Dan Snow's History Hit - Modern Medicine

Episode Date: December 13, 2022

The American Civil War saw a transformation in medical provision on the battlefield. A loose grouping of medical practitioners was reshaped into a burgeoning, professionalised occupation. How did the medical profession rise to the challenge of treating thousands of wounded soldiers? What lessons were learnt about treating not just battlefield wounds, but infection and disease as well? Dan is joined by Carole Adrienne, author of Healing A Divided Nation to discuss the American Civil War, and the birth of modern medicine.Produced by Hannah Ward and edited by Dougal Patmore.If you'd like to learn more, we have hundreds of history documentaries, ad-free podcasts and audiobooks at History Hit - subscribe to History Hit today!Download History Hit app from the Google Play store.Download History Hit app from the Apple Store.

Hello everybody, welcome to Dan Snow's History Hit. We're talking about the US Civil War on the podcast today. Not just the war itself, but the transformation that took place in terms of medical provision on the battlefield. At the start of the war, there were really only barely more than a handful of medical practitioners available to either side. And by the end of the war, there were tens of thousands of them. In fact, by the end of the war, there were almost more military doctors than there had been soldiers on the outbreak of war. And it was a particularly bloody and brutal war. It remains the bloodiest war in US history. Over 600,000 people killed. If you're looking at injured and mentally traumatized, probably three times that number. By the end of the war, there were over a million men serving the US Army on the Northern Union side. And there were some very, very bloody

days indeed. But the bloodiest day in US military history was the 6th of June 1944 at D-Day, over 2,000 people killed in one day alone. But the second bloodiest day in US history was the Battle of Antietam. Again, just over 2,000 people killed that day. And there are dozens of these battles, multi-day battles that see atrocious casualties. And that's before you even start talking about the death and illness due to infection and disease. It was a terrible, terrible time to be a soldier. And to talk to us all about that,

we've got the very brilliant Carol Adrienne. She's a historian. She's made a documentary on Civil War medicine. Now she's written a book called Healing a Divided Nation on Civil War medicine and the transformation that took place. It's a heck of a story. Enjoy. T-minus 10. The atomic bomb dropped on Hiroshima. God save the king. No black-white unity till there is first and black unity.

Never to go to war with one another again. And lift off, and the shuttle has cleared the tower. Carol, thank you very much for coming on the podcast. Oh, thank you so much for having me, Dan. I'm pretty thrilled to be here. Well, it's an extraordinary subject, one we should talk more about, I think, the history of medicine. In 1861, what does military healthcare, frankly, what does healthcare look like in the US?

Well, it looks to me like it was the wild, wild west of medicine. One did not need a license to practice medicine. There were no examining boards. Medical education in this country was a two-year process rather than the European four-year requisite. So if you had a friend or a relative who was a healer and you could follow them around and learn and then hang up your shingle, you could not be excised from the profession for not having the credentials. And medicine had pretty much stayed the same for the last hundred years. It was considered an art and not a science. So hospitals were few and far between. Very little surgery had been performed in America to that point. It was estimated that perhaps 300 doctors in the entire country had ever witnessed surgery.

They were not familiar with gunshot wounds and even veterinary medicine because America had not had a livestock epidemic yet, which Europe had. And there had been a College of Veterinary Science in France since the mid-18th century. So things were pretty rough and ready. So this is the backdrop in front of which America's bloodiest war is about to play out. So let's just very quickly, very early 1861, several states, the so-called slave states, secede from the United States of America, form the Confederacy, and you've got a civil war. Correct. And it was very loosely formed. Well, in the Union, the North, so the Union was the North, the South was the Confederacy. In the Union, there were 16,000 troops in the army, and there were 120 some doctors, of whom 24 resigned because of their allegiance to the South. So fewer than 100 doctors for 16,000 troops. By the end of the war, five years later, almost, it would be 12,000

doctors in the Union Army. Wow. So not just a big physical expansion, but as I think you're going to tell me, a kind of revolutionary practices and knowledge was acquired during that period as well. Huge. When I started working on this, the popular presentation is that medicine did not really evolve during the Civil War. But I did several years of research from primary source documents. Philadelphia, fortunately, has more libraries and archives than any American city except Washington, D.C. So we have a plethora of items to work with. But it seemed to me that everything really did advance. And when I followed it through, there are tremendous advances made in

surgery, in anesthesia, in prosthetics. Neurology appears for the first time. So it's a huge differential from the beginning of the war. And it would need to be because we're seeing the impact of industrial weapons on the battlefield. So the rifled gun barrel, which means that individuals and teams can fire further and more accurately than ever before. You've got repeating weapons, so the rate of fire can increase. You've got huge numbers of wounds, I guess, on these battlefields, have you? And are they different kinds of wounds? They are. They're never-before-seen wounds in this country. You're exactly right on all of that. Well, the musket, which was a smoothbore long gun, had been in use really for the previous

couple of centuries. Any shoulder weapon, any long gun shoulder weapon was referred to as a musket. So they used little lobe-shaped ammunition, musket balls that were wrapped in a fabric patch and a tool called a ramrod that entered from the end of the barrel was used. They had to be wrapped in something because if not, they would rocket around inside the barrel and get a very erratic trajectory. So when they began to, as you said, rifle the inside of those barrels, so that spun the ball as it went through and really advanced the trajectory, penetration, and the distance at which troops could fire. It revolutionized combat and warfare, rifling of the weapons. Then there were other advances in grenades, which have been really in use since

probably the 13th century in various forms. And in fact, you have the Queen's grenadier guards, who evolved from groups trained to throw grenades. So lots of grenades, torpedoes make a really big advance on the combat stage. The weapons advancement was huge. There was also a cannon that had been developed by Louis Napoleon in France known as le canon de l'empereur, which America adopted very rapidly. And this was a weapon that combined the cannon, which had a flat trajectory, and the howitzer, which had an arcing trajectory. So you could hit troops in trenches, you could smash through fortifications. It was a wholesale slaughter. And some of the bloodiest days of US history take place during that war. I guess you've got Gettysburg famously and Titum Shiloh. It would have overwhelmed an organization on that small

scale's ability to cope with them. Oh, absolutely. The first Battle of Bull Run in 1861, where the Union was just decimated by the Confederate troops, which they had not expected. And there were no ambulances. If I'm lecturing here, I always explain that if one was on a main thoroughfare in America in 1861 and got run over by a horse and wagon, you would pray that somebody got word to your family to come scrape you up because ambulance service did not exist. And once you were home, you hoped that somebody in your family could take care of you because there were no skilled nurses. So this is really such a pivotal point in medical history when everything changes. Before we talk about the changes, tell me also, traditionally, if you look at the Napoleonic campaigns I know a little bit about, or the British Navy's Napoleonic Wars, the vast majority of casualties are suffering from disease, whether it's typhus or the pox or dysentery.

the pox or dysentery. Were those still very prevalent when large bodies of men got together and not really understanding how to deal with fresh water and removal of sewage? You make the perfect point that it is estimated that at least half of the deaths in the American Civil War were caused by disease and infection. Now, I realize that that infection pretty much comes after surgery and wounds. So it's an odd crossover there. But the diseases swept through these army camps, which were famously unhygienic. They were drinking contaminated water. They did not have healthy food. They were frequently camped by bodies of water. So malaria was a huge problem. But thousands of these men died from what we would consider today the childhood diseases, measles, chickenpox, mumps. Well, in Europe, of course, you guys were always a little ahead of us. We don't like to admit that here, but you were. But Louis Pasteur in Paris, who was working with germs, really, you know, do these diseases generate spontaneously or is something causing them? And then Dr. Joseph Lister, who was English but working in Scotland and working on infection.

So they were making fantastic discoveries. Lister discovered that carbolic acid would stop infection, but none of this got to the American doctors in time for the hundreds of thousands of men who died in the American Civil War. So yes, disease swept through those army camps, and they began to suspect that quarantine was going to stop some of the spread. So they did begin to institute quarantines and they separated smallpox and yellow fever victims from victims of infection. But it was terrible.

If you listen to Dan Snow's history, we're talking about medicine in the US Civil War all coming up. Hi there, I'm Don Wildman, the host of the brand new podcast, American History Hit. Join me twice a week as I explore the past to help us understand the United States today. You'll hear how codebreakers uncovered secret Japanese plans for the Battle of Midway. Visit Chief Poetin as he prepares for war with the British, see Walt Disney accuse his former colleagues of being communists,

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And crusades. Find out who we really were by subscribing to Gone Medieval from History Hit, wherever you get your podcasts. Talk to me about some of the remarkable people that were drawn into this as the call went out for more medics on either side? The tectonic plates of caste kind of are really rocked at this point because of desperation and necessity. So very few women at the time were admitted to American medical schools. Now, the American medical schools usually were a faculty of professors. And the courses that were offered, you bought tickets for midwifery, poulticing,

anatomy, and attended those classes. And the second semester really was a repeat of the first. And then at the end, this board of professors would decide whether to confer the degree of MD upon you or not. Well, women were not admitted to most of the medical schools. But in the mid-1800s, there begins to be medical education for women. So we start to get the first women doctors, and we get the first African-American doctors who are commissioned into the army, 13 of them that we know of served in the American Civil War, but most of them got their educations in Canada because the American medical schools would not admit them owing to the color of their skin. Also, I wanted

to point out that one of the things that really stunned me about this, if you were a person of color, chances are you were not going to be admitted to an American medical school. But prior to that attempt, you had to be able to read. And in some of the southern states, notably Virginia and Georgia, there were laws enacted criminalizing literacy for people of color. So the first laws forbade slaves to learn to read. And then into the 19th century, they expanded those laws to include freeborn people of color. So some of the laws punished the slaves and the newer laws punished the masters or owners for allowing them to attain literacy. So you had to overcome incredible barriers just to become literate, to apply to a university or a medical school, to learn how to become a doctor. I think America is one of those places where an alpha people or our history is. For example, here's one of my favorite stories about a woman named Susie King Taylor, who became very well known as a nurse in support of the soldiers. At six years Six years old, she really risked bodily harm by sneaking out of her residence on the plantation

to learn how to read. Six years old, you know how tiny kids are then. And she became very good at it. And at age 14, she escaped with her uncle and wound up in Union-occupied Morris Island off of the coast of Georgia. And when they discovered that this young teenager was literate, they set her up as a teacher. So during the day, she taught children who were there. And at night, the adults came. And she is the only woman, black or white, to have written a book about her experiences from inside of an army camp. But she said, at night, the adults came to me eager to read, to read above all else. And she wrote a very moving book, which is actually still in print through university presses, Susie King Taylor. But Dr. Alexander Augusta is one of my favorites. He was just

awesome. He was freeborn in Virginia. He could not be admitted to university due to the anti-literacy laws for African Americans. So he again secretly found some sympathetic professors who tutored him. He became literate. He then married a Native American woman and they moved to Toronto, Canada, which was much more not only accepting, but welcoming of African Americans. So he attended Holy Trinity Medical College there in Toronto. He was in a six-year program. And when he graduated, the dean said he was one of the most brilliant students ever. And he set up a business, a pharmacy there to support himself and his wife and pay for his medical education. And when the Civil War started, he wrote to President Abraham Lincoln, offering his services to the army. He said he felt it was a point of responsibility to offer

these services as support to his country and to other African Americans. So Lincoln first said yes, but then other governmental officials said, no, no, no, he's of color. He can't be commissioned into the army. So this hard-won literacy of Dr. Augusta served him very well. He wrote to Lincoln again. So after several exchanges, he finally was accepted and commissioned as a major in the Union Army, where he served. And he, of course, ran into obstacles all along the way. There were white doctors who refused to work with him. They wrote to the government saying that it was humiliating. He was with hospitals originally, and then he was assigned to a recruiting station for black troops, but he just never gave up.

Well, in Baltimore, he was attacked while in uniform on a train. And in Washington, D.C., it was a very rainy winter day and he was on a streetcar. And there were platforms on the outer edge of the cars where you could stand and ride. And it was raining cold rain and he wanted to stand inside and the other passengers refused. So he wrote one of his excellent letters to a Republican senator and it started a movement. A year later, the streetcars and public transportation in Washington, D.C. were desegregated. So Dr. Augusta and his assistant, Dr. Ruffin, who was also Black and had been educated in Canada, were invited in 1865 by President Lincoln to the White House to a reception there. He broke through so many barriers, this

doctor. And they said later when the two Black doctors came into the reception, everyone stared at them. So they walked around the perimeter of the room examining the artwork, and they said it was a memorable occasion. They did not say it was fun, but he later became the first Black hospital administrator, the first Black faculty member in a medical school at Howard University, and he was the first Black Army officer to be interred at Arlington Cemetery, the first black army officer to be interred at Arlington Cemetery, the national cemetery for heroes of war in this country. That's a remarkable story. What an extraordinary guy. What are people like him doing to transform healthcare,

battlefield medicine at this time? There's nothing to go on, right? They're building it from scratch. Many of them came to the UK to advance their educations. I'm also thinking of Dr. William Powell. William Powell Sr. was a freeborn African-American. His wife was Native American and they had seven children. They lived in New York. And at the time, there was a law enacted called the Fugitive Slave Act, which meant that anyone of color could be yanked off the street, accused of being an escaped slave, sent to the South. Terrible things happened to people. So he was afraid for his family.

He had seven children and a wife of color, as he was. And so he moved them to Liverpool. And so he moved them to Liverpool. When you think about this, these are people getting onto wooden ships that took at least six weeks to cross the ocean. So you're already putting your life at risk. They went to Liverpool and his son, William Powell Jr., was accepted to medical schools in England and Scotland. He finished his course of study.

He came back to America. He served in the war and he served as the head of an orphanage for African-American children for 20 years. So I think that in small struggles, just staying with their heads above water in the medical community, to not be accepted by the hospitals where you had to only work in a hospital for African Americans or for slaves. The term contraband was used to refer to escaped slaves, implying that they were stolen property. So there were hospitals just for contrabands. And it's a pretty disgusting situation when not only care, but treatment is affected by the color of your skin. But let's talk about treatment now that the men like this and the women like this were performing. How did it change from the early years? You mentioned

that you discovered some big sort of revolutionary changes. Tell me about those now. One of the biggest was in hospitals. Prior to the Civil War, hospitals in America really were eight or 10 bed infirmaries, usually attached to almshouses because hospitals were a place where poor people went to die. It was not a place you went to for treatment. And now again, across the pond, the UK was ahead of this country in having much more established institutions of healing. So hospitals and schools both. So the largest hospital at the time of the Civil War was in Fort Leavenworth, Kansas. It had 40 beds. Anything larger than these infirmaries were usually military hospitals. So what happened with the Civil War, where by the end of the war, there were more than 400 hospitals in America with more than 400,000

available beds. So people like, well, like your Florence Nightingale, who espoused sanitation, hygiene, ventilation, scheduled administrations of medicine, it was a radical change. of medicine. It was a radical change. Let me back up a little to the Crimean War, where Florence Nightingale, who she had always aspired to being a healer, and it was looked down upon to have women handle the bodies of men who were not part of their families. So this was a pretty outrageous form of behavior for a woman born to a wealthy family like Florence Nightingale. But she was very different. And she also was fascinated and good at data collection and analysis, which was something

else, which really had not been done on a large scale. When she got to the Crimea and saw the conditions where the hospitals literally had no beds and there were men from teenage on lying on the floors in deep muck and mud and blood and excrement, and you couldn't even clean the floors because there were no beds to move the men onto. So she came in, she had found her moment and she was there for that. She had beds brought in.

She got men off the floor. They cleaned the floors, instituted regular schedules of ministering medicine, opened windows. It was a revolutionary transformation of healthcare, which then women in the United States emulated here. People who went over and nuns who learned from Florence Nightingale and brought those ideas and treatments back.

So the hospitals change radically. The other thing that we get from Europe here, they institute the pavilion-style hospital, which had become popular in France and England. So these were generally wooden buildings, and they were built like spokes on a wheel. The hospitals that were here in Philadelphia had more than 3,000 beds each. I mean, some were even larger. Chimborazo in Virginia had more than 8,000 beds. So they could move supplies and personnel more easily through these spokes, and the buildings were better ventilated. Mostly prior to that, at the beginning of the war, they simply used existing buildings. They used the post office, the patent office, hotels, private homes.

There really were no huge facilities with the ability to deal with these terrible illnesses and grievous wounds. So the hospitals changed everything radically as well. And by the end of the war, if you were wounded, were your chances of survival much higher than they would have been at the beginning? Yes, because they had discovered some interesting things. Most wounds were in the extremities, and they discovered the fastest way to save those lives was by amputation. They did not have time. with thousands of guys waiting for surgery. They could not resection. It was just too crazy. But amputating the limb was the best way to save a life.

So they discovered that the further from the heart that the amputation was, you saved as much of the leg or arm as you could. You didn't cut through a joint, which was something else they discovered in the process. And so what would happen would be they would bring these guys to a field hospital, which was a pretty crude setup. And they had pretty much lined amputations. They took an average of six minutes. They got really good at it. And then they transported them to general hospitals. So frequently infection did set in. And when they got to the general hospital, they would amputate more of the limb in order to save life. It was really hundreds of thousands of amputations that took place. But 75% of them, despite the ensuing affections, did survive. Wow. And I guess in terms of the facilities, they were able to get you to a medical facility quicker as the war went on. They were, and largely because of trains. Trains really came into use in America in the 1830s. So by the time of the Civil War, this becomes the first use of trains in this country

as ambulances, really. Because also at the time, the way they set up for a battle, I always think of it as like setting up for a football game. You know what the date and the place were. You brought in all the supplies and, you know, it said go. It was not a sudden action. So they would send supplies to the battlefields in boxcars, and they would return the boxcars filled with wounded and sick soldiers. And as the war went on, the Union, which was in a better position to handle this. For one thing, they had far more miles of railroad track available. The manufacturing had not been interfered with by the war. The South, unfortunately, had a number of different rail companies. So the track gauges were different. It created a whole problem. I mean, they were using the train, certainly.

It created a whole problem. I mean, they were using the train, certainly, but there are a lot of stories about the Southern ambulance trains where they were powered by wood burning. trains frequently had to stop and available men got out and chopped down trees to be able to provide fuel. But it did really advance the cause of getting men from the battlefield to cities with general hospitals much faster than in any previous war. And so what were the lasting legacies, I guess, for the US, the world of medicine after the war for both soldiers and civilians as well? I think that answer is even bigger than America. The thing that impressed me was looking at this action on the world stage, because the reverberations and the ripples go far. And many of them were generated or began really in Europe. So the legacies here, I would say some of the biggest

ones that you would certainly be familiar with are the International Committee of the Red Cross and the American Red Cross. That and the Geneva Convention, I would say, were the biggest. So the Geneva Convention established the need for protection of the wounded and their caretakers. And it's interesting because you see the echoes of this in both North and South, where doctors were pardoned. If the Confederacy had captured Union doctors, they would frequently parole them so they could treat the wounded troops on site. And a lot of these doctors really developed the feeling there should be a non-combatant status for doctors. And we get the beginnings of the first Geneva Convention in 1864 from this,

where they established elements that had to be met for medical caretakers and the wounded. And we still deal with that today. It's certainly been rattled around, but it's an important factor of combat and warfare. The International Committee of the Red Cross, there was a Swiss businessman named Henri Dunant, who happened to be in Solferino, Italy, at the time of the emperor's war there. And in one day of fighting, there were 43,000 casualties on that field and the armies left. So Dunant was horrified. He organized women and anybody who could walk really to help with the situation with getting these men off the field and treated with whatever was available. It changed his life. The entire

trajectory of his mission became this protection for the victims of war. And he worked with four other men to establish what became the International Committee of the Red Cross. Well, Clara Barton in America was a relief worker. She's frequently referred to as a nurse, and she did do nursing, but she considered herself a relief worker. Right at the end of the Civil War, or after the end of the Civil War, she traveled to Europe, and she met with Dunant and read his book, and she was profoundly impressed. Well, it took her 17 years to convince the American government to establish a branch of the Red Cross in this country. She did not give up. These were people with extreme tenacity. She was the first president

of the American Red Cross, which she held almost till the end of her life. And I believe she was 89 when she passed. But these are the kinds of legacies that the Civil War left. The other thing that I found was, to me, one of the most meaningful things was that in these horrible circumstances, a four-year epidemic of violence and disease. And yet, in the medical field, I want to say profession, but I would combine them. This was true heroism. These were people operating in a fog of grief. These were tenacious, courageous people. These were women, thousands of women who really had never operated outside the household, who suddenly said, we can't allow this to be. And they appeared, and they traveled to the hospitals and the battlefields at a time when women didn't

travel alone. And they taught each other the nursing skills they were aware of. To me, this was Americans at their best. And I found that to be one of the most emotional and strongest legacies I perceived. Well, thank you so much for coming and sharing your insights, the results of that research you've done in and around those archives in Philadelphia and everywhere else. Everyone needs to go and buy your book. What's it called? It is called Healing a Divided Nation, How the American Civil War Revolutionized Western Medicine.

And it's a good beach read. It's a great beach read. It's a great fireside read for the winter if you want as well. So thank you very much, Carol, for coming on. Oh, thank you, Dan. I really really enjoyed it and i was honored to be here you