In 1862, U.S. Surgeon General William Hammond put out a call to medical field officers in the Union Army: Send any specimens of morbid anatomy that might be valuable to military medicine and surgery. It might seem like a strange request, but the medical profession was in the midst of change—from a system based on tradition to one based on evidence.
“When there’s a war, there are evolutionary changes, not necessarily revolutionary changes,” says Jeff Reznick, a historian at the National Library of Medicine in Bethesda, Maryland. Medicine in the United States did some significant evolving during the Civil War. Prior to the war, humoral theory—where an imbalance between the body’s “humours” caused illness—still formed the basis of medical practice. The idea of a germ wasn’t even on physicians’ radar. More than 12,000 physicians served during the Civil War on both sides. Together, they treated patients in the millions, and sometimes they had to get creative and veer off from the teachings of classical physicians.
“The real lasting impact was the change in mindset of both doctors and the people who they were treating,” says NLM historian Ken Koyle. Writing this week in the New England Journal of Medicine, Koyle and Reznick argue that the war instigated these lasting changes in mentality that forever altered the American medical profession:
Early Field Medics
When Hammond became surgeon general of the Union Army in 1862, he shook things up. At the beginning of the war, the requirements for becoming an army physician or surgeon were minimal at best. Hammond instituted mandatory training in public health, hygiene and surgery for all Union Army medical officers. His call for specimens also provided a textbook of case studies to train doctors after the war. (Today, the collection of body parts, fluids, case notes and imaging slides is housed at the National Museum of Health and Medicine in Maryland.)
The term “combat medic” didn’t exist during the Civil War or for decades afterward. Instead, enlisted men were pulled from the ranks to serve as “hospital stewards”. Although these men received some first-aid training, there was really one main requirement: “They had to be able to read doctors’ notes,” says Reznick. As casualties mounted, attendants and nurses took on more responsibilities, especially triaging patients—noting who needed to be treated and who could wait. Some even received a more formal crash course in medicine.