Wednesday, December 14, 2011

Echoes of Navy Medicine's Past: The Civil War (1861-1865)

Echoes of Navy Medicine’s Past
Part II: The Civil War (1861-1865)
By Jan Herman and Mr. Grog

“David goes out to meet Goliath and every man who can walk to the beach sits down there, spectators of the first ironclad battle in the world... The day is calm, the smoke hangs thick on the water. The low vessels are hidden by the smoke. They are so sure of their invulnerability they fight at arm’s length. They fight so near the shore, the flash of their guns is seen and the noise is heard of the heavy shot pounding the armor.”

This is how U.S. Navy physician Charles Martin described the legendary fight between the ironclads USS Monitor and CSS Virginia. What made the Civil War at sea different from what came before is indeed that image—the first seemingly unequal duel of the ironclads—the Yankee cheese box on a raft versus the slope-sided, ungainly ex-Merrimack. After all, the once U.S. Navy sloop of war had just hours before set Congress afire, rammed and sank the Cumberland, and run Minnesota aground. The following day she was headed out to finish off the grounded vessel when Monitor, her low-freeboard decks nearly awash, popped into view and saved the day, fighting Virginia to a draw.

What was the medical aftermath of that now legendary combat: On the Union side, three men were injured on Monitor. One was the acting master whose knee came into contact with the turret at the same instant one of Virginia’s heavy shot struck it. Knocked senseless by the impact, he regained consciousness 10 minutes later. Another seaman in the turret was knocked unconscious in a similar manner. Acting Assistant Surgeon Daniel Logue described this sailor’s injury as a concussion of the brain. His circulation remained depressed and it became necessary to administer stimulants. When the patient regained consciousness, Dr. Logue watched for a reaction and then applied cold affusion to the head.

Toward the close of the action, the Confederate ironclad inflicted its last and most significant casualty—Monitor’s skipper John Worden. LT S. Dana Green, Monitor’s executive officer described the event:

“Soon, after noon, a shell from the enemy’s gun, the muzzle not ten yards distant, struck the forward side of the pilot house directly in the sight hole or slit and exploded, cracking the second iron log and partly lifting the top, leaving an opening. Worden was standing immediately behind this spot and received in his face the force of the blow which partly stunned him and filling his eyes with powder, utterly blinded him...

“[Sent for], I found him standing at the foot of the ladder leading to the pilot house. He was a ghastly sight with his eyes closed and the blood apparently rushing from every pore in the upper part of his face. He directed me to take command. I assisted in leading him to a sofa in his cabin. Dr. Logue examined his eyes, succeeded in removing tiny scales of iron and a small quantity of paint, and then made cold applications to his eyes.”

Following the battle, only Worden left the ship for hospitalization in Washington. The other two patients returned to duty the following day. Worden, it turned out, proved to be the only serious casualty of the battle, permanently losing the sight in one eye and incurring a disfiguring scar on his face.

On the Confederate side, Virginia’s crew did not get away unscathed. In her unequal fight with Congress, Cumberland, and Minnesota the previous day, Virginia suffered several killed or wounded. In contrast, her wooden-hulled victims suffered enormous losses. Cumberland alone lost over 100 men. Before the ship went to the bottom, all the wounded who could walk were ordered out of the cockpit; but those of the wounded who had been carried into the sick bay and on the berthdeck were so mangled that it was impossible to save them. So recalled her acting commander. During her engagement with Virginia the following morning, Monitor’s two 11-inch Dahlgren smoothbores did moderate damage, wounding a few aboard the Virginia but killing no one. As it turns out, the Confederates got a lucky break. Although each 11-inch Dahlgren aboard Monitor threw a shot weighing 168 pounds, Worden was under orders from the Navy Department to fire half-weight powder charges of 15 pounds for fear the guns would explode.

If this first great combat between the ironclads ended in a draw, war at sea had changed forever and with it the practice of naval medicine. What made the naval environment different from the Civil War battlefield was the advent of the ironclad ship. John Ericsson’s Monitor employed the new technology, incorporating many technical advances for the time including forced ventilation of living spaces, a protected anchor which could be raised and lowered without it or the crew being exposed to enemy fire, and a protected pilothouse.

Nevertheless, the new technology of iron and steam introduced brand-new hazards—exploding boilers, scalding with live steam, burn injuries, and primary and secondary wounds resulting from large caliber, rifled naval guns. Ironclad vessels also introduced environmental and occupational concerns for sailors aggravated by badly ventilated and hell-hot engine rooms. It is estimated that a typical low ranking coal heaver aboard a poorly ventilated ironclad routinely endured temperatures approaching 130 degrees F. In fact, aboard Monitor in summer, temperatures of 125 degrees were recorded on the berth deck and 150 degrees in the galley. One cannot underestimate the utility of awnings in deflecting the sun from ironclads decks.

Almost everyone has experienced opening the door of an automobile after the vehicle has been baking in the summer sun all afternoon. Those freshly scrubbed teak decks on World War I and World War II era battleships were not designed for aesthetics. They insulated steel decks and made living conditions somewhat bearable in the days before air conditioning. One can only imagine then, the plight of the typical Civil War ironclad sailor stationed on an inland river of the deep south or in the vicinity of the besieged Charleston, SC. Add the oppressive humidity of July or August and now one can begin to understand the life of an ironclad sailor.

There were other hazards to be endured. With only inches of freeboard, many ironclads of both navies were literally only inches from disaster. One has only to contemplate Monitor’s ill-starred voyage to Hampton Roads even before her fight with ex-Merrimack. Only one day out of New York, she encountered a storm which soon had heavy seas cascading over her deck, washing out turret caulking, flooding her berth deck, disabling her blowers, and nearly extinguishing her boiler fires. Her paymaster recalled what the ironclad’s fight for survival meant for her crew.

“Turning to go down from the turret I met one of our engineers coming up the steps, pale, black, wet and staggering along gasping for breath. He asked me for brandy and I turned to go down and get him some and met the sailors dragging up the fireman and other engineers apparently lifeless. I got down as soon as possible and found the whole between decks filled with steam and gas and smoke; the sailors were rushing up stifled with gas. I found when I reached the berth deck that it came from the engine room, the door of which was open. As I went to shut it one of our sailors said he believed that one of the engineers was still in there—no time was to be lost, though by this time almost suffocated myself, I rushed in over heaps of coal and ashes and fortunately found the man lying insensible. One of the sailors who had followed me helped pull him out and close the door.”

This nightmare would be played out again—fatally—at the end of the year when Monitor’s pumps failed to stem the incoming seas and John Ericsson’s ironclad pioneer plunged to the bottom off Cape Hatteras with the loss of several crewmen.

Even the fuel that fired an ironclad’s boilers was a threat. Coal, while not a new fuel used by the Navy, had the potential of becoming a silent killer. Fossil fuels require proper ventilation and this concept was not yet adequately understood by Civil War engineers. Untold casualties, some fatal, occurred when crewmen either loaded wet bituminous coal in below-deck bunkers or bilge water contaminated the fuel. Both the Mississippi Squadron and the South Atlantic Blockading Squadron reported a number of cases of sailors being discovered either dead or unconscious below deck. The more fortunate were revived when exposed to the fresh air. Besides unconsciousness, surgeons described their patients as being cyanotic—blueness of the skin caused by oxygen starvation with foreheads and eyelids markedly swollen. Similar cases reported aboard a coal-fired ship in 1913 recognized the problem as carbon monoxide poisoning. Wet, unventilated coal produces high levels of that dangerous gas.

Indeed, there were significant differences in warfare once ironclads came into their own. Naval guns up to the middle of the nineteenth century had an effective range of only about a mile and a half. These were the smoothbores throwing balls weighing 24 and 32 pounds. The strategy therefore called for close-in fighting terminated by boarding parties and hand-to-hand combat.

There were many differences between wounds sustained in battle on the old wooden ships and those encountered aboard ironclads. Shots striking wooden vessels tended to throw about splinters which, as secondary projectiles, caused many of the wounds. Burns were uncommon. In yardarm engagements and during the hand-to-hand fighting resulting from boarding an enemy’s vessel, many wounds were caused by small arms, cutlasses, bayonets, and pikes.

In ironclad fighting, splinters might be fewer, but burns and fragment wounds became commonplace. The so-called protected environment an ironclad warship provided was illusory. If anything, it offered fatal hazards the crew of a wooden ship rarely experienced. Take the example of the monitor Nahant. Engaged in Samuel Du Pont’s attack on the Charleston forts in April 1863, shellfire from the forts slammed against her pilot house and turret with such velocity that broken bolts ricocheted about her pilot house like bullets, killing one man and injuring two others, including her captain.

Iron shot weighing over 150 pounds were now common, making the 24- and 32-pound size thrown by earlier guns seem quite puny in comparison. What’s more, a newer generation of rifled guns that could pulverize masonry forts could do worse to those enclosed within an iron-sheathed hull. What resulted was the “garbage can” effect. Imagine yourself encased in a typical galvanized steel garbage pail or a 55-gallon steel oil drum, ears unprotected, and then having your antagonists hurling 50-pound cement blocks against your cocoon, one per second. With blood dripping from nose and ears, crewmen were sometimes driven mad under the barrage of both rifled and unrifled artillery impacting against iron armor. And if not driven mad, many sailors had their eardrums ruptured or, at very least, suffered temporary or permanent deafness. Civil War sailors frequently described ringing in the ears or tinnitus. With noise levels aboard Civil War ironclads routinely exceeding 130 decibels, one can only conjecture what kind of hearing damage resulted among these warriors. For comparison, a modern F-18 jet engine produces about 125 decibels of noise. The noise on the flight deck of a modern aircraft carrier during flight operations routinely exceeds that level. And these crews have available hearing protection. One can only imagine the degree of hearing loss suffered by Civil War sailors.

As similar as the practice of medicine may have been for both Army and Navy physicians--certainly in the treatment of battle injuries--the marine environment offered some very unique circumstances. Sailors on blockade duty experienced little battle and much boredom. Off Cape Fear, NC, a sailor in the blockading squadron wrote home to his mother that she should get some notion of blockade duty if she would go to the roof on a hot summer day, talk to a half dozen degenerates, descend to the basement, drink tepid water full of iron rust, climb to the roof again, and repeat the process at intervals until she was fagged out. Then go to bed with everything shut tight.

Needless to say, under these conditions, the psychological health of sailors was often in question. “Give me a discharge and let me go home,” a distraught coal-heaver begged his skipper after months of duty outside of Charleston. “I am a poor, weak, miserable, nervous, half crazy boy. Everything jarred upon my delicate nerves.”

And this routine was accompanied by an unbroken diet of moldy beans, stale biscuits, and sour pork. To ease the monotony or perhaps to anesthetize themselves from reality, mess crews specialized in the manufacture of outlaw whiskey distilled from almost any substance that fermented in the southern heat. Commanding officers and medical officers assigned to the James River Flotilla complained a great deal of the lack of fresh provisions and vegetables. Following a July 1862 inspection, Fleet Surgeon of the North Atlantic Squadron, Dr. James Wood, recommended that vessels be furnished with fresh provisions twice a week. His report on his inspection also contained a recommendation for improving the water supply used in the vessels. He said that the “turbid and objectionable” river water used tended to produce diarrhea. He saw no reason for continuing to use impure river water, since steam vessels could condense more pure water than their crews needed.

Even though sanitary conditions aboard ship were often superior to those ashore, and both navies probably fared better than the armies when it came to the frequency of disease, rheumatism and scurvy kept the doctors busy along with typhoid, dysentery, break bone fever, hemorrhoids, and damage done by knuckles. In the southern climes, insect-borne malaria and yellow fever laid low many a crew. And, regardless of what they had to work with, surgeons aboard the ironclads, and indeed every vessel, had no medicine for the ills of the spirit brought on by the strain of monotony, poor food, and unhealthy living conditions which produced much longer casualty lists than did Confederate shells or mines.

The ironclad navy of the Civil War was neither all wood nor all iron. Nevertheless, it represented the first, halting steps into the modern age. Even though many of the hulls were still wood with but a veneer of iron, such vessels as Monitor and the vessels it spawned would soon become commonplace. The age of sail was over and had been since Monitor and Virginia fought their legendary duel in 1862. It was a new navy in 1865, even though hard-bitten conservatives in Washington had been loathe to trade traditional wooden hulls and canvas for an all-iron fleet. By the late 1870s and certainly by the turn of the twentieth century that fact was a reality. Medical planners and health care providers would now have to face squarely the realities Civil War surgeons had already encountered during their war. The new steel ships now carried rifled, breach-loading artillery. What their muzzle-loading predecessors had inflicted upon human flesh and bone had already been demonstrated. Traumatic amputations, penetrating fragment wounds, and horrific burns had become commonplace during that war. In the post- Civil War environment, these wounds would increase exponentially as would new kinds of injuries merely hinted at during the Civil War—primary and secondary blast injuries, scalded skin and flesh caused by ruptured steam pipes and boilers, toxic smoke inhalation—the products of fire below decks. The problems first encountered during the war of the ironclads would now have to be dealt with aboard ships of the all-steel, all-steam navy.

Whether victims of disease or hostile action, sailors required treatment and much Navy medicine took place in the three existing hospitals at Chelsea, Brooklyn, and Philadelphia. By the fall of 1862, all three were filled to their utmost capacity. As a result, medical facilities at navy yards and naval stations were expanded and both civilian and Army hospitals were also treating naval patients. To remedy the situation, a major hospital expansion campaign began. Unfortunately, many of these improvements weren’t realized until the very end of the war.

Following their recapture by Union forces, the two naval hospitals in the South--Portsmouth and Pensacola were put back into operation. In addition to the naval hospitals that had been established before the war, at least four others came on line between 1862 and 1865. These hospitals at Mound City, IL (1862); Memphis, TN (1863); New Orleans, LA (1863); and Port Royal, SC (1864), were located within the theater of operations of the blockading river squadrons and acted as receiving hospitals, taking patients on a short-term basis.

Ironically, one of the medical stations that could perform long-term care was not stationary at all. In 1862, Union forces captured a Confederate side-wheeler, Red Rover. Under the order of the Naval Fleet Surgeon, the ship was converted into what can be considered the Navy’s first hospital ship (however, there is evidence that Navy ships used during the Tripolitan Wars were used as floating hospitals). According to a Navy General Order of June 1862, “only those patients are to be sent to the hospital boat who it is to be expected to be sick for some time, and whose cases may require more quiet and better attention and accommodation than on board the vessels to which they belong.”

Regardless, Red Rover was something of a naval anomaly. The vessel had a laundry; an elevator that could transport the sick from lower to upper decks; an amputation room; nine water closets; an icebox to store fresh food; and gauze blinds to keep flies, mosquitoes, cinders, and smoke from “annoying” the patients. It was also the first ship to have a staff of female nurses trained in the medical arts.

On Christmas Eve, 1862, Sisters of the Order of the Holy Cross of St. Mary’s of Notre Dame in South Bend, IN, reported aboard the medical vessel to care for sick and wounded seamen. One hundred years later, the Navy helped to honor these women at a ceremony on the campus of Notre Dame as true pioneers of the Navy Nurse Corps.

From 1862 until 1865, the medical staff on-board Red Rover cared for 2,450 casualties, including 300 wounded Confederates. In roughly the same time period, Navy shore facilities handled more than 31,000 patients, with 990 treated in 1864 alone, a record for a four-year conflict. However, the conflict was not without other distinctions. The war took a heavy toll on the Navy Medical Corps, killing 33 surgeons including Assistant Surgeon William Longshaw, Jr., who was acknowledged by Secretary of the Navy Gideon Welles and RADM John Dahlgren for gallant behavior for his action on 15 November 1863 when he, under heavy fire, volunteered to retrieve the monitor Lehigh which had run aground. In January 1865, Dr. Longshaw was killed in an assault on Fort Fisher, NC, while binding the wounds of a dying man. His heroism under fire encapsulates Navy medicine’s real Civil War legacy.

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