CWL---The Civil War's Women Nurses: Humanitarian. Moral. But Professional?

The Inhospitable Hosptial: Gender and Professionalism in Civil War Medicine, Jane E. Schultz, Signs: Journal of Women in Culture and History, 17:2 [1992], pp. 363-392.

The enthusiastic embrace by women of the benevolent organization, especially those focusing upon the health concerns of soldiers, was remarkable during the American Civil War. In the hospitals of the Union and the Confederacy, 20,000 women served. Enslaved and free black women, upper class white widows, farm women, and others served as nurses, matrons, cooks and laundresses provided paid, forced, and unpaid labor. Schultz's review of several hundred published and archived diaries, memoirs and letter collection reveals that female nursing evolved during a trend of increasing medical professionalism which was guided by men. (364-365)

In military hospitals, personal interactions of brought forth coping strategies by women. Their avoidance of the 'medical models of professionalism was a protest against male authority' that after the war were embraced. After the war in hospital training schools placed nurses at the bottom of the hierarchy. Obedience and discipline were principles were emphasized in the curriculum. Dissent and protest was not encourage among nursing students. Schultz focuses not on the post-war emerging professionalism of nursing, but the behavior of nurses that emerged as conflicts arose between male surgeons and female attendants regarding corruption, bureaucratic inhumanity and morality in Civil War hospitals. (365-366).

Between June 1861 and October 1863, Dorothea Dix appointed 3,200 women to nursing positions. In October 1863, the surgeon general allowed surgeons to appoint nurses. Frequently chosen by surgeons were Catholic nuns who would not be paid and required very little in regard to housing. Vows of poverty and self-sacrifice along with experience in asylums and orphanages seemed to suit the nature of nursing as it was recognized by doctors. Female U.S. Sanitary Commission agents at time assumed nursing duties on hospital transport boats and ships. The Union paid female nurses 40 cents a day and one ration. Cooks and laundresses earned between six and ten dollars a month. (336-367)

Untypical but noteworthy are Esther Hill Hawks and Mary Edwards Walker, both educated by medical colleges. It was inconcievable for a women to have military rank yet both performed service. Hawks tended to black federal soldiers in South Carolina and Walker performed emergency medical services at Fredericksburg in December 1862 and later Chickamauga in September 1863. The Confederacy established a pay scale for female nurses, yet it appears that most Confederate nurses provided temporary and unpaid services. (368-369)

Nurses' duties consisted of keeping clean patients with their beds and clothes, preparing and serving food and perscriptions ordered by the surgeon, and writing for and pass time with them. Military hospitals were plagued by cascading issues. Chief among was the issue of relating the early 18th century mindset of allopathic medicine to the emerging mid-19th century mindset of homeopathic medicine. Additional issues included military rank, hospital inspectors, medical competency examinations and graft among vendors and quartermasters. (370-373)

Women entered situations in which 'status anxious' poorly supplied and trained surgeons. These doctors declared that the best service to be done by women be at the bottom of the chain of command. Ratios of doctors to patients, nurses to surgeons, male nurses to female nurses created difficult situations particular to the size of the hospital. Schultz believes the small hospital homes of Richmond held fewer bureaucratic dilemmas than the larger general and pavilion hospitals like Chimborazo in Richmond. The post-war memoir by Phoebe Yates Pember reveal this. Jane Stuart Woolsey, a nurse at Washington DC hospital offered a similar reflection on her experience. (373-374)

Image Source: Civil War Nurses

CWL---When Nerves Are Literally Shot: Phantom Pain From Gunshot Wounds

"The Firm: Mitchell, Morehouse and Keen and Civil War Neurology", D. J. Canale, pp. 127-141 with notes in Years of Change and Suffering: Modern Perspectives on Civil War Medicine, James M. Schmidt and Guy R. Hasegawa, editors, Edinborough Press, 2009, $29.95 (hardcover), $13.95 (paper).

As in the case of post-traumatic stress syndrome in Civil War veterans, brilliant and hardworking individuals bring forth a new medical approach to phantom pain and sensations from amputated limbs. Silas Weir Mitchell and co-workers George R. Morehouse and W.W. Kean birthed the American study of neurology. At the outbreak of the war Mitchell declined a commission as a brigade surgeon due to family obligations including assuming his father' medical practice. In a year's time, Mitchell was serving as a contract surgeon at the Filbert Street Hospital in Philadelphia. Recognizing the experience as a unique opportunity to produce scholarly research as well as heal wounded soldiers, Mitchell pursued patients with diseases and injuries to the nervous system.

George Read Morehouse, a colleague of Mitchell, was assigned in 1863 to the Christian Street Hospital and W. W. Keen was assigned to assist Mitchell after Keen served as an assistant surgeon during the First (1861) and Second (1862)Manassas campaigns. Like several other medical discoveries during the Civil War, neurology was developed by the concentration of medical talent in Philadelphia. As the three migrated to the new 400 bed Turner Street Hospital in Philadelphia, it became the first hospital in the United States to develop treatment for neurological injuries and disorders.

The first hand observation of nerve injuries inflicted by gunshot wounds led to a classification system: the pain, paralysis and loss of sensation related to reflex paralysis, causalgia (burning sensation in attached limbs), malingering (feigned symptoms) and the perception that a missing limb is still attached. By 1864 the team wrote and published ground breaking Gunshot Wounds and Other Injuries of Nerves.

The six classifications of injuries to nerve trunks were founded upon detailed case students with the full cooperation of the afflicted soldiers. Self-reporting by articulate suffers and improvement in interviewing techniques of physicians allowed for a breakthrough in interpretation of trends found in case studies. From the 1854 Surgery (Eichsen edited by Briton), the 1861 System of Surgery (Gross) and the 1862 Treatise on Gunshot Wounds (Longmore), Mitchell and colleagues found that there was not therapy for the repairing of damaged nerves.

They successfully explored the degeneration and regeneration of served nerves and the possibility of suturing of divided ends of nerves. Reflex paralysis instigated by shock to nerves or the spinal cord and causalgia (burning sensation) brought about severed and damaged nerves were found to exist in patients. A systematic and thorough interview and collection of information from other soldiers weeded out malingers who feigned pain and disability to avoid duty. Though not systematically studied, data was collected on phantom limb sensation. Mitchell speculated on the phantom limb pain in his noteworthy, in literary terms, short story The Case of Georg Dedlow published in 1866 in the literary magazine The Atlantic .

Mitchell succumbed to exhaustion and withdrew from medicine for 1864, but during the year he travelled to Paris to consult with physicians also studying neurology. With the closing of Turner's Lane Hospital in June 1865, the team broke apart though they worked in Philadelphia at different practices. Mitchell, Morehouse and Keen continued their pioneering work throughout the rest of the 19th century with Mitchell also gaining notoriety for his short stories. Their systematic collection of data, their consistent use of interviewing methods, their collection of patient generated descriptions allowed them to advance neurology and the treatment of gunshot wounds. Surgeons in both World War One and World War Two relied on their discovers and conjectures.

Top Image: Images of Surgery

CWL: Speaking On Civil War Medicine at CWRT

Recovery From Battle Wounds Often Tortuous In 1860s, Les Harvath, Pittsburgh Tribune Review, August 9, 2009

Phantom limb syndrome, post-traumatic stress disorder, facial reconstruction and brain and eye surgery all are the product of a battlefield. The first concerted response to such wounds occurred during the Civil War in the United States. "This was a time before doctors used microscopes, before they understood germs. Many of their practices would be appalling by today's standards, but this is what they had to work with," said Rea Andrew Redd, who will be the featured speaker at the Civil War Roundtable Aug. 13, in the Kara Alumni House at California University of Pennsylvania.

During Redd's address, "Gangrene and Glory: Medical Care During the American Civil War," he will provide an overview of medical practices and advances made and detail the work of a Federal regimental surgeon. "Actually, the Civil War turned into a complete medical laboratory," Redd said. "Doctors had an abundance of bodies to which they could apply their medical studies of the skeletal, muscular, and circulatory systems. In addition to being able to study aspects of brain and eye surgery due to soldiers' wounds, other wounds exposed the inner workings of the bones, the stomach, or other organs, enabling doctors to advance their knowledge of the human body."

Redd, director of the Eberly Library at Waynesburg University and an adjunct instructor in history, brings an impressive Civil War resume to the roundtable: He made a 20-minute movie about journalism in the Civil War for the New York Times Web site and has performed at living history events at Gettysburg, Antietam and Harper's Ferry National Parks. The speaker said he has read volumes about the Civil War, but developed an initial interest in the conflict as a pre-schooler while perusing pictures in his older sibling's history books. His interest was so strong that his family claimed he had a Civil War gene in his DNA makeup.

Two members of his immediate family, Samuel Redd and George Redd, were members of Company C, 140th Pennsylvania Infantry, Second Corps, Army of the Potomac. Both fought at Gettysburg and survived the war. Distant cousins from Virginia and Alabama fought for the Confederacy, providing significant fodder for interesting discussions at family reunions. To further his interest, Redd began to participate as a Civil War reenactor in 1993, with Company A, Ninth Pennsylvania Reserves. "At that time, the movie 'Gettysburg' was out, as was Ken Burns' Civil War series, and the tide was right," said Redd, 57, who resides in McMurray. "I found a group in its 12th year as reenactors, joined, and the group is still thriving."

As a reenactor, Redd serves in the Union infantry, portraying a captain of medical services with the U.S. Signal Corps. He may drop rank to an infantry private or corporal or, as color sergeant, carry the regiment's colors. "Even though a popular school of thought is that medicine in the U.S. was inferior to that on the European continent during the mid-nineteenth century, that's not the case," he said. "Medical science in the United States at the time was as advanced and comparable to medicine being practiced in Europe.

"There was talk about phantom limb syndrome and post-traumatic stress syndrome even during the Civil War era, plus there was even facial reconstruction occurring toward the end of the conflict. With photography rapidly developing, doctors were able to photograph many stages of surgery. Advancements in reconstructive surgery developed to the point where a soldier's jaw was rebuilt over period of three years' time."

During the Civil War, there were appalling numbers of casualties accompanied by simultaneous and incredible medical discoveries, Redd noted. Because synthetic medicines were still non-existent, medicine was all herbal. After the war, he said, the discovery of vitamins would change the face of medicine. "As of 1862, there was plenty of chloroform for anesthetic purposes, and huge government contracts were awarded for its manufacture," he said. "As a result, the pharmaceutical industry was birthed during the Civil War."

Chloroform was administered through a copper funnel with a sponge at the end; a soldier inhaled the chloroform before the operation. There was no shortage of chloroform during the war, in the North or South, and there was enough even on the battlefield, as long as supplies arrived with the troops. On those bloodied and corpse-strewn battlefields, the wounded received what medical care was available. Surgeons frequently wiped a knife, thick with blood following an operation, on their clothing, only to reuse that same surgical tool on the next patient.

Northern medical personnel developed the use of the ambulance to remove the wounded from the battlefield, to perhaps a farmhouse two miles from the battlefield, which was where physicians performed amputations. Physicians, Redd noted, also speculated about blood transfusions, about getting new blood into a wounded soldier, but how was the question that puzzled them.

Gangrene, the death of soft tissues leading to a loss of blood supply, was another problem frustrating doctors on the battlefield. Wounded soldiers faced chronic blood poisoning, and there were no X-rays to determine precisely what damage wounds caused, whether from wool (uniforms), leather or buttons, which often shattered and spread throughout wounds. This lead to gangrene and often forced multiple amputations.

Amputation of a foot did not necessarily stop the spread of infection but resulted in amputation of a leg below the knee. However, infection would often lead to an entire leg being amputated, and the spread of gangrene often resulted in death, many times in a matter of days. Redd points to numerous advancements during the war. For the first time, dried vegetables were used to feed troops, and the first canned milk was sent to soldiers. "That canned milk, or bottles of milk, along with a little whiskey, often saved a soldier's life," he said.

Redd's historical anecdotes have been related to middle- and high-school students, for historical societies, and at Soldiers and Sailors Museum in Pittsburgh. Redd has put on a stove-pipe hat to perform as Abraham Lincoln for schools and historical societies and at the Allegheny Cemetery. "Everything about the Civil War comes together, from the reenactments to historical research and stories," he said. "This is something I grew up with, and I enjoy sharing my stories with anyone who will listen." Redd has a Civil War blog at www.civilwarlibrarian.blogspot.com.

Text Source: Pittsburgh Tribune Review, August 9, 2009