Medical Department #34 - The Living Museum

I have had the great pleasure of meeting Mr. George Wunderlich...for this month's "Medical Department" column in The Civil War News, I had the great pleasure of interviewing him! George is passionate about many things and his dedication as Executive Director of the National Museum of Civil War Medicine is inspiring.

In the column below, he talks about Civil War medicine, the museum's mission, and how they are reaching out beyond the bricks-and-mortar. Enjoy!

UNFINISHED WORK
By James M. Schmidt
The Civil War News – “Medical Department” – May 2010

“A finished museum is a dead museum, and a dead museum is a useless museum.” – G. Brown Goode, The Principles of Museum Administration (1895)

Although written more than a century ago, George Brown Goode’s volume on the purpose and management of museums resonates even today. He had specific advice on the relationships of museums and their communities and the responsibilities they had to each other. “For a museum to be useful and reputable,” he wrote, “it must be constantly engaged in aggressive work, either in education, investigation, or both.” Today, Goode finds a kindred spirit in Mr. George Wunderlich.

Mr. Wunderlich is currently the Executive Director of the National Museum of Civil War Medicine (NMCWM) in Frederick, MD. He came to the Museum in 2000 after moving from Missouri where he was Founder and Director of the Historical Education Center of St. Louis. In 1995, Mr. Wunderlich was awarded the Daughters of the American Revolution National Medal of Honor for his work in public history.

After receiving his Master of Arts Degree in American History from Concordia University, he went on to develop new historically-based training programs for the National Park Service, Joint Medical Executive Skills Institute Capstone Symposium, The United States Army Medical Regiment, and other civilian and government organizations. He is a nationally known speaker on various Civil War topics and can be regularly seen on the History Channel, A&E, PBS and the BBC. He was kind enough to answer my questions about Goode’s admonition that museums must be “constantly engaged,” especially with the NMCWM’s new initiative: the Letterman Institute.

In 1974 my father bought me a Hawkin rifle and taught me to shoot. From that day forward I was addicted to history,” Mr. Wunderlich told me, adding, “In 1975, I became the youngest member of the St. Louis Civil War Roundtable and my addiction deepened. Month after month I went with my father to hear speakers like Bud Robertson and James McPherson and my understanding of history grew.” He has also been very active in living history, first as a mountain man (beardless as you can imagine!) shooting in live fire competition and then as a member of Battery I, 1st Missouri Light Artillery.

Mr. Wunderlich’s interest in medical history can be traced back to 1990 when he researched the subject to perform “Ranger in the Park” programs for the St. Louis County Parks Department at Jefferson Barracks. “I was enthralled with the myth vs. reality facet of this often maligned subject,” he told me. In 1998, he was playing one of his handcrafted banjos at the NMCWM when he was asked a medical question. “To the shock of the director I knew the answer and was able to discuss the matter at length with one of the museum’s board members,” he told me. Because of that conversation, he was asked to work for the museum when a position became available in 2000, and, as he said, “the rest is history.”

As Executive Director of the NMCWM, Mr. Wunderlich is passionate about communicating the true story of Civil War medicine to the public and correcting long-standing myths and misconceptions. When he saw headlines and reports after the recent devastating earthquake in Haiti such as “Much has been made of how natural disasters temporarily plunge medicine back into the era of the Civil War” (Washington Post) or “It is just reported that doctors in Haiti do not have anesthetics and must amputate limbs without pain relief…exactly as practiced in the Civil War” (CNN iReport), Mr. Wunderlich felt compelled to write an editorial to the Frederick News Post correcting those mistaken impressions.

“I feel very strongly that ignorance of the past prevents, or at least hinders, future innovation,” Mr. Wunderlich told me. “You must have a good working knowledge of that which has come before otherwise you are prone to reinvent or make the same mistakes as your predecessors. Either way you are not succeeding in your mission.” To be sure, the bricks-and-mortar NMCWM helps combat that ignorance, but the Museum is doing much more than that, satisfying other Goode “commandments”: a museum must “advance learning” and be an “adjunct to the classroom.”

“We are taking several different steps to help correct these impressions in the media and the public,” Mr. Wunderlich told me. They include partnerships (National Park Service and television networks), publications (the NMCWM press has already published four books), social media (Twitter, Facebook, blogs, etc.) to publicize programs, and conferences. Another of their outreach programs is the Letterman Institute, named for Dr. Jonathan Letterman, Medical Director of the Union Army of the Potomac during the Civil War and often considered the “father of battlefield medicine.”

“The Letterman Institute is a professional level training organization within the Museum tasked with using the lessons of Civil War medicine and applying them to modern best practices,” Mr. Wunderlich told me. “The Institute looks at all facets of medicine, including treatment, logistics, communications, public health, law of armed conflict issues, humanitarian practices, management, command and control, relations between field and medical command and medical policy making,” he added. The Institute tailors programs to the needs of specific organizations, ranging from high level military medical officers, civilian medical professionals, all levels, and even business and non-profit leaders. “The lessons of Civil War medicine not only apply to the medical field but to all aspects of good management and communication,” Mr. Wunderlich told me.

Indeed, those lessons – as communicated through the Museum’s outreach efforts - are having an impact on battlefield even today. In one training session, Mr. Wunderlich was relating how Letterman used the orders of General George McClellan to anticipate medical needs on the field, which allowed Letterman to be proactive in dispatching medical assets rather than reactive. A doctor in the audience realized that a recent change in a communications center in Iraq had undone what Letterman had learned.

“A recent order caused removal of medical planners and dispatchers from a key communication center due to overcrowding,” Mr. Wunderlich told me. The officer realized that the move had caused increased fatalities among the wounded. “As a result, he called his colleagues in Iraq to move the medical dispatchers back into the communications center so that there would be no delay in dispatching medical help,” he added. They learned later that fatality rates returned to their pre-move rate after the corrective action.

As another example, Mr. Wunderlich recently trained a group of professionals in federal medical service. “One Air Force Colonel told me that by using the Letterman Plan of 1864 and digesting its lessons of pre-planning, efficient use of limited transportation assets, and a whole-team approach to health care, he was able to earn an award for reducing air-frame maintenance and fuel costs,” he told me. The officer did this by using all of the assets in his control to pre-plan evacuation flights so that there could be a doctor on each aircraft bound for Germany. “The presence of that doctor allowed the flights to adhere to regulation and maintain a 30,000+ foot ceiling where fuel and wear are reduced,” Mr. Wunderlich told me, adding, “Before he took over, many flights did not have doctors on board and were limited to a 10,000 foot ceiling which required refueling in Turkey and increased flight time requiring more maintenance.” The lesson? Civil War medicine can even help aircraft!

“A museum which is not aggressive in policy and constantly improving, cannot retain in its service a competent staff and will surely fall into decay,” Goode wrote in 1895. Mr. Wunderlich, the founders and their hardworking and dedicated team are making sure that doesn’t happen to the National Museum of Civil War Medicine.

"Years of Change and Suffering" BOOK GIVEAWAY CONTEST - We Have a Winner!

Thanks to everyone who participated in the Years of Change and Suffering: Modern Perspectives on Civil War Medicine book giveaway contest!

We received several entries by e-mail, on this blog, and via the book's Facebook page!

The entries included:

• Comments on favorite Civil War medical personalities, including Clara Barton and Mary Edwards Walker (isn't interesting that the female personalities seem most popular?!)

Comments on ad hoc wartime medical inventions, including the fact that boiling horsehair to use as suture thread may have (unwittingly) sterilized the hair and reduced infections

Interesting medical stories about ancestors who fought in the war

The winner is Carol Wong of Allen , TX, who - in her messages - told of a most interesting story, with a very personal connection:

"I have printed pension documents for my ancestor on my father's side who was a Union guard for a unit from Indiana. Written testimony from him and his wife and neighbors described the problems that he had with his lungs. He apparently had to stand on top of prisoner trains in the cold air and ever since he had a lot of trouble breathing and felt exhausted all the time. He complained that everytime he returned to duty after having recovered some, that he was sent back for the same type of duty. Therefore, he never did recover fully after the war.That is personally interesting to me because I have asthma and sarcoidosis. My dad and my cousin also had asthma and other breathing problems."

Congratulations, Carol!

Look for more book giveaways in the future!

"Years of Change and Suffering" BOOK GIVEAWAY CONTEST!!

To celebrate the release of the softcover edition of Years of Change and Suffering: Modern Perspectives on Civil War Medicine (Edinborough Press...hardcover still available!) and to celebrate passing 500 fans on the book's Facebook page, we've been offering excerpts from the book for the past week (here...here...here...AND here!).

NOW IT'S TIME FOR A BOOK GIVEAWAY CONTEST!!

Just leave a comment on this blog post...on the book's Facebook page...or by e-mail (schmidtjamesm at gmail dot com) by answering this question:


Tell us your favorite Civil War medicine-related story (50 words or less!)!

It could be about:

• Your favorite Civil War medical personality (nurse, surgeon, etc.)
• A medical-related event that happened to your ancestor during the war
• Your favorite medical invention from the war
• The most important medical advance during the war (in your opinion!)
• Your favorite book about Civil War medicine (besides "Years of Change"!)
  

You get the idea!

You have until the end of Sunday (12am CDT 26 April 2010)...The winner will be announced on Monday...The winner gets a free softcover copy of Years of Change and Suffering!

Put those thinking caps on and have fun!

Excerpt #4 from "Years of Change and Suffering"! - Chapter 2 - "A Multiplicity of Ingenious Articles"

Continuing with excerpts from Years of Change and Suffering: Modern Perspectives on Civil War Medicine (Edinborough Press, 2009), I am pleased to offer the following from my chapter, "A Multiplicity of Ingenious Articles."

Having written about the general history of Scientific American magazine in the Civil War as a chapter in my first book, Lincoln's Labels: America's Best Known Brands and the Civil War (Edinborough Press, 2008), in this chapter for Years of Change I concentrate specifically on the subject of Civil War medicine as revealed in the wartime pages of Scientific American. Just as it did for weapons, Scientific American played an equally important role in fostering the "healing arts" by advising soldiers and their leaders how to maintain the health of the army, urging inventors to give attention to unmet medical needs, and reporting on advances in medical technology. I also address recent historical scholarship in the economics and social impact of invention in the mid-1800s.

Enjoy the excerpt!

STAY TUNED FOR A BOOK GIVEAWAY CONTEST LATER THIS WEEK!!

Years of Change and Suffering

Modern Perspectives on Civil War Medicine

Chapter 2 - "A Multiplicity of Ingenious Articles" (Excerpt)

by James M. Schmidt

(Copyright 2009, the author)

When viewed through the lens of the American Civil War, George Bernard Shaw’s oft-quoted aphorism — “In the arts of life man invents nothing; but in the arts of death he outdoes Nature herself, and produces by chemistry and machinery all the slaughter of plague, pestilence, and famine” — is poetic, but it is also unnecessarily pessimistic. While the inventive genius of the country certainly aroused itself to improving the “arts of death,” the “arts of life” were not ignored. The Civil War witnessed innovations in ambulances, surgical implements, medicines, and especially prosthetics.

As America’s oldest continuously published magazine, Scientific American has delivered opinion and news about developments in technology for more than 150 years. Founded as a weekly broadsheet in 1845 by Rufus Porter, Scientific American of the nineteenth-century was primarily targeted towards inventors and machinists — more like today’s Popular Mechanics than its own modern counterpart, which expertly reports on the cutting edge of theoretical science. During the Civil War, Scientific American played an important role by fostering and reporting on innovations that had an impact on the battlefields and waters.

Scientific American has been used to great effect as a resource in modern studies of mid-nineteenth century military technology. Less attention, however, has been paid to it as a resource in examining patterns of medical-related invention during the era. In fact — just as it did for weapons — Scientific American played an equally important role in fostering the arts of life by advising soldiers and their leaders how to maintain the health of the army, urging inventors to give attention to unmet medical needs, and reporting on advances in medical technologies. Study of the magazine’s wartime pages also supports recent historical scholarship in the economics and social impact of invention in the nineteenth century.(1)

**********

“Promoting Health and Comfort”

Still, the genius of the magazine’s subscribers was not entirely devoted to designing implements of death and destruction. As one reader eloquently wrote:

"While many of the inventive minds of our country are devoted to the production of the most effective and destructive weapons . . . others are endeavoring to render the hard and monotonous life of our soldiers as comfortable and pleasant as possible, by furnishing them with a multiplicity of ingenious articles adapted to these purposes. Thus all are exhibiting a desire to add something to the one grand object in view, of restoring unity of States and submission to the laws. In this way those who, for various good reasons, remain at home, contribute their mite in a great many ways." (14)

Scientific American reported with “no small degree of pleasure” that its readers were also devoting their inventive faculty “in promoting the health and comfort of our soldiers and marines.” Much had been done “to improve firearms and other implements of war” but also to better “those articles and agencies which tend to promote the health of man, mitigate the privations of war, and render the army and navy more efficient.” To spur innovation (and perhaps, its own patent agency business?) the magazine often provided seeds of thought for aspiring inventors. (15)

For example, within weeks of the firing on Fort Sumter, Scientific American published a short notice entitled, “Inventions of War Wanted Immediately,” with the primary suggestion of a “simple, effective machine for cutting out bandages and making lint for army purposes.” Also needed was a “flexible india-rubber tube, fitted with a metallic mouthpiece, with some substance . . . to filter and purify the water,” so that soldiers on the march could “slake their thirst with fresh water at every running brook, without the danger of swallowing tadpoles or lizards.” (16)

In a November 1861 column entitled “Subjects for Invention,” the editors endeavored to suggest “a catalogue of subjects or problems that may, we think, be advantageously conned over with a view to further discovery of improvement.” Not surprisingly, many of the suggestions were for military use (an armor clad war vessel, “light of draft, cheap, and quick of construction”; a “pocket telegraph;” armored dress; and a tent “that could be quickly converted into a substantial boat” to carry troops across rivers), but the list also included implements for the surgeon and hospital: a “pulse indicator,” which the magazine described as a “small instrument for the sick room, capable of application to the wrist of the patient, to show and record the number of pulse beats,” and a “saddle ambulance” for mules or horses that was “capable of ready adjustment so as to remove the wounded from the field of battle.” (17)

A similar list a few months later called for more devices still, including a “simple and compact device for stretching and supporting fractured limbs” and surgical instruments, especially an improved implement for “extracting balls from wounds.” (18)

**********

“The Fatal Calamities of War”

War could be a camp-to-grave proposition, and inventors met that grim reaality with more than thirty improvements in coffins, caskets, biers, embalming implements, and Dr. Thomas Holmes’s “Improvement in Receptacles for Dead Bodies,” a body bag made of India rubber and intended to “facilitate the carrying of badly-wounded dead bodies . . . as the boxes or coffins cannot be so easily handled or transported on the field of battle.” In introducing one such innovation, the editors of Scientific American solemnly stated, “In the present condition of the country, when the fatal calamities of war render it a duty incumbent on fathers, mothers, wives, sisters and brothers to seek their dead upon the battlefield and to bring home for burial the remains of their kindred, any invention which will tend to ameliorate these afflictions and assist in the performance of this sad duty is worthy of special notice.” (30)

In a February 1863 issue, Scientific American featured Dr. G. W. Scollay’s “Patent Air-Tight Deodorizing Burial Case.” The long article outlined — rather graphically — the chemical and biological processes of decomposition, then described Scollay’s invention, and concluded with details of a successful experiment conducted by the Sanitary Commission for the Surgeon General. The article also featured an engraving of Scollay’s case with a fallen soldier as its occupant. “Especially at the present time is its introduction to be desired,” the editors declared, “when desolation and grief exist in almost every home in the land.” (31)

Endnotes

(1) See “The Present Day Use of Nineteenth Century Scientific American,” in Michael Borut, “The Scientific American in Nineteenth Century America,” unpublished Ph.D. dissertation (New York: New York University, 1977), 285-88; uses of the Scientific American specific to Civil War technology include Robert V. Bruce, Lincoln and the Tools of War (Indianapolis: Bobbs-Merrill, 1956) and Brent Nosworthy,The Bloody Crucible of Courage: Fighting Methods and Combat Experience of the Civil War (Berkeley, CA: Carroll & Graf, 2003).

(15) Scientific American, August 17, 1861, 388

(16) Scientific American, May 11, 1861, 299

(17) Scientific American, November 30, 1861, 346

(18) Scientific American, March 29, 1862, 204

(30) “facilitate the carrying of . . . .” in United States Patent No. 39,291, “Improvement in Receptacles for Dead Bodies,” to Thomas Holmes, Washington, DC, USPTO, July 21, 1863; “In the present condition . . . ” in Scientific American, February 28, 1863, 136

(31) Ibid

Excerpt #3 from "Years of Change and Suffering"! - Chapter 6 - "Southern Resources, Southern Medicines"

Continuing with excerpts from Years of Change and Suffering: Modern Perspectives on Civil War Medicine (Edinborough Press, 2009), I am pleased to offer the following from co-editor Guy Hasegawa's excellent chapter, "Southern Resources, Southern Medicines."

Dr. Hasegawa is a Senior Editor of the American Journal of Health-System Pharmacy, a published expert on Confederate pharmacy and other aspects of Civil War medicine, and a board member of the National Museum of Civil War Medicine and the Society of Civil War Surgeons. Guy should be no stranger to readers of this blog or my "Medical Department" column in The Civil War News, as he has been an interview subject several times, regarding his work on Civil War pharmacy, quinine substitutes in the Confederacy, and other interesting topics.

In his chapter, he describes "how the Confederate army marshaled a wide array of resources, natural and otherwise, to furnish its physicians with the medicines needed to treat the vast numbers of sick and wounded soldiers." He has an amazing penchant for finding and drawing on previously unpublished primary source material, and he carries that talent in to this chapter.

Years of Change and Suffering Modern Perspectives on Civil War Medicine
Chapter 6 - "Southern Resources, Southern Medicines" (Excerpt)
by Guy R. Hasegawa, Pharm.D.
(Copyright 2009, the author)

Historians recognize that one of the Confederate Army’s most noteworthy accomplishments in dealing with the Union blockade was providing its troops with sufficient arms and ammunition to carry on a long and hard-fought war. Less well known is the story, summarized here, of how the same army marshaled a wide array of resources, natural and otherwise, to furnish its physicians with the medicines needed to treat the vast numbers of sick and wounded soldiers.(1)

The Confederate medical department’s wish list for drugs was its standard supply table for hospitals, which duplicated almost exactly its Union counterpart and included an array of medicines, from acacia to zinc sulfate. Unfortunately, the conditions in the North that allowed for an uninterrupted supply of the items — a continued influx of goods from abroad and the capacity for large-scale drug manufacturing — were not as easy for the South to replicate. Some medicines in the table, like fluid extract of wild cherry bark, were made from plants growing in North America, but many others, like quinine, originated in foreign lands. Moreover, drugs like mercurial compounds, chloroform, and ether, which were made from minerals or chemicals, were not being produced in large amounts in the nonindustrial South. Before the war, these circumstances dictated that the South obtain its drugs from overseas or from Northern dealers or manufacturers. The onset of hostilities and the reduction of trade with the North forced Confederate Army supply officers, called medical purveyors, to rely initially on purchases from blockade runners and local druggists and medical wholesalers. (It is ironic that the war also threatened to cut off the supply of Southern plants needed by Northern physicians.) Although foreign goods arrived in Southern ports fairly frequently early in the war, a tightening blockade, a prolonged conflict, and rising drug prices — driven by scarcity, inflation, and speculators — would spell trouble for an army that needed massive quantities of medicines.(2)

These prospects, soon to become realities, led Army Surgeon General Samuel Preston Moore to conclude before the war was a year old that the South itself should be tapped as a well of supplies for his surgeons. Thus, orders for manufactured items — cots, tourniquets, and surgical instruments, for instance — were placed with local businesses and artisans, and natural resources, especially plants, were turned into medicines. The objects behind the “appropriation of our indigenous medicinal substances of the vegetable kingdom,” announced Moore, were to take greater advantage of the South’s resources and reduce its payment for foreign goods. (In this context, “indigenous” plants included species native to the Confederate states as well as those introduced into the South from other lands.) In practical terms, Moore hoped that Southern drug production would supplement other sources of supply such that the army would have sufficient medicines for its needs.(3)

The Decision to Use Southern Plants

An important undercurrent to the Confederate medical department’s situation was the friction between allopathic (“regular” or orthodox) physicians and other practitioners. Most Confederate surgeons, including Surgeon General Moore, were allopaths. A number of medical sects disapproved of the harsh drugs and other “heroic” treatments, such as bloodletting, used by some allopaths and instead advocated relatively mild remedies, often derived from North American flora. Allopaths already knew about and prescribed some of those plants, but they often regarded botanical and other sectarian practitioners as quacks and rejected their teachings as irrational.(4)

After the war, Moore explained his decision to turn to indigenous flora: “It had been my impression for a long time that many of the Southern medicinal plants possessed valuable properties, and that their usefulness would soon be discovered in many diseases if administered with care and attention.” Moore may have dismissed the views of botanical practitioners, but his lack of certainty about the plants’ value also seems, at first glance, to indicate a distrust of the established allopathic knowledge base. Among the species eventually used by the Confederate army, the vast majority were already in The Pharmacopoeia of the United States of America (USP), the standard listing of allopathic drugs. Many were described in the prewar curricula of Southern allopathic medical schools, such as the Atlanta Medical College and the Medical College of the State of South Carolina. Large numbers of future Confederate surgeons attended Northern medical schools like the University of Pennsylvania, whose materia medica course covered dozens of medicinal plants growing in the South. Some allopathic physicians studied and published articles about native plants.(5)

Credible information, however, did not necessarily give physicians confidence in remedies they did not personally prescribe. Moore had served in the United States Army as a surgeon for twenty-six years and may have had little opportunity to use remedies that were not on the Army’s standard list. Even practitioners familiar with Southern plants in civilian practice had little idea of the medicines’ value in treating the maladies of a large army. Whereas the allopathic literature described the medicinal properties of native plants, it did not generally claim that they surpassed or even matched standard drugs in value. Thus, it is understandable that Moore’s views about the usefulness of indigenous plants formed not a conviction but rather an impression, albeit one that clearly required action.(6)

The first known step of the surgeon general’s office in promoting the use of native flora was its publication on March, 21, 1862, of a pamphlet of indigenous medicinal plants, which was distributed to medical officers on April 2. There was good reason at the time to fear that the flow of goods from abroad was in jeopardy. Just a few months earlier, in November 1861, a Union victory at Port Royal Sound, South Carolina, had provided the U.S. Navy with a splendid base for blockading operations. During the same month, Union forces had occupied Tybee Island, Georgia, a move that threatened Fort Pulaski, which guarded the sea approach to Savannah. The pamphlet listed sixty-seven of the South’s “more important medicinal plants” and described where they grew and their uses, formulations, and dosage. Moore maintained control over the selection of plants and instructed his surgeons to collect the listed species and send them to medical purveyors. He also directed medical officers to investigate the value of indigenous remedies in relieving pain or inducing vomiting or defecation, because of the relatively small number of Southern plants recognized as useful for those purposes.(7)

In a circular issued on July 22, 1862, Moore reminded surgeons of the uses of several indigenous medicinal plants and encouraged them to report on the antimalarial effectiveness of Pinckneya pubens (Georgia bark), which had not been mentioned in the recent pamphlet. By the summer of 1862, medical purveyors were already issuing substitutes in place of scarce standard items, and this sometimes displeased the recipients. “The Surgeons around here,” wrote a medical purveyor to his assistant, “expect what they order whether it is in the Confederacy or not. They cannot appreciate kindness in substituting one medicine for another rather than let them go without.”(8)

Endnotes

(1) Descriptions of Confederate successes in supplying ordnance include Frank E. Vandiver, Ploughshares into Swords: Josiah Gorgas and Confederate Ordnance (College Station: Texas A&M University Press, 1994) and C. L. Bragg, Charles D. Ross, Gordon A. Blaker, Stephanie A. T. Jacobe, and Theodore P. Savas, Never for Want of Powder: The Confederate Powder Works in Augusta, Georgia (Columbia: University of South Carolina Press, 2007).

(2) War Department, Regulations for the Army of the Confederate States, 1862 (Richmond: J. W. Randolph, 1862), 244-57; John M. Maisch, “Report on the Drug Market,” Proceedings of the American Pharmaceutical Association 12 (1864): 187-200.

(3) S. P. Moore to John C. Breckinridge, 9 Feb. 1865, OR, Ser. 4, vol. 3, pp. 1073-76; S. P. Moore, Circular, 2 Apr. 1862, OR, ser. 4, vol. 1, p. 1041.

(4) Alex Berman, “A Striving for Scientific Respectability: Some American Botanics and the Nineteenth-Century Plant Materia Medica,” Bulletin of the History of Medicine 30 (January-February 1956): 7-31; Dan King, Quackery Unmasked: Or a Consideration of the Most Prominent Empirical Schemes of the Present Time, with an Enumeration of Some of the Causes Which Contribute to Their Support (Boston: David Clapp, 1858).

(5) Samuel Preston Moore, “Address of the President of the Association of Medical Officers of the Confederate States Army and Navy,” Southern Practitioner 31 (October 1909): 491-98. The purpose of the USP was to standardize the nomenclature and preparations of “substances which possess medicinal power...the utility of which is most fully established and best understood.” The USP’s primary list included “articles which might be considered of standard character,” whereas its secondary list included “substances as were deemed of secondary or doubtful efficacy” and articles, particularly new ones, for which further investigation was warranted. The Pharmacopoeia of the United States of America (Boston: Wells and Lilly, 1820). The USP classification scheme continued in subsequent editions, and its listings at the onset of the Civil War were included in George B. Wood and Franklin Bache, The Dispensatory of the United States of America (Philadelphia: J. B. Lippincott, 1858). Joseph Carson, Synopsis of the Course of Lectures in Materia Medica and Pharmacy, Delivered on the University of Pennsylvania (Philadelphia: Blanchard and Lea, 1855); John G. Westmoreland, A Syllabus of Lectures on Materia Medica and Therapeutics, Delivered in the Atlanta Medical College (Atlanta: G. P. Eddy, 1857); Henry R. Frost, Outlines of a Course of Lectures on the Materia Medica, Designed for the Use of Students, Delivered at the Medical College of the State of South Carolina, 5th ed. (Charleston: James and Williams, 1858).

(6) Samuel E. Lewis, “Samuel Preston Moore, M.D., Surgeon General of the Confederate States,” Southern Practitioner 23 (1901): 381-86.

(7) General Directions for Collecting and Drying Medicinal Substances of the Vegetable Kingdom (Richmond: Surgeon General’s Office, 1862); S. P. Moore, Circular, 2 Apr. 1862, OR, ser. 4, vol. 1, p. 1041.

(8) S. P. Moore to T. H. Williams, 22 Jul. 1862, OR, ser. 4, vol. 2, pp. 13-14; W. H. Prioleau to James Stewart, 12 Aug. 1862, microfilm M346, roll 983, NARA.

Excerpt #2 from "Years of Change and Suffering"! - INTRODUCTION (Part II)

As promised, we continue to post some excerpts from Years of Change and Suffering:Modern Perspectives on Civil War Medicine and will finishing with a BOOK GIVEWAY CONTEST!

Remember - all royalties from the book are being donated to Civil War medical heritage preservation!

Below is the second excerpt - the second part of the Introduction (see Part I here). Enjoy!

Years of Change and Suffering

Modern Perspectives on Civil War Medicine

INTRODUCTION (Continued)

by James M. Schmidt and Guy R. Hasegawa (Copyright 2009, the authors)

Wounds to the arms and legs, as described by Jay Bollet, were clearly not the only devastating injuries sustained by Civil War soldiers. Due to the nature of the fighting, soldiers sometimes fought kneeling, sitting, or lying prone, and they were exposed to being shot in the buttocks or genitals. In his contribution, “The Privates Were Shot,” surgeon Harry Herr describes urological wounds and treatment. Dr. Herr combines statistics and case reports, largely from the Medical and Surgical History of the War of the Rebellion, with his knowledge of wartime surgical beliefs and practices to illustrate the enormous clinical challenges faced by caregivers and the dismal outcomes that patients were likely to experience.

Dr. Herr’s case studies give graphic and grim witness to the debilitating nature of urethral wounds suffered by soldiers during the Civil War. Although generally not as fatal when compared with wounds of the chest or abdomen, urethral injuries were very troublesome for surgeons to treat, and survivors dealt with serious and painful consequences — physical and emotional — for the rest of their lives. Those consequences included chronic infection, constant leakage of urine, difficulty walking, and sexual dysfunction, as only a few examples.

The Civil War, states Dr. Herr, was a training ground for American clinicians, whose formal education was supposedly inferior to that of their European counterparts. Ironically, the survival rate was higher for Civil War than Crimean War casualties, a fact partially explained by how effectively Civil War surgeons learned from their clinical experience. Dr. Herr believes that European surgeons, reporting on their experiences in the Crimean War, had exaggerated the gravity of wounds to the pelvis. Mortality and morbidity of these types of injuries was actually better in the Civil War than the Crimean War, and Dr. Herr concludes that surgeons — North and South — must have been doing something right. He also points out that the eagerness of surgeons to share their recently acquired insight was evident in the postwar formation of medical societies, which helped to improve the quality of American medicine.

Maintaining the quality of care during the Civil War tested the resourcefulness of the South as it strove, in the face of an increasingly effective blockade, to supply its troops with medicines. Guy R. Hasegawa, a specialist in Civil War pharmacy and medical purveying, uses an array of primary source materials to describe how the Confederate Medical Department turned to internal resources — animal, vegetable, and mineral — to produce drugs. Hopes were high that medicines derived from Southern plants, in particular, would adequately fill in for standard drugs that were too scarce or expensive to purchase and issue in large quantities. Newspaper notices placed by medical officers called on citizens to collect native medicinal plants and deliver them to army-operated facilities for processing.

In examining the selection of plants to be gathered, Dr. Hasegawa questions the real influence of Resources of the Southern Field and Forests, a book credited by some historians with “maintaining the Southern war effort for many months longer than if it had not been written.” A factor complicating the use of Southern flora was the reluctance of some medical personnel to use plant-based remedies that they associated with unconventional or fringe practitioners. Mined materials, such as sulfur and iron pyrites, were used in chemical processes necessary to manufacture ether and chloroform. Citizens even gathered potato flies, which were dried and ground for use as a blistering agent.(6)

The production of Southern drugs was spearheaded by Surgeon General Moore, whose belief in the vital role of native plants resembled, according to one observer, an obsession. Moore and his medical purveyors sought the cooperation of other organizations active in the war effort—-the Nitre and Mining Bureau and the Navy, for example—-and were quick to enlist the assistance of experts in the various branches of science necessary to manufacture medicines. Thus, scientific and inventive ability, a quality discussed in the chapters by Jim Schmidt and Terry Hambrecht, was especially evident in the army drug-manufacturing facilities.

Moore’s reliance on talented botanists, chemists, and pharmacists was only one aspect of an impressive record of Confederate scientific collaboration. Likewise, in Northern hospitals, an expert research team of three military surgeons revolutionized our knowledge of neurology. In his contribution, D. J. Canale describes how “American neurology was cradled and developed in the army during the Civil War” by S. Weir Mitchell and his coworkers George R. Morehouse and W.W. Keen, who took advantage of the unique opportunities that the Civil War afforded for the study of diseases and injuries of the nervous system.

During the Civil War, Mitchell served as a contract army surgeon and persuaded his friend Surgeon General William Hammond to open a center specializing in the treatment of injuries to the nervous system at Turner’s Lane Hospital in Philadelphia. There, Mitchell, Keen, and Morehouse performed important clinical research on nerve injuries. Their research culminated in the publication in 1864 of Gunshot Wounds and Other Injuries of Nerves, which Canale describes as “one of the acknowledged classics of nineteenth-century American medicine.”

Mitchell’s postwar writing — drawn from his experiences as a Union surgeon — also made him a famed literary figure, and one of his best-known stories is “The Case of George Dedlow,” first published anonymously in The Atlantic Monthly in July 1866. It has since become a classic of American literature and medicine. Dr. Canale confirms the conventional wisdom that Mitchell used the fictional story of Dedlow, a quadruple amputee, to introduce the interesting “phantom limb” syndrome — the sensation, after amputation, that the absent part is still present — in a popular magazine before it was widely recognized in the medical literature of the day. Dr. Canale also concludes that Mitchell used the story as vehicle to describe many other important consequences of medical care in the Civil War.

For tens of thousands of veterans, amputation was no fiction. Others continued to bear the pain from wartime wounds for many years, and more still were permanently weakened from the long marches, inadequate diets, or disease. Many veterans — to all appearances healthy on the outside — bore emotional and mental scars every bit as debilitating as their comrades’ physical ones. In her contribution, Dr. Andersen describes that, during the Civil War, surgeons were beginning to recognize psychological disorders (“nervous diseases”) in soldiers, ranging from simple homesickness to more severe cases categorized as “nostalgia” or “soldier’s heart,” which were marked by troubled sleep, poor appetite, erratic behavior, and even death.

Unfortunately, as a substance abuse expert with the U. S. Army recently noted, physicians of the time “had primitive notions of mental illness . . . psychiatry and neurology were just being born around this time, and they have changed a lot [since] . . . there was no agreed-upon nomenclature and no precision in diagnoses.” In fact, one historian recently suggested that “doctors, sensitive to the demands of masculine dignity, were hard-pressed to come up with ‘inoffensive terminology.’”(7)

Certainly, our attitudes about “combat neuroses” have matured over time, and we take for granted that psychiatric casualties are an inevitable feature of warfare. It should be no surprise that Civil War veterans carried their “invisible wounds” into civilian life. Anecdotal evidence of problems in Civil War veterans abounds: divorce, domestic abuse, alcoholism, drug addiction, and more. Still, it was only recently that clinical evidence of “posttraumatic stress disorder” in Civil War veterans was verified by mental health professionals. The publication of that evidence in the February 2006 issue of Archives of General Psychiatry received widespread attention, not just in the mental health community but also in the mass media — TV, radio, magazines, and newspapers — from America to Australia.

Dr. Judith [Pizarro] Andersen, the lead author of that landmark report, has contributed a chapter on the mental health of Civil War soldiers and veterans. She draws on both anecdotal and statistical evidence to arrive at some interesting conclusions: Nearly two in five Civil War veterans later developed both mental and physical ailments, and soldiers who enlisted between the ages of nine and seventeen were nearly twice as likely as their older peers to suffer disorders. Furthermore, the percentage of a soldier’s company killed — on the battlefield or by disease — was also a significant predictor of later problems, presumably serving as a marker for traumas such as witnessing death, handling dead bodies, and losing comrades. The facts support General William Tecumseh Sherman’s oft-quoted aphorism: “There is many a boy here today who looks on war as all glory, but, boys, it is all hell.”

As important as asking when the story of Civil War medicine begins is the companion question as to when the story ends. It is too easy — and unsatisfying — to state that the story ends with the surrender at Appomattox, nor do the facts support this view. Harewood Hospital in Washington, D.C., didn’t shut its doors until a year later. The compilation of statistics, surgeons’ reports, and case studies that culminated in the landmark Medical and Surgical History of the War of the Rebellion lasted until the late 1880s. President Abraham Lincoln’s declaration that the nation should “care for him who shall have borne the battle” resulted in a strong political lobby on behalf of veterans that crafted and expanded a pension system over the following decades.

The expert and lively contributions to this book demonstrate that the Civil War itself did encompass “years of change and suffering.” They also prove that the opportunity to examine the medical aspects of the war still exists to this day: Biographies of men, women, and institutions remain to be studied and written, and archives and primary source material remain unexplored and uninterpreted. Furthermore, this book will expose interested readers and scholars to a significant body of relevant literature and other source material that they may not have considered.

Thankfully, there has been a shift in attitudes among informed Civil War enthusiasts towards that conflict’s medical casualties, their caregivers, and the challenges they all faced. Nevertheless, the myths and misinformation that still prevail among the general public indicate that there is still work to be done. We — as contributors to Years of Change and Suffering: Modern Perspectives on Civil War Medicine — happily and humbly take up that task.

Endnotes

(6) Resources of the Southern Fields and Forests (San Francisco: Norman Publishing, 1991), vii.

(7) “had primitive notions . . . ” in Aaron Levin, “Civil War Trauma Led to Combination of Nervous and Physical Disease,” Psychiatric News, 41 (2006): 2; “doctors, sensitive to the demands . . . ” in Jennifer Travis, Wounded Hearts: Masculinity, Law, and Literature in American Culture (Chapel Hill: University of North Carolina Press, 2005), 31.

EXCERPT #1 from "Years of Change and Suffering"! - INTRODUCTION (Part I)

I am happy to announce some milestones for my second book, Years of Change and Suffering: Modern Perspectives on Civil War Medicine (Edinborough Press), a co-edited (with Guy R. Hasegawa, Pharm. D.) collection of invited expert essays:

• (1) The softcover edition is now available and for those of you who prefer hardcovers, it is still available as well!


• (2) We have passed the 500 fan mark for Years of Change on the book's Facebook page!

To celebrate, I will be posting some excerpts from the book over the next few days and finishing with a BOOK GIVEWAY CONTEST!

Remember - all royalties from the book are being donated to Civil War medical heritage preservation!

Below is the first excerpt - the first part of the Introduction. Enjoy!

Years of Change and Suffering:

Modern Perspectives on Civil War Medicine

INTRODUCTION

by James M. Schmidt and Guy R. Hasegawa

(Copyright 2009, the authors)

Where does the story of Civil War medicine begin? For more than two hundred Southern students studying among Philadelphia’s several medical colleges, it began with the hanging of abolitionist firebrand John Brown on December 2, 1859. Not only was Brown’s execution a pivotal event in the road to disunion of the United States of America, the episode — and subsequent fisticuffs between abolitionists and Southerners in the “City of Brotherly Love” — proved to be the impetus for the students to “secede” and finish their studies at home, most at Richmond’s Medical College of Virginia.

The press reacted to the episode with surprisingly mixed reporting on both sides of the Mason-Dixon Line. One Iowa paper declared that the “Southern ‘deputy saw bones’” did “a very foolish thing, for the Philadelphia medical schools are the best in the United States.” Another Northern paper — rejoicing at the departures — suggested that “300 ignorant doctors let loose in the South might be as destructive of life as a ‘Brown Invasion.’” The Lancaster Intelligencer, however, found the Southern students “intelligent young men . . . universally esteemed by the great mass of our citizens,” and thought them justly “indignant at the . . . mad fanatics of the North, especially those residing in Philadelphia.”(1)

In Richmond, the Enquirer declared the exodus “Good News for Richmond and the South” and an “important step for building up our Medical College and aiding in the independence of the South.” The Richmond Whig, though, railed against the city council for subsidizing the exodus with $5,000 to meet the extra expenses of the students, scoffed at the notion that the students were “constrained” to leave the North, and considered the whole affair “absurd and foolish.” On December 22, 1859, the students arrived by train in Richmond, where they were greeted by “an immense throng of citizens . . . the shouts of the men were deafening, which the ladies manifested by the waving of their handkerchiefs.”(2)

It is with the arrival of the students in Richmond that Jodi Koste begins “Medical School for a Nation,” in which she describes the transformation of the Medical College of Virginia (MCV) from “a sleepy state institution into the premier medical school for the nascent Confederate nation.” Drawing on substantial material from MCV’s archives — of which she is the steward — she proposes that the school’s location in the Confederate capital, a stable faculty, and a newly constructed hospital all helped to propel the college to a place of prominence, while other Southern medical schools were forced to close. More important, she argues that the school’s war experience “gave the faculty chances to provide clinical instruction and undertake new professional activities,” which — when combined with the traditional curriculum — enhanced the experience for the repatriated students and helped to “catapult MCV to ‘first in the Confederacy.’”

Once the Civil War began in earnest, inventors on both sides of the Mason-Dixon Line set their minds and tools to work and — as one Northern newspaper declared — directed “their attention forthwith to the improvement of all sorts of instrumentalities.” So confident was the paper in the preeminence of “Yankee ingenuity” that it predicted that Union masterminds would “produce some patent Secession-Excavator, some Traitor-Annhilator, some Rebel-Thrasher, some Confederate State Milling Machine, which will grind through, shell out, or slice up this war, as if it were a bushel of wheat or an ear of corn or a big apple.”(3)

During the Civil War, Scientific American — America’s oldest continuously published magazine — played an important role by fostering and reporting on inventions that had an impact on the battlefields and waters. Not surprisingly, wartime issues of Scientific American have been used as resources in modern studies of mid-nineteenth century military technology. In his contribution, “A Multitude of Ingenious Articles,” Jim Schmidt — a chemist by training and profession — alerts readers to a lesser-known fact: Scientific American played an equally important role in fostering the “healing arts” by advising leaders how to maintain the health of the army and urging inventors to give attention to unmet medical needs. The magazine also reported on advances in medical technologies, including ambulances, medicines, and artificial arms and legs.

Schmidt acknowledges that it is “impossible to separate weaponry from medicine in the Civil War, as arms were responsible for hundreds of thousands of deaths and many more thousands of wounds on the battlefields,” and readers will be surprised to see how weapons of the future, especially chemical and biological, began to emerge during the war. He also contends that study of Scientific American’s wartime pages supports recent historical scholarship in the economics and social impact of invention in the nineteenth century, including the increase in patenting activity by women, the danger of relying solely on patent counts as a measure of inventive activity, and the effect that professional ethics had in restricting patenting activity in the medical community.

One invention that had a tremendous impact on Civil War tactics and medicine was not a new one at all: the Minié bullet, introduced about fifteen years earlier by the French army officer Claude-Etienne Minié in the late 1840s. The “minnie ball” — as it was often referred to by soldiers — was not a ball at all, but rather a connoidal projectile that proved to be a powerful missile, indeed, when fired through a rifled barrel, Civil War surgeons quickly recognized from battlefield experience that the Minié was “much the more destructive” compared with the round ball fired from a smoothbore musket, a fact reinforced by very recent research using ordnance gelatin to examine the wound ballistics of the Minié. The force of the bullet caused tremendous injury to soft tissue and even worse damage when it struck bone, with amputation in such cases often offering the only chance of saving the life of a patient.(4)

It is ironic, then, that if asked to conjure up a picture of Civil War medical practice, many people today imagine callous surgeons indiscriminately hacking limbs off of soldiers whose only medication was a swig of whiskey. Even during the Civil War, the increasingly common sight of amputees led many citizens to conclude that limbs were being removed too often. Medical treatment, including amputation, has been called one of the Civil War’s “most dismal failures,” when in fact it was the most frequent major operative procedure that could be done successfully, and — contrary to popular belief — patients undergoing amputation were almost always anesthetized with chloroform or ether.(5)

Amputation is the topic of the chapter by Alfred Jay Bollet, author of the modern classic survey Civil War Medicine: Challenges and Triumphs. Dr. Bollet draws on his far-ranging expertise in medical history — and a distinguished career in clinical practice and medical education — to provide the proper context in which to consider amputations. Although there were concerns that many amputations were unneeded or incompetently performed, some expert observers of the time contended that more soldiers would have survived had the procedure been carried out more often. Dr. Bollet points out that care provided during the Civil War was sometimes superior to that rendered in the Crimean War and Franco-Prussian War, which occurred in the same era.

F. Terry Hambrecht’s contribution about Confederate surgeon J. J. Chisolm continues the theme of innovation introduced in Jim Schmidt’s chapter. While Chisolm is justly recognized for his editions of A Manual of Military Surgery for Use of Surgeons in the Confederate Army, Dr. Hambrecht adds to our current knowledge by drawing on previously unpublished material to characterize Chisolm as an innovator and man of action. Chisolm could hardly ask for a more fitting biographer than Dr. Hambrecht, who had a distinguished career as a director at the National Institutes of Health and pioneered research in prostheses for the neurologically disabled, including the blind, deaf, and paralyzed.

Dr. Hambrecht, a long-time researcher in Civil War medicine and an expert in Confederate medical personnel, shares his transcription of two letterbooks from 1861-1862 that show Chisolm constantly seeking to improve conditions for patients through his considerable skills as a physician, organizer, administrator, designer, inventor, and author. Chisolm treated sick and wounded soldiers, organized hospitals, served as a medical purveyor and director of a medical laboratory, invented or improved the design of medical apparatus, and wrote a major textbook used throughout the war by Confederate surgeons. He was not shy about making his frank opinions known to decision-makers, especially Confederate Surgeon General Samuel Preston Moore.

Dr. Hambrecht, in fact, considers Moore to be the only medical officer who might have matched Chisolm in improving Confederate medicine — high praise indeed for Chisolm, given the almost universal respect that historians have accorded Moore. Chisolm’s contributions to medicine continued after the war, notably as a pioneer in the specialty of ophthalmology. In 1887, Chisolm examined the young Helen Keller, advising her father (also a Confederate veteran) to take her to Alexander Graham Bell, who in turn introduced the family to “Miracle Worker” Annie Sullivan. Chisolm’s continued importance to the history of Civil War medicine is evident in the fact that he is mentioned or cited in three other chapters in this collection.

Endnotes:

(1) “Southern ‘deputy saw bones’ . . . ” in Burlington Weekly Hawk-Eye, December 31, 1859, p. 1; “300 ignorant doctors let . . . ” in Milwaukee Daily Sentinel, December 26, 1859, p.1; “intelligent young men . . . ” in Lancaster Intelligencer, December 27, 1859, p.2.

(2)“Good News for Richmond . . . ” as quoted in Lancaster Intelligencer, December 27, 1859, p. 2; “absurd and foolish . . . ” as quoted in the American Presbyterian, January 5, 1860, p. 3; “an immense throng of citizens . . . ” as quoted in Daily Morning Post, December 23, 1859, p. 1.

(3) Scientific American, August 3, 1861, p. 75.

(4) “much the more destructive” in J. Theodore Calhoun, “Rough Notes of an Army Surgeon’s Experience During the Great Rebellion,” Medical and Surgical Reporter, IX (1862): 303; Paul J. Dougherty and Herbert C. Eidt, “Wound Ballistics: Minie ball vs. full Metal Jacketed Bullets — A Comparison of Civil War and Spanish-American War Firearms,” Military Medicine, 174 (2009): 403-407.

(5) James M. McPherson, Battle Cry of Freedom: The Civil War Era (New York: Oxford University Press, 2003), 486.

The Equation to Surviving Andersonville (Hint: Pr (S=1) = Φ(ß(1)F + ß(2)I)

A recent scientific article attracted my attention:

Costa DL and Kahn ME, "Health, wartime stress, and unit cohesion: evidence from Union Army veterans," Demography, Feb 2010 Feb, Vol. 47, No. 1, pp. 45-66 (abstract here; PDF here)

I contacted Dr. Dora Costa at UCLA for a copy of the article (which she kindly sent) and I am reading it now.

She also sent along another article which is especially interesting:

Costa DL and Kahn ME, "Surviving Andersonville: The Benefits of Social Networks in POW Camps," American Economic Review, 2007, 97(4): 1467-1487. (PDF here)

Readers are (gently) warned that the papers are heavy in mathematics and statistics, but the authors' arguments are fascinating, especially for the Andersonville paper. While there is obviously no true "equation" to explain survival, the heavy "ciphering" in the papers goes with the rigors of social science. Yet, the introduction, discussion of results, and conclusion of both papers are very readable.

As for the Andersonville paper: briefly, they conclude that being part of a "social network" (I don't mean Facebook...see here for a scientific definition) was a key factor in surviving the prison by analyzing a mountain of data from Union army service and pension records to identify variables that had a statistically significant impact on survival. It turns out, according to Drs. Costa and Kahn, that "In two independent datasets we found that friends had a statistically significant positive effect on survival probabilities, and that the closer the ties between friends as measured by such identifiers as ethnicity, kinship, and the same hometown, the bigger the effect."

The article crosses a number of economic and social science disciplines including aging studies, game theory, and others.

Look for an interview with Dr. Costa about her interesting research and conclusions in my "Medical Department" column in The Civil War News in the coming months!

The Sable Arm of the Civil War - New Medical Research

I have posted previously about some excellent books on medical aspects of African-Americans in the Civil War, including Dr. Robert G. Slawson's short - but informative - Prologue to Change: African Americans in Medicine in the Civil War Era and Margaret Humphreys' excellent Intensely Human: The Health of the Black Soldier in the American Civil War.

There has been some great new scholarly work published recently (or forthcoming) on the topic that deserve attention:

1) Sven E. Wilson - "PREJUDICE & POLICY: Racial Discrimination in the Union Army Disability Pension System, 1865-1906," American Journal of Public Health, April 1, 2010; Vol. 100, Suppl 1, pp.S56-65.

You can read an informative press release here and the abstract here.

2) Stephen C. Kenny, "'A Dictate of Both Interest and Mercy'? Slave Hospitals in the Antebellum South," Journal of the History of Medicine and Allied Sciences, January 2010, Vol. 65, No. 1, pp. 1-47. You can read the abstract here.

3) Available now is Practicing Medicine in a Black Regiment The Civil War Diary of Burt G. Wilder, 55th Massachusetts edited by Richard M. Reid.

4) Coming soon - and related to Dr. Wilson's article above - is: Race, Ethnicity, and the Treatment of Disability in Post-Civil War America by Larry M. Logue and Peter Blanck. You can read my previous interview with Dr. Blanck here.

Look for more information on these titles in my "Medical Department" columns in The Civil War News!