History That Doesn't Suck - 63: Wounded and Dying: Nurses, Doctors, and Disease in the Civil War

Episode Date: April 27, 2020

 “I had never severed the nerves and fibers of human flesh.” This is the story of Civil War medicine. At the start of the war, the wounded sometimes lay on the field of battle for days hoping for help. Some die slowly and painfully from exposure and thirst. Others are robbed as their life expires. The divided nation has new, deadlier guns, but medical treatment has changed. It’s a deadly combination.  Both sides step up. The Union’s new “Ambulance Corps” sets a new standard for battlefield first aid as the newly created US Sanitary Commission improves policy. The CSA’s “Infirmary Corps” and regional organizations make similar improvements. North and South, women save countless soldiers as they enter a new medical profession: “nursing.”  But most surgeons don’t believe “refined ladies” should be working in this professional role. Some intentionally make life downright miserable for these female patriots. Luckily for the wounded, these women don’t break easily. ____ Connect with us on HTDSpodcast.com and go deep into episode bibliographies and book recommendations join discussions in our Facebook community get news and discounts from The HTDS Gazette  come see a live show get HTDS merch or become an HTDS premium member for bonus episodes and other perks. Learn more about your ad choices. Visit megaphone.fm/adchoices

Red One... We're coming at you. ...is the movie event of the holiday season. Santa Claus has been kidnapped? You're gonna help us find him. You can't trust this guy. He's on the list. Is that Naughty Lister? Naughty Lister?

Dwayne Johnson. We got snowmen! Chris Evans. I might just go back to the car. Let's save Christmas. I'm not gonna say that. Say it. Alright.

Let's save Christmas. There it is. Only in theaters November 15th. From the creators of the popular science show with millions of YouTube subscribers comes the MinuteEarth podcast. Every episode of the show dives deep into a science question you might not even know you had. But once you hear the answer, you'll want to share it with everyone you know. Why do rivers curve? Why did the T-Rex have such tiny arms? And why do so many more kids need glasses now

than they used to? Spoiler alert, it isn't screen time. Our team of scientists digs into the research and breaks it down into a short, entertaining explanation, jam-packed with science facts and terrible puns. Subscribe to MinuteEarth wherever you like to listen. Welcome to History That Doesn't Suck. I'm your professor, Greg Jackson, and as in the terrible puns. Subscribe to MinuteEarth wherever you like to listen. ad-free episodes, bonus content, and other exclusive perks, I invite you to join the HTDS membership program. Sign up for a 7-day free trial today at htdspodcast.com slash membership, or click the link in the episode notes. Welcome to History That Doesn't Suck. I'm your professor, Greg Jackson, and I'd like to tell you a story. It's September 17th, 1862, and American men are dying by the thousands.

Yeah, you likely remember this Maryland-based battle from episode 52. It's the Battle of Antietam, or Sharpsburg. The name all depends on which side of the Mason-Dixon line you call home. Regardless of what you call it, though, one thing remains indisputable. It's the bloodiest day in American history. Blood flows on the battlefield as 300 horse-drawn ambulances from the newly created Ambulance Corps transport wounded soldiers to nearby field hospitals. But don't put too much stock in the term hospitals.

They're merely commandeered buildings where poorly supplied and understaffed surgeons desperately try to save soldiers' lives. At this moment, Clara Barton is right outside one of Antietam's many makeshift emergency rooms. She's here to help. The 40-year-old Massachusetts woman isn't formally trained in medicine, but she's a quick learner, has nerves of steel, and crucially, she's brought much-needed medical supplies collected through her own private efforts. On a day like this one, that makes her little less than a hero. As Clara's walking by the barn, an injured soldier, laying on the ground because there's no room in the swamped field hospital, gets her attention. Water! The blue-clad man weakly ekes out, or something to that effect.

Whatever he's muttering, Clara understands. She gets close to the ground herself, kindly cradling the soldier's head with one hand while holding up drink with the other. The man begins to drink, then suddenly convulses and dies. A stray bullet from the nearby, still raging battle has finished him off. Clara will later recall, when I felt a sudden twitch of the loose sleeve of my dress, the poor fellow sprang from my hands and fell back, quivering in the agonies of death. A ball had passed between my body and the right arm which supported him, cutting through the sleeve and passing through his chest from shoulder to shoulder.

But there's no time to mourn or think about how that ball was inches from ending her life instead. Clara sees another man in need laying close to the barn. Lady, will you tell me what this is that burns so? He calls out, pointing at his punctured, bulging, blood-splattered right cheek. The New Englander leans in and inspects it. That bulge in his cheek is sharp. It must be the ball, too far spent to cut its way entirely through, she answers. It's terrible, painful. Won't you take it out? The Union soldier asks. I'll go to the tables for a surgeon, Claire answers. No, no! The man begs, desperately clinging to her dress. They cannot come to me.

I must wait my turn for this little wound. You can get the ball. There is a knife in my pocket. Please take the ball out for me. You cannot hurt me, dear lady. I can endure any pain that your hands can create. Please do it. It will relieve me so much.

Well, like I said, Claire is not a trained physician. I had never severed the nerves and fibers of human flesh. She'll later observe. But she gets that as serious as his wound is, it doesn't compare to the amputations and other life-threatening situations the surgeons are facing. And so, she agrees. Another injured soldier holds his head in place as she uses the crude pocket knife to perform her first surgery. It's easy enough, but her great concern comes half an hour later when she finds him weeping.

It's not the surgery. He only thanks her again. He's just been informed that Confederate fire has slaughtered his entire regiment and captain. Clara captures the scene perfectly. To quote her, Oh God, what a costly war. This man could laugh at pain, face death without a tremor, and yet weeps like a child over the loss of his comrades and his captain. Ambulances are still bringing in the wounded the next day.

With the worst of it over, Claire is cooking up a pot of soup, but a Wisconsin surgeon named F.H. Harwood soon interrupts her. He says he needs her help with, quote-unquote, women's work. He leans in and whispers that an injured soldier won't let him operate, and he, the surgeon, suspects that his patient might be, well, female. What?

Clara responds in shock. Yes, Dr. Harwood answers. A girl, if there's any truth in signs or words combined. Dr. Harwood transports his patient to Clara in a covered wagon. The Massachusetts woman climbs inside, and sure enough, she finds the soldier is a teenage girl, maybe 16 years old. Feeling she can trust another woman, the soldier admits to Clara that her name is Mary. She disguised herself as a man to stay with her lover in the same regiment. With Clara's nudging, Mary permits Dr. Harwood to operate and remove the ball that's passed through her neck and is lodged under the skin on her back.

It's a miracle she's even alive. More than that, she'll survive this surgery and, with Clara's help, be reunited with her injured lover. The grateful couple will later name their first daughter after Clara. Clara Barton's organization, bravery, and straight-up life-saving at Antietam and countless other battles do not go unnoticed. In a letter to his wife, Brigade Surgeon James L. Dunn sings Clara's praises, then concludes with this description of the New Englander. Quote, Now, what do you think of Miss Barton?

In my feeble estimation, General McClellan, with all his laurels, sinks in insignificance beside the true heroine of the age, the angel of the battlefield. Close quote. More significant than commanding General Little Mac. Damn, that is high praise. Well, at least it is in 1862. And the moniker sticks. Henceforth, Clara will be known as the Angel of the Battlefield. Today, we leave the front lines to explore another side of the war, the medicinal side. Now, if you think that means being spared violence and gore, think again. In many ways, this is where the real death and agony happens. We'll see important innovations in medical practices, such as the creation of the U.S. Army's Ambulance Corps. I'll also walk you through the harrowing process of limb amputation.

Side note, finish that burger now. You're welcome. From there, we'll hear about the development of another important organization, the U.S. Sanitary Commission. We'll also see a few old friends while meeting a whole lot more, most of whom are women volunteering as nurses or playing other vital roles. And as we do so, we'll take note

of how their selfless work also manages to advance the cause of women's rights. So let's get to this by going back to the start of the war and seeing the evolution of the U.S. Ambulance Corps. Rewind. It's late July, 1861. The carnage of the Civil War's first major battle at Bull Run is still fresh. You might recall from episode 47 that this was supposed to be a quaint little battle. Union civilians from the area even had picnics while watching it. Remember that? Yeah, that seems crazy after the fact, but they were so sure the rebels would quickly and cleanly be put in their place. Well, there's nothing clean about the blood-soaked, oozing, and dismembered soldiers

that dragged themselves, sometimes literally, into nearby Washington City after the battle. Like a scene from some sort of apocalyptic movie, they show up in various mutilated forms day after day after day. Many were abandoned by the privately hired ambulance drivers who got scared when the battle started or were simply too drunk to do their jobs. It's clear that the army has to do better. Wounded soldiers can't be left on the field of battle to fend for themselves like this. Now this isn't to say there's no medical branch in the U.S. Army. There is a medical department. It's just small. The department consists of some surgeons, their assistant surgeons, and clerks, all headed by a surgeon general. I realize this

department sounds ridiculously, if not irresponsibly, understaffed. The medical department looks like a water gun trying to put out a house fire. Remember though, the nation has never seen war on the scale of what's happening now. This did fine when the U.S. was at peace with an entire army of 16,000 men. And as for the first aid on the battlefield, well, that hasn't always been much of a concern. Local volunteers or philanthropists have traditionally stepped in to fill this role before the Civil War. But now that we're coming to think of a 16,000-man force as, oh, two corps within one of several armies instead of the entire U.S. Army, the medical department

needs to up its game. It'll need strong leadership to do so. Unfortunately, leadership isn't the medical department's strong suit at the start of the war. The Surgeon General died suddenly two months back in May 1861, and President Abraham Lincoln appointed Clement A. Finley to the job. The 64-year-old Pennsylvanian with a Santa Claus-style beard isn't exactly dynamic or bold. He's more on cruise control. You know the type, right? Think Jerry on the TV show Parks and Rec. Remember the episode when Jerry tries to check his email by going to AltaVista and typing, please go to yahoo.com? Yeah, well, Clement is as stuck in the past as Jerry. He's been an army doctor basically since the dawn of time, or 1818, and isn't ready or able to turn the corner on this

new large-scale war reality. He keeps the same old structure and continues to promote doctors based on seniority rather than their education, innovation, or hey, a desire to bring the best care possible to the soldiers fighting for their country. To be clear, I'm not trying to knock poor old Clement or his more senior colleagues. Some of them begin to make a few changes. For instance, the Army of the Potomac's medical director, Charles S. Tripler, convinces officers to stop treating the Army's horse-drawn ambulances like a 19th century ride-sharing app that's available at their every beck and call for personal rides. He also gets rid of the rickety two-wheel ambulances in favor of solid four-wheeled wagons that can carry up to eight wounded men at a time. But these are relatively small reforms.

As we enter the second year of the war, men are still dying from the ineptness of battlefield first aid. Americans are livid. Things have to improve more and faster. Thankfully, the leadership needed to turn this corner finally starts to come together in 1862. Clement is replaced as Surgeon General by a man nearly half his age, William Hammond. The new 33-year-old, barrel-chested, bearded, and attractive Surgeon General brings the right balance of youth and expertise. With over a decade in the military, he certainly knows the ropes. He also gets the challenges and needed changes though. Two of his greatest gifts are delegation and spotting talent. As he ditches his predecessor's way of promoting in favor of an examination

process that puts knowledgeable surgeons rather than good old boys in positions of influence, things begin to change. Crucially, he promotes Jonathan Letterman to replace Charles Tripler as medical director of the Army of the Potomac in the summer of 1862. The reason this is so significant is that Jonathan creates a new unit within the Army of the Potomac called the Ambulance Corps. The idea here is that, instead of relying on privately hired, untrained, possibly drunk, scared civilians to drive the horse-drawn ambulances on the battlefield, the Army will now use actual, disciplined, enlisted medics for this life-saving task. Unlike civilians who will wait until after the battle, these medics rush out onto the field as the fighting rages. What's more, they have a sense

of identity as a distinct unit and their own chain of command within the Army of the Potomac. They even have their own uniforms marked with green inverted chevrons. This ambulance corps resolves a myriad of related problems. Take timely medical attention. Previously, if a soldier got hit, he'd have to wait for privately hired civilians to save him. They might come, they might not. If they do come, they might not show up until days later and rob the soldier in the process. Some men bleed out while waiting. Others die of simple exposure and thirst on day three or five of their wait. So having an ambulance corps with medics who risk their lives

to take the wounded to field hospitals in real time saves lives simply by getting men the medical attention they need within a timely manner. Jonathan's ambulance corps can clear the wounded from the field within 24 hours. That's quite a turnaround from a potential one-week wait. And as this efficient corps transports men on stretchers to primary stations, then takes them via horse-drawn ambulances to nearby field hospitals, they also keep more soldiers fighting. See, knowing that the wounded might die of exposure on the field, troops would often leave the battle to carry their injured brothers in arms out.

But depending on the battleground, that meant one wounded soldier could take three or four men from the fight for the whole engagement. This loss of manpower doesn't happen now though, or at least not nearly as much. Thus, the Ambulance Corps not only saves lives, it keeps more men in the fight. The Ambulance Corps premiered at the September 17, 1862 Battle of Antietam. That's right, today's opening. Its ability to clear the field of wounded in just over 24 hours is beyond impressive, and it only gets better with practice. Other U.S. armies besides the Army of the Potomac quickly follow suit, though it will take until

1864 for Congress to mandate it as part of the U.S. Army through the Potomac quickly follow suit, though it will take until 1864 for Congress to mandate it as part of the U.S. Army through the Ambulance Corps Act. Late as this adoption might be, this revolution of battlefield first aid will have far-reaching effects as European armies copy the model well into the 20th century. Now, what of the Confederacy? Well, it has an identical medical department. No surprise, given that this war is a country divided. It never develops an equal to the Ambulance Corps, though. It rolls out its own form in 1862, called the Infirmary Corps, but the less populated and less equipped CSA's ambulances never match that of the Union. That's why the South has a higher wounded-to-death rate than

the North, 18% compared to 14%. And given that the wounded are often attended to by the army that holds the field, soldiers of both sides know if they're left wounded on the field, they have a better chance of living if it's a Union victory. Okay, so we got the men off the field. What happens to the injured now? They're seen in field hospitals. These might be tents, a commandeered house, barn, you name it. Basically, it's where first aid happens. But unlike the nurse's office at a school or the first aid station on a ski slope, here we have surgeons carrying out major surgery. I know, we're all picturing it. The Civil War surgeon stands with a saw in hand, drenched in the red blood of countless

men, looking one step away from a stock character in a B-lister horror film. You're not alone if you think that. Civil War soldiers frequently think so too. As one Alabama soldier put it, quote, I believe the doctors kill more than they cure, close quote. Still, I'm going to caution you from embracing that image. Well, don't embrace it completely anyway. Let's get to know their world by taking a little tour from the field hospital to convalescence. So let's say you're a soldier who's just been shot in the left leg. Your limb fails you. You drop to the ground. Your thigh is bleeding badly. Your friend quickly tears some cloth from your blood-soaked pant leg and ties it at the wound. Thank God for the ambulance corps, or infirmary corps if you prefer to imagine this from the southern perspective.

From stretcher to ambulance, they get you to a field hospital within six hours. You're thirsty, hungry, and bleeding, but let's keep perspective. Lucky you. You got here relatively fast, and at least you weren't shot in the stomach or chest. Those are generally death sentences. The hospital's an abandoned house. Seeing the urgency of your situation, the new system of evaluating and prioritizing injuries, in other words, triage, leads the medics to place you on what used to be someone's kitchen table. Here comes the surgeon. Yeah, this is bad. There's no exit wound. That's often the case with mini-A balls. This soft, leaded ammunition penetrates the skin but frequently doesn't

make its way out. Having none of the benefits of future medical marvels, the surgeon can only stick his finger in your severed flesh and feel around to see if he can find it. Hmm, worse than he thought. The surgeon feels splintered pieces of what used to be a part of your femur. The bleeding is still bad, nor can he find the ball. In a world lacking antibiotics, or even a knowledge of how bacteria attacks our bodies, your chances of contracting a deadly infection from the lead inside your leg are high. That much the medical world of the 1860s understands. So while the surgeon had hoped to merely clean the wound and stitch your leg up, he knows that there's only one way to make sure you have a good chance of survival,

and it accounts for 75% of all Civil War surgeries. Amputation. Surgery happens now. The sooner the surgery, the more likely you are to survive, so you're rather lucky to go under the knife within 24 hours. Such rapid surgeries are known as quote-unquote primary amputations. Are you Union? They're probably dosing you with chloroform or ether. Are you Confederate? Such anesthetics are harder to come by here, so you might be relying on whiskey. You'll want to buy down on something for this. A team of assistants help the surgeon save you. One works the tourniquet while another supports your left leg as a surgeon slices your thigh just above the knee, peels back the skin, cuts through the muscle, then saws

through the bone. The surgery is over in two minutes. If this is a particularly gruesome and large battle, then your limb might join a stack of others. It's not meant to be disrespectful. That's a simple reality of the sheer volume of amputations. They stitch your stump together using one of two methods, circular or flap. Circular would have required the surgeon to roll back the skin and save it so he can now roll it back down and stitch it together. If they went with flap, it means they cut the skin so as to have two flaps that can be sewn together. The wound itself might play a role in this decision. But are you Union? They probably went with the faster, more efficient flap. Are you Confederate? They probably went with the better

healing, healthier, circular. Now where you go from here could vary. If your wound had been minor enough, you'd have recovered in camp or maybe at home with the possibility of returning. For the sake of seeing the whole system through, though, we'll say you're transferred to a general hospital. This is probably a commandeered building in a nearby city, like a hotel, as is the case in the PBS Civil War historical drama, Mercy Street. Why was that only two seasons? So good. Anyhow, you'll rest up, that is, convalesce here. By the way, if you were of higher rank, you would have received better treatment in an officer's hospital, or wing at the very least. Sorry, soldier. And things don't go smoothly for you. As is the case in one out of five surgeries in this war, your amputated stumps

developed an infection. It's gangrene. So the surgeons here have no choice but to operate. You go through the whole process again. You're lucky you got shot near the knee and not higher. If that infection had made it to your vital organs, you'd be a goner. This is all part of why the further out on an extremity of the wound, the better chance you have of surviving. And yes, many die from infections after surgery. Of the roughly 60,000 amputations performed throughout the war, 29,980 by the Union and an estimated 25,000 by the CSA. Both sides have a 27% mortality rate. Of course, it isn't just battle wounds and bacterial infections that kill soldiers. Disease is the real enemy.

Of the probably more than 600,000 soldiers who die in the Civil War, disease puts some 400,000 of them in the grave. That's right. Disease is twice as deadly as the gun pointed at you in this war. Perhaps that hits home these days. I wonder if we have a bit more respect for and fear of disease in a post-COVID-19 world. Communicable diseases, that is, sicknesses we spread to one another, could really make their way around a camp. This is what happens when Americans from across the country suddenly come together to form massive armies. They bring their local germs with them and unwittingly pass them to their fellow recruits. Oh, by the way, the soldiers have no idea what

germs are. A French biologist named Louis Pasteur is figuring out what we now call and accept as germ theory at this very same time, but of course, it will be decades before it's well accepted. That's why Civil War surgeons and nurses will use unwashed bandages over and over on different people and don't sterilize anything. They just don't know any better. Diarrhea and dysentery top the disease list of killers. See, when you don't understand germ theory, you're far more likely to unknowingly drink contaminated water. These conditions hospitalized almost 1.8 million Union soldiers throughout the war and caused 44,558 documented deaths.

Yeah, the Oregon Trail games, you have died of dysentery, just got real, huh? Let me hit you with a slew of numbers from the Encyclopedia of Civil War Medicine. The next biggest killer among federal troops is typhoid fever, which puts 34,833 of its 148,631 cases in the grave. Pneumonia ends the lives of 19,971 of 77,335 infected bluecoats. More than 1 million suffer from malaria, 10,063 of whom never recover. 29,510 Federals manifest tuberculosis. 6,946 of them die. And of course, smallpox is still doing its thing.

While not doing the same damage it did during the Revolutionary War, 18,952 boys in blue contract this fatal disease, which kills 7,058 of them. And although the Confederacy's numbers are harder to come by, they're on par with all of the above. Oh, and there's venereal disease, which has an uptick whenever armies occupy or are near a city. Gonorrhea, aka the clap, and syphilis are the heavy hitters. These infections are so rampant, prostitution is temporarily legalized in some places near soldiers to encourage testing. If you're surprised by any of this, don't be. Throughout history, armies have excelled at contracting STIs. Not sure that's something to put on a resume, but none of this stands out from other periods,

nations, or wars. And of course, treatments for these STIs are no better than treatments for the more fatal diseases listed above. Medicines, if we can call them that, are often addictive substances, like alcohol or morphine, or straight up poison, like mercury. Oh, and bleeding a patient is still a thing. Further, they assume that if symptoms are gone, so is the illness because, once again, this is a pre-antibiotics and germ theory world that doesn't really understand contagion or infection. Once more, I'm not trying to knock these doctors. They're doing what they understand to be right, but even though the weaponry of 1860s America looks more like the 20th century, its medical knowledge is still closer to that of

George Washington's day. That's a lethal combination. Was the Sphinx 10,000 years old? Were there serial killers in ancient Greece and Rome? What were the lives of transgender, intersex, and non-binary people like in the ancient world? We're Jen and Jenny from Ancient History Fangirl. We tell you true stories and tall tales of the ancient world. Sometimes we do it tipsy. Sometimes we have amazing guests on our show. Historians like Barry Strauss, podcasters like Liv Albert, Mike Duncan, and authors like Joanne Harris and Ben Aronovich.

We take you to the top of Hadrian's Wall to watch the Roman Empire fall at the end of the world. We walk the catacombs beneath the Temple of the Feathered Serpent under Teotihuacan. We walk the sacred spirals of the Nazca Lines in search of ancient secrets. And we explore mythology from ancient cultures around the world. Come find us at ancienthistoryfangirl.com or wherever you get your podcasts. When Johann Rall received the letter on Christmas Day 1776, he put it away to read later. Maybe he thought it was a season's greeting and wanted to save it for the fireside. But what it actually was, was a warning, delivered to the Hessian colonel,

letting him know that General George Washington was crossing the Delaware and would soon attack his forces. The next day, when Rall lost the Battle of Trenton and died from two colonial Boxing Day musket balls, the letter was found, unopened in his vest pocket. As someone with 15,000 unread emails in his inbox, I feel like there's a lesson there. Oh well, this is The Constant, a history of getting things wrong. I'm Mark Kreisler. Every episode, we look at the bad ideas, mistakes, and accidents that how amputations happen, as well as gotten a taste for some foul diarrhea-causing water. But much of this advancement isn't thanks to the men in uniform. It's the women on both sides who agitate and fight for better,

more humane treatment for soldiers. They create organizations that challenge the medical status quo, like the highly influential, policy-changing U.S. Sanitary Commission. They also prove nursing is a respectable profession and that women can do it. In other words, they're revolutionizing the medical field while winning some small victories in the drawn-out struggle for women's rights. And since all of this is happening at the same time as the other, in fact, some of the innovations we just talked about likely wouldn't have happened without the Sanitation Commission, we need to take this back to the start of the war once more. Rewind.

Local soldiers' aid societies spring up all over northern cities and states. On April 29, 1861, Elizabeth Blackwell, the first female MD in the United States, forms the Women's Central Association for Relief in New York. As its name implies, this group acts as a hub for the small and scattered aid societies. The WCR, as it quickly becomes known, coordinates what local groups do to avoid redundancy on a national level. It also creates the first program in the U.S. to train female nurses. Within a few weeks, the WCR is up and running, so it sends a delegation to Washington to meet with Lincoln. WCR President Henry Bellows suggests to the president that he

could get up a crew of inspectors, doctors, and nurses to help the Army Medical Department. Lincoln's not so sure about this. He's pretty certain the civilians will be no more than, quote, a fifth wheel to the coach, close quote. Still, the soldiers fighting in this bloody war need all the help they can get. On June 13th, 1861, the president creates the United States Sanitary Commission. The sanitary, as it's called, sends inspectors, medical supplies, and volunteer nurses to army camps and hospitals. According to its government charter, the sanitary creates an official place for the WCR to function in the Army Medical Bureau. If all of these levels of organization and red tape feel overwhelming,

you're not alone. War Secretary Edwin Stanton and the war's original Surgeon General Clement Finley, whom we met earlier and compared to Parks and Rex Jerry, as you recall, both despise the sanitary. Clement doesn't trust female nurses and doesn't want civilian inspectors poking around his army hospitals. But Clement gets overruled. The sanitary becomes very popular with wounded soldiers and with their families at home. This gives sanitary inspectors and doctors political clout, which they use to send a barrage of public verbal attacks at the U.S. Army's medical department. The first thing the sanitary goes after is the Surgeon General's seniority system,

which keeps educated, competent, but young doctors at the bottom of the heap. Sanitary Secretary Frederick Olmsted writes, It is criminal weakness to entrust such responsibilities as those resting on the Surgeon General to a self-satisfied, supercilious, bigoted blockhead merely because he is the oldest of the old mess room doctors of the frontier guard of the country. He knows nothing, he does nothing, and is capable of knowing nothing and doing nothing but quibble about matters of form and precedent. Close quote. Damn. Well, I think it's safe to say that Frederick's not a fan of Surgeon General Clement Finley. But the sanitary doesn't just talk big. They put their money where their mouth is.

Sanitary President Henry Bellows drafts a bill canceling the seniority system and giving the Surgeon General power to inspect medical facilities. In April 1862, after a year's hard lobbying, Henry gets Congress to pass his bill. Lincoln signs it and also gets a new Surgeon General to implement it. The new Surgeon General, our 33-year-old friend William Hammond with the mad organization recruiting skills, creates a better working relationship between the Army Medical Department and the Sanitary Commission. This works really well in the operating room and in the Army chain of command, but it also creates friction between him and the politicians trying to win this war.

Still, William and the Sanitary Commission accomplish a hell of a lot together. The Sanitary recruits thousands of female nurses to work in army hospitals, but women eager to serve their country as nurses face stiff opposition. First, they often have to go through Dorothea Dix. Dorothea, a well-known nurse and reformer, serves as the superintendent of nurses for the Union War Department. She is in charge of female nurse recruitment for the Federal Army. With the Women's Central Association for Relief, or again, the WCAR, providing training for many volunteer nurses, Dorothea has a growing pool to choose from. But she has crazy high standards. Dorothea only allows plain-looking

women between 35 and 50 to work as army nurses. She worries that soldiers and doctors will exploit young, pretty nurses. All the mildly good-looking 25-year-old nurses with training and experience will have to find a way to circumvent Dorothea's rules. Second, most field doctors are not interested in working with women. So even if nurses make it through Dorothea's tough standards or just volunteer with the sanitary, doctors often make their lives miserable. After the war, Georgiana Woolsey writes a book about her nursing experience, and she recounts, quote, "...hardly a surgeon of whom I can think received or treated women nurses with even common courtesy. Government had decided that women should be employed, and the army

surgeons, unable, therefore, to close the hospitals against them, determined to make their lives so unbearable that they should be forced in self-defense to leave. Some of the bravest women I have ever known were among this first company of army nurses. They saw at once the position of affairs, the attitudes assumed by the surgeons, and the wall against which they were expected to break and scatter. And they set themselves to undermine the whole thing. Close quote. Thankfully, northern women prove stronger than their situation. They don't let a prejudiced selection system or hostile work environment prevent them from saving lives. Soon, female nurses are a staple of army hospitals. They serve all over the place, in purpose-built city hospitals, commandeered houses close to the

battlegrounds, or even in tents near the front lines. In 1862, they're also found on the sanitary's train cars and boats, now retrofitted to serve as field hospitals. Women working on these floating hospitals on waterways near battles play a huge role in saving lives. Take Mary Jane Safford, for instance. Mary volunteered in 1861 as a nurse through the Sanitary Commission and started out working in Cairo, Illinois, but by 1862, she's aboard the boat-turned-hospital Hazel Dell. It's from this vessel that she directs a veritable fleet staffed by female nurses as they work from the river amid the carnage of the Battle of Shiloh in April 1862. Her work is exemplary. One doctor observing Mary's efficient, effective

efforts has this to say, quote, under the direction of Miss Mary Safford, the nurses prepared food for the sick and wounded, bathed their wounds, and washed their powdered and blood-stained faces. Since the commencement of the war, she has devoted her time and energies gratuitously to this labor of love. When this wicked rebellion is crushed out, the name of Miss Mary Safford will be immortalized in American history. Close quote. While overworked Mary suffers a breakdown shortly after Shiloh, her devoted care aboard the Hazel Dell, as well as her work back in Cairo, Illinois, lands her an immortalizing nickname, the Cairo Angel. By the way, she'll keep making history after the war. Mary will

become a professor at the Boston University School of Medicine. But Shiloh isn't the only place where these boat hospitals are game changers. For instance, the female nurses staffing the Wilson Small Hospital steamship stemmed the tide of death at the Peninsula Campaign in May 1862 as well. The details of this campaign are in episode 51, but after one small battle, the most severely wounded soldiers end up on the Wilson Small. These guys are so shot up that no one really expects them to survive the night. But thanks to the care of a nurse I quoted earlier, Georgiana Woolsey, as well as her sister, Eliza Woolsey Howland, and several other women,

only one man dies. Officer Newton Curtis gives all the credit to them and the other nurses on board. Quote, those who lived owed their lives to the care received from these patriotic and devoted women. Close quote. Now, in case war nursing somehow sounds glamorous to you, let me set the record straight. Devoted women like Mary Safford and the Woolsey sisters face the same grim conditions as the soldiers for whom they care. They sleep in cold, drafty, dirty cabins or tents. That is, if they can get any sleep. It's not much better away from the field either. Nurses working in hospitals near their homes in large cities work hard, long hours. On the field, nurses eat the same scanty rations as the enlisted men. Oh, and the vast majority of these women are unpaid volunteers. They don't get

a check from the medical department or the sanitary commission. Hannah Ropes volunteers as a nurse with the sanitary commission in June 1862. After a few weeks on the job, she writes home and begs her teenage daughter not to join her at Union Hospital in Georgetown, Maryland. Quote, It is no place for young girls. We get lousy and dirty. We run the gauntlet of disease from the disgusting itch to smallpox. Close quote. Sounds like Hannah doesn't work in

the officer's wing. She's probably down in the infantry in the sick ward. Hannah doesn't let the threat of lice or smallpox get between her and the patients, though. She works with famed author Louisa May Alcott as a nurse across the winter of 1862-63, and Hannah doesn't put up with incompetent or dishonest hospital staff mistreating quote-unquote her boys. Hannah finds the steward at Union Hospital stealing food meant for sick soldiers and selling it on the black market. She reports this to the head surgeon, who knows about it, and refuses to do anything. So Hannah goes right up the chain of command to War Secretary Edwin Mars Stanton. As you heard in episode 48 when we first met Mars, he has a zero-tolerance policy on corruption. Mars hears Hannah out and has the pilfering steward and the

complicit surgeon fired immediately. But Hannah's success is short-lived. Both she and Louisa May Alcott get typhoid in early 1863. Louisa gets so sick she has to go home to New England. Hannah doesn't recover. She dies in January. banking, investing, and more. We answer your real-world money questions and break down the latest personal finance news. The Nerds will give you the clarity you need by cutting through the clutter and misinformation in today's world of personal finance. We don't promote get-rich-quick schemes or hype unrealistic side hustles. Instead, we offer practical knowledge that you can apply in your everyday life. You'll learn about strategies to help you build your wealth, invest wisely, shop for financial products, and plan for major life events. And you'll walk away

with the confidence you need to ensure that your money is always working as hard as you are. So turn to the nerds to answer your real world money questions and get insights that can help you make the smartest financial decisions for your life. Listen to NerdWallet's Smart Money Podcast wherever you get your podcasts. Okay, so we've now got a good understanding of how the Sanitary Commission came into existence, functioned, as well as a small taste of life for the thousands of nurses in its ranks. But not all Northern women who volunteer do so with that organization. Some strike out on their own with impressive results. This brings us back to the woman we met in today's opening, Clara Barton. When the Civil War broke out, the dark-haired,

shy New Englander was working as a copyist in the Patent Office in Washington City. Clara heard about the violence in Baltimore where Union soldiers got attacked by a pro-Confederacy Remember that from episode 46? Well, when the 6th Massachusetts Wounded began pouring into the Capitol, she immediately organized supplies to help the beat-up boys in blue from her home state. From that day on, Clara decided how she would contribute to the war effort. On her own, she gathered medical supplies and provisions and stored them in her own apartment. After the first battle of Bull Run, Clara placed an ad in a Massachusetts newspaper for supplies. And since she didn't claim to be a Nigerian prince needing $500 a month wired to a random address in Ohio, people knew Clara was the real deal. They sent her tons of stuff, and her friends helped her distribute it. In August 1862, the determined independent New Englander decides she can't

keep operating out of her back closet. She asks military quartermasters to take her wares to the front lines, and they comply. Clara also goes to the front lines. She doesn't have formal training as a nurse, but she does whatever she can. Restocks supplies, cleans, cooks, applies bandages, even removes a bullet from a desperate soldier's face, as I told you about in the opening. Clara is like the Swiss Army knife of field nurses. Clara works at several battles, including Cedar Mountain, Second Bull Run, Antietam, and Fredericksburg. At Antietam, Clara addresses so many wounds she runs out of bandages. Putting her

ingenuity to use, she uses corn husks to wrap wounds. Like a seasoned modern-day ER doc, she stays up for nearly three days straight helping wounded men after the battle. Except after this superhuman shift, Clara doesn't go home to a shower in a warm bed. The woman now known as the Angel of the Battlefield has to sleep on the ground under a tarp she calls a tent. She pulls her dark hair out of her face, props her head out of the mud to avoid drowning, and goes straight to sleep. By the way, I need to add one thing about Clara not related to the Civil War. Two decades from now, she'll found what will become one of the largest humanitarian organizations

the world has ever known, the Red Cross. But the Red Cross isn't our focus today. The list of influential nurses in the Civil War goes on. Mary Ann Bickerdike volunteered as a nurse as soon as the war began. The straight-mouthed, dark-eyed woman has no patience for disorder or waste, and her forceful demeanor definitely pisses off a few people along the way. But she produces results, and that's why General Tecumseh Sherman is a big fan of Mary. As a rule, Cump doesn't allow civilians in his camp, but he makes an exception for Mary, whom his men affectionately call Mother Bickerdike. She keeps the hospitals well- well supplied and cleaned, and cuts

through red tape faster than he can. Mary takes her duties to keep the men healthy very seriously. When Tecumseh orders that medical supplies have to be taken off the supply chain, Mary goes to see him herself. She knows he doesn't have room for medical personnel, but she demands that he take the supplies. Tecum Kump tries to ignore her request, but like I said, Mary's not one to cave. She'll have none of that. Have some sense about it, General, Mary says, unabashedly pushing back. That's right. She, a civilian volunteer, just implied that he, a Union General, is being, well, stupid. Kump bursts out laughing. Her grit and ability not to give a damn about red tape,

rules, or anyone who gets in her way of taking care of soldiers are all the things Kump likes about her. Frankly, it probably reminds him of himself. They're two peas in a pod, and that's likely why Kump respects and appreciates Mary so much, even when he's the one she's taking to task. And he won't suffer anyone trying to get rid of her either. When a

doctor personally asks the general to remove Mary from the camp, Tecumseh refuses. She ranks me, doctor. You must apply to President Lincoln, he answers. Needless to say, Mary stays. Now Mary Bickerdike and Clara Barton are unmarried women working for the Union cause wherever they find a need. But many women attach themselves to the regiments in which their husbands or brothers are fighting. They sometimes act as vivandiers or cantiniers, literally bringing food and water to fighting soldiers. This isn't the first time I've told you about women in this role. You might remember that in episode 33, Sarah Borginas filled this position at Fort Brown during the Mexican-American War. But these women also become field medics, learning the trade as they go. Anna Blair Etheridge enlisted with her husband in 1861.

Her husband deserts in 1862, but Anna stays with her men as an unpaid soldier nurse. At the Second Battle of Bull Run in August 1862, Anna's regiment comes under heavy fire. Anna finds a rock outcropping that shields her from fire while she treats wounded men. But she runs onto the battlefield and drags wounded soldiers back to safety, coming very close to getting hit several times. In fact, a cannonball kills a man while she's dressing one of his wounds. Yeah, we won't dwell on what a gory mess this close call must be. Frankly, she's lucky to get out unscathed.

But that luck doesn't follow Anna to the Battle of Chancellorsville in 1863. While surveying the field, looking for wounded men, Anna gets shot. The bullet grazes her hand, goes through her dress, and wounds her horse. She sets her strong jaw, finds a new horse, and keeps working. Anna receives a Kearney Cross for her bravery. Like soldiers, volunteer nurses find that the romance of war wears off pretty quickly. At Shiloh, Margaret Harkin listens to the two-day battle from a hospital steamboat on the Tennessee River. After the engagement, she goes ashore to help the wounded.

She describes, quote, here we saw some of the horrors of war. There were wounded of every description and many a brave young life went out on the amputation table, then followed long, weary day and night watches with poor, suffering men. I think Margaret would agree with General Tecumseh Sherman. War is hell. Now, I've been focusing on northern women fighting for the Union, but women south of the Mason-Dixon line are doing just as much to help their soldiers. They form aid societies, send supplies to the front lines, and work as nurses at hospitals and on the battlefield. They are perhaps even less welcome on the battlefield than their northern sisters though. Southern society generally holds that

military hospitals, filled with blood and filth and lacking in privacy, are no place for a lady. But the desperate need for medical care pushes back against these social norms here just as it has in the North and in other mid-19th century wars. When Alabama Kate Cumming is told that nursing is not the place for quote-unquote refined ladies, such as herself, she cites the example of other women who've recently broken through this barrier, like the famous British nurse, Florence Nightingale, quote, I wonder what Miss Nightingale and the hundreds of refined ladies of Great Britain who went to Crimea would say to that, close quote. Against her family's wishes, Kate volunteers as a nurse and ends up seeing some of the worst

carnage of the war, including battles such as Shiloh and Chattanooga. She describes an odious scene after the Battle of Corinth in Mississippi. Quote, I sat up all night, bathing the men's wounds and giving them water. The foul air from this mass of human beings at first made me giddy and sick, but I soon got over it. We have to walk, and when we give the men anything, kneel in blood and water, but we think nothing of it. Close quote. Like countless other Southern women, Kate pushes through this nightmare and continues on.

She'll serve in hospitals and wards from Alabama to Tennessee and Georgia throughout the war. While Kate's boldly stepping outside the traditional southern feminine role in Mississippi, a wealthy single woman in Richmond, Virginia, season even steps up. In 1861, the CSA capital had a handful of hospitals, including the Chimborazo Hospital that boasted nearly 5,000 beds. There were also a couple of Army General hospitals, but most facilities were small, only 40 or so beds, and private. Expensive. So Sally Louisa Tompkins decided to start her own hospital. She rented a house and opened the Robertson Hospital in July 1861. It only had 40 beds, but Sally made the most of her facility. With eight part-time surgeons, five slaves, and several volunteer nurses, Sally's infirmary treats over

400 men a year across the war. By 1862, Sally's running a tight ship. Like Dorothea Dix in the North, she doesn't put up with delicate, ineffective volunteer nurses. When an attractive nurse blushes at the attentions of a wounded soldier, Sally doesn't hesitate to tell the woman to get back to work and stay on task. Quote, if you could only leave your beauty at the door and bring your goodness and faculty. Close quote. Sally's uncomfortably accurate appraisal of this situation, and others like it, keeps her hospital humming. Then the army throws Sally a curveball. The Confederate army decides to close or take over most private hospitals to create a more efficient medical treatment system in Richmond. Sally's hospital is slated to get the axe. Not cool. She goes straight to

CSA President Jefferson Davis and argues on behalf of her facility. In their meeting, Sally tells Jeff, I think the register of this hospital will show as great success in its management of the sick and wounded as any other. That's Sally's polite way of saying, my hospital can kick your hospitals**. But seriously, when most hospitals in Richmond have a mortality rate of over 10%, Sally's has only 5.5%. Jeff sees that this hard-working woman runs a stellar operation. He acquiesces. In fact, he goes a step further. To make Sally's hospital more official and give her access to military medical supplies, Jeff commissions the 29-year-old woman as an unassigned captain in the Confederate Army. Sally Tompkins is the only woman, north or south,

to reach that rank. The work of women like Sally and Kate Cummings opens many doctors' eyes. In late 1862, an Army doc in Danville, Virginia, does a total 180. He switches from using male nurses to preferring to work with females. In fact, he calls male nurses, quote, rough country crackers who don't know castor oil from a gunrod nor laudanum from a hole in the ground. Close quote. Now, I've been talking to you about nurses, but there is exactly one woman who manages to make the jump to surgeon in the U.S. Army. This is Dr. Mary Edwards Walker, and yes, I said doctor. Mary attended Syracuse Medical College. She graduated in 1855 and established a medical practice, but it struggled. Many, including women, were simply unwilling to see a female doctor. At the war's start, Mary wasted no time putting in

to be a military surgeon. But no dice. The U.S. Army refused the doctor on the grounds of her sex. The officers also didn't appreciate her penchant for dressing partly in men's clothing. As a doctor, Mary finds the floor-length dresses women customarily wear in the mid-19th century impractical, but she's also not interested in passing for a man. She's proud to be a woman. Her answer is to wear her dark hair and curls while wearing a knee-length skirt with men's pants underneath. In her eyes, this combines femininity and practicality, but in the eyes of the U.S. Army Medical Department of the early Civil War, it's a terrifying breach of social

norms. Mary does as so many other women we have met today have done. She goes to the front and volunteers with those armies that will welcome her help, and in her case, her expertise. Her years of volunteer work include a few generals we've come to know in recent episodes, like our sideburns sport and friend, General Ambrose Burnside. While commander of the Army of the Potomac, Ambrose relies on Mary. She arrives in November 1862, you know, the month before Ambrose's disaster at Fredericksburg, which I told you about in episode 56, and finds his army suffering through a typhoid epidemic. Probably doesn't help that their sickbeds are, quote, crawling with vermin, close quote. Good grief. She explains to Ambrose how screwed his sick men are and gets his blessing to transfer

several of the incapacitated to general hospitals in Washington City. Then, of course, she's right in the mix a month later when Ambrose's army fails to take Fredericksburg. I'm sure the debacle at Mary's Heights alone kept the good doctor plenty busy. After the battle, Dr. Preston King writes to War Secretary Edwin Stanton. Surely, the surgeon hopes, Mary should be paid at the very least. The U.S. Army has benefited from her credentialed expertise for over a year. Nope. The god of war turns down the request. Mary responds by continuing to help the war effort for free, including taking the time to set up a temporary residence for women and families in Washington, D.C. who've come to the capital in search of their injured husbands, sons, and fathers. In 1864, though, Mary finally gets compensated. Remember General Thomas from

the last episode? Nicknamed the Rock of Chickamauga for his awesomeness at that battle as old Rosie fell apart? Commander of the Army of the Cumberland? Yeah, you got it. Well, this bearded Southerner, whose loyalty to the Union has cost him his fortune and caused his family to disown him, needs an assistant surgeon for his 52nd Ohio Regiment. And Mary's on hand. So he hires her. No rank still, but she's a bona fide assistant surgeon pulling in a salary almost equal to that of a first lieutenant. Whew, it's about damn time. But Mary isn't just a doctor. It seems she's also doing a bit of espionage. At one point, her intel makes a significant change

in William Tecumseh Sherman's battle plans. But in April 1864, she gets caught. She spends four months as a prisoner of war until she's traded back in exchange for a Confederate major. Okay, so clearly, Mary's valuable. She again petitions for a legit commission. General George Thomas sends a letter in with his support for her commission as well. Take that in. A commander of an entire army just asked that doctor and union spy Mary Walker receive a commission. Still no. She'll continue on as a contracted acting assistant surgeon. But the commission matters to Mary. Like Sally Tompkins, who, as we heard, the Confederacy was willing to commission, Mary wants to be acknowledged as a

part of the army she's served tirelessly for years. She petitions yet again when the war's over, this time to President Andrew Johnson and War Secretary Edwin Stanton. She's turned down yet again. However, in January 1866, she is awarded the Congressional Medal of Honor. While throwing herself into the women's rights movement, she proudly wears it the rest of her life. But there's a sad twist to Mary's hard-earned recognition. Fast forward with me several decades to 1917. And no, I don't have a cool sound effect for fast forwarding. I've got to work on that. Looking to define what merits a Medal of Honor, Congress decides the award requires engaging in actual combat. As a result, that august legal body of the United States takes back the award

from 912 Americans. 911 of them are men. The other is Mary. Does this early 20th century Congress appreciate the irony of taking an award given to her in part because the mid-19th century U.S. Army refused to grant her a commission? Can't say, but I have to imagine some congressmen aren't heartbroken at the thought of taking the Medal of Honor from its lone female recipient, particularly one known as a, quote, militant or radical, close quote, because of her rejection of dresses and decades of work for women's rights and suffrage. But whether this is Congress being bureaucratic Congress or Congress being flat-out sexist, Mary has the perfect answer, quote, you can have it over my dead body. Close quote. That's right. The now 85-year-old will never return it. And it will take until

1977, but thankfully, America's lone spine, POW, and female Civil War assistant surgeon will have her Medal of Honor reinstated posthumously. Medicine in the Civil War was rough from our 21st century perspective. You might even call it downright medieval. But I hope you noted some of the meaningful advances that happened in these years, such as the creation of professional ambulances and nursing, the development of triage, and improvements in general anesthesia. If there's a silver lining to the tragic loss of life and limb, doctors and medical students are coming to better understand the human body as they study the dead, and the quality of prosthetics is dramatically increasing as well. We've also seen that the Civil War's medical advancements end up advancing women's

rights at the same time. In the North and South, the work and efforts of female nurses elevates the status of nursing as a profession. George Templeton Strong, the Sanitary Commission's treasurer, watches his wife work as a nurse in 1862. He says, quote, The little woman has come out amazingly strong during these two months. Have never given her credit for a tithe of the enterprise, pluck, discretion, and force of character that she has shown. God bless her. Close quote. So a little growth on George's part, and I'm sure that's the case for other men as well. That said, let's remember we're still half a century away from the national women's suffrage, let alone discussions about

women having access to the same careers and pay as men. In short, we can certainly say that the Civil War brings a measured, significant step to women's rights, but there's still a long road ahead. History That Doesn't Suck is created and hosted by me, Greg Jackson. Researching and writing, Greg Jackson and C.L. Salazar. Production and sound design, Josh Beatty of J.B. Audio Design. Musical score, composed and performed by Greg Jackson and Diana Averill. For a bibliography of all primary and secondary sources consulted in writing this episode,

visit historythatdoesntsuck.com. Join me in two weeks, where I'd like to tell you a story. HTDS is supported by premium membership fans. You can join by clicking the link in the episode description. My gratitude to you kind souls providing additional funding to help us keep going. And a special thanks to our members whose monthly gift puts them at producer status. Andy Thompson, Anthony Pizzulo, Art Lane, Beth Chris Jansen, Bob Drazovich, Brian Goodson, Bronwyn Cohen, Carrie Beggle, Charles and Shirley Clendenden, the Map Producer status. Thank you. Lawrence Neubauer, Linda Cunningham, Mark Ellis, Matthew Mitchell, Matthew Simmons, Melanie Jan, Nick Sechender, Nick Caffrell, Noah Hoff, Owen Sedlak, Paul Goringer, Randy Guffrey, Reese Humphreys-Wadsworth, Rick Brown, Sarah Trawick, Samuel Lagasa, Sharon Theisen,

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