During 1862 and 1863, Confederate armies went on the tactical offensive in six of the nine battles in which the killed and wounded of both sides together exceeded fifteen thousand. Although they won two of these six battles (Chancellorsville and Chickamauga) and achieved a strategic success in a third (the Seven Days'), their total casualties in these six contests exceeded Union casualties by 20,000 men (89,000 to 69,000). In the spring of 1864 the situation was reversed as Grant's men suffered nearly twice the casualties of Lee's army when the Yankees took the offensive from the Wilderness to Petersburg. The quest of both sides for victory through tactical assaults in the old manner proved a chimera
24. Hill, "Lee's Attacks North of the Chickahominy," Battles and Leaders, II, 352.
in the new age of the rifle. The tactical predominance of the defense helps explain why the Civil War was so long and bloody. The rifle and trench ruled Civil War battlefields as thoroughly as the machine-gun and trench ruled those of World War I.
IV
In the fog-enshrouded gloom at Malvern Hill on the morning of July 2, 1862, a Union cavalry officer looked over the field of the previous day's conflict. "Our ears had been filled with agonizing cries from thousands before the fog was lifted," he wrote two decades later with the sight still imprinted in his mind, "but now our eyes saw an appalling spectacle upon the slopes down to the woodlands half a mile away. Over five thousand dead and wounded men were on the ground . . . enough were alive and moving to give to the field a singular crawling effect."25 Soon the two armies agreed on a truce to bury the dead and succor the wounded. These tasks etched the horrors of war even more indelibly than the actual fighting. "The sights and smells that assailed us were simply indescribable," wrote a southern soldier on burial detail, "corpses swollen to twice their original size, some of them actually burst asunder with the pressure of foul gases. . . . The odors were nauseating and so deadly that in a short time we all sickened and were lying with our mouths close to the ground, most of us vomiting profusely." Writing home after another battle, a Yank described a field hospital established in farm buildings. "About the building you could see the Hogs belonging to the Farm eating [amputated] arms and other portions of the body."26
Many civilians on both sides, especially in the South, experienced these sights and smells of war directly as well as through soldiers' letters. Much of the fighting in May and June 1862 occurred almost on Richmond's doorstep. Many of the 21,000 wounded Confederates from Seven Pines and the Seven Days' were brought into the city. "We lived in one immense hospital, and breathed the vapors of the charnel house," wrote a Richmond woman.27 Churches, hotels, warehouses, shops, bams, even private homes were pressed into service as temporary hospitals. White women volunteered by the hundreds as nurses; slaves were mobilized as orderlies and gravediggers.
25. William W. Averell, "With the Cavalry on the Peninsula," Battles and Leaders, II, 432.
26. Wiley, Johnny Reb, 75; Wiley, Billy Yank, 83.
27. Emory M. Thomas, The Confederate State of Richmond (Austin, Tex., 1971), 100.
Like the Union army, the Confederates gave first aid and emergency treatment of wounded in field hospitals near or on the battlefield. The South was slow to establish general hospitals for the treatment and convalescence of the badly wounded and of soldiers with long-term illnesses. At first such hospitals were maintained primarily by local or private initiative. By late 1861 the Confederate Medical Department had taken over this function. The army established several general hospitals in Richmond, the principal one on an east-side hill, Chimborazo Hospital, which became the largest such facility in the world with 250 pavilion buildings each housing forty to sixty patients and 100 tents with space for eight to ten convalescents each. But only a fraction of these structures had been completed by June 1862, when thousands of wounded poured into the city and many died in the streets because there was nowhere else to put them. The shock of the Seven Days' and of subsequent battles in Virginia compelled the expansion and modernization of southern general hospitals.
This shock plus the vital example of women volunteers in Richmond and at Corinth, Mississippi, also forced a reversal of the Medical Department's initial hostility to female nurses.
On the eve of the Civil War Florence Nightingale was as much a heroine to American women as she was in England. Nightingale had revolutionized the inadequate British army medical services in the Crimea. She had also dignified nursing as a profession and in 1860 had established the world's first school of nursing at St. Thomas's Hospital in London. When war came to America, several southern white women volunteered their services as nurses or founded small hospitals for soldiers. One of the best such hospitals was established in Richmond by Sally Louisa Tompkins, whom Jefferson Davis eventually commissioned as a captain so that her infirmary could qualify as an army hospital.
These examples defied a prejudice against "refined ladies" working in military hospitals. It was permissible for white women to nurse the sick at home or even in the slave quarters, but they had no business in the masculine milieu of an army hospital which presented sights that no lady should see. Women should stay at home and make bandages, knit socks for soldiers, and comfort the menfolk when they returned from the rigors of battle. Despite the initial wartime prevalence of this view, numerous southern women of good families braved the frowns of father or brother to volunteer as nurses. One of them was twenty-seven-year old Kate Cumming of Mobile, who in April 1862 went to Corinth where Beauregard's battered army was trying to recover after Shiloh. "As to the plea of its being no place for a refined lady," Cumming wrote, "I wondered what Miss Nightingale and the hundreds of refined ladies of Great Britain who went to the Crimea, would say to that!"28
When Cumming arrived at a Corinth hotel that had been turned into a hospital, she blanched at the sight. "Nothing that I had ever heard or read had given me the faintest idea of the horrors witnessed here." But she and her sisters in mercy fought down the desire to run away, and went immediately to work. "I sat up all night, bathing the men's wounds, and giving them water," she wrote in her diary. "The men are lying all over the house, on their blankets, just as they were brought in from the battlefield. . . . The foul air from this mass of human beings at first made me giddy and sick, but I soon got over it. We have to walk, and when we give the men anything kneel, in blood and water; but we think nothing of it."29
Cumming and other white women who nursed in military hospitals during the summer of 1862 were volunteers. The official army nurses were soldiers detailed for the purpose (many of them convalescents themselves) and slave "attendants" impressed as cooks, laundresses, and cleanup workers. Some of the white women volunteers were Lady Bountiful types who played at nursing for a few days and then departed. But most rendered valuable service, and thereby overcame the prejudices of many army surgeons who had initially opposed the presence of white women. The medical director of the army hospital at Danville, Virginia, came to prefer women rather than his soldier nurses whom he described as "rough country crackers" who did not "know castor oil from a gun rod nor laudanum from a hole in the ground." In September 1862 the Confederate Congress enacted a law providing for civilian matrons and nurses in army general hospitals, "giving preference in all cases to females where their services may best subserve the purpose."30 A good many white women became part of the official army medical service under this law. They and their volunteer sisters earned the plaudits that, after the war, enshrined their contribution with a halo of lost-cause glory equal to that of Confederate soldiers.31 Many other women
28. Richard B. Harwell, ed., Kate: The Journal of a Confederate Nurse (Baton Rouge, 1959), xii.
29. Ibid., 14, 15.
30. Horace H. Cunningham, Doctors in Gray: The Confederate Medical Service (Baton Rouge, 1958), 72, 73.
31. Two of the most famous Confederate nurses were Kate Cumming and Phoebe Pember. Cumming became matron of an army hospital in Chattanooga after Beauregard evacuated Corinth, and subsequently served as matron a
t various places in Georgia when Sherman's advance forced Confederate hospitals to retreat further and further south. Pember, a native of Charleston who migrated to Richmond in 1862, became the first matron at Chimborazo Hospital. Cummings' journal and Pember's autobiography, published after the war and available today in reprint editions, are valuable sources for the history of Confederate medical services. See Harwell, ed., Kate; and Phoebe Yates Pember, A Southern Woman's Story: Life in Confederate Richmond, ed. Bell Irvin Wiley (Jackson, Tenn., 1959).
who did not go into the hospitals also contributed in a crucial way by organizing soldiers' aid or hospital relief societies throughout the South to provide supplies, services, and money to aid sick and wounded soldiers or their families. These efforts were part of the mobilization of resources for total war in 1862. They projected southern women into public activities on an unprecedented scale and did much to emancipate them from the pedestal of ethereal femininity that had constricted their lives.
Similar experiences befell their northern sisters who, already more emancipated when the war began, threw themselves into the fray with equal energy and in greater numbers. The principal vehicle for their activity was the United States Sanitary Commission. This powerful organization, the largest voluntary association yet formed in a country noted for such enterprises, grew from a fusion of local soldiers' aid societies that had sprung up within days of the firing on Sumter. Women took the lead in forming these associations, drawing upon their sense of commitment and previous experience in societies advocating the abolition of slavery, women's rights, temperance, education, missions, and the like. Elizabeth Blackwell, the first American woman to brave male derision to earn an M.D. (1849), took the lead in organizing a meeting of three thousand women at Cooper Institute in New York on April 29, 1861. Several prominent men also participated in this meeting, which formed the Women's Central Association for Relief to coordinate the work of numerous smaller associations. The initial task of the W.C.A.R. was to establish a training program for nurses—the first such venture in the United States. The W.C.A.R. also became the nucleus of the United States Sanitary Commission.
The "Sanitary," as it came to be called, was inspired by the example of the British Sanitary Commission in the Crimean War. Filth and primitive sanitation had bred disease and infections that had decimated the Allied armies in the Crimea and provoked a reformist response in Britain. A number of American medical men and women wanted to organize a similar commission to alleviate such problems in the Union army. On May 15 a delegation of distinguished physicians (all men) headed by Henry Bellows, a prominent Unitarian clergyman interested in medical problems, traveled to Washington as representatives of the W.C.A.R. and affiliated organizations. This delegation encountered opposition at first from the Army Medical Bureau, whose head (the surgeon general) was an aging veteran of forty-three years in the regular army who wanted no interference by busybody civilians. He also looked with skepticism upon the prospect of female nurses. The delegation went over his head to talk with Secretary of War Cameron and with the president. At first Lincoln could see little use for a civilian auxiliary to the Medical Bureau, referring to such as a "fifth wheel to the coach." But he acquiesced nevertheless, and on June 13 signed the order creating the U.S. Sanitary Commission.32
The Commission's official powers were investigatory and advisory only. But the decentralized, do-it-yourself nature of northern mobilization in 1861 offered an opportunity for a voluntary association to create its own powers. With Bellows as president and the talented Frederick Law Olmsted as executive secretary, the Sanitary did precisely that. It enlisted physicians and other prominent citizens as officers of local affiliates. Seven thousand locals dotted the North by 1863. The national officers and most of the five hundred paid agents of the Commission were men; most of the tens of thousands of volunteer workers were women. They held bazaars and "Sanitary Fairs" to raise money. They sent bandages, medicine, clothing, food, and volunteer nurses to army camps and hospitals. They provided meals and lodging to furloughed soldiers going and coming from the front. Because of the close ties between Commission leaders and the citizen volunteers who became officers of regiments, the Sanitary helped shape the hygienic conditions of army camps despite the continuing coldness of the Army Medical Bureau. "Sanitary inspectors" from the Commission instructed soldiers in proper camp drainage, placement of latrines, water supply, and cooking. Many soldiers paid little attention, and suffered the consequences. Others benefited by improved health from following this advice.
The Sanitary won popularity with soldiers and influence with congressmen.
32. William Quentin Maxwell, Lincoln's Fifth Wheel: The Political History of the United States Sanitary Commission (New York, 1928), chap. 1.
By the winter of 1861-62 it had become a power in national politics. It decided to use this power to attack the Medical Bureau's seniority system which kept young, progressive surgeons down and left the Bureau in charge of men like Surgeon-General Clement A. Finley whose thinking was geared to the somnolent bureaucracy of a 16,000-man peacetime army. "It is criminal weakness to intrust such responsibilities as those resting on the surgeon-general to a self-satisfied, supercilious, bigoted blockhead, merely because he is the oldest of the old mess-room doctors of the frontier-guard of the country," wrote Commission secretary Olmsted in a private letter. "He knows nothing, and does nothing, and is capable of knowing nothing and doing nothing but quibble about matters of form and precedent." Commission president Bellows drafted a bill to enable Lincoln to bypass the seniority system and promote younger men to top positions in the Medical Bureau. Such legislation, said Bellows, "would lay on the shelf all the venerable do-nothings and senile obstructives that now vex the health and embarrass the safety of our troops."33
The army medical establishment fought back against "sensation preachers, village doctors, and strong-minded women" of the Commission.34 But the bill passed on April 18, 1862. It not only suspended the seniority system but also gave the surgeon general authority to appoint eight medical inspectors with power to institute reforms in army procedures. Lincoln immediately appointed the Sanitary's candidate as the new surgeon general: thirty-three-year old William Hammond, a progressive, energetic, strong-willed army surgeon. Hammond's appointment marked the end of an adversarial relationship between the army and the Commission, and the beginning of an extraordinarily productive partnership between public and private medical enterprise. The army turned over several passenger steamers to the Commission, which fitted them up as hospital ships staffed with volunteer nurses for evacuation of wounded from the Peninsula to general hospitals in Washington and New York. The Commission had already proved the value of such a policy by chartering its own hospital boats to evacuate wounded men
33. Olmsted to John Murray Forbes, Dec. 15, 1861, Bellows to Forbes, Dec. 19, 1861, quoted in A. Howard Meneely, The War Department, 1861: A Study in Mobilization and Administration (New York, 1928), 228.
34. George Worthington Adams, Doctors in Blue: The Medical History of the UnionArmy in the Civil War (Collier Books ed., New York, 1961 [1952], 68.
from Shiloh. The Sanitary also pioneered in the development of hospital trains with specially fitted cars for rail transport of wounded.
Surgeon-General Hammond was so impressed by the Sanitary Commission nurses who staffed the hospital ships that he issued an order in July 1862 requiring at least one-third of the army nurses in general hospitals to be women. As early as April 1861 the venerable reformer of insane asylums, Dorothea Dix, had been named "Superintendent of Female Nurses" with rather vaguely defined powers. An assertive individualist whose long suit was not administrative ability, Dix worked in uneasy cooperation with the Sanitary Commission to recruit nurses. By the end of the war more than three thousand northern women had served as paid army nurses. In addition, several thousand women continued to work as volunteers and as salaried agents of the Sanitary Commission.
These were not the only means by which northern
women and men performed medical services in the war. Some worked for other volunteer agencies such as the Western Sanitary Commission (separate from the U.S.S.C.) in the trans-Mississippi theater, or the Christian Commission, founded by YMCA leaders in November 1861 to provide blankets, clothing, books, and physical as well as spiritual nurture to Union soldiers. And some northern women who earned fame as nurses operated pretty much on their own. One of these was Clara Barton, a forty-year old spinster working as a clerk in the patent office when the war broke out. She became a one-woman soldiers' aid society, gathering medicines and supplies and turning up on several battlefields or at field hospitals to comfort the wounded and goad careless or indifferent surgeons. Barton's friendship with influential congressmen helped bring political pressure to bear for reforms in army medicine. Her wartime experiences motivated her postwar crusade for American affiliation with the international Red Cross. Another remarkable woman was Mary Ann Bickerdyke, a forty-five-year old widow from Illinois who began her service in 1861 at the fever-ridden army base at Cairo. A large, strong, indomitable yet maternal woman, she swept through the camp like an avenging angel. She became the gadfly of obtuse officers and the special champion of enlisted men, who fondly named her Mother Bickerdyke. She cleaned up the camps and continued on with Grant's and then Sherman's armies from Fort Donelson to Atlanta. Bickerdyke earned the respect of both of these Union generals; she was the only woman that Sherman allowed in his advanced base hospitals.
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