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Fragmentation of Medicine in the United States

During the 19th century, the United States of America radically and tumultuously transformed from an experiment in democratic governance by a fledgling group of settlers populating the eastern portion of North America to a robust, free, and powerful nation encompassing a greater portion of the continent of North America and dominating technological innovation for the world. The event that served as the major dividing point in this period of development was the American Civil War of the 1860s. Wartimes trigger great social, scientific, and technologic upheavals and the American Civil War was no exception. By the 1860s, science and technology were finally beginning to be incorporated into medical diagnosis and treatment in Europe, which at the time held leadership in this field, whereas in the United States, medical care still often produced more harm than good (eg, accepted therapy for injuries with internal bleeding was bloodletting). Prior to the American Civil War, medical education was wildly variable. Additionally, numerous health care theories and disciplines (some pure charlatanism and quackery) appeared that generally had the important single benefit of being much less injurious (and equally effective or ineffective) than the established ‘‘orthodox’’ medical treatments. Despite the scientific revolution in biomedicine that flowered during the 20th century in the United States, the residua of that that earlier era still plagues health care delivery in the 21st century. Thus, it is critical now to understand history in order to build the bridges across disciplines and between providers to optimize the health and well-being of all patients. To that end, the Journal of Evidence-Based Complementary & Alternative Medicine (JEBCAM) has been able to obtain permission to reproduce material detailing the state of medical training in the United States prior to the American Civil War. This material originally appeared in 4 parts in issues of the award-winning journal Surgeon’s Call, which is published by the National Museum of Civil War Medicine. The National Museum of Civil War Medicine started as an idea of Gordon E. Dammann, DDS, whose collection of medical artifacts from the American Civil War forms the core holdings. The Museum was incorporated in 1990, and in August 1993 the board chose to locate in Frederick, Maryland, which is within a 30-minute drive to 5 major Civil War battlefields: Gettysburg, Pennsylvania; Harpers Ferry, West Virginia; Antietam, Maryland; South Mountain, Maryland; and Monocacy, Maryland. The Carty Building on East Patrick Street, a cityowned building in the heart of Frederick’s historic district, was chosen as the site. The Museum began publishing its originally quarterly newsletter, Surgeon’s Call, and on June 15, 1996, the first exhibits were opened to the public. The exhibits included dioramas, cases, and informational panels on recruiting, camp life, medical evacuation, field hospitals, pavilion hospitals, and the home-front. The displays were highlighted by a Confederate ambulance on loan from the Lincoln Memorial University, a 19th-century holding coffin, stretchers, amputation kits, uniforms of medical personnel, and numerous other medical and surgical items. In 1997, plans were developed to renovate the building with the goal of the design process to tell the story of Civil War medicine in much the same order as it would have been experienced by soldiers themselves: the first gallery establishes the context for the Museum by discussing the state of medicine and medical education at the beginning of the war, while the remaining galleries follow the soldiers through recruitment, camp life, the evacuation of the wounded, field dressing stations, field hospitals, and pavilion hospitals. The last gallery highlights specific subjects such as indigenous plants used by the surgeons, dentistry, naval medicine, and the Civil War hospitals in Frederick. On October 21, 2000, the newly renovated Museum opened its doors to the public. In addition to the exhibit galleries, the Museum has a secure, climate-controlled collections room and a research center. Since the reopening, additional exhibits have been added that study the embalming of the dead, apothecary wagons, and nursing practices during the Civil War. The author of this 4-part article is Dr Robert G. Slawson, a 1962 graduate of the University of Iowa School of Medicine, who spent 8 years in the US Army training in radiology