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... d vehicle. The staff, aside from the medical officers and hospital stewards, was mostly made up of the convalescents. They were frequently weak and weary, often snappish and irritable. They did not like the dirty work they performed. They wanted to go home.
The surgeon-in-charge, as the hospital commander was titled, was often in a dilemma. If he returned the patient to his regiment too soon, the man might relapse or die on the road to his unit. If he tried to hold on to the man too long, he might be forcibly returned to his regiment; and if he prevailed upon an inspector to give a medical discharge, he would be losing an attendant who had learned something about his work, and would be forced to rely on a new man who knew nothing. Union and Confederate surgeons-in-charge faced the same problem, although occasionally in Southern hospitals there were hired blacks of both sexes. These people were considered only marginally successful.
Some attempts in the North to use cheap male labor as hospital attendants proved unsatisfactory, the men being undisciplined, a "saucy lot" who even stole from the patients. The brilliant results of Florence Nightingale in cleaning up the Crimean hospitals had been widely noted, with the result that early on it was decided that a corps of female nurses should be added to the army, with Dorothea Dix their superintendent. Miss Dix was widely known as a reformer of jails and as the "founder" of several state mental hospitals. Devoted and hard working, she was disorganized, unyielding in controversy, and deeply in the grip of Victorian ideals of propriety. Allowed to choose the nurses and to set the rules, she announced that her appointees must be at least thirty and plain in appearance, and must always dress in plain, drab dresses and never wear bright-colored ribbons. They could not associate with either surgeons or patients socially, and they must always insist upon their rights as the senior attendants in the wards.
It was not long before outraged surgeons virtually went to war with Miss Dix's nurses, frustrating them, insulting them, trying to drive them from the hospitals. These were strong-minded middle-class American women, accustomed to ruling within the home and to receiving the respectful attention of their husbands and male acquaintances. For the most part they had no nursing training. The surgeons complained that they often substituted their own nostrums for the drugs prescribed and that they sometimes were loud and interfering when attempting to prevent amputations. As time passed, younger and less self-righteous nurses began to appear in the army, furnished by the Western Sanitary Commission or some other relief agency. Some surgeons learned to suppress their male-chauvinist behavior.
In September 1863, the War Department approved a new nurse policy that, although ostensibly a victory for Miss Dix, really defeated her. Under this edict, hospital commanders could send away Dix-appointed nurses but were forced to accept Dix-appointed replacements unless the surgeon general authorized the appointment of someone the surgeon-in-charge preferred. The surgeon general was always willing. In fact, the female nurses were much liked by the patients and were not so much nurses as mother-substitutes. They wrote letters for their "boys, " read to them, decorated the wards with handsome garlands, and sometimes sang. Both armies used small contingents of Catholic nuns in certain general hospitals.
They came from the Sisters of Charity, the Sisters of St. Joseph, the Sisters of Mercy, and the Sisters of the Holy Cross. Having been teachers, some lacked previous hospital experience, but surgeons liked them because they had been bred to discipline. The patients liked them too, but called them all Sisters of Charity. Hospital food improved perceptively when women matrons took over the supervision of kitchens.
These women came from various sources, many supplied by the United States Christian Commission, a large organization that donated delicacies to hospitals but considered the saving of souls, by passing out religious tracts, its principal mission. Because of the great fame of Clara Barton, and some women like her, an impression prevailed that women functioned in hospitals in the field. This was seldom the case. Miss Barton might best be described as a one-woman relief agency. However, the strong-minded but winning "Mother" Mary Ann Bickerdyke became so popular that in 1864 General W. T.
Sherman officially appointed her to his own corps hospital. Women could be found serving in various ways in Confederate hospitals, too, but the bulk of them were hired black cooks and washerwomen. In the conservative South there was a widespread feeling that a military hospital was no place for a lady, Only in Richmond were there significant numbers of women working in the city's many hospitals. Richmond was indeed the hospital center of the Confederacy, with twenty hospitals in 1864 after many of the makeshift type had been closed and replaced by pavilion structures. The queen of them was Chimborazo, which had beds for 8, 000 men and was often called the largest hospital on the continent. It was organized into four divisions, each with thirty pavilions.
There were also five soup houses, five ice houses, "Russian" baths, a 10, 000 -loaf per day bakery, and a 400 -keg brewery. On an adjacent farm the hospital grew food and grazed three hundred cows and several hundred goats. Almost as amazing was Jackson Hospital, which could care for 6, 000 patients in similar ways. Elsewhere than Richmond, general hospitals were neither so large nor so grand, but there were many of which the Confederates were proud.
By late 1864 there was a total of 154 hospitals, most located close to the southern Atlantic coast. They began to close down, often because of enemy action, early in 1865. Washington and its environs was the natural hospital center of the Union Army because of its proximity to major battlefields. This proved unfortunate because the city had always been considered a sickly place, chiefly because of the large open canal that stretched across town and into which much sewage was dumped.
Also, the metropolitan community had many standing pools in which anopheles mosquitoes bred. The intestinal disease and malarial rate of the hospitals were a natural result. At the end of 1861 Washington had only 2, 000 general hospital beds. The great slaughters of the Peninsular campaign, with the Second Battle of Bull Run immediately after, followed shortly by Antietam, flooded the hospitals of the Washington area and Baltimore and Philadelphia as well. Adaptation went so far as converting the halls of the Pension Office, with cots among the exhibitions, the Georgetown jail, and the House and Senate in the Capitol.
From August 31 to the end of 1862, 56, 050 cases were treated in Washington. Many of these adaptations were closed in 1863, replaced by modern pavilion hospitals. At the end of 1864 the city contained sixteen hospitals, many of them large and fine. There were seven at nearby Alexandria and one each at Georgetown and Point Lookout, Maryland.
Outstanding was Harewood, said to resemble an English nobleman's estate, with professionally landscaped grounds, flower gardens, and a large vegetable garden. Its building consisted of fifteen large pavilions with appropriate service buildings and some tents. The Western showpiece was Jefferson Hospital at Jeffersonville, Indiana, just across the river from Louisville. Built in the winter of 1863 - 64 with 2, 000 beds, later increased to 2, 600, at war's end it had plans for 5, 000 beds. Its most interesting architectural feature was a circular corridor 2, 000 feet long from which projected twenty-four pavilions, each 175 feet long.
By the last year of the war there were 204 Union general hospitals with beds for 136, 894 patients. This proved to be the maximum. In February 1865 the United States began closing down its hospitals. The many men and women, North and South, who served in the hospital and sanitary services during the war were justly proud of their achievements. The morbidity and mortality rates of both armies showed marked improvement over those of other nineteenth-century wars, particularly America's last conflict, the war with Mexico. In that war go percent of the deaths were from non battle causes.
In contrast, in the Civil War some 600, 000 soldiers died, but in the Union Army 30. 5 percent of them died in or from battle, and in the Confederate Army the percentage ran to 36 - 4. Clearly, the physicians and sanitarians had held down the disease mortalities to levels that their generation considered more than reasonable. Better, they made some few halting strides in treatment and medication, and considerable leaps in the organization of dealing with masses of wounded and ailing soldiers. It was a ghastly business for doctors and patients alike; yet without the medicos in blue and gray, much of the young manhood of America at mid century might not have survived for the work of rebuilding. Source: The National Historical Society's The Image of War: 1861 - 1865 Volume IV "Fighting For Time" article by George W. Adams
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