Prologue
THE RETURN OF PEACE
Peace had at last been restored. The Union had been preserved. With the end of the Civil War in April 1865, myriad opportunities beckoned to those with the energy, the enthusiasm, and the determination to take advantage of them. But for the Medical Department of the victorious Union Army, a huge and complex organization designed to care for men massed in large units, the return of peace held little promise. The thousands of physicians who had served during the war were no longer needed now that the Army`s only significant adversaries were the Indians. Hospital trains and ships quickly became as irrelevant as the very large and elaborate general hospitals to which they had been evacuating thousands of sick and wounded. Little that had been learned or experienced during the long and bloody conflict proved to be significant once the amateur soldiers who had formed the bulk of the wartime army had returned to civilian life.1
The war had not rendered the weapons with which the Army`s medical officers fought disease more effective. The conflict had occurred too soon to be of great benefit to medical science, for the instruments and techniques that would make significant increases in understanding possible were only just being developed. Microscopic organisms could not be seen clearly enough to be identified. Both civilian and military physicians feared infection so much that they rarely attempted any but the simplest operations. They were not able to determine what had caused the dysentery that was afflicting thousands of Union soldiers. The inability to identify either the typhoid bacillus or the malaria parasite during the war had even led to the appearance in medical literature of an imaginary disease, typho-malaria, whose symptoms in some ways resembled typhoid fever and in others malaria. And the popularity of the notion that poisonous miasmas-emanations from decaying vegetable or animal matter-were in some way behind the spread of disease and infection endured.2
Although the practical experiences of the Civil War confirmed the fact that the toll taken by disease could be lowered by improved sanitation, vaccination against smallpox, a diet rich in fresh fruits and vegetables to reduce the threat of scurvy, and the use of quinine to treat malarial fevers, disease in nearby towns often frustrated the efforts of post surgeons.3 Immunization against smallpox, mandatory in the U.S. Army since early in the nineteenth century, remained a subject of vigorous debate outside the military. In spite of a growing public health movement, widespread concern in civilian communities about water supplies and the disposal of human wastes and garbage continued to surface chiefly after an epidemic had begun.4
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When disease or infection defeated their primitive attempts at prevention, both military doctors and their civilian counterparts were as helpless in 1865 as they had been in 1861. "The treatment of disease is the weak spot in our profession," a physician noted several years after the end of the Civil War. Another reported that "the history of medical progress [was still] a history of men groping in the darkness. . . ." And Charles W. Eliot, president of Harvard, despaired at "the ignorance and incompetence of most American doctors who have graduated at American Schools. They poison, maim, and do men to death in various ways, and are unable to save life or preserve health."5
Understandably finding it difficult to stand by their patients without making an attempt to help them, neither military nor civilian physicians abandoned the type of treatment that Eliot deplored. They purged and even bled regardless of the specific disease or condition involved. The use of opiates was flourishing by the end of the war-veterans afflicted with chronic dysentery continued to use the opiates initially prescribed to them by Army doctors, joining the growing number of men and women who turned to these drugs to relieve whatever it was that ailed them. The popularity of medicinal alcohol, internally applied, persisted, and the use of aspirin and chemically similar drugs became more common because of the side effects or the cost of other drugs that reduced fever.6
Because the Civil War had emphasized on a large scale the basic helplessness of Army physicians against the inroads of disease and infection, the average line officer remained unimpressed by their recommendations about preventive health measures on post. Their position was further undermined by the fact that the exact implications of their formal rank, granted in 1847, had never been clarified; they continued to be referred to by a descriptive title, such as surgeon or assistant surgeon, rather than by rank. The surgeon general, himself a brigadier general, endured, however, as one of the Army`s powerful bureau chiefs with direct access to the secretary of war. Thus, while medical officers as individuals often had little influence, the Medical Department of 1865 retained its semi-independent status.
The war had also failed to relieve the inadequacies of existing modes of transportation in the West, which handicapped both the Medical Department and the Army as a whole. Only in 1880 did railroads extend far enough to assist significantly in moving men and their supplies and equipment, making it possible for troops to move with such speed to any location that a multitude of small and often inconveniently located forts became unnecessary. Until then, military cargo was moved by water, where possible, and posts located any distance from a major waterway relied on wagon trains that could be delayed by weather, terrain, and the enemy.7
The post surgeons` difficulties in obtaining supplies were further exacerbated by the fact that their needs continued to be met by a number of agencies. Although the Medical Department`s purveyors purchased medical and hospital supplies as well as special items of diet for the sick, the Subsistence Department furnished routine hospital rations. The Ordnance Department dispensed equipment for horses, small arms, and such items as mess kits and spurs. The Quartermaster`s Department provided the storehouses at the Medical Department`s supply depots, which were established in a few strategically located cities; transported supplies;
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purchased clothing, mules, horses, and forage for the Army`s animals; and, for five years after the end of the Civil War, built and repaired hospitals. It also procured ambulances built to Medical Department specifications.8
Despite the devastation, the huge armies, and the hordes of men suffering and dying from disease, wounds, and infection, the Civil War seemed for many years almost like an aberration in the history of the Medical Department. In April 1865 the wartime organization awaited dissolution, its medical officers a return to the conditions under which they had served before Confederate guns first opened fire on Fort Sumter, South Carolina, and the surgeon general the resumption of his struggle with a Congress congenitally unable to understand why guarding the health of a multitude of scattered units required the services of a multitude of physicians.
NOTES
1. Unless otherwise indicated, overall coverage of the Civil War in this volume is based on Mary C. Gillett, The Army Medical Department, 1818-1865; of the history of the Army on Russell F. Weigley, History of the United States Army, enl. ed., and Maurice Matloff, ed., American Military History, pp. 281-99; of medicomilitary history on Percy M. Ashburn, A History of the Medical Department of the United States Army; and of legislation on Raphael P. Thian, comp., Legislative History of the General Staff of the Army of the United States . . . From 1775 to 1901. For manuscript sources and works not listed in the bibliography, full details are given in the respective footnote entry. See the bibliographical essay for specific guidance.
2. Erwin H. Ackerknecht, A Short History of Medicine, p. 171; War Department, Surgeon General`s Office, Medical and Surgical History of the War of the Rebellion, consisting of two three-part volumes that detail the struggles of the Union Army`s medical officers to deal with diseases and infections whose causes they did not fully understand.
3. Since the earliest days of the Medical Department, the term surgeon was used to refer to all medical officers. It was a generic term and did not connote specialization.
4. John Duffy, The Sanitarians, pp. 93, 96, 99-102, 107-08, 114, 118-19; Richard H. Shryock, The Development of Modern Medicine, p. 256; Wesley W. Spink, Infectious Diseases, pp. 35-36; Stanhope Bayne-Jones, The Evolution of Preventive Medicine in the United States Army, 1607-1939, pp. 11-12, 21.
5. First quotation by William W. Wellington, "Modern Medicine," pp. 142-43; second quotation by H. C. Wood, cited in William G. Rothstein, American Physicians in the Nineteenth Century, p. 183 (see also pp. 186, 196-97); third quotation cited in John S. Haller, Jr., American Medicine in Transition, 1840-1910, pp. 218-19; Ackerknecht, Short History, p. 209; Lester S. King, "Medical Education," pp. 2457-58.
6. Rothstein, American Physicians, pp. 181-84, 187, 191, 194-95; Leon S. Bryan, Jr., "Blood-letting in American Medicine, 1830-1892," p. 520; David T. Courtwright, Dark Paradise, pp. 45-47, 54-55; H. Wayne Morgan, ed., Yesterday`s Addicts, pp. 6-7, 12, 37; Mark A. Quinones, "Drug Abuse During the Civil War (1861-1865)," pp. 1008-10.
7. Erna Risch, Quartermaster Support of the Army, pp. 395, 476-78; War Department, [Annual] Report of the Secretary of War, 1869, 1:213 (hereafter cited as WD, ARofSW, date); Darlis A. Miller, Soldiers and Settlers, pp. 288-89.
8. WD, ARofSW, 1869, 1:223-24, and 1876, 1:112-113; Risch, Quartermaster Support, pp. 486-87; War Department, Surgeon General`s Office, Manual for the Medical Department, 1900, p. 47; idem, The Surgeon General`s Office, p. 117; Miller, Soldiers and Settlers, pp. 287-88. Because of the various organizations involved in supplying the Army, obtaining ambulances of a new design required the cooperation of the Quartermaster`s Department and the Ordnance Department to facilitate the process of preparing the blueprints, constructing the vehicles, and purchasing the harnesses for the draft animals. For a detailed picture of this cooperation, see James W. Wengert, "The 1878 Ambulance Board," pp. 8-23.
