• collecting statistics
• emphasized the value of training in the south, but the medicine taught was the same
• hospitals were a place where students could get better training

almost all the army doctors were general practitioners with no military experience

• the principle of states' rights put pressure to organize everything on a state rather than confederacy-wide level
• even in Richmond there were different hospitals for soldiers from different states
• doctors did not have experience with hospitals but they did have experience with large-scale organization on plantations

J. Marion Sims is an example of the traditional approach of elite southern doctors before the war

• did a series of unsuccessful operations on female slaves from 1845-1849--operating on one woman 30 different times
• he did not use anesthesia during the surgeries; it had recently become available but was not yet fully accepted
  
• finally developed an operation for repairing vesicovaginal fistula (an opening between the vagina and the bladder as a result of trauma during childbirth)
• once it was successfully tested on slave women he began to use it on white women, using anesthesia
• he moved to New York in 1953, where he worked in a hospital and operated on women who came to the hospital because they could not afford to pay for hospital care
• he operated on one patient 30 times between 1856 and 1859
  

"Public-health-minded physicians... left the war thinking that there was much physicians could do to prevent disease and that the government had the right and the duty to assist them in the endeavor." (p. 272)

• collecting statistics
• argument over whether low rates of yellow fever in New Orleans were due to cleanup and quarantine
• right after the war cholera was fought with considerable success by isolation and disinfection
• the army stressed the importance of clean drinking water
• the modern germ theory of disease did not appear until the 1880s (that specific bacteria cause specific diseases), but the idea of infection was already fairly clear

Vaccination for smallpox (using cowpox) was well established before the war, but as a matter of individual choice

• vaccination was made mandatory for soldiers, but often not enforced
• poor vaccination practices caused ineffectiveness as well as other diseases
• in some places vaccination was effectively used after the war, in others it was controversial

Eakins, The Gross Clinic, 1875                                                                                                        Eakins, The Agnew Clinic 1889

Medical practice after the war:

• spread best practices
• surgical specialties began to develop
• standardization instead of practices individualized to the patient
• sectarian debates diminished a little--let science decide

The germ theory caught on gradually

• some diseases are transmissible, but this only helps if you differentiate smallpox, chicken pox, and measles
• small step from disinfectants to neutralize a poison to using the same disinfectants to kill micro-organisms
• shift by the 1890s to excluding germs from the operating room instead of killing them with disinfectants
  
• carbolic acid

the civil war helped medicine become more scientific

•  collecting more data
• people are slowly figuring out ideas of infection
• translating science into practice is slow and difficult

progress--science and technology making life better--is becoming much more visible by the late 19th century