Speaker: Steve Buxser
During the American Civil War, Union Army “surgeons,” the title for what we today call physicians or doctors, were required to file detailed monthly reports with Surgeons General of the Union Army. This period of history also provided the foundations for what has become modern medicine which was emerging accompanied by homeopathy and herbal medicine. When examined in its historical context, Civil War medicine was surprisingly sophisticated despite having limited theoretical bases, including the absence of the germ theory of disease. The story of measles during the American Civil War constructed from these records provides insight into the surprisingly sophisticated level of medicine at the time illustrating critical steps between medicine then and now.
Steve Buxser had a career in microbiology with additional and extensive experience in biochemistry, enzymology, cell biology and statistics applied to drug discovery, leisure reading emphasized history including military history and history of science and statistics. The talk is based on work on a thesis prepared as part of a Master's Degree in History (University of Indianapolis) earned shortly after "retirement." It is a continuation of a career merging topics and disciplines not typically combined into amalgamated viewpoints. During recent years the combinations include continuation of learning in science and math with extensions into macro- and micro-ecology with an emphasis on restoration of urban forests.
Program: Infectious Diseases during the American Civil War: 19th Century Medical Science with Emphasis on Measles
Speaker: Steve Buxser, PhD, Founder, Select Bio Consult, LLC, and Scientech Club member
Introduction By: Rick Whitener
Attendance: NESC: 95; Zoom: 30
Guests: Scott Perry, Dean Pfeifer
Scribe: Terry Ihnat
Editor: Carl Warner
Talk’s Zoom recording found at: https://www.scientechclubvideos.org/zoom/10052026.mp4
Today we had a talk by Steve Buxser, PhD, dealing with medical care in the Civil War and some important and enlightening comments on measles and immunity.
There is much more to Civil War medicine than just the idea of a surgeon with a saw and a patient missing a limb. Those operations could be lifesaving, but there was actually some impressive care and logistics involved well beyond that.
In comparing battle and non-battle casualties, we see that going back to the Mexican War, and most likely to the war of 1812 and the Revolutionary War, there was a preponderance of casualties which were not battle related. Cholera, dysentery and malaria were dominant among these casualty causing diseases.
The Crimean war, in which Britain and allies fought Russia, produced 18,000 deaths out of 97,000 British soldiers,16,000 of these by disease. A Royal Sanitary Commission, headed by the British Army Medical Department, led to reforms in military medicine. The knowledge gleaned passed on to other countries including the U.S., and this led to the formation of the U.S. Sanitary Commission at the beginning of the Civil War modeled on the British Commission.
In 1861 Elizabeth Blackwell, MD, organized the Women’s Central Association of Relief of New York City with the goal of training nurses. The next month the U.S. Sanitary Commission began with the order being signed by Lincoln in June. Initially the Surgeon General rebuffed the idea. This commission had to do with dietetics and preventive medicine expertise, camp inspection, patient transport resources, medical statistical analysis and clinical medicine guidelines. The mission was privately funded throughout the war and not officially a government entity.
In July, the Bull Run battle was a medical disaster. This led to the formation of the Army Medical Department under Secretary of War Edwin Stanton. Surgeon General Colonel Finley wanted to obstruct the USSC; he was replaced by William Hammond, a well-trained doctor, who brought in the ideas of female nurses, hospital design, and collection of information and pathology samples. He worked to obtain support of field commanders. He was fired when he banned the use of calomel because of mercury poisoning; Joseph Barnes came in and continued Hammond’s work.
Improvements in military medicine included disposing of selection of the Surgeon General based on seniority. During the Peninsular campaign, McClellan’s medical director, Charles Tripler, failed to implement measures that McClellan had seen in Europe which were most helpful. Their sick rate jumped, and Tripler was replaced by Jonathan Letterman. His plan included an ambulance corps after the chaos following the first Bull Run. Improvements included surgical field hospitals at division level outside the range of combat, and triage from the field hospitals in regimental level. The hierarchy was as follows; the fundamental units were regiments and brigades. A regiment was comprised of 10 companies of 100 soldiers each, all of which were from the same geographic area. Regiments comprised brigades of several 1000 which comprised divisions of 10s of 1000s which comprised corps and then armies, e.g. Army of the Potomac.
The ambulance corps was established in August 1862. Large general hospitals were set up in September 1862 in large cities and used for advanced care with 2 million admissions and an impressive 8% mortality rate. Each regimental surgeon filed a monthly report reporting illnesses etc. Reports were compiled for the MSHW (Medical and Surgical History of the War).
The regimental field hospital had one surgeon and 1 assistant and then later 2 assistants. The regimental had two tents, one for officers and medicines and 1 hospital tent with 8 cots. The more seriously injured were sent to base or division or general hospitals. Their supplies included opium, quinine, alcohol, sutures and amputation kits. They did have anesthesia consisting of chloroform and ether. There was a real variety of talent among the Medical Corps, starting with 113 regular army surgeons and ending with 12,000 at the end of the war. Examination boards were set up early in the war with a 3 to 4 day exam covering anatomy, pharmacology, therapeutics, chemistry, medical practice, physiology and obstetrics. Many of our surgeons had traveled to Europe for training, but about half of those who sat for exams quit before they were completed.
The Regimental Surgeon’s duties consisted of a morning sick call with the goal being to treat, hospitalize or transfer patients on to another hospital. They were there to detect malingerers and send them back to duty. Quinine was the most frequently dispensed medicine; prescription books were maintained. Sanitary inspections and cleanups were ordered, medical supplies travelled with the regiment, and there were standardized forms for daily and weekly sick call. Monthly reports were compiled and later used as part of the MSHWR (Medical and Surgical History of the War of the Rebellion). Quinine was found to be effective against malaria. These compiled monthly reports were later used for claims for pensions and other veteran benefits. These are still in the National Archive.
So the advances in medicine and surgery during the war include quinine for malaria, quarantine to prevent spread of infection, successful treatment of hospital gangrene with bromine and isolation, development of an ambulance system for evacuation of the wounded, patient transportation by train and boat, establishment of large general hospitals and creation of specialty hospitals such as those for eye injuries, non-healing fractures, artificial legs and jaw and facial injuries. From the surgical end, safe use of anesthetic was established and the performance of early neurosurgery and plastic surgery procedures took place.
This was not “modern” medicine, but what now may be considered as awareness of microbial infections by other names and their spread. There was talk of miasmic or airborne diseases; the separation of gangrene and erysipelas patients was found to be helpful as was isolation of smallpox and measles cases and keeping the camps away from swamps or permanently wet areas. Latrines were kept at a distance from the main camp’s water sources and downstream; limiting the density of soldiers in the camps in individual tents or buildings reduced transmission rates.
Reportable diseases noted in the MSHW are in five classes with class one being acute infections or epidemic or endemic and contagious diseases. Class two was constitutional such as anemia and rheumatism, and tuberculosis was in that category as well. Class three was parasitic, class four local such as headaches, strokes, earaches, and class five was injuries or poisoning.
Vaccination against smallpox was required of soldiers, this practice having been started by George Washington. From all that data, we can surmise that patients in the war that had had measles were found to suffer more from infectious diseases. This has been found to be due to measles affecting the immune system. Measles kills immune memory cells so that the response to secondary infections is reduced or eliminated. Reduced response to viral or bacterial pneumonias, influenza and so on is a much greater threat than it would have been if the patient had never had measles. Bottom line is that immunization against measles, in this day and age, is quite important to prevent the morbidity and mortality of the disease and the immunocompromised state it causes as demonstrated by history.
Steve Buxser
