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... West were spared battlefield relief scandals by the fact that major battles were fought on the banks of rivers, whence wounded arid sick could be evacuated by river boats to Mound City, Illinois, St. Louis, and other cities with general hospitals in the safety and secure supply of the North. After the relatively prompt fall of Memphis, that city became the site of several general hospitals. The evacuating boats, however, might I be maintained by individual states or by the United States Sanitary Commission or the Western Sanitary Commission, which led to confusion. The state boats, especially those from Ohio and Indiana, were so persistent in their "raiding" the evacuation hospitals for Buckeyes and Hoosiers that General Grant had to forbid their removing any patients.
After losing control of their rivers, the Confederates made considerable use of railroads in evacuating men from field hospitals to general hospitals. They had no special hospital cars and felt fortunate when they could use passenger rather than freight cars. They became adept at maintaining dressing and supply stations where wounds could be tended and the patients fed. The Union Army, too, increasingly used railroads for evacuating men north. After the Battle of Chattanooga, a real hospital train was regularly used to move the sick and wounded from Chattanooga to Louisville. Some of the cars were equipped with two tiers of bunks, suspended on hard-rubber tugs.
At the ends of such cars would be a room for supplies and food preparation. The locomotive assigned to this train was painted scarlet, and at night a string of three red lanterns burned on the front. Confederate cavalrymen never bothered this train. The truth was that the military commanders, both Confederate and Union, hated to see fighting soldiers separated from the army; the fear was they would never return. The South was well aware it was fighting a much larger people.
The Union generals were well aware that as the invaders, on the offensive, they needed a majority of the men on the battlefield. They also realized that the deeper they penetrated the South, the greater the number of men needed to garrison important points and to guard ever-longer supply lines. And so there was never an actual separately enlisted and separately trained hospital corps in either army. When Edwin M. Stanton took over as Lincoln's Secretary of War early in 1862, he realized that Dr.
Finley, now a brevet brigadier general, would have to be replaced as surgeon general. Taking the advice of the Sanitary Commission, he appointed William A. Hammond, then a junior assistant surgeon. A Marylander, Hammond had served eleven years as an assistant surgeon before he resigned and became a professor in the University of Maryland Medical School. He was to accomplish many good things and to make many good suggestions during the fourteen months he served as surgeon general. It was obvious to him and to his supporters in the Sanitary Commission that the army needed a group of medical inspectors, chosen for merit and possessing enough rank to give orders to hospital commanders.
It was obvious that the makeshift general hospitals-hotels, warehouses, schools, churches-should be rapidly replaced by pavilion hospitals designed for their function. It was obvious that corps and division hospitals should become official and that something like the Letterman Ambulance Plan should be extended throughout the army. It was obvious that the quartermaster should not be able to remove ambulances nor line officers be able to remove experienced attendants from the medical field details. Eager to educate his department in the best ideas of the time, General Hammond wrote a full length textbook on military hygiene. He brought about the writing of Joseph J. Woodward's admirable The Hospital Steward's Manual.
He gave every encouragement to the many medical societies that had sprung up in the army, ordering that interesting scientific specimens should be forwarded to Washington for inclusion in an Army Medical Museum. He began the collection of what has become the world's largest medical library. Finley and Hammond secured Congressional authority to augment the regular Army Medical Department by several hundred men, first called brigade surgeons, later surgeons of volunteers, a group that contained unusually prestigious doctors. They were used chiefly as staff assistants. As for the increase in regimental surgeons and assistant surgeons, the Medical Department was to have little say.
Higher authority had found it desirable to increase the army by a persistent raising of new regiments rather than by filling up the depleted ranks of the old ones. This maintained the state governors in their unfortunate practices of selecting and commissioning the surgeons and assistant surgeons. The surgeon general could only attempt to reject unfit professionals by extensive use of reexaminations and "plucking" boards. General Hammond felt frustrated. Secretary Stanton leaned heavily on General Henry Halleck for military advice, and this usually supported the ideas of the old regular army medics who were jealous of Hammond, the interloper who had been promoted over their heads from captain to brigadier general.
In addition, Hammond won the enmity of a large proportion of the American medical profession through his banning of the two mercurial's, calomel and tartar emetic, from the army drug table. He may have been correct in his idea that these drugs were being overused, but this seemingly arrogant action lost him the sympathy of many medical colleagues. As a result, Hammond was effectively replaced by Joseph K. Barnes, of the surgeon general's office, in September 1863 - It was almost a year before a court-martial of docile surgeons, although finding him "not guilty" on other counts, did vote Hammond guilty of, "conduct unbecoming an officer and a gentleman. " He had to leave the army. Even where successful, Hammond was only partially so. After the medical inspector bill passed, Secretary Stanton decreed that half the inspectors were to be "political" appointees.
When the ambulance corps bill of 1864 became law, what was essentially the Letterman Ambulance Plan was extended to all the armies. The Army Medical Department was to have the privilege of choosing the enlisted men to be put on ambulance and stretcher-bearer detail, and they could not be withdrawn, but there was still no ambulance corps per se. Confederate Medical Department organization was very much what Surgeon General Moore thought it should be. Congress gave him a considerable body of medical inspectors and hospital inspectors, the former operating within the field armies and the latter in the general hospitals of each state, with the medical director of each state responsible for its hospitals.
There was some debate with the quartermaster general about ambulances, but this was generally over the lack of them. Farm wagons most often constituted the ambulances of the Confederacy. Although Moore had much the same "arrogant" personality traits as did Hammond, he usually obtained prompt obedience to orders rather than conflict. Both armies experimented with "special" hospitals, with admission limited to patients with the same disorders. The Confederates established several venereal hospitals and some ophthalmic hospitals. The Unionists began a venereal hospital at Nashville and the famed neurological hospital, Turner's Lane, at Philadelphia, where W.
W. Keen is believed by some to have founded neurology in America. In contrast, a "general" hospital did not limit its admissions. The sick and the wounded were evacuated to general hospitals so that empty beds could be made available in field installations when a new rush of wounded was expected. Buildings adapted for use as general hospitals were usually considered unsatisfactory because of the inadequate plumbing, the bad ventilation, and the "crowd poisoning" and "mephfluvia" which that generation thought bred and spread disease. Moore and Hammond believed a large building program of pavilion hospitals in 1862 was the answer.
To the best of their abilities both sides carried this out, and followed it by still bigger construction programs in 1863 and 1864. The Union pavilions were longer than their Confederate counterparts. Some were as long as 120 feet, with a width of 14 or 15 feet, with a longitudinal ventilator along the 12 - to 14 -foot roof. This, along with floor ventilation, made the patients too cold and was later closed by wooden slats.
At the inner end, each pavilion, North and South, had toilets, sometimes flush and sometimes, seats over a sloping zinc trough in which water was supposed to run continuously. Reports show that often the water supply was insufficient and that toilets were flushed only after many using's. Frequently the pavilions were built as though they were spokes spreading from a hub. The buildings at the hub were operating rooms, kitchens, offices, pharmacies and supplies, "dead house, " ice house, and other services. The grounds were usually joined by a wooden roadway on which food could be hauled or the wash taken up and delivered by a steam-power...
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