Living Hell
Page 12
Given the difficulties army surgeons faced, they achieved acceptable results, keeping the death rate from all causes, including disease, to 14 percent, versus 16 percent for the Crimea, and 15 percent in the Franco-Prussian War. Military surgeries posed greater challenges than civilian: poor, filthy facilities; wood, metal and leather driven into wounds; a greater number of patients in poorer physical condition. Yet doctors in uniform achieved better success, with a mortality rate of 26.5 percent versus 50 percent. Why then did the public hold army surgeons in contempt as drunken butchers? Admittedly, some drank or took drugs, usually to stand the strain of overwork and danger, including threats of hospital infections. They feared what happened to Dr. Robert W. Gibbes, South Carolina’s Surgeon General, who became disabled, “poor creature, he is losing the joints of his hand from an operation he performed on a gangrenous wound.” Stories of boozy sawbones, based on a minority in the medical corps, unfairly brought all surgeons into disrepute.22
Also, ignorance of the fact that amputations often offered the only way to save lives also fed ill-informed hostility. Surgeons looked the part of butchers, smocks and arms drenched with blood, limbs piled nearby. Johann Stuber, 58th Ohio, described a field hospital outside Vicksburg: “The house, the halls, the yard, even the attic was pressed full of wounded. I saw the doctors on the verandah with knives and saws working as diligently as butchers at the meat market.” Outside, former slaves, who had sought refuge and work within the Union lines, buried limbs. Burial details struggled to keep up. “I notice,” said Walt Whitman at Fredericksburg, “a heap of amputated feet, legs arms, hands, &c., a full load for a one-horse cart.” In the same location, Union private William Hamilton described animals enjoying the windfall: “There was a Hospital within thirty yards of us … about the building you could see the Hogs belonging to the farm eating arms and other portions of the body.” Joseph Crowell estimated his squad buried eight hundred limbs at Gettysburg.23
Misunderstanding of anesthetic procedure further colored images of medical callousness. In the field, physicians could only roughly gauge patient bodyweight, important to measuring the dose. Shock, blood loss, and weakness also complicated estimates, so that physicians dared not apply deep anesthesia for fear of killing patients. They ordered a shallow draft to be administered, leaving patients insensible to pain but semiconscious. Drugged and fearful, seeing the knife and saw, patients hallucinated ghost pain, screaming or moaning in imagined hell, leading uninformed observers to mistakenly conclude that surgeons were callous monsters who left men in agony. The real suffering came later when the patient fully awoke to disability with all its emotional distress and physical ramifications, including the torture of prolonged swelling, inflammation, infection, and fever.
As soon as possible, postsurgical patients left for major hospitals, usually located in urban centers, to complete their recovery. But even with the wartime expansion in medical transportation, many delays occurred in moving casualties from field hospitals. The sheer volume of wounded from a major engagement temporarily overwhelmed resources. The ubiquitous rains stopped traffic, as did the depredations of raiders, taking out railroads and bridges. While on hold, postoperatives endured dirt, thirst, and hunger. Colonel James A. Mulligan, Union commander in the fight at Lexington, Missouri, September 1861, recalled: “Our supply of water had given out and the scenes in the hospital were fearful to witness, wounded men suffering agonies from thirst and in their frenzy wrestling for the water in which the wounded had been bathed.”24
With inadequate numbers of cots, men awaiting evacuation lay on bare ground. This fate awaited a private in the 48th Pennsylvania, wounded in the thigh. He lay exposed to the elements, going without food for seven days. Cornelia Hancock, nursing in a Union hospital during the Wilderness fighting of May 1864, described men on church floors and pews, rain pouring through bullet-riddled roofs “until our wounded lay in pools of water made bloody by their seriously wounded condition.” In July of that year, George Templeton Strong of the Sanitary Commission saw about six thousand men lying around Grant’s headquarters under a blistering sun, covered in clouds of dust, while turkey buzzards hovered overhead.25
When the sufferer did get a ride to the main hospital, shortages of more advanced ambulances even late in the war meant that this last journey frequently occurred in an unsprung vehicle. Rebel Walter Lenoir, who lost a leg fighting against General John Pope on August 31, 1862, endured torture in a wagon that made only twenty miles in five hours, jolting patients at every rut, causing “a pang which felt as if my stump was thrust into liquid fire.” General John Imboden, commanding the Confederate medical column taking wounded to Virginia after Gettysburg, could not forget the suffering. Many patients remained without food for thirty-six hours as rain pelted down. He watched unsprung wagons, without even straw cushioning, bounce brutally over rocky, washed-out roads:
The jolting was enough to have killed strong men, if long exposed to
it. From nearly every wagon as the teams trotted on, urged by whip
and shout, came such cries and shrieks as these:
“O god! why can’t I die?”
“My god! will no one have mercy and kill me?”
“Stop! Oh! for God’s sake stop just for one minute; take me out and
leave me to die on the roadside.”26
The condition of men arriving at permanent facilities shocked nurses. Rushing to unload ambulances coming from the Fredericksburg battlefield, D.C. nurse Louisa May Alcott met “a regiment of the vilest odors that ever assaulted the human nose,” and shortly after there assembled around the stove “the dreariest group I ever saw—ragged, gaunt and pale, mud to the knees, with bloody bandages untouched since put on days before.” Numbers temporarily overwhelmed facilities. Kate Cumming, a Confederate nurse in Corinth, after Shiloh, said the staff initially worked without cots or blankets for the men, and without plates to serve food. She said filth and vermin covered the incoming.27
Yet the effort to provide adequate facilities continued throughout the war, especially for white soldiers. Black troops experienced more neglect from both sides, some of it intentional. The wounded from Fort Wagner lay out for thirty-six hours, producing cases of gangrene. Segregated hospital units for African Americans, generally inferior structures, and less well equipped than those for whites, gratuitously raised the mortality rate. Still, by 1865, the Northern and Southern medical services between them operated some four hundred hospitals of an unprecedented magnitude and sophistication, boasting nearly 400,000 beds. More than one million soldiers had received care in Northern facilities alone.28
Daunting challenges faced physicians and nurses in providing long-term care. As medical science had gained little understanding of bacterial infection and no antibiotics existed, many patients regressed despite successful surgery, succumbing to secondary complications. Stonewall Jackson, whose weakened system fell prey to pneumonia and general debilitation following amputation, might have been saved today by postoperative treatment. Wounds frequently refused to heal without modern hygienic procedures and pharmaceuticals. At the D.C. Armory Square Hospital in February of 1863, Walt Whitman met a young New York soldier shot through his bladder half a year earlier. Waste water still oozed from the boy’s gaping wound, “so that he lay almost constantly in a sort of puddle—.” Excisions became infected. George Fisk, an eighteen-year-old Union private, took a bullet at Fair Oaks on May 3, 1862. The wound festered when the surgeon performing an upper arm ex-section failed to locate all embedded bone chips. The arm and shoulder became a dead weight, immobile and swollen. Finally, the wound exploded in a bloody eruption, killing the boy.29
Problems required repeat surgeries. Infection and blood poisoning that led to gangrene necessitated recutting flesh and further amputation to remove cankered tissue and bone. Threads tying off arteries broke loose, needing to be sewn again. Georgia private Milton Clark endured this renewed procedure at Reed’s Hospital, Lynchburg, Virginia, in August 1864. Min
imally sedated, he allowed as how it “was very painful to me.” Days later, a second artery broke, requiring the removal of further flesh and bone to expose fresh artery for retying. This time, Clark got chloroform.30
Extended surgery often failed. A bullet hit Union Corporal James Quick in the face at Fredericksburg. Despite wound cleansing, bacteria attacked, ulcerating numerous blood vessels within the skull. Hemorrhaging became frequent. Surgeons tried tying off the left common carotid artery (one of two vessels supplying most of the blood to the neck, head, and brain). The treatment failed to take. After a massive effusion of blood, Quick became comatose and died minutes later. Autopsy revealed the carotid artery rotted through at the site of the suture.31
Patients suffering massive facial damage, such as crushed jaws, had little hope of a full recovery and normal life. Mary Boykin Chesnut, nursing at a Virginia hospital, The Wayside, in November 1864, daily spoon-fed hominy rice, gravy, milk, and softened bread to four men unable to chew. “One was shot in the eye, but his whole jaw was paralyzed. Another—and the worst case—had his tongue cut away by a shot, and his teeth with it.” Without the technology to intravenously feed patients with utterly ruined jaws and swollen, lacerated throats, nurses could not provide enough nourishment to sustain life. The victims died of malnutrition.32
Many wounds involved nerve damage, causing immense pain and discomfort, while proving hard to cure. The war brought to prominence a gifted practitioner in the developing field of neurological science, Weir Mitchell. Later, he gained notoriety for a controversial isolation cure that he prescribed particularly for female patients he labeled “hysterics.” Today, the treatment appears insensitive, even cruel. Charlotte Perkins Gilman made it infamous in her story, “The Yellow Wallpaper” (1899), about a woman driven mad by medical incarceration. Mitchell could be extreme in his views; according to repute, he once set a patient’s bed on fire to jolt him out of depression. Whatever his eccentricities and later misjudgments, he dedicated his wartime career to helping men with neurological damage, achieving results in many cases. Mitchell impressed Federal Surgeon General William Alexander Hammond enough to be placed in charge of the Turner’s Lane Hospital in Philadelphia, a 400-bed facility for nervous diseases.
The doctor wrote up many of the cases he treated there in Injuries of Nerves and Their Consequences. This detailed study allows us to inspect the wards along with this eminent practitioner. A tall, gaunt, sharp-bearded man, the soldiers nickname him “Uncle Sam.” His manner intense and animated, he stalks along at a frenetic pace; we must hurry to keep up. We first meet a New York soldier, shot through the biceps of the right arm at Gettysburg on July 2, 1863. His injury spawned neuralgia and joint disease. The arm exhibits swelling, feels hard, like marble, is glossy, and extremely sensitive to the touch. It must be kept wrapped in a wet cloth. Over time, the ordeal has caused chronic emotional stress. He cannot stand even the blowing of a nurse’s breath on his arm, and complains that the sound of her dress rustling by his cot causes distress. He has declined enough mentally that some staff consider him insane.33
Moving on, we come next to an Irish soldier of the 69th Pennsylvania, shot in the left forearm six months ago. He has developed neuritis and joint disease. Dr. Mitchell tells us that a course of blistering failed to increase blood circulation and muscle mobility. The patient looks “thin, anaemic, nervous, and pain-worn.” His record states that he “sleeps badly, and has ague and dyspepsia. The arm is generally wasted; he keeps the hand wet.” Pain in damaged limbs becomes a problem for many men; they find relief only through soothing applications of cold water to combat inflammation. Even though the constant drip, drip has a wearing effect on the patient’s nervous resolution, some must continuously keep the affected limb under a tap.34
Mitchell uses leeches to stimulate areas with injured nerve endings. He advocates liberally dispensing morphine and, in extreme cases, arsenic drops to relieve excruciating misery: “The pains of traumatic neuralgia are so terrible,” explains the lanky head surgeon, “that we are usually driven at once to the use of narcotic hypodermic injections.” Opium plasters present a further option: when placed over injured areas, they introduce soothing narcotic effects directly into the affected region. Sergeant A. D. Marks of the 3rd Maryland (U.S.), shot in the neck and chest at Chancellorsville, typifies such cases. The damage resulted in partial paralysis of his neck and left arm, accompanied by pleurisy and congestion of the lungs. Treatments include icing the arm, blistering the shoulder, and then dressing it with opium plaster. The sergeant needs frequent morphine injections and electrical treatments for increasing pain. Applications of leeches also ease the patient’s suffering. (Marks’s record shows sufficient improvement for him to be released in April 1864, but still without the use of his left hand.)35
We proceed to the bedside of Private Joseph H. Corliss, 14th New York, shot through the left biceps at Second Bull Run, August 1862. He lost the use of both hands, his left arm frozen across the chest, and his right arm hanging limp. After months in hospital, recovery remains elusive. The left hand withered to a hard, thin, claw, with deformed nails. Paralysis now reaches the left leg, so he must not only drip water on both hands but also into his boot to ease the pain. Many such severe cases require constant medical attention. At Cold Harbor, in the spring of 1864, a minnie ball hit Captain A. F. Swann, 16th Pennsylvania Cavalry, in the left arm and elbow. Needing frequent morphine shots, “Both arms are covered with the punctures of the syringe, discolored, and the cellular tissue indurated.” Operations to remove the damaged nerve tissue have failed to effect a cure.36
The cases go on. Patients sit or lie with arms molded to chests, limbs shrunken and without movement in their fingers. Keeping injured areas wet occupies them constantly. Family and friends fail to recognize casualties emotionally debilitated by their ordeal. For example, Mitchell points to the case of Private David Schiveley, 114th Pennsylvania, seventeen years old. A minnie ball that ranged up through the right arm into the cheek hit him on July 2, 1863, at Gettysburg. The surgeon notes he “is nervous and hysterical to such a degree that his relatives suppose him to be partially insane.” Private John C. Dyre, 71st Pennsylvania, occupies the last cot we pause by. A bullet entered behind his left ear at Gettysburg. By February 1864, the wound has distorted his features, pulling the face to the right and slurring his speech. Neurological damage paralyzes the left side, and Dyre cannot close one eyelid. Chewing food causes him great pain. No procedures, including electrical treatments, help; the physicians see no relief in sight.37
We take our leave of Dr. Mitchell here, but pause to consider that, in addressing both the physical needs of such stricken men and also attempting to help them keep up their spirits, the hospital nursing staff also played an essential role. Many patients developed a son-to-mother relationship with their caregivers, perhaps at times childlike in its intense need and dependency, but still of positive benefit in their predicament. The nurses not only provided this feminine comfort, they fed, cleaned, and administered soothing medications to the suffering. Inevitably, this burden of responsibility put a brutal stress on the nursing staff, at least 10 percent of women attendants breaking down under the load.
Many nurses helped patients bear their encroaching mortality. Kate Cumming of Mobile, serving at a Corinth hospital, wrote: “At home, when a member of a family is about to go to his last resting-place, loving friends are around the couch of the sufferer, and by kind words and acts rob King Death of half his terrors.… But here a man near dissolution is in a ward with perhaps twenty more,” and only a single nurse keeps vigil. After Shiloh, she tended a wasted boy named Wasson. The youth suspected he was mortally wounded. “What was the matter,” he asked, “was he going to die?” Kate softened her answer, but then a surgeon bluntly told the boy he was finished. Wasson accepted his end, but told Kate it seemed hard to go so young and without seeing his family. She sat with him, cushioning his last hours, until she went to sleep, exhausted.38
The w
omen of the wards cried for the boys they came to know and love. Ella Thomas nursed at the 3rd Georgia hospital in Virginia. She talked sadly of a soldier dying in late July 1864. In a delirium, he mistakenly cried out gleefully, “I am going home, I have a furlough to go home.” She wished she had an address for the family so she could write and tell them where and when their son died, adding “but I would not have them know how he died.” Nurses every day wrote final letters for dying soldiers. On top of these painful duties, nursing staff also had to cope with the moral and physical decline of surgeons who broke under the strain of overwork and responsibility. New Englander Hannah Ropes, serving at the Union Hospital in Georgetown, near D.C., wrote that her ward physician stayed drunk all day and performed the rounds “like a somnambulist!” Sitting by dying boys, fearing hospital infections such as contracting gangrene, all the while themselves nervously and physically frayed, many nurses hung on day-by-day, wondering when breakdown would debilitate or kill them.39
No job proved worse than disposing of the dead littering the battlefields. Ironically, this involved more slaughter, as military details had to shoot herds of rogue mules and horses roaming the battlefield, along with many writhing and screaming animals mutilated by missiles. Work details burned the corpses of animals, though often they lacked the time to do a thorough job, leaving half-burned remains smoldering in decaying, stinking piles, attracting flies and scavengers. Human remains also decayed quickly, especially in hot weather at the height of the campaigning season. Until orders moved the regiments on, living soldiers coexisted with the dead. Virginian David Hunter Strother, a Union staff officer, explored the field after Antietam. He noted with distaste that “our troops sat cooking, eating, jabbering, and smoking; sleeping among the corpses.”40