Tag Archives: medicine

Caring for Veterans: The Civil War and the Present

In recent history, the state of veteran healthcare has received negative media coverage. The United States Department of Veterans Affairs suffered immense scrutiny for the deaths of at least forty United States veterans who died awaiting assistance. The deaths of these veterans prompted investigations and the eventual dismissal of Secretary of Veterans Affairs Eric Shinseki in May 2014 because these veterans did not receive the timely access to medical staff they required.[1] In December 2016, shocking reports about maggots being found in the wounds of a veteran surfaced.[2] Just recently, federal authorities announced that they were ramping up investigations regarding the increase in opioid theft and unauthorized drug use by VA employees.[3] The U.S. Accountability Office provided a harsh critique of the VA’s handling of patient claims in 2014, and a year later the Center for Effective Government gave the Department of Veterans Affairs the grade of “D”. [4] The concern for the care of veterans among public officials, soldiers, and citizenry is prevalent. While there are current criticisms regarding the management of Veterans Affairs, and demands to provide better care for veterans is widespread, this is far from the first time that healthcare for veterans has concerned the public and initiated Federal action.

The Civil War produced unparalleled casualties as well as an incomparable number of veterans. Prior to the Civil War, an estimated 80,000 veterans from previous conflicts lived in the United States. Soldiers’ homes were organized in the 1810s and later the 1850s, had a board of commissioners, and existed under federal regulations. Yet, the system was not prepared for the mass of troops that would eventually need medical assistance. The Union had 1.9 million veterans after the war’s conclusion, and Congress began to take steps towards providing care for soldiers who would require care and places of rest.[5]

Civil War veterans receive medical treatment at the Bath Branch of the National Soldiers Home in Bath, New York. Courtesy of VHA Historical Photo.

In October 1862, Congress passed The General Pension Act of 1862 which provided disability payments based on rank and degree of disability. Furthermore, the act provided compensation for diseases incurred during service.[6] This proved significant. Tuberculosis, rheumatism, chronic dysentery, and other ailments plagued Civil War veterans for years after their discharge. The Lincoln administration, however, realized that medical care for veterans—particularly the disabled—was still undermanned and staff were often inept to handle the forthcoming medicinal needs of former soldiers. Civil War casualties superseded well over 600,000 men, and tens of thousands of survivors required long-term care for wounds both mental and physical.

Concern regarding medical care of veterans was paramount enough to work its way into President Lincoln’s second inaugural address with the phrase, “…to care for him who shall have borne the battle, and for his widow and his orphan.”[7] Fulfilling this need, and with rousing public support, President Lincoln signed congressional legislation which created the National Asylum for Disabled Volunteer Soldiers in March 1865. This national institution to care for veterans was the precursor to the modern-day U.S. Department of Veterans Affairs. Hundreds of thousands of Union veterans now had an opportunity to receive treatment for their injuries and assistance with their disabilities. The National Asylum ultimately expanded to eleven homes for veterans. Quickly, the government dropped the term “asylum” because they did not wish to characterize the men receiving care at these institutions as being mentally unstable.[8]

A detail of the Eastern Branch of the National Soldiers Home in Togus, Maine. The home today is the Togus VA Medical Center. Courtesy of VHA Historical Photo.

The first branch opened in Togus, Maine, and soon the system grew to accommodate veterans from the Civil War, survivors from earlier wars, and those from subsequent military actions. By 1873, the United States Congress approved significant changes to veteran pension acts, cemetery construction, and care. As a part of these acts, Congress started an aid program in which disabled veterans received funds to hire a nurse to care for their medical issues and a housekeeper to help disabled veterans with chores and duties. The number of veterans also led to Congress authorizing further action in the 1880s to accommodate more veterans needing assistance. Many Civil War veterans lived into the twentieth century, and with the United States’ involvement in World War I, medical care for a new batch of veterans brought forth changes. In the 1920s, medical care at the homes had transformed. With veterans requesting increased benefits, each major soldiers’ home soon operated as a complete medical center with amenities matching that of hospitals at the time.[9]

Interestingly, but perhaps understandably, Confederate soldiers did not receive any federal benefits and former foes of the Union relied on other means. Thus, federal efforts to provide care for Civil War veterans did not include hundreds of thousands of individuals who experienced the pitch of battle and endured lasting complications from time spent in the military. Not until 1958, ninety-three years after the last shots of the Civil War, did Congress pardon Confederate soldiers and offer them every benefit Union soldiers had enjoyed since March 1865.[10] In 1958, Congress extended benefits to Walter Washington Green Williams, considered the last surviving soldier from the Confederacy.[11] Williams died the following year. Historians consider the validity of his service controversial; reports argued he never served the Confederacy in any capacity.[12] The last verifiable veteran who fought for the Confederacy, Pleasant Riggs Crump of St. Clair County, Alabama, had died in December 1951. Thus, it is reasonable to assert that no portion of federal aid ever went to the care of a single Confederate veteran.

The climate of the 1860s and the Civil War is different from that of today. Nevertheless, the concern and necessity for quality care for veterans remains a significant issue. The public recognizes the need to take care of those who served in the military. The challenges are different, but the importance remains. Following the Civil War, the federal government had to create a system to accommodate unprecedented numbers of veterans—many requiring care for physical and mental wounds. The task was momentous. In contrast, the contemporary system to care for veterans has its own daunting challenges. The challenges are not in creating a system or setting the course to establish homes and hospitals but rather ensure that those institutions are running properly, effectively, and devoid of corruption. Currently, the new administration is seeking to rectify the paltry condition of the VA and claims that it will do a far superior job than the previous one. Will they? Possibly, but it is an unknown. Nonetheless, every administration bears a responsibility to care for veterans of the United States. It is a task that was of paramount importance immediately after the Civil War and remains the same to this day.

[1] “Veterans Secretary Eric Shinseki resigns after report,” BBC News, http://www.bbc.com/news/world-us-canada-27640375 (accessed February 22, 2017).

[2] “Oklahoma veteran dies with maggots crawling in wound; 4 resign from VA center,” Fox 59, http://fox59.com/2016/12/05/oklahoma-veteran-dies-with-maggots-crawling-in-wound-4-resign-from-va-center/ (accessed February 23, 2017).

[3] “Opioid Theft, Missing Prescriptions Prompts Investigation of VA Hospitals Staff,” NBC News, http://www.nbcnews.com/storyline/va-hospital-scandal/opioid-theft-missing-prescriptions-prompts-investigation-va-hospitals-staff-n723291 (accessed February 24, 2017).

[4] “Making the Grade,” Center for Effective Government, http://www.foreffectivegov.org/access-to-information-scorecard-2015/ (accessed February 23, 2017).

[5] “VA History in Brief,” Department of Veterans Affairs, https://www.va.gov/opa/publications/archives/docs/history_in_brief.pdf (accessed February 24, 2017), 4.

[6] “VA History in Brief,” Department of Veterans Affairs, 4.

[7] “Second Inaugural Address of Abraham Lincoln, Saturday, March 4, 1865,” Yale Law School Lillian Goldman Law Library: The Avalon Project, http://avalon.law.yale.edu/19th_century/lincoln2.asp (accessed February 23, 2017).

[8] “The Civil War: The Origins of Veteran’s Health Care,” U.S. Department of Veterans Affairs, https://www.va.gov/health/newsfeatures/20110413a.asp (accessed February 24, 2017).

[9] “The Civil War: The Origins of Veteran’s Health Care,” U.S. Department of Veterans Affairs.

[10] “The Civil War: The Origins of Veterans Health Care,” U.S. Department of Veterans Affairs.

[11] There is no confirmation that Williams accepted any aid.

[12] “Walter Williams: Last Civil War Veteran or Hazy Memory?” Dakota Beach Morning Journal, September 4, 1959, https://news.google.com/newspapers?id=Z1crAAAAIBAJ&sjid=8JwFAAAAIBAJ&pg=6005,512182&dq=walter+williams+last+civil+war+veteran+national+archives&hl=en (accessed February 24, 2017).

Michael Megelsh

Michael Megelsh is a doctoral student at Auburn University. He studies the American Civil War and Reconstruction as well as the American West. His specific interests within those fields include the rise of young generals in the Union army and U.S.-Native American conflict during the 1860s.

Mercy Street’s Season Two Premiere: Radical Medical Procedures, Rebel Spies, ‘That’ Pinkerton, and the Plight of the Contrabands

Mercy Street header depicting three characters and a battle scene

Season one of PBS’s Civil War hospital drama, Mercy Street, took historical accuracy seriously, often reflecting recent historiography. Even its annoyingly inaccurate storyline involving John Wilkes Booth’s plot to blow up the hospital during a Lincoln visit was loosely based on actual events. The season ended with a cliffhanger involving the brutal stabbing of one character, and in the last moments, a fuse was snuffed out that would have blown up Lincoln and the hospital. The second season picks up where the first left off, throwing the audience back into the world of a federal hospital in Union occupied Alexandria, Virginia, during the summer of 1862. (Filming in Richmond, the cast and crew reportedly fell in love with Virginia’s capital city and its many historical sites and museums). The first episode is an effective concoction of romance, humor, and dramatic storylines situated within solid historical context.

Not surprisingly, medical drama is front and center. Nurse Mary Phinney (Mary Elizabeth Winstead) is seen writing a letter to the family of a deceased patient, and readers of Drew Gilpin Faust’s This Republic of Suffering will recognize elements of “the good death” in how she describes the soldier’s final moments. Phinney also finds time to share a tender kiss with Dr. Jedediah Foster (Josh Radnor), in a contrived, but effective, romantic plot line that has been building since last season. More dramatically, last season’s stabbing victim, the despicable Silas Bullen (Wade Williams) endures two medical procedures that were radical for the time. The first requires experimentally pulling his intestines out to find and repair the damage. The other procedure is even more cutting-edge and is required after a second attempt on the patient’s life causes a rapid loss of blood. Foster recalls a doctor he met in London, James Blundell, and his draining of blood from one person into another. I’m not a medical historian, but a quick online search of reputable sources verifies the accuracy of the scene, as Blundell was one of the first to perform a successful blood transfusion. Impressively, the staging of the scene looks much like an 1829 illustration accompanying an article Blundell wrote for a medical journal.[1]

Drawing of a blood transfusion
Illustration from “Observation of Transfusion of Blood,” by James Blundell in The Lancet, June 13, 1829. Bernard Becker Medical Library, Washington University School of Medicine.

The wounds are the result of the plot to kill Lincoln. At the end of last season we saw Confederate sympathizer Frank Stringfellow (Jake Falahee) commit the crime because Bullen stumbled upon the conspirators in the hospital’s basement. Frank is betrothed to Emma Green (Hannah James), eldest daughter of the wealthy family that owned and ran the building as a hotel before it was transformed into a hospital by Union troops. Last season Emma tended to the facility’s Confederate wounded, but she has now decided that, despite the current lack of rebel patients, she wants to continue “to be a part of what is going on here.” This reveals that she is quickly evolving from the spoiled and defiant rebel she was in early episodes. Her character development is important; the war transformed nineteenth-century gender roles (debatably, only temporarily), especially among volunteer nurses. When Emma discovers that Frank is involved in the dastardly plot, she quickly and decisively ends their relationship despite having recently shared a carnal moment with him. Emma Green is no shrinking violet.

Meanwhile, Frank gets closer to Emma’s younger sister Alice (AnnaSophia Robb), who the war is also transforming. Determined to leave behind her comfortable southern belle life in order to support the Confederacy, she gets involved in Frank’s spy ring, helping him cover his involvement in the assassination plot. Later, she clandestinely communicates with shadowy figures and a woman (harkening to true spy Rose O’Neal Greenhow) who asks her to steal papers from a high ranking officer living in her family’s occupied mansion house. As Northern Virginia was indeed filled with female spies, this all comes across as realistic (even if Alice and Emma’s Virginia accents do not).

Hot on the trail of the conspirators, however, is a new character who could add pizazz to the show, Union Spy Chief Allan Pinkerton. (Yes, “THAT Pinkerton,” as he humorously says whenever introducing himself). Civil War enthusiasts will appreciate the character’s pomposity as portrayed by Brian F. O’Byrne, and smirk at his comments about how much General McClellan relies on him. We are aware that his Confederate troop strength estimates were well off, playing a role in Little Mac’s timidity and failure. (In fairness, Pinkerton gave inflated numbers to McClellan largely because that’s what the general wanted to hear). Yet Pinkerton did successfully uncover spy rings, so he was not completely incompetent. Despite his comical arrogance, the show depicts him quickly uncovering the plot. “Someone is trying to kill him again,” he remarks, alluding to Pinkerton’s true-life thwarting of an alleged plot to kill Lincoln when he first arrived in Washington. Small details like this show that the writers did their homework.

Pinkerton dispatches his men to arrest Frank. When they do, as we might find out in episode two, the trail will lead to the Green household because of Alice’s involvement. There, the family is celebrating the return of their father (Gary Cole), who had been arrested for refusing to sign a loyalty oath. His son (Brad Koed) subsequently signed the oath to obtain his father’s release, but the patriarch’s sense of honor only causes him to become enraged at his son’s “unpardonable act.” It turns out, however, that Emma’s efforts are what actually secured the release. Her personal request to Lincoln results in an executive order (yes, one of THOSE) releasing the southern gentlemen.

Yet it is through the crime investigation that the show has one of its best opportunities to address the complexities of race relations during the period, and I hope this is highlighted in future episodes. Pinkerton often succeeded thanks to the aid of an African American community eager to help the Union cause even before the war transformed into one of liberation. He relied on interviews with runaways to glean information about rebel troop dispositions and fortifications, and to root out southern spies. Belinda (L. Scott Caldwell) a slave in the Green household, has just started working in the hospital’s kitchen. Might Pinkerton interrogate or even use her to gather evidence against the family that she is ostensibly loyal to, and in which she is beloved? If so, it would be a powerful storyline revealing much about how supposedly “loyal” slaves desired freedom, were willing to betray their owners, and helped the Union cause.

For now, the biggest new storyline involving African Americans is the contraband camp near the hospital, and the arrival of former slave Charlotte Jenkins (Patina Miller), a new character patterned after real life heroine Harriet Jacobs. Fortunately, it appears that this storyline will receive even more attention in future episodes. She has been sent to “educate, support and fortify” the contrabands, as she boldly tells Dr. Foster. The confident woman immediately finds evidence of a smallpox epidemic in the miserable conditions in the camp. Here, the show is accurately influenced by Jim Down’s seminal book, Sick from Freedom, as white characters express the belief that the illness is only a “negro disease,” and that its lethal arrival demonstrates that blacks “weren’t meant for freedom.” Jenkins rightfully insists that there’s nothing racial about the disease, it is the camp’s terrible conditions causing it to spread. Foster is skeptical and thinks the illness in the hospital itself is typhoid. His apparently cavalier attitude about the contraband camp immediately makes Phinney regret their kiss, and she claims she will not let him “beguile” her again. (I wonder if I’m the only one that instantly thought of the overlooked Clint Eastwood Civil War movie, The Beguiled?) The episode’s ending reveals that Phinney is ill, but is it typhoid or smallpox? Hopefully the writers won’t let her condition cause the epidemic storyline to stray too far from the African Americans. It is praiseworthy that Mercy Street is examining the deadly contraband camp conditions that blacks often encountered on the path to freedom.

All of these events in the first episode take place just after the failure of McClellan’s Peninsula Campaign in 1862. The weeks afterwards saw a major shift in federal policy, as Congress and Lincoln became convinced that the campaign’s failure revealed that they needed to deprive the South of its slave population and do more to utilize southern blacks on behalf of the Union. As a result, Congress passed the Second Confiscation Act, freeing the slaves of disloyal owners. This means that Green’s loyalty oath would prevent Belinda and his other slaves from becoming free. I’m anxious to see if the show gets this correct and if it becomes the catalyst that pushes her into helping Pinkerton. Further, just weeks after the campaign, Lincoln presented a version of the Emancipation Proclamation to his cabinet. Previews of future episodes of Mercy Street reveal this season includes an exciting battle scene (perhaps Second Manassas, which should provide the hospital with an overload of wounded), but it is how well the show handles its race and emancipation storylines that will ultimately determine its accuracy and value.

After each episode, I’ll post a short review on my blog, History Headlines (https://historyandthenews.wordpress.com). Follow the journey!

[1] James Blundell, “Observations of Transfusion of Blood,” The Lancet, June 13, 1829.

Glenn David Brasher

Glenn David Brasher is an instructor of history at the University of Alabama, and the author of The Peninsula Campaign and the Necessity of Emancipation (UNC Press, 2012) which received the 2013 Wiley Silver Award from the Center for Civil War Research at the University of Mississippi. Follow him on Twitter, @GlennBrasher.

PBS’s Mercy Street: Series Premiere “The New Nurse” Offers More Than Blue and Gray’s Anatomy

Screenshot 2016-01-10 at 7.23.20 PM
“Mercy Street,” PBS, 2016.

Mercy Street, Ridley Scott’s, fresh, compelling six-part drama captures the gritty, dangerous experience of medical caregiving during the Civil War. The series debuts January 17th on PBS, immediately following Downton Abbey. Set inside Mansion House Hotel, a makeshift hospital in Alexandria, Virginia in 1862, Mercy Street is narrated from the perspective of two nurses, Boston abolitionist, Mary Phinney (aka Baroness von Olnhausen), and Emma Green, the daughter of the hotel’s owner.

The first episode captures the intense resistance and suspicion female nurses faced when they entered wartime field hospitals. Before taking over operations at Mansion House, Phinney endures a sharp interrogation from Dorothea Dix, Superintendent of Nurses for the U.S., and then faces jeers from the male medical staff. Like Louisa May Alcott in Hospital Sketches, Phinney spends much of her time doing menial cleaning tasks, and like Alcott, Phinney perseveres. This episode’s depictions of nurses’ trials reflects the expertise of the show’s stellar team of historical consultants, including Anya Jabour, Jane E. Schultz, and Shauna Devine.

Screenshot 2016-01-09 at 10.21.18 PM
“Mary Elizabeth Winstead as Mary Phinney and McKinley Belcher as Samuel Diggs,” Antony Platt, PBS.

The show’s other main characters complement Phinney and Green, including Dr. Jedediah Foster, a wisecracking proponent of new medical techniques and advocate of the cause of Union salvation rather than abolition and Samuel Diggs, a Philadelphian of color with a mysterious past and brilliant surgical skills. The stories of contraband slaves unfold in the background in a complex interwoven subplot reminiscent of the Crawley family’s servants in Downton Abbey.

Screenshot 2016-01-09 at 10.25.15 PM
“Hannah James as Emma Green,” Antony Platt, PBS.

Despite well-developed plotlines, some of the characters fall prey to goofy stereotypes. Foster yells “hoopskirt!” and “von Outhousen!”at Green and Phinney, reflecting a grumpy misogyny that seems at times overblown. Green initially floats through scenes with a flower basket and a frilly white dress, resembling a close cousin to Melanie Wilkes, but she is wrestling with the limitations of her position as an elite white woman sitting atop a crumbling society. This tension should be further developed if the show’s writers hope to avoid making Green into another stereotypically shallow Southern belle.

Screenshot 2016-01-09 at 10.23.23 PM
“Mary Elizabeth Winstead as Mary Phinney and Josh Radnor as Jedediah Foster,” Antony Platt, PBS.

In its early stages, the show provides a fascinating look at the war beginning in its second year, before the Union’s Peninsula Campaign and the United States Sanitary Commission began to officially train nurses. Outside Mansion House Hospital, the violence was escalating and society was being radically transformed. Emancipation was yet uncertain, and the Union Army was faltering. It will be entertaining to watch Mercy Street’s characters develop as the war intensifies and to think about the real-life people they represent. Mansion House’s “McDreamy” Dr. Foster’s sharp tongue and medical brinkmanship could cut both ways. How and where did Diggs learn to yield a scalpel? Phinney’s idealism might yet be tested, as was Alcott’s. And Green’s fluffy white dress will surely be soiled–her hands dirtied by the unfolding bloodshed. We’ll be watching the show alongside you and would love to hear your thoughts! Tweet us @JCWE1.

Elizabeth Motich, JCWE Editorial Assistant, Villanova University