Watercolor illustration from the 1860s of hospital gangrene. Hospitals, with their frequent and serious outbreaks of disease, could be as dangerous as battlefields. New York Public Library.
Many of the soldiers Keen saw at his Washington hospitals arrived not only ill or wounded but debilitated by poor nutrition and the harsh physical demands of campaigning. Keen was harrowed by the sight of sick soldiers. After the Second Battle of Bull Run he wrote: “I passed such a night as I had never before experienced in my life. Long trains of ambulances arrived, carrying our wounded from the field of battle. . . . Fifty poor, thirsty fellows were crying for water; fifty more were crying with the pain from a jolting ride [to Washington] of nine miles over a corduroy road. Most of them had had nothing to eat for one, two, or three days, save what they had obtained from the haversacks of poor fellows who were dead in their neighborhood. Some had such horrible wounds that they could absolutely go no farther, and must be got out on stretchers and taken into the hospital.”
Given the major role illness played in war, military strategy had to weigh the health of entire regiments; every soldier suffered diarrhea at least once, and many experienced dysentery. Patients at Keen’s hospital were fed a healthy, vegetable-rich diet. Calomel and opium were also favored treatments. He wrote later, “What we did not have in those days was almost more noticeable than what we did have. Among our blessings, however, were ether and chloroform. . . . We had, however, no antiseptics, for antisepsis was as yet even undreamed of.” He classified fevers as common, remittent, or intermittent, some of which accompanied dysentery or may have been symptomatic of typhus or typhoid, both of which flourished in the unhygienic camps. Keen prescribed quinine or cinchona for the fevers associated with both, just as he might have for malaria. Where Keen saw the most life-threatening respiratory disease, pneumonia (then recognized as an inflammation of the lungs), he may have prescribed tartar emetic or antimony, a therapy that became the focus of a controversy within the Union Army Medical Department.
Quinine proved the true medicinal miracle of the war. Malarial fevers were omnipresent during Southern campaigns, and the Union Army’s mandated prophylactic use of quinine prevented much illness, a benefit widely lauded by military commanders. Rosengarten and Sons, a major drug supplier to the Union Army in Philadelphia, excelled at producing quinine. The company employed French chemists versed in the techniques of isolating the alkaloid quinine, a process worked out 40 years before the war.
Hospitals were not always safe for patients. Keen worried about outbreaks of “hospital gangrene” owing to staphylococcus or other causes not known at the time. Gangrenous patients were immediately removed and isolated, and Keen may have ordered an effective treatment recognized during the latter part of the war: bromine. Mortality from these infections approached 97%. Worse than these diseases—from a military commander’s viewpoint—were epidemics. Yellow fever and smallpox epidemics afflicted both civilian and military populations in the North and South. Both armies required military recruits to be vaccinated for smallpox, but vaccine supplies were irregular and of uncertain quality. In the absence of vaccines some soldiers practiced the 18th-century technique of variolation, that of removing lymph from a smallpox-infected person and introducing it subcutaneously (with a knife) to others to engender a hopefully mild infection.