Posted in American Civil War, American Civil War Medicine, History of Medicine

American Civil War Medicine – Part 5 – The Scourge of “Yellow Jack”

Medicines of The American Civil War. Exhibition by So.Sk.An.

‘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;
  • acid drinks;
  • 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.

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Posted in American Civil War, American Civil War Medicine, History of Medicine

American Civil War Medicine – Part 4 – Malaria

Medicines used in the American Civil War, from a Medical Exhibition owned by members of So.Sk.An.

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”;
  • Plasmodium Malariae;
  • Plasmodium Ovale.

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.

Pilulae Quinlae Sulphatis used for treating malaria.

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.

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Posted in History, History of Medicine, TV Programme

The Victorian Pharmacy – Pills, Custard and Plasters!

Pill advert from 1895

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.   

Advert for Bird's Custard Powder, 1895.

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.

 

Advert for Allcock's plasters, 1895.

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.

Posted in American Civil War, American Civil War Medicine, History, History of Medicine

American Civil War Medicine – Part 1 – Field Medicine

US Medical Company (Union Regiment), Southern Skirmish Association (So.Sk.An).

‘The Northern men are not only of stronger bone and muscle than the men of the South, but a very large proportion of them are mechanics and agriculturists, who are inured to labour and fatigue; whereas few, or none of the Southern men have been brought-up to bodily exertion or fatigue.’

(Extract from a ‘Letter from New York’, by J. Outram, dated 23rd April 1861 and published in The Glasgow Herald, Tuesday 7th May 1861)

One of several research projects I am working on at present is a study of the career of Dr Mary Edwards Walker (1832-1919), a female Surgeon in The American Civil War.   During the course of my research I have become increasingly interested in the broader topic of American Civil War medicine, so I thought I would share with you a few basic details of this incredibly interesting subject.

The American Civil began at Fort Sumter in South Carolina on April 12th 1861 and ended on 9th April 1865, with the final shot being fired on 22nd June.  The Surgeons and Assistant Surgeons in the US Medical Army faced a daily struggle on the battlefield to keep their soldiers alive.  There has been much written about the manner in which Surgeons often ‘mangled to death’ the wounded soldiers,  earning them the less than flattering nickname of ‘Sawbones’.  Although this did happen in certain cases, it is pretty much a distortion of the truth.  The Surgeons were highly skilled and found themselves working in unimaginable conditions on the battlefield with limited resources.  The growing number of casualties simply overwhelmed a lot of the Surgeons and facilities in the field hospitals were pretty rudimentary.   Knowledge of germ theory was not yet fully developed and it wasn’t until after the Civil War had ended that the germ theory of disease was discovered by Louis Pasteur.   Then in 1867 Joseph Lister proved his theory on the importance of aseptic surgery.   If more had been known about these two important discoveries at the time of the American Civil War, then many, many thousands of lives could have been saved. The Surgeons were simply unaware that holding bloody instruments in their unwashed hands and performing amputations on one soldier then wiping the blood off onto their apron and gown before moving on to the next procedure, was the cause of cross-contamination and infection.   However, even with the advent of aseptic surgery, physicians simply sprayed an antiseptic solution in the operating room prior to procedure believing this would kill all germs.  Many Surgeons still carried on performing operations with dirty aprons and unsterilised instruments, a practice that continued in many places  throughout the rest of the nineteenth century.

Surgeon’s on both sides in the American Civil War faced a daily battle with disease, the silent but deadly ‘third army’.   Approximately two thirds (63%) of fatalities among Union troops were from disease rather than  battle wounds.  Surgeon General William A. Hammond of the Union Medical Corps kept excellent records and his statistics support this fact.  In J. Outram’s ‘Letter from New York’, an extract of which is quoted above, he states that soldiers from the North were likely to be physically stronger than the ones from the South.  Medically speaking the statistics blow Outram’s theory clear out of the water.  Physical strength may equate to a  developed immune system but if you are living and fighting in insanitary conditions you are just as susceptible to disease as any soldier would be whether from the North or the South.  Soldiers often urinated and defecated near to the water source and would then bathe or drink from the same source, unaware of the implication of their actions.

Scurvy was also common due to the Scorbutic effect of a limited diet.  The solder’s daily ration consisted of salt pork which was often rancid, stale crackers (hardtack) and coffee.   Typhus infection and lack of sleep affected a majority of soldiers at some point too.  The nights were often freezing and to keep themselves warm the soldiers would sleep with all of their changes of clothes on and as you might imagine body lice was very common.

Malaria was rife in the South and hospital staff tried everything to control its spread.  One method involved placing heated irons into bowls of vinegar in the hope that the vapours would deter the lethal, ‘Anopheles’ mosquito.  Emetics were readily prescribed to cure diarrhea, dysentery and jaundice, a popular prescription was simply warm water and honey.   Not all prescribing was so mild, blue mass (a mix of mercury, honey and licorice)  lead acetate and silver nitrate were also  popular remedies.  Blue mass was extremely dangerous and resulted in mercurial gangrene, tooth loss and gum damage.   The South suffered quite a bit with shortages of medical supplies due to the Union naval blockade.  Desperate for ligatures for sewing-up wounds, one Southern doctor improvised by using the hair from a horse’s tail which was softened by boiling it in water.  Statistics detailing cause of death amongst soldiers of the Confederacy are much trickier to come by.   Many of the Surgeon General’s office records were destroyed during the burning of Richmond at the end of the War.

American Civil War medical instruments owned by members of the UK Re-enactment Group So.Sk.An.

Further Resources

There are too many books and resources on this topic to list them all here.  However, here are a selection that you may find useful if you wish to read further on this topic:-

The UK based Re-enactment Group,  The Southern Skirmish Association (So.Sk.An), have a US Medical Company in their Union Regiment.

The National Museum of Civil War Medicine in Frederick, Maryland, USA.

Alfred Jay Bollet M.D., (2001) Civil War Medicine: Challenges and Triumphs (Galen Press)

H. H. Cunningham, (1993), Doctors in Gray: The Confederate Medical Service (Baton Rouge: Louisiana State University Press)

George Worthington Adams, (1996), Doctors in Blue: The Medical History of the Union Army in the Civil War (Baton Rouge: Louisiana State University Press)

Posted in History, History of Medicine, Museum, TV Programme

The Victorian Pharmacy

Lloyds Dispensing Chemists, Swanage Museum

Great news for anyone interested in the history of medicine, the hugely successful series The Victorian Pharmacy is 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.

If you want to learn more about the history of medicine, check-out the London Museums of Health and Medicine website.

Middle L-R, Pill Rounder, Pill Machine, Weights and Measures, dispensing exhibit, Swanage Museum
Pestle and Mortar, dispensing exhibit, Swanage Museum