Search Results for: )

From Our Partners: Base Hospital No. 30, One Hundred Years Later – Part Three: The Work of the Hospital

  By

~This post is courtesy Polina Ilieva, UCSF Archivist.

This is a guest post by Aaron J. Jackson, PhD student, UCSF Department of Anthropology, History and Social Medicine.

One-hundred years ago, the First World War raged into its fourth year. Millions perished in the conflict as the armies of the “civilized” nations applied industrial efficiency to the brutality of warfare. The first weeks of conflict in 1914 shattered traditional conceptions of war. While battlefield success once depended on the ability to field more and better-trained men, the machines of the modern age leveled numerical and soldiery advantages. These new weapons wreaked death and destruction on unprecedented scales and forced the survivors to dig defensive trenchworks that quickly stretched from the Alps to the English Channel along Germany’s Western Front. A deadly stalemate ensued as opposing armies attempted to cross the no man’s land between the trenchworks, often suffering enormous losses in futile assaults. The war became one of attrition and soon caught civilians in its machinations as the richest economies in Europe quickly drained their resources into supplying the war machine.

The entry of the United States into the war in 1917 promised a glimmer of hope for the Allies that they would finally be able to overwhelm the Germans, but it would take time for the enormous resources of the unscathed Americans to be brought to bear. Meanwhile, the Russian collapse in March 1918 presented the German High Command with an opportunity to break the stalemate and deliver a knockout blow before the Americans could fully mobilize by shifting more than fifty divisions of troops from the Russian frontier to the Western Front. The Kaiserschacht, or Spring Offensive, would be the largest German assault of the entire war, with more than three million soldiers poised to break through the Allies’ lines and force a peace on German terms.

Figure 11 – Group photo, nurses and soldiers, World War I.

Meanwhile, the men and women of U.S. Army Base Hospital No. 30—the University of California School of Medicine Unit—arrived in France with the expectation of providing expert medical care to the soldiers wounded on the front lines. The hospital unit ostensibly formed before Congress officially declared war on April 6, 1917, and they spent more than a year gathering supplies and personnel, raising funds, navigating the Army bureaucracy, training in the latest medical techniques and military drills, and traveling to France where they expected to set up a hospital and get to “the work” of caring for the wounded. What they found in France, however, was the Herculean task of converting an ancient resort town in the Auvergne Mountains into a modern hospital.

This entry, the third of four planned posts, will cover “the work” of Base Hospital No. 30. After the arrival of the first patient train in June 1918, hospital personnel worked around the clock caring for thousands of sick and wounded soldiers—many of them surgical cases—right through the Armistice of November 11, 1918. These stories are derived primarily from materials kept at the UCSF Archives & Special Collections at the Parnassus Library in San Francisco, and it is with great appreciation to the archival staff there that I write about the experiences of the men and women of the University of California School of Medicine in the Great War. If you have not read them yet, please take a moment to read Part One: Organization, Mobilization, and Travel and Part Two: France for the context they provide.

Figure 12 – Fighting in Belleau Wood.

The German army began the Kaiserschlacht in March 1918 with a massive artillery barrage, dropping more than one million heavy shells on the Allies’ trenches followed closely by lightning-fast stormtrooper assaults to break through opposing lines and create gaps that could be exploited and held by masses of infantry. This strategy allowed the Germans to break the stalemate that had dominated the Western Front since late 1914 and gain ground. They repeated their process in five separate assaults between March and July, gaining enough ground to put Paris under threat.

By June, as the offensive approached the Marne River, American troops including elements of the U.S. Marine Corps rushed to form defensive lines to hold back the Kaiser’s troops at Belleau Wood near Chateau-Thierry. As the Marines dug hasty defensive positions, retreating French troops warned them of the coming Germans and encouraged the Marines to fall back to better ground.

“Retreat? Hell! We just got here!” replied Captain Lloyd W. Williams of the 2nd Battalion, 5th Marines. Fighting from hastily-dug, shallow fighting positions, the Marines took advantage of an 800-yard long wheat field and their training as expert riflemen to halt the German advance and force the Kaiser’s forward elements to dig their own defensive positions in Belleau Wood and the nearby town of Bouresches. Having stalled the Germans, the Americans knew that they had to counterattack before the Germans could dig in too far.

On the morning of June 6, 1918, the Marines charged across the knee-high wheat fields separating them from the entrenched Germans. As they ran, German machineguns opened up, cutting down the charging Americans like the wheat through which they ran. German artillery rained down on the Marines with the high explosive shells shaking the ground and shattering bodies. Despite heavy losses, the Marines managed to reach the edge of the woods and the outskirts of Bouresches before their assault finally stalled, but they paid a heavy price. It was the costliest single day of fighting in the history of the Marine Corps to that date as 228 men gave up their lives and another 859 suffered wounds. And the fighting was far from over.

Over the subsequent twenty days, the Marines fought so fiercely to dislodge the Germans from Belleau Wood that they earned the nickname Teufel Hunden or “Devil Dogs” from their German opponents. The fighting was often hand-to-hand with artillery splintering the trees and filling the air with deadly wooden splinters in addition to shrapnel. Desperate to halt the American advance, the Germans deployed mustard gas, a chemical weapon that painfully blisters the skin, burns the eyes resulting in blindness, and inflames the lungs making breathing impossible if inhaled. As many as 2,000 Marines fell victim to the gas. By June 26, when the Marines finally secured Belleau Wood, they had suffered 1,811 killed and 7,966 wounded.

Figure 13 – Evacuating the Wounded.

The wounded began a journey through a tiered system of medical care established by the Army. The first stage consisted of regimental aid stations located just behind the front lines. Those who were able to do so walked to these stations while stretcher bearers carried the rest. Medical corpsmen and the occasional doctor would dress their wounds, send superficial cases back to the front lines, and coordinate the evacuation of the seriously wounded by motorized ambulance to the clearing stations and field hospitals located further behind the lines.

The field hospitals and clearing stations, while out of range of small arms fire, were often still within range of enemy artillery and aircraft. Despite these hazards, teams of nurses, doctors, and surgeons worked to stabilize their patients, clean their wounds, and prepare them for evacuation to the base hospitals located well out of danger. It was at these facilities that nurses would flush the eyes of gas attack victims with saline solution and surgeons would perform emergency surgeries under extreme conditions, often lacking proper supplies. The wounded who could be stabilized enough for the trip would then be loaded onto hospital trains for the journey to base hospitals like Base Hospital Thirty at Royat, five-hundred kilometers away from the front at Chateau-Thierry.

Figure 14 – The Hospital Trains.

When the first hospital train arrived at Base Hospital No. 30 on June 12, 1918, the hospital was not yet operational as the main kitchen installation was incomplete. Thankfully, the 360 patients aboard that first train were primarily convalescents who were able to help complete the preparations in time for the second train’s arrival on June 17. This second train held 461 seriously wounded patients from the fighting near Belleau Wood. Captain Earnest H. Falconer, Medical Corps (MC), described the scene for posterity in the pages of The Record:

On June 17 a train arrived in two sections, containing many gas cases…. These cases had been gassed on June 14. Many of them had severe skin burns, some comprising as much as one-eighth to one-half the total skin surface. In the more superficial burns the skin was a dusky purplish to reddish purple hue. The deeper burns were pale, translucent, edematous, with many blisters. In most cases serum was drained from blisters. The serum from these blisters was very irritating to the skin of the hands of the dressers, causing in some cases a mild dermatitis to be set up…. Nearly all these cases had burns on the scrotum and penis, which were painful and very slow healing. Also nearly all the cases had burns of the lids and conjunctiva, with occasional burns of the face and scalp. Many cases of bronchopneumonia were already present when the patients were admitted, and a number of these cases developed shortly after admission. These cases were nearly all fatal…. The cases with superficial burns healed for the most part very slowly. New skin formation progressed slowly, and the crusts that formed invariably contained pus beneath them.

Base Hospital Thirty consisted of 25 officers (all physicians), 65 nurses, and about 150 enlisted corpsmen. By June 18, they were treating 821 wounded soldiers, many requiring extra attention due to the nature of their injuries. The staff worked continually performing surgery, cleaning wounds, and feeding the patients, all the while continuing their efforts to improve the hospital’s infrastructure. Thankfully, the surgical cases in the first two trains were less taxing because their wounds had been debrided of foreign objects and dead and damaged tissue at the clearing stations and field hospitals. Amputations were dressed but kept open, allowing hospital staff to manage the healing process and maintain an aseptic wound environment. This was achieved through the Carrel-Dakin method, which involved applying diluted chlorine and bleach solution to wounds and dressings to prevent infections. It must have been an excruciating experience for the patients, but it worked to prevent deadly infections in the era before antibiotics.

Unfortunately, not all patients arrived in similarly good conditions. A train on August 21 contained men who had been kept in the clearing stations as medical professionals attempted to stabilize them enough for travel. They arrived with infected wounds requiring extensive debridement, additional surgery, and the occasional re-amputation of a limb to establish aseptic wound environments.

After the arrival of the first trains in June, hospital staff worked around the clock for months on end. Patient trains would arrive, usually and preferably with some notice, and the wounded would be carried by stretcher into the hospital and sorted. Surgical teams worked continuously, often without the aid of the x-ray machines for a want of electric power. The laboratory was similarly handicapped, making diagnosis and treatment that much harder for physicians. Nurses worked tirelessly to clean wounds, dole out medications, fill out charts, and keep a clean and ventilated environment. Corpsmen carried patients up several flights of stairs to their rooms, hauled water in buckets for want of proper plumbing, cooked meals in the kitchens and delivered them to non-ambulatory patients’ rooms, removed waste from the rooms, made new batches of Carrel-Dakin solution, worked to improve the plumbing and heating in the old hotels, loaded and unloaded hospital and supply trains, and somehow found a way to help keep the streets of Royat clean and the hotel cesspools from overflowing. There was so much work that ambulatory patients were conscripted to assist. And just when the hospital appeared to find its rhythm, events found a way to throw it off.

Figure 15 – The Influenza Pandemic of 1918.

On September 22, 1918, when the hospital was near full capacity, a train full of French patients arrived in the middle of the night without prior notice. Due to the hour, the hospital staff decided that the best course of action was to distribute the new patients throughout the hospital wherever a spare bed could be found. Unfortunately, they discovered that practically all the new patients were suffering from acute respiratory infection. Distributing them through the hospital into crowded rooms exposed other patients as well as the staff to infection.

By the end of September, as many as 40 of the 150 enlisted men assigned to Base Hospital No. 30 had to be hospitalized themselves, and many officers and nurses were also afflicted to a milder degree. Five corpsmen and one officer died from their infections, and as the epidemic spread among neighboring units, the hospital’s local admissions amounted to between 30 and 70 new patients a day. Making matters more difficult, the hospital’s laboratory officer and his assistants fell ill, necessitating a suspension of investigative work on the mysterious disease. Autopsies of the first victims indicated the cause of death to be pneumonia developed as a complication following a likely infection of influenza. The hospital staff could do little to combat the contagious disease other than to reorganize the patients to attempt to hinder its spread.

While Base Hospital Thirty dealt with its share of the Influenza Pandemic of 1918, they received orders to expand the hospital to accommodate anticipated casualties from the ongoing Allied counteroffensive. The Germans’ kaiserschlacht floundered in July and the Allies, their numbers and supplies flush with fresh American troops and materiel, had been pushing the Germans back ever since. Base Hospital No. 30 officers examined potential sites for expansion in Royat and completed leases for new buildings in September. They established another surgical unit and moved their administrative offices into the Royat Palace Hotel on September 26. The new buildings allowed them to finally abandon the old “dungeon” kitchen in the Continental hotel and create a new kitchen in the Grand Hotel, which did not have the Continental’s cesspool problems. The new space also allowed for the creation of a dedicated ward for respiratory and enteric cases, freeing up space in the already-established portions of the hospital for surgical and bed-ridden patients.

Figure 16 – Patient wards at Base Hospital No. 30 in Royat, France, 1918-1919.

The hospital also expanded beyond adding new wards. Corpsmen built warehouses near the rail head to ease the burdens of transferring supplies and coal bunkers to provide a consistent fuel supply for heating the hospital as the days and nights grew colder. The Army assigned more corpsmen to the hospital staff, and the officers organized a small local labor force to help keep up with waste, garbage, and maintenance concerns. Perhaps the most welcome addition to the hospital’s roster was a section of Army engineers to finally improve the hospital’s water, sewer, and electrical supplies. Corpsmen would no longer have to haul buckets of water up stairs or worry about overflowing cesspools, allowing them to do the work for which they trained, and there was plenty of that to go around. By the end of September 1918, Base Hospital No. 30 had roughly 30 physicians, 60 nurses, and 250 corpsmen to take care of a 2,400-bed facility, and the combination of the war and pandemic ensured that the hospital continued to operate near capacity. Beyond the work in Royat, the UC Medical School unit also contributed surgical teams to support the effort of stabilizing the wounded near the front lines. Two such teams, each consisting of two surgeons, two nurses, and three corpsmen, set out for the front lines to work in field hospitals to provide surgical intervention to wounded men, often within only a few hours of their injuries.

Figure 17 – Members of Surgical Team 50: Weeks, Woolsey, Dunn & Ireland.

Surgical Team No. 50 was commanded by Lieutenant Colonel Alanson Weeks, who once played fullback for the undefeated 1898 Michigan Wolverines before moving to San Francisco to become a surgeon. Alongside Captain John Homer Woolsey, Nurses Agnes Dunn and Alta Ireland, and three enlisted men, Weeks set out for the front lines on June 6, 1918. The team arrived at the American Red Cross Hospital at Juilly (today on the northeast outskirts of Paris) at 3 p.m. on the 7th and his team was immediately assigned to an operating room and remained in surgery until 8 o’clock the following morning.  Dr. Weeks recalled the experiences of the team’s time at Juilly in The Record:

The wounds were very severe in type, many fractures and a high percentage were infected with “gas” bacilli. There were also 300 “gassed” cases who were first treated at this hospital. The sight of these gassed men, lying on stretchers and filling the entire courtyard—blinded, hacking, begging for water, for protection from the sunlight for their sensitive eyes, and for something to relieve their pain—gave all of us a craving desire to meet the Hun and kill. June 16 saw the end of this tremendous rush of wounded…. The Team operated for the most part at night and during its watch cared for all neurological cases and approximately a total of 240 wounded.

Surgical Team Fifty specialized in neurological cases, of which there were many. Due to the nature of trench warfare, headwounds were frighteningly common as the soldier’s head was usually the only part of his body exposed to enemy fire. But like all surgical teams, No. 50 dealt with all types of cases as they came in, often without much notice. Victims of gunshots, artillery shrapnel, high explosive shock, chemical weapons, and even bayonet wounds were common sights, and the work kept coming. The seventeen-hour shift the team worked on its first day at Juilly would become routine until the team returned to Base Hospital Thirty in late October.

Before Surgical Team No. 50 could return, Base Hospital No. 30 sent out another surgical team, No. 51, under the command of Major Herbert S. Thomson on September 10 to support the evacuation hospital at Toul, near Nancy to support the St. Mihiel offensive. Accompanying Dr. Thomson was Captain Homer C. Seaver, who had graduated from the University of California Medical School only weeks before deploying to France, along with nurses Adelaide Brown and Kathleen Fores and three corpsmen.

Shortly after arriving at Toul, Surgical Team Fifty-One was put to work and faced similar working conditions to their predecessors, working seventeen out of the first twenty-four hours. They only saw the most serious cases and had no opportunity to follow up on their patients. As soon as they finished working to stabilize one patient, orderlies would take him off the table and another patient would take his place. The pace of work and long days coincided with the military offensives as the team worked sixteen- or seventeen-hour shifts for a week during the St. Mihiel offensive. During the space between assaults, the teams often found themselves traveling to a new front to support a new offensive.

Imagine graduating medical school and within a matter of weeks finding yourself working 16-hour days, seven days a week, doing nothing but intensive surgery on the most severe trauma cases imaginable and not being able to follow up on the results of your work because there are so many patients waiting—and literally dying in the process—for you to save their life. Such was the medical residency of Dr. Homer C. Seaver.

Figure 18 – The Meuse-Argonne Offensive, September 26 – November 11, 1918.

In October, Surgical Team No. 51 received orders to support the offensive into the Argonne Forest. The fighting there resembled Belleau Wood. The Germans had been beating a slow retreat since June, but now that their homeland was imperiled for the first time of the war, they turned and fought hard. In his account of the event for The Record, Major Thomson described the work in the Argonne:

We were ordered from Toul to the Argonne Forest on October 8 and received transportation by ambulances to Evacuation Hospital No. 14, situated in the Argonne Forest near the village of Les Islettes. This hospital was situated in the heart of the Argonne Forest near the line of American advance and in a country that had been completely destroyed by the Germans in their former campaign. The hospital was entirely under canvas except for a small chateau which housed the nurses and senior officers. This country was very wet; it rained nearly every day and there was mud everywhere. The operating tent was pitched on the ground and for the first few days there was considerable mud on the operating room floor. In order to go from the operating room to the wards, one had to wade through about six or eight inches of mud. While at Les Islettes, the Team was busy all the time, working on the twelve-hour shift. There never was a time when anyone had a breathing spell as the triage was always filled with patients and there was frequently a line of ambulances waiting in the road. At this hospital, only the seriously wounded were treated and there was a very large number of gas infections. Many times, patients were brought in from two or three days after being wounded and a patient was rarely operated on within 15 hours of being wounded. At this hospital, we were near the German lines and were treated to the spectacle of anti-aircraft guns shooting at the German planes and could always see the observation balloons over the forest to the north. It was difficult to get supplies in this region and the hospital was rather poorly equipped. On the 25th of October the Team was ordered to return to Base Hospital Thirty.

Thus, the work of Base Hospital No. 30 continued throughout the long months from June to November 1918. Their commemorative book The Record demonstrates just how busy “the work of the hospital” really was by its absences more than its inclusions. The pages of The Record are filled with pictures from the hospital unit’s early days of organization, its travels to France, and its struggles to transform a resort town into a modern hospital. But it only includes a few pictures of “the work.” Perhaps this absence is due to the fact that everyone was too busy caring for their charges to be able to take pictures or jot down notes for posterity. Or perhaps the absence marks a time in the history of Base Hospital No. 30 that needed no commemoration in something like The Record because those who were there remember it well. Perhaps both possibilities are true.

Figure 19 – Armistice Declared, November 11, 1918.

Regardless, when the Armistice went into effect on the eleventh hour of the eleventh day of the eleventh month, and while the world breathed a sigh of relief at the end of the fighting, “the work of the hospital” at Base Hospital No. 30 and other hospitals throughout Europe and the United States continued at a frantic pace. For weeks, wounded men would continue to pour in to Royat.

This concludes Part Three: The Work of the Hospital. One part yet remains in the tale of the remarkable men and women of Base Hospital Thirty. In the final part of this series, we will take a closer look at some of the remarkable people who carried out that work, how they came home again, and what happened to them after the war.

In the meantime, I want to take the opportunity to encourage you to take a moment and visit the collection at the University of California San Francisco’s Parnassus Library in the Archives and Special Collections to read more about the incredible men and women who made up the University of California Medical School Unit in the First World War.

Figures:

11 – “Group photo, nurses and soldiers, World War I,” circa 1917, Mount Zion Photo Collection: Historical Life, UC San Francisco, Library, UCSF Medical Center at Mount Zion Archives, Calisphere, https://calisphere.org/item/ark:/13030/c8028ttx/, accessed July 29, 2018.

12 – Georges Scott, “American Marines in Belleau Wood,” circa 1918, Illustrations, Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Scott_Belleau_Wood.jpg, accessed July 29, 2018; and George Matthews Harding, “Rounding Up German Prisoners,” July 1, 1918, War Department AF.25747, Smithsonian National Museum of American History, http://americanhistory.si.edu/collections/search/object/nmah_448013, accessed July 29, 2018.

13 – Wallace Morgan, “U.S. Medical Officers,” circa 1918, War Department AF.25791, Smithsonian, http://americanhistory.si.edu/collections/search/object/nmah_448030, accessed July 29, 2018; George Matthews Harding, “First Aid Station with American Wounded,” circa 1918, War Department AF.25742, Smithsonian Museum of American History, http://americanhistory.si.edu/collections/search/object/nmah_448015, accessed July 29, 2018; and Wallace Morgan, “Dressing Station in Ruined Farm,” July 19, 1918, War Department AF.25767, Smithsonian Museum of American History, http://americanhistory.si.edu/collections/search/object/nmah_448052, accessed July 29, 2018.

14 – “Loading and unloading patients during World War I,” circa 1917-1919, Base Hospital #30 Collection, UC San Francisco, Library, University Archives, Calisphere, https://calisphere.org/item/d3c4b7a0-ec00-4a29-99bf-b3157799718a/, accessed July 29, 2018.

15 – “The influenza ward at Walter Reed Hospital during the Spanish flu pandemic of 1918,” and “St. Louis Red Cross Motor Corps personnel wear masks as they hold stretchers next to ambulances in preparation for victims of the influenza epidemic in October 1918,” Library of Congress.

16 – “Surgical ward, an average size room, Hotel Metropole,” circa 1918, Base Hospital #30 Collection, UC San Francisco Library, University Archives, Calisphere, https://calisphere.org/item/ad3fa9c8-8d7e-4068-917f-47c7e4217154, accessed July 29, 2018; and “Surgical ward, German war prisoners, Royat Palace,” circa 1918, Base Hospital #30 Collection, UC San Francisco Library, University Archives, Calisphere, https://calisphere.org/item/69deaae8-23af-4dd4-8092-19237319153d, accessed July 29, 2018.

17 – “Alanson Weeks in uniform,” circa 1917-1919, Woolsey (John Homer) Papers, UC San Francisco Library, Special Collections, https://calisphere.org/item/5d2ca217-a521-4573-b693-0610c6019ac3, accessed July 30, 2018; “John Homer Woolsey in uniform,” circa 1917-1919, Woolsey (John Homer) Papers, UC San Francisco Library, Special Collections, https://calisphere.org/item/ceae074e-bff0-42a2-890b-b819e0480062, accessed July 30, 2018; and “Misses Dunn and Ireland leaving Clermont-Ferrand,” 1918, Woolsey (John Homer) Papers, UC San Francisco Library, Special Collections, https://calisphere.org/item/f187f041-1911-4aa9-aa26-be3a96d813aa, accessed July 30, 2018.

18 – “Soldiers of Headquarters Company, 23rd Infantry Regiment, 2nd Infantry Division, firing a 37mm gun during the Meuse-Argonne offensive,” 1918, U.S. Army Photo; Lester G. Hornby, “Argonne-Meuse 1918,” 1918, US Army Art Collection.

Guest Posts: ““A Mind Prostrate”: Physicians, Opiates, and Insanity in the Civil War’s Aftermath”

  By

Front page of Volume 21 of the American Journal of Insanity

~Jonathan Jones is a 2017-2018 Research Fellow and is a Ph.D. Candidate in History at Binghamton University. We would like to extend our thanks to him for permission to repost this piece.

Dark rumors of Civil War veterans’ addiction to morphine and opium riveted Americans during the Civil War’s aftermath. Many observers believed the so-called “morphine habit” was a kind of “insanity” to which veterans were particularly susceptible, made so by the dangerous medical practices of Civil War military physicians that exposed soldiers to addictive opiates during and after the war. As one addicted veteran explained in his 1876 memoir, opiates left an alarming number of the Civil War’s survivors with “a mind without elasticity or fertility – a mind prostrate.”[1] “The evil is like an epidemic,” reported another author in 1878. “It is in the atmosphere.”[2]

My dissertation, “‘A Mind Prostrate’: Physicians, Opiates, and Insanity in the Civil War’s Aftermath,” is the first full-length investigation of the Civil War-era opiate addiction epidemic. I argue that opiate addiction cost addicted veterans dearly because the condition was stigmatized and gendered, seen by many Americans as a vice afflicting the insane, the effeminate, and those lacking self-control. Opiate addiction therefore left addicted veterans emasculated and stripped of entitlements like pensions, and for these outcomes veterans and their families blamed the medical profession. Veterans’ opiate addiction—and in particular iatrogenic, or, physician caused addiction—therefore threatened the credibility of the American medical profession, compelling physicians to embark on a constellation of progressive reforms intended to end the addiction crisis while bolstering “regular” medicine’s standing in the public eye.

My research utilizes unpublished, underutilized records of physicians, hospitals, asylums, and pharmacies in conjunction with recently digitized medical journals to investigate the opiate crisis. The Civil War-era medical manuscripts held by The College of Physicians of Philadelphia, Yale University libraries, and the American Philosophical Society, which I visited in as a CHSTM Research Fellow in 2017-18, made inimitable contributions to the evidentiary base of my dissertation. These manuscripts both allowed me to test my preliminary dissertation findings, and molded my argument in exciting new directions.

Historians have recognized the iatrogenic origins of Civil War veterans’ opiate addiction since the 1970s.[3] Yet no full-length studies of the Civil War-era opiate addiction crisis exist, and the few articles on the subject rely merely upon impressionistic sources. Anecdotal evidence suggests that Civil War military surgeons doled out opiates for pain and sickness by the syringe-full. For example, one Union army doctor sheepishly admitted in 1866 that during the wartime years he relied upon opiates “as an all-healing panacea, which in all quantities always does good, and can never do harm.”[4] Consequentially, military doctors fell under a wave of criticism after the war, blamed by members of the public for causing veterans’ addiction by overprescribing addictive opium and morphine for pain and sickness. Historians often replicate this criticism. A trope routinely invoked in the historiography of Civil War-era medicine is that of syringe-wielding army surgeons, who inadvertently caused an epidemic of opiate addiction through medical carelessness or ignorance.[5]

Such analyses clearly indicate physicians as the source of many veterans’ addictions, but reveal little about how the personal consequences of addiction for veterans, or how doctors attempted to resolve the ensuing crisis. Historians’ understanding of the Civil War-era opiate addiction epidemic is therefore one-dimensional. The iatrogenic origin of veterans’ opiate addiction is clear, but not the aftermath. Consequentially, we still know very little about the personal costs of opiate addiction in the Civil War-era or the systematic medical responses to the opiate addiction epidemic—gaps in our knowledge with particular resonance as the American medical community grapples with today’s opioid epidemic.

Several questions in particular remain unanswered. Did physicians realize opiates were addictive before the addiction epidemic began? If so, why did doctors continue to prescribe the drugs? What did opiate addiction, which was stigmatized and gendered, cost veterans at a personal level? How did physicians respond to criticisms after the Civil War that doctors were the culprits behind opiate addiction? What measures did physicians take to rectify the opiate addiction crisis? How did the episode affect the trajectory of American medicine? Without answers to these questions, historians’ view of opiate addiction in the Civil War era is opaque. This lack of clarity obscures our view of what Civil War-era Americans saw clearly: veterans’ opiate addiction and the medical community’s responses to it lie at the very heart of the medical legacy of the Civil War.

This juncture is precisely where spending time working in the collections of Consortium members benefited my research. Before setting out the CHSTM members’ archives, my preliminary dissertation research suggested answers to these enduring questions. Analysis of Civil War-era medical journals—only digitized in the past few years by the Medical Heritage Library—reveals that physicians proposed radical, innovative measures during the 1860s, 1870s, and 1880s in order to resolve the opiate addiction epidemic and mitigate the erosion of physicians’ reputation brought upon by the crisis.[6] Foremost among these measures, in an effort to end the opiate crisis through professional self-regulation, young, elite ex-Union army physicians called for their colleagues to prescribe fewer opiates, substitute them with less-addictive painkillers, and even ban opiates altogether. Proponents of these measures hoped they would result in less iatrogenic opiate addiction. These were truly radical proposals, considering that opium and its derivatives were some of the nineteenth century’s most important and widely-used drugs, beneficial not only as painkillers but also as medicines for everything ranging from diarrhea and cough to lockjaw and rabies. Additionally, physicians sought to “medicalize” opiate addiction by treating it as a disease of the body, rather than a moral failing, breaking with antebellum precedent. To this end, they encouraged addicted veterans to avoid asylums, which were associated with moral and mental degeneracy, and instead enter specialized medical facilities called “inebriate clinics.” These clinics—which we might consider to be the first American drug rehabilitation centers—offered innovative medical treatments for addiction, such as physician-supervised withdrawal and drug replacement therapy.

But how readily did ordinary physicians actually accept and implement the radical reforms proposed by their elite counterparts? This remains an open question because published medical journals, my primary sources before hitting the archives, speak mainly to medical theory, not practice. They cannot conclusively indicate how proposed reforms were actually enacted in post-Civil War clinics, asylums, hospitals, and pharmacies. To this end, the Civil War-era medical manuscripts in the collections of The College of Physicians of Philadelphia, Yale University’s libraries, and the American Philosophical Society will go a long way resolve this limitation in my initial research. Daybooks, account ledgers, and prescription logs kept by both military and civilian physicians working in clinics, hospitals, and asylums throughout the period contain a wealth of medical data that would allow me to test my preliminary findings. Yet despite their value, these sources are severely underutilized by historians of the Civil War era, who have traditionally employed narrative texts like letters, memoirs, and military reports to study Civil War-era medicine.

These manuscripts contain quantitative data that enabled me to test my preliminary findings. The College of Physicians of Philadelphia’s large collection of Civil War-era physicians’ daybooks, ledgers, case notes, and medical school lecture notes were particularly useful toward this end. I employed manuscripts like the William W. Rutherford and A. T. Dean Account Books to quantify the conditions for which doctors prescribed opiates before and after the Civil War, paying close attention to changes over time. By 1861, the beginning of the Civil War, American doctors employed opiates for approximately 140 unique medical conditions. During the addiction crisis many doctors called for the profession to move away from the widespread prescribing of opiates, and this number plummeted. Other manuscripts, such as the William L. Du Bois Prescription Records, indicate that the opiate prescription rate declined from an antebellum high of over fifty percent to a mere sixteen percent by 1876, a decade after the opiate addiction epidemic began.[7] These patterns suggest that at least some reforms proposed in medical journals to resolve the opiate addiction crisis were disseminated in practice to ordinary practitioners, confirming aspects of my preliminary dissertation research.

My time as a Research Fellow also spurred my dissertation research in new, exciting directions. While working at Yale’s Medical Historical Library, I stumbled across a stash of pamphlets and advertisements for patent medicines marketed to addicted people as “cures” for opiate addiction. As I thumbed through these manuscripts out of curiosity, the language in which opiate addiction cures were marketed captivated me. I came to realize that patent medicine proprietors were not simply selling medicinal “cures” to addicted veterans. Instead, advertisements were also selling veterans a way to redeem their masculinity from opiate addiction. Patent medicine proprietors intentionally marketed their wares in the language of masculinity because they understood that addicted men, including veterans, were emasculated by opiate addiction. To Civil War-era Americans, opiate addiction signaled femininity, physical weakness, and, most of all, unnatural dependence—all antithetical to Victorian manhood. Redeeming one’s masculinity by ending a man’s “slavery” to opiates, as doctors often described addiction, was thus a major selling point for patent opiate addiction cures. For example, Samuel B. Collins marketed his “Painless Opium Antidote” using testimonials from veterans who supposedly cured their opiate addictions by way of Collins’s wares. Byron McKeen, a Confederate veteran from Galveston, Texas testified in 1872 that Collins’s Painless Opium Antidote that “now, I feel myself no longer a slave, but a free man.”[8]

Without the opportunity to visit the archives of consortium members, I would not have had access to the William W. Rutherford and A. T. Dean Account Books, the William L. Du Bois Prescription Records, or Samuel B. Collins’s patent medicine advertisements. Ultimately, by providing access to medical manuscript collections of Civil War-era physicians’ daybooks, account ledgers, prescription registers, and patent medicine advertisements, a CHSTM Research Fellowship allowed me to verify my initial dissertation findings and to pivot my research in exciting new directions.


[1] Unknown, Opium Eating: an Autobiographical Sketch by an Habitué (Philadelphia: Claxton, Remsen, and Haffelfinger, 1876), vii.

[2] “The Opium Habit: Some extraordinary Stories of the Extravagant Use of the Drug in Virginia–Correspondence of the Cincinnati Inquirer,” The New York Times (March 2, 1878), 2.

[3] A point made most prominently by: David T. Courtwright, “Opiate Addiction as a Consequence of the Civil War,” Civil War History 24, no. 2 (June 1978): 101-111.

[4] Anonymous, “Editorial,” Buffalo Medical and Surgical Journal V (1865-1866), 34.

[5] An illustrative example is James McPherson, Battle Cry of Freedom: The Civil War Era, 1st Ballantine Books ed., Oxford History of the United States vol. 6 (New York: Ballantine Books, 1989), 486-87.

[6] Available via the Medical Heritage Library’s database “Historical American Medical Journals,” http://www.medicalheritage.org/content/historical-american-medical-journ….

[7] Antebellum rates in John Harley Warner, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885 (Cambridge, Mass.: Harvard University Press, 1986), Table 1 and Table 2.

[8] Theriaki: A magazine Devoted to the Interests of Opium Eaters, 1 no. 1 (July 1872), 53.

Tagged   

Images from the Library

  By

Check this out: The “Ui Breasail” home recipe cookery book, published in 1910 in Dublin, Ireland, during the heyday of what is often called the “Irish Renaissance” (alternately, the “Celtic Twilight”).

The advertisements as well as the recipe write-ups put this book squarely in the Irish-Ireland movement, a fascinating mixture of home rule politics, nationalism, and a drive towards turning Ireland’s culture inwards. “Ui breasail” translates roughly to “Hy Brasil or ‘The Blessed Isle,” a land akin to Atlantis with which Ireland was occasionally identified, supposed to be the home of eternal life among other things. Interestingly enough, flipping through the advertisements at the front of the book shows plenty for goods and services from England: fish from Grimsby, “Dr Ridge’s Food” from London, “W & G Foyle,” booksellers from London, but the vast majority are for businesses in Dublin or Belfast: the Army and Navy Stores, the Royal Irish School of Art Needlework (being “Irish-Ireland” was not necessarily a reason to avoid the “Royal” label, although it could be), Carson’s Paints, electrolysis in Ballsbridge, and a laundry in Rathmines.

This single volume is practically a case study in a key moment in the development of modern Ireland and the recipes are wonderful: learn how to make ‘beef olives’ two different ways! vegetarian puddings! queen cake and plum bread!

From Our Partners: ““FACTS AND INFERENCES”—DIGITIZING SHADOWS FROM THE WALLS OF DEATH PART 1”

  By ,

NLM has digitized and made publicly available for the first time, one of four known copies of Shadows from the Walls of Death: Facts and Inferences Prefacing a Book of Specimens of Arsenical Wall Papers, 1874. In this three-part series learn more about the origins of this rare book, the digitization effort, and the arsenic pigments of the 19th century.

By Krista Stracka ~ Krista Stracka is a Rare Book Cataloger for the Rare Books and Early Manuscripts Section in the History of Medicine Division at the National Library of Medicine.

In a digitization workflow, the assessment of the physical condition of each book is a critical step to determine whether its fragile pages can withstand the rigors of scanning without damage. However, for one book in the NLM collection, these considerations also had to be flipped. Aside from a random paper cut, what if the book itself could potentially harm the person scanning each page? Contained inside the binding of the rare but increasingly popular Shadows from the Walls of Death: Facts and Inferences Prefacing a Book of Specimens of Arsenical Wall Papers are 84 samples of wallpaper sheets colored with arsenical pigments. In appreciation of North American Occupational Safety and Health (NAOSH) Week, this three-part series will provide a behind-the-scenes look at actions that were taken by NLM staff to safely scan this curious book (now available online) and the hazardous pigments contained inside.

Faded printing on green paper gives the title of the book, author and additional information.
Detail of the original cover of Shadows from the Walls of Death: Facts and Inferences Prefacing a Book of Specimens of Arsenical Wall Papers, 1874
National Library of Medicine #0234555

The inclusion of these pigments was intentional, as you may have guessed by the dramatic title. Published in 1874, Shadows from the Walls of Death was written and compiled by Dr. Robert C. Kedzie to raise awareness about the beautiful yet toxic pigments used by many wallpaper manufacturers. Shadows from the Walls of Death is composed of a letter of introduction issued by the Michigan State Board of Health and an eight-page preface by Dr. Kedzie, the Chairman of Committee on Poisons, followed by over 80 arsenical wallpaper samples. Dr. Kedzie purchased these samples from leading dealers in Lansing, Detroit, and Jackson to compile 100 copies that were then distributed to public libraries in the state of Michigan. Out of concern for patron health, most copies have been discarded or destroyed and only four are known to exist today. The National Library of Medicine’s copy was sent in 1874 to John Shaw Billings, who was then serving as director of the Library of the Surgeon General’s Office. The other three surviving copies are located at the University of Michigan, Michigan State University, and Harvard University.

A striped pattern with grey flowers and green stripes.

Although arsenic has been used as poison and as medicine since antiquity, the nineteenth century witnessed a surge in its use in industry to manufacture consumer goods, earning the nickname “the arsenic century” from historian James Whorton. Coloring agents containing arsenic were both cheap to produce and capable of yielding vivid hues. In particular, the vibrant shades of Sheele’s and Paris green pigments became especially fashionable, leading to a demand for a variety of goods in these colors, including clothing, furniture, playing cards, toys, food…and wallpaper. Of these products, wallpaper raised much concern from the medical profession and the public as reports of illness increased with exposure to the poisonous substance in the home and on the job. Nausea, headaches, diarrhea, joint pain, skin diseases, and other symptoms of arsenical poisoning were reported to disappear once time was spent away from the offending pigments.

A vining pattern of green leaves and flowers.

Concerns about the toxic effects of arsenical wallpaper were raised as early as 1839 when German chemist Leopold Gmelin submitted a letter to a newspaper about his own findings. Although demand in the United States decreased temporarily, warnings were brushed aside by consumers as manufacturers and members of the medical profession questioned the hazards. Symptoms of arsenic poisoning were easily mistaken for those of cholera or dysentery. Susceptibility varied widely among individuals exposed to the wallpaper—even within the same household—leading many to doubt its harmfulness. Aside from physical effects, employment was another driving factor. The use of these pigments was quite lucrative, providing work for many who accepted the conditions as part of the job. With these conflicting messages, arsenical greens became highly fashionable again in the 1860s.

A shield type pattern with green pendants and white flowers on a grey background.

In response to this resurgence, education campaigns increased in the next decade to eliminate the use of arsenical pigments. As Dr. Frank Draper stated in the 1872 Annual Report of the State Board of Health of Massachusetts, “the demand ceasing, the supply will cease; and a correct taste in color will find its gratification in agents which possess no poisonous character.” Two years later, the Shadows from the Walls of Death campaign was created in Michigan. By sending the book to the leading libraries in Michigan, Dr. Kedzie went a step further than other campaigns to make the information accessible to the public. Through these efforts, demand increased for safer products which ultimately led manufacturers to produce arsenic-free wallpaper. The benefits reached both the consumers and the workforce.

By digitizing this copy, The National Library of Medicine went one step further to be the first library to make Shadows from the Walls of Death freely accessible to the everyone online. Before sending the book through to the scanning stage of the digitization workflow, NLM staff were careful to consider employee exposure and contacted the NIH Department of Occupational Health and Safety (DOHS) for guidance on the recommended protection to use while scanning arsenical wallpaper and for future handling of similar materials, because Dr. Kedzie was not the last to include samples of arsenical wallpaper in a publication!

Title page for Shadows from the Walls of Death.
A repetative lacy pattern with intermittent depictions of whiteflowers with greenery.

On Wednesday—National Occupational Health and Safety Professional Day—learn more about the safety analysis and sampling performed in cooperation with DOHS in Part 2 of this series!

Like a good mystery? Discover Shadows from the Walls of Death as seen on Mysteries at the Museum “Jack the Ripper, Wooden Money, Deadly Décor” which premiered Thursday, July 12 at 10 p.m. ET/PT on Travel Channel.

Images from the Library

  By

Looking through our recent uploads, this cover caught my eye: front page of "Social Ethics"

It’s from an anonymous “synopsis” of the papers given at a May 1886 meeting of the Society of Medical Jurisprudence and State Medicine (New York State) which was held at the Academy of Medicine (now a MHL partner!) This copy of the pamphlet was given out with the “compliments of Wm M. McLaury, M.D.,” listed as one of the trustees of the Society.

From Our Partners: “Finding the Flu: Crisis and Documentation”

  By

~From the College of Physicians of Philadelphia blog, Fugitive Leaves and Beth Lander, College Librarian.

On September 7, 1918, 300 sailors arrived in Philadelphia from Boston, where, two weeks earlier, soldiers and sailors began to be hospitalized with a disease characterized as pneumonia, meningitis, or influenza. The sailors were stationed at the Philadelphia Naval Yard.

On September 11, 19 sailors reported to sickbay with symptoms of “influenza.” By September 15, more than 600 servicemen required hospitalization.

Physicians and other public health workers in Philadelphia first met on September 18 with city officials to discuss what they perceived as a growing threat. Public health officials demanded that the city be quarantined – all public spaces, including schools, churches, parks, any place people could congregate, should be closed. City officials did not want to create panic. They were more concerned that local support for President Wilson’s efforts in World War I should not be disturbed. Anything that would damage morale – or the city’s ability to raise the millions in Liberty Loans required by federal quota – was unacceptable.

The Board of Health declared influenza a reportable disease on September 21, which required physicians to report any cases they treated to health officials. The Board advised residents to stay warm and keep their feet dry and their bowels open. The Board also suggested that people avoid crowds.

Against the calls for quarantine, the city hosted a Liberty Loan parade on September 28. The two-mile route south on Broad Street was complete with marching bands, Boy Scouts, women’s auxiliary groups, soldiers, sailors, flags, and patriotic fervor. It is estimated that more 200,000 people attended the parade.

 

Liberty Loan Parade, September 28, 1918.

 

Within 72 hours of the parade, every bed in Philadelphia’s 31 hospitals was full.

We are saturated with information today. We not only consume it, but we create it through social media posts, YouTube videos, blogs, and so on. A May 2018 article in Forbes magazine notes a terrifying thought (at least for a librarian): “Over the last two years alone 90 percent of the data in the world was generated.” Few public events today escape immediate documentation.

Researchers who are examining the 1918 influenza pandemic expect to find rich sets of primary sources at the Historical Medical Library. Unfortunately, their expectations are met with disappointment.

A simple search on the term “influenza” in the Library’s OPAC (online public access catalog) shows 688 hits across both Library and Mütter Museum collections regardless of publication or creation date. Library collections, while greater in number, are mostly secondary sources, with only a small number (19) published in the years between 1918 and 1925.

The most significant primary source in the collection of the Historical Medical Library is a scrapbook of newspaper clippings contemporary to the pandemic in Philadelphia. The majority of the clippings are not dated. A small number have enough of the masthead visible to safely assume that some, if not all, of the clippings were taken from the Philadelphia Evening Bulletin. The clippings are pasted edge to edge, roughly clipped, and assumed to be in date order. There is no provenance available to determine who created the scrapbook – it was acquired by the Library on October 19, 1919, through the Medical Library Association’s Exchange program, which encouraged medical libraries throughout the United States to swap items outside of their own collecting scope.

 

[Scrapbook of newspaper clippings (September 14, 1918 to March 1, 1919) concerning the influenza epidemic in Philadelphia, 1918-1919]. Historical Medical Library, Z10 d7

Why, then, are there so few extant primary sources about the influenza pandemic in the collections of The College of Physicians of Philadelphia?

The Historical Medical Library was founded in 1788, one year after the founding of The College of Physicians, which is the oldest medical fellowship in the United States. The Library was developed mostly through donations of books, manuscripts, and archival collections, but also through small acquisition funds and, in the late 19th and early 20th centuries, the aforementioned Exchange program. The collection reflects the interests of the Fellows of the College at any particular time in the history of the College. The evolution of medical specialization is particularly evident in the subject of books acquired; the development of the manuscript collections reflects the interests and work of those Fellows most closely affiliated with the College.

The College offered Fellows the opportunity to publish works in the Transactions & Studies of The College of Physicians of Philadelphia, which was issued between 1793 and 2002. Again, the Transactions reflect contemporary medical practice and concerns, as well as the research and teaching of Fellows.

The College was prominent in public health in Philadelphia since its founding. In November 1787, a month after the founding of the College, Benjamin Rush composed what was called a “memorial” to the Pennsylvania State Assembly promoting temperance as a measure of public health. In 1848, the College acted to mitigate urban overcrowding, intemperance, tainted food and water, poor sanitary conditions, and the solitary confinement of prisoners in city jails. After the Civil War, the College addressed issues related to industrialization, street cleaning, and the creation of public sewers and indoor plumbing. In 1883, a report was submitted to the state legislature stating “Philadelphia is now recognized as the worst-paved and worst-cleaned city in the civilized world.”

In 1912, the College created the Committee on Public Health and Preventive Medicine, one of a number of official committees that had promoted public health issues over the years. This Committee addressed long working hours for women and children, the use of night soil as a fertilizer, keeping hogs within the city borders, compulsory vaccination against smallpox – and clean streets.

One would assume that an institution committed to an active public health role within one of the country’s largest cities would have a prominent response to the 1918 influenza pandemic. Instead, between 1917 and 1925 the words flu, influenza and epidemic appear only infrequently in any College records and College publications. (Transactions published in fall 1918 and early 1919 mention a symposium that occurred at the College on complications of influenza in the “current epidemic” and lament the nursing shortages that plagued hospitals during the epidemic). It is almost as though the pandemic never happened.

There is no pat answer as to why the pandemic did not merit much official attention of the College. Perhaps it was because of World War I –three-quarters of Philadelphia’s medical staff, physicians and nurses, were already serving in hospitals in France and England by the fall of 1918.

 

Officers of Mobile Hospital No. 8, Deux-Noeuds, Oct. 27, 1918. George W. Outerbridge papers (MSS 2/138), 1916-1919. Historical Medical Library of The College of Physicians of Philadelphia.

 

Perhaps this lack of primary sources that we would typically find around an event – the letters, images, and diaries that would document individual or even corporate response to something like the pandemic – is symbolic of a sudden, overwhelming loss of structure, both familial and societal. Five days after the Liberty Loan parade, city leaders in Philadelphia shut down all public institutions and meeting places, even public funerals. Isolation and ignorance combined with rising rates of illness and death, filling Philadelphia residents with a pervasive sense of fear and dread. This shock left people in stasis, unable to process – or document – what was happening at the moment, leaving death certificates as the largest, most complete set of primary sources about the pandemic.

This lack of documentation may also be due to that lack of trained medical staff available in Philadelphia at the time – if you are scrambling for support, medicine, food, and water in the hope of forestalling death, are you going to stop to take a picture, or write a letter?

On September 29, the College will commemorate the 100th anniversary of the pandemic with a day of reflection in the Mütter Museum. In the fall of 2019, the Mütter Museum will debut Spit Spreads Death a permanent exhibit that will highlight that most complete set of extant sources: death certificates. About 20,000 Philadelphia death certificates from 1918-19 will be compiled in a searchable database, available to visitors in a touch map capable of bringing the impact of the past outbreak to present locations (and residents). This dataset will be joined with extant objects and photos, remembrances, public programming, and historical and public health information to form a cohesive chaos that will let visitors explore the fear, loss, and confusion that defined a city in the autumn of 1918. In so doing, the College will create a new material history of the influenza pandemic.

Gin and — Gingerbread?

  By

Many of us know one of the most popular methods of taking quinine was in a drink — if you watched Jewel in the Crown in the 1980s, you may even specify the drink as a gin and tonic. The liquor — of whatever kind — helped to cover the bitterness of the quinine, thus making a vital medicament palatable. Robert Robertson took it a step further and imagined quinine-laced baked goods.

The Walcheren campaign (1809) took place during the Napoleonic wars in Europe; this particular campaign left British military forces stranded in a swampy region of the Netherlands. Troops were exposed to malaria-bearing mosquitoes as well as other sources of remitting fevers. Quinine was in short supply and the campaign — such as it was — ended in an ignominious British withdrawal.

Robertson considers whether quinine might have been more effectively delivered to the troops — always assuming they had enough of it, of course — as a pastry: quinine-laced gingerbread.

Halloween Supplies

  By ,

Forgot to stock in candy for Halloween? Or got snacking a little early and need to fill in the gaps? We have candy recipes for you! You just need some sugar, water, perhaps a few cooking implements, some flavors — and if you really get on a roll, maybe a little scaffolding!

Learn the basics from The confectioner (1880).

And then work up something special from The Italian confectioner (1881): perhaps add in some flowers (page 42) or try some chocolate candy (page 50)?

If you really get in the zone, perhaps try one of the elaborate concoctions from The Royal Parisian pastrycook and confectioner (1834), like the cake arrangements on page 26 or page 345?