Civil War Medicine

1. By Bruce Clarke Civil War Medicine Most material adapted from CWI’s 2006 Conference.

2. Introduction… Before the war broke out, the US army had 108 surgeons/doctors 24 went to the Confed. 3 discharged for treason 81 remained…most in the eighty western forts… ?? How many surgeons by ‘65??? North? South? Green sash, piping on uniform for medical officers

3. AnswerUnion: 12,000Confederacy: 3,200 • The “war was fought at the end of the medical Middle Ages” • Surgeon General William Hammond

4. The number of army hospital beds in Washington on the eve of Bull Run, 1861. The number of beds in army hospitals by 1865. 40 186,894 1861: several small infirmaries 1865: 204 large hospitals

5. A brief survey of the state of pre-Civil War Medicine • 18th century: Benjamin Rush • Jacksonian era disputes • Education • Anesthesia

6. The American Hippocrates (1745-1813) • Dr. Benjamin Rush • Educated in Edinburgh & Paris • Continental Congress • Abolitionist • Instructor in Philadelphia • 2250 students • “Heroic therapy” • Bleed (phlebotomy) • blister and purge • What sets him apart: Convincing writer, speaker and a tireless teacher

7. Greco-Roman Formula Updated • A “fever” was a catchall term for virtually any illness • Imbalance of 4 elemental fluids or humors • Blood (sanguine), Black bile (melancholy), Yellow bile (choloric),Phlegm (phlegmatic) • “there is but one exciting cause of fever and that is stimulus that consists in a…convulsive action of the blood vessels” - Rush

8. Jacksonian Era gave rise to the Antebellum Doctor Wars… • Democratic spirit • Reform movements • Skepticism about heroic method • The regulars fought the irregulars • “Heroics” vs: • Thomsonism • Excess of cold in body • Hydropaths • Graham’s vegetarianism • Homeopathy • Like is cured by like 2500 homeopaths in 1861 With society, colleges, etc

9. Medical Education • Apprentice for 2-3 years at $100 year • Attend a local diploma factory • Or the more ambitious attended one of 8 medical schools 2 years @$125 term • (content repeated) • Textbooks were shared. • If passed exam... • Pay $30 for diploma • And…presto you can do amputations!

10. Education • Joseph Pancoast’s manual: • "A Treatise on Operative Surgery", Philadelphia, 1844 • Daguerreotypes added in 1852 • Note that most of these procedures done without anesthesia until late 40s, early 50s!!

11. Ether first successful in1846 • At Mass General Hospital (Harvard) • “Gentlemen, this is no humbug” - John Warren • In the Civil War, ether and chloroform were used using a paper or cardboard cone with drops of the liquid, or using device shown. Ether’s combustibility made the army prefer chloroform, however…

12. 1846 Dr. Morton Dr. Bigelow Dr. Warren First Successful Operation Using Ether Guy with growth on neck Dirty hands http://neurosurgery.mgh.harvard.edu/Rounds

13. What was the impact of the Civil War on medicine? • Thomas Eakins • “The Gross Clinic” • 1875 • Sophisticated for its time; What do you see? Or not see?

14. One clue…

15. Lasting impact should be measured by administrative care that was systematic and organized, impacting Western world • Discipline imposed on an undisciplined profession • A huge body of excellent medical records made. • Awakening populace to importance of hygiene and nutrition. • Created a huge number of doctors and nurses that spread out to nation after war, improving health care. • Experience with rarer pathologies that all took with them to smaller practices after the war. • Mingling of men with higher medical training with those of less had educational and democratic great value. • State of the art hospital design exported to the world.

16. Surgeon Generals • Union : • 1861: Finley: bad • 1862-64: Hammond: excellent • Issued hygiene regulations • Water horses downstream • Locations of latrines • Burying trash • Enlarged record keeping • Photographs of pathologies, procedures, results • Many good hospitals built • 1864-65: Barnes: (due to Stanton/Hammond clash) • Confed: Samuel Moore: excellent

17. Major Jonathan Letterman: “Father of Modern Battlefield Medicine” • Gen. McClellan’s choice as Medical Director, Army of the Potomac • Completely reorganized • a triage and evacuation system • implemented Battle of Antietam • system still used today.

18. Antietam: Rebirth of Medicine • Pry Farm Barn: 1862 Preserved Today Field hospitals were very often people’s homes commandeered by the army; The Pry farm near Antietam was so devastated economically that its owners declared bankruptcy soon after.

19. Begins training of ambulance corps with set drills. How to walk with a stretcher Rosencrans ambulance designed - with springs for patient comfort! Ambulance Corps Started

20. Lincoln at Antietam • Recognizes Letterman • Gets a tour of the “Letterman Plan” in action.

21. How were black soldiers treated? • There is no substantial body of evidence of how black soldiers were treated medically • A few black surgeons were assigned to black units

22. 3/4 who die, die of disease • Largest killer was dysentary • Typhoid • Measles, chicken pox, syphillus, tb, heat stroke, reptile bites, battle fatigue • And gangrene… • Minie balls entered with bits of dirty uniform, grease from the barrel…

23. Nursing as serious work • Sisters of Charity • US Sanitary Commission • Secular • National org. • Dr. Elizabeth Blackwell : idea • Dr. Henry Bellow Pres. • Frederick Law Olmstead Gen Sec • US Christian Commission • saving souls and bodies • State by state • Nursing Corps. • Dorothea “Dragon” Dix Superintendant • Not a nurse: Clara Barton: collecting donations, aid and resources for medical and humanitarian aid: later … • American Red Cross

24. Myth: Surgeons were heartless butchers who had patients bite a bullet during surgery… Camp Letterman Gettysburg • Team of 3 would look at patient, and all would have to agree that amputation was required to save the patient’s life. Amputations were avoided whenever thought possible. • Teeth would break…they bit on wood or leather if chloroform was not available.

25. Orthopedics are rooted in the War: Prostheses

26. Postwar: Joseph Lister Lectures in USA, Garfield Dies Anyway • Developing Pasteur’s (1869) germ theory at Philadelphia : Worlds Fair 1876 • Wash your hands • Clean everything • Don’t use a scalpel twice • Controversy ensues: general acceptance only comes in late 1880s

27. The Case of James Garfield • 1881, Garfield is shot in Washington DC by a disgruntled office seeker. • Bullet only hits muscle, no organs • His doctor, Dr. Doctor W. Bliss was anti-listerian • Put fingers into wound, put tubes in to drain fluids • Garfield didn’t eat for 7 weeks due to all the morphine, and opium given him • Bliss writes a long report, justifying all he did • Young doctors who’d trained in Europe thought Bliss crazy: ……“ignorance is Bliss”

28. Transformation of Western Medicine • The Medical and Surgical History of the War of the Rebellion • Read widely

30. Transformation of US Medicine • Gerster: publishes major textbook in 1888 • Senn : Bacteriology1889 • Johns Hopkins Hospital (1889) and School of Medicine • Required much more • First to allow women enter on equal basis

31. Between 1890 and 1911, the US will leapfrog forward to become a leader in surgery and medicine. Eakins “The Agnew Clinic” 1889, Philadelphia

32. 1890s • Within months of Roentgen’s discovery of the x-ray (1895), US doctors explored it and wrote a good textbook on it. • US doctors are the first to advance the proper treatment of appendicitis by surgery, which becomes a textbook operation.

33. Book and Internet Resources • Rutgow, Ira. Bleeding Blue and Gray. New York: Random House, 2005. Web sources: • Civil War Homepage. http://www.civil-war.net (18 Aug 2006). • Civil War Medical Care, Battle Wounds and Diseases. http://www.civilwarhome.com/civilwarmedicine.htm (10 Aug 2006) • National Museum of Civil War Medicine, Frederick, Maryland • http://www.civilwarmed.org/index.cfm (Aug 10 2006)