Physicians generally relied on the Supply Table-the army’s standard table of drugs, their effects, and their preparation for use. Although Keen had a good knowledge of materia medica-pharmacy-the army’s organization of medicine might have impressed him with its diversity and complexity. The military had created a cadet corps, a comprehensive examination procedure, and a training school, and decided rank and assignments based on merit. Keen returned to the army to find the medical service invigorated. During the fall of 1861 he went to Philadelphia to complete his formal studies, which at that time required a year of anatomy classes, which was then repeated and followed by several years of apprenticeship with an established physician. On July 21, however, Keen was unable to benefit from these future developments. In addition, Civil War pharmacology produced competing therapies and bitter disagreements that brought the Union Army surgeon general to court-martial and established the position of one of the most versatile and effective medicines of the late 19th century: quinine. The demand for new chemical and botanical sources for medicines and for the production of reliable vaccines accelerated laboratory-based research and guided postwar pharmacology-including the growth of major manufacturing firms John Wyeth and Eli Lilly. A new system-of government-funded pharmaceutical research and manufacturing-had taken hold. The Medical Department could boast of an ambulance system, a sequence of care facilities from battlefield surgery to general hospitals, evacuation of the sick and wounded by train, and a nascent nursing profession. Beyond battlefield wounds, soldiers suffered malnutrition (including scurvy), dysentery, typhus, typhoid, respiratory illnesses, rheumatism, and outbreaks of malaria, yellow fever, and even smallpox (despite the prevalence of vaccination).īy the end of the war a radical reorganization of the medical field had occurred. Counting deaths from wounds or disease, the war claimed between 600,000 and 700,000 lives, more than the number of soldiers killed in all other American wars combined. Germ theory and antisepsis entered medicine only after the war. The soldier’s life may have been punctuated with combat terror, but disease and illness afflicted far more troops than did battlefield wounds. Soldiers with severe abdominal or chest injuries were left to die: no surgical intervention was possible without the sure consequence of infection. Battlefield hospitals were triage centers: stacks of amputated limbs marked the surgeons’ tents. In fact, the lack of infrastructure, particularly ambulances, meant that many Bull Run casualties waited for days on the battlefield before soldiers or civilians removed them to hospitals.Īt Bull Run, Keen received a crash course in misery. His experience typified the Federal government’s lack of preparedness in wartime. Had Keen received an adequate briefing before battle, he would still have been left frustrated with a medical infrastructure unchanged in its essentials since the Mexican War of the 1840s. Keen later wrote, “My experience in this battle is a good illustration of the utter disorganization, or rather want of organization, of our entire army at the beginning of the war.” Hearing that the Confederates were about to overrun the makeshift hospital, Keen’s patient, a soldier with a fractured humerus from a Minié ball (a powerful new rifled bullet), jumped up and ran for the woods, his bandage unraveling from his arm as he went. During the entire engagement, I never received a single order.” Inside a church he and fellow soldiers placed two boards on boxes in front of a pulpit for an operating table. “It was an exceedingly hot day, and we marched and halted in the thick dust under a broiling sun until about noon. Less than three weeks later, and with only nine months of medical training, Keen stood clueless, in his blue uniform with the green sash of a medical officer, near the battlefield at Bull Run in Virginia. A few months after the Civil War began, on July 4, 1861, a group of patriotic young volunteers stood in the shadow of the Capitol, waiting to be sworn into the Union Army on a 90-day enlistment.
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