After-Action Report for Paynes Farm, October 2005, Part 1

[NoahBriggs]

In an effort to help out the folks who are asking about becoming an assistant surgeon I am posting my AAR I wrote for Paynes Farm. This was the forst time i was doing this, so I wrote down what I did in more significant detail than I normally would, in an effort to pass down my successes and mistakes to others that they need not reinvent the wheel.

------------------------------
Objective:
My overall goal for the Paynes Farm event was to provide a realistic campaign-style field dressing station which interacted with the rest of the battalion. I wanted to recreate a hospital without the excessive canvas, the pink bloodstained aprons and tacky overacting which seems to be standard at most battle reenactments. My thanks to Kevin O’Bierne who invited me to participate. He provided me with several articles from the upcoming [now available] 2nd Edition of the Columbia Rifles Research Compendium to aid in my research and impression.

Research, like life, is a journey, not a destination. This field hospital is only the first in a long line of attempts to put into practice what I have only read about. If this was the first time for you to see a more accurate field hospital, then it was definitely the first time I managed to put one together. It’s no small feat. I am excited to try it out on a micro-scale and I am equally happy you were willing to help out. Constructive questions, comments, criticisms and recommendations are always welcome, and try to provide documentation if you can. Send ‘em to my e-mail or PM me.

Background:
The Columbia Rifles provided me with the name of the regimental assistant surgeon – George Steinert. Subsequent research revealed he was in his thirties, married with three children at the time of Paynes Farm. Further research hinted that in the 1880s he might have been the police surgeon (aka the medical examiner today) for the New York City Police Dept. He was from the Grand Duchy of Baden in Germany but immigrated to the US sometime in the ‘50s. There were no references to his religion and not enough time to establish what his religion was, so I went with generic Protestant.

I had with me Herr Abraham Karl, played by Hank Trent. He was my orderly detailed to carry the medicine saddlebags. His character was working as a druggist when the war broke out. He, also, was an immigrant, from the Hannover area. Hank and I worked out our backgrounds together. We decided that after I discharged my first steward for incompetance and poor record-keeping I filed paperwork recommending Herr Karl as my new hospital steward. He was temporarily attached to me from Company I.

Dr. Steinert would have worked as a liaison between Col. Bowden (battalion commander) and the Third Corps hospital in order to set up a field dressing station which was to be accessible by road for the ambulances.

I labored with my old unit’s surgeon and personal mentor Dr. Charles Raugh, DPM to create as closely as possible the look, texture and taste of whatever medications I would be carrying. All medications with the exception of the creosote and the iodine were inert and could be consumed without side effects. I had with me:

· Two bottles of opium pills (whole allspice seeds)
· Tincture of opium, aka laudanum (cola syrup mixed withanise flavoring)
· Tincture of Belladonna (Teriyaki BBQ sauce, for that salty, gritty look)
· Calomel (cake decorations, but raw tapioca works just as well)
· Blue mass (raw tapioca spritzed with blue food coloring and anise flavoring, then rolled in blue baking crystals)
· Iodine (the real thing)
· Quinine pills (actually empty because I could not find anything proper to simulate it in time for the event)
· Ipecac pills (coriander seeds)
· Stomachic (altoids)
· Creasote (the real thing, it was a Lysol cleaning concentrate)
· Alcoholis fortius, known to you as medicinal whiskey (cheap bourbon whiskey, brand unknown and best to keep it that way)
· Icthymol ointment (the real thing)

I carried bandages, one capital surgical kit, one personal surgical kit, one half-gill measuring cup and my stethescope. Anything we were missing we could say we had forgotten back at the division hospital. I skipped blistering cups, fleams and other extras because I knew I would not use them in the field. [As mentioned by Tim Kindred a dozen or so field tourniquets woul be here as well.]

My secondary goal was to try as best I could to emulate the paperwork of a field dressing station. Realistically a dressing station is not going to be too concerned with the finer niceties of paperwork – as I both expected and discovered Sat. night. It was a chore merely to keep track of who had arrived, let alone stopping to fill out Form 7, “Account of Clothing, Arms, Equipments, &c., of Patients in Hospital”. For the patient log I carried with me a notebook loosely ruled up and arranged approximately to hospital Form 9, simply referred to as “Register”, as provided in the Official Regulations. I needed to enter quick and dirty data which could be later written up on Form 21, which is a summary of persons killed, wounded and/or missing in an engagement [which is found in Kautz's Company Clerk.

Regulations seem to stipulate that most hospital records are to be entered in registers, or large notebooks. This makes sense, as it is easier to keep track of books than loose sheets. Regs. 1242, 1245, 1246 (regarding Form 7 above) are good examples of data which had to be entered into books.

I meant to copy and use casualty forms. These are small slips of paper which list the patient’s name, rank, company, regiment, diagnosis, treatment and other details,very much like an initial patient chart in a modern hospital. It stayed with the patient and allowed any other medical personnel to see what had been done by the initial examining surgeon. I did not reproduce these in time. I suspect had I used them in the scenario then it would have been easier to keep track of the patients and their treatments.

And in case you still have not gotten a hernia from reading all we carried, here’s one more. I had with me a copy of Form 16, the Surgeon’s morning report, to be handed to the adjutant after sick call and the roll call, to account for those too sick to be present for duty. It’s also the place to note malingerers so they can be duly noted and put on the orderly sergeant’s S list.

Friday

Friday evening the members of the battalion were inspected as they arrived and shuttled to the first bivouac. My staff and those soldiers present assisted the QM and Commissary to lug the food and whatever other supplies we needed down to the site, get fires started and issue rations. Unlike most reenactments there was a clear chain of command, and things got done – so quickly we actually had the time to mosey over to others and offer assistance. There were areas for the four companies, officer country, the band section. Herr Karl prepared a simple yet sumptuous meal of chicken and pumpkin mush, accompanied by rasin bread and some –ahem- pies liberated in the name of the Republic. Rations were issued to all personnel. We bedded down for the night.

Saturday:

Saturday moring dawned bright and cold. We were up early, breakfasted and packed up ahead of the bugle calls. The companies spent the morning running through company, battalion and skirmish drill for about two hours. Meantime we [the medical and the chaplain, played by Reverend Michael Peterson] assisted the QM and the Commissary to bring up the extra boxes and tools for the hard-working kabukis to take over to the next site.

Shortly after noon we fell out onto the road to begin our approach march. It’s interesting to note the hospital staff tried marching in several different spots along the column. We decided the back seemed to be the place to be nearby and out of the way.

“Omnia mea medica mecum porto” (All the medical stuff which is mine I carry with me) – our new official motto. “My shoulders ache from lugging this s—t” was the unofficial motto. My food haversack was filled with my ration on my right side, the medical haversack with my personal surgical kit, bandages and a few personals on my left, then the canteen (which leaked and needs to be upgraded to something better than sutler row junk anyway) and then my bedroll. The weight was fine, the rope handle on my bedroll biting into my clavicle was not. I should have done a dry run with my gear on before the march. I had not. Needless to say I was glad when we got the two-hour rest stop. I felt like a cat. Eat, then pee, followed by a nap in sunshine. God, it was bliss. Good thing too; I would need the extra energy for this evening.

Here ends Part 1.

[NoahBriggs]

Sat. evening:

We approached and ascended “Dead Cow Hill”. The Col. had us open our fate cards once the battalion hunkered down in anticipation of action. The cards had been issued to everyone in the battalion. Your fate card was an “order” which told you how to behave during the battle. O’Bierne wanted to provide the battalion with some idea of realistic casualties and what happened to them after a battle. He also wanted the troops to understand real loss – your buddy is not going to be back with the company, he won’t be joking with you. He won’t be pissing into your coffee. He’s dead, dammit, or in my hospital somewhere, assuming he was even identified properly. It’s a sober lesson, and one which has a real impact on us, since troops and families are doing this for real overseas.

Kevin had e-mailed the battalion beforehand and asked those who did not wish to portray wounded e-mail him to say so. What was left was a group of highly motivated reenactors who were willing to play along with me.

The cards reflected a variety of fates – some mundane, some bizarre. A lot of them referred to the high volume of bullets – either the person’s equipment was “hit”, a near miss, or they were “hit” with spent rounds (bullets without enough velocity to penetrate the skin or clothing, but they still hurt on impact). A few were issued wound cards – they detailed what kind of wound you received, and how you were to react to it. The cards had symptoms of shock plus one feature seen in original reports but not often done at reenactments –extreme thirst, due to massive blood loss from the wound. The rest had death cards. More accurately their cards were mortal wounds. You were encouraged to do everything in first-person.

· Lesson 1 – after setting up the station, have lots of pails of water nearby. Or, as the Hospital Steward’s Manual states on page 69, “Water is to be brought, both for drinking purposes and for the surgeon’s use. . .”

The ball opened and the pressure was on - set up a dressing station, and right fast. The QM assisted by setting up two flies to create recovery areas. The third fly was my surgery.

Our original intention was to set up a separate area with a fire for the “Dead”. We did not have the time to sort the dead from the wounded and get a fire going, plus there was not enough wood for lots of fires. We settled on two fires, one in front of each recovery fly.

I set up bandages on top of one box, my surgical stuff on another and used a lid from another as a “shelf” to hold the medications. I baptized the band with white armabands from one of my bandage rolls and gave them instructions to get as many casualties as they could without endangering their lives. Thanks to the band members for assisting in casualty retrieval and supplying the Friday night officers’ cook fire with wood.

· Lesson 2 – have a sufficient way to mark the hospital to make it easy for the incoming casualties to spot it fast. Likewise, have plenty of spare yellow/red/easy-to identify color armbands to mark volunteer stretcher-bearers.

The first casualties began to stream in. I had them laid down in the surgery area to inspect them, render treatment and give them opium pills to ease the pain in case they had to wait. We had about four casualties retrieved when the firing stopped.

1. Robert Carter, ball to the left elbow
2. John Brady, ball to the right wrist
3. Michael Petes, side wound
4. Jeffrey Johannes, (original name, real casualty) chest wound from spent round, delerious and confused

After stabilizing the first four I went out to see what else needed to be done. I arrived to see the Rebs withdrawing from the field and extracting their wounded in the process. Duty and compassion tore at me. We needed to get our boys off the field fast, as the twin dangers known as Darkness and Cold were approaching at a good dog-trot. We could not, however, because we had to have pickets deployed as security for casualty retrieval.

I actually toyed with the idea of thinking “Hey; let’s get them out of there and screw my safety”. I did not- I had to see to the other patients. Also, I did not want to sacrifice the band members by exposing them to enemy fire. They are too talented.

Pickets were posted and the remaining eight casualties arrived from the field–

1. Ethan Bradley (original name, real casualty) ball to the right arm
2. Theodore Brayton, (original name, real casualty) ball in glutius maximus
3. William Stebbins, (original name, real casualty) chest wound
4. Colin Ryan, ball in right thigh
5. Evan Evans (original name, real casualty) sucking chest wound
6. Michael Ryan, sucking chest wound
7. Shaun Willard, ball in the hip
8. Sgt. Steven Tyler, (original name, real casualty) ball to the head.

Triage was a new formal procedure in the field hospitals. Wounds were classified as Slight, Serious and Mortal.

· Mortal wounds (frequently the head, chest and abdominal areas) were given opium to ease their pain as they made their peace with God. If the person with a mortal wound was still alive when the surgeon got to him, then surgery might be tried, but there was not much hope. Sgt. Steven Tyler’s eerily accurate portrayal of a real head wound at Paynes Farm is a perfect example.
· Slight injuries (grazing wounds, cuts, spent round hits and so on) could wait until things died down. They received opium and water.
· Serious wounds (anything to the limbs) tended to take priority. Contrary to spectator and reenactor folklore, the surgeons wanted to do whatever it took to treat a limb without having to remove it. Advanced treatments like exsections were available at larger hospitals, but it’s not something to do by candlelight at a field dressing station in the middle of Nowhere, Virginia.

My dedicated orderly and acting hospital steward Abraham Karl logged the patients in, ran around trying to organize water details, making sure the men had their knapsacks and blankets and such, assisting me in anesthesia and generally acting like a multi-limbed Hindu god keeping the place organized.

Our chaplain, Michael Peterson (aka Rev. Lemuel Foote) provided practical assistance and spiritual succor throughout the hospital. His was a soothing presence – no preaching, no witnessing, just a good ear and a genuine faithful assurance throughout the battalion.

A couple of miscellaneous thanks to the anonymous privates who showed up to help get fires going for the patients and transfer the patients to the recovery area. Your actions will not go unrecognized.

Here neds Part Deux.

[NoahBriggs]

Personal highlight – sitting down after treating the patients and trying to update my registers to write up a “Form 21 –Return of Killed, Wounded and Missing” by dying candlelight – only to be interupted by a steady parade of line officers asking after certain troops from their companies. We had entered them as they came in; there was no “by company” or “by last name”, so we had to skim the list. Once I heard the name, though, I knew exactly what I had done with the patient under discussion and hardly needed the notes. I also found myself referring to the patients by their diagnosis rather than the name - “The Head Wound” or “That Delerious Fella”. It’s not a conscious attempt to dehumanize the patients, it’s just to keep it straight in my head.

It’s not hard to picture an original assistant surgeon sitting in the mud with a pencil, bleary-eyed, candle stub wavering in the wind, trying hard to remember what he observed and did after standing at an operating table for sixteen hours almost nonstop. I had a merry time keeping track of twelve men for one night without serious consequences. How did the hospitals keep track of hundreds?

Here are a few rhetorical thoughts to piss off the academics who think it’s only numbers in a book – how do you count the wounded? If someone has two wounds, do you write it down as two wounds? What if he was wounded but died from pneumonia? Is that a battle wound, or disease? I could not figure how to classify the wounded on Form 21. Nobody actually came in "dead", so there were no “killed”. A couple “died” after they were admitted. Were they killed, or mortally wounded? What’s the difference between the two (besides semantics)? What’s “slight”? A grazing wound on the hand? A spent round? How do you classify those who were suffering from mental apoplexies (aka PTSD)? One fella was shot on sentry later at night – by his own side. He never turned up in my hospital. How did he get recorded/counted as a casualty?

Another highlight. Well, it’s a reenacting moment, but not really a highlight if it happened in real life. It seems Michael Ryan was concerned for his younger relative, Colin. I found it was easy to fix up Colin. I extracted the ball and stitched him back up. Michael, however, had a collapsed lung and sucking chest wound. I could hear the rattle. The “moment” to which I refer was the look on his face when I told him his wound was mortal and there was nothing I could do to save him. It was heart-wrenching. Even more so that he did not really put up a dramatic fuss about me trying to save him no matter what. (At a mainstream event that’s what would probably happen, and at full volume.) Instead he quietly asked for the chaplain. I obliged- it was the least I could do.

I handed the form 21 to the Col., along with my apologies it was not written in ink. He forgave me and had me hand the form to Adjutant Jewell, aka Chris Pering.

Sleep came hard. The cold was one factor. Another factor was seeing the parade of names on the list and my hard notes on treatment – “extracted ball, bandaged, 1gr. Opium Piulae every 4 hrs.”; “Mortal; 1gr. Opium Piulae every 4 hrs. until death”; “extracted ball, dressed wound”, &c. It’s hard to see numbers and statistics when you can see faces.

And hear comrades writing letters for the wounded.

And rosaries recited.

And last rites.

How in **** could the generals sleep at night with this knowledge on hand?


Sunday:

Up and pack yet again. We marched to the center of the field where the event ended and we learned something about the battle, preservation and maybe a little bit about ourselves.

I cannot remember the blur of names which passed before me. If I missed yours, it’s included in this section. Thanks to all who participated

* * *

Highlights

· Realistic force ratios for the regiments engaged.
· Incredible planning and clear coordination before, during and after the event. This includes the kabukis and their tireless efforts.
· Less is more on the field. Shed of typical reenactor impdeimentia – excess canvas, camping crap and the like. The result felt like a real battalion on campaign.
· Everyone was told what their job duties were, from private to Col. and they knew it well in advance. Everyone did what needed to be done, fast and efficient. So efficient, we helped others as well. This was enforced with the staff meetings going over the schedules.
-----------------------------------------------

[decajun4513]

I'm looking to start my own Field Dressing Station for the group in Louisiana I belong to. What kind of boxes do you use for the station? And did you set up some kind of make-shift surgical table?

Thanks.

[NoahBriggs]

I was borrowing from my friend at the time, so most of the meds were in slender vials and put into a wooden holder in a set of saddlebags. Since then I have had a crate made which I subdivided with cardboard so my bottles (now more correct with caps) would not clink together and break.

I used no table because lugging one for a field dressing station is awkward and makes no sense. The purpose FDS is to apply bandages, feed laudanum or opium pills, or administer medicinal alcohol for shock symptoms. If the wounds are minor enough you can send the patient back to the fighting, and the malingerers to the Provost for wasting your time. At most the assistant surgeon will have his own bag of stuff, and/or an attendant with a hospital pack or bag loaded with bandages, splints, styptics, &c.