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David goes out to meet Goliath and every man who can walk to the beach sits down there, spectators of the first ironclad battle in the world... The day is calm, the smoke hangs thick on the water. The low vessels are hidden by the smoke. They are so sure of their invulnerability they fight at arm’s length. They fight so near the shore, the flash of their guns is seen and the noise is heard of the heavy shot pounding the armor. -Surgeon Charles Martin, USN on the Battle between the Monitor and Merrimac
What was the medical aftermath of that now legendary combat: On the Union side, three men were injured on Monitor. One was the acting master whose knee came into contact with the turret at the same instant one of Virginia’s heavy shot struck it. Knocked senseless by the impact, he regained consciousness 10 minutes later. Another seaman in the turret was knocked unconscious in a similar manner. Acting Assistant Surgeon Daniel Logue described this sailor’s injury as a concussion of the brain. His circulation remained depressed and it became necessary to administer stimulants. When the patient regained consciousness, Dr. Logue watched for a reaction and then applied cold affusion to the head. Toward the close of the action, the Confederate ironclad inflicted its last and most significant casualty—Monitor’s skipper John Worden. Following the battle, only Worden left the ship for hospitalization in Washington. The other two patients returned to duty the following day. Worden, it turned out, proved to be the only serious casualty of the battle, permanently losing the sight in one eye and incurring a disfiguring scar on his face.
On the Confederate side, Virginia’s crew did not get away unscathed. In her unequal fight with Congress, Cumberland, and Minnesota the previous day, Virginia suffered several killed or wounded. In contrast, her wooden-hulled victims suffered enormous losses. Cumberland alone lost over 100 men. Before the ship went to the bottom, all the wounded who could walk were ordered out of the cockpit; but those of the wounded who had been carried into the sick bay and on the berthdeck were so mangled that it was impossible to save them. During her engagement with Virginia the following morning, Monitor’s two 11-inch Dahlgren smoothbores did moderate damage, wounding a few aboard the Virginia but killing no one. As it turns out, the Confederates got a lucky break. Although each 11-inch Dahlgren aboard Monitor threw a shot weighing 168 pounds, Worden was under orders from the Navy Department to fire half-weight powder charges of 15 pounds for fear the guns would explode.
The new technology of iron and steam in the Civil War introduced brand-new hazards—exploding boilers, scalding with live steam, burn injuries, and primary and secondary wounds resulting from large caliber, rifled naval guns. Ironclad vessels also introduced environmental and occupational concerns for sailors aggravated by badly ventilated and hell-hot engine rooms. It is estimated that a typical low ranking coal heaver aboard a poorly ventilated ironclad routinely endured temperatures approaching 130 degrees F. In fact, aboard Monitor in summer, temperatures of 125 degrees were recorded on the berth deck and 150 degrees in the galley. One cannot underestimate the utility of awnings in deflecting the sun from ironclads decks.
Even the fuel that fired an ironclad’s boilers was a threat. Coal, while not a new fuel used by the Navy, had the potential of becoming a silent killer. Fossil fuels require proper ventilation and this concept was not yet adequately understood by Civil War engineers. Untold casualties, some fatal, occurred when crewmen either loaded wet bituminous coal in below-deck bunkers or bilge water contaminated the fuel. Both the Mississippi Squadron and the South Atlantic Blockading Squadron reported a number of cases of sailors being discovered either dead or unconscious below deck. The more fortunate were revived when exposed to the fresh air. Besides unconsciousness, surgeons described their patients as being cyanotic—blueness of the skin caused by oxygen starvation with foreheads and eyelids markedly swollen.
There were many differences between wounds sustained in battle on the old wooden ships and those encountered aboard ironclads. Shots striking wooden vessels tended to throw about splinters which, as secondary projectiles, caused many of the wounds. Burns were uncommon. In yardarm engagements and during the hand-to-hand fighting resulting from boarding an enemy’s vessel, many wounds were caused by small arms, cutlasses, bayonets, and pikes.
In ironclad fighting, splinters might be fewer, but burns and fragment wounds became commonplace. The so-called protected environment an ironclad warship provided was illusory. If anything, it offered fatal hazards the crew of a wooden ship rarely experienced. Take the example of the monitor Nahant. Engaged in Samuel Du Pont’s attack on the Charleston forts in April 1863, shellfire from the forts slammed against her pilot house and turret with such velocity that broken bolts ricocheted about her pilot house like bullets, killing one man and injuring two others, including her captain.
Iron shot weighing over 150 pounds were now common, making the 24- and 32-pound size thrown by earlier guns seem quite puny in comparison. What’s more, a newer generation of rifled guns that could pulverize masonry forts could do worse to those enclosed within an iron-sheathed hull. What resulted was the “garbage can” effect. Imagine yourself encased in a typical galvanized steel garbage pail or a 55-gallon steel oil drum, ears unprotected, and then having your antagonists hurling 50-pound cement blocks against your cocoon, one per second. With blood dripping from nose and ears, crewmen were sometimes driven mad under the barrage of both rifled and unrifled artillery impacting against iron armor. And if not driven mad, many Sailors had their eardrums ruptured or, at very least, suffered temporary or permanent deafness. Civil War Sailors frequently described ringing in the ears or tinnitus. With noise levels aboard Civil War ironclads routinely exceeding 130 decibels, one can only conjecture what kind of hearing damage resulted among these warriors.
Needless to say, under these conditions, the psychological health of Sailors was often in question. “Give me a discharge and let me go home,” a distraught coal-heaver begged his skipper after months of duty outside of Charleston. “I am a poor, weak, miserable, nervous, half-crazy boy. Everything jarred upon my delicate nerves.” In the Civil War we begin seeing terms “nostalgia,” “melancholia,” and “irritable heart” masking conditions that would in future years be called “shell shock,” “combat fatigue” and “PTSD.”
Civil War Sailors at sea usually faced a steady ration of moldy beans, stale biscuits (hard tack), and sour/salt pork. To ease the monotony or perhaps to anesthetize themselves from reality, mess crews specialized in the manufacture of outlaw whiskey distilled from almost any substance that fermented in the southern heat. Commanding officers and medical officers assigned to the James River Flotilla complained a great deal of the lack of fresh provisions and vegetables. Following a July 1862 inspection, Fleet Surgeon of the North Atlantic Squadron, Surgeon James Wood, recommended that vessels be furnished with fresh provisions twice a week. His report on his inspection also contained a recommendation for improving the water supply used in the vessels. He said that the “turbid and objectionable” river water used tended to produce diarrhea. He saw no reason for continuing to use impure river water, since steam vessels could condense more pure water than their crews needed.
Even though sanitary conditions aboard ship were often superior to those ashore, and both navies probably fared better than the armies when it came to the frequency of disease, rheumatism and scurvy kept the doctors busy along with typhoid, dysentery, break bone fever, hemorrhoids, and damage done by knuckles. In the southern climes, insect-borne malaria and yellow fever laid low many a crew. And, regardless of what they had to work with, surgeons aboard the ironclads, and indeed every vessel, had no medicine for the ills of the spirit brought on by the strain of monotony, poor food, and unhealthy living conditions which produced much longer casualty lists than did Confederate shells or mines.
Whether victims of disease or hostile action, Sailors required treatment and much Navy medicine took place at hospitals in Chelsea, Brooklyn, Mound City, New Orleans, and Philadelphia. By the fall of 1862, Navy hospitals were filled to their utmost capacity. As a result, medical facilities at navy yards and naval stations were expanded and both civilian and Army hospitals were also treating naval patients. To remedy the situation, a major hospital expansion campaign began. Unfortunately, many of these improvements weren’t realized until the very end of the war.
Following their recapture by Union forces, the two naval hospitals in the South—Portsmouth (Va.) and Pensacola were put back into operation. In addition to the naval hospitals that had been established before the war, at least four others came on line between 1862 and 1865. These hospitals at Mound City, Ill. (1862); Memphis, Tn. (1863); New Orleans, La. (1863); and Port Royal, S.C. (1864), were located within the theater of operations of the blockading river squadrons and acted as receiving hospitals, taking patients on a short-term basis.
Ironically, one of the medical stations that could perform long-term care was not stationary at all. In 1862, Union forces captured a Confederate side-wheeler, Red Rover. Under the order of the Naval Fleet Surgeon, the ship was converted into what can be considered the Navy’s first hospital ship (however, there is evidence that Navy ships used during the Tripolitan Wars were used as floating hospitals). According to a Navy General Order of June 1862, “only those patients are to be sent to the hospital boat who it is to be expected to be sick for some time, and whose cases may require more quiet and better attention and accommodation than on board the vessels to which they belong.”
The Red Rover was something of a naval anomaly. The vessel had a laundry; an elevator that could transport the sick from lower to upper decks; an amputation room; nine water closets; an icebox to store fresh food; and gauze blinds to keep flies, mosquitoes, cinders, and smoke from “annoying” the patients. It was also the first ship to have a staff of female nurses trained in the medical arts.
On Christmas Eve, 1862, Sisters of the Order of the Holy Cross of St. Mary’s of Notre Dame in South Bend, Ind., reported aboard the medical vessel to care for sick and wounded seamen. One hundred years later, the Navy helped to honor these women at a ceremony on the campus of Notre Dame as true pioneers of the Navy Nurse Corps.
From 1862 until 1865, the medical staff on-board Red Rover cared for 2,450 casualties, including 300 wounded Confederates. In roughly the same time period, Navy shore facilities handled more than 31,000 patients, with 990 treated in 1864 alone, a record for a four-year conflict. Hospitals in New York (Brooklyn), Portsmouth (Norfolk), Mound City, Ill, and Chelsea, Mass. were the busiest naval hospitals in the Civil War.From 1862 until 1865, the medical staff on-board Red Rover cared for 2,450 casualties, including 300 wounded Confederates. In roughly the same time period, Navy shore facilities handled more than 31,000 patients, with 990 treated in 1864 alone, a record for a four-year conflict. Hospitals in New York (Brooklyn), Portsmouth (Norfolk), Mound City, Ill, and Chelsea, Mass. were the busiest naval hospitals in the Civil War.
The war took a heavy toll on the Navy Medical Corps, killing 33 surgeons including Assistant Surgeon William Longshaw, Jr., who was acknowledged by Secretary of the Navy Gideon Welles and Rear Adm. John Dahlgren for gallant behavior for his action on November 15, 1863 when he, under heavy fire, volunteered to retrieve the monitor Lehigh which had run aground. In January 1865, Dr. Longshaw was killed in an assault on Fort Fisher, N.C., while binding the wounds of a dying man. His heroism under fire encapsulates Navy medicine’s real Civil War legacy.