This article isn't typical of the oddball stuff I normally post to this site, I know, but it's about reenacting Civil War medical care. I don't have anything on that subject yet. So consider it a nod to medical impressionists. As usual I cannot restrain myself, so my occasional comments are in brackets. - Jonah

Civil War reenactors revere, learn from the past

by Thomas B. Cole

(From The Journal of the American Medical Association, April 17, 1996)

At the Third Annual Convocation of the Society of Civil War Surgeons, held last month in Harper's Ferry, WVa, reenactors and historians met to consider not only what happened during the war but how and why it happened that way. Rather than sail, fly fish, or pursue some more usual avocation, these men and women (not all of them physicians) devote themselves to reenacting as authentically as possible or studying intently the events of those four awful years.

James Ellison, for example, assumes the role of a medical officer in the 33rd Virginia Regiment, Stonewall Brigade, to provide some context for the popular image of the Civil War surgeon. "We were bloody surgeons, yes, but forget Hollywood. Think why." He explains: Before every battle, the surgical team would take the smoothest, most solid wooden door they could find off its hinges and lay it across two supports. They might cover it with a poncho to keep the blood from soaking through.

Wounded men would be lifted onto the improvised operating table and anesthetized with a rag soaked in chloroform. "You didn't like to use ether because it was explosive around flames," says Ellison, "so let's say you're working by candlelight. ..." An experienced surgeon, using a scalpel and a handsaw, could amputate a leg in 15 minutes. "Then you'd give [the patient] a whiff of ammonia or splash a little chloroform on his scrotum to wake him up. [That would do the trick for me! - Jonah] Toss his leg away, put him on a blanket to carry him outside, maybe give him a couple of opium balls for the pain, turn back around and there's another man on the table."

At this point the experienced surgeon would make the tactical decision not to wash his hands and instruments. "Water is scarce, and wounded soldiers are always thirsty," says Ellison. And washing takes time. "If it takes 2 minutes to wash times seven amputations, that's 14 minutes and you've just killed a man."

This scenario was replayed thousands of times between 1861 and 1865. According to Bruce G. Wolff, MD, professor of surgery at the Mayo Clinic, Rochester, Minn, three fourths of the wounds received in the Civil War were to extremities, and three fourths of all operations were amputations. Casualty rates were high, says Wolff, because the evolution of battlefield tactics did not keep pace with the improved efficiency of Civil War weaponry. Handheld weapons could wound or kill at far greater distances than were possible a few years earlier. The Civil War resulted in more than 600,000 deaths, one third from battle injuries and the remainder from disease. Reliable estimates of the number wounded or missing in action are difficult to obtain, in part because Confederate records were burned when Richmond, Va, the capital of the Confederacy, fell to the Union Army.

`Doubt Would Be Disloyalty'

Under these circumstances, why were so many young men willing to put themselves in harm's way? Wolff suggests that each side believed fervently in its cause, many soldiers expected little out of life, and most had confidence in their leaders and were accustomed to doing what they were told. Religious influences were also important, agrees Ralph C. Gordon, MD, professor of pediatrics at Michigan State University College of Human Medicine, East Lansing, and adjunct associate professor of history at Western Michigan University in Kalamazoo. Gordon's copy, of The Soldier's Hymnbook, published during the war by the Chicago Young Men's Christian Association, bears a poem on its cover that ends with the lines "... to doubt would be disloyalty, to falter would be sin." [A major difference from the "Question Authority" line I learned in the antiwar 1960's! - Jonah]

Whatever the motivation, says Ellison, it was experienced intensely by the individual soldier and cannot be understood by studying the movements of armies and decisions of commanders. He says the best book about a soldier's experience in combat is The Face of Battle by John Keegan (Viking Press, 1976). "That's one of my favorites," says Ellison, "because I'm not interested in generals. When I turned 65, I had to quit the infantry and become a medical officer [in the Stonewall Brigade] because I was slowing the boys down. But when I was in a line of bluecoats facing the enemy, and the bayonets came down, and there was a flash of flame from the rifles, I felt like I knew what it must have been like." [I've read Keegan's book and agree that it is excellent. My favorite section was about Agincourt. Highly recommended. - Jonah]

Achieving the mind-set of a 19th-century soldier is the aim of all Civil War reenactors. However, 19th-century thinking can be hazardous. B. Jay Carmichael recalls how an enlisted man hurt himself with an axe during a recent reenactment. "He came up to the medical tent as we were eating dinner, waited respectfully to be acknowledged, and said he cut his hand. One of my fellow medical officers said, `Can't you see that we are eating?' To which the soldier replied, `Sorry, sir, when should I come back?' They were both in the 19th-century mind-set," says Carmichael, who had to reason with them to ensure that the injured man received immediate medical attention. The real-time problem was compounded because neither Carmichael nor his fellow officer was a physician. Nevertheless, the 19th-century relationships of officer to private soldier and physician to patient nearly determined the course of action taken in the 1990s. [Not with me, it wouldn't! - Jonah]

Swapping `War Stories'

Such a story is typical of those reenactors tell when they get together, as though they were indeed former Civil War soldiers reminiscing about their experiences in battle. Many of these tale take the form of gallows humor. Reenactors admit that they have sometimes one so far as to simulate abdominal wounds, with intestines spilling out on he ground, or have pretended to amputate the leg of a comrade who has in reality lost part of an extremity as a result of trauma or disease.

Gory demonstrations such as these may be staged to impress spectators at a reenactment, but sometimes they are performed for the sole benefit of other reenactors. Carmichael once stumbled on a soldier lying against a tree with what appeared to be a bullet hole in his forehead and blood running into his eyes. The soldier was so intent on playing dead that Carmichael, who says he was genuinely worried, had to kick him twice to get a response. Alvan St. Jacques, an expert in the simulation of traumatic injuries, recalls that he once lifted the head coverings of one "dead" soldier after another until he came to one he seemed to recognize. Then he gently cradled the man's head in his hands and whispered, "I told you to stay home with Ma."

Other stories recount the discomforts and hazards of playing the men in blue and gray. Allan Hordof, MD, a pediatric cardiologist who serves as the chief medical officer of the Third New Jersey Regiment, recalls a reenactment of the Battle of the Wilderness. In 1864, this battle was fought in thick woods that gunpowder set ablaze, with the result that many wounded soldiers were burned alive. To recreate the effect, some participants wanted to burn tires to produce thick smoke. [Typical New Jersey approach, bring trash fires to Virginia - Jonah] Fortunately, says Hordof, he had the ear of the commanding officer and this plan was thwarted. Nevertheless, the combined effects of heat, allergens, and smoke from the black-powder weapons reduced visibility and comfort to levels reminiscent of the actual battle. As in other reenactments, Hordof recalls, many cases of heat exhaustion and heat stroke occurred among the spectators as well as the reenactors.

According to Ron Paull, president of he Great American Civil War Society, here are about 30,000 Civil War reenactors with 6,000 of them to reenact Pickett's in the United States. He worked with 6,000 of them to reenact Pickett's Charge for the filming of Gettysburg. Only a few reenactors are medical officers, who represent about two thirds of the Society of Civil War Surgeons. At the society's annual conference, they soak up details and contextual information about the war so that their reenactments will be as lifelike and historically accurate as possible. In turn, the historians at the conference benefit from the perspective of those who go through the duties and rituals of Civil War soldiers.

Understanding the Medical Past

This perspective adds insight to the historical evidence that physicians usually treated symptoms and signs rather than disease processes because of their limited understanding of pathophysiology. For example, digitalis, according to William D. Sharpe, MD, a retired pathologist, was given to stimulate the flow of urine and slow the pulse, rather than for heart failure.

One reason smallpox flourished during the war was that the safety and efficacy of immunization was doubted by commanding officers such as General J.E.B. Stuart, one of the most successful cavalry officers of the Confederate Army. On the other hand, says Peter W. Houck, MD, assistant clinical professor of pediatrics at the University of Virginia School of Medicine in Lynchburg, slaveowners routinely vaccinated slaves to protect their investment. To overcome the problem of vaccine instability for army units that did wish to vaccinate their men, says Houck, inoculum would be obtained from the scabs of recently vaccinated slave children.

Military medical officers often took measures to control the spread of epidemic disease. In Nashville, Tenn, prostitutes were licensed by a Provost Marshall of the Union Army for a fee of 50 cents per week, which covered the costs of routine medical examinations and hospital care for those found to be diseased, according to amateur historian Arthur Cadenquist. Such measures resulted in dramatic decreases in the rates of syphilis and gonorrhea among Union soldiers.

Illustrations like these confirm that Civil War medicine is still relevant today, says Sharpe: "The fundamental problems, aiding the sick, diagnosis and treatment, and the patient-physician relationship, are the same." However, he also says he believes that Civil War history has broad appeal because it was the defining event of our nation's history. People in different parts of the country still refer to the conflict as the War Between the States, the Brother's War, the War of the Rebellion, or the War of Northern Aggression, indicating that differing views of its meaning and impact persist. Houck concludes, only partly in jest, that "like the Union Army, smallpox can be considered to have invaded the South" when infected soldiers were taken prisoner by the Confederate Army at the Battle of Antietam. Spectators at reenactments can also be partisan, at least when the reenactments take place on southern soil. Hardof, who wears Yankee blue, says he has been booed in Virginia [So have I - Jonah], and fights over display of the Confederate flag make news today.

History Repeats itself

Because of the drama and immediacy of Civil War history, it can be tempting to immerse oneself in it. One who manages to function appropriately in both the 19th and 20th centuries is Glenn W. Davis, a physician assistant who practices emergency medicine. A "living historian," Davis portrays two different Civil War military officers. During the reenactment season he wears a flowing handlebar mustache and full goatee to appear as the historical figures of Dr Nugent of the Union Army and Dr Fite of the Confederacy. He has researched the lives of these men, relying on the assistance of state historical societies, town historians, and even the granddaughter of Dr Fite. At reenactments, Davis talks with spectators in the character of one of these two medical officers, taking off his hat on the rare occasions when he feels that he has to break character to answer a question.

Once Davis had to break character to treat a reenactor's sprained ankle. "I used the Ottawa ankle rules to determine that he didn't need an x-ray. Then I wrapped the ankle, covered the wrapping with some dirty bandages, and lent him my set of Civil War-era crutches. Those crutches must have been photographed a thousand times that weekend." He has found that basic fife-support techniques, first aid, and common sense preventive measures, such as providing water to spectators and reenactors on hot days, are sufficient to manage most medical problems at reenactments.

What worked well in Civil War times can still work well today, observes Davis. When I was activated for Desert Storm, they assigned me to a medical tent draped around a supply wagon, just like the ones you see in old etchings of the Civil War." The main difference was that the wagons were no longer drawn by horses.