Thursday, June 7, 2007

"Medical Department" Column #4 - "Medicine Men"

This column was published in the December 2000 issue of The Civil War News. It is a favorite of mine for two important reasons: 1) as a pharmaceutical research scientist myself, this intersection of the Civil War with my profession was very interesting; 2) most important - the interviewee in this column - Guy Hasegawa, Pharm. D. - has beame a very good friend and a faithful correspondent ever since. Among his other interests in the Civil War, Guy is an expert on drugs and drug supply. He has published several interesting papers since the one noted below, and will be contributing a chapter to our forthcoming compilation Phantom Limbs and Glowing Wounds: Essays on Civil War Medicine (Edinborough Press, Spring 2009). Enjoy!

"Medicine Men"
by Jim Schmidt
From the December 2000 issue of The Civil War News

Rising drug costs. Government-run health care. Competition from alternative therapies. We may think these challenges are unique to modern medicine and election year politics. In fact, the Union and Confederate medical supply systems faced identical challenges during the Civil War.

Pharmacists participated in nearly every aspect of military drug supply during the war, and their important role is described in an excellent article, “Pharmacy in the American Civil War,” by Guy R. Hasegawa, Pharm. D., in the American Journal of Health-Systems Pharmacy (Vol. 57; March 1, 2000; pp. 475-489).

The article begins with a description of civilian pharmacy in the mid-1800’s. Most crude drugs were imported and then sold to wholesalers or large drug companies, mainly in the northern states. Finished medicines were then distributed to retail pharmacists and physicians for sale to the public. The industry faced several challenges during this period, including volatile prices due to speculators, drug adulteration, and the lack of formal pharmacy education. Mention is made in the article of several men who left careers as druggists to become soldiers, including Indiana artillery Captain Eli Lilly and Confederate Major General Pat Cleburne.

The article then focuses on the four major stages of drug supply during the war: acquisition of materials, inspection and preparation of finished medicines, distribution to depots and hospitals, and dispensing to patients. Dr. Hasegawa notes that pharmacists were involved at every step.
Before the Civil War, the U.S. Army bought medicines on the open market and then distributed them through a large depot in New York and a few smaller ones. During the war, the Union expanded its network to as many as 30 depots, with major centers in New York and Philadelphia. The army relied heavily on a handful of large domestic drug companies for stable inventories and prices. In the field, medical purveyors requisitioned medicines and distributed them to units.

Drug acquisition in the Confederacy was hampered by the Union blockade, and medicines in possession of Southern drugstores were quickly used up. Other means, including blockade running, smuggling through enemy lines, capture of Union supplies, and use of native plants and remedies, saw the Confederacy through the war.

Both the Union and Confederacy established laboratories to inspect raw drug materials and to prepare finished medicines. The article includes descriptions of the major Union labs in Philadelphia, Long Island, and Brooklyn (Navy), and the minor one in St. Louis. The Confederacy established a naval lab in Richmond, and no less than eight Army labs spread among Alabama, Georgia, North and South Carolina, Arkansas, and Texas. Both sides benefited from the expertise of talented and innovative chemists to ensure quality and efficiency.

The article includes excellent descriptions and illustrations of the equipment used to carry drugs in the field. Surgeons and their assistants often carried medicines in saddlebags, haversacks, and in their pockets. On the march, the drugs were transported in large boxes (panniers) stowed in ambulances. The innovative Autenrieth wagon was specially designed with shelves and work counters to operate as a “pharmacy on wheels.”

Dr. Hasegawa concludes the article with a description of the challenges and responsibilities faced by the hospital stewards. The stewards were in charge of purchasing and stores, sometimes assisted in minor surgery, and were responsible for the general cleanliness and discipline of the hospital.

As a scientist in the pharmaceutical industry myself, a most interesting part of the article for me was the mention of the contributions of several companies who are recognizable even today, including Squibb, Pfizer, and Wyeth; and of notable chemists such as John M. Maisch and Charles T. Mohr.

The article is superbly illustrated and meticulously researched. Nearly twenty illustrations include portraits of several Union and Confederate medical notables, period photographs of laboratories and stewards, and etchings of period medical knapsacks and panniers. More than 150 footnotes drawing on dozens of sources provide excellent leads for further study by interested readers. Two appendices feature Union and Confederate standard medical supply tables.

“I’ve had an interest in the Civil War and military history since my boyhood, but it wasn’t until I moved to Maryland twelve years ago that the interest became more intense,” Dr. Hasegawa told me. Inspired by the battlefields and other historic sites in the area, Guy volunteered his services to the National Museum of Civil War Medicine (NMCWM) in Frederick, MD. Relying on his expertise in pharmacy, they asked him to write short summaries about a number of herbal medicines used during the war, resulting in some exhibit panels at the museum.

“Doing the research on these remedies brought me into contact with the literature of the day and with people sharing my interest in pharmacy and Civil War history,” he told me. He enjoyed the research and after gathering sufficient material he wrote the article for the Journal. He has also presented his research at roundtables, the NMCWM’s annual conferences, and the annual national conventions of the Society of Civil War Surgeons (SOCWS).

A follow-up to Dr. Hasegawa’s article, “The other pharmacists in the American Civil War,” was published in the July 1, 2000, issue of the Journal. In a letter to the editor, Captain Steven R. Moore of the U.S. Public Health Service (USPHS) and John Parascandola, a historian with the National Library of Medicine, provided a brief history of the Marine Hospital Service (MHS), the forerunner of the USPHS.

Begun in 1798, the mandate of the Marine Hospital Service was to care for merchant seamen. The hospitals always employed pharmacists, who aside from the physicians, were the only professionally trained personnel on duty. At the outbreak of the Civil War, the MHS operated 27 hospitals in major seaports across the United States. During the war, the MHS hospitals also cared for wounded soldiers and sailors, and in the South (Charleston, Natchez, etc.) the hospitals were controlled by whichever side held them. By the end of the war, only a few of the hospitals remained operational. Eventually the mission of the MHS was enlarged and it was transformed into the USPHS. Suggestions for further reading are included.

There’s even more good news for those interested in the pharmaceutical aspects of the Civil War! Haworth Press (Binghamton, NY) is reprinting George W. Smith’s Medicines for the Union Army: The United States Army Laboratories During the Civil War, originally published in 1962 by the American Institute of the History of Pharmacy (AIHP).

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