Do you have what it takes to become a Civil War surgeon?

- Jack Dowd

Gaining access to medical schools in the twenty-first century is a seemingly impossible task to countless pre-meds across the country. A stable and well respected career draws students to college with dreams of one day donning a white coat. In one study of 16,000 students across 102 institutions between 2006 and 2009 only 16.5% of students intended to be pre-med finished college with required prerequisite coursework (Zhang et. al, 2020). That does not even account for the fact that only 45.2% of medical school applicants ever matriculate into medical school (Zhang, 2021). You would think that things would be easier today, with 155 allopathic medical schools in the United States, compared to that of only 99 medical schools existing prior to 1865 (Slawson, 2012) yet medical education then did not look like what it is today.

The bloodiest war in US history, a war in which more Americans died than all other wars combined, had a woefully underprepared medical care team on both sides (Reilly, 2016). Not only were infrastructure and technology lacking for treatment and recovery, doctors who were performing operations were raised in a medical education system much different than the hypercompetitive atmosphere surgeons today train in. That said, less than 12% of the 3,500 colonial physicians during the war actually held a medical degree (Ludlow, 1944). Most medical knowledge at the time was passed down through apprenticeships, demonstrations and didactic lectures. Today’s standardized lectures and tests were a foreign concept and brought about through decades of evolution of modern medical education. Medical schools themselves only came about as supplementary education to that of a preceptorship position, which training-doctors would work in for two to five years before taking on their own practice. As medical schools became more formalized towards the mid 1800s, a standardized path to a medical degree was developed. Future doctors had to complete two years of classes, followed by three years of preceptorship similar to what we refer to as “residency” today (Slawson, 2012). Interestingly enough, although one had to be 21 years of age to attain a medical degree, previous college experience was not required (Norwood, 1944). In fact, only a high school degree was required for application.

Before arriving at Georgetown University School of Medicine, I heard the phrase “getting accepted is the toughest part”. After a fast 12 months, I have reached the conclusion that was false. That said, that saying may have been passed down from medical students from the days prior to the civil war, where each semester was only 16 weeks and the second year was a repeat of the first (Slawson, 2012). It is interesting to hypothesize why that could be. Perhaps what was known in the 1850’s was only a small fraction of what is in the First Aid for Step 1 book sitting in front of me. More likely, it was due to the perceived value of preceptorship and the need for practicing physicians instead of students.

I would be remiss not to highlight the difference in cost between medical education today compared to that of pre-civil war time as it is a constant source of pain for me as I debate if I can afford to order an Uber instead of walking. Currently, Georgetown University School of Medicine has an estimated cost of attendance over $70,000. Medical school in the 1850’s cost about $120 a year for tuition or about $4800 in today’s money. In addition, preceptorship could cost about $100 a year as well after your two years of classes (Moore, 1946). In one of the greatest similarities between medical school then and medical school now, it required a wealthy upbringing to be able to afford to pursue a career in medicine as you surrendered years of salary and hours you could be contributing to your household.

It is important to acknowledge that all providers during the civil war were not graduates of US medical schools, and that this picture of medical education during the civil war is only a part of the story of those who served as surgeons in the Union Army. Medical education has come a long way since the mid 1800’s and as we work towards our ultimate goal of becoming physicians and surgeons it can be empowering to reflect on the training of those who came before us. Acceptance may have been more lenient, cost may have been lower and the requirements for earning your medical degree may have been less stringent but those who graduated from medical school and served in the civil war helped shape the history of our country and paved the way for the medical advances we practice with today such as prosthetics.

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Citations:

1. Zhang C, Kuncel NR, Sackett PR. The process of attrition in pre-medical studies: A large-scale analysis across 102 schools. PLoS One. 2020;15(12):e0243546. Published 2020 Dec 28. doi:10.1371/journal.pone.0243546

2. Zhang D, Li G, Mu L, et al. Trends in Medical School Application and Matriculation Rates Across the United States From 2001 to 2015: Implications for Health Disparities. Acad Med. 2021;96(6):885-893. doi:10.1097/ACM.0000000000004033

3. Slawson RG. Medical Training in the United States Prior to the Civil War. Journal of Evidence-Based Complementary & Alternative Medicine. 2012;17(1):11-27. doi:10.1177/2156587211427404

4. Reilly RF. Medical and surgical care during the American Civil War, 1861-1865. Proc Bayl Univ Med Cent. 2016;29(2):138-142. doi:10.1080/08998280.2016.11929390

5. Ludlow AI. Medical Education in the United States before the Civil War. Bull Med Libr Assoc. 1944;32(4):533.

6. Norwood WF. Medical Education in the United States Before the Civil War. Philadelphia, PA: University of Pennsylvania Press; 1944.

7. Moore TE Jr. The early years at Harvard medical school. Bull Hist Med. 1946;19:530-561.