Civil War Civil War Civil War Civil War MMMedicineMedicine

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Michael A. FlanneryMichael A. Flannery

Illness vs. injury StatisticsDuring the American Civil War, 1861-65

Total Wounds Treated Total Non-Battle Illness

400 000 6 000 000400,000 6,000,000

Important Facts

Two out of three fatalities were from diseaseTwo out of three fatalities were from disease.

Mortality statistics show the average solider was five times more likely to die from disease than the civilian population.

Comparative Mortality Rates

Civil War 53.4 per thousand

Spanish-American War (1898) 16.0 per thousand

World War I (1917-1918) 12.58 per thousandSource: George Worthington Adams, Doctors in Blue (1952; reprinted Baton Rouge: Louisiana State g g ( p gUniversity Press, 1996); and The Medical and Surgical History of the War of the Rebellion, 3 vols, 6 pts. (Washington: GPO, 1870-1888), esp. medical volume 3.

Most Common Camp DiseasesMost Common Camp Diseases

Diarrhea/Dysentery Diarrhea/Dysentery –– 711 avg. per thousand711 avg. per thousandCamp fevers Camp fevers –– 584 avg. per thousand584 avg. per thousand

Malarial fever Malarial fever –– 522 avg. per thousand522 avg. per thousandContinued fevers Continued fevers –– 40 avg. per thousand40 avg. per thousandTyphoTypho--malarial fevers malarial fevers –– 22 avg. per thousand22 avg. per thousand

Respiratory ailments Respiratory ailments –– 261 avg. per thousand261 avg. per thousandAcute bronchitis Acute bronchitis –– 174 avg. Per thousand174 avg. Per thousand

Digestive disorders Digestive disorders –– 252 avg. per thousand252 avg. per thousand

C f d t I j /Di /M t lit R t Confederate Injury/Disease/Mortality Rates: Chimborazo Hospital Nov. 1861-Nov. 1863

650,000

47 ,17 6

40,000

45,000

34,223

30,000

35,000

numbertreatedmortality

15 000

20,000

25,000

2,7 39 3,47 4

6,7 40

1 9653,0315,000

10,000

15,000

637 951 37 71,965

0

pneumonia typhoid fever gunshot wounds all diseases total admitted

Confederate Sick and Wounded: Reports on File in the Surgeon-General's Office, 1861-62

350,000

250,000

300,000

150,000

200,000

100,000

0

50,000

'cont. fever parox. fever erupt. feverdiarrhea/ d t

pulmonary gunshot

d all other di

field cases 36,746 115,415 44,438 226,828 42,204 29,569 324,321

hospital cases 40,565 49,314 32,755 86,506 36,988 47,724 123,402

p pdysentery

p ywounds diseases

field cases hospital cases

Disease and U S Army Mean Troop StrengthDisease and U.S. Army Mean Troop Strength

1,400,000

1,169,476

1,019,717964 685

1,200,000

, ,

964,685

614 325 619 703800,000

1,000,000

516,824

279 371

614,325 619,703 572,022

400 000

600,000Disease(casestreated)

279,371

200,000

400,000 )Mean troopstrength

0'1861/62 1862/63 1863/64 1864/65

William A. Hammond Samuel Preston Moore

Zuave units loading wounded onto ambulance.

First aid station in the Civil War

TheTheTheTheU iU iUnionUnion

BlockadeBlockadeBlockadeBlockade

General Winfield Scott

Ella and AnnieElla and Annie

Francis N. Bonneau

The discovery of quinine sulfate from cinchona bark in 1820 by the Frenchchemists Pierre-Joseph Pelletier (1788-1842) and Joseph-Bienamé Caventou(1795-1877) became one of the therapeutic sensations of the century. By( ) p y y1827 Pelletier and Caventou proudly announced that the use of quinine wassweeping Europe with French manufacturers producing about 90,000 ouncesannually. While the French article (center) was first preferred in the UnitedStates, William Farr along with Thomas Powers and Wm. Weightman soongave Americans a reliable domestic source. Civil War demands would soonhave the Philadelphia firms of Rosengarten & Sons and Powers & Weightman

f f fproducing some 19 tons of quinine sulfate from 1861 to 1865.

Two of the most important industry giants for the Union were (left) Thomas Powers (1812-1878) and (right) William Weightman (1813-1904) who produced the bulk of the U.S. Army’s quinine sulfate.1904) who produced the bulk of the U.S. Army s quinine sulfate. Photos courtesy of Merck Archives, Whitehouse Station, NJ.

He [William Weightman] was a singularly reserved man, a captain of industry, a practical scientist of rank; a man of sagacity, energy, and thrift, who amassed a fortune of at least $50,000,000 and died in the harness. Eminently fitted to

h h h d l l h Th f serve the community he had little in common with it . . . . The store of Darlington & Co. belonged to him; whole blocks in Philadelphia were his; and his personal property tax return for 1903-04 was over $5,000,000. Here we find, personal property tax return for 1903 04 was over $5,000,000. Here we find, then, the resting place of the dollars that went for those 19 odd tons of quinine and of the many thousands of dollars that followed them when the monopoly established during the war lived on and grew fat. . . . But in estimating the price [of the Civil War], do not think only or chiefly of the life lost in the four

f t t R b ll th di bilit d d bilit th l ft b hi d unfortunate years. Remember as well the disability and debility they left behind them: and in considering the vast financial perplexities which came when reconstruction days began, do not overlook the quinine monopoly which the war had reconstruction days began, do not overlook the quinine monopoly which the war had made possible but which a suffering people overthrew. – John W. Churchman, “The Use of Quinine During the Civil War,” Johns Hopkins Hospital Bulletin17 (June 1906):

The Quinine Market in the 1860s by Highest Annual PricesHighest Annual Prices

$3.7 5$4.00

$2.90$3.25 $3.40

$2.60$2 35 $

$3.00$3.50$4.00

$1.80$2.10 $2.20 $2.35 $2.30

$1 50$2.00$2.50

$0.50$1.00$1.50

$0.00$0.50

1860 1861 1862 1863 1864 1865 1866 1867 1868 1869

Source: “Table of Prices of Quinine Since 1823,” Pharmaceutical Era (October 15, 1891): 2381891): 238.

Quinine Market by Highest Annual Prices,1823-1880

$2 0.00$20.00

$25.00

$1 4 .00$15.00

$8 .00

$2 .5 0 $3 .1 2$2 4 0

$3 .7 0$3 .00$ 8 $2 1 0

$2 .9 0$3 .2 5$3 .7 5$3 .4 0$2 .6 0$2 3 0$2 3 0

$3 .2 5$5.00

$10.00

$2 .5 0$1 .6 5

$2 .4 0 $1 .8 0$2 .1 0 $ $2 .3 0$2 .3 0

$0.00

1823

1824

1825

830

1835

840

1845

850

1855

860

1861

1862

1863

1864

1865

1866

870

875

880

18 18 18 183

183

184

184

185

185

18 18 18 18 18 18 18 187

187

18

Civil War amputation kit

Disease stalks the army

Civil War proprietary medicine stamp

I t f th Ci il W A i Impact of the Civil War on American Medicine

•The practice of surgery and surgical technique was advanced.•The development of an efficient medical supply system with effective field hospitals proved to be the foundations of modern military medicine.y

• The war served not only as a proving ground for surgical technique, it verified the effectiveness of surgical technique, it verified the effectiveness of quinine in malarial fevers. More than 19 tons of quinine sulfate were dispensed during the war.

• Pharmacy entered the war with a few large companies concentrated in Philadelphia; it left the war poised to join the industrial revolution of t e a po sed to jo t e dust a e o ut o oEurope and ready to compete effectively with it.

Impact of the War (cont.)

•The work of the U.S. Sanitary Commission did much to foster an awareness of public health and hygiene.

• The war also became a proving ground for general anesthesia. While it was used early in the war, by 1865 it was universally employed where available. Of the 8900 cases where the anesthetic agent was definitely known (76% chloroform, 15% ether, and y ( , ,9% mixed agents), a total of just 37 deaths from chloroform, 4 from ether, and 2 from a combination of both were reported. This safety record made of both were reported. This safety record made anesthesia generally accepted and widely used from 1865 onward.