Mobile Hospitals in Appalachia During the Civil War

An amputation is being performed in front of a hospital tent at Gettysburg in July 1863. (Photo courtesy of the National Library of Medicine.)

By Phillip J. Obermiller

and Thomas E. Wagner

The Civil War lasted longer and produced more disabled soldiers than Union or Confederacy officials anticipated. In addition to the thousands wounded in battle, camp diseases such as smallpox, pneumonia, cholera, typhoid, and dysentery put many combatants in need of medical care. In the North, the U.S. Army Medical Department organized an ambulance corps and deployed field hospitals, but they proved inadequate to the need — the ambulances were horse-drawn wagons, and the hospitals were rudimentary tents. 

This led to the 1861 founding of the United States Sanitary Commission, a civilian volunteer effort that raised funds to purchase or operate land-based hospitals as well as hospital trains and ships for evacuating casualties.

The Commission’s steamboats and train cars were staffed by Army surgeons aided by Black and white volunteers, mostly women, who tended to patients. For example, Ann Bradford Stokes, enslaved until 1863, served as a nurse on the Union hospital ship Red Rover.

An engraving taken from Century Monthly Illustrated magazine depicts steamers at Pittsburg Landing on the Tennessee River after the Battle of Shiloh. The vessel farthest to the right is the Tycoon, which was dispatched by the Cincinnati Branch of the Sanitary Commission to drop off supplies and pick up the wounded. (Wikimedia Commons.)

Steamboat cargo decks were converted to wards with crew and medical staff quartered in the cabins above. In the era prior to antibiotics, amputation was a standard means of preventing infection. Although some vessels were equipped with surgeries, most were used to transport patients to land-based hospitals in cities along the Mississippi and Ohio Rivers. A few vessels without engines were towed to accessible points near the fighting and used as floating hospitals. Barges with tents sheltered those with communicable diseases.

An engraving after a drawing by Theodore R. Davis, published in Harper’s Weekly, depicts a scene in a ward aboard the USS Red Rover, which served as the U.S. Navy’s hospital ship on the Western rivers during the Civil War. (Image courtesy of U.S. Naval Historical Center.) 

The hospital ship Nashville, between 1861 and 1865. (Library of Congress photo.)

Although the Tennessee and Cumberland Rivers reached well into what would become the Appalachian Region, the Confederate control of portions of each waterway combined with shoals, shallows, and tight bends to prevent hospital ships from making their way very far upstream.

Hospital trains were more amenable to the Appalachian uplands. Initially, the rail evacuation of the sick and wounded involved flatcars or boxcars with floors covered in straw or pine boughs. 

Wounded soldiers being transported on railroad cars are shown in this 1862 image titled “Wounded at Savage Station, Virginia,” from Brady’s National Photographic Portrait Galleries. (Library of Congress photo.)

As the war progressed, the eponymous “Harris car” came into use. These custom-built 51-foot cars had three tiers fitted with India rubber loops between upright posts, allowing stretchers to be loaded without having to move the patient to a fixed berth. The loops cushioned the jolting movement of trains that often had as much as six inches of play between couplings. The Harris cars provided abundant light and ventilation while doors at each end allowed staff to attend patients throughout the length of the train.

The above images depict exterior and interior views of a U.S. Sanitary Commission hospital car designed for transporting sick and wounded soldiers during the Civil War. (Wikimedia Commons.)

Hospital cars on the Nashville and Chattanooga Railroad, for example, played a key role in evacuating casualties from the Battle of Chickamauga in Appalachian Georgia and the Battle of Chattanooga in Appalachian Tennessee. They transported the wounded to hospitals in Nashville and in the town of Stevenson in the Appalachian portion of Alabama, ascending and descending the Cumberland plateau in the process 

Mary C. Vaughn, who made the daylong trip on a hospital train from Chattanooga to Nashville, gave this account:

“There were 314 sick and wounded men on board, occupying nine or 10 cars, with the surgeon’s car in the middle of the train. This car is divided into three compartments; at one end is the storeroom where are kept the eatables and bedding; at the other, the kitchen; and between the two the surgeon’s room…In the morning after a breakfast…the wounds have to be dressed a second time, and again in the afternoon, a third.”

In another part of the mountains, the Baltimore and Ohio Railroad ran through the panhandle of what became West Virginia in 1863. Its trains included hospital cars carrying the sick and injured from the battles around Harper’s Ferry and the upper Shenandoah Valley to hospitals in Parkersburg and Wheeling to the west, and Baltimore and Washington, D.C., to the east.

The Confederacy had fewer trains and steamships, and often resorted to wagons and boxcars to move its casualties. Having fewer hospitals, the South often sent casualties home to convalesce. The Union did not normally discriminate between soldiers of the North and South in treating the sick and wounded, but space was limited on its hospital trains and ships, so an informal political triage certainly occurred. 

The Frank Thompson Hospital Train, on the Nashville and Chattanooga Railroad, and the interior of a hospital car, are depicted in this image from Harper’s Weekly magazine published in 1864. (Wikimedia Commons.)

The great numbers of Civil War wounded led to improved medical care by the military. Treatment was enhanced by placing surgeons and medical stewards with each battalion, setting up field hospitals, using ambulances, trains, and steamships to evacuate the wounded.

An important aspect of the war was that the United States Army Medical Department learned how to provide rapid trauma care near the front lines. First deployed during the Korean War, the Department’s MASH units’ use of ambulances, buses, and helicopters were clearly part of the Civil War heritage of hospital boats and trains.

(For further reading, see: Hospital Trains and Vessels during the Civil War, 2020, by Anthony G Puzzilla.)

Phil Obermiller and Tom Wagner are affiliated with the School of Planning at the University of Cincinnati. Lacking immediate rail access across the Ohio River, Cincinnati became a major destination for Civil War hospital ships that brought casualties to the city’s three large hospitals.