Medicines for the Union Army

The United States Army Laboratories During the Civil War

Dennis B Worthen, Greg Higby

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317789222
• Edition: 1
• Topic: History
• Subtopic: World History
• Index: History

It wasn't only combat that killed during the Civil War!Among white Federalist troops alone, there were 1, 213, 685 cases of malaria, 139, 638 cases of typhoid fever, 67, 762 cases of measles, 61, 202 cases of pneumonia, 73, 382 cases of syphilis, and 109, 202 cases of gonorrhea between May 1, 1861 and June 30, 1866. (Statistics for Negro troops covered less than three years of the Civil War period.)Preventative medicine at the time had little more to offer than quinine and a few disinfectants. There was no real understanding of the germ theory of disease. But Medicines for the Union Army: The United States Army Laboratories During the Civil War shows that in the evolution of the army's Medical Department from incompetence to general efficiency during this time, and in the vastly improved organization and supply system designed by William A. Hammond, Jonathan Letterman, the medical purveyors, and others working under the Surgeon General, there was evidence of a great achievement.In Medicines for the Union Army you will come to understand the medical purveying system of the time and its problems, and you will witness the birth, growth, and remarkable achievements of the Federal government's pharmaceutical laboratories at Astoria, New York, and Philadelphia, Pennsylvania.Medicines for the Union Army will inform and enlighten you about the these laboratories, including:

• the funding and transportation obstacles faced at the Astoria lab
• the processes by which raw materials became drugs ready for distribution
• drug testing and inspection methods
• the bottling of "medicinal whiskey" and wine at the labs
• the people whose work laid the foundation for modern drug production and distribution methods
• the contents of the medical supply cases (panniers) and wagons in use at the time... and much more!

Medicines for the Union Army: The United States Army Laboratories During the Civil War brings to light the groundbreaking achievements of unsung American heroes working to preserve life while the country was in bloody turmoil. No Civil War historian should be without this volume!

Chapter 1

The Medical Purveying System and Its Problems

In the final months of the Civil War, as the Army of the Potomac besieged Petersburg and Sherman made ready at Savannah for his devastating sweep northward through the Carolinas, William Procter Jr., the “father of American pharmacy,” reflected upon the quantities of medicines that had been supplied to the Union army. He concluded that never before, not even in the wars of Europe, had military pharmaceutical operations reached such tremendous proportions.¹ Procter could have elaborated by noting that the number of casualties might have been as large or even larger in previous European wars, but that the degree of neglect had always exceeded the amount of attention given to the sick and wounded.

Even in France, where military medicine had developed to a high degree of perfection during the reign of Louis XIV, the military hospitals that “le roi soleil” ordered to be erected were chiefly used for the enrichment of the civilian entrepreneurs who administered them.² Frederick the Great permitted Prussian executioners to treat the ulcers, fractures, and wounds of his men, and waged his Silesian campaign with his army sadly deficient in surgeons.³ In spite of the brilliant services of Dominique-Jean Larrey, the greatest military surgeon and administrator of his time, the sick and wounded of Napoleon’s army often were left to die without medical care on the field or were carried into barns or other nearby structures, then abandoned.⁴ Compared to the 218,952 British soldiers who were hospitalized during the Crimean War,⁵ far more than a million cases were treated in the 192 general hospitals of the United States Army during the Civil War.⁶

Concern for the sick and wounded of the federal armies was self-evident in the medical statistics. There were more than 6,000,000 reported cases of disease, and another 500,000 men who suffered battle wounds, accidents, and other injuries.⁷ Among the white troops alone (statistics for Negro^* troops covered only the period from July 1, 1863 to June 30, 1866), there were 1,213,685 cases of malaria; 139,638 cases of typhoid fever; 67,763 cases of measles; 61,202 cases of pneumonia; 73,382 cases of syphilis; and 109,397 cases of gonorrhea between May 1, 1861 and June 30, 1866.⁸ Any discussion of these figures in terms of modern achievements would immediately disclose the limitations of medical science in the Civil War era; preventive medicine was limited to the prophylactic use of quinine and the empirical application of a few disinfectants, without any real understanding of the germ theory of disease. Despite the advances that came out of the experiences of the war, especially in surgery and neurology, as Reasoner has said, by modern standards “much of the theory and practice was still wrong.”⁹ But in the evolution of the army’s Medical Department from incompetence to general efficiency, in the vastly improved organization and supply system fashioned by William A. Hammond, Jonathan Letterman, the medical purveyors, and others who worked under the surgeon general, and in the general environment, which was created for healing and recuperation, there was evidence of a great achievement. Not only was the mortality rate less than in any previous war, but the ratio of deaths from disease compared to battle deaths was lower among the northern troops than in any war before then.¹⁰

The Civil War was a war of superlatives, one that involved millions of combatants, mountainous quantities of material, and an unprecedented power in its weapons to maim and kill. It also was fought during the “heroic age” of medicine by a generation of believers in the healing power of a complex array of drugs, administered in massive dosage.¹¹ When the standard supply table of the United States Army was fully revised in 1862 to meet the needs of the sick and wounded, it embraced “a more liberal supply of articles and drugs than [was] furnished to any army in the world.”¹² No less than 131 distinct varieties of materia medica and pharmaceutical preparations from the supply table went through the Medical Department’s major purveying depots to the armies.¹³

In quantity, these drugs varied from 1,232 ounces of strychnine to 539,712 pounds of magnesium sulfate.¹⁴ The total issue of opium preparations (including powdered opium, powdered opium and ipecac, tincture of opium, and Camphorated Tincture of Opium) was 2,841,596 ounces, and, in addition, 442,926 dozen opium pills. The medical purveyors sent forward 987,687 ounces of ether (Aether Fortior); 1,588,066 ounces of chloroform; 1,688,943 ounces of sweet spirit of nitre (Spiritus Aetheris Nitrici); and of the various cinchona products, 2,072,040 ounces.¹⁵ As an emetic and diaphoretic, ipecac had been superseded to a degree by calomel earlier in the nineteenth century, but it was once again in demand during the war,¹⁶ especially for dysentery,¹⁷ in three forms. As a fluid extract, as a powder, and in combination with opium, 1,005,779 ounces of it went to the troops.¹⁸ A number of fluid extracts, first introduced in the fourth revision of the United States Pharmacopoeia (1863), were issued: ipecac, 268,936 ounces; cinchona, 544,110 ounces; and ginger, 607,940 ounces.¹⁹ Among the other preparations supplied in large quantities were copaiba (1,292,129 ounces), powdered acacia (1,050,580 ounces), extract of licorice (818,485 ounces), tincture of ferric chloride (690,692 ounces), Hoffmann’s anodyne (367,807 ounces), and camphor (569,485 ounces). The armies also received 2,430,785 quart bottles of medical whiskey.²⁰

The great variety and enormous volume of medical supplies reached the Union armies only through a difficult trial and error process that brought significant changes in the Medical Department of the United States Army. From almost every standpoint the army medical system was inadequate to meet the unprecedented situation created by the outbreak of hostilities at Fort Sumter. The backlog of supplies at the New York City purveying depot was small, the War Department lacked adequate funds to buy more of them in the market,²¹ the manufacturers of pharmaceutical preparations (with the exception of Edward R. Squibb and a few others) were unprepared to meet the government’s requisitions without delays,²² and the administration of the Medical Bureau by Surgeon General Clement A. Finley and other conservative old-school officers—who still thought essentially in terms of a regular army of 13,000 men—revealed little imagination in dealing with the new medical problems.²³

Nevertheless, in the summer of 1861, a revised edition of the Regulations of the United States Army contained a medical supply table that changed the quantities of medicines recommended for the army.²⁴ After Brigadier General William Alexander Hammond became surgeon general in 1862, a thorough revision of the supply table accompanied other innovations in the purveying system. At his direction, a board composed of surgeon Richard S. Satterlee, United States Army medical purveyor in New York City; surgeon R. O. Abbott, United States Army; and Edward R. Squibb, convened to discuss and recommend alterations in the supply table.²⁵ Although Hammond did not expect this board merely to carry out his opinions, he did not hesitate to express his views on possible changes to its chairman (Satterlee). The new surgeon general was a “regular” in the medical profession, but at the same time he was restless, imaginative, with a zest for experiment that made him willing to break with tradition if he could advance the health of the troops.²⁶ The members of the board barely received their appointments when Hammond dictated a letter to Satterlee in which his amanuensis wrote:

He [Hammond] thinks there should be supplied the Gum Acacia in lump, the Opium also, and the quantity of powdered gum is not sufficient to make the proper quantity of Paregoric and Laudanum. For the former of these official preparations are also needed benzoic acid and anise, neither of which are placed on the Table. A pint of Laudanum is hardly deemed enough for a hospital for six months. Other articles should also be supplied, e.g., acetic extract of col- chicum, zinc cerate, the bicarbonate and nitrate of potash, the fluid extract of cubebs or powder, as there are no cubebs at all on the list… ²⁷

The board, after accepting some, but not all of these suggestions, reported on July 15; a new table was then drafted and Hammond promulgated it in a circular on October 20, 1862.²⁸ This was followed by another revision (announced May 7, 1863) that made relatively few important changes except for the controversial omission of calomel and tartar emetic from the table.²⁹ After more than two years, largely due to Hammond’s influence, the standard supply table had become adequate to the needs of the armies.

A rigid application of the supply table was indicated in the Revised Regulations of 1861, which stipulated:

The medical supplies for the army are prescribed in the standard supply table. When any requisition for medical supplies is not according to the supply table, the reason therefore must be set forth.³⁰

This regulation, however, created something of a problem when surgeons, many of whom left the practice of medicine to serve the volunteer regiments of their states, began to treat the sick and wounded. For although the supply table remained firmly in control of the “regulars,” there had been a marked increase in the demand for indigenous materia medica in the years that preceded the war. As Procter indicated, there was in progress during that era “a voluminous mixture of regular medicine, and new discoveries in the literature of Eclecticism.” While the “regulars” of the army’s Medical Department might stand by their “mineral medications,” there were those in the ranks of the volunteer army who rejoiced that numerous indigenous plants were finding their way into the United States Pharmacopoeia.³¹ Surgeons might therefore be expected to diverge from the standard supply table, with or without authorization from a superior, to test their therapeutic convictions. In the West, William R. Smith Jr. treated camp dysentery with “extraordinary success” at a Cairo, Illinois, post hospital by combining a fluid ounce of fluidextract of redbud (Cercis canadensis) with three fluid ounces of aromatic syrup of rhubarb.³² In another illustration drawn from a different theater of the war after Gettysburg, we find a volunteer assistant receiving permission from the hard-pressed surgeons of the V Corps to pour coal oil into suppurating wounds.³³ Many another country doctor, well versed in his herbals and eclectic formulas, became a problem for Charles S. Tripler, the medical director of the Army of the Potomac in 1861. He summarized his dilemma and explained his solution when he said:

The volunteer medical officers being many of them country doctors accustomed to a village nostrum practice, could not readily change their habits and accustom themselves to the rigid system of the army in regard to their supplies. To meet the difficulty I attempted within reasonable limits to disregard supply tables, and to give the surgeons articles of medicine and hospital stores to suit even their caprices, if in my judgment such articles could be of any avail in the treatment of disease …³⁴

The medical purveyor of the army, however, was not so liberal in his interpretation of the regulations. He insisted upon submitting all extraordinary requisitions to Surgeon General Finley, who would not permit anything that was not on the supply table to be issued without his personal consent.³⁵ Tripler’s orders not only were countermanded, but he found that when he himself wished to prescribe whiskey and quinine as a prophylactic against malarial fevers, it was necessary to ask the United States Sanitary Commission to give him a small amount of the drug for his experiment. After he received favorable reports on its effectiveness, the surgeon general gave him permission to issue it in “reasonable quantities” to the regiments.³⁶ It soon became well established.

When Hammond followed the ultraconservative Finley in the surgeon general’s office, he informed Jonathan Letterman, Tripler’s successor as medic...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• About the Author
• Foreword
• Acknowledgments
• Chapter 1. The Medical Purveying System and Its Problems
• Chapter 2. The Beginnings of the Laboratories
• Chapter 3. Obstacles and Achievements at the Astoria Laboratory
• Chapter 4. Operations at the Philadelphia Laboratory
• Chapter 5. The Balance Sheet
• Appendix A: Materia Medica and Preparations on the U.S. Army Supply Table During the Civil War, Together with Constituent Drugs and Chemicals
• Appendix B: Contents of Autenrieth Medicine Wagon
• Appendix C: Contents of U. S. Army Medicine Pannier (Squibb)
• Notes
• Index