Saga of a Civil War Surgeon

Lecture recalls Harvard physician who also served in the infantry

From: "The Harvard Gazette"

By Corydon Ireland, Harvard Staff Writer

There are 2,000 plaques and other memorials on what was once the Civil War battlefield in Gettysburg, Pa. Only one is dedicated to a physician, Zabdiel Boylston Adams, an 1853 graduate of Harvard Medical School.

The story of Adams, including his famous Boston lineage, Civil War service, and postwar practice, was recently told at the Countway Library of Medicine, part of a series of lectures on medicine during the murderous national conflict 150 years ago.

“He jumped right in,” said Mitchell L. Adams ’66, M.B.A. ’69, of his great-grandfather’s service, “and was in it from the beginning to Appomattox,” when Southern forces surrendered.

Mitchell Adams, who delivered the lecture, is a former member of Harvard’s Board of Overseers and recently retired after 10 years as executive director of the Massachusetts Technology Collaborative.

Along with many other tales, he told of his ancestor’s Gettysburg experience. On the afternoon of July 2, 1863, the doctor set up a rude field hospital close to the line of battle. (One flat rock that was used as a surgical table is still there.) Adams had noticed how many soldiers were dying during transport from combat to distant medical care. Because he began treating patients so quickly and near the fighting, the 1895 plaque reads, “many of our wounded escaped capture or death.”

For Adams (1829-1902), as for his American generation, the Civil War was life’s most defining period, which not only recorded stories of bravery but also opened postwar lives to heightened inspection. Countway is home to the Zabdiel Adams papers, ranging from battlefield letters, maps, and diaries to documents that illuminate later medical practice.

An advocate for vaccination

Nuggets abound. For instance, Adams was an ardent advocate for vaccination, inspired in part by his prewar experience as a surgeon aboard an immigrant ship. During the war Adams was not a champion of hasty amputations, but argued for excision and other limb-saving measures. And he describes the everyday pressures of a country practice in Framingham, Mass.

But the Civil War — with its 750,000 dead, its slaughterhouse battles, and its crude medicine — was at the center of the Feb. 7 lecture.

Adams, his great-grandson recounted, labored so long in surgeries at Gettysburg — up for two days and three nights — that he was blind with exhaustion. Twice wounded, he fought hard to get back into the service when mustered out. By 1864, Adams resorted to an unusual ploy to extend his service. He gave up battlefield medicine and rejoined the army as an infantry officer.

As delivered by the present-day Adams, “Dr. Zabdiel Boylston Adams: Surgeon and Soldier for the Union” was breezy and dramatic. It placed the doctor in the context of his two originating families, Boylston and Adams, both woven tightly into the history of early America. It recounted a modest, quiet postwar medical practice. But it also leapt fully into the action of the war as the doctor witnessed it.

The lecture was the second in the Medicine and the Civil War Series, co-sponsored by Harvard’s Center for the History of Medicine and the Office for Diversity Inclusion and Community Partnership. The lectures are paired with “Battle-Scarred,” an online exhibit.

Adams was an ardent abolitionist, and to him a war to end slavery was a “high and worthy and holy” goal, his great-grandson said. The same day Bostonians learned of the Southern attack on Fort Sumter, Adams left his lively city medical practice and reported to the State House to volunteer. Pictures of the time show a young man in uniform, robust and full-bearded.

Adams enlisted as an assistant surgeon with the 7th Massachusetts Volunteer Infantry and was with the 32nd Massachusetts at Gettysburg. As an infantry officer in 1864, he was severely wounded at the Battle of the Wilderness and captured by Confederate forces. His left leg shattered, he lingered untreated for weeks. Gangrene set in, but Adams treated himself by pouring pure nitric acid into the wound, “although the pain,” he wrote later, “was almost unendurable.”

His wartime experience was Gump-like and broad. He was within earshot of the First Battle of Bull Run, reporting there the next day on an ambulance wagon. He took part in many iconic battles, from the Peninsular Campaign to Second Bull Run, Antietam, Fredericksburg, Chancellorsville, Gettysburg, the Wilderness, and, by 1865, the siege of Petersburg, Va., that ended the war.

Along the way, said his great-grandson, Adams was a witness to the social history of the time. Entering the unguarded grounds of the White House one day, he saw President Abraham Lincoln reading on a White House porch, his chair tipped against a wall. A touch of the Boston patrician emerged then, when Adams disparaged the unkempt kitchen garden and wondered out loud when the first family would take in boarders.

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Spurious Vaccination in the Civil War

From: Historyofvaccines.org

March 25, 2011 by Project Staff
Spurious Vaccination, The College of Physicians of PhiladelphiaSpurious Vaccination, The College of Physicians of PhiladelphiaRobert D. Hicks, PhD, Director, Mütter Museum/Historical Medical Library, The College of Physicians of Philadelphia, contributes today’s blog post. In preparation for an exhibit on Civil War Medicine at the Mütter Museum in 2012, Dr. Hicks has been researching, among other topics, the occurrence of spurious vaccination in the Civil War. Spurious vaccination was smallpox vaccination that either did not produce immunity in the recipient or that resulted in complications such as vaccination site infection, or that spread a communicable disease such as syphilis. While physicians in the United States frequently used humanized smallpox vaccine during the Civil War, French physicians at the time were popularizing a mode of smallpox vaccination that relied solely on serial propagation of vaccine in cows. Human transmission of smallpox vaccine disappeared by the turn of the century.

According to Joseph Jones, MD, Professor of Physiology and Pathology, University of Nashville, vital medical research was “brought to a sudden and unexpected close, by the disastrous termination of the civil war.” Writing in 1866, in a radically changed and changing South in the aftermath of the Civil War which ended the previous year, Jones expressed frustration that a Confederate medical investigation on smallpox vaccinations “was destroyed during the evacuation of Richmond.” Confederate medical records in Richmond, Virginia, disappeared after the victorious Union Army torched the city. Vexed by these circumstances, Jones surveyed physicians throughout the South who served in the Confederate Army to elicit data about “spurious vaccinations” and resurrect the destroyed report. Spurious cases were smallpox vaccinations of soldiers deemed “accidents” because they conferred no subsequent immunity to the disease or, compounding misery, introduced other diseases incident to vaccination, particularly syphilis. Jones paints a dire portrait of a Confederate Army that experienced far too many deaths and disabilities due to spurious vaccinations.

Jones published the survey results in the Nashville Journal of Medicine and Surgery, and in 1867 printed and circulated an offprint entitled, Researches upon “Spurious Vaccination,” or the Abnormal Phenomena accompanying and following Vaccination in the Confederate Army, during the Recent American Civil War, 1861 – 1865. Written undoubtedly with Union troops still occupying Tennessee as Reconstruction fashioned a new social order, Jones’s survey is clinically fascinating for its empiricism about vaccinations gone wrong, its tone of urgency barely disguising desperation, and the window it opens on the new social world of the Reconstruction South. (1)

Jones and his colleagues found cases of spurious vaccinations so prevalent that physicians:

instituted a series of experiments upon the inoculation of cows with small-pox matter, in order to produce, if possible, cow-pox, from whence a supply of fresh and reliable vaccine might be obtained. It was our design to carry out an extensive series of investigations upon the various secondary afflictions following vaccination, and to determine, if possible, what contagious principles could be associated with the lymph of the vaccine vesicle. (p.4)

Based on his survey, Jones offered several causes of spurious vaccinations:

The Confederate Army’s “depressed forces,” owing to the demands of hard campaigning with consequent exhaustion, exposure to harsh environments, and poor nutrition;
The introduction of infections from previously vaccinated soldiers who had been “affected with some skin disease at the time of the insertion of the vaccine virus”;
The harvesting of “decomposed dried vaccine, lymph, or scabs” from vaccinated soldiers;
The extraction and application of lymph from soldiers and its introduction in others who were already “laboring under the action of the poison of Small Pox”;
The harvesting of scabs, dried vaccine, or lymph from soldiers who had erysipelas [a bacterial skin infection usually attributed to Streptococcus]; and
The harvesting of scabs, dried vaccine, or lymph “from patients suffering from Syphilis, at the time, and during the progress of vaccination and the vaccine diseases.”
To arrive at this list of causes, Jones proceeded with admirable skepticism and caution in evaluating anecdotal reports. In his letter to fellow physicians, he wrote that “It is important that we should carefully distinguish the accidents which result from carelessness in the selection of the [vaccine] matter, and from ignorance of the true character and progress of the vaccine disease.” Jones particularly invites attention to the inadvertent transmission of erysipelas and syphilis. He cautions his comrades, though, that his inquiry is not intended to disparage the value of vaccination:

We should exercise the utmost caution in discussing the value of vaccination … to bring it into disrepute with the public; for all conscientious physicians and lovers of mankind will agree that this question … comes home to every individual of the human race … I should disclaim all design of decrying vaccination when properly performed.

Jones offers readers a brief history of vaccination in which he scrupulously outlines the early mistakes and misjudgments occasioned by overconfidence in the newly-invented vaccination procedure. He is bold in stating that most mistakes have arisen “directly or indirectly from the ignorance, and inattention” of physicians. Nonetheless, Jones can visualize a future free of smallpox torment for, through Edward Jenner, “the world has been furnished with the means of completely eradicating this terrible scourge.”

Former Confederate surgeon James Bolton, MD, who practiced at Chimborazo Hospital in Richmond, Virginia, contributed his own observations to the report. The Surgeon-General of Richmond ordered him to propagate the virus among children and vaccinate all government employees. In tracing the vexing cases of vaccination accidents, he posited “some occult influence, atmospheric or other” that may have affected the health of people from whom vaccination scabs, or crusts, were collected. Bolton therefore set about canvassing “the plantations in the interior of Virginia, vaccinating whites and negroes, and retracing … steps for the purpose of gathering the crusts.” He collected 800 crusts, “mostly from healthy negro children.” Processed into vaccines, these crusts proved effective. Chimborazo Hospital, he reports, obtained the virus “from the arms of healthy infants.” All things considered, Bolton found that the application of “good” vaccinations to unhealthy people nevertheless protected them, but with “abnormal sequelae.” Bolton concludes, as Jones does, that poor nutrition, exhaustion, and exposure conspired with people of poor “vital powers” to produce the attributes of spurious vaccines.

Jones considers the recent smallpox outbreak in Mobile, Alabama, the previous winter and, mindful of the foregoing analysis by Bolton, offers the view that the explanation for the new outbreak was “very obvious”:  Reconstruction.  Suddenly liberated slaves, “freed from their accustomed restraint and the fostering care of their former masters,” now congregate in towns. Having never been vaccinated, they wander, susceptible to disease, and present a threat to everyone. “Fully nine out of ten of the deaths from Small-pox have been among the Freedmen.” People of “the better class,” however, who take better care of themselves, have arranged for re-vaccination and therefore experienced only mild cases.

The report concludes with cautious but hopeful observations. The dilemma, however, observed abundantly by physicians during the war remains:

Suppose you are called upon to vaccinate half-a-dozen children, and it is performed on them all at the same time and with the same virus. What happens? One may not receive it at all, in all the others it may take showing its characteristic vesicle [raised cavity with the vaccine], but affecting the individuals in various degrees, thus showing different grades of susceptibility. In one good vesicle will appear without constitutional symptoms, in another the vesicle may be accompanied by high fever, glandular swellings &c, and the others will present grades of effect.

So, thus encapsulated, what are the implications for the South?  And for how long, asks Jones, are vaccinations effective?  Do they produce lifelong immunity? In addition to the social disorganization and confusion of authority following the war, southerners now registered the fear of new epidemics of smallpox.  Whatever thoughts a white southerner might have had on seeing migrating black families, newly freed, traveling along common roads, the threat of infection seems to have been a paramount concern. White people’s views of uneducated black people on the move registered apprehension, and the stereotype of poor people as unintelligent and unkempt in body and appearance strengthened worries that these itinerants spread smallpox. Thus, Jones’s report, while reporting on wartime circumstances, enlists former army colleagues to pool data to give scientific support to future decisions about public health policy in the South.

In the … distressed condition of the Southern States, cut off from the surrounding world, with the necessity of Vaccinating the entire male population capable of bearing arms, and without any means of obtaining fresh and reliable [vaccine] matter outside of the Confederate States, the experience of Medical Officers of the Confederate Army possesses a high and peculiar value

Clearly, Jones feels that the South still exists within a cultural cordon, incompatible with the North. Not only do southerners worry about the inversion of the class order, but they worry that the upheaval will make them sick.

Notes:

(1)   The observations by Jones and his colleagues are echoed in a fascinating correspondence between Henry Austin Martin (1824-1884), a former Union Army surgeon, and Thomas Fanning Wood (1841-1892), a former Confederate Army surgeon, found in the North Carolina State Archives. Years after the war, both men, advocates of vaccination, corresponded about their experiences regarding spurious vaccinations, the ravages of smallpox, and techniques for obtaining reliable vaccines.  See John Joseph Buder, Letters of Henry Austin Martin: The Vaccination Correspondence to Thomas Fanning Wood, 1877-1883. Master of Arts thesis, University of Texas at Austin, 1991.

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The Minister of Death: Smallpox

From: The New York Times, The Opinion Pages
By Carole Emberton

From April 29 to May 30, 1862, some 300,000 men — including my great-great grandfather, Pvt. Edward Willis — converged at the tiny railroad depot of Corinth, in northern Mississippi, where they laid siege to the Confederate forces under Gen. P.G.T. Beauregard. The Union soldiers scarred the landscape with miles of earthen fortifications. But the trenches could not protect Edward and his fellow soldiers from what Thomas Macaulay called “the most terrible of all the ministers of death,” a predator that craved those close, confined spaces, where men’s blood, breath and spit mingled freely. Although they fought on opposite sides of the trenches, the Union and Confederate forces shared a common enemy: smallpox.

Edward was hospitalized for the two months following the Union’s capture of Corinth. While his service record gives no reason for his hospitalization, his wife Edith’s pension application after his death in 1878 claimed that he had contracted smallpox while in the Army, “which afflicted his eyes and head, from which condition said soldier never recovered.” It is likely that he spent June and July in a “pest house,” quarantined along with other soldiers displaying signs of what Army doctors called “eruptive fevers” – smallpox, scarlet fever, measles and erysipelas (a bacterial skin infection caused by streptococcus).

Of these infectious diseases, smallpox was not the most common, but it was the most feared. During the course of the war, the Union Army reported only about 12,000 cases of smallpox among white troops, compared to nearly 68,000 cases of measles. However, total deaths from both diseases were about the same — 4,700 and 4,200, respectively — with the death rate from smallpox hovering around 39 percent.

It is little wonder that medical personnel in both armies wrung their hands over the prospect of an impending smallpox epidemic, scouring Northern cities and the Southern countryside in search of small children to inoculate so that their scabs could be harvested to produce “pure vaccine” free from other diseases, like syphilis, that might be transmitted from adults. Fear of the “speckled monster” also led soldiers to take desperate measures, including self-inoculation with the pus from other men’s sores that they believed to be smallpox but could, in fact, be syphilis or some other gangrenous lesion. The resulting infections incapacitated thousands of soldiers for weeks and sometimes months. The inspector general for the Army of Northern Virginia estimated that when the battle of Chancellorsville was fought in May 1863, as many as 5,000 men were unfit for duty due to these “spurious vaccinations.”

It is widely accepted that disease claimed more lives than bullets during the Civil War. The first wave of infection hit new recruits soon after they arrived in camp. Men from rural areas were especially vulnerable, lacking immunity to the childhood diseases to which their urban counterparts most likely had been exposed. Before Edward’s regiment, the 17th Kentucky, left camp at Calhoun where they enrolled, an outbreak of measles “raged through the camp like some attacking army.” According to the unit’s historian, more than 20 men died in those first few months, before they even heard a rebel gun.

Historians of medicine commonly refer to the mid-19th century as the “medical Middle Ages” in the United States because of the lack of understanding about sanitation and contagion, and thanks to a medical profession that lagged behind its European counterparts in procedural knowledge, institutional structure and numbers of certified physicians. When the war began, the Union Army medical division consisted of fewer than 100 surgeons and assistant surgeons. There was no organized ambulance service to remove wounded soldiers from the battlefield, and those who did make it to a squalid camp hospital fared little better than those left to die where they fell. With the help of the United States Sanitary Commission and a reorganization of the Army medical corps, which included the creation of an ambulance corps to rival any European army and a modern general hospital system across the nation, the Civil War revolutionized medical care in the United States. But for those men who fell victim to smallpox and other infectious diseases, modernity mattered little.

Smallpox was an ancient disease. For millenniums, it had followed the routes of trade, empire and war. The earliest descriptions of smallpox’s telltale pustules date from the fourth century A.D. in China. However, scientists believe they have identified smallpox scars on the bodies of Egyptian mummies from the 12th century B.C. “An inveterate camp follower,” according to the historian Michael Willrich, the virus, whose Latin name variola means “spotted,” spread across the globe along with the armies of the Roman, Mongol and Ottoman Empires, claiming the lives of kings, queens and emperors as well as common folk. No one was safe. It followed Europeans to the “New World,” wiping out as much as 90 percent of the indigenous populations of North and South America and the Caribbean. By the time the English physician Edward Jenner introduced the first vaccine for smallpox in 1798, at least 400,000 Europeans were dying each year from the disease.

What made smallpox so deadly? W.W. Brown, a surgeon with the 7th New Hampshire stationed in St. Augustine, Fla., wrote that the disease, “when uncomplicated, requires no medication except an occasional anodyne to allay nervous irritation and procure rest.” Unfortunately, in an era before modern sanitation or antibiotics, not to mention in the middle of a war, few cases were “uncomplicated.” Many of the men stricken with smallpox were already suffering from other ailments – fatigue, malnutrition, typhoid or dysentery. With their immune systems compromised, smallpox struck a deadly blow. In the worst cases of “fulminating and malignant” smallpox, the patient began to bleed out through the mucus membranes and the skin sloughed off in great patches. The virus attacked the internal organs, resulting in “general toxemia” and eventual death. Post-mortem examinations revealed considerable tissue deterioration and severe internal hemorrhaging.

The case of 25-year-old Enos W. Bratcher of the Third Kentucky Cavalry was typical. Bratcher contracted smallpox while in the hospital near Madison, Ind., being treated for tonsillitis. Although the doctors noted that “his general health appeared good,” he also suffered from chronic diarrhea. As with other smallpox patients, doctors treated Bratcher’s sores with a tincture of iodine applied with a small brush to his face, where the pustules congregated and ran together. For pain, he was given the ubiquitous “Dover’s powders,” a crystallized combination of ipecac and morphine dissolved in liquid. He was encouraged to drink fluids, although the prescribed mix of “ale, milk-punch, egg-nog, chicken and beef tea” probably did not appeal to a man suffering from violent nausea. In other cases, when the oozing pustules invaded the mouth and throat, making it difficult for the sufferer to breathe or swallow, doctors gave a small dose of potassium chlorate as a gargle, a solution that could prove fatal if swallowed. In any case, nothing worked for Bratcher. Delirious with fever and with his tongue and teeth turned black, a common occurrence in patients suffering from dehydration and prolonged infection, he died after two weeks of hellish suffering.

For those like Edward, who survived smallpox, the road to recovery could be long. In addition to the pockmarks left on the skin, the disease could cause permanent hair loss, recurring eczema and deformities in limbs resulting from muscle and tissue damage. In men, it could result in sterility. The virus infected the eyes, causing eruptions on the eyelids and scarring of the cornea (the eye problems cited in Edith Willis’s pension application were consistent with the long-term effects of smallpox).

There were psychological effects as well. Walt Whitman may have admired “faces pitted with small-pox over all latherers,” but not everyone saw the scars as symbols of rugged masculinity. Instead, the disease’s association with filth, vagrancy and foreignness could stigmatize survivors long after their bodies had recovered, condemning them to social ostracism and loss of employment.

The racial politics of disease in the era of emancipation also complicated the cultural understanding of smallpox. After multiple epidemics among freed people, smallpox assumed a negative association with blackness, further adding to the popular belief that sufferers were both filthy and inferior. But if black soldiers and freed people suffered from smallpox disproportionately, it wasn’t because they were inherently susceptible to it because of their race. As the historian Jim Downs points out in his recent book on the health care of former slaves, smallpox spread among the freed population because of unsanitary living conditions, including the refusal of local officials to properly bury the dead and burn their belongings, which carried the contagion. Already malnourished and in poor health, many of the slaves flocking to Union lines and joining the ranks of the Federal Army stood little chance against the disease.

Other than his eye problems, I do not know what other scars Edward bore from his battle with smallpox. He had faced down an enemy much older, and in the grand scheme of things far deadlier, than the Confederacy. But there were no medals earned from his victory. By August 1862, he was back on duty, driving the commissary wagon.

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