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.

Tuesday, May 24, 2016

History of Artificial Respiration (excerpt)

From: en.wikipedia.org

The Greek physician Galen may have been the first to describe artificial ventilation: "If you take a dead animal and blow air through its larynx through a reed, you will fill its bronchi and watch its lungs attain the greatest distention." Vesalius too describes ventilation by inserting a reed or cane into the trachea of animals.

In 1773, English physician William Hawes (1736–1808) began publicizing the power of artificial ventilation to resuscitate people who superficially appeared to have drowned. For a year he paid a reward out of his own pocket to any one bringing him a body rescued from the water within a reasonable time of immersion. Thomas Cogan, another English physician, who had become interested in the same subject during a stay at Amsterdam, where was instituted in 1767 a society for preservation of life from accidents in water, joined Hawes in his crusade. In the summer of 1774 Hawes and Cogan each brought fifteen friends to a meeting at the Chapter Coffee-house, St Paul's Churchyard, where they founded the Royal Humane Society as a campaigning group for first aid and resuscitation.[citation needed] Some methods and equipment were similar to methods used today, such as wooden pipes used in the victims nostrils to blow air into the lungs. Others, bellows with a flexible tube for blowing tobacco smoke through the anus to revive vestigial life in the victim's intestines, were discontinued with the eventual further understanding of respiration.

The 1856 works of English physician and physiologist Marshall Hall recommended against using any type of bellows/positive pressure ventilation, views that held sway for several decades. A common method of external mechanical manipulation, introduced in 1858, was the "Silvester Method" invented by Dr. Henry Robert Silvester in which a patient is laid on their back and their arms are raised above their head to aid inhalation and then pressed against their chest to aid exhalation.

The shortcomings of mechanical manipulation led doctors in the 1880s to come up with improved methods of mechanical ventilation, including Dr. George Edward Fell's "Fell method" or "Fell Motor", consisting of a bellows and a breathing valve to pass air through a tracheotomy, and his collaboration with Dr. Joseph O'Dwyer to invent the Fell-O'Dwyer apparatus, a bellows and instruments for the insertion and extraction of a tube down the patients trachea. Such methods were still looked upon as harmful and were not adopted for many years.

Civil War Pharmacy: A History of Drugs, Drug Supply and Provision, and Therapeutics for the Union and Confederacy (review)

Reviewed by Gregory J. Higby

Michael A. Flannery. Civil War Pharmacy: A History of Drugs, Drug Supply and Provision, and Therapeutics for the Union and Confederacy. New York: Pharmaceutical Products Press (Haworth Press), 2004. xiii + 358 pp. Ill. $59.95 (cloth, 0-7890-1501-3); $34.95 (paperbound, 0-7890-1502-1).

In lieu of an abstract, here is a brief excerpt of the content:
As is often the case today, a work's subtitle tells the full story of its contents. While Michael Flannery gives attention to the traditional aspects of pharmacy—the making of medicines—he focuses on the drugs themselves and their use. Forty years ago, when George Winston Smith wrote Medicines for the Union Army, history of pharmacy, like the discipline it studied, was limited to the production and distribution of medicines. Today the field of pharmacy includes pharmacology, therapeutics, and drug utilization, an expansion reflected in Civil War Pharmacy. Flannery has written a valuable book for both buffs and historians. For the lover of Civil War lore, the text yields useful details and captivating stories. For the professional, the author provides a solid narrative, cogent interpretation, and good documentation. Not one to shy away from controversy, Flannery tackles a few "old chestnuts," including the court martial of Surgeon General Hammond and the debatable efficacy of Civil War therapeutics.

The narrative of Civil War Pharmacy is divided into three parts, followed by a set of exceptionally useful appendices that include the Union and Confederate standard supply tables for medicines, a long excerpt from The Hospital Steward's Manual, and the text of Hammond's famous Circular No. 6. In part 1, Flannery "sets the stage" with three chapters—one largely historiographic, another on the "State of Pharmacy in America, 1861," and a third examining women and Civil War pharmacy. Readers knowledgeable about Civil War medicine should resist the temptation to skip the first chapter, because mixed in with the expected references to Doctors in Blue and laudable pus is a solid argument for the importance of medicines in the conflict: because of the high rate of treated diseases—malaria, respiratory ailments, and digestive disorders—"the medical context for the Civil War . . . was not one principally of saws and sutures but of mortar and pestle" (p. 23).
In part 2, Flannery concentrates on pharmacy in the Union with chapters on purveyors, manufacturing, and therapeutics. This is the strongest section of the book. An entire chapter is devoted to calomel and quinine, two favorites of allopathic physicians of both armies. While the calomel story, wrapped up with the downfall of William Hammond, might be more sensational, Flannery's discussion of quinine as drug and commodity is enlightening. After this, part 3 on the Confederacy is a bit of a disappointment. Flannery bears little blame for this: Many of the records of the South were lost. More importantly, there was much less pharmacy in the South—almost no significant medicine manufacturing existed there before the war, and the Union's naval blockade hampered the importation of drugs. (The vast majority of botanical drugs came from abroad.) Instead, Flannery's story shifts from laboratories and tons of output in the North to the South's blockade runners and the valiant attempt of Southerners to find substitutes for foreign drugs. [End Page 774]

Flannery concludes his book with a short epilogue arguing persuasively that the Civil War had sweeping influences on the development of the American pharmaceutical trade in the late 1800s. Forced by an incredible increase in demand, companies like Squibb, Wyeth, and Sharp and Dohme industrialized their operations—ending the era when the drug business was a cottage industry.
Because this is a work on the Civil War, its nearly inevitable popularity should elicit a second edition. If so, I encourage the author to consider the following suggestions: First, insist on better production values from your publisher: the uninteresting typography and murky photographic reproduction detract from the work; also, add a few maps showing laboratory locations and other sites of interest. Second, avoid "pharmaceutical care," a loaded term that carries a specific meaning for today's pharmacists that is not equivalent to "medical care." Third, carefully go over the quinine/cinchona sections: in some places, cinchona is called a derivative of quinine...

From: Bulletin of the History of Medicine
Volume 80, Number 4, Winter 2006
pp. 774-775 | 10.1353/bhm.2006.0129

From: muse.jhu.edu

Dean of The College of Pharmacy Speaks About Civil War Medicine

Written by Sarah Foltz, 9-16-13

In August, Don Stansloski, dean of the College of Pharmacy, visited Lakeside Chatauqua, a historic Ohio community and resort, to share his knowledge of the Civil War and the impact it had on medicine in the United States.

In a uniform of a pharmacist in the Union Army, he shared interesting before-and-after facts of the war. “Essentially, I talked to them about what the north and south were like before the civil war,” Stansloski said.

Stansloski explained many aspects of the Civil War, including the industrial environment in the north where people depended on machinery, while the south depended on slavery for agriculture. In terms of health care and medicine, the north and south were very similar.

“Prescriptions were one-of, meaning that each medicine was made from scratch for each patient. One did not buy a bottle of aspirin for example. Rather the pharmacist would take a chemical and make it into a dosage form like a capsule,” said Stansloski. “The war changed everything because suddenly there were six million people in the armies that had to be cared for all at once. You could no-longer provide prescriptions one-of anymore then you could provide weapons one-of.”

During the Civil War, the general manufacturing process greatly expanded in the United States. Stansloski explains that prior to the war, there were 19,000 manufacturing plants in the south while 22,000 plants were in New York alone.

“Before the war, there were 84 places making drugs, and after the war there were 300,” said Stansloski. “Nursing did not exist in the US before the war, but it did after.”

Stansloski also shared how the world learned about infection. Even those with the best medical care possible still suffered from illness because they did not know what infection was.

Before the war, people were routinely poisoned with mercury because it was thought to follow the best medical ideas of the time.

“There was a widespread feeling that most of the bad things that happened to us were a result of our own immoral behavior or failure to have enough willpower,” said Stansloski. “People didn’t know there were infections before the war and afterwards everyone did.”

During the war, both sides used the same medical books and some of the drugs used at that time are still used today. Many drug companies were established after the war as well.

“It was a very fascinating time. 600,000 people died and about half of them died from disease,” said Stansloski.

Stansloski has shared his knowledge of Civil War medicine with several other groups and continues to enlighten others. “I do this because I’m interested and I’m able to tell the stories.”

From: newsroom.findlay.edu


Treatment of War Wounds: A Historical Review (Excerpt)

M. M. Manring, PhD, Alan Hawk, Jason H. Calhoun, MD, FACS, and Romney C. Andersen, MD

Abstract
The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. We review the most important trends in US and Western military trauma management over two centuries, including the shift from primary to delayed closure in wound management, refinement of amputation techniques, advances in evacuation philosophy and technology, the development of antiseptic practices, and the use of antibiotics. We also discuss how the lessons of history are reflected in contemporary US practices in Iraq and Afghanistan.

Introduction
The need for surgical care of survivors of accidents or animal attacks is part of the story of civilization, as is the story of medical care of those wounded in that other peculiarly human endeavor, warfare. During the past 250 years, and particularly during the 20th century, developments in military trauma care for musculoskeletal injuries have greatly influenced civilian emergency medicine. The history of military trauma care must be understood in terms of the wounding power of weapons causing the injury and how the surgeon understood the healing process. Improvements in weapons technology forced surgeons to rethink their interventions in their effort to tip the odds of survival in favor of their patient.

Our purpose is to review the evolution of military trauma care during the past two and a half centuries in major conflicts in the West. The major areas of emphasis are medical evacuation and organization; wounds and wound management; surgical technique and technology, with a particular focus on amputation; infection and antibiotics; and blood transfusion.

Medical Evacuation and Organization
Perhaps the most basic problem facing physicians during wartime historically has been whether (and how) to transport the wounded to care or transport the caregivers to the wounded. A secondary problem historically has been how best to organize the delivery of care as modern nations began to dispatch vast armies and navies to fight across vast distances.

For example, Pikoulis et al. reviewed the wounds depicted in The Iliad and determined the arrow wounds such as the one suffered by Menelaus carried a mortality rate of 42%, slingshot wounds 67%, spear wounds 80%, and sword wounds 100%. These high mortality rates suggest surgeons were unable to get to wounded soldiers during the melee, treating only the higher class or those who survived after the battle had concluded. These Greek surgeons, whether they realized it or not, faced the same issues as all future practitioners engaged in wound care: wound management, The Golden Hour (the principle that a victim’s chances of survival are greatest if he receives resuscitation within the first hour after a severe injury), and infection control.

During the American Revolution (1775–1783), the Continental Congress authorized one surgeon to serve in each regiment. Few of the regimental surgeons, mostly trained through the apprenticeship system as there were only two medical schools in the United States (King’s College [now Columbia University] in New York, NY, and the University of Pennsylvania in Philadelphia, PA), had any experience treating trauma. The organization was minimal, and regimental surgeons tended to work for their unit instead of seeing themselves as part of the Hospital Department, which was rendered ineffective by bureaucratic infighting.

The outstanding military surgeon of the Napoleonic Wars (1792–1815), Baron Dominique-Jean Larrey (1766–1842), generally is regarded as the originator of modern military trauma care and what would become known as triage. He placed surgical teams near the front lines to shorten the time elapsed after injury and instituted specially designed horse-drawn “flying ambulances” in which the wounded rode with an early version of emergency medical technicians. Care was prioritized to provide first for the most badly wounded, without regard to the patient’s chances of survival or the need to restore less gravely wounded soldiers to the front lines quickly. After Larrey’s system was used during the Battle of Metz (1793), he was ordered to organize medical care for the entire French Army. Rapid access to care and immediate amputation reduced morbidity and mortality.

The Crimean War (1854–1855) underscored the importance of methods used by Larrey decades earlier, particularly the importance of organized evacuation and surgical care close to the front line. The war revealed a stark contrast between the battlefield care provided by the French, with their expert organization and system of light ambulances, and the poorly organized British Medical Services. Outrage over the poor treatment offered to the British wounded led the War Office to send a young nurse, Florence Nightingale (1820–1910), and a staff of 38 volunteers to the British barracks in Istanbul, Turkey, where Nightingale’s first act was to thoroughly scrub the hospital, provide clean bedding, improve ventilation and sewage disposal, and reorganize everyday sanitary procedures. She was an early theorist of sanitation and the design of hospital buildings. Although her efforts created intense resentment in the army bureaucracy, she was one of the founders of the modern nursing profession. She broke the monopoly of health care as the sole providence of the physician, which led to the development of the healthcare team in modern medical practice.

Nikolai Pirogoff (1810–1881), who served in the Imperial Russian Army, brought skilled nurses into military hospitals and worked to modernize Russian medical equipment. He is the namesake for a conservative technique of foot amputation.

At the onset of the American Civil War (1861–1865), the US Army and Navy combined had about 100 physicians, many with no experience with battlefield trauma, almost 30 of whom resigned to join the Confederacy. The structure of the Medical Department was decentralized with no clear chain of command and control of supplies. The US Army Quartermaster’s Corps, whose primary duties were supplying and provisioning troops, were responsible for direct battlefield evacuation. The Regimental Band served as litter bearers. The first Battle of Manassas (July 21, 1861) was a rout for the federal forces and the soldiers fled back to Washington. Ultimately, 2708 men were killed or wounded and the Medical Department could not handle the load. Regimental surgeons, because they worked for their unit only, were either swamped with casualties or idle. Regimental band members and civilian ambulance drivers hired by the quartermaster’s corps fled from the battle. Most of the wounded had to walk the 27-mile distance from the battlefield to Washington to reach the hospitals in the rear. Those who could not walk remained on the battlefield for several days until they were picked up by ambulances, captured by Confederate forces, or died.

The Union Army quickly reorganized its Medical Department in 1862 after prodding by a Sanitary Commission created by President Lincoln. Jonathan Letterman (1824–1872) reorganized the medical care in the Army of the Potomac. Wounded soldiers were removed from the battlefield by litter bearer, the predecessor to the medic or corpsman. Regimental Surgeons were responsible for dressing wounds and patients were evacuated in ambulances driven by Medical Corps noncommissioned officers to a division level field hospital for surgical treatment. By the end of the war, the Medical Department expanded this system by creating a national network of hospital trains, hospital ships, and general hospitals that could treat the patient near his hometown if he so desired. The main advance in American medicine during the Civil War was the creation of an effective military medical corps with medical evacuation, hospitals, and surgical specialists. Health care was beginning to become a system. Still missing was a formalized approach to care that recognized the severity of injuries. The poet Walt Whitman, who worked at several Union hospitals in Washington, DC, noted, “The men, whatever their condition, lie there, and patiently wait until their turn comes to be taken up”. Whitman’s poem “The Wound Dresser” (1865) poignantly illustrates the state of care at the time.

From: ncbi.nlm.nih.gov

Image: Civil War Gunshot Wound Of Private Cyrus Straus Of Illinois

The Ghastly Work Of The Field Surgeons

From: civilwarhome.com

      Here are three descriptions of the work of the surgeons, all of them tending to bear out the complaints of the Baroness von Oinhausen. These descriptions of heartlessness could be matched in letter after letter, diary after diary, North and South. One Kentucky editor charged that the doctors had " slain more of our troops than all of Lincoln's minions " and a Richmond one characterized the Medical Department as "unfeeling,'shameful and brutal." We must remember however that it is the exceptionally bad conduct that gets recorded; routine work is taken for granted. On the whole the surgeons and nurses did about as well as they could. Certainly many of those who worked all through the war, at great peril to themselves, were distinguished members of a distinguished profession.

        The first of these critics, Samuel Nichols, was an Amherst College student who enlisted in the 37th Massachusetts Volunteers; served through the war; and later edited the Pittsfield (Massachusetts) Sun. The second is the famous politician and reformer Carl Schurz, who commanded the XI Corps at Gettysburg. The third is Augustus Brown, Captain in the 4th New York Heavy Artillery.

A. THE HEARTLESSNESS OF THE SURGEONS

Hd. Qtrs- 37th Regiment Mass. Vols.
Camp near Stafford Court House
Nov. 23rd 1862

My Dear Cousin Phebe:

        As yet only four of our number have died and some six have been discharged, two of the latter of whom were officers. Lieut. Eli T. Blackmer, a son of the Blackmer that moved from Hodges Corner in Warren, is discharged and has gone to his home in Chicopee. His health is much impaired, and his discharge was merited. Everything here concerning sickness and its management seems so repulsive that the thought of being sick or of having one of your friends in the Hospital, is filled with gloom. I will relate an instance. It is probably an instance more censurable to those having charge than usually occurs; but if the whole history of this war were brought to light more such facts would be revealed, in my mind, than would be pleasing to men (no, brutes) whose duty it is to look after the physical health of the soldier.

        In our regiment was a man, private of course, who came under my notice while we were at New Baltimore, a little over one week since. He was emaciated and almost spiritless. He, to be sure, was not as cleanly as he should have been; but I know that it requires much exertion where water is scarce (and it always is in the vicinity of an army like ours) to keep decent. He looked as though he had been sick for some time. He like many others had acquired a dislike to reporting himself to the surgeons, as they have an idea the surgeons are destitute of feeling and unjust. I will not say how far this feeling is just. He at length came with those of his company who reported sick that day to the Surgeon's office within a few steps of where I sleep. I stood at the mouth of my tent and saw and heard the treatment each patient received. This fellow was treated as the rest. He took his turn and came to the front of the Doctor's tent, and received the customary question, "What's the matter with you?" (pretty question for a doctor). "What are you here for? Let's see your tongue. Shall return you to duty."

        He was returned to duty. He refused to do duty and as punishment was sentenced to stand on the barrel (a very severe punishment), and added to this, to hold a heavy stone in his hand, two hours on and two off. This was the Doctor's work and not the Colonel's. I admit that it was the Colonel's duty to stop an unjust punishment if he saw one being exacted, but he would probably refer the whole case to the Doctor. To continue my story: after this I watched that young man. All energy seemed absent from him, and he acted as if he was unable to stir. I went to him and advised him to go to the Surgeon again, knowing that by tiring out the M.D. he might receive attention. I could not induce him. I saw during my conversation that he was really sick; and I was anxious to find out what ailed him, knowing if I did, I could find him medicine. I went to another regiment to get a doctor with whom I was acquainted to come and see him; but the regiment had moved that morning, and so I let the matter go for the time being. Two mornings after I saw him again at the Doctor's tent. With the usual flourishes he was reported for duty, and the next morning he was brought to the Hospital to die almost immediately. The same day he was buried with soldier's honors; and with the last volleys fired over his grave died all feelings of remissness or regret, if any such feelings were entertained.
-UNDERHILL, ed'., "Your Soldier Boy Samuel"

B. CARL SCHURZ WATCHES THE SURGEONS AT WORK AFTER GETTYSBURG

        To look after the wounded of my command, I visited the places where the surgeons were at work. At Bull Run, I had seen only on a very small scale what I was now to behold. At Gettysburg the wounded-many thousands of them-were carried to the farmsteads behind our lines. The houses, the barns, the sheds, and the open barnyards were crowded with the moaning and waiting human beings, and still an unceasing procession of stretchers and ambulances was coming in from all sides to augment the number of the sufferers. A heavy rain set in during the day-the usual rain after a battle and large numbers had to remain unprotected in the open, there being no room left under roof. I saw long rows of men lying under the eaves of the buildings, the water pouring down upon their bodies in streams. Most of the operating tables were placed in the open where the light was best, some of them partially protected against the rain by tarpaulins or blankets stretched upon poles.

        There stood the surgeons, their sleeves rolled up to the elbows, their bare arms as well as their linen aprons smeared with blood, their knives not seldom held between their teeth, while they were helping a patient on or off the table, or had their hands otherwise occupied; around them pools of blood and amputated arms or legs in I heaps, sometimes more than man-high. Antiseptic methods were still unknown at that time. As a wounded man was lifted on the table, often shrieking with pain as the attendants handled him, the surgeon quickly examined the wound and resolved upon cutting off the injured limb. Some ether was administered and the body put in position in a moment. The surgeon snatched his knife from between his teeth, where it had been while his hands were busy, wiped it rapidly once or twice across his blood-stained apron, and the cutting began. The operation accomplished, the surgeon would look around with a deep sigh, and then-"Next!"

        And so it went on, hour after hour, while the number of expectant patients seemed hardly to diminish. Now and then one of the wounded men, would call attention to the fact that his neighbor lying on the ground had given up the ghost while waiting for his turn, and the dead body was then quietly removed. Or a surgeon, having been long at work, would put down his knife, exclaiming that his hand had grown unsteady, and that this was too much for human endurance-not seldom hysterical tears streaming down his face. Many of the wounded men suffered with silent fortitude, fierce determination in the knitting of their brows and the steady gaze of their bloodshot eyes. Some would even force themselves to a grim jest about their situation or about the "skedaddling of the rebels." But there were, too, heart-rending groans and shrill cries of pain piercing the air, and despairing exclamations, "Oh, Lord! Oh, Lord!" or "Let me die!" or softer murmurings in which the words "mother" or "father" or "home" were often heard.

        I saw many of my command among the sufferers, whose faces I well remembered, and who greeted me with a look or even a painful smile of recognition, and usually with the question what I thought of their chances of life, or whether I could do anything for them, sometimes, also, whether I thought the enemy were well beaten. I was sadly conscious that many of the words of cheer and encouragement I gave them were mere hollow sound, but they might be at least some solace for the moment.
-BANCROFT AND DUNNING, eds., The Reminiscences of Carl Schurz

C. THE HORRORS OF THE WILDERNESS

        Tuesday, May 10th [1864]. Heavy cannonading from 8 A.M. to 1 P.M. The Pontoon train has been sent back to Fredericksburg, apparently to get it out of the way, and the army horses are put on half-rations, that is, five pounds of food. Ambulances and army wagons with two tiers of flooring, loaded with wounded and drawn by four and six mule teams, pass along the plank, or rather, corduroy road to Fredericksburg, the teamsters lashing their teams to keep up with the train, and the wounded screaming with pain as the wagons go jolting over the corduroy. Many of the wounds are full of maggots. I saw one man with an arm off at the shoulder, with maggots half an inch long crawling in the sloughing flesh, and several poor fellows were holding stumps of legs and arms straight up in the air so as to ease the pain the rough road and the heartless drivers subjected them to. These men had been suffering in temporary field hospitals, as no opportunity had been afforded to send them to the rear until we got within reach of the road running to Fredericksburg.

        And this reminds me of a scene I witnessed a day or two since which seemed to me to cap the climax of the horrors of war. Passing along a little in the rear of the lines when a battle was raging in which in battalion was not engaged, I came upon a field-hospital to which the stretcher-bearers were bringing the men wounded in the conflict. Under three large "tent flies," the center one the largest of all, stood three heavy wooden tables, around which were grouped a number of surgeons and their assistants, the former bareheaded and clad in long linen dusters reaching nearly to the ground, which 'were covered with blood from top to bottom and had the arms cut off or rolled to the shoulders. The stretcher-bearers deposited their ghastly freight side by side in a winrow on the ground in front of the table under the first tent fly. Here a number of assistants took charge of the poor fellows, and as some of them lifted a man on to the first table others moved up the winrow so that no time nor space should be lost. Then some of the surgeons administered an anaesthetic to the groaning and writhing patient, exposed his wound and passed him to the center table. There the surgeons who were operating made a hasty examination and determined what was to be done and did it, and more often than not, in a very few moments an arm or a leg or some other portion of the subject's anatomy was flung out upon a pile of similar fragments behind the hospital, which was then more than six feet wide and three feet high, and what remained of the man was passed on to the third table, where other surgeons finished the bandaging, resuscitated him and posted him off with others in an ambulance. Heaven forbid that I should ever again witness such a sight!

The Feminist Origins of “Eight Cups a Day”: The Water-Healing Quackery That Empowered Women’s Medicine. (Excerpt)

By Erika Janik

Today, when it seems that most Americans carry a water bottle to drink their eight daily glasses, the importance of water to health seems obvious. But for 19th-century hydropaths, water was more than just a sugar- and calorie-free drink: It was a social good able to cure nearly every disease as well as the social and cultural ills that threatened the health and stability of the nation.

Drinking was not the only way to enjoy water’s munificence, though; water was also to be experienced through elaborate rituals of bathing, showering, soaking, sweating, and wrapping. This diversity of baths, not to mention the idea of bathing itself, was highly unusual for most Americans. In 1835, a letter from a reader in the Boston Moral Reformer asked, “I have been in the habit during the past winter of taking a warm bath every three weeks. Is this too often to follow the year round?” Although it offered cures for disease, hydropathy functioned more as a water-based lifestyle plan with a vision of radically transforming the world through personal health achieved through nature’s purest substance.

Hydropathy grew out of the observations and experiments of Vincent Priessnitz. A peasant born in 1799 on a farm in Grafenberg in Silesian Austria, located in today’s Czech Republic, Priessnitz discovered water’s potential as a cure-all after an 1816 farm accident. One day while he was baling hay, a runaway horse and wagon trampled the teenaged Priessnitz, leaving him with several broken ribs and a bruised left arm. The doctor from a nearby town told him that the severity of his injuries made it unlikely he’d ever work again. Priessnitz, however, refused to accept this prognosis. He wrapped himself in wet cloths and ate very little while consuming large quantities of cold water. To reset his broken ribs, he pressed his abdomen against a chair and inhaled deeply, allowing the expansion of his chest to push his ribs back into place. Priessnitz eventually recovered from his injuries, and the success of his self-cure led him to broaden his investigation into the curing power of water.

Priessnitz sought not only to wash disease away but to deny it entry into the body through a healthy lifestyle of diet and exercise. Priessnitz argued that filth and a poor diet gave disease easy access into the body. In The Hydropathic Encyclopedia, American hydropath Dr. Russell Trall explained that disease was “produced by bad air, improper light, impure food and drink, excessive or defective alimentation, indolence or over-exertion, [or] unregulated passion.” For Trall, it all boiled down to “unphysiological voluntary habits.” In other words, sickness resulted from laziness, a lack of exercise, and junk food, the familiar chords of obesity debates to this day.

Perhaps hydropathy’s most visible legacy is in the popularly held belief in drinking eight glasses of water a day. This notion was appropriated and echoed with increasing fervor in the late 19th century by the temperance movement. By the 1910s and 1920s, American newspapers and magazines were filled with exhortations to consume eight glasses of water for health on a daily basis. Although scientists and doctors continue to disagree over how much water is enough, the idea of drinking fluids regularly for health remains undisputed.

Priessnitz’s water cure became renowned throughout the Western Hemisphere. Visitors marveled at Priessnitz’s ability to diagnose disease and devise a treatment plan simply by studying the quality and cast of a patient’s skin. He never checked the pulse, looked at the tongue, or asked patients about their complaints. By 1840, nearly 1,700 patients per year sought treatment at Grafenberg.

Priessnitz’s success spurred countless imitators and admirers. The first water cure in the United States opened its doors in 1843, followed by a second the next year. Both were in New York City and were operated by disillusioned regular doctors. But it was Mary Gove Nichols and her husband, Thomas, who made hydropathy famous. Born in Goffstown, N.H., in 1810, Mary Sargeant Neal was the precocious daughter of a freethinking father who encouraged her active and curious mind. As a teenager, she pored over the pages of the books her medical-student brother brought home, fascinated by the workings of the human body but perhaps also wondering why she could find so little information on the health of women like herself.

An unhappy marriage in 1831 to Hiram Gove, who disdained her reading and creative writing, helped turn Mary into a champion of women’s rights and a prominent health reformer. To ease her mental and physical suffering, Mary defied her husband and turned back to the medical books that had so enthralled her as a child. She discovered Sylvester Graham, an early advocate of dietary reform, vegetarianism, and hygienic reform and determined that women’s well-being and happiness depended on the freedom achieved through personal health. Excited by her newfound knowledge, Mary wanted to tell other women of the salvation that could be found in knowing about and taking charge of their own bodies.

In 1838, Mary made a name for herself lecturing (a scandal in and of itself for a woman) on the shocking topics of women’s health, anatomy, and physiology. Women’s health was a topic rarely, if ever, discussed at the time, much less in public. With no female regular doctors, many women ignored their own health problems and endured in silence to avoid being seen by male doctors, which social mores deemed improper. Hundreds packed lecture halls to see the thin, dark-haired woman with an open and intelligent face and exuberant brown eyes discuss the healthy female body.

In the summer of 1845, finally free of her husband, Mary traveled to Brattleboro, Vt., to investigate Priessnitz disciple Dr. Robert Wesselhoeft’s Hydropathic Institution—one of the most exclusive and expensive water cures in the United States. Impressed by what she saw, she began training as a water-cure physician, offering physiology lessons to patients in exchange for her education.

While Priessnitz’s original system called for water to be used both internally and externally, most American hydropaths believed that water worked best when applied gradually through the skin. The wet sheet became the standard method of application. First, the attendant would dip a sheet of cotton or linen in cold water and spread it on several thick wool blankets. The patient would then be wound up in the sheet and blankets by the attendant and secured with pins or tape. Once wrapped, patients would shiver and then lie sweating on feather beds for anywhere from 25 minutes to several hours depending on the seriousness of the illness. After they worked up a good sweat, the attendant unwrapped them and plunged them in a cold bath followed by a brisk drying. For severely debilitated patients, the wet-sheet treatment could be too much, so an alternative known as the wet dress was used instead. A loose-fitting nightgown-like garment, the wet dress allowed patients to dispense with the services of an attendant and to walk comfortably while also soaking up water. Most wet-dress patients also went to bed in the outfit, a damp and presumably clammy night of sleep.

Wesselhoeft taught his students, Mary among them, the art of individual prescription, adapting cures to each patient’s symptoms, stamina, and age. “The same treatment that would cure one might fail entirely with another,” she later noted.

After three months in Brattleboro, Mary moved to New York City in 1846 and began giving lectures and writing articles and books on health and hydropathy.

Though she’d never attended medical school, by the late 1840s, she led a doctor’s life and had earned a reputation as a trustworthy medical expert. Mary’s husband, Hiram Gove, finally consented to a divorce in 1847. That same year she met a young writer named Thomas Low Nichols, whose writing and progressive views on women she admired. The two married the following July. Inspired by his new wife’s work in hydropathy, Thomas enrolled in medical school to study “the very errors and absurdities” of regular medicine, graduating from New York University with his medical degree in 1850.

Most hydropaths believed that the only qualifications necessary to practice should be a personal commitment to the principles of hydropathy and a willingness and ability to practice them responsibly. Unlike regular medicine, hydropaths de-emphasized the authority of the physician in favor of creating independent patients able to diagnose and care for themselves. Patients thus had a substantial responsibility for their own outcomes. “If a patient thoroughly understands his or her disease, and has the requisite energy to accomplish a cure,” wrote Mary, “it may be done almost anywhere, and with very meager advantages.” She recounted stories of female patients who managed to heal themselves even while weak with disease through their own “indomitable energy.” Hydropaths believed that hygienic habits were best mastered through willpower and self-control, an ideology that mirrored wider societal beliefs about personal responsibility and social improvement.

In 1851, Mary and her new husband opened the nation’s first hydropathic medical school, the American Hydropathic Institute, in New York City. Concerned about the dangers of the misapplication of cold water, not to mention charlatans masquerading as hydropaths for profit, the Nicholses believed that the potency of water required expert guidance. More than teaching about water, though, Nichols wanted to provide a medical education for women to meet the national demand for female doctors.

With few exceptions, most of the nation’s medical schools refused to admit women. By and large, regular medicine tended to regard being female as a disease in and of itself. At the American Hydropathic Institute’s inaugural ceremonies, Mary delivered an address entitled “Woman the Physician” that argued for the importance of female doctors. Rather than reject cultural assumptions about women’s caring nature, she claimed women’s innate talents uniquely qualified them for the profession. The Nicholses’ progressive views of women aligned perfectly with hydropathy’s expansive understanding of women and women’s health. Hydropaths shared their era’s belief in women’s softer, more caring nature: They just did not see this as a justification for keeping women out of the medical profession.

Encouraging women to get involved in hydropathy contributed to the financial health of the nation’s water cures as well. To attract women and their money, hydropaths needed female attendants and practitioners to serve them. Women consistently outnumbered men in attendance at hydropathic institutes. It’s not hard to imagine why. For many women, visiting a water cure was the first, and perhaps only, time their needs were put above those of their husbands and children.

Hydropathy took the radical step of naturalizing women’s life stages. For hydropaths, puberty, menstruation, childbearing, and menopause were not dread diseases needing intervention but natural processes in a woman’s life. Women did not become weak and ill because of their sex but because of some outside cause, just like men. Hydropaths urged women to take an active role in their own health and to maximize their health and happiness through diet, exercise, and other hygienic practices, all of which dramatically expanded women’s power to determine and control their own lives. As a result, hydropathy provided a refuge for progressive women, and many of America’s first generation of female doctors came out of hydropathy.

Excerpted from "Marketplace of the Marvelous: The Strange Origins of Modern Medicine" by Erika Janik, out now from Beacon Press.

Erika Janik has written for Smithsonian.com, Mental Floss, The Onion, and Wisconsin Public Radio.

Tuesday, May 17, 2016

Nurses Supporting the Army in the Civil War

By COL Elizabeth Vane, Army Nurse Corps Historian

The Civil War was a time when the profession of nursing (with education, licensing, and specialization) did not exist as we know it today. Victorian thinking allowed for women to care for family members, but did not allow women to care for men they were not related to, or outside
their homes, without causing damage to their delicate natures or their reputations. Women in religious orders were able to work from a higher calling that allowed them to care for men without the scandal other women would bring upon themselves. Other women could work through aid societies and the Sanitary Commissions to provide care, and some Union Army surgeons chose their own nurses to work for them.

Some women followed their family members to the battlefields to help care for them. Black women, both freed and escaped slaves, also cared for soldiers, and they may have been called nurses, cooks, or laundry women for the work they carried out.

It was not only women who participated as nurses during the Civil War. Many of the nursing duties were given to musicians (Army bandsmen) and convalescing soldiers (termed invalids) who were healthy enough to help out with those tasks. These men may or may not have received training, or derived satisfaction from this work, but they were assigned to it from necessity. The men could
have been called nurses, attendants, or hospital stewards. These men provided care for the wounded on the battlefields and in the variety of hospitals that existed. Hospitals could be found in private homes, churches, donated buildings, tents, in other structures of convenience, ships, or out in the open fields.

The nurses of the Civil War could be volunteers or they could be paid, and they worked for both the Union and the Confederate armies. The work they did included bathing patients; delivering food, water and medicines; dressing wounds; washing floors; reading, writing and praying for the wounded; managing supplies; and laundering clothes and bedding. The sanitary environments created by these nurses were helpful in preventing further spread of infection and disease. Cleanliness and ventilation was difficult to maintain in dark, filthy, cramped spaces but the nurses attempted to make the best of their environments. In fact, dysentery, malaria, typhoid, and small pox killed more men during the Civil War than battle wounds did. The battle wounds were horrific, disfiguring, maiming, mutilating, and the number of casualties created from the battles completely overwhelmed medical resources, leading to the enormous demands that nursing had to face.

During the course of the Civil War, women like Dorothea Dix and Clara Barton worked and fought to have trained nurses recognized as respectable and organized workers.

Dorothea Dix was picked as the first superintendent of U.S. Army nurses in August 1861 as the Union Army leaders saw the need for nurses to help fill the medical gap in order to properly care for soldiers in general hospitals. Ms. Dix decreed that her nurses needed to be in good health, have high morals, be between the ages of thirty-five and fifty years, be plain in looks, and wear dark clothing without bows, jewelry, or hoopskirts. Hoopskirts could not be worn as they would cause accidents by catching on beds, dressings, patients, and other objects. Darker clothing was worn as the blood was not as easily seen on those colors, and did not draw attention to the women wearing them. Ms. Dix had to convince military leaders that women could successfully perform the work necessary to care for wounded and ill soldiers during war.

Clara Barton worked outside of the military system, but was in support of it. She helped care for soldiers returning to Washington, D.C. and helped raise financial support for supplies, traveled to the front lines to deliver them, and later helped to create the American Branch of the International Red Cross.

Women in the north and the south proved that they could work in terrible conditions and make great contributions towards the sick and wounded they cared for. They used their compassion, strength, intelligence, dedication and gifts to help their countrymen and show support for their soldiers and the war effort. They earned respect for nursing as a something that could be taught and performed outside of the home, and also showed that successful care could be given in a hospital setting, not just in the home. Their efforts also showed the value that a trained corps of nurses could have in treating military patients under chaotic circumstances. The U.S. Army Nurse Corps as we know today was established in 1901 and it was because of wars like the Civil War that demonstrated the benefits of having permanently trained nurses in the military that allowed such a
corps to be a component of the Army.

For further reading:
Mary Sarnecky, A History of the U.S. Army Nurse Corps.
Mary C. Gillett, The Army Medical Department 1818-1865.
An idealized vision of nursing.
Courtesy National Library of Medicine.
A more realistic view of nursing.
Courtesy National Library of Medicine.
Number 5, Winter 2014 Page 3
Doctor Jonathan Pot

From: history.amedd.army.mil/newsletters

The Founder of Wyeth Pharmaceuticals

From: nndb.com

John Wyeth
Born: 1841
Birthplace: Harrisburg, PA
Died: 30-Mar-1907
Location of death: Philadelphia, PA
Cause of death: unspecified

Gender: Male
Race or Ethnicity: White
Sexual orientation: Straight
Occupation: Business
Party Affiliation: Democratic

Nationality: United States
Executive summary: Founder of Wyeth

John Wyeth, founder of the present-day pharmaceutical giant, was the son of a druggist, and studied at the Philadelphia College of Pharmacy (now the University of the Sciences in Philadelphia). At graduation he took employment at Henry C. Blair's apothecary store in Philadelphia, and four years later he was made a partner in the shop. In 1860 he quit Blair's shop and, with his brother Frank Wyeth, opened John Wyeth & Brother, Chemists, at 1410 Walnut Street in Philadelphia. The shop's key innovation was to mix medicinal compounds in advance, in large batches, allowing the Wyeth Brothers to sell commonly-prescribed drugs at a lower price than competitors. Wyeth's main success, however, came from a government contract during the American Civil War, to deliver medicines and beef extract to the Union Army.

In 1872, an employee of Wyeth's, Henry Bower, invented a machine for making tablets from medicinal powders, allowing mass production of pills with pre-measured dosages. After fire destroyed the shop in 1889, the brothers left the retail business and opened a larger manufacturing facility at the corner of 11th & Washington. The company's products included a wide array of compressed pills, effervescing salts, elixirs, lozenges, suppositories, and bottled cannabis powder (to be taken with hot brandy, according to its label). Wyeth was also a key player in a syndicate which purchased and published the Philadelphia Record newspaper. His son Stuart took over the drug business at John Wyeth's death in 1907, and at the younger Wyeth's death in 1929, the company was bequeathed to his alma mater, Harvard University. Harvard sold the company to American Home Products in 1932, and AHP rebranded itself Wyeth in 2002.

Father: John Wyeth (chemist/newspaper worker, b. 1798, d. 1876)
Mother: Elmira Jane Canfield Wyeth (b. 1814, d. 1878)
Brother: Frank Wyeth (pharmacist)
Wife: Sarah Wyeth (b. 1844)
Son: Stuart Wyeth (Wyeth executive, b. 1862, d. 1929)

University: University of the Sciences in Philadelphia (1854)

Wyeth Founder and President (1860-1907)
The Philadelphia Record Owner

Author of books: "An Epitome of Therapeutics" (1906)

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