By David A. Carrino, Roundtable Historian
The Cleveland Civil War Roundtable
Copyright © 2015-2016, All Rights Reserved
Editor’s note: This article was the history brief for the May 2016 meeting of the Cleveland Civil War Roundtable.
Anyone who has watched television in Cleveland has almost certainly seen one of the commercials that end with the following emphatically confident promise, “I’ll make them pay.” These advertisements are for a law firm that specializes in personal injury cases, such as medical malpractice. If this law firm had been in existence at the time of the Civil War, one of the medical practices used by the Union army may have provided an opportunity for this firm to follow through on its confident promise. Battlefield medicine saw amazing advancements during the Civil War, and Civil War physicians worked tirelessly and admirably to deal with one seemingly hopeless injury after another. In spite of this, there were flaws in the medical treatment that soldiers received. With regard to one serious flaw, the person in charge of medical matters for the Union army was not responsible for this problem and, in fact, mandated a correction of this flaw. But a political appointee who is well known to every Civil War enthusiast undid the corrective action.
Many horrific descriptions can be found to convey the enormity of the frightful task that Civil War physicians faced in field hospitals. A gruesomely accurate description was written by Jacob R. Weist, a physician from Ohio who served in the Union army. Weist wrote, “Wounded men are lying everywhere. What a horrible sight they present! Here the bones of a leg or an arm have been shattered like glass by a minnie ball. Here a great hole has been torn into an abdomen by a grape shot. Near by see that blood and froth covering the chest of one choking with blood from a wound of the lungs. By his side lies this beardless boy with his right leg remaining attached to his body by only a few shreds of blackened flesh. This one’s lower jaw has been carried entirely away; fragments of shell have done this cruel work. Over yonder lies an old man, oblivious to all his surroundings, his grizzly hair matted with brain and blood slowly oozing from a great gaping wound in the head. Here is a bayonet wound; there is a slash from a sabre. Here is one bruised and mangled until the semblance of humanity is almost lost…The sum of human agony about us is so great that no expression can describe it.” Against this backdrop of ghastly medical need, physicians in battlefield hospitals performed extraordinary feats to assist the wounded. But in spite of this, there were some flaws in the treatment given by the Union army’s medical corps, and one flaw in particular led to what became known as a rebellion among the members of that corps.
The person at the center of this rebellion was William A. Hammond. Hammond was born in 1828 and received his M.D. at the age of 20. After a one-year internship and a few months in civilian practice, he joined the army as an assistant surgeon. Hammond spent 11 years in the army, mostly in the West, and the strong reputation that he developed led to him being offered a position as chair of anatomy and physiology at the medical school of the University of Maryland in Baltimore. Hammond resigned from the army on October 31, 1860 to take this position. Six months later Hammond had his first experience with Civil War wounded when he treated some of the Union troops who were injured by a pro-secessionist mob in an infamous riot in Baltimore. One month later Hammond resigned from his academic position and returned to the army, where he was eventually assigned to West Virginia as a physician in the army commanded by William Rosecrans. Hammond was later assigned to the Army of the Potomac. During his first year of Civil War service Hammond met and interacted with Jonathan Letterman, another army physician who has been called the Father of Modern Battlefield Medicine.
In the spring of 1862 Clement Finley, who at that time was the Union army’s surgeon general, became engaged in an acrimonious argument with Secretary of War Edwin Stanton over some issues in the army’s medical department, and Stanton relieved Finley of his duties. Stanton had someone in mind as Finley’s successor, but by this time William Hammond had developed such a strong reputation as an administrator and innovator that there was much support for Hammond to be named the army’s surgeon general, including from the Sanitary Commission. Contrary to the wishes of his own secretary of war, Abraham Lincoln promoted Hammond to army surgeon general on April 25, 1862. This led to friction between Hammond and Stanton, which reached a boiling point a little over a year later.
To make the situation worse, Hammond was an assertive and imposing person, which made it difficult for Hammond and Stanton to co-exist. In fact, in a short biography of William Hammond on the website of the U.S. Army Medical Department, there is a statement that reads, “It was inevitable, however, that the masterful personality of Hammond would excite the disapproval of such an autocratic spirit as Secretary Stanton.” However, no one could deny that under Hammond’s stewardship the army’s medical corps experienced immense improvements. Drawing on what he learned during his first tenure in the army, Hammond redesigned army hospitals to improve the floor layout and to provide more ventilation, lighting, and space. He also raised the qualification standards for army physicians, improved and increased medical records of patients, instituted an inspection system for army hospitals, and implemented throughout the entire Union army the ambulance system that Jonathan Letterman had developed for the Army of the Potomac. Mortality among army patients decreased, and efficiency and effectiveness of the army’s medical corps increased.
But one of Hammond’s directives for improving patient care gave Edwin Stanton an opening to dismiss the man whom Stanton did not want as the army’s surgeon general and toward whom Stanton felt fierce disdain. On May 4, 1863 William Hammond banned the use of calomel, a chemical that was widely used for medicinal purposes and had been so used for centuries prior to the Civil War. Calomel is a chemical compound that contains mercury. Specifically, calomel is mercurous chloride. Calomel was routinely given orally to treat a number of diseases and ailments, including typhoid fever, yellow fever, dysentery, and constipation. Despite its mercury content and despite abundant evidence of its deleterious side effects, calomel was even given to children. As an indication of how standard and trusted calomel was as a medicine, on the day that George Washington died, he was given calomel to treat the respiratory illness from which he was suffering.
At the time of the Civil War germ theory had not been proven, so it was not known that many diseases are caused by microorganisms. The rationale for calomel treatment grew out of the medical thinking that diseases resulted from an imbalance in the body’s humors, that is, the body’s fluids, and it was thought that one method for curing a disease involved purging unhealthy humors from the body. This is the thinking that led to the medical practice of bloodletting. Another method for purging unhealthy humors was to use cathartic chemicals. Calomel is well suited for this purpose, since calomel has been said to cause explosive evacuation of the bowels. For example, according to an account written by two of the physicians who treated George Washington just before his death, the Father of Our Country endured the intense and copious bowel evacuation that is typical after calomel administration, and this likely contributed to his death. In addition, calomel, at the doses at which it was used medicinally, frequently produced extreme salivation, which was the rationale for administering calomel, since it was thought that the intense salivation removed unhealthy humors from the body.
Patients who were treated with calomel often experienced loosening of their teeth or even loss of teeth. Associated with the oral administration of calomel were deterioration of facial tissue, such as the cheek and gums, as well as loss of muscle and bone from the jaw with consequent facial deformities and sometimes partial loss of functionality of the mouth. There were also harmful effects on the internal organs, particularly the gastrointestinal tract. One documented Civil War case involved Union soldier Carleton Burgan, who was given calomel in 1862 after he contracted pneumonia. Two days later an ulcer had formed on Burgan’s tongue, which subsequently spread to his cheek and the roof of his mouth and then became gangrenous. After the gangrene destroyed Burgan’s upper mouth, palate, right cheek, and right eye, his right cheekbone was removed to stop the gangrene from spreading further. Fortunately, Burgan’s facial deformities were able to be alleviated by reconstructive surgery, although some facial abnormalities remained.
William Hammond correctly recognized that calomel is toxic and that its administration to patients does much more harm than good. However, his directive banning calomel infuriated most of the ‘conventional’ physicians of his time, both military and civilian, who considered that Hammond must be a fringe physician if he banned such a widely used medicine. The uproar over Hammond’s ban of calomel came to be known as the Calomel Rebellion, and the widespread criticism of Hammond’s directive led Edwin Stanton to take action that resulted in Hammond’s dismissal as the army’s surgeon general. First Stanton ordered that Hammond conduct a lengthy inspection tour of military hospitals, which effectively removed Hammond from his post as surgeon general. Stanton then directed that a personal friend, Joseph Barnes, assume the duties of the surgeon general.
When Hammond returned to Washington from the inspection tour, he demanded that he either be returned to his position or face trial by court-martial. Stanton chose the latter for Hammond and, by some accounts, arranged that the court-martial’s panel be composed of people who shared Stanton’s dislike of Hammond. It was not difficult to find such people, because Hammond was certainly overbearing and heavy-handed, and he had earlier made known his contempt for some of the people who were eventually selected by Stanton to serve on the court-martial. One member of the court-martial’s panel had once been described by Hammond as a “vulgar ignoramus” and another as “unscrupulous, dishonest, cowardly, and ignorant.” In the end Hammond was found guilty of irregularities in procurements for the medical department, and he was dismissed from the army on August 18, 1864. William Hammond was known to be arrogant, and it is reasonable to conclude that this played a role in his dismissal, if for no other reason than because Edwin Stanton, by all indications, was the type of person who simply would not tolerate his own arrogance being overshadowed by someone else’s.
On the day after Hammond was dismissed from the army, The New York Times characterized Hammond’s guilt as being “of a very vile sort.” The Times also claimed that Hammond had “stooped to the level of the lowest shoddy knave” and went on to state “he will be remembered only to be loathed.” In a whirlwind journalistic reversal, the Times sheepishly admitted one day later, “We know nothing of the case beyond the fact of conviction.” The hasty prediction by The New York Times regarding how William Hammond would be remembered could not have been further from the truth. After the Civil War Hammond became a pioneer and innovator in the nascent field of neurology, he held several appointments in academia, he wrote seminal works in his field, and he participated in the founding of medical journals and of the American Neurological Association. In 1879, 15 years after Hammond’s dismissal from the army, the wrong that Edwin Stanton wrought was corrected when William Hammond was restored to the army as a retired member at his previous rank, although without pay. Upon his death in 1900 Hammond was buried in Arlington National Cemetery. There was, however, one consequence of Stanton’s actions against Hammond that could not be corrected, and this is that calomel continued to be used not just during the Civil War, but for decades afterward, even into the early 20th century. In time William Hammond was proven to be correct regarding his ban of calomel, which is unquestionably toxic and is now known to be of no use in the treatment of diseases.
If the Cleveland law firm which promises to “make them pay” had been in existence at the time of the Civil War, this firm may have found a fertile field for liability in the Union army’s use of calomel for medicinal purposes. Occasional and random errors that lead to personal injury can be a valid reason for liability. But a systematic flaw is an even more likely reason for widespread liability, particularly if the person in charge recognizes the flaw and endeavors to correct it, but his corrective effort is overruled. This was the case with regard to the medicinal use of calomel in the Union army. In light of the extensive use of calomel to treat the diseases of Union military personnel, it is certainly possible and perhaps likely that calomel was at least a contributing factor in some and maybe many of the more than 200,000 Union military deaths that were classified as death by disease. Consequently, the medicinal use of calomel may have been a sufficient cause for personal injury cases, in the same way that Vietnam veterans were compensated for exposure to Agent Orange after a lengthy process that began with a lawsuit. Physicians in the Confederate army also used calomel, so perhaps there were grounds for southern cases to be prosecuted as well. But if lawyers did decide to prosecute southern cases involving calomel, they would have to be careful to “make them pay” in something other than Confederate currency.