Tuesday, December 9, 2014

William Hammond and the End of the Medical Middle Ages

By Pat Leonard, April 27, 2012

While other events of April 25, 1862, dominated the nation’s headlines — most notably the Confederate surrender of New Orleans — perhaps the most significant single event in the life of the average Union soldier was a presidential appointment that day that was hardly noticed outside Washington. Over the objection of Edwin Stanton, his secretary of war, President Lincoln named William Alexander Hammond as surgeon general of the Army.

Hammond was the preferred candidate of Gen. George B. McClellan and the handpicked choice of the United States Sanitary Commission, a civilian organization created to improve Army living conditions. Though only 33 years old and holding just an assistant surgeon’s rank, Hammond had attracted the commission’s attention through his work as an inspector of camps and hospitals.

Hammond quickly proved he was up to the job. Possessing a brilliant organizational mind and boundless energy, he started making changes at every level of the Army Medical Department. He established more stringent requirements for physicians joining the service and set up examination boards to evaluate their qualifications. He initiated a hospital inspection system and designed new pavilion hospitals with strict specifications for layout, lighting, ventilation and patient space allotments.

He standardized a medication table for military use, established laboratories to manufacture needed pharmaceuticals, founded the Army Medical Museum and collected information that formed the basis of The Medical and Surgical History of the War of the Rebellion. Finding no suitable text on the subject of hygiene, Hammond took pen in hand and wrote the industry standard, one of 30 books and more than 400 articles he would write in his lifetime. Hammond revolutionized the practice of military medicine almost overnight, saving the lives of thousands of men in the process.

Much of what Hammond advocated he had learned from his 11 years as an Army assistant surgeon in remote outposts, including present-day Arizona, Kansas and Florida. Unable to sustain a growing family on military pay, he had resigned his commission in 1860 to become an instructor at the University of Maryland Medical School in Baltimore.

He was in this position when he first attended to wounded Union soldiers: the Sixth Massachusetts Regiment, passing through Baltimore on its way to Washington, was attacked by a proslavery mob in April 1861. Hammond’s diligent treatment of the injured men led to his being offered the position of surgeon of a rebel regiment, an offer he rejected “with no great fastidiousness in the choice of his language.”

Hammond rejoined the Union Army shortly thereafter and was made a hospital and camp inspector in Maryland and what would soon become West Virginia. He impressed his superiors, as well as the Sanitary Commission, with his detailed reports and strident requests for improved hygiene. Those who met him found him equally impressive in person, standing 6 feet 2 inches tall with a booming voice that, one admirer said, “could be heard upwind in a hurricane.”

Appreciating Hammond’s talents from a distance, however, was apparently easier than working with him directly. Throughout his tenure as surgeon general, peers and subordinates described him as arrogant, impetuous, boastful and insensitive. Stanton, who had favored another, more senior officer for the pre-eminent medical post, found Hammond’s personality insufferable and his incessant demands excessive. Illustrating that point was Hammond’s $10 million budget for the 1863 fiscal year, which was four times what his predecessor had requested for 1862 – and which he still managed to overspend by 15 percent.

But the young surgeon general was effective. By one estimate – arrived at by taking the rate of mortality among sick and wounded soldiers in the war’s first chaotic year and extrapolating it across the carnage that followed – Hammond’s initiatives saved nearly 26,000 lives. Such calculations are guesswork, but there’s no question that his measures resulted in substantial improvements in the care and outcomes afforded Union soldiers and captured Confederates.

Yet even with his state-of-the-art initiatives to improve sanitation and save lives, Hammond was fighting an uphill battle. The American Civil War was fought during what he would later describe as “the end of the medical Middle Ages.” An understanding of germ theory was still a decade away, and thousands died not from their wounds but from infections or gangrene that developed later. During and following a major battle, doctors performed amputations by the hundreds, sawing off mangled limbs as quickly as men could be lifted onto makeshift operating tables, without so much as wiping their blades between procedures. The death rate following amputations ranged as high as 50 percent, especially when major limbs were involved or when soldiers had to wait more than a few hours to be treated.

And that wasn’t the worst of it. The greatest menace to Civil War soldiers was not enemy fire, nor even the infections that almost always inflamed their wounds and/or stumps. The majority of field fatalities – an estimated three out of five among Union dead, and two out of three among Confederates – were caused by preventable diseases that swept through camps and hospitals, including dysentery, typhoid fever, pneumonia, tuberculosis and even “childhood” ailments like measles, chickenpox and whooping cough.

Writing home, soldiers often remarked that they didn’t fear the big battles as much as being taken to a hospital, where they would be exposed to killers they couldn’t see and didn’t understand.

Hammond persevered through all of this, but at last his peremptory directives started to turn even some of his supporters against him, especially when he revised the approved medication table in 1863, removing two drugs that were very popular with surgeons in the field.

Sensing an opportunity, Stanton assembled a committee in July 1863 to investigate the Medical Department. Among the members of this committee were known rivals of Hammond, including a man he described as a “vulgar ignoramus” and another he had denounced as “unscrupulous, dishonest, cowardly and ignorant.” It can safely be surmised that such men would not be favorably, or even impartially, disposed toward the surgeon general.

Five weeks after the committee began its investigation, Stanton dispatched Hammond on an inspection tour of facilities in the South and West, and two days later replaced him with a surrogate. Hammond’s wife suspected something underhanded was taking place and asked Stanton if he intended to discharge her husband. The secretary denied her suspicions.

Returning from his inspection tour in late 1863, Hammond demanded his position back, or to be court-martialed. He tried to appeal to Lincoln, but – with the Sanitary Commission’s influence waning and Hammond’s former champion, McClellan, now a political foe – the president chose to ignore him. In all probability, Lincoln had tired of the bickering between Stanton and Hammond, and had decided to let his secretary of war handle the matter himself.

And handle it Stanton did, convening a court-martial staffed by nine generals hand-selected for the task, none of whom had a medical background but nearly all of whom either disliked Hammond or were beholden to Stanton. Hammond welcomed the trial, naïvely believing that his innocence would guarantee his exoneration.

Based on the investigating committee’s report, 3 charges and 10 specifications were brought against Hammond. These included a hodgepodge of accusations ranging from overpayment of suppliers to procurement of inferior goods to that military catch-all, conduct unbecoming an officer and a gentleman. Some of the charges were absurd and some, though plausible, were hardly criminal, given the exigencies of an all-consuming war. (If everyone who ever overpaid for military supplies was court-martialed for doing so, the War Department would have ceased to exist long before Hammond came along.)

Stanton not only stacked the deck; he didn’t even deal Hammond a playable hand. When Hammond requested a copy of the investigating committee’s report, Stanton refused. When, during the trial, Hammond presented a purchase order showing that Stanton had approved a procurement named in the specifications, the court would not allow it to be placed into evidence. And Hammond was unable to present a letter that would have exculpated him of one of the more serious charges — because it had mysteriously disappeared when his office was burglarized.

After nearly seven months of trial and 25,000 pages of testimony, the board deliberated for just 90 minutes before returning a guilty verdict on all three charges and most of the specifications. They removed references to corruption and tainted goods from the verdict, but nevertheless ordered Hammond “dismissed from the service and to be forever disqualified from holding any office of profit or trust under the Government of the United States.”

Again Hammond tried to appeal to Lincoln, as did his wife, but the president declined to see either of them. Lincoln approved the guilty verdict on Aug. 18, 1864, and Hammond was dishonorably discharged 10 days later.

The New York Times piled on in an Aug. 23 editorial, calling Hammond’s guilt “of a very vile sort,” asserting he had “stooped to the level of the lowest shoddy knave” and predicting “he will be remembered only to be loathed.” A day later, however, after receiving a letter from Hammond himself – in which he promised a review of the case and declared he had been “the victim of conspiracy, false swearing, and a malignant abuse of official power” – the Times backpedaled, admitting “we know nothing of the case beyond the fact of conviction,” and maintaining “we shall be most heartily rejoiced to be convinced of his innocence.”

Hammond moved to New York City and set out to have his conviction overturned and to rehabilitate his reputation. Though nearly penniless – “I did not know where my next meal was going to come from,” he wrote of this period – Hammond used his connections to set up a practice in the still-infant field of neurology, and within a decade he was one of the highest-paid physicians in the country.

In 1878, Hammond returned to Washington to restore his good name. He received a Congressional hearing, and both houses passed a bill annulling the court-martial proceedings and sentence. It was signed by President Rutherford B. Hayes on Aug. 27, 1879, and Hammond’s name was placed on the retired list of the Army as surgeon general with the rank of brigadier general.

Nine years later, Hammond sold his practice and moved from New York to Washington. He established a sanitarium and unfortunately engaged in some questionable business practices, which eroded the reputation he had fought so hard to regain. Ever flamboyant and ever the self-promoter, he had himself fitted with a surgeon general’s uniform late in life, for no other purpose than to have a portrait of himself painted. He died in 1900 at the age of 71.

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Sources: Bonnie Ellen Blustein, “Preserve Your Love For Science: Life of William A. Hammond, American Neurologist”; Frank R. Freemont, “Gangrene and Glory”; “The Embattled Surgeon, General William A. Hammond,” Alex Zeidenfelt, Civil War Times Illustrated, October 1978; Glenna R. Schroeder-Lein, The Encyclopedia of Civil War Medicine.

Pat Leonard is the editor and publisher of The Gold Cross, a magazine for volunteer E.M.T.s in New Jersey. He has written two novels, “Proceed With Caution” and “Damned If You Do.” His great-greatgreat uncle, Sgt. Jerome Leonard, 55th Pennsylvania Infantry, was wounded at the Battle of Cold Harbor and later died at Bermuda Hundred hospital after his leg was amputated.

From: opinionator.blogspot.nytimes.com


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