field-surgeon-kit

To many North Carolinians, the war brings danger and death. To most, it brings unimagined hardship and want. To a fortunate few, it brings the opportunity of a lifetime.

Thomas Fanning Wood has aspired to be a doctor from his earliest boyhood in Wilmington. By the time he is a teenager attending the Odd Fellows School, run by Levin Meginney, Wood has acquired such a taste for scientific reading and experimentation that his teacher gives him his own set of chemistry apparatuses. His heart is set on enrolling at the University of North Carolina to study medicine. But his father, a brick mason and builder, won’t hear of it. His father says the young men at Chapel Hill learn nothing more than how to “dress like gentlemen and act like rowdies.”

He wants Thomas and his brothers to become engineers and work alongside him.

In any case, the family can’t afford the modest tuition. His father and uncle came to Wilmington together from Nantucket, Massachusetts, after the whaling industry crashed in order to build a church, the magisterial St. James Episcopal. They worked under Thomas U. Walter, the architect renowned for designing the new U.S. Capitol dome in Washington, D.C., which — at the time North Carolina secedes — has been under construction for more than four years. Flush with the success of the church project, the brothers start their own building firm. Among their commissions are the new City Hall and the railroad line connecting Wilmington with Charleston, South Carolina.

But by 1859, their firm is foundering, and they contract their services to United States Army Maj. William H.C. Whiting, who is building a lighthouse near Beaufort, South Carolina. They stay at the plantation of a cousin, Thomas A. Coffin. Wood roams the Lowcountry, learning to identify plants and trees as an amateur botanist. His father contracts virulent dysentery. In that remote country, with no doctor on hand, Wood takes it upon himself to find a treatment. He consults Dunglison’s Medical Dictionary and concocts a treatment of Dover’s powder, which contains opium for pain and ipecac to make him sweat out the fever. Calculating the dosage based on his reading, Wood doses his father with five grams every three hours. The fever breaks, the pain subsides, and within days his father enjoys a full recovery.

It is Thomas Fanning Wood’s first medical success.

First bloodshed

In 1861, Wood’s father and uncle join Major Whiting, now a Confederate officer, to construct a massive sand fort at the mouth of the Cape Fear River. Medical school is still out of the question, but after a stint as a rural schoolteacher, his friend and mentor Dr. James McRee secures Thomas a position at a pharmacy owned by Louis B. Erambert. Wood borrows medical textbooks from McRee and studies during every spare hour.

War is imminent. It is not on some far-off battlefield where Wood witnesses his first bloodshed — it is right inside the pharmacy. A group of drunken University of North Carolina rowdies invades the pharmacy one evening. Two of them begin fighting. Erambert draws a pistol and orders them to leave the store. One of the young men jerks a pistol and fires, and Erambert fires back. When the gunfight is over, one boy is badly wounded and Erambert lies with a gunshot in his shattered thigh. For the next six months, Wood runs the pharmacy on his own and teaches himself the art and science of mixing and dispensing drugs.

The war breaks over North Carolina like a fact of weather, a charging of the atmosphere like the ozone chill breezing across a meadow in advance of a thunderstorm. Wood’s father is an avowed Unionist. Wood is proudly secessionist. Loyalties are being counted.

Churches play a role in determining politics. St. James, whose pastor is from the North, remains conservatively pro-Union. The Methodist church, which Wood attends, is outspoken in its support for secession. Wood volunteers as secretary of the Committee of Safety, an organization modeled on such committees in the Revolutionary War.

Soon, military companies begin to form. After secession, Governor Ellis orders the formation of 10 regiments of state troops. But Wood is trapped running the pharmacy for four more months. Then in September 1861, when Erambert recovers from his wounds, Wood joins the Wilmington Rifle Guards. Even his Unionist father now drills with a mounted cavalry unit. The Guards become part of the 18th North Carolina Regiment, detailed to garrison Fort Fisher. The duty is easy, the atmosphere more like a boys’ summer camp than a wartime garrison. The young men delight in defying the orders of their officers, like errant boys playing pranks on the teacher.

Wood bunks with five other young men in a canvas tent. Each tent squad invents its own rakish nickname. Wood christens his group “Les Elites.” He turns out to be anything but an elite soldier: inept at field drill, indifferent to military protocol, even a hopeless cook. When his unit mobilizes north to Virginia, he finds himself marching for grueling miles on muddy, rutted roads toward battle at Hanover Court House, thirsty and exhausted from hauling a heavy, custom-made, patent-leather pack. “It was only suited for holiday soldiering,” he recalls, “but I was too proud of the appearance it made to give it up for the poor rag of a thing the men had.”

In it he carries two fine, white blankets, his mother’s parting gift. “As we were running into battle, my knapsack got too heavy — I was very thirsty — and confident that we would return by the same road when the fight was over, I threw my precious knapsack into a tangle of smilax vines and went on, now and then stopping to scoop up water from the cart-ruts which were running with muddy water.”

Soon enough, he is distracted from his thirst by the distant concussion of guns. “Just as we neared the battlefield, I saw the first wounded man I had ever seen in battle. … He had been shot in the bowels, and was a pale and horrible sight.” He advances through a field strewn with dead and wounded horses, and is ordered to lie down. The enemy encompasses them, and the din of battle seems to move around them in waves just beyond his sight. At nightfall, Wood and his company are ordered to retreat.

Alas, they retreat by a different route, and he loses his knapsack and blankets. But along the way, he picks up a discarded Enfield rifle and casts away his old-fashioned percussion musket.

The dirty rut water turns out to be more dangerous than the Yankees — fever soon strikes Wood, and he is out of commission for weeks. When he recovers, he is ordered to report with other convalescents to the North Carolina hospital in Richmond, Virginia — a converted tobacco warehouse near the James River named the Moore Hospital, after the Confederate Surgeon General S.P. Moore. The Confederate Medical Department has determined that men will recover more quickly and with better morale among comrades from their own states, so each state has its own facility. Moore is comparatively small, with just 120 beds.

Moore Hospital is just down the hill from the Chimborazo Hospital, a 40-acre complex with more than 75 wards and beds for 3,000 wounded and sick men. Seventy-six thousand patients pass through Chimborazo alone, and one in five dies there, the common rate.

The largest hospital in the Confederacy is Winder Hospital, with six regular wards and a tent ward, 5,000 beds in all. By 1863, North Carolinians fill three of the wards, and by 1864, they fill five wards — 3,500 of the beds.

In addition to Moore, Chimborazo, and Winder, there are 25 more large, official hospitals in Richmond, as well as two dozen private homes or boarding houses converted into small hospitals. Doctors designate separate hospitals for prisoners of war, smallpox cases, and the insane. Yellow fever hospitals fly a yellow flag.

Even the many hospitals in Richmond are not enough. During the course of the four-year struggle, more than 75,000 Confederate soldiers are wounded on battlefields within a 90-mile radius of the city. Thousands more arrive by train from more distant fields of carnage: Sharpsburg, Shiloh, Gettysburg. In nearly every railroad-depot town throughout the South, boardinghouses and churches become hospitals.

Operating under duress

Both sides start the war confident it will not last long. There is little planning for the treatment of the wounded, let alone wounded by the tens of thousands. The Confederacy fields fewer than 8,000 doctors. Every regiment of a thousand men has just two ambulances, spring wagons with no cots or bedding. The Union at least begins the war with a medical department, and the Confederacy scrambles to match it but always lacks essential medicines, supplies, mules for the ambulances, and surgical equipment.

The wounded lie on the field untended for hours after a battle. Sometimes, as at Cold Harbor and the Wilderness, they lie all night in agony, calling out to their comrades for relief. On other battlefields, the soldiers are too exhausted to tend the wounded and sleep on their arms wherever the tide of battle has carried them. Sometimes the wounded remain under the fire of the enemy and cannot be safely removed without a truce, which is hard to arrange in the chaos of conflict.

Once the smoke clears and the field is safe enough, regimental musicians, medical orderlies, and slaves attached to the army carry off the wounded on stretchers. They place them on two- and four-wheeled ambulances, rough conveyances that may be merely farm wagons pressed into service. Assistant surgeons rove the battlefield, treating some men on the spot, directing that others be carried to field hospitals. There, stewards divide the wounded into three categories: those who are going to die no matter what treatment they receive; those who will not die immediately without treatment; and those whom immediate treatment can save.

Most wounds of the stomach, chest, and bowels are untreatable. Wounds to the limbs often require amputation. The operating theater is a living room, a front porch, a barn, a shed. Doctors perform surgery on kitchen tables, the tailgate of a wagon, a door set across two barrels. If a man undergoes amputation within 24 hours of being wounded, his chance for survival is almost 75 percent.

After initial treatment, the soldier travels by wagon or rail to a regular hospital for extended care and convalescence — hospitals like Moore, Chimborazo, and Winder.

The hospitals are laid out in pavilion-style wards, full of air and light, with beds placed in orderly rows, as in barracks. A label pinned to the wall at the head of the bed identifies the patient and indicates his malady and prescribed treatment.

Wood is fortunate to be assigned to Moore, run by Dr. Otis Frederick Manson, a handsome dandy of a man with jet-black hair and mustache, who has an eye for talent. “When I reported at the hospital I expected to be examined and returned to my regiment,” Wood writes. “Dr. Manson found out I was a medical student … and he put me to work.” He also shares his considerable library with Wood, who douses himself with cold water to stay awake at night studying reference works on pathology, fevers, fractures, and wounds.

Wood is named “wardmaster” of the second floor, in charge of 50 patients, most of whom are suffering from typhoid and malaria, with five nurses to assist. The nurses have no formal training. They are volunteers who learn on the job. It turns out that women from the working classes cope better with disease, suffering, and mutilated bodies than their more genteel sisters, who are well-meaning but pampered and unaccustomed to such strenuous labor.

One anonymous nurse writes, in a poem called “Hospital Duties”:

Fold away your bright-tinted dresses,
Turn the key on your jewels today,
And the wealth of your tendril-like tresses
Braid back in a serious way;
No more delicate gloves, no more laces,
No more trifling in boudoir or bower,
But come with your souls in your faces
To meet the stern wants of the hour.

Wood sleeps on a cot in the dispensary, separated by a partition from the ward. During the days, he attends lectures at the newly opened medical college. Wood keeps his ward scrubbed clean, and when Gov. Zeb Vance visits, spitting tobacco on the floor, a black orderly follows along behind him and mops up the spittle.

The staff treats Vance like visiting royalty, for he has made sure the hospital for North Carolina soldiers is the best equipped and supplied in Richmond — so well equipped, in fact, that the Confederate surgeon general orders Manson to share his largesse with other hospitals. Outraged, Manson at first refuses to comply.

Wood, meantime, keeps meticulous records of the patients in his ward, noting similarities between typhus and typhoid, tracking the effects of quinine dosage on malaria, identifying a new virulent strain of measles that he calls “Army Rubella” — using his ward as a classroom and a laboratory. Like some of the best doctors in both armies, he learns from the sheer number and variety of illnesses and wounds, altering his treatment according to experience, trying to better understand the mysteries of the human body and its pathogens.

Neglecting hygiene

Medical practitioners and the general public alike commonly accept that disease is caused by a miasma in the air, detectable by bad smells. But Wood, like many army doctors, understands early that cleanliness, proper sanitation, and good personal hygiene promote health. They don’t know why this is so, but they are practical men, men who respect empirical data and value results.

Their remedies include a few that are helpful: for pain, laudanum, a mixture of opium and alcohol; and paregoric, or tincture of opium. They prescribe quinine, a South American import made from cinchona tree bark, the only reliable proof against malaria — the quinine is so rare in the South as the war enters its second year that women spies smuggle it across the Mason-Dixon Line in hollowed-out dolls.

Their pharmacy also includes many “medicines” that are useless, even harmful: most notoriously, calomel, a mercury-based substance used for purging the system that is in fact a virulent poison.

For anesthesia, surgeons have ether, which is highly combustible and dangerous near flames and gunfire; and chloroform, which is not and therefore is preferred. The Confederate Army rarely has enough of either one. In Salisbury, a distillery manufactures medicinal whiskey for use in field hospitals.

Young men who have never ventured beyond their neighbors’ farms, who have never been exposed to the diseases of cities, are suddenly crowded into camps full of thousands of strangers, where contagion is easy — a single case of smallpox or measles becomes, overnight, an epidemic. Exposure and fatigue bring on pneumonia. The price of malnutrition is scurvy — open sores, collapsing joints, teeth that loosen and fall out.

In the camps, sanitation is primitive and hygiene lax, ideal breeding ground for dysentery. Lice carry typhus, which strikes almost every soldier before the end of the war. Contaminated drinking water spreads typhoid fever, which has a mortality rate of 60 percent and takes three agonizing weeks to kill a man. Of the slovenly habits of his own soldiers, Gen. Robert E. Lee comments with bitter sarcasm, “They are worse than children, for children can be forced to clean.”

In the coastal lowcountry and swamps, mosquitoes, “galli-nippers,” become a more fearsome foe than the Yankees: They carry malaria and, worse, yellow fever. Known as the Scourge of the South and the black vomit, yellow fever kills half of those it infects. Soldiers who survived it in childhood are immune.

Of 620,000 who die in the war, 400,000 are the victims of disease, and on their charts is noted simply, “D.O.D.” — Died of Disease. Every soldier on both sides is seriously ill at least twice during his service — some 10 million cases.

Fewer than one percent of all battlefield wounds are caused by the bayonet. Soldiers more readily yield their rifles as clubs, reluctant to stab. During the excruciatingly long course of the war, 3.2 million men serve. A soldier’s chance of dying in service is one in four. Nearly half a million suffer wounding, many more than once. There is no accurate accounting of the maimed — missing limbs, hands, eyes, jaws.

Surgical kit

As the war opens, Wood is just as experienced with gunshot wounds and other traumas as most veteran surgeons — which is to say, he hasn’t treated such wounds before.

But even country doctors know how to perform an amputation. Most carry a boxed surgical kit that hasn’t changed since the American Revolution, when surgeons perfected the art of removing an arm or a leg in an average time of three and a half minutes. The kit includes a screw tourniquet made of a canvas belt and an iron tightening screw; a long, straight bullet probe with a ceramic tip and another fashioned into pincers; a trepanning saw for boring a hole in the skull to remove pressure on the brain; sutures made of readily available horsehair, which is boiled to make it pliable and is often the cleanest item in the kit; a wooden or leather bite-strap for the patient’s mouth; lances and scalpels; an anesthesia funnel; several amputation knives curved to fit around the muscle tissue of various limbs; and a rubber-handled capital or bone-saw to complete the operation.

Wood sits before the examining board in February 1863 and waits days to learn he has at last achieved the rank of assistant surgeon. He writes, “I was now 22 years old, rather an unripe specimen of a doctor, with but a young moustache, and not much external evidence of wisdom and skill, but my appointment was a great source of internal satisfaction.”

He briefly visits his family on Masonboro Sound near Wilmington, then reports back to Richmond for orders. To his chagrin, he is not ordered to return to duty at Moore but sent into the field. Thomas Fanning Wood joins the 3rd North Carolina Regiment, marching toward a country crossroads in Virginia called Chancellorsville. There, 90 days after passing his board exam for assistant surgeon, without any supervision, he performs his first battlefield amputation.

See the tools

All of the surgical tools used in the photos in this installment of our Civil War series came from the Vierling House in Old Salem. The pieces are on exhibit year-round.

Old Salem Museums and Gardens
600 South Main Street
Winston-Salem, N.C. 27101
(336) 721-7364
oldsalem.org

Selected Sources

The author is indebted to the following people and sources for material in this article: Heidi Appel and Dr. Al Denn, Sc.D, Burgwin-Wright House; Donald G. Johnson, M.D., M.P. H., Brunswick Civil War Roundtable; Dr. Chris Fonvielle, UNCW Dept. of History; the staff of the American Civil War Center, Richmond, Va.; the staff of Chimborazo Hospital, Richmond National Battlefield Park; the staff of Special Collections, William Madison Randall Library, UNC Wilmington; A Confederate Nurse: The Diary of Ada W. Bacot, 1860-1863, edited by Jean V. Berlin (University of South Carolina Press, 1994); Kate, the Journal of a Confederate Nurse by Kate Cumming, edited by Richard Barksdale Harwell (Louisiana State University Press, 1959); Doctor to the Front: The Recollections of Confederate Surgeon Thomas Fanning Wood 1861-1865, edited by Donald B. Koonce (The University of Tennessee Press, 2000); Swamp Doctor: the Diary of a Union Surgeon in the Virginia and North Carolina Marshes, edited by Thomas P. Lowry, M.D. (Stackpole Books, 2001); Confederate Hospitals on the Move by Glenna R. Schroeder-Lein (University of South Carolina Press, 1994); and Confederate Military Hospitals in Richmond by Robert W. Waitt, Jr. (Richmond Civil War Centennial Committee, 1964).

Philip Gerard is the author of two historical novels set in North Carolina: Hatteras Light and Cape Fear Rising. He is chairman of the department of creative writing at the University of North Carolina at Wilmington.

To view all stories from Our State‘s Civil War Series, visit http://www.ourstate.com/topics/history/civil-war-series

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Gerard is the author of Our State’s Civil War series. He has published fiction and nonfiction in numerous other magazines, and is the author of two historical novels set in North Carolina. He is the chairman of the department of creative writing at the University of North Carolina at Wilmington. He lectures widely on the art and craft of writing history-based stories. His book, Creative Nonfiction: Researching and Crafting Stories of Real Life, is a standard in college classrooms across the country.