- Ashley Isenberg
The Civil War not only transformed the political and social landscape of the United States but also fundamentally reshaped the medical profession, particularly in the South. While Northern physicians entered the conflict with stronger institutional ties to hospitals, more reliable access to cadavers, and a tradition of clinical instruction, Southern medical schools were often proprietary institutions with limited resources and inconsistent curricula.[1] When the war began, most Southern schools closed, leaving only the Medical College of Virginia open. In the postwar period, the South faced the challenge of rebuilding its devastated infrastructure while also modernizing its medical education. This essay explores how Southern schools adapted after the Civil War, emphasizing the reforms that gradually aligned them with Northern standards.
Before the war, Southern medical education was characterized by shorter lecture terms, limited emphasis on dissection, and minimal hospital training. Whereas Northern schools benefited from anatomy acts such as Massachusetts’ 1831 law and New York’s 1854 “Bone Bill,” which secured a legal cadaver supply, Southern students relied on grave robbing or personal appeals to governors for access to anatomical subjects.[2] Clinical instruction was similarly limited. At the University of Virginia in 1850, for example, candidates were required to complete two lecture courses in anatomy, medicine, and chemistry, but there was no mandatory hospital component. Charlottesville General Hospital did not even open until 1861, leaving graduates with little hands-on surgical experience.
The wartime consequences of this educational gap were Southern surgeons that were thrust into battlefield hospitals with minimal operative experience, often learning amputation techniques on wounded soldiers rather than in a controlled learning environment. In contrast, many Northern professors—including Samuel Gross of Jefferson Medical College and William Hammond of the University of Maryland—directly authored surgical manuals or led the Union’s Medical Department.[3] The South entered the war at a distinct disadvantage, both in training and institutional support.
Given the lack of prior training, the Confederacy was forced to improvise and learn on the spot. The Confederate Surgeon General, Samuel Preston Moore, commissioned new manuals tailored to resource-limited settings, the most notable being J.J. Chisolm’s Manual of Military Surgery (1861).[4] Southern surgeons turned to local herbal remedies when cut off from imported drugs like quinine and morphine, and many younger physicians gained surgical exposure only through battlefield necessity. While these adaptations revealed ingenuity, they underscored the lack of a standardized medical education system prior to the war.
Following the war, southern states rapidly responded to deficits in medical training highlighted by the war. By the 1870s, institutions such as Tulane, Vanderbilt, and the Medical College of Georgia began to re-emerge as important centers of medical education. These schools consciously modeled themselves on Northern universities, adopting graded multi-year curricula that replaced the traditional two terms of lectures. This shift was significant: students were now expected to progress through increasingly advanced coursework rather than repeat the same set of lectures twice.
Dissection also became more standardized in the postwar years. Although a uniform legal framework for cadaver donation would not arrive until the twentieth century with the Uniform Anatomical Gift Act (1968), Southern schools gradually secured more consistent access to anatomical material, bringing their training closer in line with national norms.[5]
Perhaps the most important reform in the South was the integration of hospitals into medical education. Prewar Southern schools were often located in smaller towns or rural settings without large patient populations, which severely limited clinical exposure. After the war, schools in urban centers such as New Orleans, Richmond, and Nashville developed partnerships with hospitals that allowed students to gain bedside experience. This mirrored the longstanding model of Northern institutions like the University of Pennsylvania, which had required attendance at Philadelphia Hospital or Pennsylvania Hospital as early as 1840.[6]
The new emphasis on hospital-based training in the South not only improved the quality of education but also aligned with broader national trends. By the late nineteenth century, the apprenticeship model was giving way to an institutional model in which hospitals, laboratories, and formal curricula defined the physician’s training.
The Civil War exposed the weaknesses of Southern medical education, but it also created an impetus for reform. Confederate alumni such as Joseph Jones of the Medical College of Georgia later became advocates for scientific rigor and clinical observation.[7] By joining the American Medical Association in greater numbers after the war, Southern schools linked themselves to national debates about standards, curricula, and licensing. Over time, these reforms helped Southern schools move away from the proprietary, profit-driven model that had dominated before the war.
Still, progress was uneven. Many institutions struggled financially, and it was not until the Flexner Report of 1910 that sweeping, nationwide reform would fully eliminate underperforming proprietary schools.[8] Nevertheless, the Civil War created a moment of reckoning for the South. By demonstrating the human cost of underprepared surgeons, the conflict forced Southern educators to invest in anatomy, hospital partnerships, and graded curricula that better prepared their graduates for the demands of modern medicine.
References
[1] Medical Lecture Tickets: Historical Narrative. University Archives and Records Center. Published March 29, 2018. Accessed September 19, 2025. https://archives.upenn.edu/exhibits/penn-history/medical-lecture-tickets/history/
[2] Anatomical Theatre at the University “Subjects” for Anatomy Class. Virginia.edu. Published 2023. https://exhibits.hsl.virginia.edu/anatomical-theatre/subjects-for-anatomy-class/index.html
[3] Hammond, William A. Circular. No. 2. Washington City: Surgeon General’s Office, 1862. Print.
[4] Chisolm’s Manual of Military Surgery, Civil Practice to Civil War: The Medical College of the State of South Carolina 1861-1865. Musc.edu. Published 2025. Accessed September 19, 2025. https://waring.library.musc.edu/exhibits/civilwar/ChisolmMMS.php?
[5] Sadler AM. The Uniform Anatomical Gift Act. JAMA. 1968;206(11):2501. doi:https://doi.org/10.1001/jama.1968.03150110049007
[6] I I. Accessed September 17, 2025. https://archives.upenn.edu/media/2017/10/catalogue-1840-41.pdf
[7] JOSEPH JONES: CONFEDERATE SURGEON - ProQuest. Proquest.com. Published 2025. Accessed September 19, 2025. https://www.proquest.com/docview/288310009?fromopenview=true&pq-origsite=gscholar&sourcetype=Dissertations%20&%20Theses
[8] February 2010 - Volume 85 - Issue 2 : Academic Medicine. Lww.com. Published 2025. Accessed September 19, 2025. https://journals.lww.com/academicmedicine/abstract/2010/02000/abraham_flexner_of_kentucky
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