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:
Restocking the Pharmacy
On one level, the war buffered pharmaceutical knowledge because the influx of patients allowed doctors to figure out the best dosage rates for known medications like quinine, used to treat malaria. The war also highlighted the meds that just weren’t working—although not everyone was happy about the change in attitudes.
One of Hammond’s most controversial moves as surgeon general was to remove mercury- and antimony-based medications, like calomel and tartar emetic, from the formulary, or army pharmacy. These purgative medicines had been prescribed for centuries for everything from headaches to malaria, rooted in the principles of humoral medicine. Patients vomited dramatically, but the medication didn’t actually do anything. To make matters worse, these medications came with side effects like mercurial gangrene.
By removing them from military pharmacies, Hammond didn’t outlaw their use, but he did prevent battlefield doctors from ordering new supplies. With mounting evidence against mercurial meds, some doctors embraced the change, while others dug in their heels. “There was resentment and there was resistance to it,” says Koyle. “The need for evidence wasn’t really embraced by a lot of doctors.” The controversy added fuel to growing opposition against Hammond, and he was replaced as surgeon general in 1864.