Army surgeons in front of a hospital tent in Petersburg, Virginia, 1864. Contrary to popular belief, most surgeries during the Civil War were performed under some kind of anesthesia—either ether or chloroform. Library of Congress.
The battlefield presented even more challenges. At Gettysburg, with almost 30,000 soldiers awaiting treatment, Keen probed a soldier’s gunshot wound near the upper shoulder and neck, trying to stop the bleeding. “The bullet had not emerged; its direction was unknown; the hemorrhage was profuse. . . . I etherized the man and proceeded to search for the wounded vessel.” Contrary to popular opinion, more than 95% of major Civil War surgeries were performed under ether or chloroform. Ether’s flammability, however, was yet another danger. “My only light was a square block of wood with five auger holes,” Keen continued, “in each one of which was placed a candle. . . . As the wound was so near the mouth, of course the light had to be near the ether cone [the mask placed over the patient’s face to receive the anesthesia]. . . . Suddenly the ether took fire and the etherizer flung away both cone and bottle. Luckily the bottle did not break or we might have had an ugly fire in a hospital constructed wholly of wood.”
The chief medical achievements during the war were organizational. Apart from the banning of mercury, wartime medicines underwent little change until germ theory became understood. At first physicians applied medicines based on their own observations of the results, which created different philosophies of medication. The huge demand for drugs during the war allowed physicians to investigate and study the effectiveness of their pharmacopoeia more systematically and created the infrastructure for large-scale drug manufacturing and testing. As the federal government operated processing laboratories, government support and testing gradually became more important. Quinine and its various forms were abundantly tested, and their value was confirmed.
The distance in time between the beginning of World War II and today is equivalent to the time between the end of the Civil War and the beginning of World War II—not so long, but distant in medical ideology and practice. Keen’s wartime practice heeded the holistic perspective demanded by medical director Jonathan Letterman, who pointed out “that the duties of Medical officers are not confined to prescribing drugs, but that it is also their duty . . . to preserve the health of those who are well. . . . The prevention of disease is the highest object of medical science.”
Keen himself, the only physician to serve in uniform in both the Civil War and World War I, participated in the transformation of American medicine and therapeutics into the 20th century. He eagerly embraced antisepsis and germ theory, kept current with such new technologies as X-rays, and abandoned counterproductive medicines. Recollecting the War of the Rebellion, as he called it, “Only too sharply do we remember the dreadful things that we did do and the good things that we did not dare to do."
Robert D. Hicks is director of the Mütter Museum and Historical Medical Library of the College of Physicians of Philadelphia.