Civilian Health Care

For most of the nineteenth century, health care in the United States took place within the confines of the home. Physicians routinely paid visits to their patients to deliver diagnoses or to dispense treatments by the fireside. Only rarely were individuals treated in infirmaries. What few hospitals existed at the outbreak of the Civil War were typically considered the last refuge of the insane or fatally ill.

Soon after the onset of hostilities between the North and South, however, this situation changed, with many doctors soon finding their services in high demand on the battlefield. As a result, in-home medical care became harder for Americans to secure, especially in war-ravaged areas of the South. Still, as a percentage of the general population, the number of physicians remained high. Additionally, large numbers of midwives and folk healers—white and black alike—continued to provide care alongside their licensed counterparts.

Indeed, one of the chief impediments to civilian health care in the South during the Civil War was not a lack of medical practitioners but a lack of supplies. In particular, the Union blockade of Confederate ports prevented many much-needed medicines, deemed to be contraband during the conflict, from entering the region. With their already limited pharmacopeia continued shrinking in size, southerners began to seek alternative remedies in native medicinal plants.

Both lay and professional practitioners were aided in their attempts at alternative homeopathy by the 1863 publication of Francis P. Porcher's work Resources of the Southern Fields and Forests, Medical, Economical, and Agricultural. Written at the behest of the Confederate surgeon general, Porcher's book identified a number of indigenous plants that could serve as substitutes for many of the major refined pharmaceuticals of the age. Ultimately, Resources of the Southern Fields and Forests aided doctors and herbal healers, as portions of Porcher's work were widely reprinted throughout southern newspapers during the war. One southerner's description of the situation is recounted in Parthenia Antoinette Hague's 1888 work A Blockaded Family: Life in Southern Alabama during the Civil War. "the woods… were also our drug stores" (p. 46).

Beyond foraging through forests for alternative remedies, southerners also raised curatives in their own gardens. For instance, refined opium, one of the favored painkillers of the age, quickly came into short supply. Many citizens planted rows of poppies in their gardens to make opium. Such measures proved to be a very successful enterprise too. The homegrown products were just as effective as the ones that would have otherwise been purchased in stores and such individual production assured that pain relievers would be available when needed.

Regarding medical care for slaves on the home front, it remained similar to that of whites during the period. Physicians, who were typically kept on yearly retainer by an owner to attend their slaves, routinely traveled to the plantation to administer treatment either in the slave quarters or in the master's home. In these cases practitioners also faced a shortage of essential medications. For example, former slave Louis Hughes remembered in a 2005 reprint of his autobiography, Thirty Years a Slave: From Bondage to Freedom, The Autobiography of Louis Hughes, an instance during the war when he was treated for chills and fever. Since quinine was rare, he drank a tea made from lemon leaves."I was treated in this manner," Hughes recounted, "to some advantage." He admitted that not all were so lucky however. While this makeshift remedy worked for him, the same "cannot always be said of all methods of treatment" (p. 73).

Aside from dealing with a dearth of pharmaceuticals, many doctors also had to manage their medical stores more closely. Not long after the outbreak of hostilities, Union and Confederate armies began appropriating existing supplies for military use. Basic items such as bandages and surgical implements quickly became scarce. For physicians on the home front, this situation only grew worse over time. While civilian aide agencies such as the United States Sanitary Commission emerged early in the war to assist in forwarding supplies to physicians on the battlefield, health care workers at home still had to scrounge for even the most rudimentary tools of their trade.

Notwithstanding the scarcity of pharmaceutical and medical supplies, civilian practitioners faced no shortage of sickness during the Civil War. Although spared the devastation of communicable diseases like typhus, measles, and whooping cough that spread rapidly through crowded, squalid military encampments, civilians in the South still suffered from high rates of infectious disease. The subtropical climate of certain portions of the region, for example, ensured that endemic ailments like malaria and yellow fever continued to wreak havoc. Moreover, chronic malnutrition compromised the immunity of many residents, creating conditions in which simple sicknesses could readily develop into deadly maladies. As for residents of the North, they too suffered from disease, especially the ever-present plague of urban life in the nineteenth century: tuberculosis.

Medicine's Internal Civil War: Mainstream Medicine and Homeopathy

At the time of the Civil War, there were a number of different approaches to medicine in the United States, each having its own schools and curricula. It was not until the Flexner Report of 1910 that there was any attempt to standardize the training and certification of American physicians. What we now think of as mainstream or scientific medicine (sometimes called allopathic medicine) had a serious rival at the time of the Civil War-homeopathy. Homeopathy is now considered an alternative form of treatment and is used by only 2 percent of Americans, but in the 1860s, it was more popular in many areas of the country than mainstream medicine.

Homeopathy is a form of treatment in which the practitioner administers, in extremely dilute formulations, substances that would ordinarily cause symptoms similar to the patient's illness. For example, arsenic and belladonna, which cause fever in humans when given in large doses, are used by homeopaths in extremely small doses to treat fevers. The founder of homeopathy, a German chemist and physician named Samuel Hahnemann (1755-1843), experimented with minute doses of a wide range of plant and mineral compounds, believing they cured patients by stimulating the body's own vital force.

Although a commonplace modern criticism of homeopathy is that the remedies used are so diluted that they retain too little of the original substance to have any effect on the body, it is likely that their very mildness was one reason for the popularity of homeopathy in the United States from the 1830s to the 1860s. Mainstream medical practitioners often used bloodletting and dosed patients with such harmful compounds as calomel (mercurous chloride, used as a laxative). While some turned to folk remedies or Native American herbal treatments as alternatives to mainstream medicine, others were attracted to homeopathy because its practitioners had largely been educated in Europe. Immigrant homeopaths were often more highly educated than American allopathic physicians. The first American homeopath was Hans Gram, a Boston-born physician of Danish extraction who went to Europe to study homeopathy and returned to the United States to open a homeopathic practice in 1825. In less than a decade there were several schools of homeopathic medicine, the most famous of which was the Homeopathic Medical College of Philadelphia. In 1844 practitioners of homeopathy in the United States formed the American Institute of Homeopathy.

Orthodox or mainstream physicians began to oppose homeopathy in the early 1840s. The American Medical Association, founded in 1847, was organized at least in part to counteract the American Institute of Homeopathy. Oliver Wendell Holmes Sr. (1809-1894), a physician practicing in Boston, delivered two public lectures in 1842 on "Homeopathy and Its Kindred Delusions," in which he systematically mocked the underlying assumptions of homeopathy. When the Civil War began, the medical corps of the Union Army were dominated by allopathic doctors, and its examining boards routinely denied military commissions to homeopaths. This exclusion had the unfortunate side effect, however, of intensifying the shortage of experienced surgeons in the army, as many homeopaths in the 1860s had had more training in surgery than their mainstream medical counterparts.

rebecca j. frey

BIBLIOGRAPHY

Holmes, Oliver Wendell, Sr. "Homeopathy and Its Kindred Delusions." 1842. Available online from http://homeoint.org/cazalet/holmes/index.htm.

National Center for Complementary and Alternative Medicine (NCCAM). "Research Report: Questions and Answers about Homeopathy." Available online from http://nccam.nih.gov/health/homeopathy/.

Rutkow, Lainie W., and Ira M. Rutkow. "Homeopaths, Surgery, and the Civil War: Edward C. Franklin and the Struggle to Achieve Medical Pluralism in the Union Army." Archives of Surgery 139, no. 7 (2004): 785-791.

There were numerous practical and epidemiological challenges civilian health care workers faced during the Civil War. In general, however, physicians, midwives, and folk healers continued to serve the American public without interruption, even if sometimes without necessary medicines and supplies in hand.

BIBLIOGRAPHY

Current, Richard N., ed. Encyclopedia of the Confederacy, vol. 2. New York: Simon and Schuster, 1993.

Flannery, Michael A. Civil War Pharmacy: A History of Drugs, Drug Supply and Provision, and Therapeutics for the Union and Confederacy. New York: Pharmaceutical Products Press, 2004.

Hague, Parthenia Antoinette. A Blockaded Family: Life in Southern Alabama during the Civil War [1888]. Bedford, MA: Applewood Books, [1995.]

Heidler, David S., and Jeanne T. Heidler, eds. Encyclopedia of the American Civil War: A Political, Social and Military History. New York: W.W. Norton and Co., 2000.

Hughes, Louis. Thirty Years a Slave: From Bondage to Freedom, The Autobiography of Louis Hughes. Montgomery, AL: NewSouth Books, 2002.

Porcher, Francis Peyre. Resources of the Southern Fields and Forests, Medical, Economical, and Agricultural [1863]. San Francisco: Norman Pub., 1991.

Rothstein, William G. American Physicians in the Nineteenth Century: From Sects to Science. Baltimore, MD: Johns Hopkins University Press, 1972.

Amy Crowson