“My Hands and Heart Full”

How Did Civil War Surgeons Cope?

Peter Stanley

Originally published in June 2014 in the Surgeon’s Call, Volume 19, No. 1

There is a familiar figure in Civil War literature: that of the surgeon operating in the immediate aftermath of battle. General Carl Schurz described a familiar nightmarish scene at Gettysburg:

… there stood the surgeons, their sleeves rolled up to their elbows, … their knives not seldom between their teeth … The surgeon snatched his knife from between his teeth …, wiped it rapidly once or twice across his bloodstained apron, and the cutting began. The operation accomplished, the surgeon would look around with a deep sigh, and then – “Next!”

This has been a familiar image for over a century, since Louis Duncan first quoted it in 1910, and it has appeared many times, although no one seems to have noticed that Duncan thought that in holding the knife in his teeth this man was “no doubt the striking exception.”[1]

But if this is a familiar image, it has overwhelmingly been used as a way to explain what the surgeons did. No one much seems to have asked: what did these surgeons feel? Civil War medical history has devoted prodigious scholarship to the effects of the surgeons upon their patients; but little to asking what effect undertaking surgery had upon those who performed it. Thanks to the devoted work of libraries and museums (like the NMCWM) in collecting memoirs, diaries and correspondence, and of scholars in transcribing, editing and publishing them, we can now know a great deal more about the lives of Civil War surgeons.

In my recent honorary research fellowship at the NMCWM, I have consulted surgeons’ diaries, letters and memoirs held in its library, and have suggested some tentative responses and sketched out some lines for further research. I’ve looked at evidence from both Union and Confederate surgeons – more published primary sources are Union, but the NMCWM’s archives have helped me to redress the balance. My scope has been not all of the 20,000-odd medical officers who served on both sides. Though a great variety of medical personnel could be found in Civil War hospitals – physicians, dentists, apothecaries, hospital stewards, contract and volunteer surgeons – my focus soon became the surgeons serving with regiments or brigades, and to a lesser extent those employed in the larger hospitals.

Before understanding what surgeons felt we must understand what they did. William Child of the 5th New Hampshire Volunteers served from the Battle of Antietam to the war’s end, rising from regimental to divisional surgeon. From Antietam he wrote to his ‘dear wife’ Carrie how he:

… dressed the wounds of 64 different men – some having two or three each. Yesterday I was at work from daylight till dark – today I am completely exhausted – but shall soon be able to go at it again.[2]

The days after a major action, he wrote were for surgeons “a thousand times worse than the day of battle … how awful it is …”

Surgeons bore a burden as heavy as those who fought. After the costly and futile assault at Cold Harbor Daniel Holt, Surgeon to the 121st New York Infantry, confided to his diary that “the wounded as they come to the rear, make a person feel sad … My hands and heart full,” he wrote.[3] That seems to be as concise a description of the surgeon’s predicament as we might find: having to treat wounded men with all their professional skill, but carrying the burden of that responsibility for evermore. Carl Schurz gave an example of a surgeon who found the ordeal too much and in the midst of operating (at Gettysburg) put down his instruments, “exclaiming that this was too much for human endurance, hysterical tears streaming down his face.”[4] From the Confederate side, the anonymous Texan ‘rebel surgeon’ recalled a young doctor who “backed out; went back to his old Kentucky home; couldn’t stand it; too sanguinary for him.”[5] And who could blame any of them?

Daniel Holt thought that operations in a divisional hospital – where by the middle of the war most serious surgery occurred – were “the very worst part of the business.”[6] But the medical and surgical work in even large, well designed and well-run general hospitals could be arduous and relentless. At a time when wounds would take months to close and heal – partly because of the unwittingly unhygienic conditions of hospitals, partly because surgeons tolerated and even encouraged ‘laudable pus’ – wards remained full for months, and hospitals on both sides saw the arrival of repeated waves of casualties.

Surgery was a source of intense strain, but it was also these men’s calling: what they had trained and volunteered to do. The Autobiography of Silas Trowbridge, who served under Grant at Shiloh, Corinth and Vicksburg, suggests that professional ambition motivated some conscientious operators. In detailing the range of operations he undertook in two terrible weeks after Shiloh, he listed “in multiplied variety all the kinds of wounds on which the surgeon’s skill and practice could be exercised,” and acknowledged that he “had an aspiration for the successful accomplishment of what is called … ‘major operations.’”[7] In June 1864 a Maine surgeon, James Moore, wrote in successive letters how “it was heart renching” [sic] to hear the groans of the wounded, on which he performed “any quantity of amputations” in what “looked j[us]t like a big Slaughterhouse,” and then admitted that “I have a good opportunity to see & practice surgery much better” in the divisional hospital, “I could not be better situated to see surgical practice.”[8] On the other side, the Confederate Missouri doctor Caleb Dorsey Baer captured the ambiguity many surgeons felt in a letter to his wife after fighting near Helena, AR, in July 1863. For him, as for all surgeons, it was “a day of work … and of sorrow too.”[9]

Jonathan Letterman, the Medical Director of the Army of the Potomac, conceded that after Antietam many surgeons “sickened from excessive labor,” but individual examples emphasize the toll the surgeons paid.[10] The letters of William Watson, surgeon to the 105th Pennsylvania Infantry, document its physical cost. He had been commissioned in 1862 as a 24-year-old, almost immediately tending the massive casualties of the blood-bath at Fredericksburg. Already he decided that “I have had enough surgery now to do me for quite a number of years…”[11] By the middle of 1863 he was “completely exhausted.” A year later, treating casualties in the Wilderness and at Spotsylvania, he was, he wrote in successive letters “getting old” (he was 27), “very tired,” “pretty well through.”[12]

What kept them going? One answer is that humans can come to regard anything as ordinary: Confederate surgeon Edward Craighill (who claimed to be the youngest Confederate surgeon, at 20) mused in his memoirs that “human beings never know the limit of their endurance until the test comes.”[13] The anonymous “rebel surgeon” simply observed that after a “the bloody battle of Perryville… By-and-by I got sorter used to it.”[14] This article looks at what seemed to have sustained them or helped them cope. Many wanted to forget – the Texan Alex Morgan, who had also operated at Shiloh, remembered it a year later “that night + the next … I will never forget … well it is past now.”[15] Passed; but neither forgotten nor forgettable, no matter how much he may have wanted to. Neither Silas Trowbridge nor Alex Morgan drank to forget– but some must have.

Did doctors drink? Of course they did – except for evangelical believers who declined hard liquor, practically all medical officers drank. Did some seek solace or relief from the burdens of their profession in drinking? Certainly– substance abuse occurs today– why should it not have happened then?

But how prevalent was it? On the one hand it is easy to find allegations, both general and specific. A journalist charged Confederate surgeons of taking a sip at the operating table every time they administered “stimulants” to patients, and later claimed to have seen surgeons so drunk that “they could not distinguish between a man’s arm and the spoke of a wheel, and who would just as soon have sawed off the one as the other.”[16] Records of courts-martial provide numerous cases of medical officers arraigned on charges of drunkenness – Thomas Lowry and Terry Reimer’s book Bad Doctors mentions drinking as a factor: on one page of ten entries, three mention “continued drunkenness,” “drunkenness and worthlessness” and “constant drunkenness.”[17] Most pages include at least one case, some of spectacular alcoholic decline – of a surgeon too drunk to hear the court’s sentence of dismissal, another too drunk to remember a patient’s answers to his questions; a third who in two months drank 72 bottles and seven gallons of hospital whiskey. But 12,000 surgeons of all kinds served the Union: a couple of hundred court-martialed or dismissed seems a tiny proportion when considering both the pressures to which the war subjected them and their ready recourse to alcohol.

While American society may have condoned drinking, it drew the line at prolonged drunkenness. The Confederate Surgeon General, Samuel Moore, warned, “drunkards are not wanted in the Medical Department.” As the historian of Confederate medicine, Horace Cunningham, judged, “reports of drunkenness seem to have been exaggerated.”[18] The evidence of those who saw the work and knew the characters of hundreds of men and found only isolated examples of drunkenness seems to carry more weight. It is possible that drinking was so unexceptional that only unusual cases of drunkenness attracted censure, but perhaps “drunken doctors” is another of those persistent myths of Civil War medical history.

Civil War America was pervasively Christian, and it’s likely that their faith sustained many men. But the experience of war surgery also tested men’s faith. Though a devout Christian, William Child’s experiences made him wonder:

…who permits it to see or feel that a power is in existence that can … hurl masses against each other in deadly conflict – slaying each other by the thousands … it is almost impossible.[19]

It is notable that some of the most candid admissions of the strain that surgeons felt come in letters to their wives or sisters. They often thought of home, family and loved ones, and confided in them, and they produce some of the most compelling and moving evidence. The most melodramatic plea comes from Surgeon Isaac Kay of the 110th Pennsylvania Infantry, whose letter to his wife, Catherine, approaches the hysterical: “I cannot sleep my dear darling wife! … a letter from you will be sufficient to ease me of pain.” This sounds almost comically overwrought, but the next line suggests that Isaac has things to say that he can perhaps only say to Catherine: “I must wait until I get home to tell you of the scenes through which I have passed.” He has had experiences in the Shenandoah Valley that he could perhaps only speak of to her.[20]

A profound sense of duty also sustained many. To these doctors it had two real meanings; professional and patriotic. War service brought those two ideas together in what became an iron grip, for surgeons on both sides. Edward Craighill justified his decision to treat patients in the smallpox wards at Gordonsville in one simple sentence: “I was not acting from choice, but from DUTY.”[21]

Men on both sides accepted standards of manly endurance, and accepted the notion of “cowardice” as a real presence. As Confederate fortunes waned the idea of giving in became more attractive but less feasible. Alex Morgan, whose letters to and from his wife Fanny provide a wealth of evidence, wrote to her from the trenches at Marietta, GA, during the Atlanta campaign that “it would be cowardly to leave my post now … in the crisis of our affairs, a big battle imminent.”[22] William Child, who after Antietam and Fredericksburg had written to his wife Carrie with “groaning men … all about me” confided that “three days at Antietam and one night at Fredericksburg” had “given me enough of battle.” But he could not say so openly: “some might say that I was a coward to talk so.”[23]

We need to be wary about either unduly generalising or sentimentalising. Of course surgeons reflected a range of personalities and responses. Jane Woolsey, one of the most perceptive of the female nurses to have written of her experiences, wrote that she had found surgeons who had been drunk, incompetent and neglectful, but that recalled other men as faithful, sagacious and tender-hearted.[24] Others conformed to the rough exterior of the indifferent or callous surgeon, such as the man a visitor described while visiting a church in Gettysburg after the battle:

a brute … smoking and swearing and paying no attention … to the frequent appeals made to him …[25]

It is hard to believe, but Dr Harvey Black of the 4th Virginia Infantry wrote to his wife how he “had a very pleasant time in the practice of my profession in the late battle” – even though that battle had been Chancellorsville.[26] And of course we need to be wary of projecting or imposing our ideas of medicine, progress, hygiene, or indeed what would be stressful onto a different time. For example, when after the battle of Antietam Jonathan Letterman toured the hospitals in Frederick (including one just across the street from the NMCWM building), he reported with satisfaction that “in no instance did I find undue suffering.”[27] To us, suffering is the essence of those hospitals, and they affected the surgeons who worked in them, just as they affect us still. More work needs to be done on the social history of Civil War medicine and its practitioners; but the sources in the NMCWM provide a superb starting point.

Want to learn more? Read “UNPLEASANT RECOLLECTIONS” also by the author.

Sources

Louis Duncan, The Medical Department of the United States Army in the Civil War [1910], Olde Soldier Books, Gaithersburg, nd, p. 235 Merril Sawyer, Betty Sawyer & Timothy Sawyer, (eds), Letters from a Civil War Surgeon: the letters of Dr. William Child of the Fifth New Hampshire Volunteers, Peter Beer & Company, Solon, 2001, pp. 33-34 James Greiner, Janet Coryell & James Smither, A Surgeon’s Civil War, p. 195 quoted in Gerard Patterson, Debris of Battle: the Wounded at Gettysburg, Stackpole Books, Mechanicsburg, 1997, p. 13 F.E. Daniel, Recollections of a Rebel Surgeon, Clinic Publishing, Chicago, 1901, p. 75 Greiner et al., A Surgeon’s Civil War, p. 124 Silas Trowbridge, Autobiography [1874], Southern Illinois University Press, Carbondale, 2004, p. 80 quoted in John Warner & Janet Tighe (eds), Major Problems in the History of American Medicine and Public Health: Documents and Essays, Houghton Mifflin Company, Boston, 2001, p. 177 Caleb Baer, Letter, 28 July 1863, SURG-BAE-L-001, NMCWM Archives Letterman report No. 4, Sep-Nov 1862, SURGU-LET-O-001, NMCWM Archives Paul Fatout, (ed.), Letters of a Civil War Surgeon, Purdue University Press, West Lafayette, 1996, p. 61 Fatout, Letters of a Civil War Surgeon, pp. 111, 131, 136, 137 Peter Houck, (ed.), Confederate Surgeon: the Personal Recollections of E.A. Craighill, H.E. Howard, Lynchburg, 1989, p. 23 Daniel, Recollections of a Rebel Surgeon, pp. 75; 79 Letter, Alex Morgan to Fanny Morgan, 6-7 April 1863, www.baylor.edu/lib/believemeyourown, SURGC-MOR-L-001, NMCWM Archives Horace Cunningham, Doctors in Gray: the Confederate Medical Service, Peter Smith, Gloucester, 1970, p. 259 Thomas Lowry & Terry Reimer, Bad Doctors: Military Justice Proceedings Against 622 Civil War Surgeons, National Museum of Civil War Medicine, Frederick, 2010, p. 59 Cunningham, Doctors in Gray, pp. 259-60 Sawyer, et al, Letters from a Civil War Surgeon, p. 34 Letter, Isaac Kay to Catherine Kay, 3 April 1862, 2007.7.7, NMCWM Collection Houck, Confederate Surgeon, p. 42 Letter, Alex Morgan to Fanny Morgan, 30 June 1864, www.baylor.edu/lib/believemeyourown, SURGC-MOR-L-001 Sawyer, et al, Letters from a Civil War Surgeon, p. 71 Jane Stuart Woolsey, Hospital Days: Reminiscence of a Civil War Nurse [1868], Edinborough Press, np, 1996, p. 93 Gregory Coco, A Vast Sea of Misery: A History and Guide to the Union and Confederate Field Hospitals at Gettysburg, Thomas Publications, Gettysburg, 1988, p. 17 Glenn McMullen, (ed.), The Civil War Letters of Dr. Harvey Black, Butternut & Blue, Baltimore, 1995, p. 1 Letterman report No. 4, Sep-Nov 1862, SURGU-LET-O-001, NMCWM Archives

About the Author

Prof. Peter Stanley, of the University of New South Wales, Canberra, Australia, is one of Australia’s most active military-social historians and a joint winner in 2011 of the Prime Minister’s Prize for Australian History. He is the author of 25 books, mostly in Australian military history, but including For Fear of Pain: British Surgery 1790-1850 (Editions Rodopi in association with the Wellcome Institute for the History of Medicine, Amsterdam, 2003). In July 2013 he spent a two-week honorary research fellowship at the NMCWM in Frederick, MD.