Thursday, February 6, 2014

Civil War Pharmacy: A History of Drugs, Drug Supply and Provision, and Therapeutics for the Union and Confederacy by Michael Flannery

Review by Gregory Higby

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.

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 (pp. 99 and 131), while the opposite is true.

Until the second edition arrives, those interested in the American Civil War and nineteenth-century pharmacy will be well served by Flannery's first version.

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


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