Then & Now
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then and now.
The immense scale of the Civil War and the unprecedented number of casualties challenged existing systems of medicine in Pennsylvania and throughout the country, spurring rapid developments in training, hospital care, techniques, medications and more.
More than 12,000 physicians served in the Union army during the war. They faced numerous challenges. Advanced rifles and artillery inflicted severe wounds that were difficult to treat. Battles were bigger than ever before; Gettysburg, the deadliest battle of the war, involved nearly 165,000 combatants and resulted in 51,000 casualties. At the start of the Civil War, few physicians were experts in surgery, the skill most often needed for wartime injuries. Shortages of personnel, transport and supplies caused frequent problems, and the unpredictability of battle made it impossible to be always prepared.
Many American physicians were as well-educated as their European counterparts. They were familiar with the latest discoveries in medicine, such as the use of anesthetics for surgical procedures, including amputations. In the mid-1800s, however, no one knew that germs were responsible for many diseases. It is estimated that nearly two-thirds of the approximately 620,000 soldiers killed in the Civil War perished from diseases; the other third were killed in action or died from battle wounds or other injuries. Communicable diseases and infected wounds caused many deaths; poor diet and sanitation contributed to many more. Some medications used at the time, including the quinine used to treat malaria, were very effective, but others did not work or were even harmful, such as calomel, a popular compound made with the poisonous metal mercury.
Nevertheless, physicians and other medical personnel learned quickly, gaining skills on the job and creating innovative treatments for some diseases and conditions. After a few false starts, an effective system of battlefield triage and transportation for the wounded developed, involving specialized ambulances, dedicated train cars and even hospital ships. New hospitals were built to house thousands of patients, and new systems of organizing and managing them were put into place, including improved record-keeping.
To fulfill wartime demands for medications, pharmacists in Pennsylvania and elsewhere greatly expanded their businesses, some becoming large-scale pharmaceutical manufacturers such as Wyeth & Brother, Powers & Weightman, and Rosengarten & Sons. The women who worked as nurses during the war paved the way for the later development of nursing as a profession, while private organizations and volunteers contributed greatly to the care and comfort of the wounded. Physicians such as S. Weir Mitchell, who started a Philadelphia hospital to study nervous disorders, did pioneering work in specialized medicine. The thousands of detailed case histories kept by doctors during the war formed a vast archive of medical learning. And when the war was over, physicians took their new skills back to medical schools and their civilian practices, where they passed on their knowledge to the next generation of students and apprentices.
Many medical developments that began in the Civil War era continued throughout the 1800s and into the 1900s, including the growth of medical schools, teaching hospitals and research universities; advances in hospital management and patient care; increasing professionalization and specialization among physicians; the rise of nursing as a skilled profession; and the industrialization of pharmaceutical companies.
Modern wartime medicine also takes many lessons from the Civil War. For instance, the speed of triage and evacuation from the battlefield has increased dramatically over the past 150 years. The wounded troops in today’s wars can be taken immediately to advanced, well-equipped hospitals for treatment, greatly improving their chances of survival and recovery. High-tech imaging now allows close examination of wounds inside the body; such head, chest and abdomen wounds were virtually untreatable during the Civil War. Rehabilitation medicine also continues to make advances, such as robotic prostheses. Pennsylvania-trained physicians and medical staffs have contributed to all these developments, both on and off the battlefield.
The medical schools, research universities and hospitals in the Commonwealth have been home to numerous breakthroughs in medicine. For instance, Dr. Thomas E. Starzl, known as the father of transplantation surgery, made the University of Pittsburgh an international center for liver transplants and multiple organ transplants beginning in the 1980s. In 2004, he was awarded the National Medal of Science, the United States’ highest scientific honor. At Fox Chase Cancer Center in Philadelphia in the 1960s, Dr. Baruch S. Blumberg and his colleagues discovered the virus that causes the liver disease hepatitis B and invented a vaccine against the disease. Dr. Blumberg won the 1976 Nobel Prize in Medicine for his efforts.
Today, Pennsylvania continues to be a leader in medicine and the life sciences. The state is home to nine medical schools and about 24,000 practicing physicians. The 254 licensed hospitals in the Commonwealth evaluate and treat nearly 45 million people annually. More than 1,750 biosciences companies are located in the state, and the Greater Philadelphia region is ranked second in the nation as a center for medical research and biotechnology. Many pharmaceutical companies, some with roots in the Civil War era, are located or headquartered in the area. As Pennsylvania’s health care system faces new challenges in the 21st century, thousands of people involved in medicine and the biosciences are working to improve the quality of life for the state’s residents.
Information for this section was contributed by The College of Physicians of Philadelphia, in particular Jane E. Boyd, Ph.D., Wood Institute Research Associate, and Robert D. Hicks, Ph.D., Measey Chair for the History of Medicine and Director of the Mütter Museum & Historical Medical Library. For more information about The College of Physicians and the Mütter Museum, visit www.collphyphil.org.
Image: Amputation Scene at Camp Letterman (General Hospital) near Gettysburg, Pa. Photograph attributed to Peter S. Weaver of Hanover, Pa., October 1863. Courtesy of Still Picture Records Section, Special Media Archives Services Division (NWCS-S), National Archives at College Park, Md., 79-T-2265.
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- Louisa May Alcott, Hospital Sketches (James Redpath, 1863)
- Charles R. Greenleaf, A Manual for the Medical Officers of the United States Army (J. B. Lippincott, 1864)
- Samuel D. Gross, A Manual of Military Surgery (J. B. Lippincott, 1861)
- S. Weir Mitchell, George R. Morehouse, and William W. Keen, Gunshot Wounds and Other Injuries of Nerves (J. B. Lippincott, 1864)
- Charles J. Stillé, History of the United States Sanitary Commission (J. B. Lippincott, 1866)
- United States Surgeon-General’s Office, The Medical and Surgical History of the War of the Rebellion (1861–65) (Government Printing Office, 1875–83)
- Walt Whitman, Walt Whitman’s Civil War, edited by Walter Lowenfels (Da Capo Press, 1989)
- G. W. Adams, Doctors in Blue: The Medical History of the Union Army in the Civil War (1952; reprint, Louisiana State University Press, 1996)
- Alfred Jay Bollet, Civil War Medicine: Challenges and Triumphs (Galen Press, 2002)
- Alfred Jay Bollet, “The Truth About Civil War Surgery,” Civil War Times, October 2004
- H. H. Cunningham, Doctors in Gray: The Confederate Medical Service (1958; reprint, Louisiana State University Press, 2003)
- Gordon Dammam and Alfred Jay Bollet, Images of Civil War Medicine: A Photographic History (Demos Medical Publishing, 2007)
- Drew Gilpin Faust, This Republic of Suffering: Death and the American Civil War (Vintage Books, 2008)
- Michael A. Flannery, Civil War Pharmacy: A History of Drugs, Drug Supply and Provision, and Therapeutics for the Union and Confederacy (Haworth Press, 2004)
- Frank R. Freemon, Gangrene and Glory: Medical Care During the American Civil War (University of Illinois Press, 2001)
- Ira M. Rutkow, Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine (Random House, 2007)
- Glenna Schroeder-Lein, The Encyclopedia of Civil War Medicine (M. E. Sharpe, 2008)
- C. Keith Wilbur, Civil War Medicine (Illustrated Living History Series) (Globe Pequot, 1998)
Resources & Reference Material
- National Museum of Civil War Medicine, Frederick, MD
- Civil War Medicine Research Guide, Virginia Commonwealth University Libraries
- Civil War Medical Care: Photographs from the United States Sanitary Commission Collection, 1861-1872, New York Public Library Digital Gallery
- The Society of Civil War Surgeons