Lawson’s twenty-five-year tenure had been marked by isolated medical corps accomplishments. Infamous for his impatience, aggressiveness, and jealous stewardship of his authority, Lawson on his death bequeathed his department many of the same issues that had confronted his predecessor a generation earlier: inadequate staffing, a pressing need for medical qualification standards, and adequate authority over medical supply logistics.
Part of his legacy was an army medical corps trained in outpost medicine, but that knew little more. Four decades of Indian wars resulted in small, mobile military outposts and self-reliant medical officers whose standing orders included treating soldiers, observing the local population and topography, and recording each day’s weather.
Some American military officers had been sent to Europe in the 1850s to study the medical corps of other armies and their equipment and procedures. Yet, although medical officers had examined such things as alternative designs for an improved carriage for battlefield evacuation, no decisive action had been taken prior to the Civil War. Nearly eighty years old by the time of his death, Lawson had become so parsimonious that he considered medical textbooks and extra surgical instruments an extravagance.
He spent nearly a third of his budget on contract physicians. Citing a lack of medical office replacements, he had kept some of his medical officers at their posts up to ten years before granting them a two-month leave of absence. His departmental budget on the eve of the Civil War was $115,000, an inadequate sum to staff dozens of outposts and treat 30,300 disease cases annually (which represented about two illnesses per man). After the outbreak of the Civil War, his department’s budget would skyrocket to a congressionally authorized $241,000 in the first year, mostly for supplies.39 Yet stagnation, not innovation, had become the defining characteristic of his administration.
While America’s military medical corps remained focused on outpost medicine, elsewhere in the world the changing face of warfare assailed and overwhelmed military medicine. In the late eighteenth century, the chief surgeon for Napoleon, Baron Dominique-Jean Larrey, had developed a rudimentary mobile field hospital concept comprised of surgeons and supplies in modified horse-drawn carriages. The carriages moved with the flow of fighting on the battlefield. The usefulness of this concept was proven in the Napoleonic Wars that followed, and by the 1830s it had become a standard component of the French army.
Conversely, the British medical corps largely had failed the 83,000 troops sent to fight in Russia in the Crimean War of 1854–1856. About one in four of the troops died, the vast majority succumbing to disease. The horrific conditions aboard patient transport ships bound for Turkey, where wounded soldiers lay on open decks, precipitated a massive public outcry. Thanks to this, a sanitary commission was eventually established to monitor and support the British medical corps.
After the fall of Fort Sumter in April 1861, war loomed in America. President Lincoln called for volunteers, and by April 27 several states had responded, with the rolls of volunteers ranging from 1,000 from Rhode Island to 30,000 from New York, and to as many as 100,000 from Pennsylvania.40 State volunteer regiments included surgeons who lacked battlefield experience and some who had never operated on a patient. The state regiments’ civilian doctors, who had almost no relevant experience and had no understanding of the unique challenges of military medicine, marginally augmented the undermanned and ill-prepared army medical corps.
Equally challenging, volunteer physicians often differed in their approach to patient care. Some, considered “irregular doctors,” were not necessarily medical school graduates. Irregulars included eclectic practitioners who blended family herbal medications, botanical medicine, and sometimes Native American remedies. Some were homeopaths who believed small doses of substances that caused symptoms in healthy patients could cure sick patients who exhibited those same symptoms. Unlike the eclectic and homeopathic doctors, the army’s “regulars” favored massive doses of purgatives as well as mercury- and opium-based compounds as medications.
By mid-July, tens of thousands of soldiers sat idle in suffocating humidity among hundreds of white conical tents in army camps around Washington, waiting for orders. Army doctors checked their supplies and requisitioned more while President Lincoln pressed Brigadier Irvin McDowell of the Army of Northeastern Virginia, to attack the Confederates in Virginia. Twentyfive miles away, near Manassas Junction, Confederate generals Joseph E. Johnston and P. G. T. Beauregard prepared their 30,000 troops for battle. McDowell lacked confidence in his untested army, which was comprised mostly of new volunteers, but he developed a plan to make a diversionary attack at Manassas and then flank the Confederates’ position to cut off their retreat to Richmond.
On July 16, McDowell’s army, the largest army assembled in the history of the nation to that point, left Washington to confront the Confederates. The lumbering, undisciplined, and poorly coordinated march toward the enemy squandered McDowell’s manpower advantage. And while his army took two days to reach Centreville, the medical corps lost critical supplies when many of its wagons were left behind to hasten the march toward the enemy. Then, during the two days the Union army spent in the Centreville area, “no hospital arrangements were made . . .; no plan was made for transporting the wounded; everything was left to take care of itself, haphazard.”41 The disorganized battle preparation gave Johnston and Beauregard invaluable time to marshal their Confederate forces, since they knew where McDowell’s troops were positioned.
Before dawn on July 21, more than 30,000 Union soldiers marched toward Manassas Junction followed by hundreds of Washington residents in private carriages, eager to watch the first major battle of the war. Most had yet to set out picnic blankets atop ridges when the first artillery exchange started a little after 5:00 a.m.
Once the battle began, Union artillery proved particularly lethal as the fighting intensified throughout the morning. But the frequently timid McDowell held two of his five divisions in reserve and allowed a lull in the fighting to take hold about midday. As the Confederates regrouped, hundreds of soldiers wounded after a few hours’ fighting confronted McDowell’s medical officers.
The medical department’s lack of preparedness and cohesive authority became evident as the casualties mounted. Some state regiments had gone into battle with almost no field medical support. The First Connecticut Volunteers, numbering nearly 700 men, “had one two-horse ambulance and two wall tents for hospital use; no hospital supplies and apparently no litters. There were no men to use this equipment except the band men.”42 There were few places to evacuate the most seriously wounded. Medical officers set up treatment stations in commandeered houses, churches, and dry creek beds where necessary.
Once the aid stations became operational, the fragmented nature of a Union army comprised of federal troops and state volunteer regiments became evident. Army medical director William S. King reported that “a hospital established by one regiment, refused to receive certain wounded men because they belonged to other regiments.”43
The fighting resumed at mid-afternoon after the Confederates had fallen back and regrouped. The battle turned in the Confederates’ favor when one of their Virginia units, dressed in blue uniforms similar to the Union army, advanced to within seventy yards of the Union’s deadly hilltop artillery. Their sneak attack devastated the artillery troops and enabled the Confederates to take control of the strategic position. Although McDowell’s forces assigned to the hill outnumbered Confederate forces by an almost two-to-one margin, he engaged just three of his five divisions at any one time, neutralizing his advantage for lack of nearby reinforcements in the midst of battle.
Carnage in the Union army mounted under withering Confederate fire. Nurse Emma Edmonds recorded the destruction in her diary. “Still the battle continues without cessation; the grape and canister fill the air as they go screaming on their fearful errand; the sight of that field is perfectly appalling; men tossing their arms wildly calling for help; there they lie bleeding, torn, and ma
ngled; legs, arms and bodies are crushed and broken as if smitten by thunder-bolts; the ground is crimson with blood; it is terrible to witness.”44
Without artillery protection, the poorly disciplined Union army disintegrated. By 4:00 p.m. full and chaotic retreat had begun, leaving hundreds of wounded lying on the battlefield and at makeshift aid stations. Wagons that could have evacuated some of the wounded had been commandeered for a more rapid retreat. In some cases, medical officers abandoned their patients to the enemy, while others stayed at their posts.
As the Union army fell back, some medical officers reassigned to makeshift hospitals in the rear at Centreville found conditions little better than those on the front line. “We had no bandages, no lint, no sponges, no cerate, and but very little water, and I think only one basin. . . . Three or four (patients) had balls (pass) through their bodies, and had walked two or three miles to the village . . . one was brought up with a wound in his thigh, who had lain on the field since the Thursday preceding (a casualty from a pre-battle skirmish),” wrote New York volunteer surgeon Frank H. Hamilton.45 The army’s retreat continued into the night as a handful of doctors frantically sought to stem the bleeding of the wounded.
The handful of ambulances available had no field hospitals to which they could transport wounded. Three hundred wounded were deposited at Sudley Church and in nearby stands of trees. Surgeons gathered there as well, in the absence of clear orders to treat the wounded at specific locations. The bulk of the battle’s wounded were left to either walk off the battlefield or lie abandoned in the field of fire.
The following day, when the weather turned cold and wet, Hamilton and other surgeons left their most severely wounded patients at Centreville to the Confederates and returned to Washington. “I could not tell them I was about to leave them, and I trust in leaving them so I did them no wrong. I could be of no more service to them until morning, and then I presumed they would be in the hands of a civilized and humane enemy who would care for them better than we could.”46 A few surgeons voluntarily stayed with approximately 500 wounded army soldiers in the Sudley Church area, where the wounded and doctors were eventually taken prisoner and shipped to Richmond as a blanket of shock settled on the defeated Union army.
The shock wave reached Washington the following morning, when residents rose to a ghastly sight. “I awoke from a deep sleep this morning, about six o’clock. The rain was falling in torrents and beat with a dull, thudding sound on the leads outside my window; but, louder than all, came a strange sound, as if of a tread of men, a confused stamp and splashing, and a murmuring of voices. . . . I saw a steady stream of men covered in mud, soaked through with rain, who were pouring irregularly, without any semblance of order, up Pennsylvania Avenue towards the Capitol. . . . Many of them were without knapsacks, crossbelts, and firelocks. Some had neither great-coats nor shoes, others were covered with blankets. . . . I ran down stairs and asked an officer . . . where the men were coming from. ‘Where from? Well, sir, I guess we’re all coming out of Verginny as far as we can, and pretty well whipped, too . . . I know I’m going home. I’ve had enough of fighting to last a lifetime.’”47
That soldier had reached Washington after a retreat that had become mired in “the dust of the turnpike, between Centreville and Fairfax, raised by our soldiers and wagons passing, floating over the road like a thick fog . . . in this passage, horse, foot, and vehicles were jammed in great confusion; upturned wagons and their contents blocked the way at short intervals . . . so slow was our progress that we did not reach Fairfax, a distance of only seven miles, till two o’clock the next morning,” wrote King.48
For days in the battle’s aftermath, the walking wounded wandered the streets of Washington, waiting for space in one of the city’s four hospitals. More than 1,500 casualties had overwhelmed an inexperienced medical corps that had no medical battle plan, suffered from a significantly fractured organization, and had endured a paucity of resources. Hundreds more casualties remained on the battlefield, enduring two days of cold and rain. The last of the wounded were removed from the battlefield a week after the battle.
Reports from regimental surgeons horrified the general public. W. W. Keen of the 5th Massachusetts stated that his ambulance drivers and hospital stewards were members of the regiment’s drum corps. John Foye of the 11th Massachusetts wrote that his regiment was supplied with a single ambulance well stocked with stimulants and medical implements but devoid of medicine and tents.
Yet the Army of Northeastern Virginia’s medical director William S. King painted a different picture five days after the battle when he wrote, “It is due to the ambulance drivers to say that they performed their duties efficiently, and the results of their operations also show how absolutely necessary these means of conveyance are to the comfort and relief of the wounded, in giving them shelter and water when ready to perish with heat and thirst.” He claimed regiment medical staff “discharged their duties satisfactorily” but acknowledged that “The impossibility of making a careful survey of the field after the battle had ceased must be my apology for the briefness and want of detail in this report.”49
Regardless of King’s claims, reports of how the wounded suffered and lay unattended horrified the North. President Lincoln, political leaders, and civilians in Washington looked out their windows at homeless, wounded soldiers in search of shelter. Many had walked more than twenty miles back to the city. One soldier hiked back to the city after an arm had been shot off. Another made it after having been shot through his cheeks, jaw and tongue. One soldier hiked back to the city after being shot through both thighs and the scrotum. The dehydrated, walking wounded reached a city whose hospitals were already full. A report issued after the battle by a civilian organization formed to assist the military’s medical department stated dimly: “The Sanitary Commission was unable to learn of a single wounded man having reached the capital in an ambulance.”50
The Union had suffered a crushing defeat on a battlefield almost within sight of the nation’s capital. The debacle revealed a fundamentally flawed and unprepared Union army incapable of ending the war in a few months, as many had formerly expected. Its medical department needed new leadership, organization, resources, and perhaps most importantly, the authority to adequately prepare, deploy and treat the wounded in battle. Worse, the battle at Manassas Junction (which was also called Bull Run) would become a harbinger of far larger and deadlier battles. Ultimately the 2.2 million–man Union army would become a fighting force more than twenty times larger than the army that had been assembled in the Mexican-American War thirteen years earlier. Those soldiers would depend on a meager medical corps that would have to hone its medical skills and leadership ability under fire.
3
THE HAMMOND ALLIANCE
“Their wounds, as yet, undressed”
The disaster that ripped through the Union troops at Bull Run should not have been a surprise. Brigadier General Irvin McDowell had taken command of the Army of Northeastern Virginia only two months earlier, over the objections of the Union army’s general in chief, Winfield Scott. A surprise appointment by President Lincoln, the forty-two-year-old West Point graduate from Ohio had never commanded troops in battle. Oddly proportioned with a large body atop short legs, he had a huge appetite, spoke French, and had a fondness for waltzes, landscape gardening, and architecture. McDowell had been inspecting volunteer regiments at the time of his appointment. Scott considered other officers better qualified to lead troops into the first major battle of the war.
McDowell’s medical director, William S. King, had much less time to prepare for war. He had arrived at McDowell’s headquarters a few days before the army began its march toward Bull Run. King had only seventy-two hours to make preparations for a major campaign by 30,000 soldiers. The quartermaster corps, responsible for providing medical transportation, denied his request for twenty medical wagons, an omen of the medical-supply shortages he would face under fire. During the battle, King’s medical corp
s was hamstrung by an inventory of only approximately fifty ambulances manned not by teamsters but by the army’s musicians. The army’s line officers, anxious to engage the enemy, had ignored King’s counsel to feed the troops before embarking on a double-quick march hours before sunrise on the day of battle.
Bull Run confirmed the worst fears of many in the civilian medical community. Early in 1861, with war on the horizon, several private humanitarian organizations had been established, mostly to provide supplies and technical assistance to the Union army. Chapters were established in various states that were forming more than three dozen volunteer regiments.
One such organization was the United States Sanitary Commission. A few days after the attack on Fort Sumter, Dr. Henry Bellows, a prominent Unitarian minister, and Dr. Elisha Harris, the superintendent of a New York City hospital, began forming a humanitarian organization. They feared Union soldiers could suffer as horribly as British soldiers had during the Crimean War five years earlier. Massive armies around the world with increasingly lethal weaponry produced unimagined numbers of wounded in the mid-nineteenth century. Few had confidence that the Union army’s medical department had kept pace.
They marshaled commitments from other newly formed relief societies and sent a delegation to Washington. On May 18, they asked acting Surgeon General R. C. Wood to recommend establishment of a Sanitary Commission representing their interests that would investigate and advise on standards of soldier care. They sought no federal funds or legal authority. Wood clung to the belief that imminent war with the South would be “only the Florida or Mexican war on a large scale, and that the existing machinery was capable of such expansion as fully to provide for every possible contingency . . . and any attempt from outside to interfere with its methods, could produce only confusion, embarrassment, and all those evils which destroy an army by introducing into it loose notions of military discipline and responsibility.”1
Surgeon In Blue Page 6