There have been many conceptions of the "Field Hospital" during the Civil War. In the first years of the war, each Regiment had one and usually set them up in an abandoned building, barn or under tarps.  The horrors, that occurred within these Field Hospitals", especially at the Regimental level, would be hard to imagine today if not for the writings left behind by some of the physicians that actually worked in them.  

At the Regimental Field Hospitals, the scene was horrifying to say the least. It is hard to conceive, with the advances made in modern medicine today, the suffering that was endured in the name of "modern medicine" back in the 1860's. 

Standards of treatment essentially did not exist even though there were a number of fine medical manuals available. Physicians, many of whom never graduated from a medical school, liberally administered opium and morphine and then went about their grizzly tasks. Many amputations were justified, due to the damaged inflicted to nerves, blood vessels, bone and muscle tissue by the conical bullet. However, many were not.  It was basically up to the whim of the surgeon. The fear of infection, the cause of which was unknown back then, forced many a physician to amputate an extremity rather than risking the spread of the " corruption" to healthy tissue.  "Better to loose a limb to the knife then a patient to infection" was all to common a diagnosis when army surgeons had hundreds of wounded soldiers thrust upon them in the space of a few hours. The picture (left) is a reconstructed  "operating room", the only type commonly available at "field hospitals" .   

As one Surgeon noted in his diary....."At the Field Hospital, critically wounded soldiers staggered about in a daze from both shock and the effects of morphine and whisky that was given to them by the Assistant Surgeon. Many soldiers bled profusely from gaping wounds to their arms and legs caused by the new high velocity Minie bullet (conical). The ground around the hospital was littered with severed limbs, bloody dressings, torn uniforms and discarded weapons and equipment. Outside of an occasional moan, there was little screaming or shouting as most of the wounded either silently bled to death or were in a stupor from the effects of opiates and liquor. Soldiers lay on the ground, exposed to the elements and swarms of flies, as they waited their turn on the blood soaked operating table. Many never got their turn “under the knife”, for they simply died where they lay, alone and without a whimper or a prayer.  

At these small, independently operated Regimental Field Hospitals there was neither the medical staff nor the proper facilities to perform any type of major surgical procedures much less the amputation of extremities. There was also no space or nursing staff to offer any type of convalescent care.  Nonetheless, sweating Surgeons, with the aide of their assistants, sawed off legs and arms amid piles of previously amputated limbs. Feverishly, they worked throughout the day and into the night, within the dim glow of lamplight or oil lanterns, as they continued on...and on...and on.  They often worked two or three days without respite. Amputations had first priority, and since gunshot wounds to the head, chest and abdomen were usually fatal, those unfortunate enough to sustain such wounds were cared for last. Many died where they lay at these Field Hospitals.  Medical officers, shocked by the extensive damage to bone, muscle and tissue by the Minie bullet, and fearing the on-set of infection, performed amputations at the Regimental Field Hospitals without benefit of the most rudimentary of aseptic procedures. Bloody sponges were used from patient to patient without being cleaned as physicians worked with bloody and pus smeared hands. "

Bandages were unsterilized, and operating tables were often nothing more then an old door laid across two large barrels or boxers. Like the Surgeon’s instruments and his gore-drenched clothing, the operating “table” was rarely washed between amputations. If an amputation knife, scalpel or capital saw fell to the blood soaked ground it was quickly retrieved and used again without benefit of even a hasty rinse off in clean water."  

Amid blaring bands, flickering torches and patriotic speeches, the Boys in Blue and Gray, giddy with anticipation and dreams of glory, marched off to fight the "short war".  Four bloody years later, they hobbled and shuffled their way back home, some 600,000 less in number.  Aged, battered, torn but still proud, the Men of both sides, had been bloodied but remained unbowed. Yet, they were not Boys anymore.  Shot and shell has seen to that. 

THE GAYDEN HOUSE, JONESBORO, GEORGIA 

  The photos above were taken at a living history presentation that was done during the Annual Reenactment of the Battle of Jonesboro, Georgia. This "field hospital" was set up in the Gayden House on Church Street, a structure which actually served as a Field Hospital during the battle. The scene, unfortunately,  all to clearly illustrates what the medical staff had to work with when set up close to the shifting battle lines.  It is  furnished (sic) by the Medical Department of the Military Division of the Mississippi, a reenactment group that portrays the Federal Medical Staff that served in Sherman's Army during the Georgia Campaign of 1864.  This is what the wounded and dying soldiers witnessed when brought into one these forward "dressing stations"  and their reactions are not hard to envision.  There was no unsoiled linens, sparkling instruments and or even clean water.  There was no glamour in a gore and brain-splattered, filthy apron.  No heart-stirring drum-rolls nor softly waving flags. Gone were the patriotic speeches, the shiny brass buttons and immaculate uniforms. 

THE  NEW MILITARY HOSPITAL SYSTEM

This was the reality at the poorly staffed and supplied  individually operated Regimental Field Hospitals, and the main reason why Federal Medical Director Jonathan Lettermen initiated sweeping changes in 1862.  He consolidated the Union Army hospitals into a three-tiered system. The first tier consisted of regimental field dressing stations (once known as regimental field  hospitals), where no amputations or other surgical procedures were attempted. Staffed by a Regiment's Assistant Surgeon and his Orderlies, only immediate care was rendered, wounds being quickly dressed, medications for pain given and the patient transported to a larger and better staffed "consolidated" Brigade hospital further back from the battlefield.  The second tier consisted of the Brigade hospitals. These were staffed by the surgeons and stewards, who were assigned from the Brigade's various Regiments, and who worked in "teams", performing the major operational procedures and amputations.  Hereto, wards were established,  which permitted the patients to convalesce, under the watchful eye of male nurses (for the most part) until they had sufficiently recovered from their ordeal and could be transported (usually by train) to a divisional or general hospital well out of harms way. The third tier consisted of the General, or in some cases, the Divisional Hospitals. Here, more definitive "post operative" care could be given and those requiring a long convalescence could adequately cared for by nurses, and at this level, female "matrons". 

Not only was this "restructuring" an attempt to put an end to the totally adequate care and hasty, hap-hazard operational procedures, that were performed at these filthy and ineptly run "regimental field hospitals" (a term loosely applied), but it also allowed the Federal Medical Department (and soon after, the Confederate Medical Department, in a great many cases)  to efficiently face the many difficult battles still ahead. By 1864, this new hospital system became the basis for military medical administrations for the rest of the Civil War and has been used, in all of America's wars , since.