Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine
http://www.100md.com
《新英格兰医药杂志》
For the curious uninitiated, or for people like me who grew up in a household in which the battles of the Civil War and the prominent figures who commanded the vast armies during it were topics of constant conversation and interest, Bleeding Blue and Gray provides rare insight into an era in which surgery and medicine were in considerable flux in the United States. The book recounts this history in large part from the perspective of the northern states and the Union Army. The opening vignette is based on an 1859 newspaper article describing the willing transfer of 250 medical students, who were originally from southern states, from Thomas Jefferson University and the University of Pennsylvania to schools below the Mason–Dixon Line, where they found an audience sympathetic to their proslavery views. The author captures the drama of this event and makes it clear that what was known as either the war of secession or the war against northern aggression, depending on allegiances, was more than a series of military conflicts; it was also a war fought in a broad social arena. The protagonists were doctors of medicine, military surgeons, and nurses, as well as zealots who were determined to improve the hygiene of vast numbers of soldiers and city dwellers, who died in droves from near-pandemic infectious diseases in an era that predated germ theory and antisepsis.
Intertwined in an abbreviated history of the major military campaigns and specific smaller conflicts are other themes and the biographies of many important figures in medicine and public health during the latter half of the 19th century. Prominently featured are the history of the U.S. Sanitary Commission and the story of Frederick Law Olmsted, who designed many public park systems throughout the country and who championed public health before microbial pathogens were discovered. Among the other fascinating themes are the rise of nursing as a profession and the sectarian disputes between allopathic and homeopathic physicians — a civil war within the Civil War, fought mainly through legislative means and in the press.
The book is punctuated by carefully researched cases in which military injuries, their treatment, and the outcomes in particular patients were recorded, along with relevant accounts of the conduct of certain battles. Breathing life into many of the characters, the author captures the chaos of 1860: no plans were made for the evacuation of the injured, anyone claiming to be a physician could perform disfiguring amputations, and vast armies were decimated not only by minie balls (conical bullets that expanded on impact) and grapeshot but also by dysentery, typhoid, and battlefield gangrene (necrotizing soft-tissue infection). By 1864 and 1865, however, the Sanitary Commission had begun to provide more care than the Union Army Medical Department could provide, strict guidelines governed who could perform surgical procedures (mainly amputations), and public hue and cry had led to legislation creating a robust ambulance corps and to a massive, well-organized evacuation by land and sea of injured soldiers to enormous, carefully designed military hospitals.
(Figure)
Wounded Soldiers at a Hospital in Fredericksburg, Virginia, 1864.
From the National Library of Medicine.
I remember leafing through books in the extensive Civil War library of my father, a physician, when I was a child. Initially, while reading this book, I was a bit disappointed by what seemed to be a lack of photographic reproductions, especially because extensive photographic documentation of the war is available. However, the author hides the photographs away in the middle of the book — as a reward, I am sure, for the serious reader who makes it to page 204.
In essence, this book presents a cogent argument for the view that the concurrent internecine military, medical, and public health conflicts that occurred in the United States from 1858 to 1865 set the stage for the emergence of modern medicine. For Civil War history buffs, medical historians, military physicians, and anyone who wants to understand our medical roots, this is an important book to read.
David L. Dunn, M.D., Ph.D.
University at Buffalo, State University of New York
Buffalo, NY 14214
dldunn@buffalo.edu(By Ira M. Rutkow. 394 pp.)
Intertwined in an abbreviated history of the major military campaigns and specific smaller conflicts are other themes and the biographies of many important figures in medicine and public health during the latter half of the 19th century. Prominently featured are the history of the U.S. Sanitary Commission and the story of Frederick Law Olmsted, who designed many public park systems throughout the country and who championed public health before microbial pathogens were discovered. Among the other fascinating themes are the rise of nursing as a profession and the sectarian disputes between allopathic and homeopathic physicians — a civil war within the Civil War, fought mainly through legislative means and in the press.
The book is punctuated by carefully researched cases in which military injuries, their treatment, and the outcomes in particular patients were recorded, along with relevant accounts of the conduct of certain battles. Breathing life into many of the characters, the author captures the chaos of 1860: no plans were made for the evacuation of the injured, anyone claiming to be a physician could perform disfiguring amputations, and vast armies were decimated not only by minie balls (conical bullets that expanded on impact) and grapeshot but also by dysentery, typhoid, and battlefield gangrene (necrotizing soft-tissue infection). By 1864 and 1865, however, the Sanitary Commission had begun to provide more care than the Union Army Medical Department could provide, strict guidelines governed who could perform surgical procedures (mainly amputations), and public hue and cry had led to legislation creating a robust ambulance corps and to a massive, well-organized evacuation by land and sea of injured soldiers to enormous, carefully designed military hospitals.
(Figure)
Wounded Soldiers at a Hospital in Fredericksburg, Virginia, 1864.
From the National Library of Medicine.
I remember leafing through books in the extensive Civil War library of my father, a physician, when I was a child. Initially, while reading this book, I was a bit disappointed by what seemed to be a lack of photographic reproductions, especially because extensive photographic documentation of the war is available. However, the author hides the photographs away in the middle of the book — as a reward, I am sure, for the serious reader who makes it to page 204.
In essence, this book presents a cogent argument for the view that the concurrent internecine military, medical, and public health conflicts that occurred in the United States from 1858 to 1865 set the stage for the emergence of modern medicine. For Civil War history buffs, medical historians, military physicians, and anyone who wants to understand our medical roots, this is an important book to read.
David L. Dunn, M.D., Ph.D.
University at Buffalo, State University of New York
Buffalo, NY 14214
dldunn@buffalo.edu(By Ira M. Rutkow. 394 pp.)