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.

Showing posts with label Civil War Pharmaceuticals. Show all posts
Showing posts with label Civil War Pharmaceuticals. Show all posts

Thursday, March 2, 2017

Dr. Francis Peyre Porcher: Civil Practice to Civil War

From: waring.library.musc.edu

Francis Peyre Porcher was born at Ophir Plantation in St. John’s, Berkeley County, South Carolina on December 14, 1824 to Dr. William and Isabella Sarah Peyre Porcher. Through his mother's side, he was a descendant of the well-known English botanist, Thomas Walter author of Flora Caroliniana, the first catalog of the flowering plants of South Carolina published in 1788.

Porcher graduated from the South Carolina College (now the University of South Carolina) in 1844 after which he enrolled in the Medical College of the State of South Carolina.  He graduated with first honors, out of a class of seventy-six, in 1847 and his thesis, A Medico-Botanical Catalogue of the Plants and Ferns of St. John’s, Berkeley, South Carolina, was published later that same year by the faculty of the Medical College.  After graduation Porcher spent two years traveling and studying medicine in Europe. Upon his return to Charleston, he entered practice and in 1852 with Dr. E. Belin Flagg opened the Charleston Preparatory Medical School of the Medical College and lectured on materia medica and therapeutics.

During his long affiliation with the Medical College, Porcher served as professor of clinical medicine and chair of materia medica, which position he held from 1874 to 1891. He also served as attending physician at the Marine Hospital in Charleston from 1855 to 1860. Porcher was editor of the Charleston Medical Journal and Review and served as president of the South Carolina Medical Association (1871), the Medical Society of South Carolina (1874), and as vice-president of the American Medical Association (1880).  With fellow Medical College alumnus Julian J. Chisolm (1830-1903), Porcher opened a hospital specifically for the care of plantation slaves.

At the outbreak of the Civil War, Porcher joined the Confederate Army as a surgeon to South Carolina’s Holcombe Legion and was then transferred to the Naval Hospital at Norfolk, Virginia in March 1862.  He finished his Confederate service in the South Carolina Hospital at Petersburg, Virginia.

When the war ended, Porcher returned to Charleston and resumed his academic positions at the Medical College.  He was on the staff of the City Hospital from 1866 to 1887 and again served a three-year term as editor for the Charleston Medical Journal and Review.  As his professional career thrived, he remained a prolific contributor to the medical literature and wrote on a variety of topics including yellow fever, diseases of the heart, typhoid, and malaria. Porcher received many honors during his career including an LL.D. of the University of South Carolina (1891); he was one of the founders of the American College of Physicians, was one of the committee of ten U.S.  physicians selected to attend the International Medical Congress in Berlin (1890), and was chairman of the section on general medicine at the Pan American Congress of 1892.

After suffering a paralytic stroke, Porcher died at his home, 38 Meeting Street, Charleston, on November 19, 1895.

Porcher’s Resources of the Southern Fields and Forests

From: waring.library.musc.edu

It is intended as 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, whether employed in the arts, for manufacturing purposes, or in domestic economy, to supply a present as well as a future want.
Francis Peyre Porcher
Preface, page iii

At the outbreak of the Civil War, Francis Peyre Porcher joined the Confederate Army as a surgeon to South Carolina’s Holcombe Legion and was then transferred to the Naval Hospital at Norfolk, Virginia in March 1862. He finished his Confederate service in the South Carolina Hospital at Petersburg, Virginia. While in Virginia Porcher was “released temporarily from service in the field and hospital” [Preface, page iii], by C.S.A Surgeon General Samuel Preston Moore to write, Resources of the Southern Fields and Forests, Medical, Economical and Agricultural; Being Also a Medical Botany of the Confederate States; with Practical Information of the Useful Properties of Trees, Plants, and Shrubs, first published in Charleston in 1863. The handbook identified local plants with therapeutic qualities that could be used not only by Confederate surgeons, but planters and farmers, in place of manufactured drugs made unavailable because of the Union blockade. The handbook was of such value that a revised edition was published in 1869.

The Regimental Surgeon in the field, the Physician in his private practice, or the Planter on his estate may themselves collect and apply these substances within their reach …
Preface, page iii

Four editions of the manual were produced during the course of the war and are now available for research use at the Waring Historical Library:
1863 edition
1869 edition
1863 edition, [transcription]

1869 edition
I here introduce a notice of upwards of four hundred substances, possessing every variety of useful quality. Some will be rejected as useless, others may be found upon closer examination to be still more valuable. The most precious of all Textile Fibres, and Grains, Silks, Seeds, Oils, Gums, Caoutchouc, Resins, Dyes, Fecula, Albumen, Sugar, Vegetable Acids, Starch, Liquors, Spirit, Burning Fluid, material for making Paper and Cordage, Barks, Medicines, Wood for Tanning and the production of Chemical Agencies, for Timber, Ship-building, Engraving, Furniture, Implements and Utensils of every description--all abound in the greatest munificence, and need but the arm of the authorities or the energy and enterprise of the private citizen to be made sources of utility, profit, or beauty.
Preface, page vii-viii

Tuesday, January 3, 2017

Middleton Goldsmith and the Use of Bromine to Treat Gangrene

From: library.uthscsa.edu

The P. I. Nixon Medical Historical Library owns a report to the Surgeon General of the United States by Civil War surgeon Middleton Goldsmith on the use of bromine to treat hospital gangrene in wounded soldiers. Published in 1863, the report is entitled A Report on Hospital Gangrene, Erysipelas and Pyaemia as Observed in the Departments of the Ohio and the Cumberland, with Cases Appended. It contains detailed case reports, a foldout table containing all of Goldsmith’s research data, and his correspondence with other surgeons on the treatment of gangrene. The overall mortality of hospital gangrene cases from the Civil War has been reported as 45.6% (The Medical and Surgical History of the Civil War, Washington, U.S. Government Printing Office, 1875-1888). However, only 8 of Goldsmith’s 304 patients receiving bromine-based therapy for gangrene died, a mortality rate of only 2.6 per cent.

Goldsmith’s work predated Joseph Lister’s 1867 paper linking microbes and surgical infections and Louis Pasteur’s groundbreaking work on microbes, also published after the Civil War. Goldsmith did not know what agent caused the gangrene, erysipelas and pyaemia he observed in the wards of his hospitals, but he theorized that they were related to each other and sought a curative agent to cure the infections and prevent the spread between patients.  Goldsmith’s data was so meticulously documented that it was easy to prove his bromine treatment had cured his gangrene patients. By the conclusion of the Civil War, surgeons throughout the country applied variations of Goldsmith’s bromine therapy regimen in the treatment and prevention of gangrene.

Tuesday, December 20, 2016

Camphor (excerpts)

From: wikipedia.org

Camphor (/ˈkæmfər/) is a waxy, flammable, white or transparent solid with a strong aroma. It is a terpenoid with the chemical formula C10H16O. It is found in the wood of the camphor laurel (Cinnamomum camphora), a large evergreen tree found in Asia (particularly in Sumatra, Indonesia and Borneo) and also of the unrelated kapur tree, a tall timber tree from the same region. It also occurs in some other related trees in the laurel family, notably Ocotea usambarensis. The oil in rosemary leaves (Rosmarinus officinalis), in the mint family, contains 10 to 20% camphor, while camphorweed (Heterotheca) only contains some 5%. Camphor can also be synthetically produced from oil of turpentine. It is used for its scent, as an ingredient in cooking (mainly in India), as an embalming fluid, for medicinal purposes, and in religious ceremonies. A major source of camphor in Asia is camphor basil (the parent of African blue basil).

The word camphor derives from the French word camphre, itself from Medieval Latin camfora, from Arabic kafur, ultimately from Sanskrit, कर्पूरम् / karpūram. Camphor was well known in ancient India during the Vedic period. In Old Malay it is known as kapur Barus, which means "the chalk of Barus". Barus was the name of an ancient port located near modern Sibolga city on the western coast of Sumatra island. This port traded in camphor extracted from laurel trees (Cinnamonum camphora) that were abundant in the region. Even now, the local tribespeople and Indonesians in general refer to aromatic naphthalene balls and moth balls as kapur Barus.

Camphor is readily absorbed through the skin, producing either a coolness or warmth sensation, and acts as slight local anesthetic and antimicrobial substance.

Camphor is an active ingredient (along with menthol) in vapor-steam products, such as Vicks VapoRub. It is used as a cough suppressant and as a decongestant.

Camphor may also be administered orally in small quantities (50 mg) for minor heart symptoms and fatigue. Through much of the 1900s this was sold under the trade name Musterole; production ceased in the 1990s.

Camphor was used in ancient Sumatra to treat sprains, swellings, and inflammation. Camphor is a component of paregoric, an opium/camphor tincture from the 18th century. Also in the 18th century, camphor was used by Auenbrugger in the treatment of mania. Based on Hahnemann's writings, camphor (dissolved in alcohol) was also successfully used to treat the 1854-1855 cholera epidemics in Naples.

It has long been used as a medical substance in ancient India, where it generally goes by the name Karpūra. It has been described in the 7th-century Āyurvedic work Mādhavacikitsā as being an effective drug used for the treatment of fever. The plant has also been named Hima and has been identified with the plant Cinnamomum camphora. According to the Vaidyaka-śabda-sindhu, it is one of the “five flavours” used in betel-chewing, where it is also referred to as Candrabhasma (‘moon powder’).

Small dose
Its effects on the body include tachycardia (increased heart rate), vasodilation in skin (flushing), slower breathing, reduced appetite, increased secretions and excretions such as perspiration and urination.

The sensation of heat or cold that camphor produces is caused by activating the ion channel TRPV3.

Large dose toxicity
Camphor is poisonous in large doses. It produces symptoms of irritability, disorientation, lethargy, muscle spasms, vomiting, abdominal cramps, convulsions, and seizures. Lethal doses in adults are in the range 50–500 mg/kg (orally). Generally, two grams cause serious toxicity and four grams are potentially lethal.

Wednesday, October 12, 2016

Squill (Excerpt)

From: botanical.com

Botanical: Urginea scilla (STEINHEIL)
Family: N.O. Liliaceae

---Synonyms---Maritime Squill. Scilla maritima (Linn.). Urginea maritima. Urginea. Indica. White Squill. Red Squill.
---Part Used---Bulb, cut into slices, dried and powdered.
---Habitat---The Squill is found in dry, sandy places, especially the seacoast in most of the Mediterranean districts, being abundant in southern Spain, where it is by no means confined to the coast, and is found in Portugal, Morocco, Algeria, Corsica, southern France, Italy, Malta, Dalmatia, Greece, Syria and Asia Minor. In Sicily, where it grows most abundantly, it ascends to an elevation of 3,000 feet. Its range also includes the Canary Islands and the Cape of Good Hope. It is often grown under figtrees in the Italian Riviera, and is grown in many botanical gardens, having first been recorded as cultivated in England in 1648, in the Oxford Botanic Gardens.
---Description---It is a perennial plant with fibrous roots proceeding from the base of a large, tunicated, nearly globular bulb, 4 to 6 inches long, the outer scales of which are thin and papery, red or orange-brown in colour. The bulb, which is usually only half immersed in the sand, sends forth several long, lanceolate, pointed, somewhat undulated, shining, dark-green leaves, when fully grown 2 feet long. From the middle of the leaves, a round, smooth, succulent flower-stem rises, from 1 to 3 feet high, terminating in a long, close spike of whitish flowers, which stand on purplish peduncles, at the base of each of which is a narrow, twisted, deciduous floral leaf or bract. The flowers are in bloom in April and May and are followed by oblong capsules.
It is a very variable plant, the bulb differing greatly in size and colour, and the leaves of the flower presenting similar varieties, which has led to the formation of several species, about twenty-five species having been described. Two varieties of Squill, termed respectively white and red, are distinguished by druggists. In the first named, the bulb scales are whitish or yellowish in colour, whereas the red species has deep, reddishbrown outer scales and yellowish white inner scales, covered with a pinkish epidermis, intermediate forms also occurring. No essential difference exists in the medicinal properties of the two kinds.

The White Squill, collected in Malta and Sicily, is preferred in England, while the Red Squill, collected in Algeria, is used in France. Both varieties are mentioned by Pliny and other ancient writers: the white is more mentioned in mediaeval literature, though the medical school of Salerno preferred the red variety of the drug.

The United States Pharmacopoeia defines the drug Scilla as the inner scales of the bulb of the white variety of Urginea maritima (Linn.).

Scilla, the classical name of the plant, is derived from a Greek word meaning to excite or disturb, as an emetic does the stomach. Scilla maritima was the name given by Linnaeus, but this was changed to Urginea, in allusion to the Algerian tribe Ben Urgin, near Boma, where Steinheil in 1834 examined this plant, removing it from the genus Scilla. The main difference between the genera is that the genus Urginea has flat, discoid seeds, while in Scilla proper they are triquetrous (threeangled, with three concave faces). Baker named it Urginea maritima, but it now retains Scilla as its specific name.

As seen in commerce, the undried bulb is somewhat pear-shaped, and generally about the size of a man's fist, but often larger, weighing from 1/2 lb. to more than 4 lb.

It has the usual structure of a bulb, being formed of smooth juicy scales, closely wrapped over one another. It has little odour, but its inner scales have a mucilaginous, bitter, acrid taste, owing to the presence of bitter glucosides.

In its home, it is frequently used fresh, but in other countries it is directed by the pharmacopoeias to be deprived of its dry membraneous outer scales (which are destitute of activity), cut into thin, transverse slices and carefully dried, either in the sun, or by artificial heat, the inmost part being rejected, as this central portion, being the youngest growth, is deficient in activity.

Owing to the mucilaginous nature of the tissue, drying is tedious and difficult. When fresh, the bulb abounds in a viscid, very acrid juice, which is capable of causing inflammation of the skin. On drying, the bulb loses four-fifths of its weight, and its acridity is largely diminished, with slight loss of medicinal activity.

Squill is generally imported in ready-dried slices, packed in casks, from Malta, where the largest collections are made.

The dried slices are narrow, flattish, curved, yellowish-white, or with a roseate hue, according to the variety of Squill from which they are obtained, from 1 to 2 inches long, more or less translucent.

When quite dry, the strips are brittle and can easily be powdered, but they are tough and flexible when moist and dried. Squill should be kept in well-stoppered bottles, on account of its readiness to absorb moisture, when the slices become tough and cannot be reduced to powder. When kept in a dry place, Squill retains its virtues for a long time. When powdered, unless carefully preserved in a dried state by absorption of moisture, it forms a hard mass, and it is therefore officially recommended that powdered Squill should be kept quite dry over quicklime.

Occasionally, entire bulbs are imported, but are difficult to keep in the fresh state as they preserve their vitality for a long time, and if allowed to remain in a warm place, rapidly develop an aerial shoot. Professor Henslow reports (Poisonous Plants in Field and Garden) that a bulb was found attempting to grow after being stowed away for more than twenty years in the museum of St. Bartholomew's Hospital Medical School.

---Constituents---The chemical constituents of Squill are imperfectly known. Merck, in 1879, separated the three bitter glucosidal substances Scillitoxin, Scillipicrin and Scillin. The first two are amorphous and act upon the heart, the former being the more active; Scillin is crystalline and causes numbness and vomiting. Other constituents are mucilaginous and saccharine matter, including a peculiar mucilaginous carbohydrate named Sinistrin, an Inulin-like substance, which yields Laevulose on being boiled with dilute acid. The name Sinistrin (in 1834, first proposed by Macquart for Inulin) has also been applied to a mucilaginous matter extracted from barley, but it remains to be proved that the latter is identical with the Sinistrin of Squill. Calcium oxalate is also present, in bundles of long, acicular crystals, which easily penetrate the skin when the bulbs are handled, and causes intense irritation, sometimes eruption, if a piece of fresh Squill is rubbed on the skin.

The toxicity of Squills has more recently been ascribed to a single, bitter, non-nitrogenous glucoside, to which the name Scillitinis given, and which is the active diuretic and expectorant principle.

The bulbs also yield when distilled in a current of steam, a slightly coloured liquid oil of unpleasant odour.

The chemistry of Squills cannot yet be regarded as fully worked out, since most of the glucosides described have only been prepared in an amorphous condition of uncertain chemical identity.

---Medicinal Action and Uses---The Medicinal Squill was valued as a medicine in early classic times and has ever since been employed by physicians, being official in all pharmacopoeias. Oxymel of Squill, used for coughs, was invented by Pythagoras, who lived in the sixth century before Christ.

It is mentioned by Theophrastus in the third century before Christ, and was known to all the ancient Greek physicians. Epimenides, a Greek, is said to have made much use of it, from which circumstance we find it called Epimenidea.

It is considered to be the Sea Onion referred to by Homer. Pliny was acquainted with it, and Dioscorides, who lived about the same time, describes the different varieties of the bulb and the method of making vinegar of Squills. A similar preparation, as well as compounds of Squill with honey, was administered by the Arabian physicians of the Middle Ages, who introduced the drug into European medicine, these preparations still remaining in use.

The mediaeval reputation of Squill was originally as a diuretic, the older authorities attributing its diuretic action to a direct stimulant effect upon the kidney.

As a diuretic, it is frequently employed in dropsy, whether due to chronic disease of the kidneys or to the renal congestion consequent to chronic cardiac disease. Squill is not employed, however, when the kidneys are acutely inflamed. In the treatment of cardiac dropsy, Squill is frequently combined with digitalis.

Squill stimulates the bronchial mucous membrane and is given in bronchitis after subsidence of the acute inflammation. It is generally used in combination with other stimulating expectorants, its effects being thereby increased, and is considered most useful in chronic bronchitis, catarrhal affections and asthma. The tincture is administered combined with other expectorants, especially ipecacuanha and ammonium carbonate. Vinegar, Oxymel and Syrup of Squill are also common constituents of expectorant cough mixtures.

It is largely sued for its stimulating, expectorant and diuretie properties, and is alsoa cardiac tonic, acting in a similar manner to digitalis, slowing and strengthening the pulse, though more irritating to the gastro-intestinal mucous membrane. On account of its irritant qualities it is not administered in diseases of an acute inflammatory nature. It has also been given as an emetic in whooping-cough and croup, usually combined with ipecacuanha, but as an emetic is considered very uncertain in its action.

To prevent its too great action on the stomach, it is frequently eombined with a portion of opium. With calomel, it forms a powerful stimulant of the urinary organs. (A pill containing 1 grain each of Squill, digitalis and calomel is popularly known as Niemeyer's pill.)

In poisonous doses, Squill produces violent inflammation of the gastro-intestinal and genito-urinary tracts, manifested by nausea, vomiting, abdominal pains and purging, and, in addition, dullness, stupour, convulsions, a marked fall in temperature, enfeebled circulation and sometimes death.

Image: Red Squill (Urginea maratima printed as Urginea Scilla)

Sunday, July 24, 2016

Herbalism

From: mnwelldir.org

The use of foods to heal is as old as the human spirit; it is as natural as breathing. Even today, when we get a cold or flu, we also get a bowl of hot chicken soup. However, the chicken soup we get from a can is hardly related to the chicken soup grandma made from scratch.

Herbs are food. Our medicines of the early 1800s were mostly herbal. What we did not bring from Europe we learned from the Natives, who were far more sophisticated than many give them credit. While surgeons theorized why some patients died of infections and others did not, our natives were very familiar with the role of pathogens in infection (sepsis) and created salves to clean wounds and kill off the pathogens that could cause infections.

The two great names in the early American herbal movement were, Samuel Thomson and Constantine Rafinesque. Rafinesque came to America as a young man, studied botany and herbalism and became a professor of botany. Around 1830 Rafinesque published his book, Medical Flora of the United States, which became the chief reference for herbalists of that period. In his book he described in detail the healing properties of a New World herb, goldenseal. For its immune stimulating properties, the goldenseal was highly prized, and the European communities were soon cultivating seeds they’d received from America. Nothing in the pharmacopoeia could compete with goldenseal, that is until the Natives introduced us to echinacea, the purple coneflower.

Thomson, on the other hand, was not a scholar. He created nothing new, but to his credit, he brought herbal and Native medicines to the common people. He was attacked by the regulars, even found himself facing murder charges for losing a few patients, but was acquitted and went on to publish his New Guide to Health. He is even, according to Ingrid Naiman’s book, Cancer Salves, “credited with the development of a cancer plaster made from red clover blossoms.” Most likely, he learned this too from the Natives, though he was the first to get this procedure on paper. Herbalists today still use this and many other preparations Thomson passed onto us.

At the time of his death, in 1843, his followers numbered around three million. The latter part of his life was spent deflecting criticism from the regulars, though many a regular physician adopted much of Thomsonian medicine as they did Hahnemann’s homeopathy. One constant in history is that when something works, the more liberal minded have a tendency to examine it and eventually incorporate it.

Mixing “pharmaceuticals,” as noted already, is dangerous. However, herbalists, on the other hand, mixed many herbs together, since herbal medicines, for the most part, did not contradict each other, and worked in harmony. Herbs are food. Together, many herbs act to potentiate [make stronger, better] each other. For instance, adding cayenne pepper to any herbal medicine makes the action of the preparation stronger and faster acting. This is just one example of synergy, where the answer to 2 + 2 is actually greater than four.

Image 1: Constantine Rafinesque

Image 2: Notebook kept by Constantine Samuel Rafinesque on a trip from Philadelphia to Kentucky, 1818

Horace Wells Discovers Pain-free Dentistry

By Emily E. Gifford

In the early 19th century Hartford dentists Horace Wells and William Morton played instrumental roles in the development of anesthesia for dental and other medical applications. Horace Wells, born in Hartford, Vermont, and educated in Boston, began his practice in Hartford, Connecticut, in 1836 and quickly rose to prominence. He married Elizabeth Wales in 1838 and continued to write about dentistry and invent various devices, such as a foot-powered shower.

Wells Sees Potential in Laughing Gas
In 1842, Wells took Morton, first, as his student and then as his partner. Morton, who was born in Massachusetts and trained for dentistry in Baltimore, Maryland, married Elizabeth Whitman, daughter of Lemuel Whitman, on her father’s condition that he quit dentistry and study to practice medicine instead. In 1844, Morton began (but never completed) his studies at Harvard Medical College.

Although Wells tried to form a dentistry practice with Morton in Massachusetts, the new partnership lasted less than two weeks, and Wells returned to Connecticut. In December of 1844, Wells and his wife attended a demonstration at Union Hall in Hartford of “laughing gas” (nitrous oxide) put on by showman Gardner Colton, who had briefly studied medicine. Wells noticed that one of the volunteers, while ingesting the gas to the amusement of the audience, had injured his leg during the demonstration. Wells later talked to the man and found he was unaware he had suffered an injury.

Since Wells had long been concerned about the amount of pain suffered by his patients during dental procedures, he immediately enlisted Colton’s help. The day after the demonstration, Colton came to Wells’s practice and administered nitrous oxide while Wells’s associate, John Riggs, extracted one of Wells’s own troublesome wisdom teeth. Feeling not “so much as the prick of a pin” in the course of this usually painful procedure, Wells believed that he, with the help of Colton and Riggs, had invented painless dentistry.

Experiments with Anesthesia
After Colton taught Wells how to administer the gas, Wells performed a dozen painless procedures over the next few weeks. Always intense, Wells became more excited with each successful procedure. He decided to demonstrate painless dentistry in Boston and did so in January of 1845 at Massachusetts General Hospital for the benefit of Harvard Medical School students and faculty members. The demonstration did not go well. The patient moaned as if in pain, and the audience drove Wells from the lecture hall with cries of “Humbug” and “Swindler,” even though the patient tried to explain that he was not, in fact, in pain.

Despite his setback in Boston, Wells continued to use nitrous oxide in his practice in Hartford and freely shared his discovery area dentists. While dental patients elsewhere continued to suffer, many throughout Hartford were enjoying painless dentistry by the middle of 1845. Wells’s apparent failure in Boston, however, temporarily deterred him from any further attempts to publicize his innovation nationally.

Meanwhile, in Boston, Wells’s former partner Morton was experimenting with the use of ether as an anesthetic. In 1846, Morton demonstrated the use of ether to perform a painless tooth extraction. He did not, however, identify his anesthetic as being ether. Instead, Morton called it “letheon” and applied for a patent for his “substance.” He established a monopoly on painless dentistry in the Boston area and soon got positive publicity for his discovery of ether’s medical applications. Morton also tried to make a profit from his discovery, but his attempts to claim sole discovery of anesthesia in general and ether in particular were denied.

Both Horace Wells and Charles Jackson, who had been Morton’s chemistry professor at Harvard and originally introduced him to ether, stepped forward to challenge Morton’s claim that he had discovered anesthesia. Wells, for his part, sought to strengthen his claims by publishing History of the Discovery of the Application of Nitrous Oxide, Ether, and Other Vapors, to Surgical Operations (1847). Morton and Jackson entered into protracted legal battles in their attempts to prove their claims.

Wells Seeks Fortune in NYC
Wells was also trying to find a way to gain fame and fortune as an anesthetist. By the end of 1847, he had participated in dental and other surgical procedures in Hartford, but decided that he should relocate to New York City to achieve greater recognition and success.

He moved there in January of 1848, intending to establish himself before sending for his wife and their young son, Charles Wells. Loneliness and homesickness overcame him, however, and Wells began using ether and chloroform in an attempt to ease his depression. Wells spent several days intoxicated on the combination of drugs, eventually becoming so confused that he could not distinguish sleep, dreams, and reality.

On the night of his 33rd birthday, Wells went out and threw acid on a pair of women in the street. Fortunately, the acid only burned their clothing and did not permanently injure the women. The police responded to their cries for help and arrested Wells, who they incarcerated in the Tombs Prison. He continued to ingest chloroform and ether while in jail, but in moments of clarity realized the depths to which he had sunk.

Believing that he had disgraced himself and his family beyond repair, Wells took a large dose of chloroform and used a razor to slash a major artery on his thigh. He quickly bled to death, and his body was released to his family for burial at Old North Burying Ground in Hartford. In 1908, Charles Wells re-buried his father and mother (who had died in 1889 and been buried alongside her husband) at Cedar Hill Cemetery. Wells’s tombstone identifies him as the “discoverer of anesthesia.” (In like fashion, Morton’s stone acclaims him as the “Inventor and Revealer of Inhalation Anesthesia.”)

The Nature of Discovery
In 1864, the American Dental Association, followed by the American Medical Association in 1870, recognized Horace Wells as the discoverer of anesthesia. Morton was never able to gain the fortune he sought for his own contributions to the field, including a $100,000 prize which was contested by Jackson and Wells’s survivors.

Although claims to singular discovery reinforce society’s fascination with individual genius, historians of science note that it is not unusual for innovations to occur at a moment when several individuals—sometimes with knowledge of each others’ efforts and sometimes not—are working along similar lines. Discovery, they emphasize, is not typically an event but a process. Wells, then, is rightly recognized for his pioneering role in pain-free dentistry and the field of medical anesthesia.

Emily E. Gifford is an independent historian specializing in the history of religion and social movements in the United States.

Image: Miniature Portrait of Horace Wells

Sunday, July 10, 2016

The American Civil War Experience: Lice, Disease and Quinine

By Rene Tyree, 1-17-10

The statistics of those who died during the Civil War, not from injury but from disease, are shocking. Of the 360,222 men known to have died on the Union side, a quarter of a million were lost due to disease rather than the enemy. While the Confederates didn’t keep records, it is estimated that seventy-five percent of the 258,000 Southern deaths could be attributed to disease.
For many, the cycle of illness started soon after joining up. Those from the less populated countryside found themselves in large groups after mustering in – perhaps for the first time in their lives – and were exposed to childhood maladies like the measles, mumps and smallpox.

Confederate soldier William A. Fletcher’s experience appears to be not uncommon. A young man from Texas who first signed on in 1861 as a member of the 5th Texas Infantry of Hood’s brigade, he wrote in his memoirs that in the first large camp he was assigned to after signing up, he contracted the measles. While in the hospital recovering from an associated extremely high fever, he became infested with lice and before being released, he contracted the mumps.

"In this camp we suffered a good deal with sickness—the most fatal I guess was measles. I had an attack of measles and was sent to the hospital in Richmond and remained there a few days and got tired of hospital life, so I tried to be a good boy and please the woman who had charge of the ward in which I was. I soon persuaded her to get me a discharge, and I returned to camp one cold, frosty morning; the next day I was hauled back a very sick man; was put in a small room that had a coal grate and was instructed to stay in bed and keep well covered up. I lay there a few days with a burning fever, taking such medicine as was prescribed. I had learned the “itch” [from lice] was getting to be a common complaint in the hospital, and after the fever had somewhat abated, I found I had it, so when the doctor made his next visit I drew my arms from under the covers and showed him the whelps or long red marks of itch, and he said he would send me some medicine that would cure it. "[i]

While encamped near Fredericksburg, Fletcher suffered from a severe attack of jaundice and was given a permit of sick leave. Rather than moving with his unit, he took a room in a Fredericksburg hotel where he received no medical care and almost died of food poisoning. [ii]  Cases like this – and worse – were common due to a lack of sanitary conditions, adequate food, clean water and trained medical care. Gerald Linderman confirms that “each army suffered two waves of disease,” the first being “acute infections of childhood.” [iii] Because those who survived the first wave developed immunities, the incidence abated over time. But it was followed by a second wave that decimated the ranks in ever increasing numbers. Considered “camp” diseases, dysentery, malaria, and diarrhea, took men in their tents and in hospitals by the thousands, reducing the effective fighting force of many units dramatically. [iv]

John D. Billings, in his memoir "Hard Tack and Coffee", brought up two important points about health in army camps. The first was that many men Hard Tack and Coffee by John Billings came to the army already ill. This was particularly true of the recruits in 1864 and 1865, “for those who have occasion to remember will agree that a sufficient number of men too old or diseased came to the front in those years – no, they did not all get as far as the front – to fairly stock all the hospitals in the country.” [v] Billings attributed this to both the incompetence of some of the doctors providing physical examinations for enlisting recruits and the desperation of the government willing to use marginal physicians and accept men clearly unfit for duty.

Billings also spoke of the presence in every company of men who feigned illness to escape duty. As might be expected, these men were seen as shirkers who burdened others in the company with the work they did not perform. These “beats on the government” showed up routinely at the sick tent to receive the care and, in some cases, medicine administered by the doctor. Quinine was the drug du jour “whether for stomach or bowels, headache or toothache, for a cough or for lameness, rheumatism or fever and ague.” [vi]  Some who feigned illness went so far as to refuse food and so created a real health crisis for themselves with varying consequences ranging from transfer to a hospital and eventual release from the service, to susceptibility to more severe and long term conditions. [vii]

The fact remains that many, many men died of very real and unwanted maladies. Diseases flourished in camp because of poor nutrition, inadequate sewage disposal, dirty water and infrequent bathing. Typhoid, measles, cholera and dysentery killed hundreds. Even General Lee contracted dysentery on his way to Gettysburg.  Billings spoke eloquently of his many friends who suffered and died of wasting illnesses, either in the field or in hospitals, away from the families who could have unquestionably cared for them better at home. [viii]

As James I. Robertson, Jr. pointed out in his book, Soldiers Blue and Gray, “more confederates died of illness during the seven week aftermath at Corinth than fell in the two days of intense fighting at Shiloh,” an aftermath not at all uncommon during the war and certainly after every battle. [ix]

Disease was – without question – the war’s biggest killer.

Copyright © 2010 Rene Tyree
i.  William A. Fletcher and Richard S. Wheeler, Rebel Private: Front and Rear: Memoirs of a Confederate Soldier, (Meridian: New York, 1995), 7.
ii. Ibid.
iii. Gerald Linderman, Embattled Courage: The Experience of Combat in the American Civil War,  (The Free Press: New York, 1987), 115.
iv. Ibid.
v. John D. Billings, Hard Tack and Coffee: The Unwritten Story of Army Life (originally published in 1887 by George M. Smith and Company, Boston.), 173.
vi. Ibid., 175-176.
vii. Ibid., 175.
viii. Ibid.
ix. James I. Robertson, Jr., Soldiers Blue and Gray, (University of South Carolina Press: Columbia, South Carolina ), 145.

From: wig-wags.com

Wednesday, June 29, 2016

History Affects Morphine: The Hypodermic Needle

From: itech.dickinson.edu, 4-30-08

“Ah! Pierce me one hundred times with your needle fine
And I will thank you one hundred times, Saint Morphine,
You who Aesculapus has made a God.”
- Jules Verne
(Poem taken from In the Arms of Morpheus by Barbara Hodgson)

Despite its impact on the science of pharmacology, morphine had limited medical impact until the invention of the hypodermic needle in the 1840s/1850s

A number of individuals are associated with the invention of the hypodermic needle, but among them, Alexander Wood, a Scottish physician, is perhaps the most prominent

Wood used morphine in conjunction with his newly invented needle to treat a patient with neuralgia, otherwise known as a sharp pain in the nerves; unfortunately, Wood also used his device on both he and his wife, and both became addicted. In fact, Wood’s wife became the first woman to die of a narcotic drug overdose

In light of this, however, Wood found that upon injection, morphine’s results were both immediate and much more powerful, certainly a success; such success led to a rise in the medical use of morphine, especially in the realm of surgery and anesthesia

Unfortunately, though, morphine administered through hypodermic needle was not thought to be addictive, and thus it further proliferated the drug, increasing use and addiction

Interestingly, it is worth noting that shortly after the time of the hypodermic needle’s inception, there began a debate over whether the effects of morphine post-injection were localized or not; and while many believe the effects to be non-localized – hence the name hypodermic – the debate actually continues to this day

Image: historical perspective: old syringes



Wednesday, June 15, 2016

Anesthetics in Use During the Civil War: Use of Sulphuric Ether and Chloroform

From: medicalantiques.com

Edited from the medical textbook "Handbook of Surgical Operations, U. S. A. Medical Department, 1863", (in this collection)  written during the Civil War by Stephen Smith, M.D.:

ANESTHETICS
The anesthetics in general use are sulphuric ether and chloroform.

Sulphuric Ether.- — This agent is liable to adulteration, by sulphurous acid, alcohol, volatile oils, and by oxidation; it may be rendered purer by agitation with lime water, and afterwards separating it by decanting.

Method of Administration.—The following practical remarks on the administration of ether were made by a Committee appointed by the Boston Society for Medical Improvement to investigate the alleged dangers from inhalation of ether :

Ether should never be given from any inhaling apparatus. The best medium of its administration is a bell-shaped sponge, large enough to cover in the nose, mouth, and chin; but it is difficult to find one of sufficient size and close enough in texture, or without such numerous apertures at the root as to admit too freely the atmospheric air. A sponge of this sort, moreover, being as expensive as rare, is seldom used outside of hospitals. A stiff towel, properly folded, may be substituted, and has the advantage of being always at hand; as it may be left behind, the surgeon does not carry away with him the annoying odor of an impregnated sponge. It is desirable that the towel should be a new one, and of pretty good size. It is to be taken just as it comes from the laundry, and not unfolded further than to display it in the dimensions of about ten inches by five; by folding down two of the corners in such a way that they shall lap over each other a little, and securing them by stout pins, a cone will be made which fits the face admirably. The thick layers of towelling will hold sufficient ether, and its texture will prevent a too free dilution of the anesthetic by the atmospheric air, provided the apex and seam of the cone are carefully and tightly closed, either by pins or the fingers. As the cone becomes collapsed by saturation, it should from time to tune be opened, and kept in shape by distending it with the hand. Unless these details are attended to, and especially the closure of the apex of the cone, the induction of anaesthesia will be uncertain and protracted.

In anything so porous as a towel or sponge, the difficulty is to exclude enough air; for while its adequate admission to the lungs during etherization is essential to the life of the patient, its too free entrance not only delays anaesthesia, but induces a condition of excitement, both mental and physical. The importance of excluding the air, as above stated, is a point not generally appreciated, but the necessity of it has long been known to those most accustomed to the use of ether, as shown by the " chemise" with which, in hospital practice, a too porous sponge is often covered to expedite the etherization of a rebellious patient. Ether should be poured lavishly on the towel or sponge, an ounce or two at a time, especially at the commencement of inhalation. Although it may be wasted, too much, as far as safety is concerned, cannot be used. A small quantity poured on hesitatingly and timidly, as is sometimes done, has the same effect as a too free dilution of the vapor with air, producing simply intoxication and its accompanying excitement without anaesthesia; whereas a large amount, though the cough and choking sensation which the greater volume of vapor produces may cause the patient to resist and struggle, is certain to bring about a satisfactory condition of insensibility.

Phenomena of Etherization.—A strong, full-blooded man is pretty sure to resist the approaches of anesthesia under any circumstances. This may sometimes be overcome by warning him beforehand of such a possibility, and inducing him to resolve not to struggle; the last impression on his mind influences him even in his stupor. The same thing is liable also to happen with almost all patients just before complete anesthesia takes place, but the ether rarely requires to be suspended. Occasionally the respiration becomes embarrassed during the period of excitement, partly from the struggle itself, and partly perhaps from the increased flow of saliva, which is a common phenomenon of etherization, or from the position of the tongue or head of the patient, and a condition may sometimes show itself characterized by lividity, rigidity, and convulsive motions of the extremities. Although alarming to the inexperienced, the state is in fact devoid of danger, provided the ether be momentarily suspended; this being done, the refusal to breathe soon gives place to a long-drawn inspiration, and in most instances complete insensibility immediately ensues. In such a case it is interesting to observe how readily the spasm yields, and how complete is the muscular relaxation which follows the free respiration of air unmixed with ether.

 It should therefore be borne in mind, that when there is muscular rigidity with lividity, the suspension of etherization will transform this into the relaxation of anesthesia. Persons of intemperate habits succumb to ether slowly, and with greater reluctance and more opposition than persons unused to intoxication. The pulse should be watched by a competent person from the outset, and its failure, either in strength or frequency, lead to more cautious use of the ether. It must, however, be remembered, that in experiments with anesthetics upon animals, the heart has been found to be the ulttmum moriens; the respiratory movements, therefore, should not be forgotten or neglected, but any slowness or irregularity in the performance should at once receive attention. Ether is not to be withheld from a patient to be operated on, even in a state of collapse after severe accident, but great caution is demanded in its use with patients who are near death from chronic and exhausting disease, and who require operations.

The best test of complete etherization is the snoring of the patient; and no operation, unless slight, should be undertaken until this symptom presents itself. The relaxation of the muscles of the extremities may occur without insensibility. The important distinction between snoring and stertor is, however, to be borne in mind. Whilst the former is caused only by the relaxation of the muscles of the palate, the latter arises from spasm of the vocal cords and partial closure of the rima glottidis, and thus becomes the immediate forerunner of the train of symptoms already referred to as indicative of partial asphyxia. Stertorous respiration demands, therefore, a brief suspension of inhalation; one or two inspirations of fresh air will, as already mentioned, almost instantly dispel the symptom. Ether may be administered to persons of all ages, from the new-born infant to the octogenarian. There is, however, a condition prone to manifest itself with children, especially those who, are weak, strumous, or overgrown, which is due to its cumulative properties. It may show itself after almost any degree of etherization, and is characterized by a feeble pulse and slow respiration, not passing off with the readiness usually marking the phenomena of etherization. "With young persons a cautious inhalation of five minutes will often induce an anesthesia of half an hour, an effect wholly out of proportion to what the same amount of ether would produce in an adult. This state is not a dangerous one, and only requires time to dissipate its symptoms. Compression of the chest will expel the fumes of ether being eliminated from the pulmonary surface, and permit the entrance of a fresh supply of oxygen to stimulate the circulation. The inhalation should therefore be suspended at short intervals with children, and but little ether given at a time."

Chloroform:  Chloroform may be adulterated with alcohol, oils, and ether. Alcohol can be added without being detected by the smell, but may be detected by dropping the chloroform into water, when it assumes a milky appearance. Oils are detected by strong sulphuric acid, which gives a yellowish or reddish brown color; the presence of ether is detected by its readily burning when exposed to a flame. Pure chloroform may be thus tested:—-When dropped on the hand it evaporates without leaving the least smell or moisture behind; it is free from color or opacity; it does not redden or bleach litmus paper; it does not become opaque when dropped into water; it does not coagulate the white of egg.

Administration:  In the administration of chloroform great care must be exercised. The following judicious rules by Prof. Gross (System of Surgery) cannot be too carefully followed:

" 1st. During etherization the patient may sit up with impunity, but this is not the case during the inhalation of chloroform, owing, apparently, to the greater relaxation of the muscles, and consequently, to the greater difficulty in maintaining the circulation of the brain through the influence of the heart's action. Not only should the body be recumbent, but care should be taken to depress the head and shoulders, bringing them nearly to a level with the trunk.
" 2d. An empty state of the stomach is desirable for two reasons; first, because if chloroform be given soon after a hearty meal it will be almost certain to induce vomiting; and, secondly, because a crowded condition of the organ interferes materially with the movements of the diaphragm. Food must not be taken for at least four hours before the exhibition; but, on the other hand, the interval should not be too protracted, lest serious exhaustion result from »he want of the necessary stimulus.
" 3rd. Care must be taken, before the inhalation is commenced, that the patient's clothes are sufficiently loose to prevent constriction of the chest and abdomen. Any compression from this source would necessarily impede the action of the diaphragm, and might thus become a cause of mischief.
"4th. The importance of having an abundance of atmospheric ah- during the inhalation of an article so potent as chloroform, is self-evident; in etherization this is of comparatively little consequence, but in the exhibition of chloroform for surgical and obstetrical purposes, it is absolutely indispensable to the safety of the patient.
" 5th. The inhalation must be effected gradually, not hurriedly, time being allowed to the system to accommodate itself to the influence of the remedy, thus avoiding the shock which might otherwise result to the heart and brain. From six to eight minutes should usually be spent in producing the full effects of the anaesthetic.

When the patient is very feeble, or pale and.timid, it will be advisable to give him, immediately before the operation, from half an ounce to an ounce of brandy; and the dose may afterwards be repeated, if the effect is obliged to be maintained for an unusual length of time, sufficient consciousness being permitted for the performance of deglutition. The best mode of administration of chloroform is to pour the fluid upon a napkin or handkerchief previously folded into a kind of cup-shaped hollow, and held securely in the hand. Or, instead of this, a small, hollow sponge may be used. As to the various inhalers that have been devised for the purpose, they are all objectionable on account of their inconvenience and the difficulty of obtaining a sufficiency of atmospheric air. The patient having taken his place upon the table, and emptied his lungs by a deep and protracted expiration, the napkin, impregnated with a drachm of chloroform, is held over the mouth and nose, at a distance of about two inches, being gradually brought nearer and nearer until it is within half an inch, beyond which it should not be carried, the chest being at the same time regularly and powerfully distended. On no account should the liquid be permitted to come in contact with the surface, as it might thus cause vesication.

All unnecessary conversation is avoided, lest the attention of the patient should thereby be unduly distracted. The assistant having charge of the administration gives it his earnest and undivided care; wetting the napkin from time to time with the fluid, and seeing that the patient gets an abundance of air, his vigilance increasing as the effects of the medicine become more and more apparent. As soon as the sensibility is completely abolished, the operation is commenced, a return to consciousness being prevented by holding the napkin, wet with a small quantity of the vapor, occasionally before the nose; and thus the impression is maintained, steadily and cautiously, not only until the knife has fully accomplished its object, but until the principal arteries have been secured, and, in some cases, even until tht dressings have been applied.

As soon as the inhalation has been fairly entered upon, one of the attendants should sedulously watch the state of the pulse, of the respiration, and of the countenance. Any sudden failure in any one of these should at once create alarm, and induce a suspension of the operation, or provision for the admission of a greater quantity of atmospheric air. I do not deem it necessary that a finger should be constantly kept upon the pulse; for the color of the face and the nature of the breathing will always sufficiently indicate the effects which the anesthetic is exerting upon the system, and thus afford abundant opportunity for preventing any unpleasant occurrence.

The quantity of chloroform required during an operation, and the time during which its effects may be safely maintained, must, of course, vary according to the exigencies of each particular case. In general, from half an ounce to an ounce may be regarded as a fair average^ but very frequently it takes three or even five times that amount, depending upon the severity and duration of the operation, and the susceptibility of the individual. In some instances almost an incredibly small portion answers the purpose. Children usually require comparatively little; and it is well known that women are, as a general rule, more susceptible to its influence than men. Persons exhausted by hemorrhage are very easily affected by it, owing to the rapidity of its absorption, and hence it should always be administered to them with unusual care."

Dr. Simpson has advised that chloroform be given by laying a handkerchief over the face, and letting the chloroform fall on it drop by drop.

Resuscitation: The towel or inhaler being removed, the patient's tongue should be drawn forward with forceps or a tenaculum, fresh air admitted from the door or windows, or induced by a fan, and artificial respiration instituted. Stimulating applications to the surface, cold douche to the head, and stimulating injections may be added. The main reliance is on artificial respiration, and this is best kept up by Marshall Hall's method as follows: " Turn the body gently, and completely, on the side and a little beyond, and then on the face, alternately; repeating these measures deliberately, efficiently, and perseveringly, fifteen times in a minute, only [when the patient reposes on the thorax, this cavity is compressed by the weight of the body, and respiration takes place; when he is turned on the side, this pressure is removed and inspiration occurs]. When the prone position is resumed, make equable but efficient pressure along the spine ; removing it immediately before rotation on the side [the first measure augments the expiration, the second commences inspiration]." As soon as the patient can swallow, give brandy and ammonia. Efforts at resuscitation should not cease until death is evident.

A method of producing artificial respiration has been introduced by Dr. Sylvester; it consists in laying the patient on his back, drawing the tongue forward, then carrying the arms slowly upwards over the head, thus elevating the ribs by means of the pectoral muscles, and inducing respiration; the arms are then brought down to the side of the chest and slightly compressed against it; these movements are to be repeated slowly as by the other method.

If a galvanic battery is at hand it should be resorted to among other possible means of restoring animation.

Modern Anesthesia Traces Roots to the American Civil War

By Bob Shepard, 8-12-14

The use of the anesthetic agents ether and chloroform was first described in the 1840s by American physicians Crawford Long, William Morton, William Edward Clarke and James Simpson, but anesthesia was not commonly used by physicians in the United States prior to the outbreak of the Civil War in 1861.

The sheer magnitude of battlefield injuries during the conflict played a major role in establishing the regular use of anesthesia, according to an article in the newsletter of the American Society of Anesthesiologists written by Maurice S. Albin, M.D., a professor in the Department of Anesthesiology at the University of Alabama at Birmingham.

“Prior to the war, alcoholic drinks, physical restraints, opioid drugs and bite blocks were the most typically employed methods of keeping a patient under control during surgery,” Albin said. “It was thought to be unmanly for a male to undergo surgery with an anesthetic, which was usually reserved for women and children. There was even a belief that the use of ‘cold steel’ had a beneficial effect, and it would not cause the depression thought to occur with the use of anesthesia.”

The fury of the war changed all that. Albin suggests that there were more than 120,000 uses of anesthetic agents by surgeons on both sides during the fighting.

Prior to the war, it was thought to be unmanly for a male to undergo surgery with an anesthetic. The fury of the war changed all that.

“Fortunately for both the Union and Confederate medical corps, many manuals by outstanding surgeons, both national and foreign, were available,” Albin said. “Some of these manuals contained descriptions on the use of these agents. Eminent Confederate surgeon John Julian Chisholm published a manual for battlefield surgery in 1861 that included a chapter on the use of chloroform, and famed surgeon Valentine Mott’s essay on the use of the same agent was available to Union surgeons.”

The mortality rate associated with the use of anesthetic agents was remarkably low. Chisholm stated he never had a single death from chloroform in more than 10,000 uses, while Confederate surgeon Hunter Holmes McGuire claimed to have used chloroform more than 28,000 times with no loss of lives attributed to the agent.

Albin says approximately 15,000 physicians served in the two armies, and were men who had come from diverse educational and medical backgrounds.

“Firsthand exposure to anesthetic agents and techniques, as well as to their side effects and complications, gave these physicians an insight into the world of anesthesia that might never have been possible without this conflagration’s occurring,” he said. “After the termination of this horrendous conflict, these doctors would return to their practices, hospitals and medical schools, all the richer for being exposed to this unique American contribution to the life-easing quality of mercy — the discovery of anesthesia.”

UAB created the world’s first academic anesthesiology history unit in 2002 with the development of the David Hill Chestnut, M.D., Section on the History of Anesthesia. The section is designed to expose anesthesiology residents, fellows, faculty, medical students and the general public to the historical developments behind the progress of anesthesiology as a specialty.

From: uab.edu

Tuesday, May 24, 2016

“An Aristocracy of Talent”: The South Carolina Physician-Naturalists and Their Times

By Charles S. Bryan, MD (by invitation) and A. Weaver Whitehead, Jr, MD

Abstract
During the natural history movement of the 18th and early 19th centuries, Charleston as a center was rivaled in the United States only by Philadelphia, New York, and Boston. Prominent physician-naturalists included Alexander Garden (for whom the gardenia is named), John Edwards Holbrook (“father of American herpetology”), and Francis Peyre Porcher (whose Resources of Southern Fields and Forests helped Confederates compensate for drug shortages). The Charleston physician-naturalists belonged to an “aristocracy of talent” as distinguished from the “aristocracy of wealth” of lowcountry planters, who probably did more than any other group to perpetuate slavery and propel the South toward a disastrous civil war. None of the physician-naturalists actively opposed slavery or secession, a reminder that we are all prisoners of the prevailing paradigms and prejudices of our times.

INTRODUCTION
The South Carolina lowcountry elicits mixed emotions. Its beauty and diversity of flora and fauna bring out the joyous naturalist in a person, yet such sights as abandoned rice fields, tabby ruins of plantations and chapels-of-ease, and Civil War cemeteries remind us of a way of life based on African slavery. During the natural history movement (the descriptive study of the three major kingdoms—animal, vegetable, and mineral—during the 18th and early 19th centuries), Charleston as a center for naturalists, especially physician-naturalists, was rivaled in the United States only by Philadelphia, New York, and Boston. How did these men respond to slavery, that singularly defining fact of American history?

My text comes from a remark made sometime around 1830 at a dinner party: “Whatever parties may exist in a country, and under whatever names they may go, there are always two aristocracies—the aristocracy of wealth and the aristocracy of talent.” Turning to his guest, the speaker added: “You belong to one and I to the other”. The speaker was young Tom Heyward, scion of a rice-planting family. The South Carolina lowcountry planters, an argument goes, did more than any other group to perpetuate African slavery, defy the federal government and its constitution, propel the nation toward civil war, and establish a mindset that reverberates today in our hyperpolarized national psyche. The listener was a young lawyer named James Louis Petigru, who went on to such distinction that by the eve of the Civil War he is said to have been the only Unionist in South Carolina who could walk down the streets of Charleston or the aisle of St Michael's Church and gain a respectful nod from everyone he passed. To Petigru is attributed the famous mot that “South Carolina is too small to be a republic, and too large to be an insane asylum.”

The physician-naturalists constituted an aristocracy of talent. A few, to be sure, became planters and slaveholders, but most earned their livings practicing medicine. Their lives and achievements have been previously summarized, but, to my knowledge, no attempt has been made to situate all of them within their eras' general histories. This meeting's setting in downtown Charleston, the scheduling of this paper late in a program sated with basic and clinical science, and last evening's address on the bombardment of Fort Sumter by Professor James Rembert suggested it might be more useful to underscore the contexts of their times that to dwell at length on their specific contributions to natural history, which at this late hour might fly by like so much scenery. Let us then consider some of the more prominent Charleston physician-naturalists in four contexts: the colonial and revolutionary periods, during which the die was cast for a later reckoning on the slavery question; flush times between 1783 and 1830, when diversity of opinion on slavery was still tolerated; stormy years between 1830 and 1860, during which southern attitudes hardened; and the Civil War, which destroyed the aristocracy of wealth and effectively closed an era of physician-naturalists in South Carolina.

COLONIAL AND REVOLUTIONARY PERIODS: DR ALEXANDER GARDEN
Colonial Americans bent on studying medicine typically went to Edinburgh. Native Scots trained in Edinburgh often went elsewhere to practice, as the supply of doctors in Scotland exceeded the demand. The late Dr Joseph Waring determined that 17 of 28 doctors who practiced in Charleston between 1725 and 1780 were either born in Scotland, trained in Scotland, or, and more typically, both. During the colonial and revolutionary periods, the leading South Carolina naturalist by far was Dr Alexander Garden (1730−1791), a Scot who came here in 1752 seeking a milder climate for his lung condition, probably tuberculosis. He began practice in what is now Beaufort County but due to illness went north for a few years. There he met other naturalists and learned the Linnaean method of classification. Returning to South Carolina, Garden practiced with Dr John Lining, another Scottish immigrant remembered as a pioneering American meteorologist. Garden applied Linnaean taxonomy to the flora and fauna of South Carolina. He submitted botanical specimens to the British naturalist John Ellis, who read Garden's papers to the Royal Society and made Garden known to the great Swedish physician-naturalist Carl Linnaeus. The latter showed appreciation by naming the Cape jasmine the “Gardenia” and encouraged Garden to send animal specimens. Linnaeus eventually credited Garden for describing three new genera of plants, two new genera of fish, and 60 new species of serpents, insects, and fish. Garden's specimens were so well-prepared that many remain on display in London museums. His observations and experiments on electric eels drew the attention of London's John Hunter and others, contributing to a chain of events leading to the idea that human nerves and muscles might operate on electric impulses.

Garden's productivity as a naturalist becomes all the more remarkable when one considers his poor health, his probable attacks of malaria, the Carolina heat, and a practice that grew busier after Lining died in 1760. He was driven in part by a desire for recognition by European scientists. He held little hope for recognition by fellow colonists, telling Ellis that South Carolina was “a horrid country, where there is not a living soul who knows the least iota of Natural History”. Garden took a dim view of the lowcountry planters, writing that they were “absolutely above every occupation but eating, drinking, lolling, smoking, and sleeping, which five modes of action constitute the essence of their life and existence” (whether he left out sex inadvertently is unknown).

Also driving Garden like most naturalists was the desire to know God by studying His handiwork (natural theology; the “argument from design” for the existence of God). Thus, in 1763, Garden wrote Linnaeus of “the mental pleasure and rational employment, which I have had in examining, determining, contemplating, and admiring this wonderful part of the works and manifestations of the wisdom and power of the Great Author of Nature,” which was “so full and replete with innumerable marks of Divine” that Garden planned to devote full-time to it “as soon as my business of the practice of medicine will permit me”. Linnaean taxonomy was predicated partly on the idea that God had formed each creature independently; therefore, each species reflected a divinely created “original mold.” How Garden reconciled his pursuit of the divine with the harsh reality of slavery is unknown, but he made scathing observations on the slave trade.

More than 200,000 Africans were brought to South Carolina between the late 17th century and 1808, when the slave trade was officially abolished. Charleston's first English-speaking settlers came from the West Indies in 1670 as experienced colonists well-aware of the profitability of cash crops using slavery. The brutality of slavery in the hot and humid Carolina lowcountry prompted the Stono Rebellion of 1739, which resulted in the deaths of approximately 45 whites and an equal number of blacks. Whites' attitudes hardened but the slave trade resumed after brief suspension. Garden was among the doctors who examined newly arrived slaves quarantined on Sullivan's island, which became the Ellis Island for at least 40% (some estimates run as high as 60%) of today's African Americans.

Garden described the horrors to the British botanist Stephen Hales: “There are few Ships that come here from Africa but have had many of their Cargoes thrown overboard; some one-fourth, some one-third, some lose half; and I have seen that some that have lost two-thirds of their Slaves. I have often gone to visit those Vessels on their first arrival. .. but I have never yet been on-board one, that did not smell most offensive and noisome; what for Filth, putrid Air, putrid Dysenteries (which is their common Disorder), it is a wonder any escape with Life”. Nevertheless, Garden as a man of his times did not forswear slavery. Reputedly the colony's wealthiest doctor by the eve of the revolution, he bought a plantation only to have his enjoyment of a slaveholding planter's lifestyle cut short by the Revolution.

South Carolina was the wealthiest of the 13 colonies. If you belong to the privileged class, should you bet on the Continentals or the Crown? This question became urgent after Charleston fell to the British in early 1780, leaving Lord Cornwallis in charge. Garden tried to stay neutral. However, his signature on a memorial congratulating Cornwallis on his route of the Continentals at Camden (August 1780) proved his undoing.

South Carolinians taught the British a lesson (and a lesson apparently forgotten by US leaders beginning around 1960) that a well-equipped, well-fed, well-dressed occupying force from across an ocean may lose to insurgents who know the terrain, blend in with the population, use hit-and-run tactics, and are not answerable to public opinion in a faraway land. Francis Marion (“the Swamp Fox”), Thomas Sumter (“the Gamecock”), and other partisan leaders with their ragtag troops disrupted British supply lines between Charleston and the “backcountry.” Marion and his colleagues effectively wrote a manual on asymmetric warfare that is still studied. Backcountry farmers, many of them Scots-Irish with no particular fondness for the British, became enraged by occasional atrocities such as Banastre Tarleton's massacre at the Waxhaws (May 1780). They teamed with Continental regulars to win decisive battles at Kings Mountain (October 1780) and Cowpens (January 1781) and drive Cornwallis up through the Carolinas and then to Yorktown, where the British were trapped between George Washington's army and the French fleet. After the war, Garden became one of 13 doctors banished in 1783 as “obnoxious persons” for supporting the British cause. He returned to Great Britain, became vice-president of the Royal Society, and died there in 1791.

FLUSH TIMES (1783 TO 1830): MEDICAL EDUCATION AND BOTANY
The fate of America, it is suggested, may have been sealed during the Constitutional Convention of 1787 when a Charleston lawyer-politician named John Rutledge invited Roger Sherman of Connecticut to dinner. Rutledge chaired a committee that wrote much of the final version of the Constitution. Only 3 of the 13 states—the two Carolinas and Georgia—had a vested interest in perpetuating slavery indefinitely. Most southerners like most of the Founding Fathers tolerated slavery but predicted its eventual decline. Rutledge, perhaps through a lie, persuaded Sherman to vote with South Carolina on the slavery issue in exchange for which South Carolina would support Connecticut's desire to invest in western land through the Ohio Company (that is, to establish the Western Reserve). The slave trade was thus extended until January 1, 1808. Pierce Butler, another South Carolina delegate to the Constitutional Convention and one of the South's largest slaveholders, inserted a clause mandating return of fugitive slaves. Butler also promoted a compromise that allowed states to count three-fifths of the slave population for the purposes of Congressional apportionment. This gave the slave states disproportionate power in the new Congress, the first iteration of a “solid South” in American politics.

The half century that followed the Revolution brought flush times for lowcountry planters. They lost the British bounty for indigo (a plant from which blue dye was produced) but discovered the profitability of “Carolina gold” rice. Rice plantations lined stretches of rivers where fresh water rises and falls with the tides. The rice fields were alternately flooded and drained by harnessing tides with dikes, floodgates, and trenches—elaborate systems requiring large numbers of slaves to be cost-effective. By the 1820s, the population of Georgetown County, north of Charleston, was more than 90 percent black. The widow of a Georgetown rice planter wrote her son at West Point: “Rice [that is, the price of rice] fell badly, and that depresses the spirits of the Majority of the People here, whose chief object is to make Rice to buy Negroes and Buy Negroes to make Rice”. Malaria and other diseases rendered the rice plantations extremely insalubrious. The seasonality of malaria prompted one of the strangest migration patterns in the history of agriculture: the planters and their families absented their country homes during the growing and harvest seasons, taking extended summer vacations including the European Grand Tour. The lowcountry planters came to view slavery as a permanent necessity for their way of life.

Rice was, of course, not the only source of South Carolina's wealth. In 1793, Eli Whitney of Massachusetts, fresh out of Yale College, invented the cotton gin. Backcountry Carolinians turned forests into cotton fields. It is said with only slight hyperbole that one could have walked from Charleston to Walhalla (in the western corner of the state) without stepping out of a cotton field except to cross the occasional creek or river. Southern planters perceived two threats to their power in Congress: rapid population growth in the northern states and the possibility that western territories would become states that outlawed slavery. Tensions were appeased but not resolved by the Missouri Compromise of 1820, which banned slavery in the former Louisiana Territory north of the 36° 30' parallel (but allowed slavery south of it) except within the boundaries of the proposed state of Missouri.

Emblematic of South Carolina's prosperity during the early decades of the 19th century was the opening of the Medical College of South Carolina in Charleston, which at its creation in 1824 was the first such school in the Deep South. All but one of the seven charter faculty members had been graduates of the University of Pennsylvania, which had replaced Edinburgh as the destination of choice for American medical students. The exception was Stephen Elliott (1771−1830), whose honorary medical degree was conferred by the new school. Three of the seven charter faculty members were naturalists: Elliott, John Edwards Holbrook (1794−1871), and Edmund Ravenel (1797−1870).

During the early 19th century, many educated Americans took up botany. A South Carolina example was Joel Roberts Poinsett (1779–1851), who used the small fortune inherited from his father, Dr Elisha Poinsett of Charleston, to pursue a diplomatic career. In 1825 Joel Poinsett became America's first minister (ambassador) to Mexico, from which he brought back a flowering plant known there la flor de Nochebuena and to us as the poinsettia. Among the South Carolinian physicians who studied botany during this period, the most prominent were Elliott and John Lewis Edward Whitridge Shecut (1770−1836). Shecut's application of Linnaean taxonomy resulted in The Flora Carolinaensis, or a Historical, Medical, and Economical Display of the Vegetable Kingdom according to the Linnaean or Sexual System of Botany (1806). Shecut also experimented with electricity to treat various conditions, especially withered or paralyzed limbs, and wrote two novels. Elliott published between 1816 and 1834 a Sketch of the Botany of South Carolina and Georgia, a classic of American botany. Plants bearing his name include the shrub Elliotia.

Shecut and Elliott left little evidence of their views on slavery, which, however, changed after the slave trade ended in 1808. Slaves were treated better because they could no longer be replenished from Africa (or at least not legally). They no longer slept on bare ground. Many were taught Christianity. Many kept their own vegetable patches and some kept livestock. Some sold goods at markets such as the one directly across Meeting Street from where we now assemble. Charleston and other cities became home to an increasing number of free blacks, one of whom—a man known to history as Denmark Vesey—supposedly led an insurrection in Charleston in 1822. Although slavery became in some respects a kinder and gentler institution, white southerners' attitudes toward their “peculiar institution” and toward the federal government inexorably hardened.

STORMY YEARS (1830 to 1860): NATURALISTS AND THE THEORY OF POLYGENESIS
The naturalist movement in the United States peaked between 1830 and 1840; the years between 1830 and 1860 constituted a golden age for naturalists in South Carolina (7). Three physicians—Edmund Ravenel, Lewis Reeve Gibbes (1810−1894), and John Edwards Holbrook (1794−1871)—deserve mention, as does a Lutheran minister, the Reverend John Bachman (1790−1874). Their times were characterized politically by the doctrine of states' rights and by the “positive good” theory of slavery, ideas that led southerners down the primrose path toward secession and civil war.

The first flash point in South Carolina's journey toward secession was the Nullification Crisis, a reaction to the federal Tariffs of 1828 and 1832. South Carolinians considered these tariffs oppressive, designed as they were to protect northern manufacturing to the detriment of southern agriculture. In 1832 the state legislature passed an Ordinance of Nullification declaring federal tariffs null and void within the state borders. President Andrew Jackson sent naval forces to Charleston, warned South Carolinians not to commit treason, and supported a bill in Congress giving him power to enforce tariffs. A compromise ensued and South Carolina repealed the ordinance. However, an irreparable rift developed between President Andrew Jackson and his vice-president, South Carolina's John C. Calhoun. Calhoun, as a recent commentator puts it, “made it impossible to be both antislavery and reasonable”.

Calhoun popularized two theories later used to justify secession and civil war: the “theory of the concurrent majority” and the “positive good” theory of slavery. In his Disquisition on Government Calhoun railed against “the tyranny of the majority” and implied the rights of states to nullify acts of Congress. The positive good theory of slavery, first articulated by Thomas Dew of Virginia, held that blacks were incapable of self-government and benefitted from slavery. It was during the gathering firestorm fueled by Calhoun's theories that physician-naturalists Ravenel, Gibbes, and Holbrook contributed to their era's scientific thought.

Edmund Ravenel, who served as dean of the Medical College in Charleston from 1829 until 1834 when his health began to fail, spent summers on Sullivan's Island where he practiced medicine and collected seashells. Between 1827 and 1829 he befriended a soldier stationed at Fort Moultrie who had enlisted as “Edgar A. Perry” but whose real name was Edgar Allan Poe. In Poe's short story “The Gold Bug” the protagonist William Legrand, modeled in part after Ravenel, finds a bivalve mollusk on the beach at Sullivan's Island before being bitten by the scarab-like “gold bug.” In 1834 Ravenel published a catalogue of his collection, the first of its kind in the United States and containing more than 3500 shells. His collection is still intact in the Charleston Museum and some consider him the “father of American conchology.” Ravenel published on other scientific topics including geology, and in 1853 was a founding member of the Elliott Society of Natural History in Charleston. Lewis Reeve Gibbes was perhaps the most versatile of the Charleston physician-naturalists although, to be sure, he never practiced medicine after receiving his degree, electing instead to teach mathematics. In 1835, he published a “Catalogue of the Phaenogamous Plants of Columbia, S.C. and its Vicinity,” describing some 900 species.

The most eminent Charleston physician-naturalist of this period was John Edwards Holbrook, the first professor of anatomy at the Medical College of South Carolina. Holbrook is considered the “father of American herpetology” on the basis of his five-volume North American Herpetology; or a Description of the Reptiles Inhabiting the United States, begun in the 1820s and ultimately completed in 1842. He personally collected reptiles in every state from Maine to Georgia and named 29 new species. He then turned to fish. In 1847, and again in 1848, 1855, and 1860, he published treatises on the fish of South Carolina and neighboring states. Holbrook developed a vast network of naturalists including physicians to collect specimens—an early model of collaborative research. He insisted that his illustrations be drawn from life, which explains in part their high quality. A self-effacing man, Holbrook never made much money practicing or teaching medicine and spent much of what he earned on his collecting trips and book publishing. However, his devoted wife came from a wealthy slaveholding family and supported his scientific endeavors.

Edmund Ravenel, Lewis Gibbes, and John Holbrook belonged to a circle of naturalists led by the Reverend John Bachman. Born in Rhinebeck, New York, on the Hudson River, Bachman, similar to Garden before him, came to South Carolina seeking a better climate for tuberculosis. He served as minister of St John's Lutheran Church in Charleston from 1815 until his death in 1874. He is remembered eponymously for Bachman's sparrow, Bachman's hare, and the probably extinct Bachman's warbler, but during his day the quality and quantity of his observations, especially on small mammals such as moles and shrews, drew admirers on both sides of the Atlantic. The artist John James Audubon became his close friend. They collaborated on the three-volume Viviparous Quadrupeds of North America (1846−1853), for which the self-promoting Audubon took most of the credit even though Bachman did nearly all of the writing. As a naturalist, Bachman was Audubon's superior and objected to the artist's rushing into print despite inaccuracies. Bachman apparently did not object to the marriage of two of his daughters to Audubon's two sons. (Both of these daughters later died of tuberculosis, as did another daughter and both of Bachman's wives; Bachman seems to have been an effective disseminator of the tubercle bacillus.) Bachman's opposition to a prevailing view on polygenesis—the derivation of a species from more than one ancestor—makes him a still-relevant figure in the broader history of science.

Calhoun and others supported the positive good theory on slavery with an argument that blacks were not just intellectually inferior to whites; they were a separate species. The idea of polygenesis—that is, that there were multiple creations, not just the singular creation of Adam and Eve—was respectable during the 18th century (defended, for example, by Voltaire and David Hume), was widespread in Europe by the 19th century, and by 1830 had spread to the United States. Among its champions was the celebrated Swiss-born Harvard scientist Louis Agassiz. In 1839 polygenesis received a boost in the United States when the Philadelphia physician Samuel George Morton (1799−1851) published his long-awaited book, Crania Americana. Morton, one the world's foremost “craniologists,” used internal dimensions of skulls to support an argument that blacks were the “lowest grade of humanity.” Among Morton's most enthusiastic supporters was Dr Josiah Clark Nott (1804−1873), a native of Columbia, South Carolina, who made his mark in Mobile where he founded the Alabama College of Medicine. Nott became the South's leading physician-polemicist on racial theory. He used Morton's data to strengthen the case for polygenesis, black inferiority, and the positive good theory of slavery.

John Bachman, although a social reformer who ministered to both races, did not dispute the idea of black inferiority. However, he like other ministers was troubled by Morton's challenge to the biblical creation story. In 1850, Bachman published The Doctrine of the Unity of the Human Race Examined on the Principles of Science shortly before the American Association for the Advancement of Science held its third annual meeting in Charleston. Ravenel, Lewis Gibbes, Holbrook, Nott, and Bachman all presented papers. Bachman's paper on the “unity of the human race”—monogenesis as opposed to polygenesis—created a stir. Louis Agassiz, a frequent visitor to Charleston, attended the meeting and contested Bachman. After the meeting, Agassiz went to Columbia to spend 2 weeks with Dr Robert Wilson Gibbes (1809–1866), a Charleston native who had become a versatile physician-scholar and authority on paleontology. Gibbes took Agassiz to various plantations where Agassiz made observations on slaves that strengthened his conviction that blacks were a separate species. The Harvard scientist now sided completely with Morton and Nott on polygenesis. Bachman, meanwhile, was unable to convert any of his fellow Charleston naturalists, or any of the professors at the Medical College, to his point of view.

These events coincided with debates in Congress that led to the Compromise of 1850—five bills that defused a confrontation between slave states and free states on the status of territories acquired during the Mexican-American War. John C. Calhoun died that year, but his doctrine of states' rights and his positive good theory of slavery became mantras for pro-slavery southerners.

In a recent book entitled America's Longest Siege, Joseph Kelly argues that “the siege of Charleston” was not merely the siege of Fort Sumter; rather, it was a decades-long siege of southern thought led to a large extent by the South Carolina lowcountry planter aristocracy. Freedom of speech on slavery and states' rights virtually disappeared among white South Carolinians. Root causes included greed, fear, and preservation of a way of life because an estimated two-thirds of the state's private wealth consisted of slaves. During the war, the British-Irish reporter William Howard Russell attended a gathering of lowcountry rice planters and wrote in his diary: “These tall, thin, fine-faced Carolinians are great materialists. Slavery perhaps has aggravated the tendency to look at all the world through parapets of cotton bales and rice bags, and though more stately and less vulgar, the worshipers here are not less prostrate before the ‘almighty dollar’ than the Northerners”.

SECESSION AND CIVIL WAR (1860−1865): DR FRANCIS PEYRE PORCHER
Historian William J. Cooper argues that secession was not an inevitable result of the pro-slavery and pro–states' rights dogmas of the antebellum South. If South Carolina seceded, would the other southern states follow? South Carolina had acted alone during the Nullification Crisis of 1832; would the Palmetto State again be “hung out to dry”? Pro-secession “fire-eaters” advanced three arguments. First, the right to secede was implicit in the Constitution. Because the Union had been entered voluntarily it could be left voluntarily. Second, the federal government had not enforced the Fugitive Slave Law, and now northern opinion threatened abolition. Finally, Lincoln's election was intolerable, tipping as it did the balance of power in Washington. Although Lincoln did not call for the immediate abolition of slavery, he was clearly no friend of the South's “peculiar institution.” He had little first-hand knowledge of the South. He had no plan for reparations to slaveholders should slavery be abolished.

The Charleston physician-naturalists supported secession and, like other able-bodied men, served the Confederate cause. John Holbrook chaired the Examining Board of Surgeons for South Carolina and was a medical officer in the Confederate Army. Robert Wilson Gibbes served as Surgeon General of South Carolina. One physician-naturalist, Dr Francis Peyre Porcher (1824−1895), made himself useful through his knowledge of medicinal botany.

In 1847, Porcher had been the first honor graduate of the Medical College in Charleston, writing his thesis on the flora of the Carolina lowcountry. In 1848, he published “A Sketch of the Medical Botany of South Carolina” and in 1854 he reported to the American Medical Association on “The Medicinal, Poisonous, and Dietetic Properties of the Cryptogamic Plants of the United States.” He might have veered off into the emerging field of cellular pathology had the war not intervened, for in 1860 he presented a paper to the state medical association on “Illustrations of Disease with the Microscope; Clinical Investigations, with upwards of five hundred original drawings from nature and one hundred and ten illustrations in wood.” Porcher's knowledge of medicinal botany drew the attention of the Surgeon General of the Confederacy, Dr Samuel Preston Moore, a Charleston native who had relocated to Arkansas. Moore asked Porcher, then a surgeon in the Confederate army, to prepare a manual on botany to compensate for the effect of the Union blockade of Southern ports on Confederate drug supplies. Porcher's manual, 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 (1863), was widely used. It was so successful that a revised and expanded edition was issued 4 years after the cessation of hostilities.

The Civil War was disastrous for South Carolina, which lost 23% of its white male population of fighting age, the highest percentage of any Confederate state. John Holbrook lost all of his papers when Charleston was ransacked. He eventually retired to Massachusetts where he died in 1871. Robert Wilson Gibbes lost nearly everything including his extensive collection of fossils when Columbia burned shortly after William Tecumseh Sherman entered the city (February 1865). He died in 1866 “full of loneliness and despair.” The elderly and kindly Reverend Bachman, who despite northern roots had supported secession, lost his papers and was seriously roughed up by Union troops. True to his religious beliefs, he declined to identify his attackers.

The natural history movement faded during the closing decades of the 19th century. Darwinism dimmed enthusiasm for natural theology and the argument from design. Professionalization and compartmentalization of most branches of science discouraged talented amateurs or “gentleman” naturalists. The advent of anesthesia, the germ theory, and aseptic surgery opened new avenues for innovative physicians. Francis Porcher, the youngest of the physician-naturalists considered here, went on to a distinguished medical career and in 1890 was 1 of 10 Americans invited to attend the 10th International Medical Congress in Berlin. A few physicians soldiered on as naturalists in South Carolina and elsewhere, but the movement had by and large run its course.

PARTING THOUGHTS
Looking out on this audience, I see an aristocracy of talent dedicated to the advancement of scientific medicine. As William Osler put it: “Linked together by the strong bonds of community of interests, the profession of medicine forms a remarkable world-unit in the progressive evolution of which there is fuller hope for humanity than in any other direction”. Yet looking beyond this audience, beyond the salt marshes of the South Carolina lowcountry, I see a nation nearly as hyperpolarized as it was on the eve of the Civil War, a nation divided not as Blue versus Gray states by the Mason-Dixon line but as Blue versus Red states divided more or less (and fortuitously) by whether their ticks carry Borrelia burgdorferi, the agent of Lyme disease. Sadly, I see politicians of my own state voting to nullify the Affordable Care Act (just as their forebears nullified the tariff), voting to oppose expansion of Medicaid, and acting (at the time of this meeting) in such a way as to bring the federal government to a near-standstill. Like James Louis Petigru, I wonder whether we—Americans and, in a broader sense, all of Homo sapiens—will ever “get it right.” The root cause of at least some our troubles remains greed—aspiration to, or preservation of, an “aristocracy of wealth.” The social predicaments of the South Carolina physician-naturalists, and their tacit approval of slavery and states' rights, remind us that we are all at least to some extent prisoners of the prevailing paradigms and prejudices of our times, and that future generations may see us quite differently than we see ourselves. We forget this lesson at our own risk.

Image 1: Selected military, political, and ideological events between 1750 and 1865 (shown to the left of the timeline) and dates of major contributions including published treatises by selected South Carolina physician-naturalists (shown to the right of the timeline).

Image 2: Dr Francis Peyre Porcher (1824−1895), whose Resources of Southern Fields and Forests (1863) helped Confederates compensate for the scarcity of drugs, enjoyed a successful medical career after the Civil War.

ACKNOWLEDGMENT
Peter McCandless provided valuable assistance during the research for this paper.

From: ncbi.nlm.nih.gov

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