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, April 25, 2017

Production Update: The U.S. Army War College's MOLLUS Collection

By Carole Adrienne

The Military Order of the Loyal Legion of the United States, (MOLLUS), is an American patriotic order formed on April 15, 1865 by military officers of the United States who had "aided in maintaining the honor, integrity, and supremacy of the national movement" during the Civil War.

This venerable organization collected and preserved thousands of photographs and documents from the war. The U.S. Army Heritage and Education Center Library in Carlisle, Pennsylvania, counts these among their vast holdings.

The original images have been photocopied and placed in more than 140 binders. The originals are stored in their temperature and humidity-controlled archives. We are working with these albums to select hundreds of photographs for use in our documentary series, "Civil War Medicine".

In these photocopies, you can see the elegant presentation of the original pictures, with hand-drawn embellishment on most pages. Many of the portraits include the subject's "autograph" or signature, pasted into a box drawn onto the page.

Visit more libraries, archives and museums with us as production continues on this unique documentary series. You can also make a tax-deductible contribution to the "Civil War Medicine" project on our website, Thank you!

Mary Putnam Jacobi: Pioneer for Women in the Medical Professions

By Maggie MacLean, 6-26-15

Mary Putnam Jacobi was a prominent physician, author, scientist, activist, educator, and perhaps most importantly, a staunch advocate of women's right to seek medical education and training. Men in medicine claimed that a medical education would make women physically ill, and that women physicians endangered their profession. Jacobi worked to prove them wrong and argued that it was social restrictions that threatened female health.

Jacobi was the most significant woman physician of her era and an outspoken advocate for women's rights, rising to national prominence in the 1870s. She was a harsh critic of the exclusion of women from the professions, and a social reformer dedicated to the expansion of educational opportunities for women, labor reform, and suffrage - the most important women's rights issues of her day. She supported her arguments for the rights of women with scientific proof.

Early Years
Mary Corinna Putnam was born August 31, 1842 in London, England, daughter of American parents, George Palmer Putnam and Victorine Haven Putnam, and the oldest of eleven children. Her family had been living in London since the previous year, while her father established a branch office for his New York City publishing firm, Wiley & Putnam. The Putnam family returned to the United States in 1848, and she spent her childhood and adolescence in Staten Island, Yonkers, and Morrisania, New York.

Mary received her early education from her mother at home, at a private school in Yonkers, and then at a new public school for girls in Manhattan, where she graduated in 1859. She published a story, "Found and Lost," in the April 1860 issue of Atlantic Monthly. Throughout her life she wrote political essays and fiction, and more than 120 scientific articles and 9 books.

Medical Education
After her 1859 graduation, she decided she wanted to become a doctor. Her father thought medicine was a repulsive profession, especially for a woman, but he ultimately supported her decision. No medical school in New York admitted women, so she studied medicine privately with Dr. Elizabeth Blackwell [link], the first woman in American to earn a medical degree (1849), and attended pharmacy school, graduating from the New York College of Pharmacy in 1863, while the Civil War was being fought.

Female Medical College of Pennsylvania
In 1864 she earned a M.D. (Doctor of Medicine) degree from the Female Medical College of Pennsylvania in Philadelphia (founded in 1850), the first medical institution in the world established to train women in medicine and offer them the M.D. degree. The college legally changed its name to Woman's Medical College of Pennsylvania in 1867.

A group of Quaker women, particularly Ann Preston [link], founded the Woman's Hospital of Philadelphia in 1861 to provide clinical experience for Female Medical College students, and to:

"... establish in the City of Philadelphia a Hospital for the treatment of diseases of women and children, and for obstetrical cases; furnishing at the same time facilities for clinical instruction to women engaged in the study of medicine, and for the practical training of nurses; the chief resident physician to be a woman."

This teaching hospital could provide many patients gathered in one place for some time, who could be examined while the course of their diseases were observed.

Jacobi convinced the faculty to allow her to sit for her exams early, and in protest over the special allowances made for her, Dean Edwin Fussell resigned after her graduation. Ann Preston, who had argued for Putnam's early examination, took over his post as America's first woman dean of a medical school.

She received her Doctor of Medicine degree at the Female Medical College of Pennsylvania in 1864 and moved to Boston to study clinical medicine at the New England Hospital for Women and Children, founded in 1862 by fellow graduate, Marie Zakrzewska [link]. After a few months, Jacobi realized that she needed more education before practicing medicine. At that point she began to support co-education for men and women, arguing that women's medical schools could not provide the same training and clinical practice as at established universities affiliated with large hospitals.

Medical Education in Europe
Jacobi decided in 1866 to seek further training in Paris, France. There she attended clinics, lectures, and a class at the Ecole Pratique, and then decided to seek admission to the L'Ecole de Medecine of the University of Paris, which refused to admit women. She remained in Paris studying in less well-known schools and contributing letters, articles, and stories to American journals and newspapers, including the Medical Record, Putnam’s Magazine, the New York Evening Post, and Scribner’s Monthly.

In January 1868 a directive from the minister of education forced the faculty to admit her as the first woman student. Her course was a distinguished one, and she graduated in July 1871 with a prizewinning thesis, the second woman to get a degree at the prestigious L'Ecole de Medecine.

Career in Medicine
After returning to the United States in the fall of 1871, she established a medical practice in New York City and became lecturer of materia medica (medicines) from 1871, and professor of materia medica and therapeutics from 1873 to 1889 at the Women's Medical College of the New York Infirmary, just opened by Dr. Elizabeth Blackwell and her surgeon sister, Dr. Emily Blackwell [link]. Jacobi also practiced medicine among the poor in the slums while working there.

Her mentor Dr. Elizabeth Blackwell viewed medicine as a means for social and moral reform, while Jacobi focused on curing disease. On a deeper level, Blackwell believed women would succeed in medicine because of their humane female values, but Jacobi believed that women should participate as the equals of men in all medical specialties.

The quality of her own education demonstrated to her the poor training available to most American women who wanted a career in medicine. In 1872 she organized the Association for the Advancement of the Medical Education of Women to improve that situation; she served as president of the association from 1874 to 1903. Her teaching at the Medical College often exceeded what her students were prepared to learn and led to her resignation from the Medical College in 1888.

Marriage and Family
When Mary applied for membership in the Medical Society of the County of New York, Abraham Jacobi was president. In 1873, Mary Putnam married Dr. Jacobi, who is often referred to as the "father of American pediatrics." They had three children, though their first daughter died at birth and their only son died at age seven. Their third child, Marjorie Jacobi McAneny, survived to adulthood, and Mary educated her daughter according to her own educational standards.

In the same year (1873), Dr. Jacobi began a children's dispensary service at Mount Sinai Hospital. From 1882 to 1885 she lectured on diseases of children at the New York Post-Graduate Medical School. As an attending and consulting physician, Dr. Jacobi opened a children's ward at the New York Infirmary in 1886. Her ability to diagnose and her insistence on the highest standards ranked her among America's great physicians. In addition to clinical work and teaching, she continued to find time to write.

Dr. Jacobi became a member of several medical associations, including the New York Pathological Society; memberships in these organizations were vital to securing jobs and the respect of her colleagues. She was admitted to the prestigious New York Academy of Medicine by one vote, making her the society's first female member. She was the second woman member of the Medical Society of the County of New York and was admitted to the American Medical Association.

In 1891 she contributed a paper on the history of women physicians in the United States to Women's Work in America (1891). Entitled "Women in Medicine," this is an excerpt from that paper:

When people first began to think of educating women in medicine, a general dread seemed to exist that, if any tests of capacity were applied, all women would be excluded. The profound skepticism felt about women's abilities, was thus as much manifest in the action of the friends to their education as in that of its opponents.

But by 1882, the friends dared to call upon those who believe in the higher education of women, to help to set the highest possible standard for their medical education; and upon those who do not believe in such higher education to help in making such requirements as shall turn aside the incompetent, not by an exercise of arbitrary power, but by a demonstration of incapacity, which is the only logical, manly reason for refusing to allow women to pursue an honorable calling in an honorable way.

A career is open to women in the medical profession, a career in which they may earn a livelihood; a career in which they may do missionary work among the poor of our own country, and among their own sex in foreign lands; a career that is practical, that is useful, that is scientific.

Late Years
Jacobi's work with reformers and suffragists made her a leading spokesperson for women's health. As a leading feminist, she rejected the traditional wisdom about the weaknesses of women. This excerpt from her book, Common Sense Applied to Woman Suffrage (1894), illustrates her dissatisfaction with women's place in American society, especially the lack of suffrage:

No matter how well-born, how intelligent, how highly educated, how virtuous, how rich, how refined, the women of to-day constitute a political class below that of every man, no matter how base-born, how stupid, how ignorant, how vicious, how poverty-stricken, how brutal. The pauper in the almshouse may vote; the lady who devotes her philanthropic thought to making that almshouse habitable, may not. The tramp who begs cold victuals in the kitchen may vote; the heiress who feeds him and endows universities may not.

Over the course of her career, Jacobi wrote more than 100 medical papers. So it should come as no surprise to learn that she wrote a detailed account of her own fatal illness, a meningeal brain tumor: "Description of the Early Symptoms of the Meningeal Tumor Compressing the Cerebellum. From Which the Writer Died. Written by Herself."

Dr. Mary Putnam Jacobi died June 10, 1906 in New York City at age 63, and was buried in Green-Wood Cemetery in Brooklyn. Many prominent physicians, including Dr. Emily Blackwell, honored her at her funeral.

Wikipedia: Mary Corinna Putnam Jacobi
Encyclopedia Britannica: Mary Putnam Jacobi
Wikipedia: Woman's Medical College of Pennsylvania
Changing the Face of Medicine: Dr. Mary Corinna Putnam Jacobi


Glowing Wounds at the Battle of Shiloh: The Strange Facts Behind the Legend of the Angel’s Glow

By Mark Weaver, 3-15-14

Wars breed blood and death on a massive scale. They also breed their share of strange stories. The American Civil War was no exception to this rule. Whether it was the governor who wanted to arm his troops with pikes on battlefields dominated by rifles and artillery, or the doctor who plotted to use biowarfare on Northern cities, the War Between States had its fair share of strange factual stories.

But another thing that warfare breeds is folklore. These apocryphal stories seem too good to be true. Once such bit of folklore that was largely dismissed as wishful thinking came from the Battle of Shiloh, which took place on April 6-7, 1862. The bloodiest battle up to that point in the war, two days of fighting produced 23,000 casualties on both sides. The battlefield itself was a boggy, mud soaked hellhole. Medical services on both Confederate and Union sides were woefully unprepared for the scale of the slaughter, and many wounded were left to fend for themselves among the watery morass.

When help finally managed to reach those poor souls, their rescuers noticed something odd. Their wounds gave off a faint glow in the night! Furthermore, the wounded whose injuries glowed had a better survival rate than their peers whose wounds did not. At a loss to explain what was happening, the flummoxed soldiers dubbed the strange phenomena “Angel’s Glow,” because it truly did seem to be the work of angels.

For a long while, the story was regarded as little more than folklore. That is, until seventeen year old Bill Martin heard the story, and asked his mother, Phyllis Martin, who is a microbiologist, if the bioluminescent soil bacteria she was studying, photorhabdus luminecens, might be responsible for the strange tale. She encouraged her son and his friend, John Curtis, to do further research and experiment to uncover the answer (because that’s what happens when mom is a scientist.) What they found was a remarkable explanation behind a story that was long regarded to be little more than a legend.

P. luminescens is an unlikely saviour. The bacteria hangs out in the guts of various nematode worm species, living in an odd symbiosis. The nematodes are predators of the soil, hunting down insect larva which they devour with P. luminescens’ help. The nematodes burrow into the unfortunate larva’s bloodstream, where they puke out their bacterial payload. P. luminescens releases toxins that kill the bug in short order, giving the nematode quick access to an insect buffet. These toxins also inhibit the growth of bacteria that would decompose the insect corpse, letting the germ and the worm have plenty of time to feast and multiply in their prey’s carcass.

It is this toxin that was likely responsible for helping the soldiers survive their horrific wounds. The hypothesis that Martin and Curtis developed claimed that the glowing bacteria entered soldier’s wounds when nematodes attacked the insect larva who are naturally attracted to such injuries. The resulting infestation would wipe out any of the normal, disease causing bacteria found in wounds.

The only problem with the hypothesis was that P. luminescens cannot survive at human body temperatures. The teenage scientists came up with a novel way to approach this problem.

For once, hypothermia was a good thing

Their answer lay in the muddy battlefield itself. The battle took place in early April, when temperatures were relatively low. Adding to the misery, it rained on and off throughout the battle. Injured men were left exposed to the elements for two days in some cases. By that time, hypothermia would have set in. That would have given P. luminescens time to take hold and kill off harmful bacteria. Then, when the soldiers were taken in and warmed back up, their bodies would have naturally killed off the bug. For once, hypothermia was a good thing.

With that, the teenagers managed to present a plausible explanation for the Angel’s Glow, a phenomena that was long thought to be little more than fanciful thinking by desperate men. The exact nature of the toxin the bacteria uses to perform its medical miracles has yet to be identified, but the duo are working to isolate it. Perhaps the bacteria that saved lives 150 years ago might be able to save even more today.

“Glowing Wounds.” AAAS ScienceNetLinks. March 15, 2014. <>

Byme, James. “Photorhabdus luminescens: The Angel’s Glow.” February 25, 2011. The Naked Scientists. March 15, 2014. <>

“Shiloh.” CivilWar.Org. Civil War Trust. March 15, 2014. <>

Image: A false color micrograph of a soybean cyst nematode and an egg. The species that lived symbiotically with P. luminescens would have looked similar.


Walt Whitman: Civil War Missionary

From:, 4-11-14

After his brother was wounded in battle, Whitman volunteered many hours helping wounded soldiers in Washington D.C.

In late December 1862, national poet Walt Whitman arrived in Washington D.C., intending to stay for just a few days. He ended up staying for the next ten years; for the first three, he was a regular visitor at the various military hospitals in and around the nation’s capital.

In “The Soldiers’ Missionary,” Roy Morris Jr.’s in-depth feature in the Spring 2014 issue of Civil War Quarterly Magazine, you’ll get to read all about Whitman’s interactions with the wounded soldiers.

Whitman’s time in Washington actually began with the wounding of his brother George at the Battle of Fredericksburg in late December 1862. At home in Brooklyn with his mother, they received unexpected news that his brother was on a list of regimental casualties published by the New York Tribune. Fearing the worst, Whitman and his mother threw together some belongings and hurried south to Washington.

While visiting his brother, Whitman was immediately struck by how many soldiers were hospitalized. “The mass of our men in our army are young,” he wrote in an article published in the New York Times. “It is an impressive sight to me to see the countless numbers of youths and boys, many of them already with the experiences of the oldest veterans.”

Mrs. Keckley, “Contraband” and The Lincolns

By Feather Schwartz Foster, 10-19-15

The Civil War brought out great bitterness. It also brought out great generosity.

Shortly after the Civil war began, runaway slaves were give a unique new name: “Contraband of War.”

Fortress Monroe, near Norfolk, VA, was a crucial center for the Union, since it commanded the Chesapeake Bay, its trade, commerce and defensive position. General Benjamin Butler, a “political” general and Massachusetts lawyer, was in command of Union forces in that area, which was a magnet for the runaways. Technically, they “could not” be freed and “should” be returned to their masters, but Butler, an abolitionist, was not about to permit it. He declared the runaways as “contraband of war”, giving quasi immunity and a sense of growing pride and importance to the once-enslaved.

The Sanitary Commission

Early in the war, the Sanitary Commission was formed in the North. As a precursor to the Red Cross, the organization was devoted to provide money, goods and services for Union soldiers, particularly the wounded.

The idea caught on like wildfire, and hardly a Northern town  was without a chapter. (In the South, there was no structured organization; everyone pitched in however they could.)

Men had organized the Sanitary Commission, but it fell to the women to organize many of their activities: fairs and bazaars, knitting and sewing circles, assembling mess kits and sundries.

Huge sums were raised. Thousands upon thousands of articles – from fully-equipped ambulance wagons to socks and pajamas – were provided to army hospitals.

Mrs. Elizabeth Keckley

Elizabeth Keckley (1818-1907) was born in Petersburg, VA, a mulatto slave.  At a young age, she discovered a rare talent for sewing and designing ladies fashions and eventually became so adept that she earned enough money ($1200) to purchase her freedom.

As a free woman, she moved to Washington in 1860 and opened a shop, making gowns for the capital’s elite. She had come highly recommended to Mary Lincoln, and began working with the new First Lady the day the Lincolns entered the White House.

“Lizzie” Keckley became an indispensable part of the Lincoln White House.

The relationship between Elizabeth Keckley and Mary Lincoln would steadily deepen. Mrs. K. would not only be engaged as her modiste and personal dresser, but helped nurse Willie and Tad when they were sick, and tended to an ailing (and grieving) Mrs. Lincoln as well. From time to time she even combed the President’s thick and unruly hair. In short, she became indispensable, and the close confidante and companion to the First Lady.

Elizabeth Keckley and Contraband

Free Negroes and former slaves came to Washington in droves during the Civil War. They were usually “disappointed” by freedom.

While the North and South actively supported their wounded, “Contraband” were given little assistance. Where were these poor souls to go? How would they find work and avoid starvation?   They were being ignored and neglected.

Mrs. Keckley had become a prominent figure among the free Negro citizens of Washington, well respected by her community. After witnessing a fund-raising fair in Washington to help wounded Union soldiers, she approached the pastor of her church about forming a society to assist all those “contraband” who needed food, clothing, medical attention and shelter. An organization was formed to collect money and goods, and to distribute them where they could. They named it the Contraband Relief Association.  Once Negroes were accepted as soldiers in the Union Army, it became The Ladies’ Freedmen and Soldiers Relief Association.

It was one of the first organizations established for Negroes to provide care for their own, and set a standard for subsequent charitable groups, uniting assistance among the capital’s Black Churches.  They organized their own fairs and bazaars, lectures and dances.

President and Mrs. Lincoln Contribute

President Lincoln approved a generous personal donation to the Contraband Relief Association.

Lizzie Keckley had had a very brutal upbringing. Her “masters” were cruel; she was subject to beatings, rape and humiliation, yet she rose above it and was proud and self-sufficient. She was not given to beg for favors. Her prominence as dressmaker to the First Lady, and the genuine kindness she received at the Lincolns’ hands was sufficient.

Mary Lincoln was a generous supporter to the Contraband Relief Association.

However, a month after the Contraband Relief Association was formed, she accompanied Mrs. Lincoln on a trip to New York, and took advantage of that time to tell her about her new “organization.” Mrs. L. was delighted to lead off the fund raising drive, and after requesting support from the President, pledged $200 (which would be far more than $2500 today). Mrs. Lincoln’s influence also brought Lizzie in contact with many prominent Northerners who also contributed generously. Wendell Phillips and Frederick Douglass were included among the subscribers, and even gave lectures on its behalf.

Both Lincolns would make subsequent contributions from time to time.

Mrs. Keckley: A Fall From Grace

“Behind the Scenes” has been reprinted many times – but it was unsuccessful when it was written. It is said that Robert Lincoln arranged to purchase every existing copy to prevent his mother’s embarrassment.

The rupture of the close friendship between the First Lady and her dressmaker began basically over money. After Lincoln’s assassination, Mary Lincoln needed Mrs. Keckley’s near-constant companionship and nurturing, but she could no longer afford to pay her. Mrs. Keckley needed the money. Devoting all her time to the demanding former First Lady left her no time to tend to her business. She lost her customer base.

Elizabeth Keckley lived a long life, but it was mostly in poverty, relying on assistance from some of the charitable organizations she helped to found.

In a effort to support herself, she penned an autobiographical book with a ghost-writer, called Behind the Scenes: Thirty Years a Slave, and Four Years in the White House. In it, she presented an intimate portrait of the Lincolns including private letters from Mrs. Lincoln. This was a total breach of trust and privacy and Victorian morality, and the relationship between the two women was severed. Mrs. Lincoln never spoke of her again except to refer to her as the “Negro historian.” Mrs. Keckley had not intended to harm or humiliate the former First Lady, and indeed was devastated by the broken relationship.

Elizabeth Keckley later spent time as a dressmaking instructor at Wilberforce University, but eventually died at age 89 in poverty, at a Home for Destitute Colored Women, one of the offshoots of the Contraband Relief Association.


Fleischer, Jennifer – Mrs. Lincoln and Mrs. Keckley – Broadway Books, 2003

Keckley, Elizabeth – Behind the Scenes: Thirty Years a Slave, and Four Years in the White House – Important Books, 2013

About Feather Schwartz Foster
Feather Schwartz Foster is an author-historian who has made more than 500 appearances discussing presidential history. She teaches adult education at the Christopher Wren Association (affiliated with William and; Mary College), and adult Education programs at Christopher Newport University. She has been a guest on the C-SPAN "First Ladies" program. She has written five books.


Mental Health

By Barbara Floyd, University Archivist, University of Toledo

In early 19th century America, care for the mentally ill was almost non-existent: the afflicted were usually relegated to prisons, almshouses, or inadequate supervision by families. Treatment, if provided, paralleled other medical treatments of the time, including bloodletting and purgatives. However, in a wave of concern for the oppressed, some took action. Among these, Dorothea Dix was the leading crusader for the establishment of state-supported mental asylums. Through her efforts, the first state hospitals for the insane were built in New Jersey and Pennsylvania. She and other reformers sought humane, individualized care with the rich and the poor housed together to insure high standards for all. The movement was generated by social reform, but throughout the century, mental illness was probed and analyzed, and "cures" prescribed by both the scientific and lay communities.

"Moral treatment" was the predominating philosophy to cure the insane. This system was developed
in late 18th century Europe, and by Benjamin Rush in the United States. It challenged the demonic explanations for insanity and emphasized the role of environment in determining character: improper external conditions could induce derangement. The "moral treatment" system was optimistic that an appropriate environment could facilitate cure, especially for those with acute (not chronic) afflictions.

Essential to this theory was a physiological basis for mental disorder: insanity was caused by brain damage. The brain's surface was soft and malleable and physically altered by outward influence. This idea was closely related to phrenology which assigned specific faculties to sections of the brain.

The notion that mental illness resulted from physical impairment was rarely challenged, but the nature and treatment of ailments were continually debated. To find physical evidence for mental deficiencies, autopsies were performed on mental patients to discover lesions or other abnormalities. Although progress was made in the diagnosis of somatic diseases like tumors or syphilitic derangement, these efforts were frustrating and subjective. Also controversial was the fate of the chronically versus acutely ill: the differences between them, whether they should be housed together, and whether the chronically ill should be treated at all.

Superintendents of early mental institutions were well educated, although not necessarily in medicine, and active in the community. Thirteen heads of institutions, called "alienists," formed the Association of Medical Superintendents, and began the American Journal of Insanity. Asylums were built in rural areas to remove patients from their home environments and to provide fresh air in a bucolic setting. Patients were offered exercise, work, education, and religious instruction. Most alienists did not dispense drugs, but stressed healthy, clean living. They lived near patients, invited the public in for programs, and promoted the view that the insane were not monsters but rather "unfortunate fellow beings." Focusing on societal causes, alienists believed mental health problems could be avoided, especially in the young: children's brains were softer, vulnerable, and more prone to influence.

After the Civil War, faith in "moral treatment" declined because the curability rate had been overestimated, the cost of facilities was high, the government curtailed funds, and the public became disillusioned with "experts" and their failed promises. Repeated failures also frustrated practitioners who responded with an increased use of physical restraint. An influx of immigrants caused overcrowding and a loss of fee-paying private patients. As the medical field was slow to become interested in the care of the mentally ill, there was a lack of trained personnel. The original, more idealistic practitioners were gone, and new managers, many of whom were political appointees, were less inspired and qualified. These alienists became self-protective and isolated from the public. They also feared that "moral treatment" was responsible for the rise in spiritualist movements, considered fanatical and dangerous, and they further tightened the reins of custodial care.

Between 1850 and 1880, viewpoints reverted back to pre-asylum assessments, with the added element of heredity: mental illness resulted from a weak family and vice committed by ancestors. This led to a fatalistic view of cures, and a new wave of books detailing the dangers of bad habits such as alcoholism and masturbation. Influenced by Social Darwinism, practitioners believed mental illness could be eliminated through eugenics. Although there were scientific advances, particularly in neurology, the tendency was to classify ailments rather than investigate through observation. Drugs such as chloroform, bromides, and ether were increasingly used to subdue patients.

By the 1880s, asylum conditions had deteriorated significantly, and neurologists began to vie for control of institutions. They opposed superintendents and questioned the validity of the asylum itself, promoting the clinic instead. In 1880 they formed the National Association of the Insane and the Prevention of Insanity. A public interest in reform ensued with exaggerated stories of asylum abuse appearing in newspapers. By 1884 the neurologists and superintendents were forced into an uneasy truce resulting in medical standards for superintendents, greater control over asylums, oversight commissions, psychopathic hospitals for the acute, out-patient care, and research. Medical education began to include the study of insanity. The word "asylum" was replaced by "hospital" to reduce the stigma of mental illness.

Neurologists made some sound contributions to the field, but they also promoted dubious treatments such as static electricity and the "rest cure." Eventually, neurologists formed two camps: those who focused on somatic cases, and those who embraced psychological theories as medically respectable.

To remove the chronically ill from overcrowded asylums and in a general effort to promote non-restraint, alternative care facilities such as the tent treatment, the free air system, and the cottage system were attempted in the latter part of the century. The Toledo (Ohio) State Hospital was the first mental health institution in the country to be designed exclusively on the cottage system. In spite of such reform efforts, the dominance of Social Darwinism condemned the chronically ill as genetically inferior. It was not until the final years of the century that Sigmund Freud's theories about the unconscious crept into the professional arena.

Beard, George M. A Practical Treatise on Nervous Exhaustion (Neurasthenia). New York: E. B. Treat, 1889. MCO

Buckham, Thomas R. Insanity Considered in its Medico-Legal Relations. Philadelphia: J. B. Lippincott & Co., 1883. MCO

Deslandes, Leopold. A Treatise on the Diseases Produced by Onanism, Masturbation, Self-Pollution, and Other Excesses. Boston: Otis, Broaders, and Company, 1838.

Fowler, O. S. Hereditary Descent: Its Laws and Facts Applied to Human Improvement. New York: Fowler and Wells, 1853.

Gilman, Charlotte Perkins. "The Yellow Wallpaper." In New England Magazine, Vol. 5, September 1891-February 1892.

Hammond, William A. A Treatise on Diseases of the Nervous System. New York: D. Appleton and Company, 1873. MCO

Laurie, J. The Parent's Guide: Containing the Diseases of Infancy and Childhood and their Homeopathic Treatment. Philadelphia: Rademacher & Sheek, 1854.

Mott, Mrs. The Ladies' Medical Oracle; or Mrs. Mott's Advice to Young Females, Wives, and Mothers. Boston: Samuel N. Dickinson, 1834.

Packard, Elizabeth. Prisoner's Hidden Life: Or Insane Asylums Unveiled. Chicago: J. N. Clarke, 1871.

Ranney, Ambrose L. Lectures on Nervous Diseases: From the Standpoint of Cerebral and Spinal Localization, and the Later Methods Employed in the Diagnosis and Treatment of These Affections. Philadelphia: F. A. Davis, 1890. MCO

Shannon, Bishop Samuel. Nature's Secrets Revealed. Scientific Knowledge of the Laws of Sex Life and Heredity; or Eugenics. Marietta, Ohio: S. A. Mullikin Company, 1914.

Walker, Alexander. Intermarriage: Or the Mode in Which, and the Causes Why, Beauty, Health and Intellect, Result from Certain Unions, and Deformity, Disease and Insanity, from Others. New York: J. H. G. Langley, 1839.

Image 1:  Many authors warned of the dangers of masturbation in the 19th century, including Leopold Deslandes in A Treatise on the Diseases Produced by Onanism, Masturbation, Self-Pollution, and other Excesses, published in 1838.

Image 2:  Title page from Alexander Walker's Intermarriage: Or the Mode in Which, and the Causes Why, Beauty, Health, and Intellect Result from Certain Unions, and Deformity, Disease and Insanity from Others, published in 1839.

Image 3:   The Indianapolis Hospital for the Insane, ca. 1854.


Healers or Horrors: Civil War Medicine

By Richard A. Gabriel, 9-22-16

Safe behind its ocean barriers, the United States paid scant attention to the wars that raged abroad during the early 19th century, taking little notice of the lessons that might have been learned from the European experience with mass killing. With few opportunities for its own military medical establishment to acquire field experience, the U.S. Army’s military medical service remained primitive. In 1802, the U.S. Army Medical Corps comprised only two surgeons and 25 orderlies. By 1808, the number of surgeons had increased to seven and surgical assistants to 40. There was no ambulance corps during the War of 1812; after the battle wagons were sent to search for the wounded. There were no hospitals, either, and the wounded were treated in temporary shelters near the battlefield. Even these primitive facilities were dismantled when the war ended. In 1818, Congress finally authorized the appointment of Dr. Joseph Lovell to head the medical corps as surgeon general.

At the start of the Mexican War in 1846, the American medical corps consisted of one surgeon general and 71 medical officers. Statistically, the Mexican War was the deadliest ever fought by an American army. Of the 100,182 soldiers committed to the campaign, 1,458 were killed in action and another 10,790 died of disease, a disease mortality rate of 11 percent. This compared to a similar rate of 6.5 percent for the Civil War, 2.7 percent for the Spanish-American War, and 1.6 percent for World War I. The single medical contribution of the Mexican War was the first use of anesthesia by a military surgeon in combat. The medical service was once more reduced in strength when the war ended. At the outbreak of the Civil War, no one on either side was remotely prepared for the magnitude of the slaughter, forcing both sides to endure a medical catastrophe that was unprecedented in military history.

The Shocking Casualties of Total War
The Civil War was the first modern war in which the productive capacities of the industrial state were completely integrated into the war effort. The number of combat engagements was the largest in history to that time, and exponential increases in the killing power of weapons produced rates of casualties beyond the imagination of military medical planners. In a four-year period, 2,196 combat engagements were fought, in which 620,000 men perished—360,000 in the Union Army and 260,000 in the Confederate Army. Some 67,000 Union soldiers were killed outright, 43,000 died of wounds, and 130,000 were disfigured for life, often with missing limbs; 94,000 Confederate soldiers died of wounds.

Deadlier Rifles
The minie ball (actually a bullet) caused 94 percent of all wounds, artillery shell and canister accounted for 6 percent, and the saber and bayonet fewer than 922 wounds, of which only 56 were fatal. Some 35 percent of all wounds were to the arms, 35.7 percent to the legs, and wounds to the head and trunk accounted for 18.4 percent and 10.7 percent, respectively. In a statistical sense, the Civil War was the most life-threatening war ever fought. The chances of not surviving the war were one in four, as compared to one in 124 in the Korean War.

The staggering increase in the number and seriousness of wounds was due to the .58-caliber rifle-barreled firearm, which was capable of propelling a bullet 950 feet per second to a range of 600 yards. The heavy, soft, unjacketed lead bullet flattened out on impact, producing severe wounds and carrying pieces of clothing into the wound. When the bullet struck a bone, its weight and deformation shattered the bone or severed it completely from the limb. The old tactic of massing troops to deliver mass fire, once made necessary by the inaccuracy and limited range of the musket, persisted, making troop formations extremely vulnerable to long-range rifle fire. The deployment of troops over greater frontages also increased the dispersal of the wounded, making it difficult to locate, treat, and evacuate them. The Civil War medical officer faced problems of wound management that were unique for the time.

More Limbs Lost Than in Any Other American War
The improved kinetic power of the rifle bullet made amputation the most frequently performed battlefield operation. Of the 174,200 gunshot wounds to the arms and legs suffered by Union soldiers, 29,980 required amputation. Confederate soldiers suffered 25,000 primary amputations. The mortality rate for primary amputation was 26 percent, compared to 52 percent for secondary amputation. Another 26,467 wounds of the extremities that were complicated by an injury to the bone were treated by expectation (left alone to heal), with a mortality rate of 18 percent. More limbs were lost in the Civil War than in any other American conflict before or since.

In the first years of the war, control of bleeding (hemostatis) was achieved mostly through the use of tourniquets and cauterization, methods dangerous to the patient when practiced by physicians with limited experience. As the physicians gained experience, pressure dressings and ligature became the primary methods for controlling bleeding. But ligature often led to infection. The mortality rate for these secondary infections was 62 percent. The usual array of infections—tetanus, erysipelas, gangrene, and various streptococcus infections—was always present, and the mortality rate in hospitals from such infections reached 60 percent in the early days of the war. By the end of the war, this had fallen to 3 percent. Hospital infection remained a major problem on both sides throughout the war, however. William W. Keen, a surgeon in the Union Army, observed in his memoirs that “it was seven times safer to fight all through the three days of Gettysburg than to have an arm or leg cut off and be treated in a hospital.”

Battlefield Drugs and Anesthetics
For the first time in history, anesthesia was used on an unprecedented scale by military physicians. No fewer that 80,000 applications of anesthesia were administered. General hospital records show that anesthesia was used in 8,900 operations, of which 6,784 used chloroform and 811 used ether. In 1,305 cases, a combination of the two was used. Remarkably, only 37 deaths were attributed to anesthesia. Advances were also made in the immobilization of limbs using plaster of Paris. In 1863 the famous Hodges splint, still used today in the fracture of the lower femur, was introduced by Union surgeon John Hodges.

The use of drugs was primitive at best. Calomel (mercurous chloride) was so heavily prescribed that the Surgeon General forbade its use as dangerous. The most useful drugs were morphine, opium, and quinine, the latter as a preventative for malaria. Morphine was usually dusted directly on the wound, and only occasionally injected hypodermically. The hypodermic syringe appeared in the 1850s but was used only rarely in the Civil War—at least on the physically wounded. Dr. Silas Weir Mitchell noted that in the army hospital for nervous diseases, more than 40,000 doses of morphine were given hypodermically to psychiatric patients in a single year. A staggering 10 million opium pills were given to patients during the war, along with 2,841,000 ounces of other opium-based preparations such as laudanum, opium with ipeac, and paregoric. In all, 29,828 ounces of morphine sulphate were administered. Not coincidentally, by 1900 there were 200,000 drug addicts in America.

Disease: The Number-One Killer
Disease was the number-one killer of soldiers on both sides during the Civil War. Most recruits were physically unfit for the rigors of war. Three-quarters of the Union soldiers discharged from the army in 1861 were so unfit that they should never have been allowed to enlist. Most recruits came from isolated rural towns, and this isolation prevented them from developing immunity to a wide range of common childhood diseases. Being brought together in the close quarters required of military life, many fell ill with diseases to which they had never previously been exposed. Poor physical condition, few immunities, poor nutrition, and the general stress of military life reduced resistance to disease. Scurvy was endemic, and outbreaks of cholera, typhus, typhoid, and dysentery took a heavy toll. Disease killed approximately 225,000 men in the Union Army and 164,000 men in the Confederate ranks. It is estimated that disease killed five times as many men as weapons fire.

The Union Army Adapts its Medical Corps
The Union medical service was completely unprepared for war. In 1860, the 26,000-man army was scattered along the frontier and had no military medical service to speak of. The army had only 36 surgeons and 83 assistant surgeons, 24 of whom resigned to join the Confederacy. Medical supplies were in short supply, and there were no army general hospitals. There was no ambulance service to locate and evacuate the wounded. The incumbent surgeon general was Thomas Lawson, a sick and dying man who economized on expenditures by refusing to purchase medical books and supplies.

In the 1850s, then-Secretary of War Jefferson Davis had ordered two officers, one of whom was Captain George B. McClellan, to prepare a study of medical lessons learned from the Crimean War. The report recommended the creation of an army ambulance corps. But by 1860, no such corps had been established. For the first two years of the war, there were no systematic provisions to evacuate the wounded. At the Battle of Bull Run, wagons had to be commandeered from the streets of Washington to transport the wounded. In the Peninsular Campaign, a Union Army corps of 30,000 men had ambulance transport sufficient for only 100 casualties.

At the Battle of Wilson’s Creek, Missouri, in August 1861, the wounded could not be moved for six days due to the lack of ambulances. In November of that same year, Brig. Gen. Ulysses S. Grant abandoned his wounded at Belmont, Missouri, because there were no ambulances. In 1861, Lawson was replaced by Dr. William Hammond, who appointed Dr. Jonathan Letterman as surgeon general of the Army of the Potomac. Letterman immediately set about creating an ambulance corps.

Each army corps now acquired its own organic medical transport. Each division, brigade, and regiment had its own medical officer who answered to the corps’ medical officer responsible for coordination at all levels. The chief surgeon within each division controlled the ambulance corps. Each regiment was assigned three ambulances and a complement of drivers and litter-bearers, and each division had its own ambulance train of 30 vehicles. The ratio of ambulances to men averaged 1 to 150. Only medical personnel were permitted to remove the wounded from the battlefield, a regulation designed to reduce the manpower loss that often resulted when several men left the line to transport their wounded comrades to aid stations. Ambulance wagons were removed from control of the quartermaster and used only for medical transport. They were posted near the front of the column to be within easy reach once a battle began.

Transporting the Wounded: Letterman’s Ambulance System
The first test of Letterman’s ambulance system came at the Battle of Antietam in September 1862. Union forces alone suffered 10,000 wounded scattered over a six-mile area. The system reached and evacuated most of them within 36 hours. A month later at Fredericksburg, the system worked so well that the wounded piled up at aid stations faster than they could be treated. Within 12 hours, all 10,000 wounded had been located, transported, and cleared through the aid stations. Letterman’s ambulance system was integrated into the larger network of casualty evacuation from field hospitals at the front to general hospitals in the rear. Railroads evacuated casualties from collection points behind the battlefields to the general hospitals. By the end of the war, Northern railroads had transported 225,000 sick and wounded men from the battlefields to the general hospitals.

The Union medical service also used coastal steamers and river steamboats under the control of the medical corps to transport the wounded. In 1862, the Union Army contracted for the use of 15 steamboats on the Mississippi and Ohio Rivers and 17 seagoing vessels for use along the Atlantic coast. In the last three years of the war, 150,000 casualties were transported by boat to the general hospitals. The first use of a hospital ship was at the Battle of Fort Henry in February 1862, when the City of Memphis transported 7,000 casualties to hospitals along the Ohio River. Also in 1862, the navy purchased the D.A. January as its first hospital ship. By the end of the war, January had transported 23,738 casualties on the Ohio, Missouri and Illinois rivers, with a mortality rate of only 2.3 percent, significantly lower than the rate in land-based hospitals. The first naval nurses in America, the Catholic order of the Reverend Sisters of Mercy, served aboard Red Rover, tending the wounded after the siege of Vicksburg, Mississippi. In March 1862, Hammond recommended that all Union armies adopt Letterman’s system, which until then had been limited to the Army of the Potomac. Congress approved the recommendation in March 1864. It was only at the end of the war, however, that Letterman’s reforms were fully implemented.

Reforming the Field Hospital System
Letterman also changed the structure of the field hospital system by turning regimental hospitals into frontline aid stations. Treatment of the wounded at these stations was limited to control of bleeding, bandaging wounds, and administering opiates for pain. This allowed medical officers to hold the slightly wounded there and return them to the line, reducing manpower loss due to needless evacuation. Behind the aid stations, Letterman created mobile surgical field hospitals. These hospitals were the critical link between the frontline aid stations and the rear-area general hospitals. The system was tied together by the field ambulance corps, railways, and hospital ships.

The general hospitals were located in major cities along established water and rail routes. By 1862, a building program was undertaken in the North to construct additional hospitals. A year later, the Union Army had 151 general hospitals with 58,715 beds ranging in size from small facilities of 100 beds to the Mower General Hospital in Philadelphia with 4,000 beds. Some of these hospitals became treatment centers for medical specialties such as orthopedics, venereal disease, and nervous disorders. St. Elizabeth’s in Washington, D.C., became the first military psychiatric hospital in the country.

Another of Letterman’s innovations was the establishment of a modern medical supply system that worked well under field conditions. Until this reform, medical supplies and equipment were obtained from the quartermaster through the usual supply system. This often led to medical units not receiving adequate supplies. Letterman established basic medical supply tables, equipping all medical units from regiment through corps with basic loads of medical provisions. Each unit was to carry with it supplies for 30 days. A medical purveyor accompanied the army and was responsible for continually replenishing the medical supplies of each unit.

13,000 Physicians and Surgeons
Most surgeons in both armies were commissioned by state governors to provide medical support for the regiments raised by the states. With few standard licensing procedures for medical certification, it is not surprising that basic competence was a major problem. Few of the physicians entering the state regiments had surgical training. As the war dragged on, however, many of the marginally competent physicians and surgeons became excellent practitioners as a result of their battlefield experience.

About 13,000 physicians and surgeons served with the Union Army. Of these, 250 Regular Army surgeons and assistant surgeons were appointed by Congress to serve as staff and administrators. Some 547 brigade surgeons were commissioned by Congress to assist the corps of regular surgeons. Another 3,882 regimental surgeons and assistants were appointed by governors to state regiments. These surgeons usually served in the aid stations and mobile field hospitals. The army hired 5,532 contract surgeons, mostly civilian doctors, to staff the general hospitals. An additional 100 doctors staffed the Veterans Corps to provide aid to the disabled, and 1,451 surgeons and assistants served with the 179,000 Black troops in 166 regiments. One of the Union surgeons was Mary Edwards Walker, the first woman in American history to hold such a position. Women mostly served as nurses, however. In the North, 3,214 female nurses served in military hospitals under the control of Dorothea Dix, who had been appointed as superintendent of Women’s Nurses. One of Dix’s nurses, Clara Barton, went on to found the American Red Cross. The special place of women in Southern culture militated against using women in military hospitals. Consequently, female nurses were not used there on a large scale.

With the end of hostilities, the Union Army was demobilized and along with it the military medical service. By the end of 1866, the Union Army had been reduced to a force of only 30,000 men. The army and its skeleton medical corps were scattered among the 239 military posts throughout the country. By 1869, the entire medical service corps consisted of only 161 medical officers. Most military posts had no surgeons at all, and they were forced to rely on contract physicians for medical support. Only 282 surgeons were available to the military. Letterman’s system for dealing with mass casualties disappeared virtually overnight.

The Confederate Medical Corps
In general, the Confederate medical service was organized and operated very much like the Union system, although it suffered more from shortages of personnel and equipment that magnified its shortcomings. The total number of medical officers in the Confederacy was 3,236, of which 1,242 were surgeons and 1,994 assistant surgeons. The Confederate naval medical corps had only 107 medical officers, including 26 surgeons and 81 assistant surgeons.

The South’s shortage of physicians was to some extent self-inflicted. For reasons that remain unclear, all medical schools in the South with the exception of the University of Virginia were closed at the start of the war, cutting off the Confederate armies from an invaluable source of trained medical personnel. Moreover, the Confederate surgeon general established unrealistically high qualifications for physicians wishing to join the medical service, causing still more shortages. Worse yet, he examined those physicians already in the medical corps for competency, forcing significant numbers to resign. The Confederacy was never able to provide adequate numbers of surgeons and other physicians to deal with the heavy casualties it suffered on the battlefield.

Deficiencies in Confederate Supplies
The Confederate ambulance service was never adequate and suffered from a chronic shortage of wagons and other transport. In 1863, Confederate medical officers complained that there were only 38 ambulances in the entire Army of the Mississippi. The situation worsened as the war continued. In 1865, not a single ambulance could be found in the combat brigades of the armies of West Virginia and East Tennessee. The shortage of ambulances forced the South to make greater use of steamboats and railroads to transport its wounded. But the undeveloped nature of the Southern railroad system resulted in a shortage of efficient track routes over which to transport casualties. Small 100-bed hospitals were constructed at rail junctions to deal with the problem.

Shortages of vital medical supplies plagued the South until the end, including shortages of quinine and anesthetics. Paradoxically, these shortages sometimes produced beneficial if unexpected results. It had been the common practice on both sides to cleanse wounds with sea sponges kept in buckets of water next to the operating table. Squeezed in dirty water and used repeatedly, these sponges became major sources of infection transmission. The shortage of sponges in the South as a result of the Union blockade forced Confederate surgeons to use cotton rags instead. Since the rags were used only once, disease transmission was reduced considerably.

The used rags were recycled, a process that required them to be washed, boiled, and ironed, and thus made sterile. Bandages, too, were better in the South since they were made of cotton that had first to be baked to be made useable. It had been common practice to use harness-maker’s silk for ligatures and sutures. With no silk available, Southern surgeons used horsehair instead. To make horsehair pliable enough for suturing, it first had to be boiled. Boiling made the suture material sterile.

The South recognized dentistry as an important medical specialty. As secretary of war before hostilities broke out, Jefferson Davis had tried to convince the army to establish a separate dental corps, but had failed to do so. The South had a more comprehensive dental care program than the North, which contented itself with transferring to the artillery any toothless soldiers who could not bite off the ends of their cartridge packets.

Medical Personnel Become Noncombatants
The Confederacy’s general hospital system was perhaps the only element of the military medical service that was somewhat equivalent to the system in the North. The largest hospital on either side was the 8,000-bed Chimborazo Hospital outside of Richmond. With 150 single-story pavilions organized into five divisions, each with 40 to 50 surgeons and assistant surgeons per division, it was the largest military hospital ever built in the Western world. The pavilion-style hospital proved to be the best design for reducing infection by improving ventilation and isolation. These hospitals consisted of a series of long, single-story buildings isolated from each other. High ceilings with vents at the top and sufficient windows provided ventilation. Usually connected to a central semicircular corridor, these 60-patient buildings were sometimes unconnected, providing excellent isolation for disease wards. The pavilion-style hospital is generally credited to Dr. Samuel Moore, the Confederate surgeon general, who supposedly got the idea from British hospitals used in the Crimea. In fact, the design is actually much older and reflects the design of legion camp hospitals used by the Roman medical service.

One of the more significant military medical contributions of the South is attributed to Lt. Gen. Thomas “Stonewall” Jackson. In 1862, Jackson ordered all Union medical officers held by his command to be released and henceforth treated as noncombatants. By June of that year, both Lee and McClellan agreed to a similar practice. Medical personnel were no longer to be subject to capture. If taken, they were to be allowed to treat their wounded and immediately released. All medical personnel held in Union and Confederate prison camps were freed in 1862, and exchanges of captured medical personnel continued until the end of the war. Jackson had instinctively anticipated the regulations dealing with medical personnel that were adopted by the First Geneva Convention a few years later.

Medical Advances of the Civil War
A number of advances in military medicine resulted from the Civil War. Hammond created the Army Medical Museum to collect and study artifacts and information relevant to military medical care. John Shaw Billings began the Library of the Surgeon General’s office which remains the largest military medical library in the world. Congress established a pension system for disabled soldiers far more generous and comprehensive than anything seen in Europe at the time. The
pension system was chosen over the asylum system of permanent care because it provided the disabled soldier with more freedom and mobility. For the first time an accurate medical records system was created that made it possible to track casualty records for every soldier. One consequence was the publication of the massive Medical and Surgical History of the War of the Rebellion, which remains the standard against which all such works are judged.

The Civil War saw the development of the first effective military medical system for dealing with mass casualties, including aid stations, field and general hospitals, ambulance and theater-level casualty transport, along with an effective staff to coordinate it. For its time it was the best military medical system ever deployed, and it remained a model for other countries for decades. The introduction of the pavilion-style hospital was so effective in reducing disease mortality that it became the standard design for both military and civilian hospitals for the next 75 years. Wide use of anesthesia, primary amputation, the splint, and debridement (cutting away dead tissue) were the first effective methods of wound management in the modern age. These techniques, taught to thousands of physicians through hard experience, were carried back to civilian life, elevating the general level of medical care available to the nation as a whole.

The prevalence of facial injuries encountered during the war stimulated the development of the new medical specialty of plastic surgery. Civil War surgeons performed six reconstructions of the eyelid, five of the nose, three of the cheek, and 14 of the lip, palate and other parts of the mouth. Dr. Gordon Buck performed the first total face reconstruction in history. Joseph Woodward, another war surgeon, became the first person to link the new technology of the camera to the microscope, and he published the first microphotographs of disease bacteria. He is also credited with the technique of using analine dyes to stain tissues for microscopic analysis. The advent of microphotography served to make the American military medical establishment receptive to the germ-fighting discoveries of Pasteur and Lister when they came along a few years later.

Despite the terrible slaughter and suffering that it caused, the Civil War ironically marked one of the most progressive periods in the history of military medicine. That it came at a cost of hundreds of thousands of ruined lives and shattered families goes without saying.

Image: Zouave soldiers prepare an injured comrade for the amputation of his right arm while surgeons stand by with their instruments.


Rabies History

By Yolanda Smith, BPharm

Rabies has long been recognized throughout history, which is most likely due to the particularly stark symptoms associated with the disease. It appears to have been ever present in dog species, as well as occurring intermittently in other animal species such as bats.

Early History
It was quickly understood even in ancient history that the rabies virus could be passed on via an animal bite. Rabies is mentioned in several ancient literature works, such as the paper by Aristotle (300BC) that notes rabies as one of the diseases that affects dogs and any animal that the dog bites.

Also in early historical times, the owner of a dog displaying symptoms of rabies such as excessive salivation was required to take precautions to prevent their dog from biting someone.

The prevalence of rabies in different areas of the world varied throughout history. Some regions were thought to be free of rabies in particular time periods, although this changed with time as the disease crept back in depending on the animal population and prevalence of the disease.

At the turn of the 20th century, rabies was greatly reduced from many developed regions that were previously affected such as Central Europe. This is thought to be largely due to the introduction of rabies vaccination, although other factors may also have had an impact. Other parts of the world, however, continue to experience effects as a result of the rabies virus even today.

Prevention of Rabies Transmission
In the 18th century, legislation was passed in countries like Germany, France and Spain for the destruction of stray dogs, in attempt to reduce the risk that a rabid dog may come into contact and bite a human in the region. However, this was not held well by the public and was not enforced in most areas throughout the world.

Other preventative methods were introduced in the 19th century, such as quarantine and other health initiatives, due to a better understanding of dogs and the transmission of rabies to urban populations. Likely as a result of these measures, the number humans affected by rabies were greatly reduced and by the 20th century, many areas were considered to be free from the virus.

Rabies Vaccination
Pasteur first demonstrated the possibility of vaccinating dogs to prevent rabies infection and possible transmission to humans in 1885. However, this was not routinely practiced until the 1920s, when domestic animal vaccination was developed and became widely used.

This practice helped to reduce the prevalence of rabies in animals dramatically. Provided that the majority of domestic animals (70%) were vaccinated, the effect of rabies could essentially be eliminated from the region.

Current Management of Rabies
Even today, once symptoms develop there is no known treatment for rabies. Instead, the current management for someone exposed to rabies is post exposure prophylaxis (PEP). This involves administration of rabies immunoglobulin and vaccine soon after exposure to the virus, followed by a series of injections over 30 days.

To date, PEP has a success rate nearing 100% when administered correctly shortly after exposure to the rabies virus. As a result, there are now comparatively few cases of rabies when people have access to adequate medical treatment. 95% of the 55,000 cases of rabies each year occur in Asia and Africa where medical attention after exposure to the virus is often lacking.


Tuesday, April 18, 2017

Failed Objects: Bullet Proof Vests and Design in the American Civil War

By Sarah Weicksel, 4-29-13

Scholar Sarah Weicksel continues her exploration of Civil War clothing with a look at the bullet proof vest.

In late March 1862, Illinois officer John Cheney wrote home to his wife Mary about recent happenings in camp. "Lew Smith is here selling those bulletproof vests," he relayed. "I think they are a good thing and may buy one" (quoted in Gordon Armstrong, ed., Illinois Artillery Officer's Civil War, 24).

John Cheney was one of many Union soldiers who were tempted by advertisers' promises of the merits of bullet proof vests. Such protective battle garments were not, of course, altogether new—armor had been used for centuries. But, continued advances in weaponry—and ballistics technology in particular—far outpaced the technology used in the design of such protective garments, posing a serious dilemma for military men in the mid-nineteenth century.

Multiple styles of bullet proof vests were commercially available and advertised during the Civil War. Although they were not issued by the army, soldiers or their families with disposable income could purchase vests by mail, in stores, or from camp peddlers like Lew Smith for between $5.00 and $8.00 (approximately $115.00 to $147.00 in today's currency)—the equivalent of roughly one-third to one-half of a private's monthly pay.

Advertisers made great claims about the effectiveness of these vests, touting them as having "saved the lives of Generals, Colonels, Captains, and thousands of soldiers" and asserted that the vests would continue to save the lives of thousands more. Wearing such a vest, they explained, would "double the value and the power of the soldier," presumably suggesting that, with the appropriate battle garments, a Union soldier could achieve an even more glorious victory.

The most widely available vest seems to have been "The Soldiers' Bullet-proof Vest" that was advertised in Harper's Weekly, a widely-circulated New York City-based newspaper.

These vests, as one soldier aptly described, "were nothing more than ordinary vests with metal plates between the lining and the outside of the front of the vest" (DeVelling, History of the Seventeenth Regiment, 119). Sheet-iron or cast iron plates were formed to fit the general curvature of a man's torso before being inserted between layers of cotton and wool fabric. The vests, however, were far from custom-made. Instead, they could be purchased in sizes "Nos. 1, 2, and 3." According to the pictured advertisement, No. 2 would fit nearly all men. Potential purchasers were also assured that the vests were "repeatedly and thoroughly tested" and would repel rifle bullets at 40 rods (220 yards) and pistol bullets at 10 paces.

In theory, the vests were appealing. As one soldier wrote: "To be 'iron clad' when the bullets should fly as thick as hail! What more could a soldier ask?" (Walker, History of the Eighteenth Regiment Conn. Volunteers, 21). In actuality, however, the vests proved to be failed objects on multiple levels, ranging from ease of use to their effectiveness. Although advertisers claimed that the vests were "simple" and "light," soldiers found them extremely cumbersome due to their inflexibility and weight. Colonel Charles F. Johnson of New Jersey explained to his wife: "the only objection that I have to them is that they are so confounded heavy for this season of the year" (quoted in Pelka, ed., The Civil War Letters of Colonel Charles F. Johnson, 112). Many soldiers' letters and memoirs recounted the abandonment of bullet proof vests along the march, where they littered the side of the road along with other unwanted gear.

With no oversight to ensure the reliability of manufacturers' claims, it was the soldier's prerogative as to whether or not to accept assurances that the vests had been "repeatedly and thoroughly tested." While some soldiers wore the vests into battle, others opted to first test the effectiveness of the garments themselves. Colonel Johnson, for instance, sat down one morning in May 1862 to write a letter to his wife, telling her that he and his fellow field officers were just about to test their newly arrived bullet proof vests with muskets, rifles, and pistols. He resumed his letter a few hours later, reporting that they had "just returned with the great, mighty, powerful 'bullit proof' vest and the result is that a common musket put a ball clear through it at 50 yards, through yes, and carried some four or five inches of the stuff with it." The metal and cloth fragments carried by the bullet into a man's body, he surmised, "would have killed the devil himself if it all had entered his body" (Pelka, 112-113).

The vests did provide some degree of protection, judging from the bullet-shaped dents in surviving vests. But they were ineffective in close combat, and, as Johnson rightly pointed out, wearing a vest could have resulted in an even more deadly wound if a man was shot at close range, whether from immediate impact, or an infection festering around the bits of cloth and metal that the bullet pushed into his body.

While it is difficult to calculate how many bullet proof vests were actually sold, most soldiers who did purchase these vests seem to have abandoned them relatively quickly, although not always prior to battle. Men were occasionally discovered to be wearing the vests as they lay on the battlefield, wounded or dead.

American manufacturers continued to experiment with bullet proof technology after the Civil War. However, it was not until one hundred years later, in the 1960s, that chemist Stephanie Kwolek developed Kevlar, the first technology to successfully repel bullets with any consistency.

Sarah Weicksel is a Ph.D. Candidate in the Department of History at The University of Chicago, and a Graduate Scholar-in-Residence at The Newberry Library. She is currently at work on her dissertation project: "The Fabric of War: Clothing, Culture and Violence in the American Civil War Era." She has also blogged about other types of clothing in the Civil War.

Image 1: This regular, non-bullet proof vest was worn by a colonel in the Confederate Army Infantry.

Image 2: The Soldiers' Bullet Proof Vest, "Harper's Weekly," March 15, 1862, p. 176


Hannah Myers Longshore: Pioneer Physician and Professor of Anatomy

By Maggie MacLean, 8-23-14

Hannah Myers Longshore graduated from the Female Medical College of Pennsylvania's first class in 1851 and became Philadelphia's first woman doctor with a medical degree to establish a private practice, which she continued for forty years. She also lectured extensively first at the Female Medical College, and later in public speeches about sexual health at a time when there was little public discussion of any kind on the subject.

Early Years
Hannah Myers was born May 30, 1819 in Sandy Spring, Maryland, where her father taught at a Quaker school. She was the daughter of Samuel and Paulina Myers, Quakers from Bucks County, Pennsylvania who believed in equal education for boys and girls. While Hannah was still very young, her family moved to Washington, DC, where she attended a Quaker school until her early teens.

Her father, an abolitionist, was angered by the existence of slavery in the nation's capital. In 1833 he moved the family to a farm in Columbiana County, Ohio, where they could be close to the Quaker colony at New Lisbon. From an early age, Hannah was interested in science. Her early education was obtained at New Lisbon Academy, but she was unable to attend Oberlin College due to a lack of funds.

In 1841, Hannah Myers married Thomas Ellwood Longshore, a teacher at the New Lisbon Academy and a staunch supporter of advanced education for women. Thomas supported his new wife's plans to go to medical school but Hannah's education was again postponed by the birth of two children: Channing (1842) and Lucretia (1845), named after abolitionist Lucretia Mott.

In 1845, Thomas lost his teaching position because of his abolitionist convictions, and he then moved his family to his hometown, Attleboro, Pennsylvania, where he again began teaching at a Quaker school.

Thomas' brother, Dr. Joseph Skelton Longshore, was a physician in Attleboro who strongly supported medical education for women. Dr. Longshore was involved in some of the earliest efforts to open the field of medicine to women in the United States. He encouraged both Hannah and his sister Anna Longshore to study his medical books and to observe his work with patients.

Female Medical College of Pennsylvania
On March 11, 1850, the Pennsylvania legislature passed an act to incorporate the first regular medical school for women in America: the Female Medical College of Pennsylvania in Philadelphia. The school was founded by Dr. Joseph S. Longshore and three other physicians, as well as four philanthropists, several of whom were Quakers.

In its early days, the Female Medical College of Pennsylvania faced serious opposition from the male medical establishment. These men believed that women were, first of all, too feeble-minded to learn the demanding curriculum, and they were also too delicate to endure the physical requirements of practicing medicine.

One of the most serious barriers to the success of the college was the lack of clinical experience available to its students and interns because area hospitals would not allow women to attend lectures or to treat patients. To remedy this situation, Dr. Ann Preston, also a member of the College's first graduating class, founded Woman's Hospital of Philadelphia in 1861.

hannah-longshore2In 1850, Hannah Myers Longshore, thirty-one year old mother of two, enrolled in the first class at the Female Medical College of Pennsylvania. On October 12, 1850, forty students were greeted by six faculty members. Thomas' sister Anna Longshore was also a member of the first graduating class of the Female Medical College.

Image: Female Medical College of Pennsylvania

Completing the customary four months of training, Longshore was one of eight women who received MD (Doctor of Medicine) degrees, all with the unfailing support and encouragement of her husband. Dr. Hannah Longshore was then appointed instructor of anatomy at the Female Medical College, serving in that capacity from 1851 to 1852.

The Myers family was very active in Philadelphia medicine in the 19th century. Hannah's sisters, Mary Frame Myers Thomas and Jane Viola Myers, also graduated from medical schools. Dr. Mary Frame Thomas became a prominent physician in Fort Wayne and Richmond, Indiana (1854-1888). Despite the unpopularity of women physicians at that time, Dr. Thomas was elected a member of the Wayne County Medical society in 1875.

Dr. Mary Frame Thomas studied at the Western Reserve College of Medicine, was president of the Indiana State Medical Society and worked with the Sanitary Commission during the Civil War. She was also a leader in the causes of temperance, prison reform and women's suffrage, and operated an Underground Railroad station for escaped slaves.

Learn more about these fascinating women in Frederick Clayton Wait's book, The Three Myers Sisters: Pioneer Women Physicians.

From February to June 1852 Dr. Hannah Longshore served as an instructor of anatomy at the New England Female Medical College in Boston, becoming one of the first women faculty members at an American medical school. She also gave public lectures on sexual health at a time when there was little public discussion of any kind on the subject.

She returned to Philadelphia to work at the Female Medical College later that year, but left in 1853 after a rift with the college faculty over how medicine should be taught. When Dr. Joseph Longshore and others left the college to start a new medical school, the Pennsylvania Medical University, Dr. Hannah Longshore went with them. She taught anatomy at the Pennsylvania Medical University for the next four years.

When Dr. Hannah Myers Longshore began her private practice in 1858, she became Philadelphia's first woman doctor in private practice, a role she maintained for forty years. Despite her eventual success, her early work in private practice was not without challenges. Many male doctors would not consult with her; one advised her to "go home and darn your husband's socks." Many pharmacists would not fill her prescriptions. For a time, she had to prepare her own medicines by hand.

Despite objections, Dr. Longshore offered a series of public lectures on physiology and hygiene, encouraged by women's rights leaders such as Lucretia Mott. Dr. Hannah Longshore's frank discussions of sexual matters shocked conservatives but brought her praise by others, and many patients.

Dr. Joseph Longshore served as chair of obstetrics at the Penn Medical University until his death in December 1879, and remained active writing and publishing books on obstetrics and medical education for women. His obituary stated that, "to educate women in medicine was the leading desire of the last 30 years of his life [and] by his voice and pen, in private and public, he advocated and defended it amid great opposition."

Over the years, Dr. Hannah Longshore's practice became very successful. At one point, her practice included around three hundred families, a record met by few other doctors of the time. After forty years, she retired in 1892. Thomas Longshore died on August 19, 1898 in Philadelphia.

Dr. Hannah Myers Longshore died October 19, 1901 at the age of 82, leaving a remarkable legacy of four decades in private practice.

Her daughter, Lucretia Mott Longshore Blankenburg, became active in women's rights.

Longshore Family Papers
National Library of Medicine: Dr. Hannah Myers Longshore
Female Medical College and Homeopathic Medical College of Pennsylvania

Image 1: Hannah Myers Longshore

Image 2: Female Medical College of Pennsylvania


Nostalgia and Malingering in the Military During the Civil War (excerpt)

By Donald Lee Anderson, Godfrey Tryggve Anderson

In lieu of an abstract, here is a brief excerpt of the content:

The American Civil War witnessed a revival of nostalgia, a mental disorder that had created problems for armies for centuries. It is not within the scope of this study to trace the origins of nostalgia in detail. If we were to attempt this we might begin in early biblical times and consider the words of the psalmist: "By the waters of Babylon, there we sat down, yea, we wept, when we remembered Zion".

As early as 1569, a Swiss officer reported that one of his cadets had succumbed to homesickness. References to this problem can also be found in the first half of the seventeenth century. In 1688 Johannes Hofer, a medical student in Germany, wrote a dissertation on the subject. He was the first to use the term "nostalgia" and to identify it as a disease. He described the symptoms as anorexia, insomnia , slow fever, irritability, anxiety, and a general wasting away of the organism. Hofer pointed out that separation from the homeland was the basis of this ailment and that an "afflicted imagination" was an important cause of this malady. In the course of his description of this "wasting disease" he used such expressions as "nervous fluid" and "the animal spirits".

During the seventeenth and eighteenth centuries, this malady attracted the attention of German physicians. Prominent also in the consideration of nostalgia were the Swiss, who seemed to have particular problems with this malady. It was believed, incorrectly, that those from the vicinity of Bern were especially susceptible to homesickness when they left their native habitat. However, at various times people of Scotland, Wales, Ireland, Lapland, and almost every country showed symptoms of this problem. Beginning at about the time of the French Revolution and extending into the nineteenth century, the French physicians became very concerned with problems of nostalgia in their military ranks. Nostalgia was of epidemic proportions in the French army of the Rhine in 1793.

The official records of noninfectious diseases in the federal army during the American Civil War reveal 5,213 cases of nostalgia and 58 deaths from this malady among white troops from May 1861 to June 30, 1866. The record for "colored troops" reveals 334 cases of nostalgia and 16 deaths. The number of cases of nostalgia is relatively small when compared with such diseases as rheumatism and typhoid, yet the cases which were labeled nostalgia posed a perplexing problem in some areas for the army during the entire duration of the war.

During the early years of the conflict the number of cases of nostalgia among Northern troops increased. In the year that ended June 30, 1863, 2,057 cases and 12 deaths were reported. The next year the number of cases decreased by 800, and the last year of the war the number of cases dropped markedly, although deaths continued to increase slowly but steadily. The year following the war brought a drastic drop to less than 200 cases. The decline after 1863 was due in part to the type of men being taken into the service and the more realistic view of the duration of the war at this time. It was generally felt that nostalgia was most prevalent among the young recruits, and partly for this reason the surgeon general favored increasing the age for induction from 18 to 20 years. Early in 1863, the assistant surgeon general, Dr. Dewitt C. Peters, described nostalgia as found in the military at this time: "... a species of melancholy, or mild type of insanity, caused by disappointment and a continuous longing for the home . . . and is daily met with in its worst form in our military hospitals and prisons, and is especially marked in young subjects".

From: Perspectives in Biology and Medicine
Volume 28, Number 1, Autumn 1984
pp. 156-166 | 10.1353/pbm.1984.0021


Robert E. Lee’s “Right Arm”


Although Stonewall Jackson’s death was unpreventable, given the state of medicine at the time, it is more likely that he died from thromboembolism than from the indirect cause of pneumonia.

Although Stonewall Jackson’s death was unpreventable, given the state of medicine at the time, it is more likely that he died from thromboembolism than from the indirect cause of pneumonia.
Following his greatest victory, at the Battle of Chancellorsville on May 2, 1863, Confederate Lt. Gen. Thomas J. “Stonewall” Jackson was scouting ahead of the lines with members of his staff when tragedy struck. In the pitch blackness of the early spring evening, Jackson and his men were mistaken for Union cavalry and fired upon by their own side. Jackson sustained a severe wound to his upper left arm, necessitating amputation. Upon hearing the news, victorious General Robert E. Lee remarked, “He has lost his left arm, but I have lost my right.” Lee’s words proved prophetic. Eight days after the amputation, Stonewall Jackson was dead.

Dr. Hunter McGuire, medical director of the Confederate Army II Corps believed that pneumonia was the cause of Jackson’s death, along with the general’s other attending physicians. However, modern-day analysis raised the more likely possibility of pulmonary embolism. The source of Jackson’s so-called “pleuro-pneumonia,” as McGuire put it, was presumed to be a lung contusion incurred during Jackson’s fall from a litter after leaving the battlefield at Chancellorsville. However, from the distance of a few feet at most, the ribs would have absorbed most of the force of the fall, protecting the underlying lung. There would also have been external evidence of trauma such as bruising in an injury serious enough to result in a lung contusion. Neither McGuire nor the other physicians found any evidence of such trauma.

Pleuro-pneumonia is a medical term that is rarely used today. Pleurisy occurs when inflammation involves the pleura, or outer surface, of the lung. Pleuritic chest pain often accompanies pneumonia, thus the term pleuro-pneumonia. Sir William Osler’s 1892 edition of his classic textbook, The Principles and Practice of Medicine, states: “Pneumonia is a self-limited disease, and runs its course uninfluenced in any way by medicine. It can neither be aborted nor cut short by any means at our command.” Osler went on to say that “the first distressing system is usually pain in the side, which may be relieved by local depletion—by cupping or leeching.” Such treatment was used unsuccessfully on Jackson.

Did Jackson Die of Pneumonia?
According to the thinking of the day, Jackson’s clinical presentation fit with pneumonia. His physicians cannot be faulted for their diagnosis or treatment, although it should be noted that 19th-century physicians were adept at eliciting the subtle physical signs of pneumonia, such as hearing a cracking sound in the lungs with a stethoscope or finding dullness to percussion of the chest. Neither of these classic signs of pneumonia was found by any of Jackson’s doctors.

In terminal pneumonia, the clinical course typically goes from bad to worse. But in Jackson’s illness, there were two distinct, sudden episodes of deterioration. These occurred on May 3 and May 6, and both were described as being associated with the onset of acute chest pain, shortness of breath, fatigue, and perhaps fever. These symptoms are consistent with pulmonary emboli, which are blood clots traveling to the lungs. Among the numerous complications following amputation of an extremity are nonhealing of the stump, infection, and thromboembolism, or the formation of a blood clot within a large vein. According to McGuire, Jackson’s wound appeared to be healing properly and infection did not seem significant.

It is known today that an amputee is at significant risk for venous thromboembolism and pulmonary embolism. Immobilization of the patient following surgery can allow the blood to pool and clot within the veins. More dangerous is the formation of clots in the large veins that are tied off during amputation. The tying off of the veins, or ligation, leads to stagnation of blood in the veins, which leads in turn to a thrombus, or clot, which can then travel to the lungs and kill the patient.

Even with today’s advanced technology, it is estimated that as many as half of all pulmonary emboli go undetected by physicians. The current treatment and prevention of thromboembolism is accomplished by the use of blood-thinning agents such as Heparin and Lovenox. Although Stonewall Jackson’s death was unpreventable, given the state of medicine at the time, it is more likely that he died from thromboembolism as a direct consequence of his wound and amputation, than from the indirect cause of pneumonia.

Documentary Production Update: The United States Army War College

April 12, 2017

The "Civil War Medicine" documentary team is selecting 3,000 still images for the series. We are now working with the amazing collections in the library of the U.S. Army Heritage and Education Center (USAHEC) in Carlisle, Pennsylvania.

This incredible facility "makes available contemporary and historical materials related to strategic leadership, the global application of Landpower, and U.S. Army Heritage to inform research, educate an international audience, and honor Soldiers, past and present."

Among their components are the Army Heritage Museum, the U.S. Army War College Library and the Military History Institute.

JAMCO Films is honored to be accessing the resources of this incredible facility. Visit the USAHEC Library with us in our next Production Update!

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You can make a tax-deductible contribution to "Civil War Medicine: The Documentary Series" on the home page of this website. Thank you!


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