Catching up with Shauna Devine, historian of Civil War medicine

Shauna Devine, PhD is a Civil War historian and assistant professor at University of Western Ontario. Devine will speak about the transformation of American medicine during the Civil War at the Health Sciences Library at UNC-Chapel Hill on April 8 at 5:30 p.m. Devine recently published a book titled, “Learning From the Wounded: The Civil War and the Rise of American Medical Science” (UNC Press, 2014). In this interview, Devine will debunk several of the common assumptions made about medicine in the Civil War.

Catching up with Shauna Devine, historian of Civil War medicine click to enlarge Shauna Devine, historian of Civil War medicine

 Read more about Devine's upcoming lecture and the corresponding exhibit in the Health Sciences Library. 

Q: What do you think are the leading misconceptions about medicine in the Civil War?

A: When thinking about the challenges of doctoring in Civil War hospitals, it is important to understand that the war was incredibly overwhelming in its scope, and physicians were forced to deal with diseases and injuries that differed both quantitatively and qualitatively from their usual practice patterns in civilian life. Civil War doctors practiced tirelessly in the new general hospitals or temporary field hospitals; they treated the dying and wounded after horrific battles such as Antietam – where more than 23,000 men were either killed or wounded as a result of the one-day battle. From the beginning of the war, doctors managed the catastrophic wounds of battle, but an equally important objective of their practice was to arrive at new understandings of and ways of coping with the unfamiliar diseases that abounded in the camps and hospitals as the war raged well past the prophesied three months, which is a part of the story that has not been well integrated into the existing historiography.

The medical history of the war, captured in the letters, diaries, case histories, the medical and surgical specimens that were prepared, and the photographs of diseases and unique operations that were submitted to the new Army Medical Museum confirms the impression of a medical profession trying to learn, adapt, and develop wartime and American medicine.

Q: Where do you think the most misconceptions come from regarding war or specifically wartime medicine?

A: Certainly films and TV shows play a role. The viewer, when watching popular depictions of Civil War medicine often sees scenes of pure chaos, overwhelmed physicians, or characters begging to keep their limbs, or patients biting down on bullets to suppress the pain of an operation. I was also recently reading a newspaper article after one of the disasters abroad—and the author was discussing the inadequate medical treatment and suggested “it is no better than Civil War medicine.” While post-battle scenes were of course chaotic, this is only a small part of the larger story. It is a mistake to judge Civil War medicine or criticize the doctors for not applying the standards of medical knowledge today. In 1861 - 1865, Civil War physicians, many of which were the best in the country, actually applied the most up to date medical knowledge of the time.

3. What assumptions do you think consumers have about the medical care providers’ training and education?

Q: I think it is understood that a physician trained in America would have had some kind of formal education and have met at least a few basic standards. By the 1830s and 1840s medical standards had been lowered in response to the attacks on elitism and the professions in Jacksonian America and most states had abandoned licensing laws and state recognition of medical societies. The absence of legal regulations for medicine not only lowered educational standards but also encouraged the proliferation of competing sects, including unorthodox practitioners such as homeopathists, eclectics, and Thompsonians. On the eve of the Civil War, America was one of the most open medical centers in the Western world.

Perhaps more problematic, although there were numerous medical schools and societies in the country, most schools offered generally weak curricula, and societies were unlicensed and unlike the professional organizations common today. But while medicine as a whole might have been relatively weak, when the Civil War erupted in 1861, there was in fact an infrastructure in place that would support the improvements in American medical education and science that were just ahead. And once William Hammond was appointed Surgeon General he was able to begin the process of reforming military medicine quickly so that the medical developments that took shape during the war would and could reshape wartime medical practice.

Q: Many people imagine very primitive facilities and tools for medical purposes. What influence did Civil War facilities have on the transformation of medicine that occurred?

A: One of the most important new avenues to support this professional development was in the wartime hospitals. In America, urbanization and permanent hospitals had not developed at the same rate as in Europe, and physicians did not have significant hospital opportunities before the war. Until the Civil War, hospitals in America were small, private institutions, and hospital training was not considered essential or even important for most American physicians. The war changed all of this – medicine was no longer community medicine; soldiers were scattered throughout the United States. Laymen were not able to perform the necessary surgery that was often required after battle. And households were not able or equipped to manage the war convalescents, making the hospital necessary for a new class of patients and physicians. A huge national hospital system was created and many pavilion style hospitals were built – some of these hospitals (for example, Lincoln Hospital, Armory Square, Harewood, among others) were so large that they could accommodate as many as 140,000 patients. As Walt Whitman noted, they were like small cities. And, physicians clamored for the opportunity to work in the new hospitals, to gain clinical experience on domestic soil, instead of having to travel overseas.

Q: Without the technology of today, we assume that medical practitioners couldn’t easily or regularly share information or discoveries. Is this true?

A: One of the most important medical directives on the Union side came from Surgeon General William Hammond. On May 21, 1862 Hammond issued a circular letter simply called “Circular No. 2,” and shortly afterwards, “Circular No. 5” and these circulars did a number of important things: first, they provided for the establishment of the Army Medical Museum—a new social and physical location to study wounds and diseases. Secondly, they asked that physicians collect and dissect bodies and specimens and submit the results of their investigations to the museum along with a medical case report.

What I found most interesting about the case histories was that, many physicians realized early on that their limited knowledge of the body and disease was inadequate to care for the thousands of patients created by the war. But as the war went on and physicians gained experience performing surgeries or studying diseases, physicians shared this knowledge. They developed new ways to produce and record knowledge about the causes, treatment, management, and prevention of disease—and there was a conscious effort to learn and develop this knowledge. These case reports were widely shared, disseminated and discussed—at medical society meetings, at the Army Medical Museum, in Medical Journals, in the Medical and Surgical History of the War of the Rebellion, at public lectures and through private courses. Not only did physicians develop a strong identification with medicine and science particularly relating to practical instruction, diagnosis, treatment, but the dissemination of this medical knowledge was one of the most important educational legacies of Civil War medicine.

So while I think the perception that Civil War physicians were ill equipped to handle the medical challenges of the war is perhaps a correct assumption, particularly in those early months of the war, I think what is less well known is that physicians in fact adapted very quickly to the pressures of wartime doctoring, which is the story that I was interested in telling in my new book, Learning From the Wounded: The Civil War and the Rise of American Medical Science (UNC Press, 2014).