Amidst all the disease, suffering and death that occurred during the American Civil War, I was heartened to come across an extraordinary act of compassion shown by the citizens of Philadelphia. The Cooper Shop Volunteer Refreshment Saloon was a 2 storey brick building, 50 yards from Washington Avenue, on Otsego Street. Philadelphia was the main travel intersection between the East and the seat of rebellion. Large numbers of troops marched along Washington Avenue before boarding the railroad cars, of the Philadelphia, Wilmington and Baltimore Railroad Company, for onward transportation. Before the War, Messrs. Cooper & Pearce, owners of The Cooper Shop as it was then known, were involved in the manufacture of shooks for the sugar planters of the West Indies.
The Saloon operated between 26th May 1861 and 28th August 1865 and served approximately 600,000 patriots. During this period a committee of women, assisted by the generosity of friends and neighbours, took over The Saloon’s organisation. The committee consisted of: Mrs William Cooper, Mrs Grace Nickels, Mrs Sarah Ewing, Mrs Elizabeth Vansdale, Miss Catherine Vansdale, Mrs Jane Coward, Mrs Susan Turner, Mrs Sarah Mellen, Miss Catherine Alexander, Mrs Mary Plant, Mrs Captain Weston, Mrs Thomas D. Grover and Mrs James M. Moore. Day and night the team tended to the sick and wounded Union troops, mended and washed clothes and offered all the comforts of home to any soldier who turned-up. The Saloon remained open around the clock and the public were also welcome to visit. Women from the “neck”, which was the garden area of Philadelphia, came to The Saloon daily with wagons laden with fresh milk. At one point, 100 gallons of coffee was being made every hour in the shop’s large fireplace.
Soldiers presenting themselves at The Saloon were in a truly terrible state. Nearly all were starving, exhausted, badly sunburned (particularly on their faces), wearing filthy, tattered and lice-ridden clothing. All got a warm welcome from the Saloon team. Each soldier would be thoroughly washed, supplied with a fresh set of clothes including underwear, socks and mittens and given cup of coffee and some food. The ladies took care of letter writing requests from the soldiers and attended to their every need with warmth and compassion.
In December 1861, a private, non-military hospital was established above the main Saloon. The aim of The Cooper Hospital being to create a safe, pleasant ‘home from home’ environment for the sick and convalescing soldier with no strict military discipline or regime imposed. Dr Andrew Nebinger was in charge assisted by Dr George W. Nebinger, both worked tirelessly night and day without pay. In February 1862, Robert Nebinger began work as the Hospital’s dispensing pharmacist. The Hospital also had its own apothecary shop. Originally there were 11 beds and by 1st March 1862 bed capacity had increased to 27. Miss Anna M. Ross was the Lady Principal of the Hospital and oversaw the women who volunteered to nurse the sick and wounded. Sadly, on 22nd December 1863 aged 50, Miss Ross died. The Hospital entered a 30 day period of mourning and the Manager’s Room remained draped in mourning paraphernalia for 6 months. Following her death, Mrs Abigail Horner became the Lady Principal.
Conditions in the Hospital were excellent. The rooms were clean, well-ventilated and brightly lit. In March 1862 the Philadelphia Associates of the US Sanitary Commission visited the Hospital and its Chairman Dr Francis G. Smith stated that he was ‘…impressed with the comfortable and home-like appearance of the Hospital, and with the kindly ministrations of those having it in charge.’ Mrs Dorothea Dix visited the Hospital and her sentiments echoed those of Dr Smith. She was extremely pleased with what she had seen and gave the venture her highest commendations, fully endorsing its usefulness. In fact, she was so impressed that after her visit she sent The Hospital a donation of books. The Hospital closed in the autumn of 1865 and out of the 854 patients treated there, only 14 died.
‘The Federal army may soon have to contend with a more deadly foe than the Southerners. The yellow fever season is fast approaching, and, if the Vomito stalk through its ranks, he will slay more than the sword has done; and it is possible that the Confederacy have calculated on the reinforcement.’
(New York State, 14th July 1862)
‘The yellow fever is raging with unabating fury at Wilmington, N.C. Letters from the scourged city are many, calling for help from abroad. Its rapid spread and malignity arises from utter ignorance of the physicians and others in their treatment of the disease.’
(The Sheffield & Rotherham Independent, 18th October 1862)
I recently came across the above in contemporary British and American newspapers. There are many other examples of media reports on the devastation caused by the scourge of yellow fever or “Yellow Jack” as it was referred to in everyday parlance. The disease was a particular problem in the South, killing over 10,000 people and, like malaria, epidemics occurred mainly during the summer and autumn months. Outbreaks were reported in Charleston, Galveston, Mobile, New Orleans, Norfolk, Savannah and many more cities besides. Wilmington’s epidemic, which killed 15% of its population, was traced to the arrival of the blockade runner Kate. If you did manage to survive yellow fever, which was rare as mortality rates were over 50%, then you would acquire lifelong immunity.
Yellow fever is transmitted from person-to-person by the Aedes aegypti mosquito. This type of mosquito lived in the Southern States and laid its eggs in hollow logs and other receptacles that contained fresh water. Horse troughs, clogged gutters and rubbish lining the streets, that had been filled with rainwater, were popular incubators for the Aedes aegypti’s eggs. During the winter, the heavy frosts helped to curb the mosquito population. The mid 19th century American physician was ignorant to the causes of this disease. It was the popular held belief that yellow fever was a mysterious filth that lived in certain types of clothing and travelled aboard ships.
Drugs and therapies for its treatment were based upon antebellum practices of inducing vomiting, sweating and purging of the bowels or bladder to release toxins from the body. Once the toxins had been expelled, then the diseased body could be brought back into balance. The most popular medication administered by the Army Surgeon was calomel, containing a mix of alcohol, opium, honey, chalk and mercury. A typical treatment regime for a Civil War soldier suffering from yellow fever would have been:
mix of spirits of ether and whiskey;
calomel and 15 grains of rhubarb;
liquid potasse citrate;
1 ounce of castor oil;
30 drops of laudanum;
6 drops of oil of turpentine.
In the advanced stages of the disease you bleed from the nose and mouth, suffer crippling headaches, fever, jaundice and vomit a substance that resembles coffee grounds. This blackened, grainy substance is in fact half-digested blood, caused by internal hemorrhaging. Army Surgeons in the Civil War were accused of prescribing calomel too readily to their patients. In the Spring of 1863 an ambitious young Surgeon General, Dr William A. Hammond (1828-1900), ruffled more than a few feathers amongst his colleagues. Hammond believed calomel was indeed being overused and he decided to do something about it. He issued the infamous, Circular No. 6, insisting that the medication be removed from all the Union Army Surgeons’ supply tables. Hammond believed that its overuse was the cause of a range of nasty side effects amongst the soldiers. Examples of the side effects that Hammond cited include: melancholy, hypersalivation and gangrene of the mouth. His colleagues were angry at this dictate and at what they thought to be interference in matters that were not of his concern. The situation escalated resulting in Hammond’s eventual court-martial. It wasn’t until 1878 that he was finally exonerated of the charges brought against him.
Between 1861 and 1866 over 1 million Union soldiers were diagnosed with malaria. Malaria is a parasite transmitted by the Anopheles mosquitoes. The mosquito breeds in stagnant, sunlit pools of fresh water and the adult female requires a blood meal in order to be able to ovulate and lays somewhere between 100-300 eggs at any one time. Symptoms of the disease are chills, shakes, nausea, headache, an enlarged spleen and most notably, a fever that spikes every 1 to 3 days depending on the type of malaria and its parasitic cycle. There are 4 species of malarial parasite that commonly infect humans:
Plasmodium falciparum – Common type that was found in the United States during The American Civil War. Results in a congestive and malignant fever. A pernicious malaria which left untreated is fatal;
Plasmodium Vivax – not often fatal and commonly referred to as an “intermittent fever”;
Malaria is categorised according to how often the fever spikes or paroxysms occur:
quotidian fever – every 24 hours;
tertian fever – every 48 hours;
quartan fever – every 72 hours.
The further south you travelled, the more prevalent malaria was. The South’s “Sickly Season”, as it was referred to, took place during the months of summer and autumn. The impact of malaria upon military campaigns in The American Civil War cannot be underestimated. Examining the causal links between human health in general and developments in military history is extremely complex and lies outside the confines of this blog. But there is no doubt that military operations are affected by epidemics and seasonal outbreaks. For example, when the “Sickly Season” was in full swing, major offensives were less likely to be initiated by the Union army in certain areas of the Confederacy.
The treatment options available in 1860s America were pretty good. Quinine, which occurs naturally in the bark of the cinchona tree, was the most effective in controlling symptoms of the disease. The cinchona bark was known for its febrifugal properties and continued to be used in anti-malarial drugs until the 1940s. The Pilulae Quinlae Sulphatis treatment (pictured above) was standard issue in the Army Surgeon’s medicine chest. The recommended dosage would be 3 grams of Sulphate of Quinia. A fatal dose of quinine is 8 grams and many soldiers were given high doses of the drug. Side effects of overdosing included ringing in the ears, headaches, nausea and blurred vision. There were two large pharmaceutical companies whose headquarters were in Philadelphia, Rosengarten & Sons and Powers & Weightman both of whom cornered the market in quinine based medications.
Union blockades meant stock piles of quinine in the South dwindled with each year of the war. When quinine supplies did sometimes get through the blockade, Confederate soldiers hijacked it for themselves, leaving many civilians to suffer, untreated, the disease’s terrible side effects. Quinine was also used to treat gout and dyspepsia. Quinine substitutes were created by the Southerners to try to counter the shortages. Constituents of these preparations included 30% dogwood bark, an equal portion of poplar bark, 40% willow bark all mixed with whiskey. Alternative remedies were also tried by the desperate civilian. Some believed that rubbing turpentine on the stomach prevented paroxysms and others tried putting red pepper in their tea. All substitutes proved ineffective. Throughout the War, travel restrictions were in place in the South which meant that white Southerners, who would have normally fled their plantations during “Sickly Season”, had to stay put and face the ravages of the disease.
Union Surgeons issued more than 19 tons of quinine throughout the War. The daily ‘quinine call’ queues were a familiar sight in Union encampments. Soldiers taking part in The Siege of Vicksburg (18th May – 4th July 1863) exploded powder cartridges in their tents to smoke-out the mosquitoes. Many soldiers were most vulnerable from being attacked by Anopheles mosquitoes whilst performing picket duty.
To find out more about So.Sk.An. please click here.
Situated approximately one mile outside the city of Winchester, on the Alresford Road, is the site of St. Mary Magdalen Hospital, a former medieval leper hospital (‘a lazar house’). It is possible that this Leprosaria was one of the England’s first hospitals. Archaeologists at The University of Winchester began excavating the site in 2007. In 2000 Channel 4’s Time Team also conducted a short excavation at the site. The Hospital began mid 12th Century, was reformed and rebuilt in the 14th Century and demolished in the 16th Century to make way for brick-built almshouses. The almshouses were finally demolished in the 1780’s by order of the then Bishop of Winchester. The site does not contain any above ground evidence. I was fortunate to be able to visit this extraordinary archaeological dig in September 2010.
Leprosy, or Hansen’s disease as it is also known, is a particularly nasty condition. The skeleton of a leprosy sufferer is quite distinctive. The facial skeleton will show signs of degeneration, the foot phalanges will be wasted and the lower legs and feet will have bony changes. Sometimes, although not as frequently as once believed, extreme cases led to amputation. During the Middle Ages lepers were thought to have been punished by God for the sin of inappropriate sexual conduct. However, we now know that leprosy is a highly contagious disease spread from person to person via exposure to respiratory droplets. Victorian archaeologists and historians believed that medieval society treated lepers as social outcasts, one of the reasons why leper colonies were located away from ordinary citizens on the outskirts of a village or town. The excavations taking place near Winchester reveal that the patients were actually well cared for. The site provides a fascinating insight into the origins of institutional care in early Medieval English Society.
In a field opposite the site of the Hospital, Archaeologists have also discovered the foundations of Hampshire’s largest First World War base camp. The camp consisted of a stable block, barrack blocks on wooden bases, drainage trenches, and gravel paths. Brick foundations have been unearthed of the camp cinema-theatre which provided entertainment to the troops before they left for the battlefields of France and Belgium. Again, no above ground evidence now exists.
If you want to find-out more about archaeological digs across Britain then I recommend the BBC’s Digging for Britain. The second series began Friday 9th September 2011, 9pm on BBC 2.
Don’t miss the superb Heritage Open Days taking place between the 8th and 11th September. Free events and activities will be happening right across England. Some events require pre-booking but many do not. There are 4,300 entries on HOD’s register this year so you are bound to find something happening near to you. Check-out what’s on in your area. I have two fantastic days out planned this weekend and will be posting about them in due course. This is your perfect opportunity to discover England’s hidden heritage and even better it is absolutely free!
I recently discovered, in a London newspaper from 1895, some fascinating adverts for pharmaceutical products and thought you would be interested to see them. Also, if you are a fan of the BBC 2 series Victorian Pharmacy, the Royal Pharmaceutical Society’s website has a really good article available to view from the July/August 2010 issue of Professional Pharmacy. Jeff Mills discusses the making of the BBC series with one of the participants, Professor Nick Barber.
On Victorian Pharmacy, Ruth Goodman recreates the recipe for Bird’s Custard. Originally formulated by Chemist Alfred Bird. His wife had an egg allergy and this prompted Alfred to create a custard powder that would bind without having to use eggs. He made his first batch in 1837. The product was so successful that Alfred decided to go into manufacturing, setting-up Alfred Bird & Sons in Birmingham. In 1895, he had expanded his product range to include blancmange powder and jelly powder. Bird’s Custard powder is still available and popular today. We always have a tub of it in our store cupboard, if you add a dash of good quality, organic vanilla essence it makes the most delicious accompaniment to stewed rhubarb and ginger.
Plasters in Victorian times were not exactly the same as they are today. Plasters were made by the Chemist out of flattened leather, white sheepskin or chamois shaped according to where it was to be placed on the body. The plasters were partially covered with a thin layer of either melted resin, wool fat or beeswax which contained active ingredients, often essential oils. When the plaster was placed onto the body part, heat would melt the resin, fat or wax and the oils would penetrate through the skin to ease the symptoms. The plasters were packed into a box, each layer separated by grease-proof paper. They sold well in the Victorian Pharmacy.
This posting contains some detailed descriptions of medical procedures that a few of my regular followers may find a tad gruesome. If this topic is not for you, then please check back again in a few days time, when there will be some lovely postings on Victorian actress Lillie Langtry, the 1940s Make Do and Mend Campaign and of course, more cooking with Mrs Beeton. If you like your history of medicine straight-up, then please read on….
As you know if you have read my previous posting on American Civil War Medicine, I am researching the career and life of Civil War Surgeon Dr Mary Edwards Walker (1832-1919). In the course of this research I have come across some great material on medical practices and procedures used by Surgeons during this time which I thought would be of interest to those of you who are keen to find-out more about this fascinating topic.
Amputation was the stock-in-trade of every Civil War Surgeon. The procedure was used to treat bullet wounds and infections. The most skilled Surgeon could amputate a leg at the thigh in about 40 seconds. Reporting on ‘Amputation at the Ankle-Joint’ in The British Medical Journal in August 1869, Prof. George H. B. Macleod, M.D., F.R.S.E., a Professor of Surgery in the Andersonian University, Glasgow, said that ‘..Essentials of any good method of amputation is the removal of the whole disease or injured parts to be removed with as little mutilation as possible and with as great a saving of the body (especially the bone) as can be.’ Macleod’s own research into mortality rates post ankle-amputation in the Crimean War (22.2%) and the American Civil War (8%), demonstrate that even in the few short years that had elapsed between the two campaigns, the Surgeon’s skill at perfecting this procedure had probably reached a high level. These mortality figures are quite incredible when you think how insanitary the conditions in the Field Hospitals actually were. The large volume of amputations performed by Surgeons would have ensured that the skill was being practiced on a regular basis.
What is unclear from Macleod’s statistics is whether the amputations were flap or circular. There were several methods of ankle-amputation available to the Surgeon: Syme’s, Postero (internal flap), Soupart’s, Sédillot’s and Pirogoff. Flap method amputations were dangerous in the battlefield as they were particularly prone to gangrene. However, the flap method was quicker to perform than the circular and would have been popular where speed was of the essence. Macleod believed that the best method was Syme’s flap method which he describes as follows:
‘The knife best fitted for amputation at the ankle is a short, strong bladed one. That the covering retained for the ends of the bones should be ample in amount, healthy and firm in quality, so as to make it capable of withstanding pressure and attrition; that the blood-vessels and nerves should be placed out of the way of pressure, and that they should be well-covered and protected; that the flap or flaps should be well supplied with blood, and fall easily together, and be capable of easy retention; that secretions should have easy exit; that the resulting cicatrix should be out of the line of pressure; and, lastly, that the stump should be one to which the mechanist can with greatest facility adjust a substitute for the removed part.’
Macleod offers plenty of advice on aseptic surgery, which was not practiced during the Civil War. It wasn’t until 1867 that the benefits of a sterile operating theatre began to be accepted across Europe. America did not adopt aseptic surgery practices until the end of the 19th century. Macleod, writing in 1869 advocates its use but the last couple of sentences on dealing with wound dressings would horrify us today:-
‘I have employed various disinfectants and antiseptics in the after-treatment of these and other wounds, and am strongly impressed with their advantages in lessening discharge and destroying smell. Carbolic acid dissolved in water (1 to 30) or Condy’s fluid or Chloride of zinc (gr 15 or 20 to the ounce), are very useful indeed, when used to wash over the flaps at the time of the operation; and carbolic acid or Condy’s fluid should always be mingled with the water used for syringing out the stump (which I always do at each dressing, so long as pus lodges in its interior). I am a strong advocate for dressing as seldom as possible. Unless the suppuration is very profuse, and the drainage bad, it is not necessary to interfere oftener than every second day; and in fact, if the dressings applied be of the simplest and lightest kind, very little meddling will be required. I rarely make my first dressing till the third or fourth day.’
Many Surgeons during the Civil War reported on the neurological phenomena known as ‘the phantom limb’. Contemporary researchers on the topic included physicians, S. Weir Mitchell, W.W. Keen and George Morehouse. They had all experienced reports of this phenomena amongst their patients. Many amputees reported feeling a sensation from the amputated portion of limb.
Conditions in the Civil War field hospitals were basic and grim. Field hospitals were converted schools, hotels, churches, barns, private homes and even boats. The injured soldier did not recuperate on sprung mattresses in clean, tidy wards but instead would find himself lying on makeshift beds. These beds were boards on top of church pews or on the ground and if they were lucky they might be given a mattress made of sacks of straw or corn husks. The operating table would have been a wooden bench often set-up underneath a tree. Drugs and medical supplies were in short supply and in emergencies corn husks were sometimes used as a substitute for bandages on patients injured on the frontline. Suppurating wounds were treated by applying an ointment consisting of 2 parts fresh lard and one part white wax. (For more on this particular topic, see Agatha Young’s, The Women and the Crisis: Women of the North in the Civil War, published by Thomas Yoseloff: New York, 1959).
Apart from amputation skills, the Civil War Surgeon developed relatively sophisticated techniques in the use of plaster splints. I came across an article, ‘Plaster Splints in the American Civil War’ published 1943 in the December issue of The British Medical Journal by an author just referred to as ‘S.W.’ S.W. had discovered a series of essays, titled ‘A-T’, that had been published between 1862-4 by The United States Sanitary Commissioner and intended for distribution amongst Army Surgeons. The essays covered a wide ranges of topics on battlefield medicine, including techniques for creating plaster splints which can be found in Volume ‘T’. The Army Surgeons were recommended to use the Maisonneuve technique and A.W.’s article details this procedure:
‘Shave or oil the skin. Make a paper pattern of the area to be covered and cut to it two thicknesses of Canton flannel or old muslin, devising windows if wounds are present; the sides of the flannel should remain about one inch apart when in position. Sprinkle plaster into equal quantity of water to a creamy consistence. Immerse cloth till thoroughly saturated, lay it on a flat surface and smooth with hand. Apply flannel to limb and put snugly over it a roller bandage. The limb is then held for a few minutes, extension being made if necessary until the plaster sets, when the roller bandage is removed. If it is necessary to delay the “setting” of the plaster this maybe achieved by adding a small quantity of carpenters’ glue.’
S.W. goes on to discuss the importance role that the use of plaster splints played in improving survival rates of Civil War soldiers:
‘..a patient with a much swollen elbow-joint wounded at the Battle of Cross-Keys. The joint had been entered by a round bullet, which was removed two weeks later, when free incisions around the joint were found to be necessary. At this stage a plaster splint was applied to the anterior surface of the arm and retained by a transverse band above the wrist and another at the middle of the humerus, the arm being flexed. This splint was worn for a month and then renewed. The head of the radius came away and the patient recovered with some degree of motion in the joint. Dr Swan employed the plaster splints in several cases of fracture after the seven days’ fighting before Richmond, during M’Clellan’s campaign, and the patients were comfortable transported to Washington.’
I hope that you have found the above interesting. I will post further on this topic in the future. For further resources please see my previous posting.
Great news for anyone interested in the history of medicine, the hugely successful series The Victorian Pharmacyis currently being repeated on BBC2, Monday evenings at 7pm. Professor Nick Barber, historian Ruth Goodman and PhD student Tom Quick bring to life the challenges faced by the Victorian pharmacist. The BBC recreated an everyday pharmacy at Blists Hill Victorian Town in Ironbridge.
I recently stumbled upon a charming little Museum situated on Swanage sea front. The Swanage Museum was founded in 1976 by a group of enthusiastic artists and historians. The displays have been arranged and constructed with care by a team of volunteers. One of the exhibits that caught my eye is the replica of Lloyds Dispensing Chemists shop (see image above) which was situated at 42 High Street in Swanage. Following Pharmacist Henry Lloyd’s death in 1933, the business was carried on by his wife Kathleen and later by their daughter Mary. The shop closed in 1995. Some of the equipment in the images will be appear familiar if you are a fan of The Victorian Pharmacy!
Here is how the Victorian pharmacist created pills from raw ingredients:
all the dry ingredients were pulverised and mixed in a pill mortar and pestle;
excipient was added, drop-by-drop to bind form into a pliable mass. Excipient was usually syrup of liquid of glucose;
the mass was then rolled into a ball and then into a long, even sausage-style length;
the sausage-style length was cut into portions;
using the pill machine, the pill mass would be rolled to the number required to create rounded portions;
each pill round was roughly rolled between the finger and thumb and a smooth finish was created by using the pill rounder in a circular figure of eight movement;
the well-rounded pills were then set aside to dry.
A very warm welcome to ‘Come Step Back in Time’, a non-commercial blog, which promises to be an interesting read for anyone fascinated by history. My name is Emma and am a writer, researcher and historian living in Hampshire, England. I originally trained as an art and design historian but my areas of historical interest are now quite varied. I love discovering new topics to research, the more obscure, challenging and quirky the better, although I do confess to having a few favourites: fashion and the history of retail; all things now referred to as ‘vintage’; architecture; interior design; food; medicine; motoring and theatre. All photographs that illustrate my articles, unless otherwise stated, have been taken by myself. Happy reading and Enjoy.