"To Increase the Efficiency of the Medical Department": A New Approach to U.S. Civil War Medicine.

Abstract

"TO INCREASE THE EFFICIENCY OF THE MEDICAL DEPARTMENT": A NEW APPROACH TO U.S. CIVIL WAR MEDICINE Bonnie Ellen Blustein "The connection of science and war is by no means a new phenomenon ," wrote J. D. Bernal in 1939. "This is not due to any mystical affinity between science and war, but to the more elementary considerations that the urgency of war needs, expressed in willingness to incur expenditure , are greater than those of any civil needs, and that in war novelty is at a premium." Historical studies of wartime medicine and other sciences have usually produced essentially quantitative estimates of the "extent" to which the war influenced medical development, and wartime progress is understood mainly as a list of benchmarks on an assumed scale of achievement.1 What has been too often ignored, at least in the study of American medicine during the Civil War period, is the qualitative change resulting from, and underpinning, this roster of accomplishments. This study of medical science in the Union army explores the interconnections between the reorganization of the U.S. Army Medical Department and mid-century American medicine as a whole. "Progress" in U.S. military medicine can best be understood, in primarily qualitative terms, as the solution of particular, historically rooted problems posed An earlier version of this paper was presented at the 1981 annual meeting of the American Association for the History of Medicine, Toronto; I am grateful to the members of the AAHM for the many useful comments and criticisms I received there. Also, I especially thank Kathryn Russell and John T. Cumbler for their patient, sharp, and insightful criticism of preliminary drafts, and Barbara Foley and Richard Cooper for suggestions at a later stage. The research for this paper was funded in part by a grant from the American Philosophical Society. ' J. D. Bernal, The Social Function of Science, (Cambridge, Mass.: The M.I.T. Press, 1967), 165; for a classic description of this approach, see Herbert Butterfield, The Whig Interpretation of History, (London: G. Bell, 1931) ; see also Robert Nisbet, A History of the Idea of Progress, (New York: Basic Books, 1980). Civil War History, Vol. XXXIII, No. 1, © 1987 by The Kent State University Press MEDICAL DEPARTMENT 23 by an elite (lay and medical) with reference to the material needs and ideological conceptions of the northern upper class. The task of radical reorganization of the military medical services gave impetus in turn to the adoption of what has been called "scientism" as a central part of the ideology of this class in the postwar period. Furthermore, the Civil War experience was critically important in setting not only the pace but the pattern of civilian medical science and practice in the last third of the century. Leonard Curry has thoroughly documented the activerole of the first Civil War Congress in "drafting the blueprint for a new social order." Although his analysis of civil legislation necessarily omits thereorganization of the Army Medical Department, this same Congress enacted the main measures authorizing reorganization. In subsequent decades, moreover, dramatically changed modes of medical thought and practice would become part of the new order. Curry's metaphor is most suggestive in the light of David Noble's important conclusions drawn from his study of technology since the nineteenth century. Noble emphasizes that "the task of designing America has . . . been an ongoing social process, one marked as much by human conflict (and design failure ) as by smoothly running machinery. . . . However impersonally the 'problems' might be formulated, the main challenge has always been people, people with a different vision perhaps, with equally rational but nevertheless conflicting aims."2 This theme will run throughout the present study. The United States Sanitary Commission (USSC) played a leading role in organizing the provision of health care for Union troops, especially the tens of thousands in volunteer regiments, from almost the outset of the war. The leaders and most other commissioners came from the elite of New York City and other northern commercial and manufacturing centers.3 For them, medical reform was part and parcel of the general war aim: national unification in accordance with a "blueprint for modern America" conceived and dominated by representatives of the...