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Tuesday, September 24, 2013

Dermatology and Skin Disease in the American Civil War

Excerpted from highbeam.com

The American Civil War (1861-1865) took place at an interesting moment in the history of medicine and nursing. Only 5 years before, in the mid-1850s, the well-publicized medical disaster affecting British and French troops in the Crimean War had catalyzed a number of fundamental changes in military and civilian medical practice. Most visible were two innovations championed by the British reformer Florence Nightingale: (a) the introduction of professional, female nurses in the military hospitals and (b) an emphasis on sanitation in hospitals and in military camps. Nightingale's efforts culminated in the formation of the Royal Sanitary Commission, a civilian organization with broad authority over military hospitals. The Royal Sanitary Commission would later serve as the model for the United States Sanitary Commission during the American Civil War.

Much later, from the 1870s on, American medicine and nursing progressed rapidly, as advances in microbiology, aseptic surgery, histopathology, epidemiology, medical education, and professional nursing training--all directly influenced by American wartime medical experiences--propelled the United States into the unaccustomed position of medical world leader.

But in between the Crimean War and the medical boom of the latter third of the 19th century came the Civil War, and it is especially interesting to look back to the 1861-1865 period to find the early traces of our shared history of progress in medicine and in nursing in America. It is not an exaggeration to say that history still resonates in our modem practices. (Some examples: the helmet-like gauze compression dressing still used to bandage large scalp incisions is known as a Nightingale dressing, the American Red Cross is the direct descendent of the U.S. Sanitary Commission, and scabies and lice are treated with pyrethroids first used in the Civil War.)

There was a great deal of skin disease in America during the Civil War, the result of poor hygiene and sanitation, lack of knowledge of microbiology, displacement of civilian populations, and movement of the armies themselves, all of which allowed the spread of infectious diseases and infestations in particular. Table 1 lists the most common skin diseases reported in Federal (Union) soldiers during the war. Table 2 provides a smaller-scale look at skin diseases in a pair of Confederate hospitals in Atlanta. As can be seen in both tables, infections and infestations composed the majority of skin diseases.

It should be mentioned that these patients were not diagnosed and treated by dermatologists. Rather, their doctors were the army surgeons who, despite having little specialized knowledge of skin diseases, generally did the best they could for their patients. There were in fact only about one dozen dermatologists in America at the time of the Civil War, all in the north. There were no dermatologists in the states of the Confederacy, nor were there any military dermatologists in either army. Most of the treatment for skin diseases, such as it was, was administered by the nurses who labored in the army hospitals.

Visit www.CivilWarRx.com to learn more about Civil War medicine.

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