.

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, September 29, 2014

Cesarean Sections

From: historyengine.richmond.edu

On January 29th, 1822, Dr. Ebenezer Basset who was the town physician of Nassau, New York was abruptly interrupted by his medical assistant Jacob Kipp, who notified the doctor of their servant girl who was terribly ill. Braving the cold, Dr. Basset attended to the black servant girl who was lying in the snow with an unusually large cut on her abdomen and right next to her was a razor blade that was covered in blood. Upon further examining the youth of fourteen, Dr. Basset noticed and began to uncover a fetus hidden underneath the snow. Dr. Basset was in complete shock at what he had just witnessed. To his amazement, the youth of fourteen had just conducted a cesarean section on herself. After Dr. Basset recovered from his shock he sent Jacob Kipp to a neighboring town to retrieve Doctors Francis and Beck to help assess the situation.

Upon their arrival to the city of Nassau, Dr. Basset explained to his colleagues what had occurred. The three physicians began to treat the African American servant girl while making detailed notes of the procedure. The physician’s amazement is understandable given that cesarean sections were known about, but not widely used. Even more amazing, the procedure was a self-administered one. How could a black youth of fourteen perform such a complicated procedure on herself?

Historians have always claimed that cesarean sections had been performed by slaves who came from Africa to America. In fact, the first recorded successful cesarean section was performed in Colonial America. There is an account of a doctor in Virginia by the name of Dr. Jesse Bennett who on January 14th, 1794 performed the first cesarean section on his wife with the help and guidance of their slave who was well versed in the procedure of cesarean section. According to author Herbert M. Morais who wrote, The history of the Negro in medicine, African Americans had prior knowledge and used cesarean sections in Africa and brought that knowledge with them to the early colonies of America. Although the procedure was amazing to these white doctors, it would have not been foreign to black females in this era.

Did Stonewall Jackson Have Hypochondria?

From: uselectionatlas.org

General Thomas “Stonewall” Jackson was one of the most gifted commanders in U.S. History. But he has a dubious distinction that had haunted his legacy since the 1850’s; Jackson has been accused of being a hypochondriac.

Jackson had some strange distinctions:

1 He thought he was “out of balance” in battle if he didn’t raise one arm while on his horse. He said he wanted to, “Keep the blood balanced.”

2.He refused to have pepper on his food, stating it made his left leg weak.

3.Despite wartime shortage, Jackson would constantly suck on lemons because he felt it helped his “dyspepsia.”

4.His staff noticed his strange diet, some of his meals consisted of only raspberries, bread, and milk.

5.Jackson was only comfortable when he was in an upright position, and I mean standing straight up. He felt it helped his organs stand “naturally” one atop each other. For this reason he had no chairs in his study at Lexington, Virginia. He spent long hours reading the Bible or memorizing Virginia’s laws.

6.While on honeymoon with his second wife (seeing how his first wife had died) he took her to Eastern America so he could bath in the mineral spas to “improve my sagging bad health.”

7.Even while he was a plebe West Point, first classman Ulysses S. Grant called him a “fanatic” whose “delusions took strange forms- hypochondria, fancies that evil spirits had taken possession of him.”

8.Jackson offered some dietary advice to his sister Laura, “If you commence on this diet, remember it is like a man joining a temperance society, if he afterwards tastes liquor he is gone.”

9.His complaints listed almost endlessly through his young manhood: rheumatism, chilblains, poor eyesight (witch he treated by dipping his head in a vat of cold water, eyes open, for as long as he could hold his breath), cold feet, nervousness, neuralgia, impaired hearing, tonsillitis (which required surgery), biliousness and “slight distortion of the spine” as Jackson stated in the late 1840’s.

Because of these things it is now said Jackson was a hypochondriac. But modern physicians have stated that Jackson may have suffered from the fairly common and most uncomfortable diaphragmatic hernia. This is the theory of Dr. E.R. MacLennan of Opp, Alabama. He states that this hernia caused Jackson to suffer from his many body ailments.

Ironically Jackson’s habit of draping his abdomen with cold towels to heal his “dyspepsia” may have caused his death. Soon after the amputation of his left arm at Chancellorsville, cold towels were laid on his abdomen as Jackson did everyday. This may have led to his contraction of pneumonia that killed him.


Was Stonewall Jackson a Hypochondriac?

By Usha Hari

Stonewall Jackson, the Confederate general, was thought to be a hypochondriac. Even when his hand got wounded by a bullet during the First Battle of Bull Run, he kept his arm raised so that the blood might flow into his body. He avoided pepper in his food as he had a strange notion that it made his left leg weak. He was most comfortable in an upright standing posture so that all of his organs were aligned "naturally." He tried to cure his poor eyesight by keeping his head dipped into a basin of cold water with eyes open!

From: au.ibtimes.com

“King Alcohol is More Formidable than Tyrant Lincoln”

From: historyengine.richmond.edu

In 1862, throughout the war-ravaged Confederacy, the thoughts of all were turned to the War that tore apart the country.  The death and destruction that had already occurred seemed to foretell a conflict that would not soon be resolved.  In the midst of the fighting, soldiers struggled to remain vigilant and confident.  Romanticized visions of passionate soldiers, Confederates in particular, were created to motivate future as well as current soldiers to continue fighting “the good fight.”  An ideal soldier was one who fought bravely for a cause he believed in, and these beliefs were strengthened when God was on his side.  Thus religion and the strength of a soldier’s faith were often tied directly to his ability to prevail in battle.

An article in The Confederate Baptist entitled “Temperance in the Army” stated that there was evidence that the reason that battles had been lost was because of the drunkenness of the commanders.  Subsequent articles in the paper had already declared that God was on the side of the Confederacy; the postulation of a possible explanation of recent defeats looked to the soldiers themselves and their behavior while fighting for the Confederacy.  The author J.L. Reynolds looked to the experiences of other countries to teach a valuable lesson.  He cited the Madras Presidency, a part of present-day India, and the proportion of temperate men who died in battle to the number of drinkers who died in battle.  The number of temperate soldiers who died numbered 2,315.   The number of drinkers who died was 4,458.  According to Reynolds, “this proves that soldiers will be healthy in proportion to their temperance”.   Alcohol was “the bane of our soldiery,” and if use was not curbed immediately, the Confederacy, despite being divinely-ordained, would surely fall.

To bring these soldiers back to morality, religious revivals were often held in which missionaries traveled to soldiers’ camps to instill a renewed sense of faith.  These revivals also served to inspire the citizen morale that waned as the war dragged on and the death toll rose.  The temperance movement as a whole, however, was not an issue of great national or regional importance during the Civil War.  The Temperance Societies that had emerged in the decades prior had claimed millions of members but receded into the background as the nation faced a crisis of unprecedented proportions.

The Day in the Life of a Union Prisoner of War: Disease and Deprivation

From: historyengine.richmond.edu

The United States Sanitary Commission conducted a series of interviews following the conclusion of the Civil War. The Commission focused on the details of Union soldier's imprisonment during their service. The soldiers gave testimony as to their experience as a prisoner of war. The compilation of accounts details the suffering and privations of different soldiers both commissioned and non-commissioned officers.

Private Joseph Grider was sworn in and examined in Virginia by the Commission. He detailed his survival from both the Libby and Danville Prisons operated by the Confederate States of America. The main discussion elaborated on the health of Private Grider and the conditions in which he was held. Grider detailed the rations allotted to himself and his fellow prisoners of war; the main storyline revolved around the bread ration, a staple in the diet of Civil War soldiers. The bread was rough with whole grains; when he was moved to Danville he received black bread made of cane seed. Grider discussed the deterioration of his health as a result of the food rations and inadequate housing. The prisoners suffered from diarrhea and other ailments. One other area of interest from Grider's testimony involves the severity of punishment enforced by the Confederate guards; during his stay at Danville seven men were shot for out the window. Other punishments involved the holding of men in chambers until they 'fouled on the floor.'

Another testimony from Private Robert Morrison detailed the differences between Richmond, Pemberton, and Danville Confederate Prisons. Similar to Grider, he discussed the loss of personal items and the deprivation of clean and warm shelter during his early experiences in the prisons. The deprivation of healthy and clean food was another problem for Private Morrison. He noted the decline in his health as coinciding with his entrance into the prisoner of war encampments. Prior to his capture he did not have problems with diarrhea or fever; sickness did not take hold upon Morrison until he began eating the rations given to him by Confederate guards. Unlike Grider's testimony, Morrison detailed his final living quarters as warm, spacey with endless amounts of food and also access to a 'privy.'

The similarities between these two privates testimony is parallel when it comes to their experiences with food rationing. In many instances they expressed their opinion that it was contaminated or perhaps undercooked. Private Morrison stated, "I got a chunk of corn bread daily...sometimes it was about half baked." Dr. Joseph Jones, a witness in trial against Henry Wirz, 'formerly the commandant of the interior of the Confederate States military prison at Andersonville', shared this hypothesis stating, "As far as my experience extends, no person who had been reared on wheat bread, and who was held in captivity for any length of time, could retain his health and escape either scurvy or diarrhea, if confined to the Confederate ration (issued to the soldier in the field and hospital) of unbolted corn meal and bacon."

Interestingly enough, Confederate law decreed that all prisoners should have access to the same privilege and food rations as the Confederate Soldiers; this act was acknowledged by General Robert E. Lee himself in a letter to a relative stating, "The laws of the Confederate Congress and the orders of the War Department directed that the rations furnished prisoners of war should be the same in quantity and quality as those furnished enlisted men in the army of the Confederacy, and that the hospitals for prisoners should be placed on the same footing as other Confederate States hospitals in all respects." Whether this was an act of forbearance or an act of compassion it is easy to see, Union soldier in Confederate prisons suffered through disease and desperation similarly. Although this was an act in effect, prisons in the South failed to comply with all its' standards and requirements. William Best Hesseltine pointed out that the closing of the summer of 1863 brought about the halt of a cartel in which prisoners from both sides of the war were exchanged; this halt increased the number of mouths to feed and also the growing debt of the Confederacy. Prisoners in southern camps suffered the consequences of this halt. Hesseltine remarked that the quality and quantity of rations for prisoners especially at Libby prison decreased markedly as the days passed by and yet the officers continued to enjoy luxuries such as apples, sugar, eggs, molasses, and corn.



State-Supported Schools for the Blind for African-American Children

From: aph.org

The first school for blind children in the United States was chartered in 1829, in Boston. It was quickly followed by schools in New York, Pennsylvania, and Ohio. In these cities, as well as other Northern cities in which schools for the blind were established, black and white children attended the same classes.

In the South, however, racial attitudes, complicated by the institution of slavery, were much different. Slowly, after the close of the Civil War in 1865, the states in which slavery had been well established began to open departments or divisions for African-American children, usually in facilities separate from the school for white children. By the middle of the twentieth century, there were fifteen residential schools for African-American children who were blind: North Carolina, founded in 1869; Maryland, 1872; Tennessee, 1882; Georgia, 1882; South Carolina, 1883; Kentucky, 1884; Texas, 1887; Arkansas, 1889; Alabama, 1892; Florida, 1895; Oklahoma, 1909; Virginia, 1910; Louisiana, 1892; West Virginia, 1929; and Mississippi, 1951. Thus, as one Southern legislator remarked, "color was distinguished where no color was seen."

Ironically, in nineteenth century, separate schools for African-American children who were blind were viewed as a positive social reform and were encouraged as much by African- American leaders as by whites. Separate but equal education had been established as the law, and, for a while, it seemed to promise two flourishing societies, one white, one black, in the same country. The author of the entry on "blindness" in the 1918 Encyclopedia Americana observed:

In northern schools the colored blind are educated with the white; in Southern schools it is best for the colored to have schools of their own. Both the whites and they prefer this arrangement.

In the two decades following the Civil War, African-American leaders generally left unchallenged the existence of segregation in social programs. When they felt denied certain benefits, such as education for blind children, they demanded the establishment of separate programs. The Georgia Academy for the Blind responded to petitions from black churches when it proposed the "Negro Division" of the Georgia School for the Blind in 1881. A black legislator, Thomas A. Sykes, introduced the bill that provided the "Colored Department" for the Tennessee School for the Blind in Nashville, and in West Virginia, three black legislators pushed for the creation of a school to serve both the deaf and blind. In both Tennessee and Texas, where African-American women had taken on the task of teaching blind children in their own homes, the state formalized what already existing by making the women the matrons, or housemothers, of the new schools.

The ten schools founded in the nineteenth century were created as departments of the already-established schools for white children and were under the nominal rule of the white superintendent. Students were housed in separate campuses or separate buildings on the same campus. The five schools founded after the twentieth century--Oklahoma, Virginia, Louisiana, West Virginia, and Mississippi--had no ties with the white school.

As was true throughout the South, in the public schools, equipment, materials and facilities provided for African-American children who were blind were generally, although not always, inferior, and their education suffered, despite the efforts of excellent teachers and supportive families. In 1945, Charles Buell pointed out that the annual reports issued by the various schools "suggest to the reader that the education of the Negro is similar to that for the white students." Buell's exhaustive study of the curriculum of the schools for African-American blind children indicated "this theory is not put into practice." He found that the "colored departments," as a whole, spent more time on manual training, that science classes suffered for lack of laboratory equipment, that texts were outdated and inadequate, and that instruction was formal and not practical.

Buildings housing African-American students were sometimes unsafe and their furnishings bare, with "worn furniture, chipped crockery, and faded towels." A teacher at the Negro Department of the Florida School for the Deaf and Blind recalled, somewhat bitterly, "When a typewriter or a sewing machine got too old or broke on North Campus, they'd send it over to us." Margaret Johnson, who attended the whites-only school for the blind in Arkansas in the 1950s, remembers, even as a child, being appalled by the conditions at the black school, where the white students were bused for a Christmas concert. Their auditorium "had no stage and only straight-backed chairs." She also remembered feeling bad that the white school's worn-out books were sent to the Colored Department; "Why, the dots were so worn they could scarcely be read," she said.

In general, teacher-pupil ratios were higher in the African-American schools and teachers' salaries were lower. African-American teachers could not attend training courses offered at segregated universities, nor could they afford to attend similar institutions in the North. Enrolling children was also a problem. Not all African-American children who were blind attended the state schools, despite compulsory education laws. To identify students, an African-American superintendent would have had to visit places throughout the state, asking questions and checking public records--not a safe undertaking in the Jim Crow South.

In the 1940s, Helen Keller emphasized the needs of African-American children who were blind to a committee studying the public and private aid given to physically disabled students.

"In my travels up and down the continent I have visited their shabby school buildings . . . I have been shocked by the meagerness of their education . . . I feel it is a disgrace that in this great wealthy land, each injustice should exist to men and women of a different race--and blind at that!"

Her words were instrumental in prodding the state of Mississippi to establish a state school for African-American students who were blind. However, the battle for legislative support was intense, and the Mississippi School for the Negro Blind didn't open its doors to students until 1951—only three years before the ruling of the U.S. Supreme Court in Brown v. Board of Education signaled the end of segregated schools in the United States.

It was more the beginning of the end than the end itself. The process of integration took nearly twenty-five years and varied considerably by state. Some schools integrated peacefully, with little fanfare, whereas others dealt with lawsuits and threats, just as schools for sighted children. Some schools did not integrate until after the passage of the Civil Rights Act, in 1964. Other schools delayed integration into the 1970s. Among the first schools, sighted or blind, to be integrated in the United States were the Kentucky School for the Blind and the West Virginia School for the Blind, both in the summer of 1955. One of the last schools in the South to be integrated, sighted or blind, was the Louisiana School for the Blind, in 1978.

Even though classrooms were integrated in the North, some dormitories were not. In the 1940s, the Missouri School for the Blind had separate dormitories for white and blacks.

Change is slow. In a 1945 study of the "Education of the Negro Blind" in the United States, Charles Buell notes that an earlier study, done in the 1920s, "assumed that all Negroes desire segregated schools, but many leaders among the colored people have expressed the opposite point of view".

In Mississippi, African-American children who were blind could attend the Piney Woods Country Life School, a private boarding school for African-American Youth. A department for deaf and blind children was established in 1929, and the school did receive some money for the students' room and board from the state of Mississippi at the outset.

Image: Museum at the Perkins Institution for the Blind

Remembering Our Gallant Dead

From: historyengine.richmond.edu

Dealing with death is as unavoidable as death itself.  Grief that weighs on the hearts of those who have lost someone dear to them is a great burden to bear.  Imagine then the amount of sorrow and mourning in the Confederate States at the height of the American Civil War.  Ways of thinking about and dealing with the amount of loss of life during the Civil War were diverse.  William C. Davis in his book, "The Cause Lost: Myths and Realities of the Confederacy", addresses the changes that took place throughout the war in how citizens in the South dealt with the overwhelming personal loss.  At the onset of the war, Davis explains; when patriotism and military zeal were at their highest points, men were quick to rush off to join the ranks and the great adventure that awaited them.  Similarly, those who suffer the loss of a family member early in the war in large part viewed the death as a heroic sacrifice to a just cause. This notion did not hold as the war became prolonged and the death toll rose.  Writings, both public and private, took a more realistic and negative tone, moving away from the romantic, almost idealistic, vision of war seen at the onset.

A piece from the January 14, 1863 edition of "The Confederate Baptist" attempted to address and assuage the grief of those personally touched by the war.  The section, entitled “Our Gallant Dead,” both gave honor to the memory of brave unknown soldiers and addressed the reality of a deadly campaign.  The author called to the “noble spirits…whose graves are unmarked…but their memory is none the less dear” and for the living he advised that “it well becomes us to mourn both as a nation and individuals…it is indeed noble to weep for the good and the brave.”  However the imagery is far from romantic.  The author acknowledged the brutality of war and wove a tapestry of mental images including “precious blood…oozing from a fatal wound” and “the falling, mangled forms of the deadly combatants…Sublime tragedy! Awful spectacle!,” hardly the common language of a religious newspaper.

"The Confederate Baptist" presents us with an interesting snapshot of the war.  At the time of this publication in 1863, the subscribers of this paper were likely undergoing the change in outlook on the war from ‘heroic crusade’ to ‘useless sacrifice’ and the language and imagery of this particular article perfectly captured the tension between these two opposing forces.

Image: Georgia Clayton County Jonesboro Confederate Cemetery



"The Popular Dose with Doctors": Quinine and the American Civil War

By Robert D. Hicks
From: Chemical Heritage Magazine

 1862, the second year of the American Civil War, Southerners took satisfaction in knowing that invading Union army troops would succumb to tropical diseases endemic to the South’s bayous, swamps, and coastal regions. Just wait until summer, Southern newspapers predicted.

The first test of this theory came in April 1862 in Shiloh, Tennessee, where Union General William T. Sherman’s forces met the enemy in a bloody battle. Before and after the fight, typhoid, diarrhea, scurvy, and the fevers associated with malarial diseases ravaged troops on both sides. One physician wrote, “The pestilential atmosphere of the country about Shiloh was producing an amount of sickness almost without parallel in the history of the war.” In May, Sherman mustered only half of his 10,000 troops because the other half were sick.

At Vicksburg, the disease-ravaged Union navy and army failed in its first attempt to capture the strategically important Southern city on the Mississippi River. One soldier observed that the gallinippers—slang for mosquitoes—were so thick about the camp that they “filled the air like rain drops.” Mosquito nets, called bars, were not yet widely available, and soldiers exploded gunpowder cartridges in their tents to keep the pests away, unaware that they were the source of much of the illness gripping the encampments. (It would be another 20 years before doctors began to suspect mosquitoes were to blame for malaria and yellow fever.) Almost three-quarters of the besieging Union troops were dead or too sick to work. Vicksburg’s defenders were no better off, described by a Union army commander as “haggard & care-worn.” One of the defending officers wrote, “The command suffers greatly from intermittent fever, and is generally debilitated from the long exposure and inaction of the trenches.”

Pestilential Warfare
Southern military physicians, all of whom were titled surgeons, took no satisfaction in the malarial outbreaks that decimated the ranks of their opponents. Disease takes no sides. South Carolina Surgeon Francis Peyre Porcher, who knew intimately the devastation caused by tropical diseases, attended to sick and wounded soldiers in several hospitals before his assignment to the Naval Hospital in Norfolk, Virginia. His patients arrived in Norfolk from all theaters of war, and when he looked eastward to the sea, the distant masts of blockading Union ships reminded him of supply shortages and the medicines he badly needed. Porcher worried especially about the scarcity of quinine, the closest thing to a miracle drug known to Civil War physicians.

Malaria, yellow fever, and other tropical diseases had several symptoms in common, including fevers, chills, and nausea. In the early stages of these diseases Civil War physicians gauged the illness by the frequency of recurring fever, hence “intermittent,” “remittent,” “tertiary,” or “quotidian” fevers. Physicians of the time did not connect mosquitoes to malaria, but they did know quinine was a sure way to ease its symptoms. The problem was getting and administering the drug, especially getting it in quantity.

The Southern Solution
Quinine is an alkaloid synthesized from the bark of cinchona, a tree native to South America. The Northern blockade of Southern ports made importing quinine difficult, and smuggling from Northern or European sources proved unreliable. Northerners had intercepted quinine in the heads of girls’ dolls and found it stuffed within the intestines of slaughtered animals. The need for quinine was desperate. One South Carolinian wrote to her mother, “I write now to beg you to send in your next letter a quarter of an ounce of quinine. You know, in this climate, life depends upon quinine—and though large quantities come in every ship, it is taken up so immediately for the army that it is exceedingly difficult for private individuals to procure it even at a very high price.”

Confederate Surgeon General Samuel P. Moore, the man in charge of creating an entire medical infrastructure for the South, needed large quantities of quinine to relieve Southern soldiers of fevers, and he needed them fast. A 50-year-old veteran of the Mexican War, Moore knew the success of his army depended at least in part on a reliable supply of quinine. But where could he find it?

Moore’s solution was to search for quinine equivalents among the flora of Southern fields and forests. He issued a directive to Confederate physicians to gather specific plants and send them for processing. But what plants native to the South would make good medicines?

In 1862 Moore summoned Porcher, a studious man in his late 30s, from his hospital duties for a special assignment. Porcher had all the credentials Moore needed. He was a descendant of the botanist Thomas Walter, who in 1788 published the first catalog of flowering plants in South Carolina. Porcher had graduated at age 19 from what is now the University of South Carolina with a thesis on botanical medicine, A Medico-Botanical Catalogue of the Plants and Ferns of St. John’s, Berkeley, South Carolina, and took his medical degree from the Medical College of the State of South Carolina. In his 15 years of doctoring he had studied in France and Italy, founded a medical journal and a preparatory school for medical students, and joined the faculty of the Medical College. He was fascinated by the medicinal applications of plants, and his wide-ranging experience as a physician equipped him with the analytical skills required for the job.

Although Moore had already put out a call for the collection of medicinally useful plants, he proposed that Porcher survey all Southern plants, shrubs, and trees and document all practical uses. Discovering a substitute for quinine was the priority.

Malaria and Quinine
A single female Anopheles mosquito was born in a stagnant pool of water, emerged, and joined millions of others following soldiers in camp and on the march during the warm 1862 summer. She dropped onto a soldier’s neck and injected her proboscis into his flesh. Sporozoites (parasites) transmitted from a previous meal—from another soldier’s infected blood—entered the new victim’s bloodstream, carrying parasites into the liver of the soldier. During an incubation period of one to two weeks the merozoites (transformed sporozoites) grew within blood cells, causing sickness. As the parasites multiplied, they slowed the flow of blood and brought on fevers, profuse sweating, violent shivering, aches, nausea, and chills. Symptoms lasted for many hours and returned periodically, even daily.

Not until 1880 would a physician discover the single-cell Plasmodium parasites that cause malaria, and their carrier would not be confirmed as the mosquito until the end of the century. Although malaria was usually not fatal, during the Civil War its symptoms debilitated whole regiments of soldiers, while malaria’s perceived close cousin, yellow fever, was deadly.

Just as the war began, Scientific American published an anonymous essay on what was then known and unknown about malaria, reflecting both an outlook recognizable to modern eyes and an older medical ideology. The origin of the word malaria—bad air—reflects this ideology. The essay observes frankly,

What malaria is nobody knows. It may consist of organisms, either animal or vegetable, too minute for even the microscope to detect or it may be some condition of the atmosphere in relation to electricity, or temperature, or moisture; or it may be a gas evolved in the decay of vegetable matter. The last is the most common hypothesis, but it is by no means proved. . . . There is no doubt, however, that malaria is some mysterious poison in the atmosphere.

The essay describes various types or stages of “malarious disease,” from its mildest symptoms—intermittent fever or “dumb ague”—to its most common, “the ordinary fever and ague,” which produces violent shivering. The unknown author wrote that two substances had proven effective in either preventing or curing malarious disease: one, “a harmless vegetable substance,” cinchona bark, which has been known for centuries, and its quinine derivative; and the other, “one of the most terrible and deadly of the metallic poisons,” arsenic. Quinine did not cure the disease, but suppressing its symptoms was enough to keep a Civil War army on the march and in combat.

Astute military commanders made sure their soldiers took quinine prophylactically. Medical discipline was not easy to enforce: some, perhaps many, soldiers dosed themselves with patent medicines or other remedies that proved ineffectual and even dangerous. The command “fall in for your quinine” forced soldiers to leave their cooking fires and line up for their whiskey-laced ration. Soldiers even improvised words to the bugle tunes announcing sick call:

Dr. Jones says, Dr. Jones says:
Come and get your quin, quin, quin, quinine,
Come and get your quinine,
Q-u-i-n-i-n-e!

In his memoir of the war Union army Surgeon John Shaw Billings wrote, “Quinine was always and everywhere prescribed with a confidence and freedom which left all other medicines far in the rear. Making all due allowances for exaggerations, that drug was unquestionably the popular dose with doctors.”

The Northern Solution
Surgeon General Moore’s Northern counterpart, Union army Surgeon General William Hammond created the U.S. Army Laboratory to ensure the purity of drugs and to create standards for drugs purchased by medical purveyors (agents authorized to purchase raw materials for medicines) and distributed to the various theaters of war. Young, brilliant, and abrasive, Hammond reformed a superannuated army medical department still organized as it had been during the War of 1812. To meet the demands of a modern war Hammond assigned like-minded doctors to head the two laboratories established to assay drugs for purity and distribute them to the North’s fighting forces. To outsiders the laboratories—one in Astoria, New York, and the other in Philadelphia, but together making up the U.S. Army Laboratory—would have resembled strange manufacturing plants. The Philadelphia laboratory, for instance, also manufactured ordinary civilian clothing and towels. Its buildings housed steam engines, boilers and distillation equipment, administrative offices, chemistry apparatus, and storage for raw and repackaged materials. Soldiers, chemists, women, and the girls who sewed the clothing came and went.

Powers and Weightman, one of only two pharmaceutical firms in the United States to produce quinine during the war, leased some of its space to Hammond’s Philadelphia laboratory. The lab required an energetic chemist who would quickly get the place running and ensure that the North’s 30 medical depots got their supplies promptly. John Michael Maisch, a young German “of tall and commanding appearance,” was the choice. Maisch grew up in Hanau, Germany, entered the military, and was sentenced to prison for revolutionary speech during the Revolution of 1848. He escaped and came to the United States in 1849, virtually penniless. Maisch, a superb autodidact, learned pharmacy through his mentor, Philadelphia pharmacist Edward Parrish, and his School of Practical Pharmacy. Despite his lack of formal credentials Maisch eventually took over the chair of materia medica (a discipline focused on the therapeutic uses of medicine) at the College of Pharmacy of the City of New York. Hammond’s new Philadelphia laboratory, managed by Maisch, worked intimately with Powers and Weightman and other firms to produce quinine in reliable quantity for the North. Porcher, by contrast, had no such resources.

A Handbook and a Laboratory
Before the end of 1863 Porcher published Resources of the Southern Fields and Forests, Medical, Economical, and Agricultural: Being Also a Medical Botany of the Confederate States; with Practical Information on the Useful Properties of the Trees, Plants, and Shrubs. He organized the book for field use despite its 600-page length and included Latin and common names for about 3,500 plants and trees. The book instructed soldiers—and the officers who supervised them—to collect and dry plants and forward them to the South’s medical purveyors. Porcher’s detailed and encyclopedic instructions and advice used patriotism to appeal to its readers: “These a bounteous Providence has vouchsafed to a Confederacy of States, starting forth upon their career under new and happier auspices, and with independence and self-reliance forced upon them by an almost sacred necessity.”

Porcher believed his book provided a “repertory of scientific and popular knowledge as regards the medicinal, economical, and useful properties of the trees, plants, and shrubs found within the limits of the Confederate States.” His native plants would be as valuable as their more expensive foreign counterparts and would benefit the South’s doctors and farmers both during and after the war.

To complete his book in only a year Porcher put his mother and wife to work as assistants, consulted the best available libraries on botany and chemistry, and enlisted such colleagues as Joseph Le Conte, a well-known chemistry professor who worked at the medical depot in South Carolina (and who later cofounded the Sierra Club in California). Unlike the North, the South lacked the chemical ability to synthesize quinine from its alkaloid, but Porcher believed that he had found reliable native substitutes, including yellow poplar bark, tulip tree bark, holly, black alder, hazel alder, and knotgrass. Other promising substitutes included boneset (thoroughwort) and dogwood. For the former, Porcher recommended using an ounce of dried herb in a pint of boiling water to make a tea that would prove “quite sufficient in the management of many of the malarial fevers that will prevail among our troops during the summer.” Porcher cited dogwood bark as having “been employed with great advantage” in South Carolina, particularly as a substitute for cinchona, with the added benefit of reducing fever “of a typhoid character.”

But the exigencies of war limited Porcher’s inquiry. He found it impossible to test these plants in clinical trials. In some cases he was forced to rely on anecdote, folk tradition, or the recommendations of others.

Surgeon General Moore eagerly awaited Porcher’s book and wasted no time getting it into the hands of Confederate physicians. Based on Porcher’s work Moore recommended various substitutes mixed with whiskey—dogwood, poplar, and willow bark—to achieve the same effect as quinine. Newspapers published extracts and lists of needed plants to encourage citizens to help. The Confederate government also sent circuit riders to collect plants. Yet despite Porcher’s stature and Moore’s recommendations, some physicians rejected Porcher’s work, distrusting substitutes for quinine and other drugs. Others believed that plant-based medicines catered to fringe medical practitioners who refused to use “chemicals,” or synthesized medicines.

The Civil War provided a rigorous testing ground for which drugs worked and which did not. None of Porcher’s quinine recommendations proved successful, and the South struggled through the war years with what quinine it could smuggle or capture. The lasting legacy of Porcher’s book is as a layman’s guide to Southern botany, and it is still cited today. In the end Northern soldiers took their quinine rations and suffered less from Southern diseases than did their Confederate opponents, despite the hopes and predictions of Southern newspapers.

Unlike Francis Peyre Porcher, John Michael Maisch had plenty of quinine. After French chemists first isolated the alkaloid from cinchona bark, Philadelphia-based Zeitler and Rosengarten (later Rosengarten and Sons) had the foresight to hire French chemists and within three years of the discovery were selling quinine. Powers and Weightman, which merged with Rosengarten after the war, also processed quinine with other in-demand drugs, such as opium. Both firms obtained cinchona in bulk at low cost and processed it to obtain the quinine, which was then extracted into sulfate. Maisch, working for the Union army, ensured the purity of the drug, developed standard doses, and oversaw the packaging and labeling of the drugs for distribution to the army medical depots. This was no small task: physicians in the field told many stories of useless or adulterated drugs that came to them from purveyors.

By the end of the war Maisch’s laboratory produced 160 different medicines, and his lab claimed to have saved the government a million dollars through its work. Maisch effectively directed the federal government’s first drug-manufacturing and regulatory operation. Not surprisingly, some people attacked Maisch’s laboratory as governmental excess that competed with private business. Yet Maisch’s work showed that his laboratory, in working closely with pharmaceutical firms, stimulated business.

The diseases Northern soldiers encountered in the South forced the North to industrialize its quinine production, which in turn required an emphasis on quality control and sophisticated channels of testing and distribution. The Civil War, although a time of incalculable destruction, provided the ingredients and conditions necessary to create the nation’s first example of modern large-scale drug manufacturing as well as the first government-run drug-testing laboratories.—Robert D. Hicks

 Robert D. Hicks is director of the Mütter Museum and Historical Medical Library of the College of Physicians of Philadelphia.

Image: Many Civil War commanders required that their soldiers take quinine prophylactically. A woodcut from the March 11, 1865, Harper’s Weekly shows quinine rations being distributed to Union troops. (CHF Collections)

Southern, Sassy, and Strong

From: historyengine.richmond.edu

Midnight train rides, cleaning wounds and changing dressing was not the job for a proper Southern woman. Kate Cummings took up the call to become and nurse and broke the holds that Southern society placed on women of middle to upper class. Kate traveled by train from her home in Mobile to different hospitals around the South assessing surgeons after the Battle of Shiloh and helping wounded in Georgia. While Northern hospitals system was very organized and detailed, the South was far from it. Doctors drank the medical whiskey that was to go to the patients, other women would not want to preform their duties fully and all the while Kate was receiving letters from her family urging her to leave the unsuitable lifestyle and return home.

Unlike their Northern counterparts, who were welcomed in the hospital, Kate along with other women were seen as the enemy to the male staff such as the Union was the enemy. Pushing this aside and ignoring society and her parents wishes, Kate "cleaned house" of the staff who were not up to standards using her society roots to help with her backing.

According to society Southern women were not to see a man's body until they married. The Civil War changed that notion. Cummings helped doctors in surgery, changed dressing, and cleaned wounds. With the new exposure to the male soldiers bodies Kate, who at the time was unmarried was in for a new concept. Throughout the war she remained professional and provided care for the wounded thus saving many lives.


Catherine Wills Wears a Hair Locket to the Dedication of the Soldiers National Cemetery

From: historyengine.richmond.edu

To commemorate the deaths of her two young sons, David Jr., and James, Catherine Wills wore a mourning brooch.  The gold brooch containing one blonde and one brunette lock of hair with a black ring around it was a fairly generic piece of jewelry during the nineteenth century.  Like many others who attended the dedication of the Soldiers National Cemetery in Gettysburg, Pennsylvania and heard Lincoln’s Gettysburg Address, Wills may have worn her broach to this occasion.  The cemetery and dedication was of particular importance to the Wills family, as David Wills, the young boy’s father, had played an instrumental role in creating the cemetery.  The Wills were prominent citizens in Gettysburg, Pennsylvania, and Lincoln himself stayed in the Wills home.

Catherine Wills probably mourned the death of her two sons for one year, as that was the standard time length for mourning a child in the nineteenth century, according to scholar Drew Faust.  Catherine would have also been the primary mourner of the children, not only because she was the children’s mother, but because women held much of the responsibility to mourn over loved ones.

As can be observed through these standards of mourning, nineteenth century America had a strong culture of mourning.  In their final breaths, individuals sought to die willfully, at home, surrounded by family.  Family and friends were to be beside the dying in order to assess whether they had passed to Heaven, and could be united there, according to Faust.

During the Civil War, not all of these practices were feasible.  As soldiers died on battlefields, far away from home, they could not have the comfort of being surrounded by family, and family could not see a son’s, father’s, or brother’s last breaths.  Due to these constraints, soldiers had to improvise.  Some would die holding pictures, or lockets of hair of their loved ones.  In preparation of this, some soldiers would take a lock of hair from their loved ones before departing for war, and also leave a lock at home for their family.  Further, possessions of the deceased were given to the family in order to demonstrate that loved ones had died.

While this style of mourning continued for many years, it eventually faded into unpopularity.  This can be observed through Catherine Wills’ mourning brooch as it was modified to have a pin to fasten it, which was not in the means of attaching the brooch at the time.

Image: Mourning brooch



A Poet Describes the Horrors of a Civil War Hospital

From: historyengine.richmond.edu

In his poem "A March in the Ranks Hard-Prest", and "The Road Unknown", Walt Whitman described one of the most haunting memories of his medical career: “Then before I depart I sweep my eyes o'er the scene fain to absorb it all, / Faces [sic], varieties, postures beyond description, most in obscurity, / some of them dead, / Surgeons operating, attendants holding lights, the smell of ether, / the odor of blood, / The crowd, O the crowd of the bloody forms, the yard outside also fill'd.” The setting of Whitman’s nightmare was an impromptu field hospital likely located somewhere near a battlefield. Whitman’s poem poignantly explained the horrors that one could find at field hospitals during the Civil War: “Entering but for a minute I see a sight beyond all the pictures and poems ever made, Shadows of deepest, deepest black, just lit by moving candles and lamps, And by one great pitchy torch stationary with wild red flame and clouds of smoke, By these, crowds, groups of forms vaguely I see on the floor, some in the pews laid down.”

The field hospitals were a horrifying sight for Whitman. This is surprising, in many ways, since Whitman served as a nurse during the Civil War.  For Whitman, the field hospitals lacked sufficient space for all the wounded soldiers in their care.  They reeked of blood and other odors. Not to mention, they presented endless labor for the surgeons and their assistants, who did everything in their power to end the suffering of the wounded and dying soldiers. What Whitman saw in the field hospital haunted his memories the rest of his life.

Nightmares, like the one experienced by Whitman, were common at field hospital during the Civil War. Because field hospitals were the quickest and most efficient source of medical care throughout the years of the war, they existed at essentially every battlefield. In a piece concerning the topic of medical care during the Civil War, historian Victoria Holder wrote that at the beginning of the war, neither the Union nor the Confederacy had any plan for hospitals because they did not believe fighting would last more than a couple months. By 1862, the Union and Confederacy had passed laws creating hospital systems, but by that time, field hospitals were the most relied upon source of treatment for wounded soldiers. Field hospitals were often located a mile or two away from the battlefield. They frequently lacked ample room and supplies to treat the men in their care.

Historian James McPherson, when he wrote about medicine in the Civil War, stated that field hospitals were often churches, hotels, warehouses, shops, barns, private homes, etc. In terms of staff, they were often composed of white women who volunteered to help out. From these sources alone, it is not farfetched to believe what Whitman described in his poem was the truth.

"The Slow Dead March of Camp-Disease": Death in the American Civil War

From: historyengine.richmond.edu

Charles Furman had known Fannie Garden for only 13 days before he asked her to marry him. In all, they spent less than a month together before the Confederate government ordered him northward to fight the “soulless soldiers” of the “despised Yankee Nation." The letters they wrote in the years that followed captured both their own deepening love and the chaos and carnage of the American Civil War. He was prepared, he wrote, to fight and die to defend her—and to defend Confederate freedom. He was utterly unprepared, however, for the reality of war—for the tedium and toil of daily life, for the savage intensity of battle, and most of all for the sweeping devastation of disease.

In November 1861, his regiment was encamped in northern Virginia. Since the Battle of Bull Run four months earlier, there had been only a few minor skirmishes to distract the men from the weariness of camp life—until now. Union general Daniel Sickles was gathering reinforcements, and Furman expected an attack any day. Responding to the news, Furman wrote to Fannie to assure her that he “love[d] her truly, and deeply, and earnestly—with all the warmth of his nature.” Nonetheless, he asked her not to worry, insisting that what he truly feared was not an instantaneous death in battle but a long, lingering death of disease. The former, he wrote, was like heavy infantry—“brilliant and rapid”—but nothing compared to the “universally destructive cavalry” of disease. Ultimately, he concluded, “the slow dead march of camp-disease is much more to be dreaded than the rapid double-quick of ball and shell.”

In the six months since Furman had enlisted, only eight of the regiment’s 900 soldiers had died in battle, and another 50 had been wounded. In those same months, measles and typhoid fever swept through the regiment, killing 43 and leaving dozens more too weak to fight. By winter’s end another 20 would be dead of typhoid and pneumonia. These losses typify larger patterns of Civil War mortality. In the first year of the war, as soldiers gathered from across the country, measles, smallpox, and other childhood illnesses devastated newly-formed armies. Exposure and nutritional deficiencies left soldiers vulnerable to disease, and the filthy, fetid water that sustained most of their camps allowed dysentery and typhoid to thrive. The Civil War, recent analysis suggests, claimed the lives of upwards of 750,000 Americans. An estimated two-thirds of those deaths—perhaps 500,000—were the result not of battle but disease. Historian Allen Guelzo has estimated that disease killed perhaps 18 percent of the entire Confederate army, and James McPherson argues that the percentage may be even higher. It is little wonder, then, that what Charles Furman feared most in the fall of 1861 was not battle—not bullets or bayonets—but disease.


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