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3.0 out of 5 stars
A readable, eviscerating account of civil war surgery and the ascendancy of allopathic medicine, December 22, 2005
This review is from: Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine (Hardcover)
This book delivers a well written account of the politics and practices that led to revolutionary changes in American medicine during the Civil War.
Author Ira Rutkow is adept at exploring how medical realities taken for granted today, such as knowledge of bacteriology, a well defined concept of nursing, and a unified medical profession were all "rough drafts" of what exists today, if they existed at all.
One reads with shock how most "nurses" were wounded soldiers who cared for other wounded soldiers. In the era fifty years before women obtained sufferage in America, the nursing profession was rife with sexual harassment, incompetent leadership and riddled with more moral than medical concerns--that is, when women were included at all. It was fascinating to read that women nurses were valued more for their appearance (the ideal nurse was expected to be over 30 and "homely"--at least there was no ageism!) than any objective standards.
If nursing was abysmal, doctoring was worse. The author describes how gangrene was "cured" with undiluted hydrochloric acid, most injuries were treated with botched amputations, and everything else was "cured" with poisonous drugs like the mercury containing Calomel or tarter emetic that created "volcanic vomiting" and diarrhea, as per the allopathic concept of curing through purging and bleeding.
If that wasn't enough, different aid groups like the Sanitation Commission and the Christian Comission sabotaged each others' efforts in campaigns of backstabbing and malcontentery. These cynical machinations reached the highest echelons of U.S. government and advanced the careers of ambitious, unworthy men, while brushing visionary women and men to the wayside.
Yet despite all this, a few visionary people fought tooth and nail to change the situation to enhance the survival of wounded soldiers. The author describes how their efforts led to the creation of a coordinated ambulance corps that evacuated wounded soldiers from the battlefield, better hygiene, food and drinking water and better sugical methods by more qualified surgeons. Readers of literature and American history will recognize names like Walt Whitman and Dorthea Dix and be surprised at their roles and their perspectives on the Civil War and its medical aspects, which are ably uncovered by Rutkow.
As a general audience reader with an interest in the history of medicine, I was most fascinated by the details of the medicine, treatment methods, and medical care, along with their rationale. With a subject where one can easily bog down in statistics, dates of battles and the sweeping geography of the Civil War, Rutkow displayed a superior ability to shift away from the big picture and home in on minute details with case studies and pathology reports of individual soldiers. I also found the political aspects interesting, not for the names and individuals involved but for the fact that politics and medicine would be so closely tied together at all. For modern readers, it is easy to lose sight of the fact that some of the most basic aspects of medicine today were once hotly debated and held in dispute--and a few still are.
Despite Rutkow's careful consideration of the context of Civil War medicine, his treatment of it is not flawless or completely without bias. The author goes to great lengths--admirably--to describe the severely detrimental effects of the allopathic techniques of Benjamin Rush--which are undisputably the forebears of modern, "scientific" medicine. Yet strangely, he seems to detach Rushes' personnage from the medical traditions that Rush founded and influenced, perhaps to give them more credibility. While this perspective should not be surprising or even troubling, necessarily coming from a historian who is also a doctor, it is worth noting.
For the reader, this results in what appears to be a double standard as the author repeatedly castigates Rush but fails to emphasize the personal ambitions and lack of scientific inquiry that even less astute readers will notice mark the early baby steps taken by the American Medical Association. In this regard, Dr. Rutkow, M.D.'s characterization of the AMA might resemble a military officer's military history of their own army, a freemason writing about freemasonry or anyone else writing a history of a venerable insitution of which they are a part. I hasten to add that the author's bias is not sweeping enough to poison the book but it is evident in his comparison of allopathy to other medical trations that were prominent then, but now might be called "alternative" medicine. Rutkow's assertion that homeopathy was completely disproven by science or that allopathy decisively "won" the battle for prominence among American medicine based solely on objective scientific superiority are sloppy generalizations at the very least. Rutkow's own historical observations cast doubt on the latter assumption, as he describes in multiple instances a history of vicious political struggles, personal attacks, propaganda and smear campaigns between every school of medicine--and continued through the Civil War. In this climate, there are many who would argue that homeopathy and the ecclectics were silenced at least as much by overwhelming political and judicial persecution as by scientific revelation spawned by an un-tainted quest for objective truth. Indeed, some aspects of homeopathy must have been proven by science because they provide the basis for health care standards today. Homeopaths traditionally treat patients using the lowest effective dose. The same methodology is used by allopathic pharmacists and doctors for the same rationale: safety. In that instance, the only disagreement between the homeopath and the allopath is what actually constitutes the lowest effective dose of a given drug. My point in all this is not to claim one system is better than another, but to point out how little the validity of our system of "heroic" medicine is questioned, even considering the early days of the "bleed, blister and burn" regimen, even when compared to less harmful alternatives.
"Bleed, blister and burn" may no longer be the order of the day for today's advanced medicine but the presence of heroic, invasive and sometimes medically unnecessary proceedures show that philosophical parallels do exist between the allopathy of old and the allopathy of today. And in fact, some of these parallels deserve to have their supposedly "scientific" validity scrutinized a little more rigorously. For instance, what is the "scientific" value of performing an episiotomy on every woman who gives birth in a hospital? What is the "scientific" value of circumcision? I don't pretend to have the answers, but these are valid questions.
My only other complaint about this book is the fact that it only considers Civil War medicine from the vantage point of the Union. Early on, Rutkow explains that this was necessary in order to narrow the scope of an enormous subject, but his assertion that medicine was basically the same on Confederate and Union sides of the battfield rings a little hollow. Rutkow claims that homeopaths and other "alternative" medical specialists were not banned from the Confederate armies as they were in the north. Furthermore, the south must have had fewer resources and this fact alone must have shaped the organization, practice and methods of Confederate medicine. I, for one am curious enough to ask what they were, and wonder if there are other books that tell the Cofederate side of the medical story of the Civil War as well as Rutkow's account chroncicles the northern side.
One final thing that I find intriguing is that what the author cites as the undoubtably revolutionary medical advances that came to fruition as a result of the Civil War--unification of standards of medicine and medical treatment, supreme efficiency and precision, large centralized hospital facilities are often nowadays considered the bane of modern medicine. Indeed, sanitation, precision and efficiency have saved lives but one wonders if this precision, taken to the extreme, might not be the ancestor of today's HMOs with their corporatization of medicine, depersonalized health care "delivery systems" and two minute long doctor visits. These lines of inquiry, and how they relate to the advances made during the Civil War are beyond the scope of Rutkow's subject matter but they certainly ought to be explored further in another book.
In summary, this is a fascinating, well written book that raises at least as many questions as it answers.
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