounds might not recover, given their weakened condition when they went into battle. Soldiers in the Civil War faced widespread disease, ignored basic hygiene, and often were malnourished. Civil War recruits typically did not receive thorough examinations by doctors when they joined the military. As in past wars fought by Americans, many soldiers came from extremely isolated areas and had not developed immunity to otherwise common childhood diseases. Those in poor health quickly became ineffective soldiers.

When soldiers fell ill, Civil War doctors were practically unarmed in their fight against epidemics. Ignorant of the organic cause of disease, they treated symptoms with little effect. Quinine, strychnine, and oil of turpentine were prescribed for many of the 1.6 million cases of diarrhea and dysentery in the Union army. Typhoid epidemics raged unabated. Doctors could only control malaria as long as they had adequate supplies of quinine. During the Civil War, disease killed twice as many men as the enemy.

The North’s blockade of the South not only prevented munitions from getting through, it also strangled the flow of medical supplies. Confederate doctors relied on ingenuity and holistic medicine. An enterprising surgeon could use a knitting needle as a tenaculum. A pen knife became a scalpel. Eating utensils had a variety of surgical uses, and green tree bark could be used as a tourniquet. A tea made from spicewood was given to malaria and diarrhea patients. Soldiers ate wild onions, mustard, sassafras, and pokeweed, which prevented scurvy. Fresh pennyroyal leaves placed under a soldier’s bed warded off fleas.

Gradually over the course of the war, doctors identified a correlation between epidemics and the horrific and unsanitary overcrowding of army camps. A sanitary commission established in 1862 issued regulations to improve hygiene. Soldiers were ordered to dig and use open-trench latrines away from tents and eating areas. Shallow wells believed to be contaminated were avoided. Soldiers were instructed to drink water from the center of a stream, not from a stagnant pool. However, many of the regulations were ignored by officers on the front line, and the men suffered for it. Vermin, black clouds of flies, and other insects plagued overcrowded and filthy military camps.

The battlefield diet also contributed to a weakened soldier’s susceptibility to disease. Although it improved later in the war, at Bull Run a typical soldier subsisted on fresh or preserved meat, salt pork, navy beans, coffee, hardtack, and thick crackers frequently infested with weevils. Each man filled his haversack with three days’ supply. Army cooks often undercooked and fried most food. It was a diet very low in vitamins. The resulting scurvy was poorly understood and misdiagnosed by many doctors. Some believed that scurvy resulted from poor ventilation, a lack of exercise, and boredom, among other factors.

Many who survived battle with both the enemy and disease ailed long after the end of the Civil War. One study showed veterans suffered from diarrhea and dysentery at fifty-six times the rate found in the civilian population.
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Heart and circulation problems occurred six times more frequently, and rheumatism developed five times more often than among nonveterans. Untold Civil War survivors suffered for years after America’s battlefields fell silent.

Sullivan Ballou was not among them. His leg had been amputated only a few hours after reaching Sudley Church in the early hours of the Battle of Bull Run. Dozens of amputations had taken place before the Confederates took control of Sudley Church late on July 21. They moved the surgeons and surgeon’s mates to a Confederate prisoner of war camp. The next day they were returned to Sudley to care for Ballou and the others. Every day the surgeons and their assistants made their rounds, checking on the oozing wounds left by hasty amputations. They removed soaked dressings, rinsed them in dirty water, and reapplied them to wounds reeking of rot. Medical supplies were soon exhausted. The smell of dead and infected flesh mixed with the stifling humidity and hung in the air, even though the few windows still intact had been opened.

Then the fevers began as infections took root. Swift and the medical team at Sudley found themselves powerless as dozens of soldiers grew delirious with fever. They had had no time to meticulously clean wounds or search for bits of skin and clothing that Minié balls had driven deep into legs and arms. They were unable to thoroughly cut away the destroyed and dead flesh to give the body a chance to grow new tissue. Now they could only watch patient after patient grow weaker with each passing hour. After suffering for more than a week, Sullivan Ballou died of his wounds on July 29, 1861, eight days after the Battle of Bull Run. He was buried near the church. Nearly a year later, when Union troops returned to Sudley, they discovered his body had been exhumed, decapitated, and burned, presumably by Confederate soldiers. They took his remains back to Rhode Island for a permanent burial ceremony that became a citywide celebration of Rhode Island’s dead war heroes.

On August 13, 1861, surgeon Foster Swift and the other surgeons and surgeon’s mates were released by the Confederates. By that time, Bull Run already had become famous as the first major land battle of the Civil War and one which had ended as a rousing Confederate victory. More than one thousand eight hundred Union soldiers had been wounded, killed, or presumably captured. The Confederates suffered slightly more casualties. The Union and Confederacy would clash again at Bull Run thirteen months later.

By then, Ballou’s wife had received her dead husband’s trunk. In it was a letter he had written only a few days before Bull Run. “Sarah, never forget how much I love you,” part of it read:

Sarah was twenty-four when Ballou died. She never remarried and died fifty-six years later at the age of eighty. She was buried beside her husband. Ballou was one of more than six hundred thousand Americans killed in the Civil War, a mortality rate of about 25 percent. Thousands of survivors were disfigured for life. An estimated sixty thousand amputations took place with a similar 25 percent mortality rate. Yet disease was an even more pervasive killer. It was responsible for approximately 60 percent of Union deaths and 65 percent of Confederate deaths.

Despite these gruesome statistics, the Civil War prompted the first significant era of military medical science progress in America. More than 3 million Americans killing and maiming each other led to the recognition that the medical corps had to play a much larger role. Soldiers could not be expected to fight to the edge of death in the absence of a reasonably staffed medical corps comprised of qualified professionals supplied with the equipment and materials necessary to save as many of their lives as possible. A cornerstone of any army’s morale is its perception of how soldiers will be cared for when they fall. The Civil War crystallized the need for a permanent American military commitment to military medicine.

Perhaps the greatest medical innovator of the Civil War was Dr. Jonathan Letterman, who became widely recognized as a pioneer of combat medicine. The horror of the abandonment of so many wounded at Bull Run in part led him to create a battlefield evacuation system using stretchers and specially designed carriages. He established a formal ambulance corps and ordered distinct uniforms and insignia. Letterman made sure the ambulance corps was positioned at the front of the battle, ready to pick up the wounded with its customized horse-drawn carriages as quickly as possible.

After a battle at Fredericksburg in December 1862, Letterman’s ambulance corps located and processed all ten thousand wounded Union soldiers within twelve hours of battle’s end. After the three-day battle at Gettysburg in 1863, more than fourteen thousand injured Union soldiers were processed by the ambulance corps within one day after the firing ceased. That was a far cry from early in the war when men were left to die on the battlefield.

Letterman also critically assessed the chain of battlefield care. He validated the concept of frontline aid stations that focused on stopping bleeding, bandaging wounds, and treating for pain. A progressive continuum of care, from emergency treatment on the battlefield toward more definitive care in the rear, ultimately became one of the Civil War’s most enduring contributions to military medicine. As a result, hospital care improved throughout the war. At the Battle of Antietam in 1862, more than 20 percent of the eight thousand wounded died after reaching a military hospital. Eight months later at Gettysburg, less than 10 percent of the ten thousand wounded died in the hospital.

Four years of war spawned other advances in military medicine that would benefit civilian healthcare in the future. The development of the pavilion-style hospital markedly reduced the spread of disease. It became the basis for hospital design for the next seventy-five years. Tens of thousands of battlefield surgeries also led to trauma-care advances. For the first time, anesthesia was used on a widespread basis as surgeons honed amputation techniques, improved the use of splints, and discovered the value of cleaning wounds and removing dead tissue. Other advances produced far-reaching ramifications. Female nurses joined the military medical corps for the first time. Brutal facial disfigurement led to the emergence of plastic surgery as a specialty.

Both the Confederate and Union military medical corps experimented with specialized hospitals, including psychiatric, venereal disease, and neurological facilities. Thousands of psychologically unstable Civil War veterans led physicians to conclude that individuals could become debilitated from emotional stress on the battlefield. Doctors called it “nostalgia,” and symptoms included excessive physical fatigue, poor concentration, a refusal to eat or drink leading to anorexia, and a pervasive sense of isolation. Left untreated, nostalgia could progress to insanity and even become fatal. Nearly ten thousand cases of nostalgia were diagnosed during the Civil War. St. Elizabeth’s Hospital in Washington, D.C., built in 1855 for mentally ill patients, became the first facility used for combat psychiatric cases, but its bed capacity paled in comparison with the need. Many psychiatric patients were promptly discharged from the Army during the war, left to fend for themselves in the absence of adequate comprehensive military mental healthcare. Regrettably, the Army closed the psychiatric hospital at war’s end, and no books or articles were published on the effects of war on the mind.

A half-century would pass before a new generation of American warriors would return to the battlefield in “the war to end all wars.”