Battle Field Angels

Your enduring courage, compassion,
and resolve arm me with strength and
perspective every day.

Foreword

By Vice Admiral Harold M. Koenig, M.D.
United States Navy, Retired
32nd Navy Surgeon General

Since the founding of our nation, more than 40 million Americans have served in our armed forces in times of crisis and conflict. They have left their families, their homes, and all they cherish to face a dangerous and uncertain future. Our nation has sent them to the Middle East, Asia, Europe, Africa, the Caribbean, and hundreds of remote locations throughout the world.

These brave Americans served with the belief that America is just and its vision noble, and that it would recognize and support their sacrifice and devotion to duty. When they joined the armed forces, few understood that their fate might well rest in the hands of a young man or woman who was a total stranger to them until they met on the battlefield.

A relatively small cadre of largely unsung heroes has made possible the eventual return home of countless soldiers. For more than two hundred years, corpsmen, medics, nurses, doctors, surgeons, medical technicians, and specialists have comprised a community within our armed forces that has been nothing short of inspirational. These extraordinary men and women have willingly confronted the horrors of war and faced conditions few can imagine. They have come to the aid of more than 1.4 million Americans who have been wounded in battle. They have been the link between trauma and treatment that ultimately enabled those injured soldiers to survive their wounds, or brought final moments of solace to many of those who did not. They have been a source of inspiration and motivation to their warrior comrades who were able to be more confident, resolute, and effective when they knew a corpsman or medic was willing to risk his or her life to reach and treat them on the battlefield. Their legacy is all the more remarkable because of the relative youth of these courageous individuals.

Battlefield Angels traces the odyssey of these American heroes from the hills of Pennsylvania in 1775 to the mountains of Afghanistan more than two centuries later. Their recognition is as worthy as it is necessary. These profiles of duty, devotion, and daring illustrate the strength of character inherent in every American generation, a strength that is never more evident or valuable than it is on the battlefield when life hangs in the balance. A stirring testament to the human spirit, Battlefield Angels also reveals how the accomplishments of these medical pioneers have resulted in numerous advances and improvements to civilian health care that have saved or enhanced the lives of countless people.

Today, more than 23 million veterans walk among us. Nearly 3 million receive disability compensation, and many more owe their very lives to an anonymous corpsman or medic. Millions of Americans and their families are profoundly grateful.

Future generations can take heart in knowing that there will always be battlefield angels alongside their sons, daughters, brothers, sisters, spouses, and sweethearts in uniform. They can take comfort in the courage, compassion, and skill of our nation’s exemplary military medical corps.

—Vice Admiral Harold M. Koenig, M.D.
Medical Corps, United States Navy, Retired
32nd Navy Surgeon General

Preface

Wars are won by killing. Death, destruction, disability, and disease have defined the battlefield for millennia as millions of warriors have waged war. Whether with catapults or cannon, arrows or artillery, the more permanent harm an army can inflict upon another, the greater the odds of victory. Yet within every war, within every battle and firefight, a handful of those in uniform have fought to save lives, including those of the enemy. The military medical corps has always faced a paradox: Its mission is to rescue the wounded and save lives even as those around them are intent on killing each other.

The history of military medicine reflects the evolution of both war and medical science. As weaponry has become more lethal from one war to the next, military medicine has been confronted with increasingly complicated conditions posed by torn bodies, horrific burns, radiation poisoning, and contagious disease. Industrialization has enabled world wars to kill as many as 35 million people. The spear has mutated into the nuclear bomb that produced more than one hundred thousand burn and radiation victims in a single flash over Hiroshima.

At the same time, the military medical corps has pioneered and field tested medical science advances in its war against the broken, infected, and diseased. Medical science and military medicine have become increasingly sophisticated as the destructiveness of weapons has grown. The practices of bloodletting, encouraging gangrenous pus, and applying blood transfusions directly from the arm of one soldier into another have been replaced by preventive medicine, antibiotics, plasma, and cutting-edge surgical care. Two hundred years ago, unfit soldiers were assigned as surgeon’s assistants. Today’s frontline medical personnel are highly trained emergency medical technicians equipped with the latest digital equipment.

A common denominator among all wars has been the young men—and more recently, women—who have made survival possible. Doctors, surgeons, nurses, and frontline corpsmen and medics have always faced enemy fire when others took cover. Their courage and compassion have enabled them to ignore their own mortality when confronted with even a remote possibility of saving another’s life. Many have endured unimaginable conditions on the battlefield. Thousands have volunteered to jump into a bomb crater or climb down inside a burning ship to treat a sliced-open belly, legless stumps, or a filleted face.

Many came from humble, nondescript towns, farms, and cities. Caspar Wistar was a pacifist Quaker who volunteered as a frontline nurse in George Washington’s army. Weedon Osborne, a dentist, became a hero as a medic in the trenches of World War I. Joe Marquez, the son of a Nevada miner, joined the Navy in World War II to escape a small-town destiny. Japanese-American James Okubo signed up for the Army from behind the barbed wire of a World War II American internment camp. Joe Keenan, an elevator repairman’s son, boarded a troop transport bound for Korea, leaving a row-house Boston neighborhood in his wake. Monica Brown graduated early from a Texas high school to enlist in the Army and become a medic in Afghanistan.

These few represent the thousands of Americans who have joined the military and become battlefield corpsmen and medics. They are our neighbors, our children’s friends, our sons, and, more recently, our daughters. As both war and medical science have driven innovations in military medicine, each successive generation of corpsmen and medics has personified the medical corps’ devotion to saving lives with increasingly sophisticated care in the midst of war’s greater lethality.

They have been the link between catastrophe and treatment after shrapnel has cut through a soldier, sailor, or Marine. Corpsmen and medics instinctively applied a few months’ medical training to make instant diagnoses when they first pressed their hands against a man’s sucking chest wound as foamy blood oozed through their fingers. Doctors and surgeons amputated, excised, stitched, and vaccinated within range of enemy fire. Nurses, technicians, and support personnel worked by their side, caring for and comforting the wounded. Their personal stories, spanning two centuries of America’s wars, illustrate how ignorance, social taboos, and myths have been overcome by the diligence and daring of medical professionals in the laboratory, alongside the operating table, and at the frontline aid station.

Battlefield Angels is about the people who practiced battlefield medicine as it evolved from one war to the next: military medical personnel from Lexington to the Shenandoah Valley, from Vietnamese rice paddies to Middle Eastern deserts. It recounts the shattering effects of low-velocity Minié balls and the battlefield care limitations that produced thousands of one-armed and one-legged Civil War veterans, and it reveals the sophisticated battlefield treatments our modern warriors receive for wounds inflicted by snipers and remote-controlled land mines.

This book illustrates how survivability in war has improved dramatically in the face of increasingly lethal weaponry. During the Revolutionary War, more than 40 percent of soldiers wounded by the enemy died from their injuries. By the Vietnam War, that percentage had dropped to 25 percent. Today in the Middle East, it is about 10 percent. Beginning with the Revolutionary War, the total number of wounded who have survived their injuries is the equivalent of every resident in San Diego, California.

The genesis of Battlefield Angels lies in another book I wrote, Midway Magic, which is about the unprecedented forty-seven-year odyssey of the now retired USS Midway aircraft carrier. More than 200,000 sailors (their average age was nineteen) deployed on the longestserving U.S. Navy aircraft carrier of the twentieth century (1945–92). On several occasions, horrific flight-op accidents left dozens of men broken, burned, and bleeding on the flight deck. Young corpsmen new to the ship sprinted toward billowing infernos and one-thousand-pound bombs lying in pools of jet fuel. Their bravery and devotion humbled as much as it inspired, though recognition often was sparse and fleeting. It led to another book, USS Midway: America’s Shield, in 2011, written specifically for high school students and young adults.

I soon discovered dozens of other instances in which young men only a few years out of high school had been equally selfless, heroes who masqueraded later in life as insurance salesmen, hospital administrators, and dentists. The path of discovery led to the operating room as well as the laboratory, where assumptions about gangrene, malaria, third-degree burns, and amputation were challenged. Battlefield Angels reflects their collective legacy in military medical science. It also provides a deeply personal context to the war experience of more than 40 million Americans who have served on the battlefield.

The core of the book is based on interviews with some of the frontline corpsmen and medics who survived, with the men they saved, and with those who served alongside them in foxholes, submarine compartments, prison cells, and Humvees. The conversations with these heroes in places like Oceanside, California, and Boone, Iowa, often stretched into the night as they relived ingrained nightmares they had previously shared only in lowered voices at reunions with their buddies. Genuine humility occasionally prevented some from sharing their personal stories directly with the author.

Many times the interviews became especially difficult for the spouses, who often sat quietly off to the side. Some cried. Others grew angry upon discovering that nightmares had long haunted their husbands, who spoke of them for the first time to a stranger sitting on their couch. “It was just my job,” a man often shrugged as he avoided eye contact with his shocked wife.

Many interviews with World War II soldiers and corpsmen as well as active-duty military personnel today provided remarkably precise detail. I discovered that in battle, many soldiers, corpsmen, and medics experienced a heightened awareness that allowed them to remember a particular sunrise, weather conditions, and even what they were thinking at specific points in time. Decades later in some cases, they were able to recall those details as clearly as if they had experienced them just the day before.

In some cases involving active-duty personnel serving in remote locations, direct interviews were not possible. Some politely declined out of modesty. Yet their stories are included based on extensive documentation and eyewitness accounts.

I also relied on recorded and written firsthand accounts from every war fought by Americans. The U.S. Navy’s Bureau of Medicine and Surgery’s collection of transcribed oral histories from hundreds of twentieth-century medical personnel was invaluable. Medical professionals such as Revolutionary War doctor William Buchan and Civil War surgeon William Williams Keen published reports and memoirs filled with detail. The diaries kept by doctors who were prisoners of war during World War II, official military records including after-action battle reports, medical training manuals, and other material in the collections of the U.S. Marine Corps, National Library of Medicine, Naval Historical Center, and the National Archives proved extremely useful. Empirical analyses and reports published by the federal government and medical journal articles provided a wealth of statistical data.

I have utilized information from all these sources—the most important of which are included in the selected bibliography—as accurately as possible. Where dates or statistics inevitably varied by source or estimation, I selected the most commonly used figures. The word choice and narrative are my own. I welcome any suggested corrections and clarifications.

Although the medical ranks on the front lines have been called different names dating back to the Revolutionary War, for the sake of clarity and consistency, I refer to them as surgeon’s mates in America’s early history and then as corpsmen in the U.S. Navy and Marine Corps and medics in the U.S. Army. Similarly, I frequently use “soldier” to refer to all those serving on the battlefield.

Many of the individuals profiled in Battlefield Angels received the Medal of Honor, America’s highest award for bravery in war; the Navy Cross or its Army equivalent, the Distinguished Service Cross; the third highest honor, the Silver Star; or the Purple Heart, awarded to those wounded or killed in combat. Sometimes a pat on the back or a nod from a chief petty officer or sergeant had to suffice. In the end, judging valor and courage in battle has always been subjective, given the era, politics, the propensity to award medals, and the standards of military medical care.

Regardless of official recognition, the real story of military medicine begins with those who breathe life into others alongside a road, deep within a jungle, or at the bottom of a foxhole. That’s where readers will find the most important insights of Battlefield Angels, the revelations of character defined by courage, duty, optimism, focus, and ingenuity. With these revelations comes the hope that each of us carries seeds of heroism buried deep within, that we all somehow have the capacity for greater courage and compassion than we dare imagine.

To the millions of fighting men and women who owe their lives to these heroes, they will always be battlefield angels.

Chapter 1

Perils of Independence

The night air chilled Caspar Wistar as he walked alongside a wagon filled with medical supplies, part of an eleven-thousand-man army creeping toward a small Pennsylvania hamlet. He wondered if General George Washington’s medical corps would again run short of wound dressings when battle met the sunrise.

Washington had divided his army into four columns for a coordinated attack against nine thousand British soldiers bivouacked at the southern end of Germantown, about five miles north of Philadelphia. With luck, Washington’s army would be in position by 0400 hours, rest two hours, then attack. More than twenty thousand soldiers would occupy a two-square-mile village, firing muskets and artillery practically at point-blank range. Nurse Caspar Wistar and a handful of surgeons, surgeon’s mates, and other volunteers soon would be confronted by hundreds of wounded and dying men on October 4, 1777.

Two weeks earlier, on September 26, Lord Charles Cornwallis had led British troops into undefended Philadelphia and taken control of the colonies’ capital. Losses by the Continental Army at the Battle of Brandywine and the Battle of Paoli had left Philadelphia susceptible to the British invasion. The British repeatedly defeated a Continental Army that was malnourished, poorly trained, and so ill equipped that some men fought barefoot. One year after declaring independence, the colonists had now lost their capital, usually a death knell in war. Once the British had secured Philadelphia, they left a force of three thousand men there to defend it and moved nine thousand soldiers north to Germantown.

General Washington saw an opportunity in the divided British army. If he could defeat the British at Germantown before the onset of winter, the Continental Army would be in a stronger position to retake Philadelphia the following spring. Equally important, a victory at Germantown would end the series of defeats the colonists had suffered on the battlefield and begin to restore the army’s plummeting morale. Washington believed his troops were sufficiently trained and experienced enough to launch a complicated, four-pronged attack against the British.

Shortly after sunset on October 3, thousands of Americans on foot and some in wagons advanced through the misty, forested hills toward the British encampment. One was Isaiah Strawn, a Quaker from nearby Bucks County. Another was John Hoskins Stone, a colonel in the 1st Maryland Regiment. Just as the sun lightened the thickening fog at dawn, the woods around Strawn and Stone exploded with British musket fire and the cries of wounded Americans. Washington’s attack had been detected by a British outpost. Men fell, bleeding onto a forest floor blanketed by fallen leaves. Whitish-blue smoke from muskets and cannon joined with the fog to reduce visibility even further. The Continental Army had lost the element of surprise.

The battle for Germantown quickly unraveled. One column of Washington’s army somehow got lost on its way to the staging area. A second, advancing on British defensive positions, veered off toward another American column. Although the attackers had been told to wear a piece of identifying white paper in their hats, visibility had deteriorated so much that Americans began firing at each other. Casualties mounted as the sun rose.

Isaiah Strawn fell wounded after he rushed to pick up the musket of a friend who had been shot dead. Strawn was three weeks short of his nineteenth birthday and had enlisted only a few weeks earlier. Not far away, John Hoskins Stone dropped to the ground in agony and clutched a bloodied leg. A relatively old man in the army at twenty-seven, he had been fighting the British for two years. He was the son of a prominent Maryland plantation owner. An older brother had signed the Declaration of Independence.

Both Strawn and Stone had been wounded in the leg by lead buckshot, a common battle wound during the Revolutionary War.

Nearly two hundred years earlier, gunpowder had transformed the battlefield. For centuries, warfare had resulted mostly in cuts to the head, legs, and arms, as well as fractures and concussions. Punctures in the torso from arrows and javelins were less common. Gunpowder, however, caused unprecedented trauma to the human body. The shattering effects of bullets and artillery shells were so profound that military doctors believed the projectiles were poisoned by the gunpowder: for decades they treated gunshot wounds as poison cases.

By the outset of the Revolutionary War, some types of artillery could fire explosive hollow shells filled with gunpowder and shrapnel more than eight hundred yards. They were utilized at the beginning of many battles. As the opposing forces converged to within fifty yards of each other, soldiers opened fire with smooth bore muskets of limited range and accuracy. Large, round musket balls hit bodies hard, sometimes burrowing deep and shattering bone. The slice of the blade in hand-tohand combat had been replaced by the concussive thunder of cannon and muskets from behind hills and in open fields. General Washington’s troops walked into a storm of flying lead and iron.

After about three hours of battle, it became clear that the American assault on Germantown had failed. The four American columns retreated, carrying as many injured with them as possible. Some members of Washington’s medical corps remained on the battlefield to treat the wounded while the remainder withdrew nearly ten miles to Pennypacker’s Mill before the British gave up the chase.

The Continental Army was plagued by a paucity of qualified medical personnel, a dearth of medical supplies, and an understanding of battlefield medicine that in some ways was less informed than that which had been practiced by the ancient Greeks and Romans.

In 1700 B.C., treatment practices were first recorded on Egyptian papyri. One document listed forty-eight specific battlefield injuries and prescribed treatment for each. A skull fracture, for example, was treated with fresh meat the first day, and the patient was kept on a full diet. Grease, honey, and lint were applied daily thereafter.

The ancient Greeks also took care to prevent disease. They instinctively demarcated dining areas from bathroom facilities. That reduced the likelihood of epidemics that left weakened soldiers more susceptible to their battle wounds. More than one thousand years later, around 400 B.C., Hippocrates wrote seventy-two medical books that reflected the state of Greek military medicine. In addition to codifying medical ethics for the first time, he documented the use of wine to moisten and disinfect a wound, chest tubes for drainage, and traction for fractures. Regrettably, he advocated facilitating the development of pus in a wound as a means to reduce inflammation. Greek army doctors were pleased if, by the third or fourth day, the lips of a grizzly gash on a thigh turned white and the exposed flesh warmed to the touch and glowed pinkish red. They considered it a necessary part of the healing process, failing to recognize it as the onset of a frequently lethal gangrenous infection.

More than six hundred years later, Roman military doctors were the most accomplished of any in the ancient world. Galen, a physician to gladiators, wrote more than four hundred wide-ranging treatises that included diverse topics such as nasal polyps, plastic surgery, and the treatment of cleft lip. A Roman military doctor’s kit included forceps, scalpels, arrow extractors, and catheters. Doctors recorded each case for medical schools back in Rome, boiled their instruments, and prescribed opium poppies as painkillers. Roman soldiers were trained in basic first aid.

Although Galen reinforced the concept that infected wounds retarded more dangerous inflammation, Roman military medicine achieved several milestones. Roman military physicians created the hospital system, wrote the first medical manuals, developed ligation techniques to control bleeding, and refined amputation procedures. But when the Roman Empire collapsed in the fifth century, its military medicine advances were buried in the debris.

In 1775, Congress created the Army’s Hospital Department. Surgeons received $1.66 per day, while nurses earned $2 per month. But the Hospital Department created confusion on the battlefield, where Continental Army physicians treated the wounded alongside the doctors attached to the regiments each colony sent to war. Sometimes one regiment’s doctor refused to treat the wounded from another regiment. Turf battles could hardly be afforded in the face of a shortage of medical personnel so acute that in some cases, one doctor and five assistants were assigned to as many as five thousand soldiers.

To make matters worse, Strawn and Stone might have been treated either by a trained surgeon or by a charlatan at Germantown. During the Revolutionary War, only about 3,500 doctors practiced medicine in the colonies, and only 10 percent of these had gone to medical school. Most had been trained as apprentices. None had to prove his qualifications in an era when doctors were not licensed. Almost anyone could claim to be a doctor, surgeon, or apothecary. Wounded soldiers had to take them at their word.

Volunteers such as Caspar Wistar often had no medical training whatsoever. Wistar came from a factory family that operated one of the largest and most prosperous glass factories in the colonies. The factory had been established by his grandfather in 1738. Wistar was one of many pacifist Quakers who either raised money for the war or who volunteered to help with the wounded. Only sixteen years old when he joined the Army, Wistar had developed an early interest in medicine and botany.

The day after the Germantown defeat, Washington’s medical corps, such as it was, faced dozens of surgeries. Most military doctors had little experience treating the mangled limbs and pulverized bodies caused by gunshots. The explosive power of the bullet typically blasted dirt and bits of clothing into the wound. If the bullet struck bone, a compound fracture usually resulted. Although some doctors had probes to trace the path of entry of a musket ball, most inserted their dirty fingers and poked around. If they could not easily retrieve the musket ball, they left it in the soldier’s body. Some Revolutionary War veterans lucky enough to survive carried the enemy’s ammo inside their bodies to their deathbeds decades later.

Much of the limb surgery after a battle centered on amputation. A practiced surgeon could amputate a leg in less than two minutes. An officer was given rum or brandy, if it was available, before his leg was cut off. Enlisted men typically had to bite down on a stick as Wistar and other assistants tightly cinched a leather tourniquet four fingers above the amputation line. Once the leg or arm had been cut off, the surgeon typically used a crooked needle to snag severed arteries and blood vessels, pull them taut beyond the bloody stump, and suture them closed. Amputation was so traumatic that those who had lived through battle only to lose an arm or leg to the army surgeon stood just a one-in-three chance of surviving shock and near-certain infection.

Military doctors also faced massive numbers of bleeding soldiers. Among the few techniques available for slowing the loss of blood was a screw tourniquet. If the bleeding stemmed from lesser blood vessels, medical personnel burned them shut through cauterization. Effective anesthesia was unknown.

Wounds to the head were altogether different. Revolutionary War surgeons learned to drill holes in soldiers’ skulls to relieve the swelling caused by a fracture or concussion. A Germantown casualty with a head wound had to sit upright in a chair and was steadied by several assistants. A surgeon cut the scalp away from the fracture, then used a trephine to drill a hole through the skull. Next he took a scalpel to probe the subdural matter to ensure it was free of excess fluid. Once the wound was drained, the surgeon’s mates packed it with dry lint and held it in place with a handkerchief.

In the aftermath of Germantown’s half-day battle, field hospitals were established in large houses, nearby settlements, and in clearings filled with tents. But recovery in Revolutionary War military hospitals proved more dangerous than facing the enemy in battle. Nine years after the war, surgeon Pierre Francois Percy described some of the challenges:

“In retreat before the enemy there is no more frightful a spectacle than the evacuation of mutilated soldiers on big wagons, each jolt bring[ing] the most piercing cries. They have to suffer from rain, from suffocating heat or freezing cold, and often do not have aid or food of any sort. Death would be a favor and we have often heard them begging it as a gift from heaven.”¹

Sometimes days passed before a soldier reached a military hospital. At that point, doctors often found caked blood covering serious wounds and field dressings contaminated with maggots.

Filthy, unsanitary hospital conditions increased Strawn’s and Stone’s 2 percent chance of dying on the battlefield to a 25 percent likelihood they would die in a field hospital. Hospitals were so poorly equipped that soldiers were expected to carry an empty sack that could be filled with straw as a makeshift hospital bed. Each was expected to provide his own blanket as well.

Medical supplies were a rare commodity throughout the Revolutionary War. Wistar and the surgeons with whom he served had little more than ingenuity and grit with which to treat patients. Some sold the fat and bones left from patients’ meals to buy supplies. Sometimes they operated with razors instead of scalpels. In the days leading up to the Battle of Long Island in 1776, the 9,000-man army had been supplied with only 500 bandages, 12 fracture boxes, and 2 scalpels. More than 1,400 men had been wounded or captured or were missing.

If their patients survived surgery, Wistar and the doctors frequently took as much as a quart of blood from injured soldiers whose wounds almost invariably became infected. The prevailing school of thought held that a wound infection was the result of an imbalance in the blood. Bloodletting drained “impure” blood from the patient to allow nature to restore this balance. A wounded or ill soldier’s hand was immersed in a bowl of hot water to swell the veins. Once a tourniquet was applied just above the wrist, a vein was sliced open at the heel of the hand. The soldier’s hand was once again submerged in the hot water to facilitate bleeding until the doctor saw the soldier’s face grow gray and his eyes flutter. Doctors put thousands of Revolutionary War soldiers into shock with this method.

Some men lying near Strawn and Stone likely had been burned in battle. If it was a minor burn, it was treated with wine or a superficial scalding of hog’s lard. More serious burns required bloodletting. Once the burns became inflamed, doctors resorted to a bread-and-milk poultice that was softened with butter or oil and changed twice a day. Wine and opium were the drugs of choice for pain, for burn and trauma victims alike.

Doctors were equally reliant on herbal ingredients as medicines, though they were constantly in short supply. Hellebore root served as a diuretic. American wintergreen was administered for urinary problems. Even the poisonous nightshade was used as an antispasmodic.

Whether it was herbal enemas, bloodletting, or packing a burn site with bread and milk, Revolutionary War doctors practiced a decidedly holistic brand of medicine. An inventory of a permanent army hospital’s medical supplies typically included powdered Peruvian bark (quinine), opium, camphor, calomel, jalap, powdered rhubarb, prepared chalk, castor and olive oils, barley, powdered Colombo, ipecuanto, tartar emetic, gambage, chocolate, tapioca, beeswax, wine, brandy or rum, vinegar, coffee, hyson tea, rice, sugar, and sago.

“It is nature alone that cures wounds; all that art can do is remove the obstacles, and to put the parts in such a condition as is the most favourable to nature’s efforts,” wrote Revolutionary War doctor William Buchan.

If Strawn and Stone somehow survived their wounds, their weakened condition made them more susceptible to disease. The disease mortality rate in the Continental Army was far greater than that inflicted by British gunfire. In February 1776, one in seven Continental Army soldiers was too sick to fight. Soldiers weakened by malnutrition and sickness were ill equipped to overcome their battle wounds. Most were rural boys who had not developed immunity to communicable childhood diseases. Many had relied on their mothers as the doctor in the family, who used herbal remedies she grew in her garden. But these homegrown approaches often were insufficient to treat the diseases that plagued the army. These young soldiers were as vulnerable to dysentery and malaria as they were to enemy fire.

Diseases in the 1700s often were poorly understood and misdiagnosed. No one knew that bacteria and viruses caused disease. Many doctors, including the military medical corps, believed all illnesses stemmed from nervous tension. A standard course of treatment included a reduced diet, aggressive digestive purges with enemas and diuretics, and frequent bloodletting to the point that patients passed out. Large doses of mercury were used to treat malaria, pneumonia, dysentery, typhus, yellow fever, tuberculosis, and other diseases. Doctors believed mercury cleansed the digestive and cardiovascular systems.

Isaiah Strawn and John Hoskins Stone were among the more than 500 soldiers who had been wounded at Germantown. More than 150 had been killed in battle. The British suffered more than 500 casualties as well. Though Germantown was another defeat, the Continental Army had fought so ferociously that the British retreated to reinforce Philadelphia.

General Washington regrouped and focused his attention on another British emplacement at Valley Forge. In the months following the Battle of Germantown, Washington ordered the construction of several new military hospitals, including one at Valley Forge. By December 1777, the Valley Forge facility listed 2,898 sick and unfit patients, a number that grew to 3,989 only two months later. It would be another six years of mounting casualties before America’s first war ended.

Strawn and Stone both survived the Battle of Germantown. Strawn refused to allow surgeons to remove the buckshot from the hollow, or, arch, of his foot. He carried it for more than sixty years as he and his wife, Rachel, raised six children who in turn produced fifty-four grandchildren. When he died in 1843 at the age of eighty-four, he was among the oldest surviving Revolutionary War soldiers.

John Hoskins Stone’s leg injury hobbled him for the rest of his life. His military career ended in 1779, when he was wounded a second time. Stone served as governor of Maryland from 1794 to 1797. He died in 1804 at the age of fifty-four.

The volunteer nurse, Caspar Wistar, never picked up a weapon during the Revolutionary War. He became a doctor in 1786 after attending the University of Edinburgh in Scotland. A noted physician, Wistar wrote A System of Anatomy in 1811, the first American medical text on anatomy. He was an advocate of vaccinating against disease, served as the chairman of the anatomy department at the University of Pennsylvania School of Medicine, and taught until his death in 1818. His scientific interests in paleontology and botany became so well recognized that botanist Thomas Nuttall named the plant genus Wisteria in his honor.

America’s military medical corps was created as a result of war and literally learned on the job. Medical books about inoculation, military hospital pharmacology, soldier health, and hospital administration were written by a handful of leading military doctors during the Revolutionary War. The experience of medical incompetence early in the war prompted states to establish doctor-licensing criteria that ultimately improved civilian healthcare.

The most notable advance was effective inoculation against smallpox. The death rate for smallpox dropped from 160 to 3 per 1,000 in late 1783, when General Washington ordered his army to be inoculated—the first time in history an army had been vaccinated against disease. Regardless, an estimated 17,000 soldiers died of disease in the war, compared with about 8,000 who were killed in combat. Strawn and Stone were among the 25,000 who survived their wounds, though many historians believe Revolutionary War statistics are conservative for lack of detailed recordkeeping.

Shortly after the war’s end, Congress disbanded the Continental Army to a force of fewer than one thousand men. Nearly eighty years would pass before America mobilized again for combat and looked to its medical community to save lives on the battlefield. It remained to be seen whether the lessons of America’s first war had been lost in the passage of nearly three generations.

Chapter 2

Battlefield Evacuation

Suffocating humidity thickened the uniforms of thousands of Union soldiers as they milled about, nearly shoulder to shoulder, in a park in Washington, D.C., (then known as “Washington City”) on July 15, 1861. Some paced between and around hundreds of white conical tents. The previous night’s campfires smoldered, and smoke drifted straight up into a lifeless sky. Sweat rolled down Foster Swift’s face as he knelt to inventory the contents of a wooden box he had pulled out of a wagon. The surgeon attached to the 8th New York Regiment had supplies to check and requisition requests to complete while rumors swirled about where General Irvin McDowell soon would be taking the Union army.

About twenty-five miles away in Virginia, Confederate generals Joseph Johnston and Pierre Beauregard reviewed battle plans. They commanded more than thirty thousand troops who were southeast of Washington near Manassas Junction. Intersecting railroad lines at Manassas offered direct routes to both Washington and the Confederate capital of Richmond. Manassas lay at the crossroad of a war that had yet to erupt on the battlefield.

Swift had heard that the first major land battle of the Civil War probably would take place near Manassas. It was clear that both sides were mobilizing for battle.

In 1861, military medicine was far from ready for battle. Very little medical progress had been made since the end of the Revolutionary War, when the medical corps had been disbanded. By 1802, the military medical corps had shrunk to less than thirty personnel. During the War of 1812, it had been crippled by a shortage of qualified doctors, the absence of a battlefield evacuation system, and military hospitals that were little more than tents and temporary shelters. The practice of bloodletting and ignorance about the causes of disease were as profound as they had been during the Revolutionary War.

Soldiers in the Mexican-American War of 1846–48, which successfully annexed Texas, suffered from a lack of care. The American army of 7,000 men was assigned only 72 medical officers at the outset of the war. When the army grew to 100,000, there were only about 250 medical officers and volunteers. Once again, the medical corps was badly outnumbered and unprepared for the ravages of what became the American army’s most deadly war. More than 11,000 soldiers died from illness, about seven times as many as those killed in battle. One out of six soldiers in the Mexican-American War died in combat or from disease. The disease rate in the military was ten times that of the civilian population. Thousands came home from war debilitated by chronic cases of dysentery.

There was no system to evacuate the wounded from the battlefield. Those who made it faced an uncertain future at best. Gunshot wounds that resulted in compound fractures were almost always deadly. Although some soldiers survived amputation and then infection of an arm or lower leg, the closer the wound was to the torso, the more likely it would be fatal. A Navy doctor who accompanied the army to Mexico noted that he did not see a single patient survive a gunshot wound to the thigh that had resulted in a fracture. ²

Almost nothing had changed by early 1861. At the start of the war, the Union army’s entire medical corps numbered only eighty-seven men. Its parsimonious eighty-year-old surgeon general, Thomas Lawson, a veteran of the War of 1812 who died shortly after the beginning of the Civil War, refused to buy them medical textbooks. Many of the doctors supplied by the state regiments had no experience with battlefield injuries, and some had never operated on a patient. Many had never seen the inside of a living patient’s abdomen. Yet by July 1861, tens of thousands of young men relied on them for survival.

Sullivan Ballou was a handsome major in the 2nd Rhode Island Regiment. At thirty-two years of age, he was considered an old man in the army, and he was uncommonly accomplished. As a lawyer, he had served as clerk and speaker of the House of Representatives in Rhode Island. Ballou had said goodbye to his wife, Sarah, and two young sons when he volunteered in early 1861.

As Swift inventoried his medical supplies elsewhere in the camp, Ballou wrote his wife:

“Indications are very strong that we shall move in a few days, perhaps tomorrow … I feel impelled to write a few lines that may fall under your eye when I shall be no more … I cannot describe to you my feelings on this calm summer night, when two thousand men are sleeping around me … and I, suspicious that Death is creeping behind me with his fatal dart, am communing with God, my country and thee.”³

Six days after writing this letter and placing it in his trunk, Sullivan Ballou, surgeon Foster Swift, and more than twenty-eight thousand Union soldiers marched out of Washington, D.C. It took the unseasoned and poorly trained troops two days to hike twenty-two miles toward Manassas and their campsites near Centreville, Virginia. A Union general left twenty wagonloads of medical supplies behind for fear they would slow the tedious advance even further. Undisciplined soldiers often fell out of formation to pick berries before arriving at Centreville and setting up camp.

On July 21, at 0230 hours, under a cloudless sky, twenty thousand Union soldiers moved out toward the Confederate positions. The summer heat was so oppressive that stragglers simply dropped to the ground along the route. Shortly before dawn, thousands of Washington residents climbed into their carriages for a ride out into the country to watch the battle between sixty thousand soldiers. The Civil War was a spectator sport in 1861.

Most were still in their carriages at 0515 when the first Union cannon fired on General Beauregard’s headquarters, launching the battle that became known as Bull Run. Three columns of advancing Union soldiers soon ran into logistical and communications problems. Within a few hours, the battle had become concentrated in a small patch of eastern Virginia filled with gentle hills and forested ridges, divided by small creeks and rivers. Isolated stone farmhouses became battlefield landmarks as incessant rifle fire and artillery attacks turned the forests into a landscape barren of cover. Both Union and Confederate troops faced barrages of defensive fire as men fell, screaming for help. Within an hour of the battle’s onset, Foster Swift and the rest of the medical corps were treating grisly wounds most had never encountered before.

At 0915, Sullivan Ballou’s unit emerged from a thicket of trees and advanced up a hill. The enemy, waiting on both sides, opened fire. A cannonball broadsided Ballou’s prized horse, Jennie, killing it instantly and crushing Ballou’s leg into a bloody pulp. Blistering pain shot up Ballou’s hip and into his brain. A brief flush of dizziness passed. Lying on the hillside, Ballou grew thirsty as he bled and waited for help. Union soldiers dragged him behind some cover, then carried him to a tall, narrow church that sat atop a ridge, near a creek and sulfur spring. Sudley Church and nearly every other building still standing were quickly converted into field hospitals by both sides.

Foster Swift and other surgeons were ordered to Sudley as dozens, then hundreds, of wounded and writhing soldiers were brought there. Planks balanced across pews became operating tables. Assistants and the walking wounded hauled water from the creek in buckets. Surgeons dipped bloody scalpels in them between operations. Swift and the other Union doctors were unprepared for what confronted them: Weaponry had progressed faster than battlefield medicine.

Their biggest challenge was posed by the Minié ball, a new kind of bullet that cut a wide path of destruction through the human body. Made of soft lead, it traveled 950 feet per second and was accurate to 600 yards when fired by a rifled musket, about 10 times further than the maximum lethal range of a smooth bore musket in the Revolutionary War. Worse, the lead flattened when it penetrated the human body. It shattered bones, destroyed blood vessels, tore through intestines, and severed fingers, hands, and arms. It also had the nasty characteristic of ricocheting within the human body when it glanced off bone.

Surgeons at Sudley Church assessed Ballou’s destroyed leg and prepared to cut it off. Far too much damage had been done, and a quick amputation might keep Ballou from life-threatening shock or infection. In less than five minutes, Ballou’s leg was tossed onto a growing pile of mangled and severed limbs. Speed was paramount in the face of mounting casualties. The smells of blood, bile, and seared flesh filled the church.

By late afternoon, the Confederates had broken through one side of the Union assault. General McDowell’s defensive line collapsed under the Confederate advance. Union soldiers retreated and then ran. They fled back toward Washington, D.C., and collided with the thousands of civilian spectators in their carriages who were escaping to safety. Wounded soldiers were abandoned on the battlefield, left to crawl through the dirt in search of shade to escape the sweltering July heat.

Swift, a handful of surgeons, and some assistants, including Gustavus Winston and Charles DeGraw, chose to stay at Sudley Church to care for more than three hundred wounded men. They performed one surgery after another—nearly all of them amputations—as Confederate troops surrounded them. By 1600 the Confederates had seized Sudley Church. Swift, Winston, DeGraw, Ballou, and the wounded lying on pews and under trees became prisoners of war.

Bull Run was an unmitigated military medical corps disaster. A massive Union army had marched into battle with no practical system or capability for treating its wounded. Bull Run was a huge battle that dwarfed any seen during the Revolutionary War catching both the Union and the Confederate military unprepared to evacuate thousands of wounded off the field of battle. Many military doctors had no or minimal surgical experience. Medical supplies were sacrificed in the interest of expediency. The lack of treatment capability was so acute that some of the walking wounded wandered the nation’s capital for days after the battle until one of the city’s four general hospitals had room for them.

The fiasco reflected the state of military medicine as it struggled to cope with unprecedented casualties. A chronic shortage of qualified doctors persisted throughout the Civil War. It was especially acute in the South, where nearly all medical schools closed during the war. The shortage created a spirit-crushing burden on doctors in uniform. After one battle, surgeon John Shaw Billings wrote:

“Only [to] say that I wish I was with you tonight and could lie down and sleep for 16 hours without stopping … [after] … operating all day long and have got the chief part of the butchering done in a satisfactory manner.”⁴

Billings was one of only two hundred fifty Union doctors available after the battle to treat twenty thousand wounded Union and Confederate soldiers.

Millions of soldiers faced a withering barrage of enemy fire in more than two thousand engagements during the Civil War. The development of a rifled musket significantly extended the range of the dreaded Minié ball ammunition. The battlefield was lengthened even further by the lightweight and portable “Napoleon” cannon, capable of firing a twelvepound shot up to 1,700 yards and ideal for the hilly country where numerous Civil War battles were fought. The Napoleon also could fire canisters filled with iron balls that sprayed enemy troops, a kind of deadly long-range shotgun. Toward the end of the war, a basic machine gun was introduced, as well as the repeating rifle, which could fire seven rounds in the time a musket could discharge a single shot. Unprecedented numbers of soldiers fell as rifle and artillery fire quickened and grew more efficient. The battlefield’s killing zone widened and deepened as a result.

At the outset of the war, a primitive battlefield evacuation system was plagued by incompetent personnel. Unfit soldiers who had been assigned as stretcher bearers became infamous for drinking the medicinal alcohol and hiding from enemy fire.

Assignment to a stretcher team was gut-wrenching duty. Following the Battle of the Wilderness in 1864, Lieutenant Colonel D. Watson Rowe wrote that:

“The stretcher bearers walked silently toward whatever spot a cry or groan of pain indicated an object of their search … [the cries] expressed every degree and shade of suffering, of pain, of agony: a sign, a groan, a piteous appeal, a shriek, a succession of shrieks, a call of despair, a prayer to God, a demand for water, for the ambulance, a death rattle.”⁵

BATTLEFIELD

ANGELS

OSPREY