THE LIKELIHOOD OF death or disfigurement on the battlefield was remote from the minds of the men of 1861 as they marched away. It became an all too urgent reality once the first shots were exchanged. The first battle of Bull Run left a thousand wounded on the field. By 1862 Union regiments were becoming accustomed to casualties of 30 percent in any engagement, of which the majority would survive to enter hospital. As quickly as Civil War soldiers learnt of the probabilities of death and wounding in action, however, they learnt to avoid, as far as possible, treatment by the regimental doctors, who acquired a reputation early on for incompetence and laziness. It was not understated; the staff of the pre-war medical department was ill-trained, rule-bound, and rarely abreast of modern methods. They were also poorly supplied with drugs or equipment. The first hospitals were improvised, often simply a few tents pitched on the outskirts of camp, attended by untrained men who acquired the reputation of shirkers.
Descriptions of the interiors of hospitals are among the most common pieces of reportage in Civil War writing, as are expressions of disgust at what was seen. The Union army had entered the war with entirely inadequate medical resources. The senior medical officer was eighty years old and his knowledge of medical practice of equal antiquity. The U.S. Medical Service possessed only twenty thermometers and lacked almost all other medical equipment. Surgeons were posted to regiments on a scale of one per unit, with an assistant surgeon as the only other trained man. In the field they took charge of the regimental musicians, who acted as litter-bearers. They were quite without medical training and earned a reputation as rough, incompetent, and often uncaring. There were at first no specialised ambulances to transport the wounded, who were jolted over rough ground to hospital on military wagons or requisitioned farm carts. The delay in evacuating the wounded was often extreme. After the second battle of Bull Run, 3,000 wounded still lay where they had fallen three days after the fighting ceased; 600 were found still alive five days after the battle. It was a week before the last survivors were got to hospital in Washington. It was often preferable to remain in a barn or private house, as many did, than to be taken to hospital, which were frequently sinks of infection, dirty, untidy, and overrun with parasites. Most soldiers were infected with lice but, while fit, were able to make some effort to rid themselves of the creepy-crawlies. In hospital they were dependent on others to delouse them, a duty not often undertaken. Many soldiers were brought in with their wounds crawling with maggots, stinking, and all too often gangrenous. Because of the prevalence of gangrene, amputation was the preferred surgical procedure. Many eyewitnesses recorded the sight of piles of severed arms and legs outside, and sometimes inside, hospitals. The frequency of amputation led soldiers to dread being taken to hospital, even though, surprisingly, anaesthesia, with chloroform or ether, was commonly available in Union hospitals. As the war progressed, its use grew rarer in the South, where the blockade cut off the supply of many essential medical stores.
As is commonly said, the Civil War occurred at a point of transition in scientific development, so that the armies had the use of some weapons of the future, such as breech-loading rifles, but, not others, such as machine guns. Military medicine was also very much at a point of transition. Doctors could administer anaesthetics, but they did not yet understand the germ theory of infection and so did not practice antisepsis. Surgeons commonly operated in old clothes stiff with blood or pus, dressing wounds with torn-up rags when bandages were not available, and they did not clean, let alone sterilise, their instruments and did not keep wards or operating theatres free of disease-carrying insects. Blood transfusion was unknown, as was blood-typing, and they would remain so until the end of the First World War. In the circumstances it was remarkable that as many wounded survived as did, given the nature of wounds suffered. The minié ball, fired from the Springfield and Enfield rifles—the main cause of wounds—was a conical lump of lead the size of a man’s upper thumb joint and weighing two ounces. It penetrated the human body with ease, producing a comparatively benign injury unless it hit a blood vessel, but it frequently hit bone, which it tended to shatter, often a cause of amputation. Even worse was the wound caused by a fragment of artillery shell, which could remove a foot or hand or smash the ribcage. Worst of all was round shot, which could decapitate. A direct hit from a cannonball almost always meant death. Seneca Thrall, the surgeon of the 13th Iowa Infantry, wrote to his wife, “I have been hard at work today dressing wounds. The unutterable horrors of war most manifest in a hospital, two weeks after a battle, is terrible. It required all my will to enable me to properly dress some of the foul, suppurating, erysipelatous fractured limbs.” Another letter to a wife, by the surgeon of a Kentucky regiment after the battle of Kennesaw Mountain in 1864, described how the wounded who had been out all day in the hot sun were covered with maggots by the time they were brought in. “You may well suppose that their suffering was immense, such as arms shot off—legs shot off. Eyes shot out—brains shot out. Lungs shot through and in a word everything shot to pieces and totally ruined for all after life. The horrors of this war can never be half told. Citizens at home can never know one fourth part of the misery brought about by this terrible rebellion.”1
During 1862 the North urgently put in hand an effort to improve the quality of medical care offered to the wounded. As with other Civil War developments, the battle of Antietam, with its huge casualty list, was the spur. The decisive step had been the appointment in April 1862 of a new director of medical services, William Hammond. Young, energetic, and well educated, Hammond was supported by a voluntary organisation, the United States Sanitary Commission, which became a power in the land. Under the executive secretaryship of the formidable Frederick Law Olmsted, it coordinated the activities of thousands of civilian volunteers, collected medical supplies of all sorts, recruited several thousand nurses, and provided welfare facilities for soldiers, both sick and healthy, all over the Northern states. The Sanitary, as it was known, also acted as a pressure group, prodding Congress and the Union army into the provision of better care for the sick and wounded. There was similar voluntary effort in the South, where a Richmond lady, Sally Tompkins, set up a hospital on her own account and was commissioned a Confederate captain, so valued were her services by President Davis.
William Hammond was responsible for widespread reform and for choosing able men to fill surgical and medical appointments throughout the Union army, among whom was a contemporary, Dr. Jonathan Letterman, appointed chief of medical services in the Army of the Potomac. Letterman expanded and reorganised the ambulance corps. The first results were seen after Antietam, when the wounded were moved from the battlefields according to a rational and disciplined schedule. Letterman also introduced carefully designed and prefabricated hospitals, the Letterman hospital, which was to remain in use up to the First World War. Modelled on the wooden “balloon” house then springing up in all American industrial cities, it grouped single-storey wards around a central complex of operating theatres and dressing stations, and was properly ventilated and heated. He also insisted on strict standards of hygiene. An important aide in Letterman’s drive to impose correct standards of hygiene and order was Dorothea Dix of the United States Sanitary Commission, who took up work as early as April 1861. The commission was modelled on that of Florence Nightingale, during the Crimean War. Dix had visited the British commission and seen Nightingale’s hospitals. Soon she was active in the dozens of hospitals which began to be opened all over Washington, which was close to most of the major battlefields. Some were improvised in the capital’s public buildings, such as the Patent Office. Others were accommodated in schools and colleges, including Georgetown University. Wooden hospitals were built wherever space was available, until more than fifty were in operation in the capital. One stood on what is now the site of the Smithsonian Air and Space Museum, another on the south lawn of the White House.
The original hospitals, since Washington had almost none of its own, were groups of tents, as used by regimental medical teams in the field. They were only slowly replaced by more solid constructions. Either too cold or too hot, depending on the season, they were open to the public, which wandered in and out at whim.
An early visitor was the poet Walt Whitman, who came to Washington following the evacuation of his brother George Washington Whitman from the field of Fredericksburg. Whitman was a New Yorker who was trying to set up as a professional writer. He did not serve in the army, though another brother did; he was never present at a battle and visited the armies only twice. Nevertheless, the war was to possess Whitman. After finding his brother, he decided to devote himself to the welfare of the wounded; he took a clerical job in the army paymaster’s office and spent the small salary he earned on tobacco and other comforts for the patients, to whom he devoted his time. He wrote copiously during his four years as a self-appointed hospital visitor. By his own reckoning, he attended at the bedsides of 80,000 casualties. He believed that his visits were beneficial and recorded that “the doctors tell me I supply the patients with a medicine which all their drugs and bottles and powders are helpless to yield.” That medicine was kindness and cheerful attention, particularly in writing and sending letters to the soldiers’ families.
Whitman, who was to become America’s leading poet of the nineteenth century, was of humble origins and simple nature. He was temperamentally egalitarian and might, had his bent taken him that way, have become a leader in the socialist movement. He was also deeply humanitarian with a heartfelt belief in the greatness of his country and its people. Besides his openhearted goodness, he also had a deep love for the beauties of the American landscape and skies, about which he wrote memorably in his first and best-known collection of verse, Leaves of Grass. The war moved him greatly, at first by its drama and display, then by its tragedy, which he was to express in deeply moving lyrical terms. One of his war poems, published in the collection Drum-Taps, is undoubtedly one of the greatest works of literature the war was to inspire and one of the finest war poems ever written. It came from his experiences as an army hospital visitor.
COME UP FROM THE FIELDS, FATHER
Come up from the fields, father, here’s a letter from our Pete;
And come to the front door, mother—here’s a letter from thy dear son.
Lo, ‘tis autumn;
Lo, where the trees, deeper green, yellower and redder,
Cool and sweeten Ohio’s villages, with leaves fluttering in the moderate wind;
Where apples ripe in the orchards hang, and grapes on the trellis’d vines;
(Smell you the smell of the grapes on the vines?
Smell you the buckwheat, where the bees were lately buzzing?)
Above all, lo, the sky, so calm, so transparent after the rain, and with wondrous clouds;
Below, too, all calm, all vital and beautiful—and the farm prospers well.
Down in the fields all prospers well;
But now from the fields come, father—come at the daughter’s call; And come to the entry, mother—to the front door come, right away.
Fast as she can she hurries—something ominous—her steps trembling;
She does not tarry to smoothe her hair, nor adjust her cap.
Open the envelope quickly,
O this is not our son’s writing, yet his name is sign’d;
O a strange hand writes for our dear son—O stricken mother’s soul!
All swims before her eyes—flashes with black—she catches the main words only;
Sentences broken—gun-shot wound in the breast, cavalry skirmish, taken to hospital,
At present low, but will soon be better.
Ah, now, the single figure to me,
Amid all teeming and wealthy Ohio, with all its cities and farms,
Sickly white in the face, and dull in the head, very faint,
By the jamb of a door leans.
Grieve not so, dear mother, (the just-grown daughter speaks through her sobs;
The little sisters huddle around, speechless and dismay’d;)
See, dearest mother, the letter says Pete will soon be better.
Alas, poor boy, he will never be better, (nor may-be needs to be better, that brave and simple soul;)
While they stand at home at the door, he is dead already; The only son is dead.
But the mother needs to be better;
She, with thin form, presently drest in black;
By day her meals untouch’d—then at night fitfully sleeping, often waking,
In the midnight waking, weeping, longing with one deep longing,
O that she might withdraw unnoticed—silent from life, escape and withdraw,
To follow, to seek, to be with her dear dead son.
What makes this poem of Whitman’s so heartrending is that everything in it is entirely genuine. Whitman knew what happened to boys shot in the chest; he knew how such news affected families, since he often met them on their visits to the hospitals; he knew what terrible truths the consoling letters sent to families concealed, since he had often written such letters himself. Even though he was not a witness of battle, he knew what results battles caused, since he saw them on the hospital wards. Whitman was a great poet of the Civil War, because he understood the purpose and nature of the war, which was to inflict suffering on the American imagination. The suffering was equally distributed between the two sides, and was felt particularly by those not present. The whole point of the war was to hold mothers, fathers, sisters, and wives in a state of tortured apprehension, waiting for the terrible letter from hospital that spoke of wounds and which all too often presaged the death of a dear son, husband, or father. It was a particular cruelty of the Civil War that because neither side had targets of strategic value to be attacked—not, at least, targets that could be reached by the armies in the field (until Sherman took the war to the Southern people by marching into their homeland)—its effect had to be directed principally, indeed for years exclusively, at the man in the field and at the emotions of those who waited at home. Torturing the apprehensions of the non-combatants was a new development in warfare, produced by the rise of an efficient postal service. Before the days of rapid and reasonably certain postal communication, soldiers could be banished to the mind’s recesses after they marched away, because the nearest and dearest knew that they would receive no news of their fate until the war was over, if indeed then. The only certain news of a soldier on campaign came by default, when he did not return. Whitman caught at the truth in an entry in one of his notebooks. “The expression of American personality through this war is not to be looked for in the great campaign and the battle-fights. It is to be looked for … in the hospitals, among the wounded.”
Whitman’s words would have carried an even stronger ring of truth had he written, “The expression of American national emotion.” Whitman’s keen sense of the national character might have encouraged him to emphasise explicitly the strength and importance of family feeling in nineteenth-century America and the degree to which the brutalities of the Civil War played upon those feelings. He touched on those truths in his great elegy for President Lincoln, which is also an epitaph for the war itself, “When Lilacs Last in the Door-yard Bloom’d”:
I saw the debris and debris of all the dead soldiers of the war;
But I saw they were not as was thought;
They themselves were fully at rest—they suffer’d not;
The living remain’d and suffer’d—the mother suffer’d,
And the wife and the child, and the musing comrade suffer’d,
And the armies that remain’d suffer’d.