Learning from the Wounded

The Civil War and the Rise of American Medical Science

Shauna Devine

• Publisher: The University of North Carolina Press
• Year: 2014
• ISBN:
  9781469611563
• Topic: Histoire
• Subtopic: Histoire de la guerre de Sécession

Nearly two-thirds of the Civil War's approximately 750, 000 fatalities were caused by disease--a staggering fact for which the American medical profession was profoundly unprepared. In the years before the war, training for physicians in the United States was mostly unregulated, and medical schools' access to cadavers for teaching purposes was highly restricted. Shauna Devine argues that in spite of these limitations, Union army physicians rose to the challenges of the war, undertaking methods of study and experimentation that would have a lasting influence on the scientific practice of medicine. Though the war's human toll was tragic, conducting postmortems on the dead and caring for the wounded gave physicians ample opportunity to study and develop new methods of treatment and analysis, from dissection and microscopy to new research into infectious disease processes. Examining the work of doctors who served in the Union Medical Department, Devine sheds new light on how their innovations in the midst of crisis transformed northern medical education and gave rise to the healing power of modern health science.

CHAPTER ONE
Circular No. 2 and the Army Medical Museum

The Union Medical Department was ill-prepared when the Confederate batteries fired on Fort Sumter, April 12, 1861. The department initially had a tremendously difficult time organizing both the volunteer and regular physicians and was inept at managing the new hospitals and training camps. Endemic and epidemic diseases were a part of life in antebellum America, and Americans were used to living with illness to some extent.¹ However, the war brought thousands of men together from all parts of the North, who were then housed in new training camps. Within these camps, overcrowding, exposure, unsanitary sewage disposal, and a lack of resistance to infectious diseases among the soldier population created ideal conditions for diseases to thrive—and they did. Diarrhea, dysentery, measles, typhoid fever, and pneumonia abounded, killing many new recruits before they even reached the battlefield.² The first major challenge, then, was finding a way to both understand and control the considerable amount of illness.

During the first year of the conflict, ranking medical officers routinely noted how difficult it was to organize and instill authority among many of the medical practitioners. Soldiers were dying, and it was argued that the laissez-faire medical culture among some physicians was contributing to the high rates of mortality and morbidity.³ In his narrative of service, J. T. Calhoun noted that the records of the medical department of many of the regiments were “so imperfect as to be absolutely unworthy . . . it was rare for any of us to keep a proper set of books.”⁴ The medical department was pitifully small in 1860 and inadequate to deal with the medical challenges of the war.⁵ The head of the Army Medical Department, Thomas Lawson, was over eighty years of age and was generally opposed to spending money on scientific advances. He died shortly after the outbreak of the war and was succeeded by the very conservative Dr. Clement Finley, the next in line in seniority of service, who was, according to one observer, “utterly ossified and useless.”⁶

Finley was hugely unpopular and, like Lawson, opposed any type of scientific advance within the medical department.⁷ More problematically, he refused to support the use of civilian organizations or women in the hospitals and was regularly accused of hindering the progress of the medical department.⁸ Frederick Law Olmsted lamented: “I believe men are dying daily for the want of a tolerable Surgeon General.”⁹ These deaths were vividly reported in newspapers and magazines. Americans had only a few years earlier read about the similar disastrous medical care of British soldiers during the Crimean War in American newspapers, medical journals, and pamphlets and were well aware of the importance of effective medical care, sanitation, proper diet, and medical treatment. To help manage the medical problem, a group of civilians formed the United States Sanitary Commission.

The commission determined early on that its objective was to “prevent the evils that England and France could only investigate and deplore. This war ought to be waged in a spirit of the highest intelligence, humanity and tenderness, for the health and comfort, and safety of our brave troops.”¹⁰ The commission proposed several reforms, including comprehensive medical exams for recruits, the use of women as nurses in the army hospitals, and the hiring of medical cadets.¹¹ Perhaps most significantly, the Sanitary Commission pressured Secretary of War Edwin Stanton to remove Surgeon General Finley and replace him with someone who would energize the medical department.¹² The Thirty-Seventh Congress was debating Bill No. 188 (the Wilson Bill), which proposed to “increase the efficiency of the medical department of the Army,” the objective being to get “the right men wherever they may be found, whether in the Army or the volunteer force to take these positions.”¹³ It was argued that “Army surgeons, having their places for life, had less inducement to improvement, and they have had fewer opportunities to improve, than surgeons in civil life . . . therefore if you want good officers enlarge your circle.”¹⁴ After some debate, Congress decided that all physicians would be appointed on merit rather than on the seniority system, which opened the door for the appointment of William Alexander Hammond.¹⁵

Hammond had spent the first few months of the war organizing military hospitals in the Northeast, where his organizational ability, openness to innovation, and scientific talents caught the attention of the Sanitary Commission. He was also one of the few military doctors who understood the important medical contribution that the Sanitary Commission could make. This was partly because he was sympathetic to both military and civilian medical needs. He had entered the Army Medical Service as an assistant surgeon in 1849 and served in various posts over the next ten years; he resigned from the army in 1860 to take the chair of anatomy and physiology at the University of Maryland, Baltimore. When the war broke out in April 1861, he helped treat members of the 6th Massachusetts after they were attacked by a mob of Confederate sympathizers while passing through Baltimore. He immediately resigned his professorship and rejoined the army.¹⁶

Hammond was considered a particularly good candidate because of his long-standing interest in medical and scientific investigation.¹⁷ Before the war, he had regularly conducted laboratory experiments, written numerous essays and articles on physiology (one winning a prize), routinely collected specimens for his peers at the Philadelphia Academy of Science and the Smithsonian Institution, and observed European army hospitals in 1858.¹⁸ As physician W. Welch noted in his letter of support, “Assistant surgeon Hammond is eminently qualified for the post. . . . I have no personal or other interest in him beyond the knowledge that he possesses such a rare assortment of good qualities as would enable him to relieve you of much care and do important service to the army if he is appointed.”¹⁹ Indeed, Hammond had a forceful personality and was known for getting things done. All this well fitted the objectives of the commission, whose express purpose was to “avoid delay and circumlocution for the purpose of accomplishing efficiency and directness of action.”²⁰ With the support of the U.S. Sanitary Commission, Hammond was officially appointed surgeon general of the U.S. Army on April 28, 1862, and he became the central architect of reform for the Union Medical Department.²¹ The appointment was eloquent testimony to the developing support for scientific medicine within the medical department.

WILLIAM HAMMOND AND THE DEVELOPMENT OF UNION MEDICINE

Hammond’s energetic approach to wartime medicine included the formal restructuring of the medical department; the development of a national military hospital system; the creation of chemical laboratories; improved record keeping; the hiring of female nurses, storekeepers, washwomen, and medical cadets to meet the demands of war; and the introduction of specialty hospitals. As the physician Silas Weir Mitchell observed, “Whatever else may be thought or said of Hammond, nothing is more sure to me than that he duly saw and used a great opportunity; that he served his country as few could ever have done; that he created the Army Medical Museum; that he saw the need for and advised the foundation of the Army Medical School; that he pointed out the men who were to direct the Army Medical Museum and the medical library.” Mitchell concluded, “Until the end of his army career, [Hammond] was the unfailing friend of scientific study,” even creating “special hospitals for diseases of the heart, lungs and neural maladies.”²²

Before the war, American medical reformers were faced with a clear difficulty: the lack of government support for the medical profession. Each state had its own ideas about how to legislate, license, and train physicians—and many states, as described earlier, had abandoned licensing regulations altogether. By 1860 there was a decline in professional morale among the elite about both the state and direction of medicine. Elite physicians knew they had to lead the charge for reform—but how? What conditions would allow for a social transformation in American medicine? Hammond saw government support for wartime medicine as a unique way to initiate the reform of American medicine and to establish common standards for American physicians. He thus sought to foster an environment that would support the improvement of knowledge and practice. He did this first by formally organizing military medicine along more scientific guidelines. The development and enforcement of the wartime medical reforms enabled the Office of the Surgeon General to transcend many of the limitations in medicine that had plagued American physicians before the war.²³ Furthermore, institutions that could cultivate the development of American medicine were for the first time supported by the government.²⁴ And these new ideals and support excited some of the American physicians, who similarly viewed the diseases and bodies produced by the war as an unprecedented opportunity to learn valuable lessons that would benefit medicine as a whole.²⁵

Hammond was incredibly ambitious, smart, and, above all, fearless in taking on the military establishment. After all, for a generation the Army Medical Department had refused to support any radical departure from the accepted and accustomed mode of operation. Hammond, by contrast, almost immediately saw the benefit of not only marshaling all of the medical talent in the Civil War North but also practically training American physicians. He decided, as part of his early reforms, that all physicians were to be scrutinized in a manner they had not been before. They were subject to strict medical examining boards, which were staffed by elite physicians who valued science as the foundation of the profession. In order to ensure that professional standards were enforced within the Army Medical Department, Hammond explicitly, and controversially, ordered examiners to exclude from practice those deemed unacceptable because of poor medical qualifications.

On July 2, 1862, Congress enacted “an act to provide for additional medical officers of the volunteer Service,” authorizing medical boards to examine candidates before the appointment of surgeons and assistant surgeons.²⁶ Physicians looking for regular army commissions or seeking promotion were also required to sit for a multipart examination, which consisted of a written examination on the basic principles of anatomy, surgery, and the practice of medicine; an oral examination on anatomy, surgery, and the practice of medicine and pathology; another oral examination on chemistry, physiology, hygiene, toxicology, and materia medica; a clinical, medical, and surgical examination at a hospital; an examination on a cadaver; the performance of a surgical operation; and an essay.²⁷ The board was permitted to deviate from this general plan when appropriate (usually if a well-known physician applied) “in such manner as it is deemed best to secure the interests of the service.”²⁸ Candidates failing one examination were permitted a second examination after two years, but never a third.²⁹

If candidates were successful, they were appointed by the secretary of war as surgeons or assistant surgeons (as determined by the examining board). Hammond’s insistence that candidates “who passed the best examinations” should be given precedence according to their examination results as reported by the examining boards proved to be a point of contention between the volunteers and the regulars.³⁰ As John Brown recalled when Hammond was finally ejected from the service, “Hammond has been the Lucifer who had endeavored to promote discord.”³¹ Brown was referring to what he perceived as the “interference of the volunteers” in assuming prestigious hospital posts, but Hammond did not mind making enemies. He wanted scientifically minded physicians who would best support his efforts, regardless of seniority of service.³²

As revealed by the letters they wrote to the Surgeon General’s Office, numerous physicians agonized over the results of their exams.³³ Those physicians who failed often provided excuses and asked to be retested; others who had not received their results wrote repeatedly to inquire why; and still others asked for a second chance on their exams.³⁴ Joseph Woodward, a prominent physician, had his examination delayed and wrote to his wife saying how anxious he was to have his exam completed as he nervously waited in his hotel room.³⁵ The physician R. Weir too recalled that “as soon as I appreciated that the military contest would last longer than the three months prophesied at the beginning . . . I went up for the required examination. . . . I was lucky enough to pass and came out fifth in the long list, thinking perhaps I might have done better had I had time . . . to read up for the trial.”³⁶ John Shaw Billings similarly remembered, “I came before the Board, and at about noon by the second day I began to feel rather comfortable and thought I was getting on very well; but by noon on the third day there was a consultation between examiners, and they began all over again, going back to anatomy and to the beginning of things. That went on for three days more and made me very uneasy.”³⁷ Billings worried needlessly, as he later secured a position with the president of his board of examiners, Dr. McClaren.

His examination was in fa...