this is what was going on, and cox tells another story how in 1863, one of the premier proprietary medical schools, half of the graduates, 25 men, they wanted to fight in the medical department. and my 1863, they had to make an examination to be able to get into the party by then. not one was able to pass the exam to get into the army. this was the state of the american medical community. there wasn't a lot of discipline in the discipline. it did not exist. it was chaos and anarchy, but this is what the civil war changed. so let's talk about hospitals in this period. this is new york hospital early 19th century, that was the best of the best. hospitals were for the december destitute, for the insane, for

the poor, you went there for one reason. not to get better, you went there to die. so wealthy people, whatever that meant back in the 18th and 19th century, they avoided hospitals. hospitals were not something you and i would go to at the time. and this was going to change in the civil war and that's what we're going to talk about. let's talk about treatments and diagnoses. diagnoses were very different during the civil war, because they had no way to differentiate diseases. if you had lupus, or if you had lung cancer or hepatitis, you had a fever. simple as all that. pathology did not exist. they did not know about the differentiation of diseases. there was one big mish mash of everybody being sick with no differentiation. benjamin rush, a very famous doctor attend of the 18th

century go into the 19th century, signed the declaration of independence. he came up with a thesis, that was not very originally, but it was his thesis and it was very well known who said that the cause of diseases was what he called stimulus. what did he mean by stimulus? he meant that blood vessels in the body were congested. filled up with fluid. and that there was only one thing that we could to make you and i better and obviously if we have too much fluid, what does that mean? you get rid of that fluid. so that is what's now called the green, the blister, the puke and the personal, heroic therapy. that's how heroic therapy came out. i'm not going to tell you about it other than to say that it was not a lot of fun. it was called heroic therapy

because of the potency of its actions, whether it was heroic, i would say it probably wasn't and caused a lot more harm than good. so, through this anarchy and chaos that existed in american medicine, we now have another group of physicians, doctors, maybe not m.d., but doctor, who also wanted to heal. what did they do? very similar, these were not traditional practices, these were your sectarians, irregulars and unorthodox, cultists, they said that disease was the excess of cold in the body. they thought you needed to have hot things put all around you and into your body. eclectic, they were the physical medicalists and injected

anything to do with benjamin rush. and the vegetarians and crackers. i just want to tell you a little story, you know that graham and crackers, they believed that if you ingested these graham crackers that it would stop sexual urges and not only that it would prevent master base and premarital sex. so that was their belief. i leave it to you to determine whether that's true or not. however i'll relate one little personal story, and this is the truth. in 1975, when i began my internship and residency, i was at boston city hospital as harvard was leaving and bu was coming in. all i remember is that at every nursing station at boston city hospital and on every ward there were boxes and boxes of graham crammers. -- crackers. i was married at the time, but i

and that we all were eating gram crackers. now, i was married at the time, so i leave it to my lovely wife to determine anything. but we were eating graham crackers right and left as residents. so -- and finally the ho homeopaths. like is cured by like, minuscule doses of drugs. you had the m.d., the allopaths. you had this big mess of what was going on and that was american medicine at the time. well, nathan davis. another picture of him. every species of medical delusion and positions allowed to spring up and grow without any legal restraint, the public press that engine all power likeness, for heralding every

variety of medicinal compound. in other words, we had no idea what we were doing. so, having now bashed doctors as i've done for the last ten minutes, we're going to spend ten minutes going forward. i don't want you to think there were no good things going on in american medicine. there were some very famous things going on. william beaumont and his famous book, 1833. and, of course, anesthesia, the beginnings of anesthesia. john collins warren, he's going to operate on this young man. this was taken about seven months after the initial event of anesthesia. everything was posed later. and if you see his -- if you look at his leg right over here. watch the next picture, there is the blood and the bandage. so this is the early use of anesthesia. at the time, no doctor could

conceive of diseases and treatments in anything revealing today's terms. other therapeutic substances consisted of herbal and mineral concoctions. the fact there would soon be fundamental developments such as radiology, bacterialology was totally besides the point. nor did it matter that the most important qualities of modern medical thought, scientific attitude, a willingness to question authority, a desire to learn from clinical experiences, and a drive to modify therapeutic practices that these will become mainstays of late 19th century medicine. in the 1860s, medicine might have stood on the cusp of a great revolution which would be heralded shortly thereafter with the likes of men like bernard, but unfortunately for civil war era physicians and combatants,

they would not benefit one iota from this reformation. filth, diseases, and ancient remedies prevailed. here is william goodell. he's buried at the cemetery in randolph, vermont. let me tell you about him. 40 years old, private, vermont infantry, 1862, gets knocked unconscious by a shell, blows up behind him, knocks his knapsack off his back, his shirt gets ripped, he gets knocked to the ground. this is from the examination, the words. on examination, no external lesion of the head or spine was discovered and no paralysis anywhere. he could move his tongue perfectly in every way, but he could not speak and he was totally insensible to all sound. he was in a word simply deaf and dumb. this is from his report. so what happened to poor mr. goodell?

the diagnosis was congestion of the brain. he gets admitted to the hospital which we will see a picture of later in philadelphia. treatment, blood taken by cups from the back of the neck and ears. they would put a cup on the back of your neck, they would put a fire to it, create a vacuum, blood would come out, create blisters, that was cupping. it was a mercury derivative, tartar -- they were deadly poisons, the most common drugs we would give to people. so much so that mercury poisoning was so rampant in the military they had to stop it. and mercury poisoning as we know is pretty severe. to the point that you would have gangrene in your entire face and your skin and mandible was slough off. blisters applied to the back of his neck, communication by a writing slate.

somebody said, hey, you know, put the guy to sleep, talk to him as he's going to sleep, if he answers your questions, we know he's not death and dumb. they etherized him and he still couldn't talk. and finally electric shock therapy. they had the beginnings of electricity, they would touch you with the -- with the wires that you would get a shock, nothing helped. so results, december 10th, 1862, this is now about six months after the shell wounded him. left leg decreased motion, face drawn to the right. two days later he has a seizure, by mid-december remains perfectly deaf and dumb. outcome, a year later he's discharged with disability and pension. in 1876 his doctor up in vermont says he's totally incapacitated from all labor requiring the aid of an attendant and 1899 he dies. why is this important?

because it sort of shows you medical care as it existed at the time of the civil war. and more importantly, that these are people we don't get to read about. he didn't die during the war, but he did die from the war. so there are many statistics that aren't apparent. well, the civil war was a dirty war in a literal and figurative sense. they did not understand antisepsis. so we're going to look at the big bang theory did. first was, it provided physicians with clinical experience they could never have gotten otherwise by just sitting around in a little town in america. three years of tramping through the woods and camping, they learned about a lot of diseases. clinical experience. second is organization.

they learned about how to organize. they learned how to organize ambulances and hospitals and we'll see that. and finally they have what i call comradery. this national concept of i need to be friends with the guy over there who is a doctor so we can get along and fix things. there were all of these different diseases. these diseases were seen by these men and would never have a chance to see them. so this concept of clinical experience, this is a disease that doesn't even exist anymore. finally, surgery. so here is a bullet wound. entry, exit, and here is the operation. that is the operation. that's how he was left. so you're looking at his femur, his patella is gone. there's no skin graft, no nothing, this is what he was left with. so -- this is what the civil war was about.

amputations and more amputati s amputations. a surgeon's hand kit for operations. again, these were not sterilized, they could not be sterilized when they wanted to. and finally a picture. why do i show this picture? and why do i talk about specialization and clinical experience? they learned all about diseases. surgeons at the beginning of the war, everybody was a surgeon. everybody was allowed to operate. that stopped by the middle of the war. and by toward 1864, they said, this is really crazy. we need to have people specialized in surgery. this is the big bang theory for specialization in america. it started in the civil war. the medical director of the civil war said, hey, enough. enough. we're having three people operate. the rest of you guys are not operating. so those three people became very tuned in to surgery. they learned to operate. and once the war was over, these men, the hundreds of them would then go out to little towns and

scatter throughout the country. that's how specialization in surgery started. then there was the concept of ambulances. we never had any ambulances during the war. in fact, when the war started, the idea was that the sick should take care of the sick. if i were wounded on the battlefield, very simple, i was sort of left on my own and maybe my friend who was also wounded would try to help me. but if i were sick, i was expendable. they didn't want to take a healthy soldier and expend them taking care of me. so this all changed during the course of the war. and some pictures of people learning how to take care. doctors began to understand that on the battlefield, you have to take care of the wounded. you have to take care of the sick. they learned how to do this. they learned the entire concept of organization. taking combatants who are

wounded. up and down the river. these all became floating hospitals, something introduced during the war. and then finally, the great hospitals of the civil war. by the time of the civil war, growing emphasis on maximizing the circulation of air along with the desire for cleanliness and ventilation found life in the form of these pavilion hospitals. that was the one, hicks town in baltimore. where multiple wards branching out from central interconnected buildings, ventilated by numerous windows and doors. and in the best of circumstances, there might have been a river nearby show they would have breezes and fresh air going through. architects designed civilian hospital complexes so that the accumulation of dirt was minimized. smooth surfaces, less right

angles. when you combine with hygienic behaviors such as chamber pods emptied on time, scrubbed daily, drainage ditches dug for human waste. it changed the -- it changed the entire concept of hygiene. although the civil war did not bring about great changes in therapeutics or diagnostics, the physical administration of the hospital was vastly changed during the course of the war and building these hospitals. none of these civilian hospitals exist anymore. they're all gone. we've had over 1,000 hospitals and the one had 3,000 beds, 3,000-bed hospital. these hospitals were triumphs for sanitary reasons. doctors understood that things needed to be cleaned. with as many as 1 million men treated and overall mortality rate of only about 10%, the army general hospitals became regarded as invaluable public

institutions. no longer were hospital sanct n sanctuaries only for the destitute and insane. whoever it might be, they experienced the positive realities of constitutional medical treatment. with massive wards maintained in scrupulous order, getting well within a hospital became quite an american experience. and just some pictures of the hospitals, this harwood, more pictures and the patients inside. our recent military experience have done more for the public hygiene in this country than any other agency. this is john shaw billings, he designed the hospital. public hygienes became very important during the course of the war. and these were members of the sanitary commission. other than to tell you it originated in new york city, they took -- it's sort of like

the red cross and the uso and whatever it might be in today's world, they're all rolled into one. it was a quasi governmental agency. but these men took care of the soldiers, they themselves are not necessarily doctors, but they introduced the concept of cleanliness. and then finally the sanitary commission -- and i put this slide up because of the home lodge of invalid soldiers. they began to understand you need to take care of the veterans. this is the big bang theory for the veterans administration starting back in the civil war. well, s.weir mitchell talking about his recollections of the civil war, 1905. the constant mingling of men of high medical culture, and the general influence of the war was a great service. in other words, men who were

very well educated got to spread the word out to the men who were less educated. and the idea is the comradery that was existing during the course of the war. finally i just wanted to say that there were other big bang theorys that happened during the war. one was nursing. i don't have the time to talk about nursing, but obviously in the beginning of nursing also came about during the civil war. so finally summing up and i'll be happy to take your questions. america's physicians made no breakthroughs during the civil war. it's not as if a surgeon operated on somebody's brain during the course of the war and cured them. this did not happen. if you were shot in the abdomen, if you were shot in the chest, if you were shot in the head, you were going to die. they did not have the capability of operating. if you got typhoid and cholera, you were probably going to die. no doctor introduced therapies.

soldiers recovered from illness injuries more from serendipity than possibility. illness, injury, more from serendipity than possibility. the nations physicians obtained a profound depth of clinical and organizational experience. this is what's most important. doctors learn about diseases and their clinical manifestations on a scale never possible. they experienced a life toim of practice and several years of camping and marching. the war created surgeons from physicians who previously had virtually no operating experience. it required administrative skills. administrative skills not feasible in antebellum america. physicians organize ambulance courts, assembled hospital trains, served on draft boards, resolved questions of medical manpower and designed, staffed and managed these vast hospitals. doctors came to understand that patient wellbeing depended on

adequate cleanliness, sound nutrition and natural ventilation. physicians grew to recognize mental health as a vital adjunct in health. a physician's dedication to a military medical objective imposed much needed comradeship and discipline. this is the big bang nearry. and i'll leave us with this last slide and i'll take your questions. this is s. weir mitchell. he's older, examining a civil war veteran at the clinic of the orthopedic hospital. this is what he had to say. he's talking about himself. we have served gratefully the great cause as earth has known. we built novel hospitals, organized such an ambulance service as had never before been

seen. what has been our award? count let statutes commemorate the popular heroes. statues of generals are in every town. some memorials to men who were wiser to forget. there is not a state or national monument to a physician. at gettysburg every battery site is marked with a recording. every general who fell is remembered in bronze and marble. what about the physician who died? nothing. and that is medicine during the civil war. so i appreciate the fact that you came out on this cold night and i look forward to your questions. thank you. they can't be too difficult that i can't answer. >> the civil war happened less than a decade after the crimean war. >> i'm sorry? >> the civil war happens less than a decade after the crimean

war. >> yes. >> and florence nightingale by this time is writing quite a bit about the hygiene lessons learned in that war. how much is that propagating into that? >> it had an impact on many people they did not get into. for instance, with the nurses, althea dix, but the answer is florence nightingale's book on nursing was throughout america. women knew about it. and dix, who started a nursing corps during the time of the civil war for the army, she read florence nightingale. the women knew about florence nightingale. so the effect was there and she was important. and it probably grew more and more as nursing grew larger. sir? >> question in the same vain, what if any influence did samuel weis' teaching have on lettermen and other members of the sanitary commission to your knowledge? >> that's an interesting question. i don't have an answer

because i'm not sure that any of them knew about samuel weis, it was later than that. the type of research that he was doing which was ongoing in the '60s, they did not know anything about. so it had minimal impact and virtually none. >> to dr. mitchell's quote -- >> yes. >> wasn't there a statue of samuel gross who wrote the field manual created in washington, and wasn't he the fellow who at the philadelphia centennial in 1876, didn't he list it that there was no value to anti-sepsis and afterwards wasn't his statue taken out of washington and taken back to his alma mater, thomas jefferson? >> this is not my father, he's not asking a staged question. that's my favorite topic.

samuel gross is my favorite individual in american medicine. the answer is very simple. there was not a statue of him in washington, his statue is by jefferson. it's on the courtyard as you walk into the medical school. he did say no american wanted to listen to what he had to say. lister came over in 1876 and made a very important tour of america. it was in new york city and i'm writing about it currently, and gross did go to the centennial celebration in philadelphia. banquet at the night that this thing was finished on a friday night, lister was here, gross was here. gross was an uppity individual. lister was a very important, a more important individual than gross was, gross was a very unassuming gentleman. and this gross praised him left and right and everybody in america knew that it was not true because just a month before gross has written an article about the history of medicine and surgery in america and he

wrote that no intelligent american would ever listen to joseph lister. so the answer is everything you said is absolutely true. it's a fascinating story with joseph lister and samuel gross and his tour of america. i thank you for bringing that up. >> i thank you for your presentation. >> you're welcome. >> i'm a anesthesiologist. i appreciate your wonderful photographs that you showed. there are statutes of corporate law who southerners believe discovered ether anesthesia all over the south. i'm not sure they were coincidental with the civil war, but certainly he's well recognized. but i also wanted to make my point is, america was known for yankee ingenuity, inventions, discoveries. in almost every field except medicine. when you compare what was known about scientific medicine in

america, in the 19th century and what was happening in europe, with great discoveries, foremost medical schools, centers of learning in england and france and germany and austria. america was way behind. it wasn't until well into the 20th century that scientific medicine really acquired its reputation. >> yes. yes. and that's an interesting phenomenon. it's been written about many times over and over again as to why that occurred. it is absolutely true what you just said. that science in america was underserved compared to how it was in europe. it's an interesting phenomenon. again, a subject that i'm interested in and i am writing something about currently. it went on for many years and it's -- america was a very raw country. despite the fact it's 1876 and 100 years later and we had the centennial celebration in washington, it was still a very raw and undeveloped country.

and that's just how it was. now, as far as crawford long who you mentioned, crawford long probably discovered anesthesia before anybody else. but, yes, he is the south's argument against the north's -- pardon? yes. yes. so he was an important individual. yes, doctor? >> would you comment on what, if any, was the influence of the french, especially the napoleonic medics? surprising we had nothing though it was well known in europe at that time. >> the flying ambulances the french started in the 1850s and 1860s did have an impact on the civil war in the sense that we began to have ambulances and we began to understand that you need to take care of soldiers who were injured and wounded on the battlefield. so the impact was there.

the specifics were not as if we use the specifics of their ambulances. the idea was there. so the answer is, yes, it did have an impact and would grow over the course of the 1870s and 1880s when the french became much more prominent with the flying ambulances. but, yes, it was there during the civil war. >> as we talk of civil war medicine, we often talk of just the north. >> yes. >> what about the south? >> well, the problem with the south, at least for me, and was that much of the southern medical records were destroyed in a fire. with sherman marching through and everything. so they were all destroyed. there are many people who write about the south. i just don't in particular, but the south has a very rich tradition relative to civil war medicine. as rich as what the north had. they did not have the information. much of this big bang t