The Healthcare Journey of a Wounded Union Soldier, from Battlefield back to Service
Introduction
The American Civil War has come to be known as the bloodiest war in American history.
According to Doctors in Blue by George Worthington Adams, 300,000 Union soldiers died and 400,000 were wounded, with 6,000,000 illnesses reported over the course of the war.[1] With so many soldiers sick, wounded, and dying, medical care had to play an important role in the war. As Adams states, “the [Union] Army Medical Department entered the war unprepared”.[2] Despite early struggles, the Medical Department turned things around, and was able to use superior medical care to their advantage. As stated by Alan Hawk in “An Ambulating Hospital: or, How the Hospital Train Transformed Army Medicine”, “During the Civil War, the army Medical Department evolved from a group of individual regimental surgeons into a system that moved casualties from the battlefield to the rear to receive the best possible medical care, freeing front-line hospitals for the next wave of the wounded.”[3] In Gangrene and Glory, Frank R. Freemon notes that the Union was able to use their superior medical care as a military advantage over the Confederates. In the campaigns of Vicksburg and Northern Georgia, the superiority of Northern medical care “made a difference in the outcome of each campaign, and a reversal of either campaign could potentially have changed the outcome of the war.”[4]
This paper will follow the journey of a wounded Union Army soldier. Steps will be traced from the battlefield, to hospitals in the field, to a general hospital in Washington, D.C., to general hospitals in the north as space was being cleared for new wounded soldiers. The focus will be on Elijah Couillard, who fought in the Massachusetts 35th Regiment of the Union Army. Couillard fought in the battles of South Mountain and Antietam in September 1862, injuring his hip at Antietam. Due to his wounds, Couillard was unable to return to active duty, and thus spent the remainder of his army service in various hospitals. First in a field hospital in Virginia, Couillard would be transferred to Lincoln General Hospital in Washington, D.C., and finally Lovell General Hospital in Rhode Island. In letters to his siblings and parents, used as a primary source for this paper, Couillard describes the hospitals, his movements, and the care he receives. Various books, including Doctors in Blue by George Worthington Adams, and Gangrene and Glory by Frank R. Freemon, and peer reviewed articles serve as secondary sources, to supplement the account given by Couillard.
Battlefield
The fighting was intense during the Civil War and was fought on a larger scale than previous U.S. wars. According to Hawk, such a large number of men “meant larger tactical formations on the battlefield that resulted in casualties on a horrific scale.”[5] In his earliest letter, written on the eve of the battles of South Mountain and Antietam, Couillard describes the mass of men, on each side, camped out “close enough to converse”.[6] Based on the size of the armies, he predicted that “if there is [a battle] fought here it will be a severe one.”[7] Couillard was right. The battles took place between September 14th and September 17th, 1862. The Battle of Antietam would prove to be the bloodiest single day in American history. Couillard described the scene in harrowing words. At one point, he and his regiment decided to hide in the woods, but the ground was covered: “in order to lie down, we were obliged to pile up the dead and wounded rebels that had fallen.”[8] Another factor increasing injury and therefore need for improved medical care was the weaponry of the time. Adams, in Doctors in Blue, claims that the musket balls used back then caused worse injuries. This was due to their “low velocity,” and the fact that they “almost invariably left an infected wound.” According to Adams, these bullets accounted for wounds in “approximately a quarter of a million patients”.[9] The injuries at Antietam were severe, (over 9,000 wounded) as Couillard confirmed.[10] “Our regiment the 35th, was the greatest sufferer- losing 243 of the 560,” he reported to his parents, solemnly noting “it was hard to see comrads fall and not be able to stop and look at them.”[11] After the battle, Couillard assed the damage, “in one spot I counted fifty dead bodies”[12]. With so many dead and wounded, medical care was going to be very important.
Medical care during and immediately following battles consisted of two key elements. Obviously treating the wounded was one major element, but before that could happen, a wounded soldier had to be removed from the battlefield. Thus, ambulances were needed According to “An Ambulating Hospital”, two types of ambulances were used, “a two wheeled ambulance that could carry two patients and a heavy four-wheel ambulance that could carry ten patients.”[13] Early on in the war, like most of the Medical Department, the Union ambulance system was in disarray. In 1862, Jonathan Letterman was appointed as the Army’s medical director and “very early identified the evacuation of patients as one of the keys to improving medical care for the wounded.”[14] Soon after, an ambulance corps was established, assigning “one to three ambulances” per regiment, which equaled “one ambulance for every 150 soldiers.”[15] At Antietam, the ambulance corps performed well, “all of the wounded [were] removed from the battlefield and under shelter by evening.”[16]
Field Hospitals
Once removed (or having left under their own power) from the battlefield, a wounded soldier would receive medical care in a field hospital. Adams explains in Doctors in Blue that each army Regiment was required to bring along their own surgeon.[17] It was thought, at the time, that a wounded soldier would fare better when treated by a doctor he knew.[18] Because of this, many small “regimental” hospitals were set up for a battle, as opposed to a few large ones. Later in the war, these larger “division” hospitals would become more prevalent. At Antietam, “seventy-one separate field hospitals were set up”.[19] These were staffed by the regimental surgeons, with “inferior, untrained men” serving as nurses. A few female nurses made it to field hospitals, but most were stationed in General Hospitals in the north. After a few days, once they were healthy enough to survive the trip, badly wounded men who would be unable to quickly rejoin their regiment were taken to a General Hospital in the North.[20]
It was in a field hospital where Elijah Couillard would have been treated for his injury at Antietam. He claimed to have stayed in a field hospital for “almost six weeks” following the battle.[21] Discussing a field hospital in a letter to his sister, he describes “tents about 14 feet wide and 16 feet long – made to accommodate about 10-12 persons.”[22] His hospital had no beds, wounded soldiers laid on straw if it was available, and if not merely a blanket on the dirt. Couillard claimed that the sick and wounded “have as good care here as circumstances will permit.”[23] Doctors and nurses were often busy, therefore some soldiers felt neglected, and because they were in a tent, they were “exposed to all sorts of weather and the night air.”[24] Despite the shortcomings, Couillard felt he was cared for well enough at the field hospital, and reported that as far as he could tell, they had a low mortality rate.
General Hospitals in Washington, D.C.
As the army had to continue moving, the wounded soldiers could not stay in the regimental hospitals, as those also moved. Therefore, the most seriously wounded were transferred north, to general hospitals. Over the course of the war, over a million cases were treated at a general hospital.[25] By the time the war ended, the army had built over 200 hospitals, with more than 125,000 total beds.[26] While field hospitals kept men closer to the field and were mobile, general hospitals boasted better administration, better kitchens & laundry, a separation between the sick and the wounded, and specialization of function of medical staff.[27] General Hospitals did however have downfalls, as they often became overcrowded and “Infectious diseases, such as typhoid fever and smallpox, plagued hospitals during the war.”[28]
Some men were forced to walk to a general hospital, and some, like Couillard, were drawn on ambulance carts. Many, however, were transported north to these hospitals via railroads. At the onset of the war, the government “rebuilt and organized the railroads into a cohesive system that provided the army the logistical support it needed to win the war,” including bringing supplies down for the southern campaign.[29] However, after the supplies were dropped off, the trains would be sent back empty. The army eventually realized they could be filling these empty rail cars with wounded soldiers, without any impact on the supply chain. The use of railroads made it much easier for the army to disperse wounded soldiers to northern cities where they could get the care they needed.[30]
After leaving Virginia, Elijah Couillard was transferred to Lincoln General Hospital in Washington, D.C. Couillard was very complimentary of both the facilities at this hospital and the care he received. He estimated that “about 1000 sick and disabled soldiers altogether” were in the hospital.[31] He described Lincoln General in a very positive light: “everything about the hospital is neat and clean.”[32] He appreciated the Surgeons and Nurses help, declaring that “a sick or wounded soldier that is in a General Hospital is well cared for. They have every attention… there are now thousands in these hospitals today that are taken better care of than they would be at home and a good deal better off.”[33] While Couillard had expected to be discharged due to his injury, he was not upset about having to stay at a hospital he received such good care at.
Along with the Army surgeons, the hospitals were staffed by nurses. While those serving as nurses included men, former slaves, and convalescent soldiers, many nurses were female volunteers. One of these volunteers was writer Louisa May Alcott. She travelled from Massachusetts to Washington, D.C. to work in a general hospital, and recorded her experiences in a book titled Hospital Sketches. She confirmed Couillard’s favorable recordings of the Washington hospitals writing, “here, order, method, common sense, and liberality reigned and ruled.”[34] She also confirmed the aforementioned disease that ran through these hospitals, painting a scene of “pneumonia on one side, diphtheria on the other, five typhoids on the opposite.”[35] When the wounded men arrived from battle, “some on stretchers, some in men’s arms, some feebly staggering along propped on rude crutches,” her duties were to “wash, dress, feed, warm, and nurse them.”[36] In Doctors in Blue, Adams argues that female nurses in the civil war had a profound societal impact, that “the war opened the gates of a great profession to women at a time when their economic opportunities were scarce.”[37]
Northern Movement
While they offered good care and many men healed well there, it was important to keep empty beds available in Washington hospitals, as they were the closest to southern battlefields. As soon as men were healthy enough to make a trip, they were typically sent north, to hospitals nearer to their homes (if they could not return to their regiment).[38] When the army was expecting a large battle, convalescing soldiers in Washington were cleared out in larger numbers. In a letter to his sister on March 13th, 1863, Couillard suspected that he soon would be transferred North. “Movements in the hospitals all show that there is to be some hard fighting in the course of a few days,” he begins, then mentioning that the army was “clearing out the hospitals for the accommodation of wounded soldiers.”[39] He predicted he would be sent north in the next week. Couillard would be sent to Lovell General Hospital, in Portsmouth Grove, R.I.
He described Lovell General as “a much larger [hospital] than any of those in Washington,” estimating that it could “accommodate about 1500 patients”.[40] Again, he was happy with the care received, claiming “I have as good care here as I should if I was at home.”[41]
Clearing Out: Return to Regiments, Transfer to Veterans Reserve Corps, or Furlough
Obviously, the goal of putting Union soldiers in medical care was for them to recover from their wounds and rejoin their regiment. This is why men were kept in field hospitals, and the field hospitals consolidated into depot hospitals once the army moved again. Keeping men close to the army as opposed to sending them to a general hospital increased the chances of them coming back to the regiment, and generals were able to “keep” men this way. Alcott noted that, at the general hospital, soldiers going back to their regiments was cause for celebration. “One of the lively episodes of hospital life, is the frequent marching away of such as are well enough to rejoin their regiments.”[42] Not all men who went into the hospital healed to the point where they could return to fighting, but of course, not all men died of their injuries, which led to the question of what was to be done with these men. Some were discharged, but the army did not want to discharge, and therefore “lose” too many men. Two solutions arose, one short-term and one-long term.
One solution, a short-term fix, was to allow soldiers to leave on furlough. Soldiers who were healthy enough were allowed to leave for a few days at a time, usually going home to visit family. According to Doctors in Blue, surgeons favored furloughs because they would free up beds “clogged” by those with long term injuries or illnesses.[43] The doctors also believed going home would help them improve, as they would typically receive better food and individual care. Military personnel feared too many furloughs. They preferred to keep all soldiers under Army control, and also worried that men would prefer the comfort of home and try to stay longer.[44] Couillard mentioned several furlough visits in his letters to his sister. These visits came during his time at Lovell General Hospital in Rhode Island, from where he would travel to Boston to see his family. Couillard was able to visit home for as long as eight days.[45]
A more long-term solution was the Veterans Reserve Corps, first dubbed the Invalid Corps. In the Veterans Reserve Corps, men who were healing but not yet ready for active service, “convalescents”, were given jobs, including guards of army supply trains, and hospital attendants. Over the course of the war, over 60,000 men would participate in this program.[46] This program achieved two things. First, by putting men to work, it freed up beds for men who were more severely injured. Second, it gave the soldiers something to do and distracted them from dull and dreary hospital life.[47] Couillard confirmed how boring hospital life was in letters to his sister: “O sister how tired and disgusted I am with hospital life. It is dull and dreary,” he wrote in September 1863.[48] In March of 1864 he reaffirmed this, claiming “I have nothing else to do but write and play backgammon”.[49] Couillard was transferred to the Veterans Reserve Corps in January of 1864. Although he would have spent the last few months of his military service before his April 1864 discharge in the Corps, Couillard makes no mention of this service in his letters.
While the Veterans Reserve Corps may have been a positive for the actual soldiers, the doctors and nurses they worked alongside were not thrilled with their “help”. In Doctors in Blue, Adams claims that the soldiers were not well trained, and lacked natural skills needed for nursing. By the time they started to get the hang of their nursing duties, many convalescents were either sent back to their regiments or discharged from the army. Because of this, they were generally seen as being in the way or unhelpful.[50] Alcott backs this up with her own account. “I should like to enter my protest against employing convalescents as attendants, instead of strong, properly trained, and cheerful men,” she begins, adding, “it was a source of constant trouble and confusion, these feeble, ignorant men trying to sweep, scrub, lift, and wait upon their sicker comrades.”[51] She even claimed that some of the men who were used as convalescent workers became more injured due to their duties in the Veterans Reserve Corps, telling the story of a man with heart disease who “grew rapidly worse” when forced to do convalescent work, and eventually died.[52]
Conclusion
Many Union soldiers were either sick or wounded during the American Civil War. An ill-equipped medical department was tasked with nursing these soldiers back to health. They were able to overcome some early failures and develop into a relatively well-oiled machine. Field hospitals improved over time, but more severe injuries required more care. The Medical Department was able to construct an impressive number of general hospitals that could treat these men. As needed, men were moved to hospitals further away from the fighting, via new and innovative transportation methods. The letters of Elijah Couillard gave a first-hand account of a soldier going through the various stages of the medical department and offer valuable insight as to a soldier’s perspective. With that being said, Couillard was just one soldier, who was treated at some of the better hospitals the Union army had to offer. Therefore, for a complete perspective as to what soldiers thought of the army medical department, the accounts of more soldiers should be consulted.
Bibliography
Adams, George Worthington. Doctors in Blue. New York: Henry Schuman, Inc., 1952
Alcott, Louisa May. Hospital Sketches. Cambridge: Harvard University Press, 1960.
Couillard, Elijah. Ms. N-350, Massachusetts Historical Society. Boston, Mass.
Freemon, Frank R. Gangrene and Glory: Medical Care during the American Civil War. London:
Associated University Press, 1998.
Hawk, Alan. “An Ambulating Hospital: or, How the Hospital Train Transformed Army
Medicine” Civil War History 48, no 3 (2002): 197-219.
Kutney-Lee, Ann, Kathleen Rodgers, and Barbara Mann Wall. “The North vs. the South:
Conditions at Civil War Hospitals” Southern Quarterly 53, no 3/4 (2016): 37-55.
[1] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 3.
[2] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 4.
[3] Alan Hawk, “An Ambulating Hospital: or, How the Hospital Train Transformed Army Medicine” Civil War History 48, no. 3 (2002): 217
[4] Frank R. Freemon, Gangrene and Glory (London: Associated University Press, 1998), 221.
[5] Alan Hawk, “An Ambulating Hospital: or, How the Hospital Train Transformed Army Medicine” Civil War History 48, no. 3 (2002): 199.
[6] Elijah Couillard, Fredericksburg, Virginia, December 1, 1861 to his Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[7] Elijah Couillard, Fredericksburg, Virginia, December 1, 1861 to his Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[8] Elijah Couillard, near the Potomac, September 9, 1862 to his Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[9] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 114.
[10] Alan Hawk, “An Ambulating Hospital: or, How the Hospital Train Transformed Army Medicine” Civil War History 48, no. 3 (2002): 206.
[11] Elijah Couillard, In Camp at Pleasant Valley, Octoberr 19, 1862 to his Parents, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[12] Elijah Couillard, In Camp at Pleasant Valley, Octoberr 19, 1862 to his Parents, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[13] Alan Hawk, “An Ambulating Hospital: or, How the Hospital Train Transformed Army Medicine” Civil War History 48, no. 3 (2002): 199.
[14] Alan Hawk, “An Ambulating Hospital: or, How the Hospital Train Transformed Army Medicine” Civil War History 48, no. 3 (2002): 205.
[15] Alan Hawk, “An Ambulating Hospital: or, How the Hospital Train Transformed Army Medicine” Civil War History 48, no. 3 (2002): 205.
[16] Alan Hawk, “An Ambulating Hospital: or, How the Hospital Train Transformed Army Medicine” Civil War History 48, no. 3 (2002): 206.
[17] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 10.
[18] Alan Hawk, “An Ambulating Hospital: or, How the Hospital Train Transformed Army Medicine” Civil War History 48, no. 3 (2002): 197.
[19] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 78.
[20] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 67.
[21] Elijah Couillard, General Hospital, Aquia Creek, Virginia, February 4, 1863 to his Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[22] Elijah Couillard, Lincoln General Hospital, Washington, D.C., March 6, 1863 to his Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[23] Elijah Couillard, Lincoln General Hospital, Washington, D.C., March 6, 1863 to his Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[24] Elijah Couillard, Lincoln General Hospital, Washington, D.C., March 6, 1863 to his Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[25] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 150.
[26] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 153.
[27] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 151.
[28] Kutney-Lee, Ann, Kathleen Rodgers, and Barbara Mann Wall. “The North vs. the South:
Conditions at Civil War Hospitals” Southern Quarterly 53, no 3/4 (2016): 41.
[29] Alan Hawk, “An Ambulating Hospital: or, How the Hospital Train Transformed Army Medicine” Civil War History 48, no. 3 (2002): 201.
[30] Alan Hawk, “An Ambulating Hospital: or, How the Hospital Train Transformed Army Medicine” Civil War History 48, no. 3 (2002): 207.
[31] Elijah Couillard, Lincoln General Hospital, Washington, D.C., February 27, 1863, to his Brother and Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[32] Elijah Couillard, Lincoln General Hospital, Washington, D.C., February 27, 1863, to his Brother and Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[33] Elijah Couillard, Lincoln General Hospital, Washington, D.C., March 6, 1863 to his Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[34] Louisa May Alcott, Hospital Sketches (Cambridge: Harvard University Press, 1960), 64.
[35] Louisa May Alcott, Hospital Sketches (Cambridge: Harvard University Press, 1960), 28.
[36] Louisa May Alcott, Hospital Sketches (Cambridge: Harvard University Press, 1960), 29; Louisa May Alcott, Hospital Sketches (Cambridge: Harvard University Press, 1960), 27
[37] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 176.
[38] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 154.
[39] Elijah Couillard, Lincoln General Hospital, Washington, D.C., March 13, 1863 to his Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[40] Elijah Couillard, Lovell General Hospital, Portsmouth Grove, Rhode Island, March 25, 1863 to his Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[41] Elijah Couillard, Lovell General Hospital, Portsmouth Grove, Rhode Island, March 13, 1864 to his Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[42] Louisa May Alcott, Hospital Sketches (Cambridge: Harvard University Press, 1960), 85.
[43] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 157.
[44] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 157.
[45] Elijah Couillard, Lovell General Hospital, Portsmouth Grove, Rhode Island, April 10, 1863 to his Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[46] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 188.
[47] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 186.
[48] Elijah Couillard, Lovell General Hospital, Portsmouth Grove, Rhode Island, September 5, 1863 to his Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[49] Elijah Couillard, Lovell General Hospital, Portsmouth Grove, Rhode Island, March 4, 1864 to his Sister, Ms. N-350, Massachusetts Historical Society, Boston, Mass.
[50] George Worthington Adams, Doctors in Blue (New York: Henry Schuman, Inc., 1952), 186.
[51] Louisa May Alcott, Hospital Sketches (Cambridge: Harvard University Press, 1960), 66.
[52] Louisa May Alcott, Hospital Sketches (Cambridge: Harvard University Press, 1960), 66.