Civil War Hospital Ship

The U.S.S. Red Rover, a captured Confederate vessel, was refitted as a hospital ship.

Evolution of Civil War Nursing

The evolution of the nursing profession in America was accelerated by the Civil War.

The Practice of Surgery

Amputations were the most common surgery performed during the Civil War.

Army Medical Museum and Library

Surgeon-General William Hammond established The Army Medical Museum in 1862. It was the first federal medical research facility.

Civil War Amputation Kit

Many Civil War surgical instruments had handles of bone, wood or ivory. They were never sterilized.

Monday, May 2, 2016

Dover's Powder

By Verner Stillner, 2001

Dover's Powder, developed and described by the British physician Thomas Dover in 1732, was one of the more popular and enduring of the opium-based medications that were widely used in the United States and Europe prior to the twentieth century. The medication combined Opium with what we know today as ipecac (ipecacuanha), a substance that induces vomiting. The result was a pain-reducing potion that might induce a sense of euphoria but could not be ingested in large quantities because of its emetic properties. Taken as a nonprescription medicine by the general public for over 200 years, it was also prescribed by physicians for home and hospital use. Versions of the preparation are still listed in pharmaceutical formularies in which "Dover's Powder" commonly denotes any opium-based mixture that includes ipecacuanha. The wide use of Dover's Powder declined in the early 1900s largely because of the addiction that resulted from the prolonged use of Opiates, because of the introduction of other nonaddicting Analgesics (painkillers), mainly aspirin, and because of laws regulating sales of opium products.

Thomas Dover (1662-1742) studied medicine at Oxford University in the 1680s. He claimed to have served an apprenticeship with Dr. Thomas Sydenham, the illustrious seventeenth-century practitioner and teacher, who originated the formula for Laudanum, another early and popular opium-based medicine. Dover practiced medicine for over fifty years, although during his lifetime he was more famous for his exploits as an adventurer and privateer. His involvement in the early slave trade and in the plundering of Spanish settlements off the coast of South America brought him fortune and fame. On one of his voyages he found the shipwrecked Alexander Selkirk, who, on being returned to London, created a sensation and was to become the inspiration for Daniel Defoe's Robinson Crusoe. Dover retired from his merchant sailing career a wealthy man, but poor investments led him to resume his medical career first in Gloucestershire and later in London.

In 1732, probably to attract patients to his new practice in London, Dover published An Ancient Physician's Legacy to His Country, one of the earliest medical treatises written for the general public. The book listed forty-two ailments with successful treatments used by Dover, and included the testimonial letters of many "cured" patients. The book enjoyed popular success and was reprinted eight times, the last in 1771, nearly thirty years after his death. One remedy described in the book, the use of mercury, earned him the nickname during his lifetime of the Quicksilver Doctor, but the formula for Dover's Powder, which appears unchanged in all eight editions, has proven to be his most enduring legacy. Appearing on page 18 of the original edition as a treatment for gout, the directions read:

"Take Opium one ounce, Salt-Petre and Tartar vitriolated each four ounces, Ipecacuana one ounce, Liquorish one ounce. Put the Salt Petre and Tartar into a red hot mortar, stirring them with a spoon until they have done flaming. Then powder them very fine; after that slice your opium, grind them into powder, and then mix the other powders with these. Dose from forty to sixty or seventy grains in a glass of white wine Posset going to bed, covering up warm and drinking a quart or three pints of the Posset—Drink while sweating."

Dover's familiarity with opium most probably resulted from his association with Thomas Sydenham and thereby his acquaintance with the benefits of laudanum (an alcoholic tincture of opium). Dover's ingenious use of opium with ipecacuanha seems to have been original. His unique formula, Pulvis Ipecacuanha Compositus, with its specificity of ingredients, produced a relatively reliable and consistent potion in an era when there was no regulation of medications and little standardization in their preparation. Medications could be purchased at apothecary shops with or without doctors' prescriptions or at back-street stores that sold drugs along with food, clothing, and other necessities of life. The major issue at the time in the use of opiate-based medications was not that they contained what we now know to be a Narcotic, but whether the consistency of the formula or the misuse by the patient caused overdoses of what could be poisonous ingredients. Dover's Powder provided a stable product that, because of the ipecacuanha, could not be taken in excess at any one time. The powder came to be trusted by the general public and widely prescribed by physicians. It was considered such a safe remedy that it was even prescribed for children.

Although Dover originated his powder as treatment for gout, it was used throughout the eighteenth and nineteenth centuries along with many other opium-based patent and official preparations by large numbers of people for a wide variety of disorders. Opium, used as a healing plant for over 6,000 years, was an ingredient in countless formulas that were openly available and credited with curing the most common disorders of the time. Mixed in a tincture, it was found in laudanum; in a camphorated formula it became Paregoric; and it was also included in preparations for lozenges, plasters, enemas, liniments, and other general medications.

Opium-based medicines were used for many disorders, including insomnia, diarrhea, bronchitis, tuberculosis, chronic headache, insanity, menstrual disorders, pain, malaria, syphilis, and smallpox. Often both physicians and patients mistook its narcotic properties, which relieved pain and created a sense of well-being, as curative rather than palliative, and little was understood of the darker side of opiate medications—the destructive nature of addiction—until well into the nineteenth century. By this time, it was common for middle- and upper-class people, especially women and those with chronic diseases, to be addicted to opiates that were frequently seen in innocuous health elixirs or in remedies that had been originally prescribed by physicians. Widespread prescribing by physicians and easy availability of the opiate medications made addiction a frequent result of medical therapeutics.

By the middle of the nineteenth century, the issue of opium addiction began to appear with more frequency in the medical literature, and in both the United States and England there were pressures to regulate both the pharmacy trade and the use of narcotic medications, especially the patent medicines containing opiates. Even then, it was not until the end of the century—as a result of better education of physicians and pharmacists, advances in diagnosis and therapeutics, and a growing understanding of the nature of addiction—that opium-based medications were supplanted by other curative treatments and by nonaddictive salicylate analgesics such as aspirin. Opium-based medicines used today, such as Mor-Phine and Codeine, are government-regulated and can be purchased legally only by prescription.

Dover's Powder in its original form is now an obsolete medication. It should be recognized for its place in the history of pharmacology as a relatively reputable medicine used from 1732 until the 1930s, an era in which opium-based medications were one of the few remedies that brought relief to suffering patients. Many of these medications came to be misused by both patients and physicians who had little understanding of addiction and few options for Pain relief. Thomas Dover, seen as an adventurer and opportunist by many during his lifetime, developed a preparation that allowed patients to use a narcotic while limiting its ingestion. More precise knowledge of the healing as well as the addictive properties of narcotics allows modern physicians and pharmacologists to deal specifically with the dosage of narcotic medications. Nevertheless, Dover's Powder, an ingenious and effective solution to a thorny problem, became a household name long after its originator's medical career had ended and his medical treatise had been published.

Berridge, V., & Edwards, G. (1981). Opium and the people: Opiate use in nineteenth century England. London: Allen Lane.

Boyes, J. H. (1931). Dover's Powder and Robinson Crusoe. New England Journal of Medicine, 204, 440-443.

Courtwright, D. T. (1982). Darkparadise: Opiate addiction in America before 1940. Cambridge, MA: Harvard University Press.

Duke, M. (1985). Thomas Dover—physician, pirate and powder, as seen through the looking glass of the 20th-century physician. Connecticut Medicine, 49, 179-182.

Osler, W. (1896). Thomas Dover, M. B. (of Dover's Powder), physician and buccaneer. Bulletin of the Johns Hopkins Hospital, 7, 1-6.

From: encyclopedia.com

Civil War: Civil Treatment on the Battlefield

By Michael Franco

While the Revolutionary War established the precedent for the proper treatment of soldiers, the Civil War truly advanced first aid on the battlefield. This is due in large part to a man named Jonathan Letterman, who became known as the Father of Modern Battlefield Medicine.

After it took one week to remove wounded soldiers from the battlefield at the second Battle of Bull Run in the summer of 1862, General George McClellan gave Letterman, who was the assistant surgeon of the Army medical department, the freedom to do whatever it took to provide the men the care they deserved.

Letterman didn't waste any time. He created the country's first ambulance corps that consisted of a multi-stage process in which men would run onto the field during battle, retrieve the wounded and get them to a field-dressing station where his new system of triage -- in which men were tended to based on their likelihood to live or die -- was used. From there, men were moved to a field hospital -- usually a nearby home or barn -- if necessary and eventually to a large offsite hospital where they could receive long-term treatment without the chaos of battle raging around them.

The new, multi-step process where soldiers were given first aid directly on the battlefield was tested at the Battle of Antietam in September 1862. It was a resounding success as medical personnel were able to remove all of the wounded from the field within 24 hours. Letterman's system was successful at both the Battle of Fredericksburg and the Battle of Gettysburg, where thousands of wounded soldiers' lives were saved. His system was subsequently adopted for the U.S. Army by an Act of Congress in March of 1864.

Image: In 1864, battlefield first aid was performed in triage stations, like this one in the camp of the chief ambulance officer of the 9th Army Corps near Petersburg, Va.

From: health.howstuffworks.com

History of Dengue

From: denguevirusnet.com

The origins of the word dengue are not clear, but one theory is that it is derived from the Swahili phrase "Ka-dinga pepo", meaning "cramp-like seizure caused by an evil spirit". The Swahili word "dinga" may possibly have its origin in the Spanish word "dengue" meaning fastidious or careful, which would describe the gait of a person suffering the bone pain of dengue fever. Alternatively, the use of the Spanish word may derive from the similar-sounding Swahili. Slaves in the West Indies who contracted dengue were said to have the posture and gait of a dandy, and the disease was known as "Dandy Fever".

The first record of a case of probable dengue fever is in a Chinese medical encyclopedia from the Jin Dynasty (265–420 AD) which referred to a “water poison” associated with flying insects. The first recognized Dengue epidemics occurred almost simultaneously in Asia, Africa, and North America in the 1780s, shortly after the identification and naming of the disease in 1779. The first confirmed case report dates from 1789 and is by Benjamin Rush, who coined the term "breakbone fever" because of the symptoms of myalgia and arthralgia.

The viral etiology and the transmission by mosquitoes were only deciphered in the 20th century. The socioeconomic impact of World War II resulted in increased spread globally (see also Dengue epidemiology). Nowadays, about 2.5 billion people, or 40% of the world’s population, live in areas where there is a risk of dengue transmission (see figure 1). Dengue spread to more than 100 countries in Asia, the Pacific, the Americas, Africa, and the Caribbean.

Possible factors for dengue fever spread include:

  Unplanned urban overpopulation of areas leading to inadequate housing and public health systems (water, sewerage and waste management)

  Poor vector control, e.g., stagnant pools of water for mosquito breeding

  Climate change and viral evolution (increased virus transmission has been linked to El Nino conditions)

  Increased international travel (recreational, business or military) to endemic areas

All of these factors must be addressed to control the spread of dengue. Unplanned urbanization is believed to have had the largest impact on disease amplification in individual countries, whereas travel is believed to have had the largest impact on global spread.

Scurvy: By the End, Death is a Mercy

By Annetta Black, 5-1-12

Identified by Hippocrates and by the Egyptians as early as 1550 BC, Scurvy was originally a relatively rare and mysterious ailment which struck on land during long campaigns and overland journeys when fresh provisions failed.

Caused by a lack of Vitamin C in the diet, with the notable exception of humans and the guinea pig, most plant and animal species synthesize vitamin C, and do not require it in the diet, but we do. Which, as it turns out, is a real problem.

But let's begin at the beginning, and meet that strange beast known as:

“Land Scurvy” Curse of the Crusaders!
Dec 1217 - While the Crusaders trudged through in Egypt: “..Soldiers with violent pains in the feet and ankles, their gums became swollen, their teeth loose and useless, while their hips and shin bones first turn black and putrefied. Finally, an easy and peaceful death, like a gentle sleep, put an end to their suffering.”

Later between 1249 and 1254, while Jean de Joinville traveled with the 7th Crusade he wrote: “the disorder I spoke of very soon increased so much in the army that the barbers were forced to cut away very large pieces of flesh from the gums to enable their patients to eat..”

But while the "land scurvy" of the crusades was bad, Scurvy's true golden age was about to begin...

“Purpura Nautica:” An Age of Discovery - and not all of them good.
Scurvy, once rare, flourished with the advent of long sea voyages of trade, discovery & conquest. Scurvy takes approximately six weeks to set it, and on month long voyages, it struck down entire crews. There are stories of Spanish galleons found floating, staffed only by the dead. The disease was nicknamed “purpura nautica” for the purplish bruises that served as the first indication of the disease. An estimated two million sailors died of scurvy between 1500-1800.

Among those lose to scurvy were Vasco de Gama in 1499 claiming 116 to 170 men. In 1520, Magellan’s round the world journey was wracked by scurvy, claiming most of the men not left to fend for themselves on a distant shore or killed by natives in the final battle. His voyage returned with only 18 out of the 230 men who originally set sail. Score one for scurvy.

This of course, was a big problem. Not just for the sailors but for the monarchs who were bankrolling them. Exploration is expensive, and governments, military and individual physicians began exploring the possible causes and cures. Luckily as early as 1593, Admiral Richard Hawkins recommended the use of citrus as an preventative measure! Score one for sailors!

In 1614, The East India Company published a pamphlet titled “The Surgeon’s Mate” which also prescribed fresh food, citrus.... and sulfuric acid. By the early 1700s saw a general increase in the knowledge that fresh foods & citrus... or possibly acids, helped the situation, but the specific cause was still a mystery and hotly contested.

In 1747 the Scottish physician James Lind conducted what is widely considered to be the first example of a clinical trial wherein he tested alleged cures on 12 scurvy-ridden sailors. They were divided into teams of two and each given a course of one of the following :

• cider  • sulfuric acid  • vinegar  • seawater  • oranges & lemons   • spices and barley water

The ambitious program was cut a bit short when they ran out of fruit in just 6 days, but by then the indications of success were clear for Team Orange/lemon. Less so for Team Seawater and Team Sulfuric Acid.

Lind published his findings in 1753 in “A Treatise on Scurvy”, but died before he could see his advice widely adopted. Following this discovery, the British military slowly began to invest in antiscorbutics. James Cook packed watercress seeds for his second epic voyage of 1772-1775 and suffered virtually no scurvy. In 1794 the Suffolk administered rations of lemon juice and had no scurvy. This was no small thing: During the preceding century scurvy had caused more losses in the British navy than were suffered in ALL enemy action.

In 1953, the British Navy Surgeon & Vace Admiral Sir Sheldon Dudley said: “The application of Lind’s recommendations suddenly killed naval scurvy in 1795...intelligent naval senior executive officers asserted that this event was the aquivelent of doubling the fighting force of the navy... it is no idle fancy to assert that Lind, as much as Nelson, broke the power of Napoleon.” Success! No more scurvy forever...right?

Limeys: When it all started to go downhill:
The British establishment grasped onto the concept of citrus, and then did it really really wrong. First, they substituted cheap and easy to get limes - readily available from British holdings in the Caribbean - for the more effective lemons or oranges. Then they further boiled the limes in copper vessels, which had the non-helpful side effect of reducing the (thus far unknown) Vitamin C content even further.

People began to suspect that perhaps this whole citrus thing was not as effective as it had been claimed. Of course by then steam engines in ships brought the age of sail and voyages of longer than 6 weeks to an end. Semi-success-via-roundabout-ways!

Of course, there was still a few very long sea voyages that those Victorians had left to make...

The Arctic: At least the blood freezes?
By the time the Race for the Poles began at the turn of the 19th/20th centuries, scurvy became a deadly problem once more. Despite all of the work of previous generations, Arctic & Antarctic expeditions set out to the icy wasteland armed with poorly tinned food, pemmican, hard tack, tea and whiskey.

The complete failure of John Franklin’s ill-fated third arctic expedition in 1847 has been partially blamed on scurvy.

Robert Falcon Scott’s 1903 and 1911 expeditions were both struck with the disease. His description: “The symptoms of scurvy do not necessarily occur in a regular order, but generally the first sign is an inflamed, swollen condition of the gums. The whitish pink tinge next the teeth is replaced by an angry red; as the disease gains ground the gums become more spongy and turn to a purplish colour, the teeth become loose and the gums sore. Spots appear on the legs, and pain is felt in old wounds and bruises; later, from a slight oedema, the legs, and then the arms, swell to a great size and become blackened behind the joints. After this the patient is soon incapacitated, and the last horrible stages of the disease set in, from which death is a merciful release.“

Arctic explorer Vilhjalmur Stefansson noted that native Inuits did not suffer from scurvy, despite a lack of access to citrus and other similar known cures. It turned out that raw seal meat and blubber provide enough Vitamin C to prevent scurvy. A good day for arctic explorers.

It wasn't until 1927 that the cause and cure were finally discovered by Hungarian biochemist Szent-Györgyi (who won the 1937 Nobel Prize for Medicine), and the conclusive proof of ascorbic acid’s efficiency was not proven conclusively until 1932.

Modern Day
Now that the cause and cure are understood, and the cure readily available to most humans, scurvy should be firmly a thing of the past. But unfortunately it’s not - in inner cities and third world countries alike, scurvy continues to strike, particularly amongst poor children. Because scurvy is now so rare, and the effects in mild cases are confusable with other disorders, it is often misunderstood and ignored. More education and access to healthy foods for poor children is needed.

But finally you must ask yourself this, is that really gum disease you have...or is it SCURVY?

From: atlasobscura.com

Kate Cumming Nurses The Wounded After Chickamauga

 From: civilwarhome.com

Kate Cumming was born in Scotland but came to Alabama as a girl, and was passionately devoted to the South; when Virginia seceded, she records,she was "delirious with joy." At the outbreak of the war she offered her services as a nurse, and nursed faithfully from Cornith to the end. Her journal tells us how much nursing was a social affair rather than a medical, how much it depended on the help and generosity of the women of the South.
September 27 [1863 ].-A Methodist minister, Dr. Heustis, made a speech at the depot calling upon the people to send up food and nurses to Chickamauga, as General Bragg has gone after the enemy, and expects to recapture Chattanooga. All who could, went immediately to work to cook food to send off.
September 28.-This morning a meeting was held on the same subject, and Mrs. Johnston and I attended. Dr. Heustis' description of the sufferings of the men would have touched the heart of the most hardened. He said he could only tell us about our own men, and if they were suffering so much, we could guess what the prisoners were enduring. He said the principal thing needed was something to eat, and that if a basketful of biscuit were to be placed in one place where he saw some wounded men, that they would send up a shout of joy that would rend the air. He urged all who could possibly go with supplies, to do so immediately, but said there was no place there for ladies. The enemy had destroyed part of the railroad, and the wounded were taken to a place called the "Burnt Shed," some twenty miles from the battlefield, there to await transportation on the cars. Money was collected on the spot, and many promised provisions.
I made up my mind to go, though many begged me not to do so. Having friends in Ringgold, I knew I could not be very bad off; so collecting all the provisions and old linen I could, I started that afternoon....
The torn-up track to Ringgold had been relaid, so we went on to that place and arrived about dark. I found what had been the Bragg hospital filled with wounded men awaiting transportation. Oh, how sad and dreary all appeared! There was not a single light in the whole building, except that which came from a fire outside, around which stood several slightly wounded soldiers shivering from cold. The balconies were filled with wounded men, wrapped in their blankets, lying on the floors. I found one room full, where all were suffering for want of water. These men were waiting to be transported to the cars....

Early the next morning I hurried back to the hospital, where I was kept busy nearly all day rolling bandages. I was assisted by a young man, Mr. Dearing, from Kentucky, who was disabled by a wound in the arm. It was as much as we could do to supply the demands of the doctors. Rev. Mr. Green and my Negro servant were kept busy dressing wounds. We were seated on an upper gallery, where we could see the ambulances come in from the battlefield with their precious burdens. I saw as many as fifty come in at one time, and a dismal sight they presented. There had been no rain for some time, and the dust was so fearful that when the men were taken out of the wagons you could scarcely tell what color they were. Rolling bandages was a necessity, but it was a great trial for us, for we would so much rather have been waiting upon the wounded. At last we were told we had rolled enough for that day, and we gladly went down stairs to see what we could do.
Dr. Devine had wine and other delicacies sent to him for the soldiers from Mississippi, and he gave me an ample supply as I was leaving Newnan. I got a bucket, and nearly filling it with the wine, put in water and sugar, making a delicious drink. This, with eatables in a basket, Mr. Dearing. and I carried around, and it was highly appreciated by the men. The Mississippians were more than pleased on telling them where the wine came from. By this time the soldiers had been supplied with plenty of food, so were not suffering from hunger. We also visited the cars, which were standing on the tracks filled with wounded....
The next morning, the 30th, I arose bright and early, and hurriedly partaking of my breakfast, went to the hospital.... I had always wished to go on a battlefield-not from any idle curiosity, but from a desire to know the worst, and see if I could be of any use. While thinking over the matter, I met a Mrs. Weir, of Griffin, Ga., whose son had lost a leg in the battle, and was in a private house near the battlefield. She had come to nurse him, and said she would go with me to the battlefield if I would go out with her to see her son. Hundreds of wagons were coming in, but none returning that day. After awhile, a nice looking, covered private wagon came along, and after depositing its load of humanity, Mr. Dearing asked the owner to take us, but this, he stoutly refused to do, saying his horses were completely worn out. Mr. D. then said that one of the ladies had nursed, at least, one thousand Confederates. On hearing this, he immediately drew up and invited us all in....
We traveled over the roughest roads imaginable, and the thought occurred to me that if the wounded were brought this way they must indeed suffer. The surmise proved to be correct, for we met hundreds of wagons loaded with sufferers wending their way to Ringgold. We also saw many slightly wounded on foot going the same direction.
We left Mrs. Weir at Mr. Strickland's, where her son was, and Mr. Tedford begged me to go on further, to Mr. Hunt's, where were the wounded of Hindman's division. He informed me that an excellent young lady, Mr. Hunt's daughter, was doing much for the wounded, and would be glad of my assistance. The temptation was a great one, as I had never seen a field hospital; neither had I heard anything certain about my brother, and as he was in the same brigade, I felt assured I would hear something of him. On our way I met Dr. Ray going to see a brother, whom he had just heard was badly wounded. He and several other surgeons had been wandering about for two days looking for the hospitals. They had had nothing to cat except a pig, which they had "pressed." I think he said they had been at General Cleburn's division hospital, and the first day they were there they dressed the wounds of twelve hundred men. This seems almost incredible, but we have had many more wounded than killed, and all of the wounded of the enemy were left in our hands. He also informed me that at first they had no food for the men nor rags with which to dress their wounds. I promised to send them some rags and also to visit the hospital.
I found Mr. Hunt's home a very pretty cottage in the midst of a garden, which before the battle had been filled with fine shrubbery and flowers, but was now covered with tents, flies and sheds filled with wounded.... Every corner of the house was filled with wounded, many of them lying upon bunks made out of the branches of trees, a hard bed at any time, but much more so for these poor wounded veterans....
As we rode out of the yard, I tried to look neither to the right nor the left, for I knew that many eyes were sadly gazing at us from their comfortless sheds and tents. I could do nothing for the poor fellows, and when that is the case, I try to steel my heart against their sorrows. We could see the men cooking out in the pouring rain; a perfect war between the two elements, fire and water. All had a most cheerless aspect. As we rode on the tents of the various field hospitals came in view, and the thoughts of the inmates and their sufferings added to the gloom. I gazed in the direction of the battlefield and thought of the nameless dead who were there. A nation weeps for them; and on that day nature, like Rachel, was shedding tears for her children because they were not. The awful conflict which had so recently raged between brother and brother was vividly pictured to my mind. Oh! what a field of fratricide was there. It wrings from one the cry of the brave Falkland of old: "Peace! peace! when will it come?"

CUMMING, "Gleanings from Southland"

Erring Women's Refuge

By Mary Linehan

In 1863, 24 white, middle-class, Protestant women opened the refuge, which found a permanent home two years later at 3111 South Indiana. Challenging the legal and social inequity of the double standard of sexual morality which punished women—but not men—for extramarital sexual relations, they provided prostitutes the support and resources necessary to leave the sex industry: education, job training, obstetric care, and the influences of Christian motherhood. The philosophy of the home was revolutionary for its time, stressing the reformability of prostitutes and the transforming spiritual power of women. By 1890 the mission of the refuge had changed. The word “Erring” was dropped and the institution became a home for delinquent girls.

From: encyclopedia.chicagohistory.org


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