We’re continuing our four part series with Erin Rainwater and her research into Civil War Medicine. You can find Part I here.
Changes in delivery of medical care resulting from the war.
When you look at the casualties wrought by the Civil War it is mind-boggling. The Battle of Antietam in Maryland was the single bloodiest day of the war. There were over 20,000 American casualties in a single day (North and South combined). The Battle of Gettysburg was fought over three days, and 51,000 men were killed, wounded or missing. In all, more than 620,000 men died during the four-year conflict.
Over half perished from disease, not battle wounds. These numbers are inconceivable, both in terms of lives lost and in the challenge of delivering medical care in a day prior to asepsis (germ-free), antibiotics, and helicopter aerovacs. As a result of the enormous casualties, many of whom were brought into nearby towns where churches, hotels, barns and even citizens’ homes were requisitioned by the armies and made into makeshift hospitals, a new system of medical care delivery was born of necessity.
Both governments ordered the swift construction of general hospitals to treat the injured and ill. Additionally, frontline hospitals were born of necessity. Initially, the ambulance service was maintained and run by the Quartermaster Corps. Around 1862, the medical director of the Union army, Jonathan Letterman (for whom the Army hospital in San Francisco was named) developed a system whereby ambulances and trained attendants were assigned to and moved with a division.
This provided for more immediate collection of the wounded from the battlefield and transport to dressing stations and on to field hospitals. The current system of rapid response and ambulance conveyance was conceived due to the necessities brought on by the Civil War. It is interesting to note that casualties from both sides were treated at the frontline hospitals.
When (unsterile) silk, cotton or catgut ligatures were at a premium, horse hair was boiled to soften the texture to make it pliable for use as suture material. It was noted by some that the infection rate dropped significantly when this was used. The same was true when a lack of reusable sponges led to the utilization of one-time use rags for cleansing wounds. Applying iodine to wounds and wiping instruments with chlorine between surgeries brought similar results, but without scientific data to prove a correlation, some physicians saw no sense in these procedures.
The surgeon general remained opposed to the use of civilians and women in the hospitals, but the lack of males to perform the required duties forced the issue. Dorothea Dix, highly respected as a crusader for improving conditions in prisons and hospital for the mentally ill, managed to convince skeptical military and government officials that certain women were capable of dealing with what the war did to men.
With the news of her appointment as Superintendent of Women Nurses in June, 1861 came torrents of applications from women offering their services. Working for no pay, Miss Dix personally looked after the well-being of the female nurses she hired as well as the soldiers to whom they ministered. However, in her attempt to weed out those merely looking for a husband, she would only hire women over thirty or married, strong, and plain of face and dress. Some hospitals’ chief surgeons rejected the hiring authority given Miss Dix, and in a show of defiance, refused to accept her nurses on their wards.
It took a literal Act of Congress to allow the surgeons to bypass her authority and hire nurses on their own. This is what happens to the heroine in my novel, True Colors, who is considered unacceptable by Miss Dix because she is under thirty, unmarried, and not so plain. Disappointed yet undaunted, Cassie follows in the footsteps of many of her fellow rejects and marches straightway to an Army hospital and applies directly to the surgeon-in-charge. She is fortunate in that this doctor had worked alongside British Army surgeons in the Crimean War a decade earlier, and was appreciative of the role of female nurses. He hires her on the spot.
The significance of the contribution of women nurses during this conflict should not be understated. Rather than being seen as mere helpers of the main players—interesting but insubstantial—available evidence indicates their activities had important ramifications in both the immediate medical sense and the broader social sense. Truly they were the forerunners of female nurses of our generation.
*********************************************************************************************Erin Rainwater is a Pennsylvania native whose trip to Gettysburg when she was twelve enhanced her already deep interest in the Civil War. She attended Duquesne University in Pittsburgh, and entered the Army Nurse Corps upon graduation. Serving during the Vietnam War era, she cared for the bodies and spirits of soldiers and veterans, including repatriated POWs and MIAs. Now living in Colorado, she is a member of a Disaster Medical Assistance Team, and has been deployed to disaster areas around the country. True Colors is partly based on her military and nursing experiences as well as extensive research. She also authored The Arrow That Flieth By Day, a historical love story set in 1860s Colorado, and Refining Fires, a uniquely written love story that was released in July, 2010. Erin invites you to visit her “virtual fireside”.
***Content originally posted January 17, 2011.***