Friday, May 14, 2004

When the poet Walt Whitman arrived in Washington in 1862 to help care for his brother George, who was wounded at the blood bath known as the Battle of Fredericksburg, he described the scene as the “marrow of tragedy concentrated in those hospitals.”

After his trip just before Christmas to the Falmouth, Va., camp for his first visit with his brother, Whitman wrote:

“Spent a good part of the day in a large brick mansion, on the banks of the Rappahannock, used as a hospital. … Out doors, at the foot of a tree, within ten yards of the front of the house, I notice a heap of amputated feet, legs, arms, hands, &c., a full load for a one-horse cart. Several dead bodies lie near. … The large mansion is quite crowded. … Everything impromptu, no system.”

Despite the chaos and the horrors, Whitman continued his nursing in Washington until the end of the Civil War.

Another battlefield nurse was Clara Barton, who went on to found the American Red Cross in 1881. Her compassionate care paralleled Florence Nightingale’s work for the British army during the Crimean War. Out of the mayhem of the Civil War came the beginnings of the current medical services now caring for the men and women in the U.S. military, once again serving in harm’s way.

Though there was an emerging medical sophistication at the start of the Civil War, the United States was not equipped to deal with either the severity or the number of casualties produced by a conflict being fought to the death concurrent with a deteriorating public-health situation. And if this was the case in the North, it was more so in a blockaded and increasingly isolated South.

At the start of the Civil War, the United States had about 40 medical schools and six schools of pharmacy. Advances were made in the treatment of traumatic wounds with the establishment in 1820 of the U.S. Pharmacopeia — a private, voluntary, nonprofit health care organization that established standards for care and a database of medicines and techniques; introduced ether in 1846; and formulated blood-pressure measures in 1860.

But most of the hospitals receiving the flood of casualties were makeshift. Amputation was a common surgery, the ambulance system was underdeveloped, and triage was generally an untested concept. It was an era in which there were no shock-fighting anesthetics or infection-battling antibiotics, and there were few surgical instruments. Surgery was undertaken only to save a life. Whitman described a gangrenous New Hampshire soldier as a man “sure to lose three toes.”

This “heroic era of medicine” is so called because some medical practitioners still relied on an understanding of the four body humors (or fluids) to explain illness. The four body humors were blood, phlegm, yellow bile and black bile. Symptoms were often described in this context.

Most medicines were considered alleviative; few cured what ailed. They were ground from natural products — roots, seeds, barks, minerals. They were administered in the form of brewed teas, syrups, emulsions, powders for pills or as ointments. A New Jersey soldier stricken with pneumonia told Whitman of his “desire for good, strong, green tea.”

Many patent medicines contained opium and morphine. A tincture was probably 20 percent alcohol. Whiskey and morphine were used as painkillers. Whitman remembered a Pennsylvania cavalryman shot in the foot as needing “to be constantly dosed with morphine.”

Whitman also told of a wounded New York soldier “low with chronic diarrhoea.” About 620,000 soldiers died in the Civil War, nearly two-thirds of disease, not wounds.

Diarrhea was a common camp disease. It is often associated with dysentery, typhoid and other infectious diseases. Debilitating, dehydrating outbreaks stemmed mostly from poor sanitation, including contaminated water supplies.

“Sweeping the eye around down the river toward Alexandria, we see, to the right, the locality where the Convalescent Camp stands, with its five, eight, or sometimes ten thousand inmates,” wrote Whitman.

Union-held Alexandria was a hospital town with more than 30 military-related facilities. In 1865, it had “not a single sewer.” All the filth drained into gutters and eventually the Potomac River. Alexandria and the hospital inhabitants were “quite sickly.”

Alexandria became a logistical supply center for the Union Army. The Quartermaster Department regulated medical supplies which were among the many items requisitioned from Edward S. Ledbeater’s Stabler-Leadbeater Apothecary Shop. In 1862, the supplies requisitioned included Castile soap, lint, syringes, laudanum and brandy, castor oil, camphor, sweet oil, slippery elm, ginger and Epsom salts, and probably mustard and Spanish flies for plasters.

Cherry syrup, horehound candy and even money were among Whitman’s favorite bedside offerings. Eventually, he learned how to treat “bad” throats, empty bloody pails and feed patients.

But he never got used to the soldiers’ suffering. Wounded soldiers could, and often did, arrive at the hospitals “at the rate of 1,000 a day.” They came by modified rail cars and steamer boats. Whitman did not have to be on the scene to hear “the clank of crutches on the pavements of Washington.”

And Whitman noted: “Most of them are entirely without friends or acquaintances here — hardly a judicious word of sympathy or cheer, through their sometimes long and tedious sickness, or the pangs of aggravated wounds.”

Looking back on the agonies and sufferings he witnessed during his service as a hospital volunteer, Whitman wrote:

“I never before so realized the majesty and reality of the American common people proper. Over the whole land [there has been] an unending, universal mourning-wail of women, parents, orphans. Future years will never now the seething hell … of the Secession War; and it is best they should not.”

Sarah Becker, former director of the Stabler-Leadbeater Apothecary Museum in Alexandria, is a free-lance writer.

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