Civil War Hospital Ship


Evolution of Civil War Nursing


The Practice of Surgery

Amputations were the most common surgery performed during the Civil War.

Army Medical Museum and Library


Civil War Amputation Kit


Saturday, August 23, 2014

The Slave South: Medicine Chests and Self-Sufficiency in Medical Care


R. Jeffery and A. Alt advertised the sale of aromatic snuff in the American Beacon and Commercial Daily on June, 27 1817 in Norfolk, Virginia. Jonathon P. Whitwell prepared and bottled the aromatic snuff in Boston. Whitwell shipped the snuff to Norfolk and various other locations across the East coast. Jeffery and Alt sold the aromatic snuff to Virginians who desired to fill their medicine chests in order to gain self-sufficiency in medical care.

According to Catharine C. Hopely, a tutor at Forest Hill near Tappahannock County in 1815, a capacious medicine chest is an inseparable part of a Southern establishment; and I have seen medicines enough dispensed to furnish good occupation for an assistant when colds or epidemics have prevailed. Virginians frequently resorted to home-remedies due to the inaccessibility of many farms to main highways, good roads and means to speedy transportation that prevented them from reaching physicians. Thus, Virginians on plantations, farms, and even urban households desired self-sufficiency in medical care. The desire for self-sufficiency stemmed from the economics of slave holding that instructed masters to do everything possible to keep their slave force healthy.

When caring for slaves, if a combination of drugs or particular medication arrested symptoms, slave owners used that treatment until a better one came along. According to historian Todd L. Savitt, plantation overseers and owners recorded useful medical recipes and clipped suggestion from newspapers into their journals. Most homes possessed a medical digest in addition to a well stocked medicine chest. Many Virginians owned Simon's Planters Guideand Family book of Medicine or Ewell's Medical Companion. Digests presented specific instructions on the treatment of many disease, the proper dosages of drugs for each age group, and the best uses for most medicine.

Historian Stephanie P. Browner claims that slaves frequently treated their diseases or illnesses themselves without their master's knowledge. Slaves did this for several reasons; to offset the failures and harshness of white remedies or the negligence of masters, and most often to exert some control over their own lives. Black home remedies secretly circulated throughout slave quarters, and elders passed them down to younger generations. According to Browner, some medicines contained ingredients that had purely superstitious values, but slaves mainly obtained cures from local plants. Occasionally, whites learned of an effective treatment that slaves used, and adopted it for themselves. However, this did not affect the business of Jeffery and Alt who traveled around Virginia and sold medicine to Virginians who desired to fill their medicine chests with a large assortment of remedies.

Slaves represented a financial investment that required protection, and it made enormous sense for masters to maintain the health of their slaves. Awareness that certain illnesses could easily spread to a master's own families if not properly treated became a strong incentive for masters to keep their slaves healthy. A sick and physically incapacitated slave could not work, and represented a financial loss. The economics of slave holding instructed masters to do everything possible to keep their slave force healthy. This required masters to keep a well stocked medicine chest and adopt an assortment of home remedies.

How the Civil War Changed Modern Medicine

By Emily Sohn

The American Civil War often gets credit for ending slavery and reshaping the federal government in this country. But the War Between the States has another, often overlooked legacy: It may have started a new era in modern medicine.

As soldiers fell in unprecedented numbers from both injuries and disease, anesthesia became a specialty. The fields of plastic and reconstructive surgery exploded. And doctors developed new ways to treat a surge in nerve injuries and chronic pain, marking the beginning of contemporary neurology.

At the same time, a visionary surgeon named Jonathan Letterman forever altered the flow of medical treatment from battlefield to hospital, said George Wunderlich, executive director of the National Museum of Civil War Medicine in Frederick, Md.

Now, 150 years later, Letterman's basic principles continue to affect medical care in a wide range of situations, from bombings in Afghanistan to heart attacks in American grocery stores.

"Civil War medicine was every bit as barbaric as it's made out to be, and surgeons weren't washing their hands," Wunderlich said. "But it was a million times more modern than almost anyone thinks. And there are a lot of lessons we can still learn from today."

Medically, the United States was woefully prepared when the Civil War began in the spring of 1861, said Michael Rhode, an archivist at the National Museum of Health and Medicine in Washington, D.C. Nearly 80 years had passed since the end of the American Revolution, the country's last major war. And the new conflict was happening on a much bigger scale.

Scientists, meanwhile, had yet to come up with the theory that germs cause diseases. Doctors didn't know that they should wash their hands before amputating limbs. As soldiers from small towns came together in large groups, they became newly exposed to pathogens that their bodies had never encountered before. But there were no antibiotics and no antiseptics.

As a result, for every Civil War soldier that died of an injury or gunshot wound, more than two died from dysentery, diarrhea or other infectious diseases.

"They had no idea what was causing it," Rhode said. "The theory was something called miasmas, or bad airs. But no, it's not a miasma when a guy is wiping his surgical knives on a bootstrap with horse dung on it."

Medicine has come a long way since then. Injuries that resulted in amputations 150 years ago now lead to X-rays, the setting of bones, and a four- to six-week recovery period before returning to battle.

Over the course of the war, doctors learned some lessons that forever changed the way medical care happens, both on the battlefield and beyond.

There was, for example, a growing sense that cleanliness reduced fatalities. Doctors who treated soldiers made leaps in understanding about neurology and other fields, and specialists continued their lines of research even after the war ended.

Then there was Letterman, who as medical director for the Union Army created a well-organized system of care that began with triage close to the source of harm and was followed by rapid transportation to a series of clinics, hospitals and specialists. Even though technological advances have replaced horse and carriages with helicopters and jets, Wunderlich said, those kinds of protocols continue to be essential today.

As the Civil War ended and soldiers returned home, they retained their expectations for quick and efficient treatment in all situations. If a wounded man could be picked up in the midst of the Battle of Gettysburg, after all, shouldn't everyone be able to get rapid help after falling off a ladder on the street?

As a result, the end of the war saw the beginning of ambulance systems in many major cities. Letterman's ideas also directly influence the way today's 911 call system works. And the National Museum of Civil War Medicine has used the surgeon's ideas to train hundreds of thousands of medical professionals who have been sent to Afghanistan.

The war "was a watershed that really changed all medicine to the point where it could never completely go back to the way it was before," Wunderlich said. "All these changes had come about, and people weren't willing to go back."


Susan Blackford Agreed to Take Up Nursing


On July 08, 1861, Susan Leigh Blackford wrote to her husband, a lieutenant who served in the Confederate army to inform him she was not “at father’s all day sewing for the [Confederate] soldiers,” her regular daily activities, but writing for a special occasion. Blackford agreed to open a local Ladies’ Hospital for injured soldiers with another woman, Mrs. Otey. Nineteenth century women were not allowed in the hospitals of soldiers; however with the establishment of a Ladies’ Hospital, the army would not have to pay for a female nursing staff, nor the extra care wounded men would receive once they were removed from the battlefield. The dedicated Susan Blackfield ended her letter with an explanation that she agreed to help only in so far as she believed her husband approved and that the woman setting up the hospital, Mrs. Otey, was pleased to work with her.

As nineteenth century war-time medicine shifted to modern techniques, organizations formed to ease the transition and extend the life of  injured soldiers. According to historian James McPherson, both Union and Confederate women were allowed to nurse the sick and injured in their homes. However, women were not allowed in military hospitals due to the unsightly and grotesque wounds of soldiers. The United States Sanitary Commission, created by women in 1861, offered charity to the military and began creating hospitals that allowed female nursing staff. Dale C. Smith, author of Military Medical History, claimed the U.S.S.C. “mobiliz[ed] the existing medical profession by providing consultations, transportation, and supplies.”

Susan Blackfield was a conventional southern woman; she sewed items in need for the Confederate soldiers, she was loyal to her husband, and she was willing to help the Confederate soldiers receive further medical aide after they were picked off the battlefield. Blackfield was only one of thousands of Union and Confederate women that was engaged in this type of nursing field work. As southern women felt that sewing uniforms and flags were not enough to help their military men survive, they went from needle and thread to needle and morphine to try and better the chance of Confederate survival.

An Assistant Surgeon Reports on Gangrene


Andersonville's prison had a hospital crowded with patients, due to the bad living conditions in the cells. The prison was overcrowded with prisoners crammed in rooms, inactive and secluded from society, lacking food, exercise and fresh air. The atmosphere was so polluted that people could hardly breathe. The promiscuity made sickness spread in a heartbeat, and in the winter of 1865, the prison witnessed an epidemic of what was called hospital gangrene, in addition to the usual scourges of diarrhea, dysentery and scorbutus. The assistant surgeon of the hospital reported that the epidemic was due to all these factors. Gangrene started from a bacterial infection in a wound and could spread to the whole body and eventually kill the patient if not handled in time. In the hospital, out of 325 patients, 208 died over the three months before January. Usually gangrene could be handled easily, but the hospital was so over-burdened and not prepared to medical care, that far more people died than typical. The patients of the prison's hospital formed a crew of 1,600 to 2,000 people, who slept in tents, with at least five other persons. They wore their battle clothing that they had not washed in six months or more. In their state, they needed strong food that could give them strength, but the hospital could not provide it for them. The medicines that the hospital received lasted only for ten days, and then they had to accommodate with what they could, such as vegetables picked in nature around the hospital. They were in such a lack for medicine that they had to carry out experiments on the patients, out of natural plants that they picked up in the countryside. The good will of the surgeons was not to question though, they were at peace with God and with themselves by trying all that was possible to improve the conditions of the prisoners.

This report reveals the conditions of prisoners of war Andersonville, the most infamous of prisons. Many of them entered in good health and caught lethal diseases there. According to Freemon, hospital gangrene was a sickness in which skin tissues became black, and it happened only in certain hospitals, due to horrific sanitary conditions. He believed that the hands of the surgeons themselves could be responsible for the spread of the disease from a wound to the other. In Catton and McPherson's view, the living conditions were atrocious and the death rates were alarmingly high. They say it was due less to the good will of people than to the heartlessness of the war. Apparently the conditions were equally bad in the prisons North and South, but no effort was made to change things.

Image: Hospital Gangrene as illustrated in the Medical and Surgical History of the War of the Rebellion.

Armory Square was a Military Hospital


Armory Square was a military hospital that sprang up in Washington D.C. during the Civil War, from 1862-1865, which recorded unprecedented numbers of soldier casualties and deaths.

While not the first military hospital to open in Washington D.C. during the Civil War, Armory Square Hospital is known for receiving some of the worst soldier casualties from Virginia’s battlefields. Situated nearest the steamboat landing at the foot of Seventh Street, S.W., and the lines of Washington and Alexandria railroad, Armory Square Hospital was the first and only stop for many Union soldiers as the seriously wounded could not afford to travel any farther, according to Martin G. Murray’s article Traveling with the Wounded: Walt Whitman and Washington’s Civil War Hospitals. The Armory Square Hospital Gazette and The National Republican papers reveal that Armory Square Hospital had an unprecedented number of soldier deaths. Notably, “from August 1861 to January 1865, Armory Square recorded the largest number of deaths of any Washington military hospital, 1,339 out of 18, 291 deaths” as recorded in the February 25, 1865 edition of the Armory Square Hospital Gazette (Murray).

Armory Square was one of the six “model” hospitals built in Washington D.C. during 1862. Whereas “barracks” hospitals were converted from unused Army barracks, “model” hospitals like Armory Square were specifically made according to the U.S. Sanitary Commission and their recommendation of a pavilion principle (Murray). There were as many as 56 separate facilities used as hospitals in Washington D.C. during the course of the Civil War, and Murray notes that Armory Square was one of 43 in use when it opened in 1862.

The Armory Square Hospital Gazette was first published on January 6, 1864. The opening page of the gazette presents the harsh reality of many a soldier’s gruesome fate--it claimed: “the Hospital is an episode in  soldier’s life--sometimes a painful termination of it, which has many an event worthy of a chronicle. Such we propose this paper to be” (“Salutatory”). While recording the deaths of soldiers who died, the gazette also notes soldiers admitted to Armory, returned to duty, transferred to different hospitals, and discharged.

As a large hospital tending to those grievously wounded, Armory Square was frequented by a few notable people. President Abraham Lincoln and poet Walt Whitman visited Armory Square, meeting with many soldiers in the hospital ward (Murray). One of Lincoln’s many visits was recalled and recorded by Armory Square nurse Amanda Akin. Whitman also went to many Washington D.C. hospitals and attended to the soldiers. He wrote copious notes about his visits, and on page 18 of his hospital journal he jots down: “In ward G, H, or I, young man I promised to come in and read to--sick with fever--he cannot read steady himself--his hand swerves--take him the paper” (Whitman). However, Whitman writes that he visited Armory Square most often “because it contains by far the worst cases, most repulsive wounds, has the most suffering and most need of consolation--I go every day without fail, and often at night” (Whitman).

Armory Square Hospital captures one side of the Civil War, but reveals volumes about the tragedy of the war through the sheer number of men dying from casualties and the hospital’s prominence through multiple visits by President Lincoln and the poet turned nurse Walt Whitman.

Surgeon Matt Turner Writes Letter of Hope and Worry to Home


Assistant surgeon to the 22nd regiment of Alabama Infantry, Matt Turner wrote a letter to his mother on May 27, 1863, speaking of his weariness in waiting to hear news from home. He served on picket duty for the past three weeks, but was now managing the Wither’s Division hospital in Shelbyville, Tennessee. Turner found working at the hospital comfortable, although he spoke of the continuous changing circumstances that were a part of military life. He wrote, “… though everything is so uncertain in the army that I am never surprised or disappointed at anything that ‘turns up’.” Turner also mentioned both his uneasiness and his confidence about the war effort. With the siege of Vicksburg having started only nine days before this letter was written, Turner wrote of the ongoing battle, “We are all looking with anxious eyes toward Vicksburg and feel as if a speedy peace will follow the sweep of our arms at that place.” With confidence in the Confederacy, he continued on, “I feel that it is impossible for Grant to extricate himself from his present hazardous condition and, with the reinforcements we have already sent on, [Grant] must be ‘cut to pieces’ or captured. May we not hope that the beginning of the end is near?”

Vicksburg was one of the longest battles of the United States Civil War, lasting from May 18, 1863, to July 4, 1863. Union General Ulysses Grant laid siege to the city on May 26, 1863. Turner, like many Confederates, knew the importance of Vicksburg in turning the tide of the war. Vicksburg sat along the Mississippi River, which was essential to northern military and commercial interests. Furthermore, the River split the Confederacy into an eastern and western half. Gaining control of this waterway was of paramount strategic importance for the Union; this would prevent CSA soldiers and supplies from moving across each side of the Confederacy. If the city did not fall, the Confederacy might win the war, and Turner was optimistic of this outcome. The Siege of Vicksburg lasted forty-seven days. Union casualties totaled 9,362 men and Confederate casualties 29,500 men. In a decisive victory, the Union managed to gain control of Vicksburg.

As an assistant surgeon in the war, Turner was a valuable resource, for he could attend to the wounded with care. Historian Harold Straubing wrote of doctors, nurses, surgeons, and others in the medical field at that time, “They dealt with the soldiers, the wounded, the diseased, and the dying. They were never too far behind the fighting front lines, often in the battle itself as forces crisscrossed the same land.” On both sides, these men and women were unsung heroes. They attended to the wounded and were often placed into the heat of battle in service to their respective country. Much of what is known in the medical industry today can be attributed to the impact of Civil War doctors, surgeons, and nurses, such as Matt Turner.

Emma Mordecai Nurses Soldier


Emma Mordecai regularly visited wounded soldiers at a nearby hospital, and on one particular day she was tending to a handless soldier whom she called my interesting Cavalry man. She bathed his wounds and rubbed his cold feet, but then she watched helplessly as he complained of an intolerable itch where his hand used to be, scratching at the amputated spot with his remaining hand. Having cared for the soldier on prior occasions, Emma noted that he was more agitated than usual and sought out some liquor to calm him, meanwhile also delivering the ice cream she had bought for another soldier who had mentioned craving the dessert. Hours later, she regretfully discovered that her Cavalry soldier would be transferred to a different hospital.

In an effort to aid the Confederacy, Southern women enthusiastically tackled new challenges during the Civil War, including caring for sick soldiers. Many in the army were wounded during their first outing on the battlefield, and still others contracted illnesses such as dysentery, typhoid fever, and the measles. Without female-run hospital relief societies, thousands of men would have suffered from a lack of any kind of nursing, for the Confederate government did not have enough resources to provide medical attention for all its soldiers.

One of the prominent goals of these organizations was to stock hospitals with both necessities and comforts like the ice cream and alcohol Emma provided. Women were tenacious in their mission to find supplies, often donating from their own kitchens, soliciting neighbors, and even smuggling medicines beyond the line in their full skirts.

Pennsylvania Surgeon Tends to the Wounded at South Mountain





Monday, August 18, 2014

A Confederate Surgeon Establishes A Field-Hospital After the Battle of Franklin


Large numbers of casualties and advanced weaponry made it necessary for surgeons to travel with military units during the Civil War.  While they could take surgeons along with them, they could not transport hospitals.  As a result, surgeons often had to improvise, turning abandoned buildings (when available) into makeshift hospitals or setting up field camps behind battle lines.  Deering J. Roberts, M.D., a Confederate surgeon, wrote an article sometime after his service in the Civil War detailing how he participated in establishing temporary hospitals both in buildings and in the field.

Dr. Roberts began serving with the 20th Regiment, Tennessee Infantry in March of 1862 and travelled with this regiment throughout the war.  On December 1, 1864, Roberts received orders to go to Franklin, Tennessee and setup a hospital for Lieutenant General Bate’s division.  He was accompanied by his hospital steward, ten men, and two wagons that would serve as ambulances.  Upon arrival, he quickly went to work finding buildings that could serve as hospitals.  He described one of the buildings by stating, “I found an old carriage –and wagon –shop about sixty by one hundred feet, two stories high.  It had a good roof, plenty of windows above and below, an incline leading up to the upper floor on the outside, and a good well.”  After securing this building and two others, Roberts formed teams which he assigned to cleaning and preparing the buildings to house wounded soldiers.

One of the bloodiest battles fought during the Civil War, the Battle of Franklin took place on November 30, 1864.  General Hood, leading the Confederate States Army, pursued the Union Army through Tennessee.  Upon arrival at Franklin, Union Major General Schofield had his troops form defensive lines.  General Hood and his men soon arrived, and the battle began at 4:00 in the afternoon.  The fighting raged on for five hours, claiming the lives of many and leaving many thousands wounded.  The Confederate States Army suffered 6,261 casualties, approximately 1,750 of which were killed and 3,800 wounded.  Roberts and his team helped care for the wounded soldiers after the battle was over.

Surgeons working in temporary establishments and field-hospitals were kept busy with wounded soldiers.  Amputations became a more common practice during the Civil War.  The advent of the Minie ball brought with it shattered, splintered bones and difficult-to-treat wounds.  Dr. Roberts described the wounds left by Minie balls as “both remarkable and frightening.”  Surgeons quickly learned that in order to save lives, amputations were often necessary.  Improvised hospitals became highly important as they served as the sites for such procedures.

Advances in technology and higher numbers of casualties made temporary hospitals a necessity during the Civil War.  Sometimes hospitals were established in buildings within towns.  When buildings were not available, however, field-hospitals were created.  Civil War surgeons had to learn how to adapt to various situations quickly.

Image: Deering J. Roberts, Surgeon

Chas. M. Evans, Manufacturer of Artificial Limbs


Chas. M. Evans, Manufacturer of Artificial Limbs of the best quality, solicits a share of the Southern patronage the ad read. Prices have been reduced and other special inducements are now offered Southern citizens and soldiers. To insure satisfaction, each leg may be fitted and test fully before any payment is required. Mr. Evans, purveyor of prosthetics, provides the Rev. C.K. Marshall of Vicksburg, Mississippi, as a reference to the suitability of his product for the citizens of the Vicksburg community.

At the time the ad was placed in the Jackson Weekly Clarion on February 16, 1879, there would have been a high demand for prosthetic limbs among those soldiers who were fortunate enough to return from the Civil War alive. Scores of the roughly eighty thousand Mississippi whites who fought for the Confederate Army were killed, and many more of those who did come home did so missing arms, legs, or sustaining other injuries. Civil War military historians Grady McWhiney and Perry D. Jamieson suggest that the military strategy of the Confederate army was particularly responsible for this state of affairs, asserting that casualty lists reveal that the Confederates destroyed themselves by making bold and repeated attacks... these bloody Confederate offensives took the lives of the bravest Southern officers and men. Relatively few combat officers went through the conflict without a single wound, and most of those who did could claim, as did General Reuben L. Walker, who participated in no less than sixty-three battles, that it was not my fault.

The unpreparedness of Confederate generals for a new sort of warfare fought with rifles, coupled with a tactical aggression that led them to strike offensively even in the face of massive casualties, meant that an entire generation of young men in Mississippi and throughout the South were either lost on the battlefields or came home dramatically wounded.

Those who survived the bullet blasts often faced even worse in Confederate hospitals. Medical historian George Worthington Adams paints a grim picture of the sort of medical services provided in wartime: The surgeons of the day thought a bare finger was the best probe; they operated in dirty uniforms; they used the same marine sponge to swab out the wounds of countless men; they reused linen dressings; they meddled with wounds and thus made bad matters worse... far from being surprised at the large number of mortalities, we should marvel that a majority of their operations recovered. Such was the state of affairs for soldiers undergoing surgery, to say nothing of those suffering from the many diseases that ravished the Confederate army.

The appearance of the Charles M. Evan's ad nearly a decade and a half after the war's conclusion demonstrates how far the consequences of the war's characteristics- from poor military strategy to dangerous operating procedures- would last into the era of rebuilding in the South. For the young veterans who would become clients of Evans' artificial limbs business, the destruction brought about by the Civil War was not limited to their land, their communities, or their former homes; they would face as well the very personal devastation of their own bodies.

Southern Women Help the War Effort in Florence, South Carolina


On August 11, 1862, one month before Southern women were officially accepted as nurses, J. Bachman announced the importance women held in the medical effort in coastal South Carolina. She explained, in a local newspaper, a proposed arrangement concerning the delivery of imperative medical supplies to Florence, South Carolina. The Northeastern Railroad had been sending donated supplies free of charge, but there was a need for them to be properly collected and distributed. She proposed that an appointed female agent travel to Florence from wherever they might be on Tuesdays and Sundays to complete the receipt of the supplies. Ms. Bachman stressed the importance of paying prompt attention to all donations from around the country to make sure none went to waste. After all, she said, it was their sole object and view to alleviate the suffering of their brave defenders. In this way, the women of coastal South Carolina could contribute to the war effort without officially being recognized by their country. They used whatever outlet they could as an opportunity to help their beloved soldiers.

Not until September, 1862 did the Confederate Congress officially authorize women as nurses. Thereafter, women were welcomed by the Southern army as a recognized source of medical help. In his book Ordeal by Fire, historian James McPhearson argues how women in the South, because of this late recognition of aid, did not play as large of a role in the war as did Northern women, since these women were allowed at an earlier time to be official nurses. However, women, such as Bachman and her partners, found ways in the South to significant ways to contribute to the war effort and assist their wounded.

Women played a vital role in the Civil War, and without them, the war would have been very different. Female efforts during this time were especially important in the medical field, since fighting was seen solely as a man's job. They did most of the hard work in the civilian volunteer agencies that were created to aid the growing number of wounded soldiers. They were dedicated, hard-working people who earned respect and praise from officers and men. The female endeavors during the war, recognized officially or not, contributed greatly to the overall efforts that were made.

Image: The most expert smugglers during the Civil War were women. An illustration depicts a southern woman unloading boots, which she attempted to wear across Union lines.

Slave Owner Uses Modern Medicine to Treat Malaria


In late September 1846 several slaves from the Fairntosh plantation in Durham, North Carolina fell sick with malaria. Their owner, planter Paul Cameron, tells his father Duncan how he provided medicine for his sick slaves as well as the traditional herbs and teas.

“Since that time we have a great deal of chill and fever at the mill quarter in [unintelligible] I have made the best arrangements possible that I could for administration of medicine by cutting it up into portions one g[rain] for the elder ones and five grains for the younger [unintelligible] with a little oil with instructions for the use of our usual teas and no doubt I will get about as good accounts from them as from the other.”

Paul Cameron, like many slave owners, was carefully attuned to the health of his work force. Neither his concern over the health of his slaves however, nor his quickness to use newer medical treatments, necessarily indicate that Paul Cameron was a more humane owner of slaves, or that he possessed more egalitarian views. Rather, Paul’s use of medicines was part of a larger debate over medical treatment for slaves. The development and application of medical science was part of the ideological environment of the Antebellum South and an important argument for the justification of Slavery.

The US South in the 19th century was an unhealthy place. Epidemics of cholera, yellow fever, and typhoid ravaged the population, killing many of those infected. Malaria, though not as lethal as other common diseases, was a great concern for slave owners as it could severely weaken their work force. Spread through the Anopheles mosquito, the parasite causing malaria damages the blood cells and the liver and causes fever, vomiting, chills and headaches. Though it infrequently causes death, the initial infection can last several weeks, and relapses of symptoms can occur months, even years, after the initial infection. 19th century physicians did not understand the origins of the disease, nor that it was spread through mosquitoes, but that did not stop them from prescribing a multitude of treatments for what they referred to as “fever and chills” or the “autumnal fever”. In the early 19th century a debate arouse over the proper treatment of slaves who contracted malaria.

Physicians were not taught specific treatments for slave diseases, despite calls for such training, and owners and doctors alike were left guessing over the proper course of medical treatment. (Savit 1981) Treatments such as bleeding and blistering had fallen out of use on whites, but were still prescribed for blacks suffering from the same diseases. Prevailing medical thought considered slaves to be resistant to malaria and other tropical diseases, and “those few blacks who fell victim to the fever were treated in a simple manner. Hot bricks were applied to the feet, hot brandy or water given in large quantities, as well as hot snake-root tea containing forty or fifty drops of spirit of ammonia.”(Haller 1973) This spirit of ammonia is likely the medicine Paul gave to his sick slaves.

Paul was confident that this minimal treatment would suffice because the leading physicians of his day believed blacks to be resistant to malaria and other tropical diseases. This belief served as a justification for the institution of slavery, as such resistance was seen as evidence of Africans’ natural suitability and inclination for fieldwork. Paul’s treatment of his slaves was modern in comparison to his Alabama overseer Charles Lewellyn, who generally took a less active approach to his sick slaves. Yet, this attention should not be considered to be an indication of a kinder type of slave owner or a rejection of the harshness of the plantation system. The modern medical science practiced in the Antebellum South created new justifications for the institution of slavery. Paul Cameron may have been modern in his application of medical science, but his motives were grounded in an ideology of racial inferiority that served to legitimize slavery.

A Local Describes Gettysburg After the Battle


The Battle of Gettysburg remains the bloodiest battle in United States history. With a combined 51,112 men killed in the battle over a three day span, the momentum of the Civil War took a turn in favor of Union forces. With fallen soldiers decorating the landscape of the Gettysburg battlefield, "The Republican Compiler", a Gettysburg newspaper from 1854 to 1868, published vivid details of what the battlefield looked like and the significant effects the battle left on the town.

A local man, Mr. Cooke, who was a special correspondent for "The Age", another local newspaper, gave one of the most graphic accounts of the battle’s aftermath. The Republican Compiler printed Cooke’s account in their July 20, tenth edition; the second paper that they had printed since the end of the battle. Cooke gave a report of the entire battle, but the section where he describes the scenery after the battle is the most moving.

He visited the battlefield on Tuesday July 7; four days after the battle had ended. He described the abandoned battlefield in a manner that is similar to it being completely destroyed. He stated that, “Every fence was knocked down, and every house or shed upon the battle field around it had its windows shattered, its walls torn out and its roof in tatters… The grain and grass which once grew there, was almost ground to a jelly.” The Union forces had about 94,000 men serving at the battle and the Confederates had 70,000 men. The number of men who marched, shot, and were killed or wounded at Gettysburg led to the destruction of the terrain.

Cooke not only described the battle and the destruction that occurred in Gettysburg, he also explained the common horrors of the Civil War. Cooke wrote about the dead soldiers that he saw on the battlefield and states that, “Many walked about amid the horrid stench of the field unmoved. The looked upon the dead, to be sure; with no expression of pity if he were a Federal soldier and only a laugh of a curse if he were a Confederate…” Cooke offered the view that all of the men should be remembered for how they fought and died, instead of who they were fighting for. And his portrait of other people looking through the battlefield for their own memento or souvenir, instead of being deeply effected by how many dead they were walking through is a prime example of how people became numb to the horrific events that surrounded them.

Childcare in the Civil War Era


The contemporary idea of childhood in the United States is distinctly domestic: it regards the home and its appendages, such as schools and churches, as the child's proper places. Although U.S. attitudes toward childhood and children have European roots, approaches to child welfare in parts of Europe and non-Western societies often differ from American attitudes, since they have included the separation of children from their homes for purposes of maturation, APPRENTICE-SHIP, and early employment. From the American view, such practices are aberrant, harmful, and tantamount to ABANDONMENT in so far as they fall short of providing children with nurturing, parental home environments. Contemporary Western notions of abandonment sprang from this particular representation of domestic childhood and from normative judgments about a child's actual and ideal life course.

The Years Prior to the Civil War
Dependent children are those who, through various circumstances, become dependent on private charity or public assistance. In the United States, ideas about children's welfare were inherited from the English Poor Laws under the principle of parens patriae, whereby the state is the ultimate parent of all children. In the colonial era, this resulted in two forms of relief for dependent children: indoor relief (assistance to parents in the home) and outdoor relief (alternate homes, such as ORPHANAGES and poor houses). For most of the seventeenth and eighteenth centuries, public administration was local and the household was the immediate source of authority, with the result that dependents had little direct contact with the state. Many thousands of children were brought to the colonies as indentures and the death rate in the Chesapeake was high for children as well as adults. Consequently, the indenture system tried to maintain household governance and the family system by placing children in homes while training them for future employment. It made little difference whether the child was poor, illegitimate, or orphaned and, regardless of cause, children who were left on their own were regularly indentured or apprenticed. Indenture afforded a reasonable solution to uncared-for children while reducing public responsibility for colonial dependents, including those who were orphaned, whose parents were unfit, or who misbehaved. In 1648 Virginia, for example, following the British model, the state could remove a child from a home with parents who were overly fond or if the child was "perversely obstinate."

The first private orphan asylum in North America appeared in 1738 in Georgia, and the first public orphanage did not open until a half century later, in 1790, in South Carolina, with 115 orphans. Others followed in New York City, Philadelphia, and Baltimore. The founding of orphanages demonstrates that by the late eighteenth century, congregate alternatives for dependent children were being tried. Whereas binding out and indenture favored the family setting and foreshadowed the subsequent shift to FOSTER CARE and ADOPTION, almshouses and orphanages foreshadowed a preference for congregate institutions.

The years prior to the Civil War witnessed a movement away from indenture and apprenticeship toward the rise of congregate institutions, based in rising objections to indenture for children, and an increase in the real numbers of dependent children. Moreover, as industrialization changed the size and nature of the family, the value of children shifted from their productive contribution to the family to parental bonds of affection for the child. The nineteenth-century cult of motherhood eroded the traditional patriarchal control over child custody, forging instead a romanticized ideology in which children were innocent and vulnerable and mothers had a special responsibility for protecting them. In 1838, a new judicial policy marked the shift from father's rights to mother's love in the adjudication of child custody. EX PARTECROUSE declared that children have needs, not rights; that they need custody, not liberty; and the place for a child was school, not prison. While the case is noted for shifting the parental responsibility of child custody from the father to the mother, it was also pivotal for legitimizing and elevating the practice of institutional custody.

Between 1820 and 1860, 150 private orphanages were founded across the United States, some in response to EPIDEMICS that orphaned many children. Orphanages were largely religious and largely for white children under ten years of age. Most orphanages indentured the older children, and few received public funds. It was not long before congregate institutions became overcrowded, underfunded, and less and less rehabilitative. By mid-century, congregate institutions that only a few years earlier had been models of care were losing their luster. An 1855 report to the New York State Legislature chastised almshouses for the outrageous conditions in which they sheltered some 3,000 children under sixteen. The problems were intensified with the children orphaned in the Civil War and as numbers of immigrants multiplied. Nevertheless, despite criticism, congregate institutions grew through the end of the nineteenth century.

Placing Out
The idea of PLACING OUT marked a departure from apprenticeship, indenture, and congregate homes. Whereas removing children from the home under those circumstances did not necessarily sever ties with the children's families, placing out included permanent transfer to foster or adoptive homes, illustrated by the NEW YORK CHILDREN'S AID SOCIETY(NYCAS) and CHARLES LORING BRACE's famous ORPHANTRAINS in the mid-nineteenth century. Brace was a critic of congregate institutions, and the NYCAS placed thousands of dependent youth in private homes. (NYCAS, however, over-whelmingly favored white western European children, who represented 95 percent of its placements; it could not or would not place black or eastern European children.) Brace romanticized the image of children being "rescued" from urban streets and placed in families in the midwestern countryside and the plains states. He spoke passionately about the practice that eventually affected some 200,000 youngsters over seventy-five years. As rapid urbanization, immigration, and industrialization widened social class divisions, reformers like Brace looked to protect society by removing children from those "dangerous" classes.

Brace's objective was to place children in caring, moral, and stable family environments, and this program signaled the triumph of the ideology of domesticity, with its emphasis on affection, romantic marriage, and innocent children. He preferred foster care to adoption, as most of his children's parents were destitute but not absent or dead, and ties of affection and Christian charity to legal bonds. Brace found a middle ground between involuntary apprenticeship or indenture on the one hand and adoption on the other. With the support of New York's upper-class reformers, he shared their concern for the waif as well as disdain for the poor and immigrant parents.

In the colonial era children outside the bloodline could not share legal status with natural-born children. However, by the mid-nineteenth century the courts, under the best interests of the child doctrine, were more willing to consider the place of affection, choice, and nurture in the family structure. In 1851, two path-breaking court cases terminated the natural rights of birth parents. More and more, judges moved the parent-child relationship from patriarchal kinship lines to a contractual relationship that reflected sentimental ties and emphasized child nurture. That year, Massachusetts passed an act to provide for the adoption of children, substituting artificial ties for those of birth. By the end of the century, the Massachusetts model existed in almost every state, and adoption became routine.

While Brace's system of fostering challenged institutional care for dependent children, asylums continued to grow in size and number but increasingly were on the defensive. In 1864 the Boston Children's Aid Society (BCAS), for example, rejected long-term care in favor of keeping the families intact to the greatest extent possible. Where Brace wanted homes for children who were homeless or in jeopardy, the BCAS developed strategies for placing dependent children, paying other families to board them, and finding places where single mothers could both work and keep their children, carefully selecting and monitoring the foster homes. Taken together, these projects encouraged the formation of foster care and the passage of adoption laws intended to place children in family environments where the relocated children would be treated like natural sons and daughters. Brace wanted to place children permanently, separated from their birth families, which, especially regarding poor or immigrant families, he considered to be incapable of raising good "American" children. The BCAS, on the other hand, wanted to place children in ways that their parents could see them, and perhaps reclaim them when their situations improved. Moreover, Brace and his peers succeeded in articulating new language that included the rights of the child, not for independence or personal liberty, but for safety from risk and corruption. Welfare policies were profoundly influenced by the idea of the child as a special category of citizen, and state-sponsored children's institutions supported this view. By the end of the nineteenth century, the best interest of the child doctrine facilitated the creation of age-segregated state laws restricting child labor and prohibiting children from buying tobacco or alcohol. It also shaped adoption and custody laws. The new laws rested on an assessment of the child's needs and the public good rather than the parents' interests. Poor and black families after the Civil War were particularly vulnerable to having their children bound out for apprenticeships without parental approval, and the best interest of the child idea sometimes resulted in injustices as the authority to control the child shifted from the parent to the state.

Image: Civil War Cincinnati Sisters, ca 1864. Carte de visite. Winder's Cartes de Visite Photograph Gallery No. 373 Central Ave, opp Court, Cincinnati, O.

Lunatic Asylums in Virginia after the Civil War


In 1881 Mr. Johnson broke free from the Central Lunatic Asylum in Richmond, Virginia. After discovering that Johnson had escaped, the staff of the asylum realized that they needed to act quickly. An employee hurriedly wrote a note in order to inform the Sheriff of Louisa County of the incident before he had an opportunity to apprehend Johnson. On February 16, 1881 the employee reported to the Sheriff, Mr. Johnson, a colored inmate from your county escaped from this asylum. If he gives no trouble he will be allowed to remain at large. . . The staff of the asylum did not want the Sheriff to return Mr. Johnson to the facility.

In Central Virginia during the late nineteenth century, judges and sheriffs decided the fate of those who the courts declared lunatics, such as Mr. Johnson. Judges customarily rendered decisions concerning a person's sanity. On January 23, 1882 a court in Mr. Johnson's home county, Louisa, declared that William P. Anderson was a lunatic and ordered the Sheriff to transport Mr. Anderson to the lunatic asylum in Staunton, Virginia. The judges noted in the next line of the court order that the Sheriff should instead take Mr. Anderson to the asylum in Williamsburg, Virginia. Judges sent lunatics to one of the several nearby asylums in the state, such as the asylum in Richmond, Staunton, and Williamsburg. Virginia asylums, such as the Central Lunatic Asylum where the Louisa judges sent Johnson, experienced problems with overcrowding in the 1880s and 1890s. Judges considered which facility could accommodate new patients when choosing where a lunatic should be sent.

During the latter half of the nineteenth century, an insanity judgment carried a different meaning for blacks, such as Mr. Johnson, and whites in Central Virginia. Fredericksburg's paper, Free Lance, printed an article about a local colored man who was sent to the jail because the asylum in Virginia for colored lunatics was full at the time. Thus, some asylums in Virginia were completely segregated. Other facilities in Virginia took in both black and white patients. Many asylums in the South segregated each ward by race, in order to prevent problems. The intermixing of black and white patients in asylums throughout Virginia and in other southern states led to racial tensions, which often escalated into verbal insults or physical assaults between inmates, according to Gerald Grob in Mental Illness in American Society. Furthermore, Grob posits that white attendants often physically attacked black inmates who retaliated against their white aggressors. To keep a colored inmate like Mr. Johnson outside of the facility would have helped to quell the racial tensions that spread throughout the asylums in Virginia and throughout the South at the time.

On account of the cruel treatment and violence against blacks that infiltrated the asylums of Virginia, Johnson had motivation to escape. As Johnson escaped from the asylum, he also escaped the cruel and inhumane punishment reserved for lunatics in the asylums of the period. Confinement in an asylum in Virginia and throughout the South during this period was in many ways comparable to placement in the penitentiary. The Fredericksburg judge decided to send the colored man to jail when the asylum was full, as a result of the similarities in the treatment received at asylums and prisons. According to David Rothman, the wardens of the penitentiaries utilized brute force and cruel torture methods to impose order and command deference to authority. The staff of the asylums also frequently utilized physical force or restraint devices on the inmates. Superintendents of insane asylums developed procedures for the asylums that instilled a militaristic sense of order, restraint, and regularity. Moreover, inmates had little to no contact with their families once admitted to an asylum. The conditions in lunatic asylums throughout the South rendered inmates, like Johnson, ready to leave upon the first opportunity.

Image: 'Women trouble', immorality and post traumatic stress from fighting in the civil war: The reasons patients were admitted to a lunatic asylum ...

No Teeth, No Man: Dentistry during the Civil War

By Douglas Richmond

During the American Civil War, the Union Army went the duration of the war without any military dental care. On the opposite side of the spectrum, the Confederate Army was heavily sympathetic to dental care and even employed dentists at one point during the war. As Dr. William Roberts explains in his March 1863 article for the New York Dental Journal, “There is no dentist in the army, so all the tooth has to do is rot away at its earliest convenience, when the soldier goes to the surgeon, the surgeon draws the tooth as expeditiously and painfully as he knows.” Those responsible on the Union military’s high command thought so little of dental care that they even neglected to issue toothbrushes to every new recruit. Despite protestations and petitions from both the American Dental Association and sympathetic dental practitioners, the Union military remained without any sort of commissioned dental care. With the amount of funding the Union had, including the fact that the Confederacy provided dental care for their soldiers, one must ponder the question, why did the Union not do the same?

The fact remains; the Union military had no rendered dental corps available and did not stress the importance of dental hygiene to their men. The only medical personnel made available to Union soldiers were medical surgeons and stewards, whose dental experience was null. Dr. Roberts would go on to claim in the same New York Dental Journal article that “the army surgeon is generally not only utterly incompetent to the proper care of teeth, but he is also entirely averse to it.” Roberts also states that issuing one dentist to every brigade and stressing the importance of proper tooth care would spare the U.S. War Department a “useless and ill-regulated expense.” The Union military had a clear disadvantage stemming from its lack of military dental care and their soldiers suffered accordingly for the duration of the war. With the amount of progress that the Confederacy made in dental care for the military, the Union Army should have provided dental care as it would have been substantially beneficial for both soldier and medical personnel alike.

In explaining why military dental care was necessary during this period, one must recognize the context for this period. By the mid nineteenth century, dentistry in the United States had acquired a strong standing. A greater understanding of dentistry in the nation in part is due to the establishment of colleges dedicated to the discipline of dentistry. By 1840, the first college of dentistry would be established in Baltimore, Maryland, and by the 1860’s, there would be two additional colleges of dentistry created in Philadelphia and New York. The establishment of these colleges provided graduating students with a Doctorate of Dental Surgery, a first of its kind in the United States. The establishment of these schools would also help spur an increase in the amount of dental professionals. By 1860, there would be five thousand dentists working in the United States.

Dentistry was recognized as important by some high ranking political figures, such as Jefferson Davis. Davis, while he was Secretary of War for Franklin Pierce, endorsed an idea to construct a dental related unit for the military. Davis “received the proposition [for dentists] as one of great value.” The idea was supported by the current Surgeon General, Thomas Lawson;however, it received no official action from Congress. This would be partly due to another pending bill, a bill that involved the addition of surgeons into the Army. Davis’s early interest in dentistry is perhaps why the Confederacy was able to construct a dental unit. Similar attempts were enacted during the Civil War, but all of them were denied and the Union Army’s dental care would be practiced by the “qualified” regimental surgeons.

The remainder of this paper will be structured as follows: the first section will discuss the Union Army’s “dental care,” and its impact on soldiers and dentists, as well as the various attempts made by the latter to provide dental care for the military. The next portion of the paper will deal with the Confederacy’s dental care. I will demonstrate the benefits and achievements obtained from the Confederacy’s dental unit as I believe a juxtaposition of the two will allow me to demonstrate why dental care is beneficial to the military. The last portion of my paper will focus on why dental care was necessary for soldiers; I will include a typical soldier’s diet and the illnesses that resulted from poor dental care. With all these portions intact, I believe I will be able to illustrate why the Union Army made a huge error in omitting dental care.

The Union Army’s “Dental Care”
​The Union Army provided minimal dental care to their troops. The only help for soldiers, if they could not afford the services of a civilian dentist, was the care from a regimental surgeon. Regimental surgeon’s inexperience with dentistry led to inferior dental services. These surgeons were inept when it came to dental matters. Dr. John McQuillen, co-editor of the dental journal "Dental Cosmos", spoke of the surgeons’ education in his December 1861 article. In it, he states, “The education of the surgeon, however, in this direction, it must be admitted, has not heretofore been sufficiently attended to, and it is extremely doubtful whether one out of ten can diagnose between an aching and sound tooth, an exposed pulp and acute periostitis.”

​Being able to properly infer a diagnosis is imperative in performing dentistry, as teeth in many instances can be saved if the dental surgeon has the correct diagnosis. In most cases, these surgeons made matters worse for their patients, through careless tooth extractions, as illustrated in the reminiscences of Dr. Williams W. Keen, a surgeon during the Civil War. Keens recalls a particular operation performed by a colleague that went less than satisfactorily:

"The [bullet] passed through the left temporomaxillary articulation and ankylosis of the jaw followed; a surgeon who attempted to remedy this ankylosis broke a number of his good teeth, and also by a later operation caused a salivary fistula, requiring another operation for its cure; repair of his teeth was impossible on account of the ankylosis, and he was compelled to live all his life after his wound on soft diet, being able only to separate his teeth to a very slight extent and not being able to masticate other food."

Adding to the Union’s dental surgery issue was the fact that these medical surgeons were ill-equipped for dental surgeries. In the New York Dental Journal, Dr. William Roberts explains that, “attached to the encumbrances of the surgeon are: one turnkey, two pairs of straight forceps, one pair of lower molar forceps, one gum lancet, and the occasional stump screw.” These tools might seem adequate for the layman, but Roberts, a trained dentist, felt otherwise. Roberts claimed that the proposed tools were inadequate and even “the best trained dentist in the world could not perform with these instruments…to any degree of satisfaction.” One could blame the Union Army for failing to properly supply these surgeons for dental duties. Another notable problem of the Union was its failure to equip all their soldiers with the most rudimentary of tools for ensuring dental hygiene, toothbrushes.

The Union Army and Toothbrushes
​Soldiers typically neglected to care for their teeth, and soldiers’ diet complicated their condition. Coupled with this was the fact that toothbrushes were hard to come by while serving for the Union, as the U.S. government failed to issue toothbrushes to all their men. They fended for themselves by either “[purchasing] from sutlers or [getting them] sent from home.” An unfortunate issue when dealing with civilian sutlers is that these individuals often did not offer toothbrushes for purchase at Union encampments. Dr. Jonathan Taft, co-editor of the Dental Register of the West, while frequenting various encampments, had this to say of civilian sutlers,“Toothbrushes, dentifrices, toothpicks…These things should be placed within the reach of every soldier; but strange as it might seem, we have not been able to find any of the kind, in a single sutler’s establishment, in a large encampment.”

A scarcity of toothbrushes, like the dental care provided by military surgeons, was an issue for the Union Army throughout the war. Without dental professionals available to stress the importance of dental hygiene and toothbrushes, many soldiers who did not have toothbrushes causing issues such as dental caries and tooth decay. Those who could not afford the services of a dentist had to endure the “tortures” of the regimental surgeon.

Impact on Union Soldiers
There were many soldiers who had to fare the inhumane procedures of these surgeons just to remedy a toothache or any other dental ailment. Sergeant Alexander G. Downing grieved about this process in his January 1865 diary log, “I arrived at the doctor's tent…I pointed out the exact tooth; he hooked on, at the same time telling me to hold on to the chair, and pulled. He succeeded in bringing the tooth, but it was not the aching one.” First Lieutenant Ziba Graham harped about his reluctant visit to the regimental surgeon in his diary:

Our surgeon, Doctor Everett, who had been hard at work all night at the amputation table, made but short work and little ado about one tooth. He laid me on the ground, straddled me, and with a formidable pair of nippers pulled and yanked me around until either the tooth came out, or my head off. I was glad when my head conquered. I then made up my mind never to go to a surgeon for a tooth pulling matinee the day after.

Soldiers loathed every moment of having to get a tooth extracted. Captain William Thompson Lusk and Second Lieutenant John W. Puterbaugh stressed the same concerns about the dental care from medical surgeons. Lusk stated that as he went to his regimental surgeon to correct his teeth, the surgeon accidentally “breaks one of [the teeth] off,” Lusk was unwilling to participate a second time and had to pay a proper dentist for the job. Puterbaugh explained, of his foray with a surgeon, that “the damned old fool broke it off and it was ten times worse off than before.”

Soldiers who refused the services, of the medical surgeon, often sought out the services of civilian dentists. Here, these soldiers could receive the attention that they required; however, the cost was paid from their own pocket. Those who could not afford to hire a dentist were left with the option of either: dealing with the pain or seeking the unit’s regimental surgeon. This improper practice of dentistry from regimental surgeons infuriated many separate dentists and dental groups, such as the American Dental Association, and caused them to voice their solutions for the Union Army’s dental problem.

Response from Northern Dentists and Dental Groups
The dental situation in the Union Army was deplorable and disturbed much of the dental community in the North. After hearing of the treatment received from regimental surgeons, coupled with the fact that the Union did not include toothbrushes in regulations for soldiers, the dental community was outraged and petitioned for changes. These changes included simple solutions such as re-educating the regimental surgeons and/or conscripting professional dentists or dental surgeons for the Union military.

Dr. John McQuillen had a particular suggestion that involved not replacing these medical surgeons with dentists but actually properly supplying and re-educating them. McQuillen voiced his concerns over the improper amount of tools given to the medical surgeon for dental surgery.In his article, “Instruments Furnished for the Extraction of Teeth to Army and Navy Surgeons,” McQuillen argued that the tools, these “two forceps,” which are provided by the medical department “are inadequate to meet the most ordinary contingencies of [tooth extraction].”McQuillen suggested that the military issue these surgeons’ larger tool sets of forceps numbering“six pair…at least twelve pair.” These larger pairs would allow the surgeons and stewards to be equipped for “every contingency that might arise.” Upon that suggestion, McQuillen advised that these surgeons and stewards be provided “text books on [dental] surgery” to properly instruct the surgeons how to perform dental surgery correctly.

Proper education and equipment would be necessary for the regimental surgeon, as the only known procedure for a soldier suffering from tooth pain would be tooth extraction. When performing such a procedure, a hint of professionalism was required, or as Dr. C.N. Peirce describes in his January 1864 issue of the Dental Times, “There is probably no operation performed by the dentist that…[has] greater liability to accident…than that of extracting teeth.”Peirce claims that “the operator should be familiar” as it would “do much to prevent accident, and render the accident less painful.” With this rhetoric in mind, there were many from the dental community that felt that an appropriation of competent dental surgeons to the Union military would be best.

In that same issue of Dental Times the article, “Dentists in the Army,” was featured with the main purpose of proposing to the Union military the employing of dental surgeons:

"I have been told by a military officer that dentists are greatly needed in the army. That he had repeated occasions to give men furloughs to go to Washington to have teeth filled and otherwise treated; for very many in our army are sufficiently intelligent to know that troublesome or decayed teeth may be saved, and are therefore unwilling to have them sacrificed by extraction, which is all the army surgeon can do; therefore, the want of an intelligent dentist is apparent, who, I have no question, could make it mutually advantageous,(as he would charge for his operations,) by remaining with the army, … Such a procedure would furnish an unanswerable argument in favor of what the profession has been long contending for, Governmental employment of dentists in the army."

Dentists such as Dr. William Roberts and George H. Perine had similar suggestions for the dental issue that the Union Army had acquired. Roberts suggested that the War Department assign dental practitioners that would practice on troops in the field at their own expense and be paid at reasonable costs. Perine in Dental Cosmos felt that, “few, if any, of our army and navy surgeons possess knowledge of dentistry, and that the appointment of physicians practicing our specialty would necessitate a new order of things.” These suggestions did little to inspire any sort of change within the Union Army. In response to the Union’s apathy toward dental care, there were attempts made by dentists and dental groups to provide dental care for Union soldiers.These attempts accomplished very little in terms of acquiring dentists for a military dental unit; the U.S. military would be without a dental unit until 1911, when the U.S. military created a Dental Corps.

Actions made by Northern Dentists and Dental Groups
​Upon realizing that their solutions and suggestions for dental care were going nowhere,those in the dental community decided to approach this dilemma in a different fashion. This approach included professional dentists offering their services, unofficially and officially, to the U.S. military to legislative attempts made by dental groups to create a military dental unit.

There were hundreds if not thousands of dentists in the North who took up arms for the Union, many of whom gave up their profession to fight. However, there were a few dentists who continued to practice dentistry unbeknownst to the Union military. One particular dentist who would fare the horrors of war for the Union was Dr. Charles Koch. Koch entered the military and would acquire a variety of roles ranging from enlisted soldier, to infantry officer, to commander of one of the Union’s colored regiments, the 49th colored regiment. Koch would still revert to his dentist sensibilities, whenever he had the free time to, and provide dental assistance to ailing soldiers. As an infantry officer, Koch commanded his subordinates and carried a “small satchel” that “kept dental instruments and medicines to relieve the tortures of the mouth”. Like Koch, there were dentists that wanted to be commissioned officially as military dental surgeons; however, these individuals were denied by the Union military.

Dr. James Garretson tried to offer his services to the U.S. military. Garretson, who has been called “the father of oral surgery,” hoped that his services would be recognized and deemed useful. In April 1862, Garretson even pleaded to the Surgeon General, William Hammond, in the hopes that Hammond would place him as the surgeon in charge at a local military hospital in Red Bank, New Jersey. Hammond responded the same month stating, “Your request cannot be granted, as the Red Bank hospital is to be placed in charge of a surgeon of regular service.”

Garretson was renowned in the dental community for his prowess in plastic and oral surgery; unfortunately, the Union military did not take advantage of his services. Coincidentally, Garretson’s book, A System of Oral Surgery, would be added in 1872 as the official reference tool for regimental surgeons when performing oral surgery. While individual dentists tried to perform dentistry for soldiers, many attempts were made by dental groups to create a dental unit for the Union military.

Much was done by dental groups, such as the American Dental Association, to establish a dental unit for the U.S. military or at least military hospitals. A committee of professional dentists was collected by the American Dental Association to pledge legislative action for a military dental remedy; efforts were made by this committee through 1863-1864. Such proceedings even involved efforts to encourage Surgeon General Hammond, in the hopes that his assistance would help solve the issue. Hammond, who appeared to be sympathetic at first, ultimately reneged on his decision to implement a dental unit. From 1861-1865, four years passed and the Union Army remained again without any military dental unit. In contrast, military dental care was well received by those involved with the Confederate Army’s high command, so much so, that the Confederacy appointed dentists into their army as early as 1861.

The Confederate Army and Dental Care
The inclusion of military dental care into the Confederate military’s infrastructure was gradual: a process that began with the incorporation of dental methods and tools into the Confederacy’s Medical Corps and ended with the full conscription of dentists into the Confederate military. By early 1864, the Confederacy would have professional dentists circulating amid the military hospitals and providing care to soldiers out in the field. High ranking Confederates’ such as President Jefferson Davis and Surgeon General Samuel Moore compassion and interest in dentistry allowed for the inclusion of dentistry within the Army. The establishment of dental care, as the Confederacy would soon learn, would allow for the swift return of soldiers with dental related ailments or wounds back to their respective units. Furthermore, the employment of dentists allowed for the conservation of medical units in the Confederacy.

A detriment to the Confederacy following secession was their lack of supplies and funds. Seceding from the Union meant that the Confederacy would be isolated from its main supply line. This was true regarding matters of dentistry, too; the Confederacy had only one dental supplier, Brown and Hape in Atlanta, and only a small percentage of the dentist population in the United States. The Confederacy would have to overcome these issues to provide dental care in their military.

Despite obvious resource and supply deficiencies, the Confederacy began to lay the foundations for what would become their dental care. As early as 1861, the Confederacy began procuring dental supplies. In Regulations for the Medical Department of the Confederate States Army, states that all medical supply tables were to be equipped with the proper amount of tooth extracting kits. Like the Union’s regimental surgeons, the Confederate surgeons were inept to dentistry. Confederate soldiers realized this and were more than willing to pay for the fees of a qualified dentist.

The issue of Confederate soldiers seeking out dentists would be the cost of their services. Dr. Watkins Leigh Burton would assess this issue in his 1867 article to the American Journal of Dental Sciences. Burton states, “The charges of dentists were proportionally high. The charge for a gold filling was $120.00, for extracting a tooth $20.00, and for an upper set of teeth on gold or vulcanite base, from $1800.00 to $4000.00.” These charges were way beyond the pay grade of soldier, as their pay would be between 12 and 18 dollars a month, depending on rank. Unlike the Union military, the Confederacy acknowledged this problem and effortlessly sought to correct it.

The Beginning of Confederate Dental Care
Dentistry brought the Confederacy to a stark realization. For one, they realized that dentistry was necessary for the continued well-being of soldiers; secondly, the Confederacy also acknowledged that soldiers could not afford dental treatment. In response, the Confederacy slowly contracted the services of civilian dentists and began to reassign soldiers with dentist backgrounds to dental units. The first dentist to be appointed would be in 1861, when the Confederacy utilized the services of Dr. J.B. Deadman. Deadman was a dentist from North Carolina who joined the Confederacy as a private in May 1861; upon hearing of his dental background, Deadman would later be reassigned as a post dentist.

Another dentist who would join the war and provide dental assistance would be Dr. Theodore Cheupein. Cheupein fought for the Confederacy as a Sergeant in an artillery unit;however, his military obligations did not prevent him from performing dentistry as he would practice whenever he found the time. Cheupein’s efficiency in dentistry led him to be reassigned to Charleston to perform dentistry for ailing soldiers. The Confederacy would not make true progress in their creation of a dental unit, until it implemented the Conscription Act of February 1864, which included dentists into the conscription by-laws.

The Conscription of Dentists into the Confederacy
The Conscription Act of 1864 drew a mixed reaction from the Southern dental community. Unlike the North, there were dentists who opposed the draft heavily, as they felt that they should be exempted like their doctor and medical surgeon counterparts. Some dentists were able to get exempted on the basis of “special practitioners.” The abovementioned Dr. Watkins Burton vehemently opposed the draft when he was conscripted in 1863; Burtons even began making legal provisions for his exemption. Ultimately, when the Confederacy adopted its 1864 Conscription Act, Burton would be drafted as a hospital steward.

Despite the slight opposition, the 1864 Conscription Act provided the Confederacy with a significant influx of dentists. Surgeon General Moore began organizing these dentists into military hospitals working as regimental surgeons, since there was no official rank of dental surgeon. These personnel worked diligently, and began extracting, cleaning, placing fillings, and treating victims with maxillofacial injuries. Dr. Watkins Burton commented on how a typical day for a dentist would constitute “twenty to thirty fillings…the extraction of fifteen or twenty teeth, and the removal of tartar.” This passionate dedication would lead to a significant improvement in not only the lives of soldiers, but how the military viewed dentistry in general.

The Impact of Confederate Dental Care
Dental Care in the Confederacy had a resounding impact on its military. With the introduction of dentists into the military, the Confederacy was able to conserve medical personnel and properly treat and utilize men who had been previously deemed unfit for service due to dental problems. New surgery techniques were being performed by dentists that allowed for the preservation of teeth rather than extraction; one particular technique that was being used by dentists was endodontic treatment, commonly known as a root canal. Such procedures saved many teeth that would have been commonly extracted.

Dentists in the Confederacy were also stressing the importance of dental hygiene, for example, the aforementioned Dr. Cheupein would stress the importance of dental hygiene so heavily that every man in his unit would carry around a toothbrush in their uniforms.Confederate dentists created new and innovative dental devices such as the Interdental Splint, created by Dr. James Baxter Bean.

The Interdental Splint or “Bean Splint” was a device that has been credited with the successful treatment of over a hundred cases of gunshot wounds to the mouth and jaw. The splint itself was made of vulcanized rubber, and braced teeth together with the corresponding indentations of the splint. The splint would keep the jaw in place and allow it to heal, thus preventing the facial disfigurement and deformity that was common with such wounds. This splint would allow the patient to continue to consume food without the fear of infection. The Interdental Splint was so successful that it was even used in the treatment of Confederate military leaders, such as James Patton Anderson and John Brown Gordon. Following the end of the Civil War, Bean tried to get his splint adopted in the North, however, a fellow northern dental surgeon, Dr. Thomas Gunning, had already created a similar device.

Near the end of the war, almost all Confederate military hospitals would have at least one dentist assigned to medical staff. Had the war lasted longer, the Confederacy would have established a Bureau of Dental Surgery; this Bureau would have been associated with the medical staff of the army. This success in dentistry could not have been accomplished had it not been for the Confederacy’s enthusiasm in military dental care. The Confederacy understood the necessity of dental hygiene and their military forces benefited from it significantly. The Union could have benefited from a similar program if it had understood the importance and reasons for military dentistry.

Additional Reasons for Military Dental Care During the Civil War
Besides the reasons stated before, there were additional reasons for the incorporation of dental care into the Union military. First, many northern Americans were exempted from military service due to the status of their teeth. This was to the increase of meals consisting of refined sugar and a larger consumption of fresh meat rather than salted. This diet, coupled with the fact that most Americans did not practice tooth brushing, could be attributed to the increase of dental problems. With an increased need for men in the subsequent Union drafts during the war, many men were exempted due to their “lack of certain teeth.” Such teeth were required to properly chew food, such as hard bread, salted pork and beef, and to effectively tear paper cartridges, which held bullets with gunpowder in place. If there were trained dentists on hand, these dentists, like the Confederate ones, could have treated most of the exempted and allowed for their military service.

Secondly, if there were Union dental care, these trained dentists could have stressed the importance of dental hygiene. Even Surgeon General William Hammond states in his book,Treatise on Hygiene, the importance of dental hygiene; yet he did nothing to help create a unit. In Treatise, he states, “No one can be healthy whose teeth are deficient or in bad condition; and soldiers, of all other classes of men, require that these organs should be sound.” Consistent dental hygiene is imperative when deterring many dental problems such as gingivitis and neuralgia. If these problems go unnoticed they could also lead to more serious problems, thus incapacitating the soldier indefinitely.

In conclusion, Dentistry in the military lacked the recognition it deserved during the American Civil War. The Union Army chose to ignore it, and as a result the Union soldiers had to suffer for their superior’s actions. The Confederacy chose to embrace dentistry and benefited from it tremendously. The Confederate military is also a nice example of how a military can benefit from dental care.

This project shows that both militaries during the Civil War had differing opinions concerning military dental care and both armies and soldiers were significantly affected by their superiors’ actions. Secondly, the significance of my project shows that even in a time as early as the Civil War, dentistry was important as it impacted the soldier’s well being. The advances made by dentists in the mid-nineteenth century allowed for better dental treatment. I believe that my research provides the historical community with a topic that is both original in the field of the American Civil War. One question that my research might suggest is why did the U.S. military wait until 1911 to implement a Dental Corps?


Dentistry during the Civil War


About two decades before the Civil War, the dental profession had gained some standing. In the Confederate states there were about 500 Dentist. Jefferson Davis had always been an advocate for a dentistry corps. As Secretary of State under President Pierce, he had called for such a Corps but never was one in U.S. Army.

After outbreak of War, the Confederate Army established a Dental program. The Union Army rejected one. Confederate Surgeon General Moore as well as Jefferson Davis was supportive of the idea of Army dentists. The dentists stated they owed more to Moore "than to any man of modern times".

Soldiers tended to neglect basic care of their teeth. Toothbrushes were scare and they had inadequate diets. Dental operations were very expensive for the common soldier. A soldier's teeth were important on the battlefield. Many recruits were turned down if they lacked six opposing upper and lower front teeth. These were considered necessary to bite off the end of the powder cartridges used with the muzzle loading rifles of the time.

Many Dentists were accorded the rank of hospital stewart. Though some could be full surgeons. Medical Director, William a. Carrington, CSA, commented that dentists "plugged, cleaned, and extracted teeth", in addition to "adjusting fractures of the jaw and operating on the mouth". A Richmond Dentist, Dr. W. Leigh Burton, commented that his days were filled of "twenty to thirty filings, the preparation of cavaties included, the extraction of 15 or 20 teeth, and the removal of tartar ad libitum".

Dentist, Dr. James B. Bean who was from Atlanta, Georgia made significant contributions to the treatment of fractured maxillary bones. Bean invented an interdental splint made of vulcanized rubber that had cup shaped indentations for teeth. His splint was a great success and he was sent to Richmond where his sprint was used for treatment at the Recieving and Way Hospital.

The Confederacy should be praised for it's Dental Corps. In Jan., 1864 the Confederacy began conscripting dentist. This gave the Confederate soldier a small advantage over the Union soldier, as all attempts at the Union Dentistry Corps was turned down.

Dr. W. Leigh Burton (1830-1892) was a Captain in Confederate Army, dentist and inventor. He was first with Quartermaster Dept. at Fredericksburg. In 1864, he worked at Richmond Hospitals as dentist. After the war, he continued working as a dentist and invented the Burton Electric Heater. He is buried in Hollywood Cemetery, Richmond, Virginia.

Dr James Baxter Bean (1834-1870) was the most important dental surgeon of the Civil War. After the outbreak of the war, Bean moved to Atlanta where he offered his services to the Confederate medical authorities. His dental device, the "Bean Splint" allowed him to treat successfully over one hundred cases of gunshot wounds to the jaw and face while preventing the facial disfigurement and deformity that frequently resulted from such wounds. In Jan, 1865 the Confederate Medical Board in Richmond, unanimously recommended adoption of the Bean splint. Dr. Bean then supervised Richmond surgeons in the use of his device.

After the war he went to Baltimore. He pioneered in the use of aluminum for dental plates. He took out a patent in 1867. His experiments weren't successful, but his casting was an important step in the development of the casting process in dentistry.

Bean died in 1870 when he and 10 others were caught in blizzard on the summit of Mont Blanc. His notebooks were later recovered from the summit. Mark Twain included extracts from the notebook in his book, "A Tramp Abroad".

Dental Surgery in the 1840s


A dental surgeon by the name of Peter J. Cairnes placed an ad in The Republican convincing the readers of the merits of dental surgery. Dr. Cairnes urges the public to start taking care of their children's teeth starting anywhere between the ages of seven and nine. Dr. Cairnes also offered a reduced rate for any slave owner or tobacco factory owner whose slave was in need of a tooth extraction.

Dr. Cairnes acknowledges public skepticism in dentistry and the fact that dental surgery was thought of as nothing compared to general surgery, but attempted to make a claim for the advancement of dentistry and the need for people to take care of their teeth. At the time there was very little knowledge of dental care, and homeopathic remedies and extractions were often common cures for oral discomforts. Medicine as a whole was in its infancy in the nineteenth century; furthermore, even less was known about dentistry and dental surgery in particular. Many regarded dental care as a luxury and not as a necessity, unless they had a toothache too unbearable to suffer through without dental intervention.

Surprisingly, dentistry was not recognized as a healthcare profession until the outbreak of the Civil War. During the Civil War soldiers who were dentist were given a special salary. Dentists later became exempt from conscription.

Image:  Civil War Dentist examines a soldier's teeth. Courtesy Association of Army Dentistry, San Antonio, TX.

Saturday, August 16, 2014


by Maria Godoy


















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