Mike McGraw is a Civil War re-enactor, and on a cool and overcast spring day, he is explaining to 20 or so students from the Uniform Services University of the Health Sciences what it was like for Union soldiers who fought in and around Antietam Creek in Maryland on Sept. 17, 1862, "the worst single day of trauma the nation has ever seen."
The police officer from the National Institutes of Health told the students "They wore all wool uniforms that were stifling hot but provided protection" from the sparks that accompanied the firing of the 10-pound Enfield rifles, imported from Great Britain, that each soldier carried.
Next McGraw turned their attention to the soldier’s shelter halves that when put together became a two-man "dog tent," and they would sleep on an issued woolen blanket.
By the end of the fighting between Union forces led by Gen. George McClellan and Confederate forces led by Gen. Robert E. Lee, one in four soldiers who participated would be missing, wounded or killed.
The National Park Service estimates that there were 12,400 Union casualties and 10,300 Confederate casualties that Wednesday.
More than 130,000 soldiers were engaged at Antietam.
"The old concept of ‘grand death’ surrounded by family where the last words were taken down was rescinded during the Civil War. Half of the graves [at Antietam] were unmarked. The government didn’t notify you that your son was killed or wounded. Casualty lists were published in the newspapers."
His was the first stop on a medical staff ride, actually a long hike, from the Dunker Church, the small white frame structure built by German Pacifists to the heights overlooking Burnside’s Bridge.
Burnside’s Bridge, named after Gen. Ambrose Burnside, in the present day at Antietam National Battlefield. Union soldiers fought Confederate soldiers for control of the bridge during the Battle of Antietam. Students from the Uniform Services University of the Health Services heard from Civil War re-enactors how medical personnel cared for the wounded during the battle.
Capt. Rich Wells, another re-enactor, had the students fall into formation as they would now. But "tall to small" was the order of the day in 1862, and he showed them with other re-enactors how he wanted them to line shoulder to shoulder and how they would march to the fight.
"Reverse, platoon, ten hut; ten hut company."
It is controlled chaos when the students begin trying to march in formation and move into firing positions off the first sergeant.
"If he won’t get out the way, push him; step up into the gap."
Rick Boyle, the first sergeant re-enactor, said the formation the students were being shown was used in Napoleon’s Grande Armee in the early 19th century. "The front rows are bullet catchers."
When "command rest" is ordered, the 20 stand at ease. "In 1862, they would’ve lain down," Wells said. "It’s a hot day; you’ve been marching, carrying a heavy rifle; they would have lain down by the road or in the grass."
Dr. John Hayden, a family practitioner, is also a Civil War re-enactor.
After the Union defeat at Bull Run in the summer of 1862, he said, Dr. Jonathan "Letterman, the second officer in the Army’s Medical Department, tried to be prepared for the next battle. Antietam had the first field hospitals."
He was reacting to the appalling post-operative casualty rates for soldiers with fractured limbs in the first year of fighting. "At Antietam, 15 percent; 85 percent at Bull Run."
The clinical duties for the assistant surgeons were now better spelled out after more than a year of war. Each regiment was keeping better records of who went to sick call, what happened after the visit "and then return them to their unit."
Instead of walking to the field dressing stations, relatively close to the fighting, and from there to the field hospitals, between two to five miles from the battle, he planned to have stretcher bearers trained by the medical commander, drivers and ambulances capable of carrying four stretchers or 12 to 16 wounded or ill men who could sit.
But medical logistics on the battlefield was rudimentary. There were not enough tents; the field hospitals [more than 70 of them along the creek] were too far from a battlefront that kept changing as more soldiers from both sides fell upon each other almost unexpectedly; and the necessary medical supplies and food were miles away.
The Union Army’s medical supplies only began moving from Frederick when the fighting ended as day turned to dusk.
Hayden handed the students the silk and cotton that were used for stitching, explained why they did not "sew up" stumps to let the wounds drain. Dr. Joseph "Lister [of the British Army] and [Louis] Pasteur made their discoveries on the need for sterile surgery and germ theory in 1865, and even they then were not immediately accepted" by the medical profession or hospitals.
He showed them an operating table. The idea was "to sluice" the table with hot water after a patient had been treated and before another was placed on it.
But the casualties kept mounting, and the fires needed to boil the water were dying because there were few soldiers to spare to tend them.
As night fell, candles were stuck in bottles or musket barrels so the surgeons and their assistants could continue with their necessary work of amputating severely damaged arms and legs.
Chloroform and ether were the anesthetics most commonly used. As the Medical and Surgical History of the War of the Rebellion noted, "The most convenient and common form of administering anesthetics was a cloth or paper folded in the shape of a cone, with a sponge at the apex."
Inside the one-room church, Navy Captain Trueman Sharp, who graduated from USUHS in 1984, said, "The Dunkers were a German Pacifist Group who thought they came to a peaceful location when they settled in this part of Maryland. They ended up in the middle of a battlefield.
"The Dunkers were devastated by this. Their farms were destroyed. Livestock were taken. Crops destroyed. Battlefield casualties were taken here and to their homes. And then there were the illnesses."
During the fighting, the Confederates used the whitewashed frame building as an aid station. Later, the Union used it for embalming.
Sharp estimated that between two-thirds and three-quarters of the 250,000 plus deaths recorded in the Confederate Army during the war died of disease – chronic diarrhea, dysentery, measles, malaria, typhus, etc.
Because these Southern soldiers came from rural families and had not been exposed to these diseases, and conditions toughened on their isolated farms as the fighting continued, the death toll "got progressively worse over the course of the war. Companies, battalions, regiments were sent home to get well" and relieve the strain on Confederate medical facilities that were treating the injured and wounded.
"Lee saw health as a command responsibility" and ordered his officers to ensure camps were clean, water as pure as possible and human waste not treated casually. "It was during the war that standards of care were developed – separating doctors from snake oil salesmen who called themselves doctors. It was also during the war that public health in the United States was transformed when doctors saw the effect on the Army of disease."
Letterman, the medical director of the Army of the Potomac, wanted artesian wells and springs ready to treat the wounded to overcome the effects on the water supply of 45,000 to 50,000 mules and horses drinking and fouling the water, George Wanderlich of the National Museum for Civil War Medicine in Frederick, said.
Dr. Hunter McGuire was Letterman’s Confederate counterpart as medical director of the Army of the Shenandoah, and he struggled against even longer odds of poor supplies, inadequate transportation, fewer physicians, etc. To overcome those odds, the Confederate medical department had to adapt.
In their retreat from Antietam, back across the Potomac River and moving southward to the Rapidan and Rappahannock rivers, "the South was particularly good at evacuation," Sharp said.
About 7,000 of the 9,000 injured and wounded left Maryland with the Army.
At Shepherdstown, Va., citizens hoisted yellow rags over the homes signaling to retreating soldiers that they could be cared for there until Union artillery fire began hitting the buildings. Many of the wounded were later taken on to Chimborazo Hospital, a sprawling complex of well-ventilated buildings and tents on the bluff of the James River on the east side of Richmond.
The number of wounded from the year of fighting including that summer’s intense combat during the Seven Days on the outskirts of Richmond overwhelmed the city’s and Confederate government’s hospitals. Church and hotel basements and factory lofts were converted to medical use.
In all, there were more than 40 buildings in Richmond calling themselves hospitals in late September 1862.
While Letterman and McGuire would have preferred to use tents or barns because they were better ventilated and straw could be spread upon the ground to soak up blood and then be removed, they fell back on what was available: Church, a town hall, the Odd Fellows and Freemasons halls, stores, schoolhouses, corn cribs, cabins, carriage and farm houses between Boonsboro, Sharpsburg and Smoketown.
The private citizens who descended on the battlefield wanted to take the wounded into homes. "No greater mistake could exist, and the results of that battle only added additional evidence of the absolute necessity of a full supply of pure air, constantly renewed," Letterman reported in 1863.
Several times during the staff ride, lecturers reminded the students that regimental surgeons tried to overcome these difficulties.
They had some plans on how to be re-supplied and knew there were places out of the line of fire and away from the swirl of combat that moved through the East and West Woods into the partially-harvested Cornfield "where you can’t see anything" including the massed guns almost directly in front where the fighting raged for two hours and changed hands six times, before starting anew on the Sunken Road also called "Bloody Lane" and at last to the bridge. To those spots, especially the defilades of this rolling farmland, they could bring patients for treatment.
As the day wore on, assaults faltered.
The artillery fire was deadly; the minnie ball carried farther than older ammunition, wounding or killing hundreds of yards away. The attacks were also breaking up because the soldiers, who had existed on a diet of starch, sugar and caffeine and furthered sickened by drinking bad water, no longer had the stamina and strength to push on.
"When they tried to go over the top, they couldn’t. They were exhausted," Wanderlich said. Some of the soldiers had fought three days earlier at South Mountain, a difficult stony terrain.
Where the fighting was planned to take place and would move was intentionally kept secret from the doctors and their attendants. Maj. Justin Woodson, an aerospace medical specialist at the university, said, "That says: Stay involved, so you can plan ahead."
There were then no international treaties covering prisoners of war, who was a combatant and who was not. The first Geneva Convention covering treatment of prisoners of war would meet in 1864, two years after Antietam.
As had been the case at Bull Run and later skirmishing and Thomas "Stonewall" Jackson’s Valley Campaign along the Shenandoah River, line commanders on both sides decided that "military doctors were not to be treated as combatants; and doctors on both sides treated all the wounded. There were also informal ceasefires around Dunker Church to exchange wounded or doctors" caught up in the fighting.
In pews that form a square, the wounded were either lying or propped up waiting their turn with a Union or Confederate doctor and then there were the civilians [from the community or the next day from the United States Sanitary Commission] caring for the soldiers taken to the church for treatment.
If a field dressing station or hospital was overrun, when the fighting was over, "the docs were exchanged."
Nonetheless, Surgeon W.J.H. White, medical director of the Sixth Corps, and Assistant Surgeon Revere of the Twentieth Massachusetts Volunteers was killed while treating the wounded at Antietam.
Air Force Staff Sgt. Troyann Ernle described the actions of the USSC that day. They were not a government agency, but they provided vital care during and after the fighting throughout the Civil War.
"Twenty-five million dollars was raised. That money helped support 3,000 women serving as nurses. This was one of the lessons the Americans learned from the Crimean War between Great Britain and France on one side and Russia on the other in the mid-1850s.
Similarly, there were medical lessons in using railroads not only to move troops but to evacuate the sick and wounded and the value of refrigeration for supplies.
At the edge of Miller’s Cornfield was Clara Barton, a one-time employee of the Patent Office in Washington. With her were wagons of supplies to help care for the wounded.
Later, Dr. James Dunn, with the Union Army and one of the surgeons working in that part of Antietam, called her the "Angel of the Battlefield."
Much of the chloroform used in the hospital came from the commission. "The medical officers of the Army united with our officers in the proper disposal of our supplies," Dr. Lewis Steiner, commission inspector, reported Sept. 20, 1862.
"The USSC had a railhead at Frederick and Hagerstown." Soon there was a steady movement of these soldiers to the railheads to be sent to hospitals in Harrisburg, Philadelphia, Baltimore, and Washington. "They tried to keep track of the patients" and where they were going, but there were too many, Ernle said.
The commission also had a large tent field hospital on Smoketown Road in its looping course toward Keadysville and possible evacuation. As a result "all casualties are being funneled" down Smoketown Road.
There was no direct Southern counterpart to the commission.
"This is where triage began," Woodson said. "There’s a splinter in the colonel’s hand versus a private with a gunshot wound."
By 9:30 in the morning, there were 12,000 casualties and most of them lying in or near the Cornfield; by noon, there were 4,500 more.
Now into the afternoon, Confederate soldiers under Gen. A.P. Hill had forced march 17 miles from Harper’s Ferry to Antietam to stave off defeat. The first of them arrived on the heights above what was now the battlefield. The 500 Confederates fell into their positions just as the first of 12,000 Union soldiers under Gen. Ambrose Burnside were approaching the largest bridge across the winding creek.
It was here the longer range and increased accuracy of the minnie ball was demonstrated with deadly effect.
As Dr. Deering Roberts of the Confederate Army wrote long after the war, "The old round ball, of low velocity, caused many fractures in bone of the extremities. But it never produced such shattering, comminution, and injury as did the heavy conical ball of increased velocity. … Conical-ball wounds in the abdomen were nearly always fatal."
The fighting to cross cost the Union Army another 500 casualties. Eighteen hundred more fell as the soldiers tried to scramble up the rocky heights.
For a very short time, they had the heights; but as more Confederate soldiers arrived, the counterattack drove them back. There were an estimated 1,000 Confederate dead in this fighting.
From the start of the battle around 6 a.m. in a misting fog until dusk 12 hours later, Letterman’s best laid plans had run into the confusion of battle, one that was to be fought north to south along a 3 1/2 –mile rolling piedmont front.
For example, much of Letterman’s Union Army medical supplies reached Antietam Sept. 20, about the same time as teams of Matthew Brady’s photographers arrived and, for the first time, graphically chronicled the carnage of war.
Although Letterman’s plan to clear the battlefield of wounded and dead within a day was not met, it was far more successful than what had occurred slightly more than a month earlier at the Second Battle of Bull Run. There and then, it took weeks to evacuate the wounded and bury the dead.
Better care for the wounded and identifying and quickly burying the dead were significant but not the only changes to emerge in the aftermath of the battle.
In the end, McClellan did not pursue Lee and his army into Virginia. Washington, Baltimore, Harrisburg and Philadelphia, however, remained in Union hands. The Pennsylvania and Baltimore and Ohio railroad lines connecting the Eastern cities with the Midwest also remained in Union hands.
Other Confederate armies in the West were also turned back as the long summer was drawing to a close.
President Abraham Lincoln had wanted a victory. He got slightly better than a draw at Antietam. It would have to do for what he intended to do next.
On Sept. 22, Lincoln, acting as commander in chief of the Union Army and Navy, a proclamation declaring that slaves in the seceding states would be free Jan. 1, if those states did not end their rebellion against the federal government. When no state agreed to return, Lincoln issued a second proclamation freeing the slaves in 10 states not under Union control.
The draw on the battlefield allowed Lincoln to change the strategic goal of the war from restoring the Union to freeing the slaves.