When members of the Sixth Massachusetts Regiment injured in the Baltimore riots on April 19 arrived in Washington, DC, later that night, they had nowhere to go. The Medical Bureau maintained a few army post hospitals in frontier states; the largest of them, located in Fort Leavenworth, Kansas, had forty beds. But there were none in the eastern states. The Quartermaster Corps, an independent department of the army, had refused to build hospitals in anticipation of the pending war on the grounds that “men need guns not beds.”2 With neither hospitals nor barracks available, the members of the Sixth, injured and uninjured alike, slept on the carpeted floor of the Senate chambers that night. The coming months would prove that men needed beds as well as guns.
The camps housing the new recruits were crowded and filthy, a cross between a garbage dump and a cesspool. Water was scarce, making it difficult for soldiers to keep themselves clean. Many gave up. As one surgeon noted, “It was a common subject of remark that men who, but a few weeks before, occupied positions in society demanding cleanliness and care for personal appearance, now disregarded it, and either from apathy or laziness neither washed their persons nor the clothing they carried upon them.”3 By June 1861, 30 percent of the army was on sick call as a result of outbreaks of infectious diseases, most notably typhoid and dysentery, both closely associated with poor sanitation.
In order to cope with the crisis of illness and minor injury among the first recruits, the Medical Bureau requisitioned buildings throughout the Washington area, primarily hotels and schools, for use as general hospitals. Many of them were run down, and most suffered from inadequate ventilation and poorly designed toilet facilities, which aggravated rather than ameliorated the problems of disease.
The largest of the Washington hospitals was the Union Hotel, where Louisa May Alcott worked in her brief stint as a Dix nurse. The hospital opened on May 25, 1861, and was soon infamous for its poor condition and worse smells. After the military and medical debacle of Bull Run, Cornelius R. Agnew and William H. Van Buren assessed the condition of the hotel for the United States Sanitary Commission. Their report, dated July 31, 1861, was negative but restrained:
The Union Hotel Hospital, Georgetown, was occupied as its name implies, until recently hired for its present use. It is considered capable of accommodating 225 patients, and at present contains 189. It is well situated, but the building is old, out of repair, and cut up into a number of small rooms, with windows too small and few in number to afford good ventilation. Its halls and passages are narrow, tortuous and abrupt, and in many instances with carpets still unremoved from their floors, and walls covered with paper. There are no provisions for bathing, the water-closets and sinks are insufficient and defective and there is no dead-house [a room or structure where dead bodies could be stored before burial or transportation—a grim necessity in a Civil War hospital]. The wards are many of them over-crowded and destitute of arrangements for artificial ventilation. The cellars and area are damp and undrained, and much of the wood work is actively decaying.4
Alcott, who would satirize the Union Hotel Hospital as Hurly-Burly House in Hospital Sketches (1863), a fictionalized account of her nursing experience, gave a more pointed description of conditions in a letter dated January 1863:
The air is bad enough to breed a pestilence; and as no notice is taken of our frequent appeals for better ventilation, I must do what I can. Poke up the fire, add blankets, joke, coax, and command; but continue to open doors and windows as if life depended upon it. Mine does, and doubtless many another, for a more perfect, pestilence-box than this house I never saw,—cold, damp, dirty, full of vile odors from wounds, kitchens, wash-rooms, and stables. No competent head, male or female, to right matters and a jumble of good, bad and indifferent nurses, surgeons and attendants, to complicate the chaos still more.5
The hospital would be closed in May 1862, reopened in July 1862 to accommodate the heavy casualties of the Seven Days’ Battles, and closed for the last time in March 1863, when its patients were transferred to other, less dangerous, hospitals in the vicinity.
It is not surprising that the Medical Bureau’s first attempts at creating hospitals would be improvised on the cheap. Surgeon General Lawson’s twenty-five years as the bureau’s head were shaped by the need to make the best use of the minuscule budgets allotted to the medical service of the peacetime army. As he wrote to Zachary Taylor, then commander of American forces in Florida, “Finery and furbelows cannot be tolerated in field hospitals or other sick stations.”6 Certainly there were neither at the Union Hotel Hospital. Lawson’s successor, Clement A. Finley, also spent many years managing with limited resources and did not grasp the magnitude of the problems facing the army after the fall of Fort Sumter. He reported with pride that the Medical Bureau spent less than it had been allocated for the fiscal year ending June 30, 1861.
His pride was misplaced. The first major battle of the war, fought only twenty-one days later, on July 21, 1861, found the medical service, like the rest of the United States Army, unprepared.
“The Great Skedaddle”
General Irvin McDowell was certain his army was not yet ready to take the field, but the political pressure to do so was strong. Many of his men were three-month volunteers who had signed up after the fall of Fort Sumter: untested troops who had never taken a long march, let alone experienced combat. But their discharge date, and the end of President Lincoln’s estimate of a ninety-day war, was rapidly approaching. On July 16, 1862, McDowell led the Army of the Potomac out of its mired and disease-ridden camps outside Washington, DC, and marched them toward Centerville, twenty-seven miles to the southwest, where the Confederate army was encamped under the leadership of General Pierre G. T. Beauregard, the commander who had taken Fort Sumter in April. Their behavior as they marched confirmed McDowell’s fears, and he later complained, “They stopped every moment to pick blackberries or get water. They would not keep in the ranks, order as much as you pleased.”7
McDowell’s uncertainties about the abilities of his newborn army were not widely shared. On July 21, a sweltering day by anyone’s standards, hundreds of Washington civilians, including two senators, at least fifty reporters from Northern newspapers, and what one Confederate observer described as “gay women and strumpets,”8 packed picnic baskets, opera glasses, and bottles of champagne and drove out from the nation’s capital to the Virginia city of Manassas so they could cheer the Union soldiers on to victory, as if the coming battle were a match between opposing baseball teams. Instead of victory, they watched the defeat and subsequent rout of the Union forces from their carriages.
For the first few hours of the battle, the popular confidence in McDowell’s troops seemed justified as outnumbered Confederate forces retreated before the 35,000-man Army of the Potomac. (The New York Times was so certain of victory that its headlines proclaimed the battle won before it ended: CRUSHING REBELLION, THE GREATEST BATTLE EVER FOUGHT ON THE CONTINENT… THE REBELS ROUTED AND DRIVEN BEHIND THE MANASSAS LINES.9)
In midafternoon, the battle turned against McDowell when Confederate reinforcements, among them a brigade of Virginians commanded by Thomas J. (soon to be “Stonewall”) Jackson, reinforced the collapsing Confederate line. According to later reports in the Richmond newspapers, Jackson told General Barnard Bee, who led a Confederate brigade at Bull Run, that he would stop the Union advance with bayonets if necessary. Bee then called out, “Oh men, there are Jackson and his Virginians standing behind you like a stone wall! Let us determine to die here, and we will conquer, follow me.” The sight, and sound, of several thousand screaming Virginians bearing down on the Union line changed the course of the battle. What began as an orderly retreat turned into a rout as the inexperienced Union soldiers panicked. Men became separated from their units and their officers, and soon the fleeing soldiers became tangled with the equally panic-stricken spectators. The Saint Paul Daily Press told its readers that the retreat was “horrible to look upon. Congressmen and gentlemen politicians, hurrying from th
e scene of danger; ambulances, wagons, wagon and artillery horses, with harness and from one to three men on their backs; the worn out and fatigued soldiers, many having lost or thrown away their guns and knapsacks, bare footed, bare headed, and some nearly naked, having their clothes literally torn off from them in hand to hand fights, with hands torn to pieces, arms broken and any quantity of flesh wounds, all winding their way, with heads down and as silent as mutes; none with comrades.”10
The Southern press simply dubbed the retreat “The great skedaddle.”
The final count of Union casualties: 750 killed, 2,492 wounded, more than 1,500 missing, and an incalculable loss of confidence.11
No Plans
The experience of the wounded and injured in the aftermath of the battle made the defeat worse. Unable to imagine the scale of the coming devastation, the Union’s Medical Bureau provided few medical supplies, made no provision for field hospitals, and made no plans for evacuating casualties. The Confederate army did no better.
Eventually the Union army would have more than eleven thousand doctors on its payroll, but at the beginning of the war the Medical Bureau staff consisted of thirty surgeons and eighty-six assistant surgeons, who had learned their trade in the army’s seventy-nine frontier outposts and the Mexican-American War. Some were too old to be fit for active service. Twenty-four of them resigned shortly after the fall of Sumter to join the Confederate army. Three more were dismissed for disloyalty. Those remaining were assigned to positions as medical directors. The experienced military doctors serving at the frontier posts were called back east over the summer of 1861, their places taken over by civilians for the duration of the war.
Some two hundred new medical officers joined the army between April and June. These volunteer physicians varied in their medical expertise. Few were surgeons, and none had experience in the realities of battlefield medicine. Some of them were not even doctors. Medical student William Williams Keen, who later became a professor of surgery at Jefferson Medical College in Philadelphia and was the first surgeon to successfully remove a brain tumor, reported that he was recruited by his mentor, John H. Brinton, an experienced brigade surgeon, to replace a man named Smith whom the state authorities had appointed as assistant surgeon for the Fifth Massachusetts. When Keen argued that he knew little as yet about medicine and nothing about military medicine, Brinton answered, “That is quite true. But on the the other hand, you know a great deal more than Smith.”12
In addition to the question of battlefield experience, professional army doctors were also divided from the volunteer physicians by the matter of military protocol. According to one observer, there was no one available to teach new surgeons in the volunteer regiments either the technical aspects of battlefield medicine or the protocols of military service. Accustomed to working alone in their civilian practices, and with no sense of why these things might be important, volunteer surgeons were apt to disregard both as “a species of red-tapeism, to be discarded by men of energy.”13 Later in the war, surgeons, military and otherwise, would complain about the same attitude on the part of volunteer nurses, who came to the task with neither medical nor military backgrounds and a tendency to sidestep the rules of both when they deemed fit.
The elderly and inflexible bureaucrats unable to imagine large-scale warfare and the inexperienced volunteer force faced their first major battle together at Bull Run.
Medical Care at the First Battle of Bull Run
On July 21, William S. King, twenty-four-year veteran of the Medical Bureau and medical director of the Army of the Potomac, rode alongside General McDowell on the field at Bull Run. By his own account, “My impression at the commencement of the battle was, that there would be a brisk skirmish, and then the rebels would most probably fall back and take up a new position.” Consequently, he did not coordinate assignments for the mass of volunteer physicians. He provided no guideline for treating battle wounds, something most civilian doctors had no experience with. And he arranged neither evacuation plans nor hospital arrangements for the wounded after the battle, assuming that each regiment’s surgeon would be responsible for the men under his care. Several hours after the battle began, thinking “it would be a small task… to make a list of the killed and wounded,” King set out, notebook in hand, to count the number of each.14 On the ground around him, men lay torn and mangled: legs, arms, and bodies crushed and broken. Those who were able waved their arms and cried for help. One soldier had his face completely shot away. Some had been felled by sunstroke and exhaustion rather than enemy fire. The ground below them all was soaked with blood.
As his count of the dead approached one hundred, King realized how desperate the battle was. He directed his assistant David Magruder, who had remained behind at McDowell’s field headquarters as King’s liaison, to send out the ambulances as quickly as possible and then go to Sudley Church, which was nearby and out of the line of fire, to set up a field hospital for the wounded. King then rolled up his sleeves and worked alongside his field surgeons to tend the wounded, leaving Magruder to create hospitals out of sows’ ears.
Magruder did his best to prepare the field hospital at Sudley Church. His men removed the church’s pews, gathered hay from nearby fields to make bedding, covered the floor with blankets, and brought in buckets of water. By midafternoon, several regimental doctors, including William Keen, medical student turned assistant surgeon, arrived at the hospital, ready to treat the wounded men from their regiments as the ambulances unloaded them. Within two hours, the improvised hospital overflowed with the wounded and dying. Magruder then commandeered three nearby buildings. When they too were full, he ordered the wounded to be placed under the trees of an apple grove near the church. The doctors performed amputations in the open, visible to those with minor injuries and to those waiting for their turn with the scalpel and the bone saw. Keen quickly realized that the doctor he was assisting had never performed surgery and had little knowledge of the anatomy of the upper arm; Keen talked him through the operation, telling him where to cut and sew to keep the patient from bleeding to death. According to one eyewitness account of Sudley Church, a volunteer staff officer from Massachusetts, “Blood trickled from the ambulances like water from an ice cart, and directly in front of the church door was a large puddle of blood.”15
Sudley Church was not the only makeshift hospital on the field. Regimental surgeons everywhere did their best to improvise shelter for the men in their care. The surgeon of the First Connecticut, showing more forethought than many of his fellows, commandeered a four-room house near the battlefield and ordered the regimental band to follow their comrades onto the field and retrieve the fallen. Another regiment took over a two-and-a-half-story stone house on the Warrenton Turnpike, so close to the battlefield that shells smashed into its walls as the surgeons worked.
Every improvised hospital was a scene of carnage. As a reporter from the New York Daily Tribune described the scene at one, “Men, dying and just dead, covered the floor, and filled the rear yard with frightful misery. Civilians and soldiers had turned surgeons, and were amputating and binding up the limbs of the wounded.”16 An eyewitness at another field hospital made no attempt to hide his horror: “The rooms were crowded, and all around on the green sward were men mortally wounded… They lay so thick around that I could hardly step between them, and every step was in blood… I gave them what little assistance I could, until becoming faint and sick, I was compelled to leave.”17
Reading these accounts, it is hard to remember that the wounded soldiers who made it to Sudley Church and its counterparts were the lucky ones. More than a thousand wounded men were left on the battlefield. Some, bloodied and often shoeless, managed to walk the twenty-five miles to Washington in search of aid. More lay helpless where they fell, without water or shelter, their suffering made worse by a cold rain that began falling early on the morning of July 22 and continued for two days. It was several days before King organized ambulances, or at least a ragtag assortment of car
ts and wagons, to find the wounded and transport them to Washington. It was a difficult task, made harder by the fact that the Confederates commanded the field. Many men died before help arrived.
The Medical Bureau had introduced ambulances for the first time only two years before the war. Bull Run was their first serious trial run, and it revealed glaring problems not only in their distribution and use but also in the design itself. An army board had recommended four-wheeled ambulances, which had been tested with some success on expeditions in the plains. They were difficult to load and their springs were stiff but still luxurious compared to the standard army wagon. Unfortunately, the Quartermaster Corps ignored the board’s recommendations and decided on a two-wheeled vehicle designed by Clement Alexander Finley, two years before his promotion to surgeon general. When the war began, the only field test the Finley design had undergone was use as a carriage for pleasure jaunts by officers and as light trucks by the Quartermaster Corps. Working under the untested assumption that the two-wheeled ambulances were superior for transporting seriously wounded men, the Quartermaster Corps issued four times as many of them as the four-wheeled design.
Their performance at Bull Run demonstrated that the design was fundamentally flawed. Nicknamed “the avalanche” by the sick and wounded who traveled in them, Finley ambulances consisted of two removable stretchers with a chassis that rested on four elliptical springs. Flimsily constructed of light-weight wood, they were prone to breakdowns. Worse, they proved to be excruciating for wounded men to ride in. Soldiers would scream in pain as they rode and beg to be let out.
Heroines of Mercy Street Page 4
