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 C H A P T E R S E V E N  Medicine for a New Nation Confederate medical leaders struggled with the same challenges as their Union counterparts, but they also embraced the opportunities offered by the war to create a new medical system for their nascent country, one that would rival the North’s and encompass the best features of contemporary medicine .1 These leaders had a fairly clear idea of what progressive medical education , research, and care should be and hoped they could construct a model system within their new country, for which they had such high aspirations. Confederate political leaders looked to the past, basing their claims for legitimacy on a return to the country of George Washington, Thomas Jefferson, and James Madison—southerners all—who founded and led the original United States. Feeling that their country had been corrupted by abolitionist politicians who led it astray, Confederate politicians sought restoration and wrote a constitution that echoed the original almost word for word (with a few additions about slavery).2 In medicine, however, Confederate leaders looked resolutely forward, seeing models in France, England, and Scotland of what the field of medicine could be. The war offered a fertile ground for the reform and improvement of the southern medical profession. Southern medical leaders were well aware of the debates and reformist measures that invigorated American medicine in the 1840s and 1850s and wanted the physicians in their region to benefit from this progressive approach to the profession. Many elite American physicians, including some from the South, studied abroad in the two decades leading up to the Civil War, and many more attended medical school at the best American institutions in Philadelphia, New York, and Boston. Particularly in the hospitals of Edinburgh and Paris, students found ample “clinical material” in the indigent wards of large hospitals and had the opportunity to witness autopsies Medicine for a New Nation 185 to correlate bedside findings with anatomical evidence.3 Such research was centered in the hospital, and American students went abroad to study in part because there were relatively few hospitals in the United States and correspondingly little opportunity for this sort of research. To be sure, there was a strong emphasis on anatomical study at the leading schools in Boston, New York, and Philadelphia, where many of the dissected corpses were African American, dead slaves whose bodies were preserved in the South and shipped north in barrels. Southern medical schools also made ample use of such bodies for learning anatomy.4 But hospital opportunities were limited. Exposure to the best of European medicine, either firsthand or through the lectures and writings of those so influenced, contributed to a strong reform ethos in American medicine in the 1840s and 1850s. The reform agenda had multiple trajectories. One called for the accurate keeping of vital statistics, so that the true state of disease prevalence and the magnitude of early mortality could be recognized and studied. Mostly this was done on the city level in the antebellum period. Southern reformers who compared the slack information-gathering of their cities to the more complete data available for Boston, New York, and Philadelphia were vocal in their calls for greater statistical awareness.5 Others recognized the need for hospital study and autopsy experience, and the best medical schools promoted such learning . The American Medical Association was founded in 1847 in part as a reaction to sectarian competition, but it also had at least a stated ambition of raising the quality of American medical practice and education.6 These voices created a new standard for the best of modern medicine, a standard that the elite medical leaders of both sides in the conflict attempted to put into practice. In some ways the medical reform impulse in the South mirrored the drive toward industrialization once the war began. Even as southern leaders depicted their country as distinctively and idyllically agricultural (in comparison to the threatening and ugly industrialization of the urban North), others called for the region to begin to modernize or else risk the loss of wealth to outside manufacturing. The war forced the issue; no longer could the southern states buy manufactured goods (including military hardware and ordnance, clothing, shoes, and even glassware) from the North, and foreign importation was limited by the blockade. The explosive growth of southern industry during the war was one of the Confederacy’s unlikely success stories; medical men no doubt looked on jealously at the resources plowed [18...

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