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Class 1: Understanding Disease and its Treatment in 1860s

Introduction:

This first class includes secondary source readings to aid in understanding medicine and medical care during the antebellum period and the Civil War. It examines the understanding of disease causation, the structure and function of hospitals, and the large role of domestic healing by women in the day-to-day life of most Americans. It describes the effective remedies that physicians had identified, such as opium, quinine, anesthetics, and laxatives, and likewise reviews the treatments that would be considered harmful today, such as the use of bloodletting and mercury compounds. It reviews the concepts about disease causation, which did not include the idea of germs, but instead focused on foul smells as the basis of infections. Physicians were quite familiar with anatomy, and had to learn about amputations "on the job" as this sort of surgery became central to Civil War practice.

Readings:

Bollet, Alfred J. Civil War Medicine, 1861-1865. Tucson: Galen Press Ltd., 2002, 75-96, 231-255.

Cassedy, James H. Medicine in America: A Short History. Baltimore: The Johns Hopkins University Press, 1991, 21-66.

Keeney, Elizabeth. "Unless Powerful Sick: Domestic Medicine in the Old South." In Science and Medicine in the Old South. Edited by Ronald Numbers and Todd Savitt. Baton Rouge: Louisiana State University Press, 1989, 276-294. [Note: Although Keeney's focus is on the plantation, what she has to say applied broadly to the north as well, especially in rural and frontier areas.]

Rosenberg, Charles. The Care of Strangers: The Rise of America's Hospital System. New York: Basic Books, 1987, 69-93.

Discussion Questions:

• It may at first glance be hard to understand why physicians continued to believe in disease ideas and medical practices that seem grossly wrong to us today. Rosenberg emphasizes that medical therapies often involved effects that were visible to both doctor and patient, a visibility that reinforced the physician's power. What did he mean by that? Can you relate this phenomenon to your own experience with physicians and medical care?
  
  
• The link between bad smells (emanating from piles of manure or rotting animal carcasses) and infectious diseases was unchallenged in the Civil War. Camps in which the latrines were not properly covered reeked, and men did get sick. Why would this idea have persisted so long?
  
  
• Before the war only the poor (and occasionally the traveler) were cared for in the hospital. Women provided most of the care, in the home, supplemented by doctor visits. During the war just about every soldier, northern and southern, spent some time in the hospital. How do you think this shift might have changed the hospital, and the patient's experience of illness?
  
  
• Why did Civil War surgeons do so many amputations? Was this practice grounded in experience or experiment? Where did they learn when and how to operate?