Thursday, April 15, 2010

EXCERPT #1 from "Years of Change and Suffering"! - INTRODUCTION (Part I)

I am happy to announce some milestones for my second book, Years of Change and Suffering: Modern Perspectives on Civil War Medicine (Edinborough Press), a co-edited (with Guy R. Hasegawa, Pharm. D.) collection of invited expert essays:
To celebrate, I will be posting some excerpts from the book over the next few days and finishing with a BOOK GIVEWAY CONTEST!

Remember - all royalties from the book are being donated to Civil War medical heritage preservation!

Below is the first excerpt - the first part of the Introduction. Enjoy!


by James M. Schmidt and Guy R. Hasegawa
(Copyright 2009, the authors)

Where does the story of Civil War medicine begin? For more than two hundred Southern students studying among Philadelphia’s several medical colleges, it began with the hanging of abolitionist firebrand John Brown on December 2, 1859. Not only was Brown’s execution a pivotal event in the road to disunion of the United States of America, the episode — and subsequent fisticuffs between abolitionists and Southerners in the “City of Brotherly Love” — proved to be the impetus for the students to “secede” and finish their studies at home, most at Richmond’s Medical College of Virginia.

The press reacted to the episode with surprisingly mixed reporting on both sides of the Mason-Dixon Line. One Iowa paper declared that the “Southern ‘deputy saw bones’” did “a very foolish thing, for the Philadelphia medical schools are the best in the United States.” Another Northern paper — rejoicing at the departures — suggested that “300 ignorant doctors let loose in the South might be as destructive of life as a ‘Brown Invasion.’” The Lancaster Intelligencer, however, found the Southern students “intelligent young men . . . universally esteemed by the great mass of our citizens,” and thought them justly “indignant at the . . . mad fanatics of the North, especially those residing in Philadelphia.”(1)

In Richmond, the Enquirer declared the exodus “Good News for Richmond and the South” and an “important step for building up our Medical College and aiding in the independence of the South.” The Richmond Whig, though, railed against the city council for subsidizing the exodus with $5,000 to meet the extra expenses of the students, scoffed at the notion that the students were “constrained” to leave the North, and considered the whole affair “absurd and foolish.” On December 22, 1859, the students arrived by train in Richmond, where they were greeted by “an immense throng of citizens . . . the shouts of the men were deafening, which the ladies manifested by the waving of their handkerchiefs.”(2)

It is with the arrival of the students in Richmond that Jodi Koste begins “Medical School for a Nation,” in which she describes the transformation of the Medical College of Virginia (MCV) from “a sleepy state institution into the premier medical school for the nascent Confederate nation.” Drawing on substantial material from MCV’s archives — of which she is the steward — she proposes that the school’s location in the Confederate capital, a stable faculty, and a newly constructed hospital all helped to propel the college to a place of prominence, while other Southern medical schools were forced to close. More important, she argues that the school’s war experience “gave the faculty chances to provide clinical instruction and undertake new professional activities,” which — when combined with the traditional curriculum — enhanced the experience for the repatriated students and helped to “catapult MCV to ‘first in the Confederacy.’

Once the Civil War began in earnest, inventors on both sides of the Mason-Dixon Line set their minds and tools to work and — as one Northern newspaper declared — directed “their attention forthwith to the improvement of all sorts of instrumentalities.” So confident was the paper in the preeminence of “Yankee ingenuity” that it predicted that Union masterminds would “produce some patent Secession-Excavator, some Traitor-Annhilator, some Rebel-Thrasher, some Confederate State Milling Machine, which will grind through, shell out, or slice up this war, as if it were a bushel of wheat or an ear of corn or a big apple.”(3)

During the Civil War, Scientific American — America’s oldest continuously published magazine — played an important role by fostering and reporting on inventions that had an impact on the battlefields and waters. Not surprisingly, wartime issues of Scientific American have been used as resources in modern studies of mid-nineteenth century military technology. In his contribution, “A Multitude of Ingenious Articles,” Jim Schmidt — a chemist by training and profession — alerts readers to a lesser-known fact: Scientific American played an equally important role in fostering the “healing arts” by advising leaders how to maintain the health of the army and urging inventors to give attention to unmet medical needs. The magazine also reported on advances in medical technologies, including ambulances, medicines, and artificial arms and legs.

Schmidt acknowledges that it is “impossible to separate weaponry from medicine in the Civil War, as arms were responsible for hundreds of thousands of deaths and many more thousands of wounds on the battlefields,” and readers will be surprised to see how weapons of the future, especially chemical and biological, began to emerge during the war. He also contends that study of Scientific American’s wartime pages supports recent historical scholarship in the economics and social impact of invention in the nineteenth century, including the increase in patenting activity by women, the danger of relying solely on patent counts as a measure of inventive activity, and the effect that professional ethics had in restricting patenting activity in the medical community.

One invention that had a tremendous impact on Civil War tactics and medicine was not a new one at all: the Minié bullet, introduced about fifteen years earlier by the French army officer Claude-Etienne Minié in the late 1840s. The “minnie ball” — as it was often referred to by soldiers — was not a ball at all, but rather a connoidal projectile that proved to be a powerful missile, indeed, when fired through a rifled barrel, Civil War surgeons quickly recognized from battlefield experience that the Minié was “much the more destructive” compared with the round ball fired from a smoothbore musket, a fact reinforced by very recent research using ordnance gelatin to examine the wound ballistics of the Minié. The force of the bullet caused tremendous injury to soft tissue and even worse damage when it struck bone, with amputation in such cases often offering the only chance of saving the life of a patient.(4)

It is ironic, then, that if asked to conjure up a picture of Civil War medical practice, many people today imagine callous surgeons indiscriminately hacking limbs off of soldiers whose only medication was a swig of whiskey. Even during the Civil War, the increasingly common sight of amputees led many citizens to conclude that limbs were being removed too often. Medical treatment, including amputation, has been called one of the Civil War’s “most dismal failures,” when in fact it was the most frequent major operative procedure that could be done successfully, and — contrary to popular belief — patients undergoing amputation were almost always anesthetized with chloroform or ether.(5)

Amputation is the topic of the chapter by Alfred Jay Bollet, author of the modern classic survey Civil War Medicine: Challenges and Triumphs. Dr. Bollet draws on his far-ranging expertise in medical history — and a distinguished career in clinical practice and medical education — to provide the proper context in which to consider amputations. Although there were concerns that many amputations were unneeded or incompetently performed, some expert observers of the time contended that more soldiers would have survived had the procedure been carried out more often. Dr. Bollet points out that care provided during the Civil War was sometimes superior to that rendered in the Crimean War and Franco-Prussian War, which occurred in the same era.

F. Terry Hambrecht’s contribution about Confederate surgeon J. J. Chisolm continues the theme of innovation introduced in Jim Schmidt’s chapter. While Chisolm is justly recognized for his editions of A Manual of Military Surgery for Use of Surgeons in the Confederate Army, Dr. Hambrecht adds to our current knowledge by drawing on previously unpublished material to characterize Chisolm as an innovator and man of action. Chisolm could hardly ask for a more fitting biographer than Dr. Hambrecht, who had a distinguished career as a director at the National Institutes of Health and pioneered research in prostheses for the neurologically disabled, including the blind, deaf, and paralyzed.

Dr. Hambrecht, a long-time researcher in Civil War medicine and an expert in Confederate medical personnel, shares his transcription of two letterbooks from 1861-1862 that show Chisolm constantly seeking to improve conditions for patients through his considerable skills as a physician, organizer, administrator, designer, inventor, and author. Chisolm treated sick and wounded soldiers, organized hospitals, served as a medical purveyor and director of a medical laboratory, invented or improved the design of medical apparatus, and wrote a major textbook used throughout the war by Confederate surgeons. He was not shy about making his frank opinions known to decision-makers, especially Confederate Surgeon General Samuel Preston Moore.

Dr. Hambrecht, in fact, considers Moore to be the only medical officer who might have matched Chisolm in improving Confederate medicine — high praise indeed for Chisolm, given the almost universal respect that historians have accorded Moore. Chisolm’s contributions to medicine continued after the war, notably as a pioneer in the specialty of ophthalmology. In 1887, Chisolm examined the young Helen Keller, advising her father (also a Confederate veteran) to take her to Alexander Graham Bell, who in turn introduced the family to “Miracle Worker” Annie Sullivan. Chisolm’s continued importance to the history of Civil War medicine is evident in the fact that he is mentioned or cited in three other chapters in this collection.


(1) “Southern ‘deputy saw bones’ . . . ” in Burlington Weekly Hawk-Eye, December 31, 1859, p. 1; “300 ignorant doctors let . . . ” in Milwaukee Daily Sentinel, December 26, 1859, p.1; “intelligent young men . . . ” in Lancaster Intelligencer, December 27, 1859, p.2.

(2)“Good News for Richmond . . . ” as quoted in Lancaster Intelligencer, December 27, 1859, p. 2; “absurd and foolish . . . ” as quoted in the American Presbyterian, January 5, 1860, p. 3; “an immense throng of citizens . . . ” as quoted in Daily Morning Post, December 23, 1859, p. 1.

(3) Scientific American, August 3, 1861, p. 75.

(4) “much the more destructive” in J. Theodore Calhoun, “Rough Notes of an Army Surgeon’s Experience During the Great Rebellion,” Medical and Surgical Reporter, IX (1862): 303; Paul J. Dougherty and Herbert C. Eidt, “Wound Ballistics: Minie ball vs. full Metal Jacketed Bullets — A Comparison of Civil War and Spanish-American War Firearms,” Military Medicine, 174 (2009): 403-407.

(5) James M. McPherson, Battle Cry of Freedom: The Civil War Era (New York: Oxford University Press, 2003), 486.

1 comment:

Robert said...

For those who haven't read this yet it is highly recommended. You don't need a lot of medical knowledge (or even interest for that matter) to appreciate this fine work. Kudos to Jim and Guy on the great work!