Revolution: William Hammond, the Civil War, the tremendous advancement of military medicine and his removal by the establishment
The war was supposed to be fast; it was supposed to be easy. On July 21st, 1863, the enthusiastic, green Union Army, 35,000 strong, vigorously moved into fight a Confederate force at Manassas Junction. The first, large operation of the war was supposed to break the Confederate forces and deter the dissidents from carrying on their rebellion. What was supposed to be a fun, phenomenal experience of growth, and coming-of-age moment for thousands of American men, woke them to the horrific realities of war.
Union Forces Flee. The First Battle of Bull Run, July, 1861.
The Union forces were poorly trained. Most of the volunteer regiments were composed of men who knew each other from their pre-military life, joined together in fighting units where they saw their childhood friends being killed or maimed. The leader of the Union forces, Irvin McDowell failed miserably with this green force, to conduct a complex operation that ended with a mass retreat.
Union forces spilled back towards Washington D.C. through all means necessary. Military ambulances that should have been hauling wounded back to field hospitals were filled with doctors, nurses, officers, soldiers and civilians who fled from the Confederate onslaught. That day the Union forces had lost 2700 men in their first taste of combat, and a rude awakening filled the minds of those all throughout the last intact portions of the United States, the war was far from decided.
From a medical standpoint the battle was a complete disaster. Hospitals set up around the battlefields were either overwhelmed or sat vacant. Each regiment had at its disposal, a surgeon and an assistant surgeon, each standing by, waiting to treat the battlefield wounded. These were civilian doctors, who had joined up with their local units. Most had only served as family physicians in their neighborhoods, and very few had any level of surgical training whatsoever. A large number of these “physicians”, given the rank of surgeon, and assistant surgeon, had only worked as homeopathic, or naturopathic doctors in their pre-war lives. These surgeons were ill-prepared for dealing the trauma of operating on combat wounded. This new battle had been eye-opening for all in the medical field.
Civil War surgeons were automatically given a commission, holding the rank of major. Many of these civilian doctors were poorly trained, inexperienced, and would later be washed out of the service.
The pre-Civil War army was small. Only 16,000 men made up the ranks of the Army forces. Of that tiny force, roughly 100 men were surgeons, and they served in posts that dotted the American landscape. Many had served on frontier forts, where they managed to gain experience in dealing with the real killer in armies, disease. While many surgeons had met many diseased soldiers, the experience of operating on torn battle wounds, was hardly experienced at all, save by a few veterans of the Mexican-American War of the 1840’s.
Military medicine was overseen by an entity known as the Medical Bureau of the United States Army. The commander of this military branch, Colonel Thomas Lawson, was a veteran of the War of 1812. This fossil of the medical profession had directed the medical arm of the Army since his appointment to the post in 1836, by President Andrew Jackson. His job had been simple. Reports from surgeons were sent to his small staff, and due to the cozy size of the US Army surgical cadre, it was easy to manage the medical faculties. That was until a war of unprecedented proportions tore the United States apart in 1861.
The Medical Bureau certainly had their work cut out for them. Now, thousands of men flocked to join the forces, and each brought with them their local doctors to serve. These were surgeons who were unknowns to the Bureau. Over 2 million men would serve the Union, organized into hundreds of regiments, each given a group of civilian surgeons and nurses to administer soldiers’ health.
To truly understand the task at hand for the medical aspect of the Union forces, a background on medical education in the mid-19th century needs discussion. Medical schools were highly unregulated. A medical education consisted of a 2-year set of courses, where students entered medical school directly from their secondary education. No prerequisites in science were needed. If you really wanted to show medical prowess, you could repeat the same 2-year course, again. Residencies in medical specialties didn’t exist, and doctors often would enter the workforce with minimal, if any hands-on medical experience.
Medicine, like military medicine, was unregulated. Doctors received no guidelines for prescribing medications or treating patients and the medical field was one rife with quackery. The medical mecca of education was found over in European countries, like France and Germany. Graduates who truly sought an in-depth education would make their rotations through these European hospitals to gain a state-of-the-art medical education. Unfortunately, most doctors could not afford to live overseas for the necessary amount of time to gain a deep education.
These poorly trained, often inexperienced doctors came with new regiments into the military ranks. They were now administered by a 70-year-old medical bureau director who had never envisioned a conflict of this size. They were simply overwhelmed. The volunteer physicians were outside of the jurisdiction of the bureau, and surgeons were accepted without merit. There were no prescribing guidelines, nor treatment protocols. Doctors had never treated battlefield wounds prior to the war, and most had little surgical experience. With no guidelines they were forced to draw on their rudimentary educations, or pedestrian experiences to treat wounds of unknown horror.
Thomas Lawson, a veteran of the War of 1812, served as Surgeon General of the U.S. Army since being appointed in 1836, by President Andrew Jackson.
This was reflected in the early conflict. Military hospitals were horribly organized. Field hospitals were often set up outside of battlefields, and after patients were treated there was hardly any place for them to go. Massive military hospitals were few in number. Doctors did have on hand a mass of medicines, including strong narcotics like morphine, which they distributed liberally. Anesthesia, like Ether and Chloroform was available for surgeries but the doctors were forced to learn proper dosing procedures on their own. Doctors were at liberty to dispense whatever medications they saw fit, and many were not experienced with the wide variety of medication available.
First line treatment for limb wounds, early in the war, was often amputation. Advanced Orthopedic Surgery did not exist, and soft lead bullets of the war created gruesome, destructive injuries to bone and tissue, leaving doctors with little choice. These surgeries were grossly unsanitary, often conducted in rooms filled with wounded patients. Surgeons would operate, listening to the groans and screams of waiting wounded. The table they operated on was used on every patient, hardly washed or sanitized. Surgical instruments were used dozens of times, usually only rinsed in water to make seeing the procedure easier. Once surgeries were completed, amputated limbs were often stacked in piles outside whatever house, barn, or tent they used as a hospital. Patients were then dosed heavily with morphine and set out wherever room could be found for recovery, with little means of transportation elsewhere.
Early Civil War field hospitals were unsanitary, horrific and often overcrowded. Soldiers would often wait hours in the sun, or rain in order to receive medical treatment. Often morphine was distributed by orderlies. One common method of administration was licking one’s finger to get morphine powder on the fingertip and sticking it directly into the wound.
The overwhelmed Thomas Lawson was overseeing a disaster, and in May of 1861 before the first battle of the Civil War, he died at the age of 72 from apoplexy, leaving the Bureau in dire straits. A veteran of nearly 45 years of military service, Clement Finley, took his place briefly, until a new leader was appointed in 1862, William Hammond.
William Hammond was appointed Surgeon General of the U.S. Army, at the age of 34.
Hammond was a volunteer surgeon, but no stranger to Army life, as he had served for 11 years as an assistant surgeon in the army. Curious about the European way of medical administration, he visited European military hospitals. After resigning his commission in 1860, he briefly served as a professor at the University of Maryland School of Medicine, before joining the army again in 1861. In 1861, Hammond was given a lowly position in the military medical department.
As Hammond was slowly making his rounds through the various ranks of the military, another major killer was on the rise, disease. The Civil War brought together Americans from all corners of the country, bringing men into contact with soldiers from every walk of life. The isolation immunity these men carried was quickly broken down as tightly confined camps, made up of a large number of soldiers, made a prime ground for disease spread. The rampant disease that killed thousands of young men brought a lot of heat for Clement Finley, the new interim director of the Medical Bureau. Congress reorganized the medical arm of the military and quickly a replacement for Clement was sought.
A set of Civil War surgical instruments. These instruments would be used on dozens of patients, without any means of proper sterilization. Germs, and bacteria were known during this era, but their mechanism and pathogenic aspects were poorly understood. Medical journals of physicians from the war note that patients were dying of bacterial infections. In 1863, Confederate General Lewis Armistead died of his wounds after the battle of Gettysburg, while under Union captivity. Upon his death his treating physician, Dr. Daniel Brinton wrote that Armistead died “not from wounds directly but from secondary bacterium, fever and prostration” (July 1863)
Hammond’s name was pulled thanks to his connection to one higher up, George B. McClellan, the commander of the Army of the Potomac. As a lowly assistant surgeon, it had been Hammond’s task to tour military camps, and hospitals to note the failures of the medical forces. His reports made their way to McClellan, and McClellan’s brother, Dr. John B. McClellan had been a professional acquaintance of Hammond’s. This unknown surgeon was appointed the Surgeon General of the United States Army in April of 1862, and a revolution in military medicine followed.
The Medical Bureau was now organized under the control of the Sanitary Commission, a branch overseen by Secretary of War Edwin Stanton. Stanton was not happy about the choice of Hammond but capitulated under increased pressure. While Hammond won the job, this later made him a target of Stanton.
Hammond undertook major medical reforms, the first being quality control methods for volunteer medical staff. Executive boards were organized and given the task of studying physician performance. This would later result in a massive purge of inadequate military physicians. The bureaucracy of military medicine made acquisition of supplies nearly impossible, and Hammond allowed agents to go over the heads of government leadership in order to purchase supplies privately. These supplies were transported to the military physicians. Agents were tasked with hiring experienced doctors from their civilian roles as doctors and surgeons.
From Hammond’s experience studying European military systems, he borrowed the idea of centralized medical records, and organized an Army Medical Museum as a place to store records, and experiences.
As a home for centralized medical records, Hammond created the U.S. Army Medical Museum. He was inspired by published medical histories of the Crimean War. While going through Mexican-American War documents, he happened upon the bones of an amputated arm, thus giving him the idea of a museum, and a library.
Necessary medications were added to a list and given to physicians as an outline for prescribing. These essential medications then became the focus of manufacturing, negating supply shortages. Hammond approached the civilian arm of medical manufacturing to produce necessary medications, giving him a surplus of needed supplies.
Hammond was tremendously instrumental in curbing the occurrence of military disease. He quickly recognized that soldiers in the field often suffered from childhood diseases, that many soldiers had already encountered in their lives. The isolation of so many Americans made it so many of these soldiers had never been exposed. In understanding this Hammond forced isolated units, and those men who never had these childhood diseases, wait in camps where they were slowly introduced to other units of men, of whom, most had already had these diseases. If disease spread, the camps of diseased were isolated until the disease passed, rather than spread it to large encampments.
Malaria, and food-borne/water-borne diseases were the biggest problems for moving armies. Hammond had ever been the astute student of medical literature, and he recognized the correlation between Quinine and Malaria, by reading the history of British military operations in Africa. While malaria rates remained high, as many soldiers were not given access to quinine, the recognized correlation between quinine and malaria was recorded, and the knowledge passed on. His Bureau created guidelines for camp set-up, and cleanliness, in order to avoid the spreading of water-borne disease. Diarrhea and dysentery were common killers of soldiers, as the common treatment for these illnesses was to purge the pathogens through laxatives, a practice that Hammond quickly put an end to.
The Bureau under Hammond forever changed battlefield medicine after his rise to office. He recognized that the time between the initial wound, and surgery, was instrumental in determining whether a patient would develop sepsis, or gangrene, the biggest killers of wounded soldiers. An organized ambulance corps was created to quickly evacuate soldiers from the field upon wounding. Immediate field hospitals were organized, allowing for rapid surgery and better organized Army hospitals were set far behind the lines for a proper place of recovery. Ambulance corps soldiers were outfitted with medical kits, creating an early version of the army medic, these soldiers were trained to properly triage and evacuate wounded soldiers, vigorously.
Ambulance Corps were organized to allow for rapid removal of soldiers to field hospitals. This practice saved the lives of thousands. Ambulances were outfitted with trained medical staff and medical kits.
Hammond, during his years serving prior to the Civil War, had studied extensively the hospital systems of other countries. As an expert in this field, he quickly reorganized the general hospital system. Hospitals, well behind the lines of combat, were built to serve as a refuge to treat those evacuated from the battlefields throughout the country. He designed his hospitals to be open concept, allowing for proper ventilation. Wards were built, and separated by a pavilion system, allowing for proper ventilation, and comfort. Latrines were set far from the hospitals, avoiding contamination.
Hammond’s administration had a major impact on the mortality of army life. His work dropped the mortality rate from wounds, and disease exponentially by the war’s end. He was a heavy-handed, but confidant administrator who oversaw a shift towards a more modern medical system for the military. He created better hospitals, better field hospitals, standards for surgery and medication, standards for treating disease and wounds. He worked for treatment plans in order to treat malaria, food-borne and water-borne illness. Hammond, despite all of his revolutionary changes, created enemies, enemies who would ultimately see him removed from his position.
Early on in the war, when the war department reorganized the Medical Bureau, Secretary of War Stanton wanted his own insider, not Hammond. Begrudgingly Hammond was accepted by Stanton, but he quickly became a detractor after the Second Battle of Bull Run in August of 1862. Hundreds of wounded were left on the battlefield after the crushing Union defeat, and Hammond blamed the inept, early, ambulance corps of Stanton’s Sanitary Commission for the disaster. He wrote directly to Stanton, accusing him of negligence, creating a major enemy.
During the early years of the Civil War, and the preceding decades of civilian medicine, Calomel was a seen as a miracle drug. Calomel is a form of the highly toxic element, Mercury. Medical, and scientific consensus saw Calomel as a cure-all, using it for STD’s, respiratory illness, cancer and influenza. During the Civil War it was the common treatment for many ailments, even prescribed for treating dysentery, causing violent diarrhea in soldiers.
William Hammond was highly skeptical of using Calomel as a treatment for any disease. The high doses used by the medical community, he believed to be toxic, and he hardly believed the drug to be beneficial. Trying to save more soldiers, he withdrew Calomel from all military medical stores, outraging the doctors under his command. Furious, these doctors staged a coup, a rebellion over the use of the drug Calomel. What followed was a typical story we see in modern society, when the “consensus” can win over real scientific inquiry. Stanton, used to the Calomel rebellion, and a handful of smaller charges, to bring Hammond down, using a court martial.
Calomel, a Mercury Chloride, was commonly used in the decades preceding the Civil War. While used in earlier American history, it gained rampant use beginning in the 1840’s. The compound, highly toxic, was seen as a miracle drug of the day, used to treat a large number of diseases and ailments.
Hammond was hardly an easy person to get along with. He was fierce, and often arrogant. He was a man of intense energy and was prone to intimidation. His attitude failed to endear him to his inferiors, and the political leaders in Washington, especially Stanton.
While the Calomel rebellion stirred the pot, Stanton brought him down using falsified records. The records, at his trial, showed that he used his post to illegally benefit from military acquisitions, and in he was dismissed from service in August 1864. His later life was fruitful in the academic sense, as he became a father of the modern medical specialty, Neurology. He was eventually given his rank of Brigadier General back by the Army, but was not granted a pension, in 1878. He was one of the founding members of the American Neurological Association. Hammond died in 1900 at the age of 71, and is buried in Arlington National Cemetery, buried with honors.
While his attitude failed to win him friends, General Hammond changed military medical practices, saving the lives of thousands. His work would evolve throughout the years, shifting American military medical practices in the right direction, further saving lives. He was given command of an impossible situation in 1862, at the age of 32 years old, taking over a stagnant department, that had been administered by one man for nearly thirty years. His open-minded, scientific, nature and his skepticism forced him to confront the medical establishment of his day, and it cost him his position. His plight is one common in our modern world, in which the modern scientific establishment fails to allow questioning outside of the consensus. The drug he was ultimately ousted over, proved to be toxic, and mercury is now treated with incredible caution. Regardless of the outcome of his skepticism, he was instrumental in shifting America towards the modern practice of medicine.