Civil War Pharmacy: A History of Drugs, Drug Supply and Provision, and Therapeutics for the Union and Confederacy (review)

Author Michael Flannery, associate director for Historical Collections at the Lister Hill Library of the Health Sciences, University of Alabama at Birmingham, draws on a cache of published and unpublished materials to write the first synoptic history of pharmaceutical practice and drug provision during the Civil War. Flannery comes to the topic as a seasoned historian, having authored several notable books, including_ John Uri Lloyd: The Great American Eclectic (Carbondale: University of Illinois Press, 1998); America's Botanico-Medical Movements: Vox Populi (New York: Pharmaceutical Products Press, 2001), which he coauthored with Alex Berman; and Pharmaceutical Education in the Queen City: 150 Years of Service, 1850 - 2000 (New York: Pharmaceutical Products Press, 2001), which he coauthored with Dennis B. Worthen. All three reflect his thorough grounding in the nature of America's pharmaceutical industry before and after the Civil War and in the evolution of botanical medicines, which played such an important role in regular and sectarian medicine.

Flannery begins by assessing the state of pharmacy and medicine at the opening of the war, and then shows how pharmacy was practiced in the Union and Confederate armies during the bloody conflict, carefully explaining the contextual nature of roles played by medical purveyors and hospital stewards. He traces the travails of drug acquisition and supply; the complementary roles of civilian suppliers and government laboratories; and the prescribing and dispensing of the remedies of choice, including calomel and quinine. Flannery is particularly good on the political fall from grace of Surgeon General William A. Hammond following his Order No. 6 that struck calomel and tartar emetic from the Supply Table, on the wartime shortages and their consequences, and on the war's overall effect on pharmacy as an industry and as a profession in the postwar period.

Flannery is at his best when he explains the broad classifications of drugs, noting their multiple uses as well as what he calls "community practice." This work lays the foundation for his challenge to John Harley Warner's claim that the therapeutic use of mercury was declining at the time of Hammond's Order No. 6. Using the Ebert (1885), Hallberg (1895), Hallberg-Snow (1907), Charters (1926), Cook (1930), and Gathercoal (1930) surveys, Flannery demonstrates conclusively that not until after 1885 did the mercurial agents in all types of prescriptions begin to fall off. Until then, mercury remained an integral part of everyday practice among regular doctors.

Also interesting is Flannery's assessment of the difference in women's influence over pharmacy between the North and South. Despite a sharply defined male-dominated culture, especially in the military theater, female nurses in the South had greater relative freedom in rendering care and faced less overall direction than their counterparts working in the U.S. Sanitary Commission. Flannery attributes this difference to the distinctive administrative and organizational structure (or lack thereof) in the Confederate states. Shortages of both men and material allowed for more impromptu solutions, including the brief entry of women into the health care arena. In both sections of the country, this role retreated considerably in the postwar years.

Flannery concludes his study by suggesting that the war acted as a catalyst for several important changes in the subsequent decades. It acted, for example, as a "proving ground" for the use of therapeutic substances, old and new (p. 232). The war years also demonstrated the positive role of the U.S. government's laboratories in stimulating private sector pharmaceutical growth and provided the take-off point for extensive mass-produced pharmaceutical drugs, with the North emerging as a leader in the industry worldwide and the South reverting to the role of supplier of crude vegetable drug products.

This is a particularly well-written and well-researched book. It comes with six useful appendixes, thorough footnoting, and a complete index. Both the...