GUYTON LECTURER DESCRIBES CHALLENGES OF CIVIL WAR-ERA PHYSICIANS

Imagine being expected to amputate a leg within 15 minutes using tools fashioned by a blacksmith while the patient, less-than-fully anesthetized with ether, lies on a barn door supported by two barrels. Imagine doing so with little or no sleep in the midst of a camp filled with wounded and dying young men who have been riddled by dysentery for weeks.

This “first-hand” account of the challenges facing a physician in the Confederate army was vividly told by Dr. Joseph A. Gerache, a retired pharmacist, during the fourteenth annual Dean Billy S. Guyton Lecture on the History of Medicine April 19. Gerache’s presentation, “A Report on Civil War Medicine from a Civil War Surgeon,” included a display of authentic surgical instruments and other tools from the bloodiest period in American history.

According to Gerache, the practice of medicine in the 1860s had advanced little from Revolutionary times, when physicians routinely “depleted” a pint or more of blood from their patients during a regular office visit.

“It was thought that all the problems with a person were in the blood,” said Gerache, who sported the uniform of the highest-ranking medical officer in the army of the Confederacy, complete with a bright star that designated the rank of major in the army and a green sash that represented medical service. “The more the body was depleted of blood, that got rid of the bad humor. This practice was extremely popular throughout the world at that time.”

A 1950 graduate of the Loyola University School of Pharmacy in New Orleans, Gerache served as a hospital corpsman to a special U.S. Navy unit in the Philippines and Okinawa during World War II. His keen interest in the Civil War was demonstrated by the museum of Civil War artifacts and apothecary memorabilia he displayed at his former Corner Drug Store in Vicksburg. He now owns the Colonial Drug Store in Vicksburg.

Gerache described the horrible conditions in which physicians were called to practice medicine during the 1860s, sometimes finding humor in many of the common misconceptions about medical care during the era.

Approximately 650,000 men and wo-men died during the “period of war of northern aggression,” as many Southerners called the Civil War. He said the number of women who served during the war could never be accurately measured because a soldier’s sex wasn’t usually determined until she fell ill or died.

“A routine physical exam consisted of assembling a group of soldiers ina field,” Gerache said. “The physician would stand on a box or a platform, and he would ask if anyone had any physical problems. Can everyone swing their arms around? Can everyone move at least two fingers on their right hand? Most importantly, does everyone have at least two teeth on top and bottom?”

He said after the physician asked a few more similar questions, he would pronounce the group fit for service. The question of gender was never brought up.

Of the more than 50 items that made up a fully equipped medical wagon during that time – everything from ammonia and hydrochloric acid to coffee, tea, milk and sugar – Gerache said the only substance that came close to having any real medicinal qualities was quinine, which was used to treat certain types of malaria.

He demonstrated several medical instruments of the day, including a depletion pan, a “bullet snatcher” and a cauterizing iron, and emphasized the primary responsibility of any medic attending to a bleeding patient was to stop the bleeding at all costs, even if it meant stuffing leaves, moss or anything else handy into the open wound.

He said physicians of the period knew about childhood diseases such as the measles and mumps, but had no idea what caused them or how to treat them; they just knew they had to be endured. He said the single biggest cause of death for Confederate and Union soldiers alike was typhoid fever, with pneumonia and malaria not far behind. He said eruptive fever, smallpox and scarlet fever were dreaded diseases of the time, but the best known treatments for these conditions were a mustard plaster, clean air and good food, none of which were available to the average soldier.

However, of all the diseases that ran rampant throughout the Confederacy, Gerache said the worst was called the “flux,” known today as diarrhea or dysentery. “Everybody had it, nobody knew for sure how they got it, but when a soldier reported to sick bay, he was told to stay outside by the shade trees.”

Gerache said physicians tried several possible “remedies,” each of which did more harm than good – from lead water and laudanum to aromatic sulfuric acid and Epsom salts – and turned their backs on a treatment the Chinese had been using for centuries that ultimately was refined into what we now know as Caopectate.

He said the latest innovation in ammunition – the conical-shaped ball fired from a rifle musket – was capable of shattering a soldier’s bone. “Physicians of the time didn’t have the time or the expertise to set broken bones,” Gerache said, “so the best way to save a soldier’s life was to saw off his arm or leg.”

The best source for surgical instruments and medication for physicians in the Confederacy was actually the Union army; failing that, Gerache said blacksmiths devised their surgical tools. He said ether was the anesthetic of choice because it could be administered so that a patient wouldn’t be completed sedated and could be “walked away” from the surgical tent. Ether is highly flammable, however, which Gerache said one unfortunate soldier discovered when he struck a match to light a lamp, so the anesthesia of choice became ether by day, chloroform by night.

Gerache highlighted the many contributions of women during the Civil War, from Dorothea Dix and Sally Tompkins to Louisa May Alcott, Julia Ward Howe, Clara Barton, Elizabeth Blackwell, and others, and described the origin of Memorial Day, a federal holiday on the last Monday of May formerly known as Decoration Day, established by the ladies of Columbus shortly after the close of the Civil War.

— Bruce Coleman (4-30-07)

2007-04-30 00:00:00 16869