Contributions of the Civil War to Medicine
Synopsis
The period of 1861-1865 was a pivotal and dynamic period in American medicine as significant advancements were instituted that took American medicine out of “the late middle ages,” as has been said, and laid important foundations for future progress. These foundations resulted in American medicine achieving par with its European counterparts and eventually taking a world leadership role. The Civil War was the catalyst that brought this about.
More lives were lost in the Civil War than the summation of those lost in all the other wars Americans have fought. Lack of knowledge of microbiology, infection, and sterility resulted in two-thirds of the deaths being due to infection. Additionally, neither side was prepared at the onset of the war to adequately manage the extensive numbers of injured combatants.
Dr. Jonathan Letterman’s Contributions
Yet, significant principles were put in place which benefited the practice of medicine today. Jonathan Letterman M.D., a career Union Army Surgeon, instituted significant changes in the evacuation and transport of the wounded. Also, he made great strides in the quality of surgery performed by improving the hospital facilities where surgery was performed and setting standards for operating surgeons. The “Letterman System” is evident today in the transport and treatment of trauma victims at major designated trauma centers. Much more detail regarding Letterman’s contributions is available.
Dr Letterman improved battlefield ambulance (evacuation) and hospital services (treatment)
Prior to the 19th century western medicine for the most was based on the Greek concepts of disease dating to the classical period (450 B.C.). The therapeutic modalities in vogue during the 19th century, referred to as “heroic therapy,” were also handed down from the Greeks: venesection (bleeding), gastrointestinal purging, blister formation and cupping, inducing emesis, diet, and diuretics. (George Washington was subjected to these “treatments” as he lay dying from a severe throat infection as reported by his physicians in the Times of Alexandria, Virginia). Referring to the ancients for answers was termed “library medicine.”
Medical theories of the ancients and their therapeutic practices persisted into the 19th century and the Civil War
Dr Benjamin Rush’s Beliefs
American medicine during the early 19th century was firmly under the influence of Benjamin Rush M.D. (1746-1813), the “American Hippocrates” and signer of the Declaration of Independence. He believed disease resulted from “morbid excitement due to convulsive activity in the blood vessels.” He was a strong advocate of heroic therapy, especially venesection. As the mid-century approached, his ideas and influence diminished being replaced with various “subjective” concepts of disease. The enthusiasm for venesection was fading, but the other modalities of heroic therapy persisted well into the civil war period. Thus one could consider medical practice during the war to be basically an art - what the Greeks referred to as “techne“- as it was not specifically scientifically based. The modern practice of medicine with a foundation consisting of recognized and accepted scientific principles began in the last one-third of the 19th century when Louis Pasteur and Robert Kock demonstrated that microorganisms were the cause of infectious diseases, i.e. “the germ theory.”
Dr. Benjamin Rush’s medical beliefs involved older methods such as blood-letting and purgatives
Dr William Hammond’s Medical Paradigm Shift
William Hammond, M.D., Surgeon General of the Union Army, created a paradigm shift in the approach to our understanding about medicine which is used today. He established the use of empiricism and inductive reasoning consisting of observation, experimentation, and organization, categorization followed by analysis of clinical data to arrive at principles of medical knowledge. This “scientific method” as outlined by Francis Bacon (1561-1626) in “Novum Organum” was instrumental in the great achievements that occurred in the natural sciences in the seventeenth century. Hammond’s many contributions were a factor that helped to change the focus of American medicine from the antiquated retrospective approach in the antebellum period to a prospective modern approach in the post bellum period. Thus, the significant achievements in medical knowledge that followed.
Dr William Hammond shifted medical practices toward scientific study and experimentation
The war resulted in the recognition of the value of nursing and thereby establishing nursing as a recognized profession. It also created the hospital system we have today. Finally, and most significant, the war experience expanded the knowledge base and ability of the physicians who served in both the North and South and resulted in increased public acceptance of surgery as a treatment modality. In the words of two veteran physicians of the war as quoted in H. H. Cunningham’s “Doctors in Grey”-
“I have lost much, but I have gained much, especially as a medical man. I return home a better surgeon, a better doctor.”
“… the doctor was ‘more practically efficient and useful, at the bedside now, than perhaps he has ever been before, and the whole country is now furnished with a medical corps which the war has thoroughly educated and reliably trained.’ ”
Old Theories of Diseases Replaced By Improved Medical Systems
In the first part of my presentation I discuss in detail the theories of disease at the beginning of the war, identify the various infectious diseases that took the lives of so many soldiers, analyze the mechanism of injury of firearms, review the operative procedures performed, report the contributions of volunteer nurses and volunteer civilians and religious sects, and show the contribution of the war to the creation of the hospital system of today.
The second part focuses on the details of Letterman’s contributions for the evacuation and treatment of the wounded and Hammond’s contributions in detail to modern medicine. In conclusion, an actual case report of a trauma victim I managed (sustained gunshot wound with extensive damage to the liver, three extensive holes in the heart, and loss of blood pressure) is presented who survived unscathed and without permanent sequelae. The application of both the Letterman System and Hammond’s contributions in the management of this case is described in detail and demonstrates by example the benefit we derive today from the Civil War, Jonathan Letterman, and William Hammond.