Friday, April 16, 2010

Excerpt #2 from "Years of Change and Suffering"! - INTRODUCTION (Part II)

As promised, we continue to post some excerpts from Years of Change and Suffering:Modern Perspectives on Civil War Medicine and will finishing with a BOOK GIVEWAY CONTEST!

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

Below is the second excerpt - the second part of the Introduction (see Part I here). Enjoy!


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

Wounds to the arms and legs, as described by Jay Bollet, were clearly not the only devastating injuries sustained by Civil War soldiers. Due to the nature of the fighting, soldiers sometimes fought kneeling, sitting, or lying prone, and they were exposed to being shot in the buttocks or genitals. In his contribution, “The Privates Were Shot,” surgeon Harry Herr describes urological wounds and treatment. Dr. Herr combines statistics and case reports, largely from the Medical and Surgical History of the War of the Rebellion, with his knowledge of wartime surgical beliefs and practices to illustrate the enormous clinical challenges faced by caregivers and the dismal outcomes that patients were likely to experience.

Dr. Herr’s case studies give graphic and grim witness to the debilitating nature of urethral wounds suffered by soldiers during the Civil War. Although generally not as fatal when compared with wounds of the chest or abdomen, urethral injuries were very troublesome for surgeons to treat, and survivors dealt with serious and painful consequences — physical and emotional — for the rest of their lives. Those consequences included chronic infection, constant leakage of urine, difficulty walking, and sexual dysfunction, as only a few examples.

The Civil War, states Dr. Herr, was a training ground for American clinicians, whose formal education was supposedly inferior to that of their European counterparts. Ironically, the survival rate was higher for Civil War than Crimean War casualties, a fact partially explained by how effectively Civil War surgeons learned from their clinical experience. Dr. Herr believes that European surgeons, reporting on their experiences in the Crimean War, had exaggerated the gravity of wounds to the pelvis. Mortality and morbidity of these types of injuries was actually better in the Civil War than the Crimean War, and Dr. Herr concludes that surgeons — North and South — must have been doing something right. He also points out that the eagerness of surgeons to share their recently acquired insight was evident in the postwar formation of medical societies, which helped to improve the quality of American medicine.

Maintaining the quality of care during the Civil War tested the resourcefulness of the South as it strove, in the face of an increasingly effective blockade, to supply its troops with medicines. Guy R. Hasegawa, a specialist in Civil War pharmacy and medical purveying, uses an array of primary source materials to describe how the Confederate Medical Department turned to internal resources — animal, vegetable, and mineral — to produce drugs. Hopes were high that medicines derived from Southern plants, in particular, would adequately fill in for standard drugs that were too scarce or expensive to purchase and issue in large quantities. Newspaper notices placed by medical officers called on citizens to collect native medicinal plants and deliver them to army-operated facilities for processing.

In examining the selection of plants to be gathered, Dr. Hasegawa questions the real influence of Resources of the Southern Field and Forests, a book credited by some historians with “maintaining the Southern war effort for many months longer than if it had not been written.” A factor complicating the use of Southern flora was the reluctance of some medical personnel to use plant-based remedies that they associated with unconventional or fringe practitioners. Mined materials, such as sulfur and iron pyrites, were used in chemical processes necessary to manufacture ether and chloroform. Citizens even gathered potato flies, which were dried and ground for use as a blistering agent.(6)

The production of Southern drugs was spearheaded by Surgeon General Moore, whose belief in the vital role of native plants resembled, according to one observer, an obsession. Moore and his medical purveyors sought the cooperation of other organizations active in the war effort—-the Nitre and Mining Bureau and the Navy, for example—-and were quick to enlist the assistance of experts in the various branches of science necessary to manufacture medicines. Thus, scientific and inventive ability, a quality discussed in the chapters by Jim Schmidt and Terry Hambrecht, was especially evident in the army drug-manufacturing facilities.

Moore’s reliance on talented botanists, chemists, and pharmacists was only one aspect of an impressive record of Confederate scientific collaboration. Likewise, in Northern hospitals, an expert research team of three military surgeons revolutionized our knowledge of neurology. In his contribution, D. J. Canale describes how “American neurology was cradled and developed in the army during the Civil War” by S. Weir Mitchell and his coworkers George R. Morehouse and W.W. Keen, who took advantage of the unique opportunities that the Civil War afforded for the study of diseases and injuries of the nervous system.

During the Civil War, Mitchell served as a contract army surgeon and persuaded his friend Surgeon General William Hammond to open a center specializing in the treatment of injuries to the nervous system at Turner’s Lane Hospital in Philadelphia. There, Mitchell, Keen, and Morehouse performed important clinical research on nerve injuries. Their research culminated in the publication in 1864 of Gunshot Wounds and Other Injuries of Nerves, which Canale describes as “one of the acknowledged classics of nineteenth-century American medicine.”

Mitchell’s postwar writing — drawn from his experiences as a Union surgeon — also made him a famed literary figure, and one of his best-known stories is “The Case of George Dedlow,” first published anonymously in The Atlantic Monthly in July 1866. It has since become a classic of American literature and medicine. Dr. Canale confirms the conventional wisdom that Mitchell used the fictional story of Dedlow, a quadruple amputee, to introduce the interesting “phantom limb” syndrome — the sensation, after amputation, that the absent part is still present — in a popular magazine before it was widely recognized in the medical literature of the day. Dr. Canale also concludes that Mitchell used the story as vehicle to describe many other important consequences of medical care in the Civil War.

For tens of thousands of veterans, amputation was no fiction. Others continued to bear the pain from wartime wounds for many years, and more still were permanently weakened from the long marches, inadequate diets, or disease. Many veterans — to all appearances healthy on the outside — bore emotional and mental scars every bit as debilitating as their comrades’ physical ones. In her contribution, Dr. Andersen describes that, during the Civil War, surgeons were beginning to recognize psychological disorders (“nervous diseases”) in soldiers, ranging from simple homesickness to more severe cases categorized as “nostalgia” or “soldier’s heart,” which were marked by troubled sleep, poor appetite, erratic behavior, and even death.

Unfortunately, as a substance abuse expert with the U. S. Army recently noted, physicians of the time “had primitive notions of mental illness . . . psychiatry and neurology were just being born around this time, and they have changed a lot [since] . . . there was no agreed-upon nomenclature and no precision in diagnoses.” In fact, one historian recently suggested that “doctors, sensitive to the demands of masculine dignity, were hard-pressed to come up with ‘inoffensive terminology.’”(7)

Certainly, our attitudes about “combat neuroses” have matured over time, and we take for granted that psychiatric casualties are an inevitable feature of warfare. It should be no surprise that Civil War veterans carried their “invisible wounds” into civilian life. Anecdotal evidence of problems in Civil War veterans abounds: divorce, domestic abuse, alcoholism, drug addiction, and more. Still, it was only recently that clinical evidence of “posttraumatic stress disorder” in Civil War veterans was verified by mental health professionals. The publication of that evidence in the February 2006 issue of Archives of General Psychiatry received widespread attention, not just in the mental health community but also in the mass media — TV, radio, magazines, and newspapers — from America to Australia.

Dr. Judith [Pizarro] Andersen, the lead author of that landmark report, has contributed a chapter on the mental health of Civil War soldiers and veterans. She draws on both anecdotal and statistical evidence to arrive at some interesting conclusions: Nearly two in five Civil War veterans later developed both mental and physical ailments, and soldiers who enlisted between the ages of nine and seventeen were nearly twice as likely as their older peers to suffer disorders. Furthermore, the percentage of a soldier’s company killed — on the battlefield or by disease — was also a significant predictor of later problems, presumably serving as a marker for traumas such as witnessing death, handling dead bodies, and losing comrades. The facts support General William Tecumseh Sherman’s oft-quoted aphorism: “There is many a boy here today who looks on war as all glory, but, boys, it is all hell.”

As important as asking when the story of Civil War medicine begins is the companion question as to when the story ends. It is too easy — and unsatisfying — to state that the story ends with the surrender at Appomattox, nor do the facts support this view. Harewood Hospital in Washington, D.C., didn’t shut its doors until a year later. The compilation of statistics, surgeons’ reports, and case studies that culminated in the landmark Medical and Surgical History of the War of the Rebellion lasted until the late 1880s. President Abraham Lincoln’s declaration that the nation should “care for him who shall have borne the battle” resulted in a strong political lobby on behalf of veterans that crafted and expanded a pension system over the following decades.

The expert and lively contributions to this book demonstrate that the Civil War itself did encompass “years of change and suffering.” They also prove that the opportunity to examine the medical aspects of the war still exists to this day: Biographies of men, women, and institutions remain to be studied and written, and archives and primary source material remain unexplored and uninterpreted. Furthermore, this book will expose interested readers and scholars to a significant body of relevant literature and other source material that they may not have considered.

Thankfully, there has been a shift in attitudes among informed Civil War enthusiasts towards that conflict’s medical casualties, their caregivers, and the challenges they all faced. Nevertheless, the myths and misinformation that still prevail among the general public indicate that there is still work to be done. We — as contributors to Years of Change and Suffering: Modern Perspectives on Civil War Medicine — happily and humbly take up that task.


(6) Resources of the Southern Fields and Forests (San Francisco: Norman Publishing, 1991), vii.

(7) “had primitive notions . . . ” in Aaron Levin, “Civil War Trauma Led to Combination of Nervous and Physical Disease,” Psychiatric News, 41 (2006): 2; “doctors, sensitive to the demands . . . ” in Jennifer Travis, Wounded Hearts: Masculinity, Law, and Literature in American Culture (Chapel Hill: University of North Carolina Press, 2005), 31.

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