– by Robert Hicks, Director of the Mütter Museum & the Historical Medical Library
William Maul Measey Chair for the History of Medicine
Special collections libraries occasionally spawn serendipitous discoveries while performing the most tedious tasks. Reference Librarian Caitlin Angelone was performing another bout of purging decades’ old pamphlet boxes of unneeded offprints of medical journal papers when she discovered a yellowed, folded wall poster. Carefully opening it, she discovered a ten-day diet schedule for posting in Union army hospital kitchens during the Civil War. In fact, the fine print at the bottom of the schedule commanded medical officers to conduct an “experimental trial” of the diet plan and report results to Surgeon General William A. Hammond, and scrupulously account for and report related expenses under the hospital fund, dated October 28, 1862.
When the war began in spring, 1861, Union and Confederate armies were unprepared for the medical challenge of disease and battle wound casualties. The Union medical department was essentially unchanged since the War of 1812 with a superannuated command structure. Soon, ambitious, confident, and competent junior military doctors found themselves promoted into positions requiring organizational and managerial skill in tandem with latest medical thinking. Hammond fit this description. He had been in army service in New Mexico before the war, returned to private practice, and when the Civil War began, he re-entered the service. Within a very short time, he found himself appointed Surgeon General. Hammond had shown an interest in experimental medicine and after the war became one of the country’s first neurologists. Hammond had to expand the medical infrastructure to such a degree that his budget for ice for military hospitals in the first year of the war exceeded the entire army medical budget the preceding year.
Army logistics understood the meaning of “red tape” and the bureaucracy of war provided lists and requirements for everything. The army decreed a daily meal allowance per soldier that included 20 ounces of fresh beef (or 12 ounces of salt pork), 22 ounces of soft bread (or 16 ounces of hardtack, a very hard and dry biscuit). Dried vegetables including beans, rice, or peas supplemented this, at least in theory. In hospitals, though, food was medicine and many hospital directors took pride in tailoring meals to individual requirements. Doctors prescribed diets as if they were medicines. Not only did the army prescribe the daily ration, but field commanders were given budgets based on them. When soldiers entered hospitals, the rations were similarly transferred. Hospitals, at least, had kitchens staffed by paid cooks and connected to a distribution system that ensured regular deliveries of fresh and preserved foods.
During the war, the army did not label food to list ingredients, and nutritional value was not analyzed in terms of vitamins. Various medical writers had employed chemistry to illuminate the process of creating health from food, even identifying proteins, carbohydrates, and minerals as essential components. Fresh foods were valued, particularly fruits and vegetables, and the anti-scorbutic properties of some fruits such as citrus had been recognized for many years.
Despite the army’s promotion of sound dietary practice, the reality in the field could be quite different: no soldier expected the army to provide all food needs. Soldiers had to forage or buy food from local citizens. Hospital-bound soldiers, though, might receive food parcels from home to supplement their diet, or visitors might bring gifts of local produce or even sweets.
Hammond’s chart groups special diets into various categories depending on the condition of the patient: full, half, chicken, low, milk, or beef-tea diets. He also decreed that food be prepared “according to receipts [recipes] in the Stewards’ Manual.” The hospital steward, the principal assistant to the surgeon (all physicians in military service were called surgeons), wore a distinctive green chevron with the symbol of the caduceus on his sleeve, and was equivalent to a sergeant in rank. Stewards supervised food preservation in hospitals (and themselves were responsible for filling medicine prescriptions) and also managed the kitchen employees. One of the workaholic young doctors in Hammond’s circle, Joseph Janvier Woodward, who pioneered photomicroscopy during the war, wrote The Hospital Steward’s Manual (J. B. Lippincott & Company, 1862), a guide to all essential duties. According to this manual, the physician would denote the type of diet on the prescription, F (full), H (half), or L (low), the three primary types. The doctor might prescribe an “extra diet,” specifying non-standard items for the patient. With requirements in hand, the steward applied to the commissary (who had charge of food stores) and the medical purveyor (a doctor who procured drugs for the medical director).
Regulations mandated three meals, breakfast, dinner (lunch), and supper (dinner). The chart for Monday’s dinner includes beef soup as a main course under the full diet (intended for soldiers with no dietary restrictions). The manual states that “dinner should consist of some well-made soup, of meat, and of vegetables. Bread in slices of two or three ounces each should be put upon the table, that each patient who wishes may eat one or more slices with his soup” (p. 187). The manual includes extensive descriptions and recipes for all foods listed in the chart. Half diets are “for those patients whose condition is such as to require a smaller quantity of nutriment that is afforded by the full diet” (p. 190). Similarly, the low diet requires “still less nutriment,” the minimum required to achieve digestion. The manual contains examples of similar diet tables from Satterlee Hospital (West Philadelphia Hospital) in Philadelphia and the Seminary Hospital in Georgetown, Washington, D.C. The specific diet table represented by the poster is not shown. Intriguingly, Hammond describes the poster diet scheme as experimental. Perhaps Hammond had issued a circular (periodic administrative orders to all medical directors) with instructions on the chart’s application. Was the Historical Medical Library chart used in a Philadelphia hospital by a surgeon who was also a Fellow of the College? Hammond’s chart was published only a few months after Woodward’s book appeared. That it is not mentioned in the book might mean that the experimental diet table was an innovation of the fall of 1862.
Whatever its circumstances, the folded chart was so creased when found that it fell apart in small sections. The Historical Medical Library sent it for repair to the Center for the Conservation of Art and Historic Artifacts in Philadelphia, and now it resides in a large document drawer for archival media, and thus awaits future researchers.