Thomas Wright's Diary

War And Medicine

               Surgical Kit, Bone saws scalpel and fleshing
                Knives, bullet extractor at the bottom.

       
                                 Ambulance

The Union Army came up with a system to evacuate the wounded. Doctor Jonathan Letterman
Established and enacted the plan.

These ideas improved the Ambulance system and the ambulance. The ambulance weighed 750 pounds, was moved by 2-4 horses was made to carry 2-6 wounded soldiers. Standard accessories included compartments to store medical supplies, stretchers, water, removable benches, and seats, to adapt to the number of passengers.

He set training standards for the crew, established routine inspections of the ambulance. Developed strategical evacuation plans, to most efficiently save and transport fallen soldiers. At the Battle of Antietam all the wounded were moved from battle within a day. Months after the Ambulance Corp was established.

The Confederate Army had a policy close to the Union, had fewer ambulances so it was never as good at evacuation.

              Union Army Field Hospital, these were
              Normally captured Plantation Mansions.
              Field Surgeon performing a amputation.

When the War began neither side, had plans in place to care for the wounded or sick. After the Battle of Bull Run, the Union took possession of several private Hospitals, in Washington, D.C. and Alexandria, VA. Officers on both sides figured the War would be short, and no need to create a long standing source of care.

After George B. McClellan took command, and organization of the Army of Potomac, things changed. He appointed the First Medical Director of the Army. Surgeon Charles S. Tripler on August 12th 1861.

He created plans to enlist Regimental Surgeons to travel with the Regiments, they could not leave for battle without one. Each Regiment had to have a Surgeon and a assistant.

1862 William A. Hammond became Surgeon General he made reforms, he raised requirements of admission into the Army Medical Corp the Surgeons were promoted to serving at Brigade level, intermediate Hospitals were established at Brigade level, then General Hospitals.

The Rank of Major Surgeon and staff were assigned to oversee the Brigade level Hospitals and that Regimental Surgeons were in compliance with the Medical Directors orders.

He increased the number Hospitals, he had plans for a Hospital and Medical School in Washington, D.C. a central Laboratory was created for Chemical and Pharmaceutical preparation.

States could use their own Tax Dollars to fund Medical needs. Ohio sent three steamboats to Shiloh after the unexpected carnage of the battle.
These steamboats were filled with Doctors Nurses and medical supplies. The State Fleet expanded to 11 Hospital ships. The State also set up 12 local offices in main transportation nodes, to help Ohio Soldiers moving back and forth.

They began Nurse enlistment in 1862, two per Regiment, one nurse per ten patients in a General Hospital. The expedited move from Field to General Hospital was over tedious many men died on this move. Jonathan Letterman was promoted to Medical Director of the Army. His Ambulance Corp ideas were used to make this move smoother.

Each Regiment was assigned two ambulances one to carry extra medical supplies the other wounded. The Ambulance Corp was under the command of the Surgeon Major at Brigade level.
By 1863 the number was expanded to three per Regiment.

By the end of 1862, each Regiment was supplied with a standard set of medical supplies including medical books, small hospital furniture bed-pans, containers for mixing medicines, vials, bedding, spoons, lanterns.

                               Surgery

Approximately 30,000 amputations were performed during the War. About 75% survived the surgery. A good Surgeon could amputate a limb in ten minutes. Think about the numbers I have given you, from battles on how many wounded. Most of those  probably were amputations, so being able to do one in ten minutes, saved plenty of lives, after a battle Surgeons worked nonstop for hours even a day or longer.

( One fact I dispute, is the use of anesthesia both Armies claim they used it, from what I have read this I find not of the norm. Being under supplied
the number of wounded at any battle. This I feel wasn't always the case, especially late into the War, for the Confederacy. My thoughts only. I have found several statements they were only given enough chloroform to put them into a stupor more like being over drunk but awake during the surgery hence the shouts and movements during surgery. Then I read that many died from chloroform poisoning. Contradicting the stupor.)

So if they had it they used it, if not you were held wide awake, cut then flesh removed enough to form a flap. Then the bone sawed off, all the while biting on a leather wrapped stick or bullet. Normally, these were Drummers and nurses, doing the holding. Amputation did save lives my Great Great Grandfather Philotos survived one during the war, left leg just above the knee from the picture I have. I have no family stories on whether or not they used chloroform or not, I imagine he didn't talk about it.

Why did they amputate? With no form of antibiotics or sterilization, infection could set in plus that bone in the picture, if you look closely. The medical procedures of the time could do no kind of repair. The biggest worry was infection.

The surgeon actually thought if the wound produced white pus the wound was healing. When in fact the wound was getting infected. Roughly three in five Union wounded died of infection Confederate two in three died of infection.

Now we Imagine again, you are wounded. Awake to know what is going on around you. The surgeon just finished his last stitch on the man before you.
They drag him off, throw a bucket of cold water over the table or a few boards stretched between two sawhorses.

You don't even have a tent over you, outside feet, legs, hands, arms maybe even a few dead are laying around. The Surgeon aids pick you up, the Surgeons hands still bloody from the last guy. All his kit bloody, they give you a little whisky then you bite on the stick. The pain shoots through you like wild fire. You can hear the saw cutting through bone. You are trying to get up, hands arms someone on your chest holding you down.

Maybe before it's over or the middle of it you pass out. Now think about the blood part, the guy before you blood is on it, the Surgeon may of dipped his hand in water or just wiped them off, to get the blood off some. Then again he probably just started on you. If you think about it, how more didn't die is a true miracle.

I think that gives you enough to see why Thomas as his fear. From the Battle of Stones River memories of the Drummer, the stacked limbs how long men laid waiting for help. This little bit of information, you can see why Thomas was being moved the way he is, they needed beds at all levels for battle wounds all were sent to the rear to recover. Thanks again for your support. I have decided to add a little note in the next chapter.  After that the next few chapters is Thomas this all leads to what happened.