Behind the Lens: A History in Pictures
Civil War Medical Practice
Editor’s Note: This essay series is written by Mercy Street's medical, historical and technical advisor, Stanley B. Burns, MD of The Burns Archive.
There were about 55,000 physicians in the United States at the start of the Civil War; most were poorly trained. There were no correct theories of disease and no adequate specific general therapies, except quinine for malaria, opiates for pain and vaccination against smallpox. It was anyone’s guess as to what was causing disease and what was physiologically happening in the body. Several medical sects developed, each positing their idea of disease and treatment. Allopathy, mainstream medicine, competed with homeopathy, eclectic, Thomsonian and other sects. All functioned under erroneous theories of disease. Allopaths offered ‘heroic’ therapy treating patients with bloodletting, blistering, purging and emetics, essentially treating symptoms with harsh deadly compounds; the theory was to effect an opposite of the disease state. Although by 1861 this therapeutic method was in decline; dosing with powerful measures of mercury, antimony, arsenic and other deadly compounds was still popular. The botanic-based medical sects which offered mild therapies appeared successful, as they did not blatantly kill or maim patients. The minimalist doses and botanic mixtures of homeopathy seemed to help patients, but many diseases were, as Dr. Oliver Wendell Holmes declared, self-limiting. The military system could only support one school of medicine; all sects lobbied Congress and allopathy was chosen.
American medical, scientific and clinical education did not measure up to the European standard. To get a complete medical education mid-nineteenth century American physicians had to travel to Europe to the clinics and laboratories of Berlin, Vienna, Edinburgh, London and especially Paris. Additionally, military medical schools were established in several European cities to train doctors to treat war wounds and disease. Upon return to the United States, many doctors became leaders of their profession. These better trained physicians often headed medical schools, and in the Civil War were in the Sanitary Commission and Surgeon General’s office. Most doctors practicing medicine did not have the benefit of a European education.
While laboratory based research exemplified European medical discoveries, typical American physicians were hampered by the belief that measurement and recording physical events, especially weather conditions, air temperature and quality, in minute detail would reveal the cause of disease. Innovative and forward-thinking Surgeon General Alexander Hammond, MD overhauled the American military medical system. The war provided a vast resource of unusual wounds inspiring him to organize specialty hospitals, which became the basis for the establishment of medical specialties. Hammond’s creation of the Army Medical Museum and his directives for study and research on disease and wounds by pathological, microscopic and photographic examination set American medicine on track for laboratory study of disease. The revolutionary scientific concepts developed in Europe by Vienna’s Rudolf Virchow, Paris’ Pierre C.A. Louis, Berlin’s Johannes Müller, among others, hastened America’s entrance into scientific laboratory medicine. The opportunity of treating, examining, and autopsying hundreds of thousands in the Civil War provided a basis for the emerging sciences.
Hammond directly influenced the practice of medicine by dictating the removal of the deadly mercury compound, calomel, and antimony-based, tartar emetic from military usage. This was very controversial, as many old-school physicians were vehemently against its removal. One of the most significant medical achievements of the war was the establishment of treatment standards that must be followed. It was the beginning of the road to today’s evidenced-based practice concepts.
As Seen in the Series
At Mercy Street’s Mansion House Union Hospital the war between old-school doctoring, epitomized by Dr. Byron Hale, abuts against new standards posited by Dr. Jed Foster. Foster, having studied in Europe, presents the latest treatments and promotes adherence to the new medical directives recently enacted by Surgeon General Hammond. Old concepts die hard and Hale exemplifies the long-held allopathic notion that ‘the doctor knows best’ and patient consideration is disregarded. He also thinks that pain is cathartic, while Foster believes pain should be relieved. The tension between Drs. Hale and Foster clearly represents what was going on throughout the Union and Confederate medical corps.