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For more than a week, Surgeon Dan Holt of the 121st New York Volunteer Infantry had been doing his best to manage his hospital, a grandiose name for what was really nothing more than brush and boughs thrown over pole frames near Bakersville, perhaps a mile north of the Antietam battlefield. Tired and homesick, he wrote to his wife on a warm September 25 day: “I have seen, stretched along, in one straight line, ready for interment, at least a thousand blackened, bloated corpses with blood and gas protruding from every orifice, and maggots holding high carnival over their heads. Then add the scores upon scores of dead horses, sometimes while batteries lying along side, still adding to the commingling mass of corruption and you get a faint, a very faint idea of what you see, and can always see after a sanguinary battle. Every house for miles around is a hospital and I have seen arms, legs, feet and hands lying in piles rotting in the blazing heat of a southern sky unburied and uncared for, and still the knife went steadily in its work adding to the putrid mess.”

Holt’s graphic description provides only a vague picture of the horrors of the struggle of September 17, 1862. In one full day of fighting between the Army of the Potomac and the Army of Northern Virginia in the vicinity of Sharpsburg, Md., 23,000 men were killed, wounded or captured. The Battle of Antietam still has the regrettable distinction of being the bloodiest day in American history; from dawn to dusk, Americans killed each other like they never had before.

For many soldiers, the battle was just the beginning of a weeks-long ordeal. Within 48 hours of the slugfest, hospitals were situated in virtually every farmhouse to the north and east of the battlefield. Wounded were also taken to nearby communities, including Sharpsburg, Williamsport, Hagerstown, Boonsboro, Keedysville and Middletown in Maryland, and to Chambersburg, Pa. Overall, more than 120 separate hospitals initially were used.

Even as fighting still raged on parts of the battlefield, ambulances began hauling their sad cargo to the hospitals. For the first time in the Civil War, the ambulance corps was fairly well organized, and most of the injured left on the field, Union and Confederate alike, were in hospitals within 24 hours. More than 300 ambulances were utilized to transport the wounded.

A New York Tribune reporter making his way to the battlefield on September 18 was staggered by the scale of the carnage and the seemingly endless number of ambulances. He wrote, “the wounded are coming in by the thousands…around and in a large barn…I counted 1,250 wounded. Along the same road and within the distance of two miles are three more hospitals each having from 600 to 700 in them, and long trains of ambulances standing in the road waiting to discharge their bloody loads. Surgeons with hands, arms and garments covered with blood, are busy amputating limbs, extracting balls and bandaging wounds of every nature in every part of the body.”

The gore-slick ambulances presented a frightful site that was burned into the mind of the cook at the Jacob Grove house in Sharpsburg. Years later, he could still recall ambulances “comin’ into town, and the wounded men were hollerin’ ‘Oh Lord, Oh Lord,’ Poor soul! And the blood was runnin’ down through the bottom of the wagons.”

Blood continued to flow in the hospitals, where limb amputation was one of the most common procedures. As Dr. Theodore Dimon of the 2nd Maryland Volunteer Regiment wrote, “besides fingers and toes I have made 11 amputations here of legs, thighs, forearms, arms at the shoulder joint. The minnie ball does not permit much debate about amputation.”

Dimon was referring to the fact that the soft lead Minié balls and round musket balls used by both sides would flatten on impact, mangling both muscle and bone. Iron canister and shell fragments also could cause similar damage. The destruction was often so complete that surgeons had no chance of reconstructing a limb. Out would come the dirty saw, and there would go the appendage.

A New York Times reporter observed, “Great complaint is made in regard to the conduct of the volunteer surgeons, who recklessly amputate the limbs of the wounded, and leave them destitute of the care needed for their recovery. Many operations are performed without judgment, and in a totally unjustifiable manner, frequently hastening the death of the patient.” Another doctor, James Oliver, of the 21st Massachusetts Volunteer Infantry, recorded a converse opinion: “I had an opportunity to watch the result of gunshot wounds to know how severe a wound must be to require amputation. Came to the conclusion that too many cases were left to nature and the knife was not used enough after a battle.”

Some amputations were botched. Samuel Watson of the 118th Pennsylvania Volunteers was shot in his left leg at the Battle of Shepherdstown on September 20, a follow-up action to the main fight on the 17th, and the leg was amputated below the knee on the 21st. Dr. E.M. McDowell of the U.S. Volunteers, working in Sharpsburg’s German Reformed Church, took off the limb. McDowell wrote in his case book on October 11 that Watson “must die unless the whole [leg] is removed by an operation above the knee and I have become sick of amputating thighs secondarily.” McDowell was sadly correct, Watson died on October 14.

The conditions of the various field hospitals did not help ensure a high survival rate. Thousands of injured gasped and groaned in breeding grounds of infection that contributed to many deaths. Many hospitals were set up in barns or houses, and wounded could also be found in churches, stores, sheds, carriage houses, corncribs, stables and mangers, in the open air under tents, or simply laid out on haystacks, in fields and orchards.

Animal manure and its attendant flies and other insects, the lack of ventilation and of sufficient light and the fact that many men lay almost on top of each other in filthy blood-caked uniforms accelerated the spread of disease. Many eventually died from typhoid fever, diarrhea or diphtheria rather than from their wounds. Those scourges also spread to and killed many local citizens.

The deplorable conditions of the Antietam hospitals inspired a government investigation, which took place in November. Assistant Medical Inspector W.R. Mosely found that intolerable conditions still existed. After he toured the hospital in Sharpsburg’s St. Paul’s Methodist Episcopal Church, he reported, “All the churches used for hospitals in Sharpsburg are in a dilapidated condition, and filthy, and unfit for the purpose for which they are used. This is especially the case with the Episcopal Church…there is not a window in the building and no means of ventilation except by removing…part of the canvas which occupies the place of glass and sash in the window frame. The interior of this place presents a spectacle of misery and poverty.”

At the Smoketown hospital, the longest-lasting of all the Union hospitals, he found that “The medi­cines are on the grounds, and tables, boxes, etc. without order or regularity. There is want of attention to the police of the wards and camp. Dirt and garbage are accumulated in large quantities….” Mosely was more pleased by the Locust Spring hospital, the largest hospital on the Union left. He declared it a model operation, noting there were 24 tents each heated with a stone fireplace and all of the bedding “straw in good sacks, with sheets, quilts, and blankets placed on bedsteads.”

In all hospitals, good and bad, wounded men suffered agonizing days. A Rebel bullet shattered the right knee of Jonathan Stowe of the 15th Massachusetts Volunteers during action at the West Woods. Stowe lay on the field for two days before being taken to the Susan Hoffman farm along the Keedysville Road for treatment. On September 20, he unwittingly began documenting his own demise as he awaited surgery: “Many must lose their arms or legs but they do not murmur. What sensation—used chloroform, hope to have no bad effects. There are some dozen or more stumps near me.”

On September 22, he wrote: “Very meager are accommodations—no chamber pots & nobody to find or rig one up. How ludicrous for 2 score amputated men to help themselves with diarrhea.” On the 26th he recorded, “This cold weather may come for the best, certainly maggots do not trouble so much.” On the 29th he sounded comparatively upbeat, and was “quite comfortable if the quinine does not choke me to death.” Stowe died, however, on October 1.

Charles Johnson of the 9th New York Volunteers had been shot in the left hip, and as he made his way to a hospital on the Michael Miller farm he remembered that “by the time I got there, faint from loss of blood and exertion…the terrible sights and sounds that met me as I approached the hospital did not tend to relieve my mind. There were already over a hundred of our boys…lying on straw and on cornstalks, with wounds of all imaginable shapes and sizes. The sights were terrible, but the sounds were more so, as a general thing, our boys made light of their wounds.”

The overwhelming numbers of wounded, lack of supplies and limited qualified personnel quickly began to take its toll on the doctors. A physician on duty at the Michael Miller farm observed on September 24: “Every object in the landscape was [not] tainted with the ravages of war, and around us the eye could wander without resting on bloody and mutilated forms, some laughing, some joking, some praying, some groaning, and some, alas, with the death rattle in their throats. If I could only get away from all this, change the bloody and filthy clothes I was compelled to wear for something clean, and what would I have not given for a bed on which I could get one night’s sleep…everything conspired against me as if to see how miserable a human life could be made.”

Doctor Dimon’s journal entries also reflect frustration: “I am slowly traveling through the disposal of and provision for 140 poor fellows under my care. Surgery, surgery, surgery. Food, food, food. Nurses, nurses, nurses. Cooks that get drunk. Everybody employed looking out for number one; nobody caring for anyone else. Surgeons come here to get me to take care of their sick, not knowing or caring to do anything but shirk them off on me.”

September soon turned to October, and as cooler weather approached simple necessities were still lacking in the hospitals. The New York Times reported that “Shirts, drawers, sheets, blankets, pillows, pillow-slips, bedsteads, large sized slippers, tea, crackers, tea cups, wash-basins, candles, lanterns, pails, bed-pans, and urinals and stationery for the soldiers to write letters on are some of the most pressing articles needed. The most essential medicines such as morphine, quinine, salts, castor oil, adhesive plasters, and tobacco would be of great value.”

Dr. Holt remembered, “Oh how cold and almost frozen I have been for a week past, sleeping [in] the open air with a blanket and the arch of heaven for a covering and the rough ground for a bed.”

The surgeon was amazed at the vitality of some of those left in his care. He wrote: “Last night a man died of typhoid fever, and quite a number look as if they would soon follow. Poor fellows, when I see the way in which they lie and the lack of all earthly comforts—without wife, mother or sister to care for them or even get them a glass of cold water to cool their parched tongues. I wonder how any get well; but they appear to do about as well in the poor quarters which they occupy as those who are better cared for. I have been astonished at the vitativeness of these men—nothing seems capable of killing them.”

Fortunately for the surgeons, and especially for their charges, various aid societies and volunteers stepped in to provide whatever assistance they could. A New York Times reporter wrote that the “inhabitants of the villages are laboring night and day to relieve the dying and the suffering. A more Christian people, in the practical sense of the word, I never saw.”

The Baltimore American praised a Mrs. Susan Harry and a Hagerstown-based Ladies Aid Society as they repeatedly “assembled at different houses, sewed bandages, scraped lint and made up such things as would relieve the sufferers, and from sun-up to sun-down you could find them in every nook of the town, and through the country, searching for, begging, and buying such articles as the sufferers might ask for or want. At morning, noon, and evening, you would see these ladies, accompanied by their husbands, children and servants, with baskets, buckets, pitchers and plates in their hands winding their way to the hospitals….”

The North’s two predominant civilian aid organizations, the U.S. Sanitary Commission and the U.S. Christian Commission, also were on hand to help out. Both were headquartered at the Susan Hoffman farm and were vital in obtaining and distributing supplies. Regarding their efforts, the Baltimore American reporter wrote, “The Sanitary Commission and the Christian Commission are performing a work of magnificent benevolence in the aid they bring to the regular medical staff in the army….”

James Grant, a volunteer with the Christian Commission, arrived during the battle and made his way to a brick farmhouse, probably the Hoffman farm, where he found “every room in the dwelling and all the outbuildings, the yard and the adjacent fields were swarming with wounded men. The excitement was intense, the scene indescribable, a great wave from the tide of battle was bearing on its bloody crest to this spot, all bleeding and torn, hundreds of heroes to suffer and many of them to die.”

A group of volunteer nurses, led by Mrs. Anna Holstein, the wife of a prominent Philadelphia Episcopal minister, traveled from the City of Brotherly Love to lend assistance. They worked out of several hospitals located in private houses in and around Sharpsburg, as well as the Locust Spring Hospital. Of one hospital she would write, “In this uncomfortable little place crowded with boxes and swarming with hospital flies, the six ladies continued their labors during the day, waiting and working faithfully among the wounded.”

Other female care providers at Antietam included Clara Barton, who probably worked at the Samuel Poffenberger farm hospital; Lizzie Brown; a Mrs. C. Evans; a Mrs. Holihan; a Mrs. Cadwalader; A. Anna Edmunds; Helen Gilson and a Mrs. Gray, both at the Hoffman farm; Mrs. Mary Lee, who worked at several locations; and Ophelia Gehrt, who worked at a field hospital for the 33rd New York Volunteers on the Susan Hoffman farm. At the Smoketown Hospital, Maria Hall, Mrs. Francis Barlow, Mrs. Mary Morris Husbands, Mrs. John Harris, Mrs. Howard Kennedy and a Miss Tyson complemented the staff of Surgeon Bernard Vanderkrieft.

Eventually, many of the small hospitals were consolidated into larger facilities. Once a soldier was healthy enough, he could be sent to even more permanent hospitals in Frederick, or to Camp Curtain in Harrisburg, Pa. Soldiers remained, however, in Sharpsburg area hospitals until spring 1863.

Hundreds of displaced civilians eagerly welcomed the hospital consolidation. Most returned to find their homes decimated by the soldiery, and in the years following the war, many farmers filed damage claims with the government in an attempt to gain recompense for their losses. John Otto, whose property was located not from Burnside’s Bridge, filed a claim in 1873 for $2,350.60 in damages. Otto asserted that his “house, barn and granary were taken possession of Sept. 17th and used for hospital purposes til the 4th of Nov. 1862, during which time everything in and around it that could be of any service was taken and used, including beds, furniture, commissary stores, condiments, and anything that would contribute to the comfort of the wounded, being either consumed entirely or rendered unfit for use.”

Otto received merely $893.85 for his losses, but he was more fortunate than most who filed claims. Ephraim Geeting’s farm was part of the Locust Spring hospital complex, and he filed a claim for $1,238.45 in damages, itemizing “occupation and use of houses, barns, furniture, bedding and household effects from September 17 to about April 15 for hospital purposes.” Geeting’s claim was rejected.

Slowly but surely, order replaced chaos in the hospitals. Sev-e­ral weeks after the battle, Dr. Dimon wrote, “During the day I dress wounds, draw rations, look after cleaning up everything, see to serving out food, etc. and make records of everything done. During the evening and night I make out some of the thousand reports necessary to be made to various quarters of the army. Last night at eleven o’clock, after three hours of writing names, regiments, company, rank, wounds, when received, how treated, etc, I went to bed….”

Dan Holt, though, could not fully adjust to the scale of misery confronting him. On October 15, he wrote: “I close my eyes—all seems like a dream. Am I here—far away from home and loved ones—from the site of my native hills—from the sparkling waters and gushing fountains—its flowing streams—its holy Sabbaths—days of rest and calm repose, upon the field of carnage and hostile encounter. I cannot realize it, although the clatter of arms, the report of cannon, the tramp of almost countless thousands tell but too truly that I have left them all behind. Everything is warlike—guns, swords, bayonets, flags, drums, tents, and indeed all the eye rests upon is unlike home.”

Like Holt, soldiers would wrestle with their Antietam injuries and experiences for the rest of their lives, and area civilians used to the regular pace of agricultural life would never forget the sight of doctors “cuttin’ off peoples legs and arms and thrown’ ’em out…jest like throwin’ out old sticks.” The wounds of Antietam might heal, but for many, only death would erase the deep emotional scars that remained.

John H. Nelson is the author of the CD-Rom “As the Grain Falls Before the Reaper:” The Federal Hospital Sites and Identified Federal Casualties at Antietam, a comprehensive database of every Union soldier injured in the battle. He writes from Williamsport, Md., and serves on the board of the Save Historic Antietam Foundation (

This article by John H. Nelson was originally published in the September 2007 issue of America’s Civil War magazine.For more great articles be sure to subscribe to America’s Civil War magazine today!