Customer Reviews

Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine

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Informative. A pleasure to read. Rutkow is a genius though. His beautiful book, SURGERY, AN ILLUSTRATED HISTORY, is still his masterpiece and will always be a prize on my bookshelf. Other reviewers have already gone into great detail on the contents of this volume, so I will just say that if you are interested in some little-known facts, stats, and extreme in-depth coverage of medicine during the Civil War, this is the best place to start. You WILL find plenty here that is new and fascinating.

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.

This book is an excellent look at a broad spectrum of Civil War medical issues. The author touches on the medical training of doctors in the 19th century, and even discusses the role of nurses in patient care at the time. Much of the information in the book was new to me, rather than a rehashing of common information, As a physician, I marvelled at how little the medical personnel of the time had to work with. The administrative structure of the Medical Corps is covered in almost too much detail, but this information is made more palatable by vivid portraits of some of the leading figures. I wanted this book to be longer-- I hope that Dr. Rutkown returns to writing soon!

Excellent! What a research project that Dr. Rutkow undertook with this book and then gave it back to us in an interesting, informative read! Thought I might get bored with all the history details and names, but I did not. Funny how much of the major movements in healthcare came with our experiences with war. Thought Vietnam was primarily the determinate change, but the Doc shows us how medicine evolved during the Civil War, but stayed stagnant at the same time. Read the book!

I would have rated this book more highly if not for the misleading title - there are no "Bleeding Gray" to be found anywhere. As the author states, it is understandable that the loss of the Confederate medical records during the fire resulting from the evacuation of Richmond is a roadblock to comprehensive research into CSA medical practices. It is also fair to point out that, since the South lost, there is no continuity of medical progress to be considered. However, there should be enough information available regarding Confederate medicine to have, at the very least, merited one chapter in this book. As I recall from the excellent Civil War series by Ken Burns, Chimborazo Hospital was considered to be the best facility on either side, and in some cases, wound dressings used by Southern medical personnel were more hygenic (scarcity of supplies lead to the use of Spanish moss, which when boiled, was rendered sterile). The author does acknowledge that Confederate mobile medical facilities were the precursers of modern MASH units, but the sum total of his investment into research of Southern medicine consists of a few sentences in the book's preface. Otherwise, this is a well researched, informative book, but the author should seriously consider rectifying the title for future editions.

I wrote a similar work, Gangrene and Glory, so I should know a good Civil War medicine book when I see it. This book taught me a lot about a subject I thought I knew. It is very well written. There is more Bleeding Blue than Bleeding Gray, but this is a small distraction from a terrific book. I still prefer my book, but only slightly (I cannot help but think I may be biased). Frank Freemon

If you only buy one book on civil war medicine, this
is the book to purchase.
Excellent.

Ther might be a tendency when reading alot of books on the Civil War to concentrate on military personalities,grand stategy,tactics,and blame,blame and more blame that even years of court martials could never hope to sort out.(Or even make it more unsortable?). This book adds a different perspective to the war, that is :the suffering of the common soldier.
The major focus of the book seemed to be the evolution of an efficient ambulance service to remove the sick and wounded and get them to field hospitals and later transferred to larger institutions if necessary. During this time period there was still not a "germ theory" on the cause of disease and microbiology was still a decade or two off from acceptance. The Civil War saw little advancement in regard to bacteria as the cause of disease and such ancient practices as bleeding and mercury treatments were still regarded as standard practice.
The book has some interesting stories related to the Army Medical Museums' current collection of "macabre" exhibits and the history of the "donors".A person would think that with all of the horrible battlefield casualties and diseases, that the persons of authority would come together for the benefit of the soldier.This however was not the case and the book spends alot of time on the political wranglings of civilian and military care providers.Lots and lots of time and apparently the Generals aren't the only ones doing the infighting.
Interesting enough there is little to nothing about the Confederate forces health care for wounded and diseased. This lack of info left me to speculate that it must have been even worse than the Union care for casualties. Often the Confederates would deliberately abandon their wounded and sick because they would receive better care from their enemies.As the book describes the surgical practices and disease treatments you get the feeling that you are actually in the "Middle Ages". There were advancements however in the evacuation process and the author does pro mini-bios on a few of the more visionary medical practitioners and some less flattering bios of some of the period "quacks" of whom there seemed to be an abundance of. The book is very readable.

Medicine was another major area where the combatants of the Civil War were ill-equipped to begin. Prior to the Civil War hospitals were by and large places where one did not want to go. Those who were pushed out of society were sent to hospitals whereas those to be saved were cared for at home. Critics of hospitals complained of grimy walls and foul air due bodily secretions. Prior to the Civil War hospitals were only sanctuaries for the destitute and insane.

Basically doctors were divided between allopaths and homeopaths. The orthodox view of medicine at 1860 was typified by Benjamin Rush who taught bleeding, blistering, and purging for every imaginable ailment. So when in 1862, William Goodell was knocked unconscious by an exploding artillery shell, and his doctor observed that Goodell could not speak and ordered that ice be placed on Goodell's head and that his neck was opened to remove blood. Vomiting was induced. Blisters were created "on his legs and behind his ears to allow 'poisonous' fluids to ooze from the body." Homeopathy was the non-orthodox view of medicine at that time. These doctors prescribed herbs, roots, and the like to cure every ailment. The regimental doctor was often the person best qualified from the town where the regiment had been formed even though he may not have had any real qualifications at all.

Ambulances... if you study EMS, you'll find that ambulance service began during the Civil War. For the most part, casualties had faced the prospect of being a liability to the army and the injuries they suffered were their own bad fortune. Perhaps their fellow soldiers would return to the battlefield... if they had been victorious. At the First Battle of Bull Run, the Union has very few two-wheeled ambulances and was forced to leave their fate in the hands of the Confederates... who had fewer resources of their own and so the wounded were hospitalized all the way back to Richmond.

Nurses, because they were women at a time when women had few rights, were largely ineffective. One of the orders from Washington put nurses at the whim of doctors. This created a situation which serves as a source for a lot of off-color jokes about nurses. Nurses were not the highly trained respected persons that they are today.

Most of Dr Rutkow's book is about the political battles which changed policies. Frederick Law Olmstead is a major figure in Rutkow's book as is the Sanitary Commission. Edwin Stanton dueled and juggled with these and the likes of William Hammond and others. Interestingly, Rutkow leaves Abraham Lincoln above most of these political battles.

During the Civil War, amputations were common due to the fact that the doctors had an anesthetic (since the 1840's) and knew that gangrene would spread unless amputated. So why amputate? Why hurry patients to hospitals? Why change ventilation? Why change linens? The answer to these questions lies in the work of previous doctors. In another book I read the story about a head physician in Vienna in 1848 who managed two maternity wards. In one the mortality of the mothers was five times that in the other. The head physician tackled the problem by wondering whether one ward was too crowded, was birth position a problem, etc. In a way, it was stroke of luck that a male doctor also lost his life with the same symptoms as the women in the first ward. The head doctor determined that "cadervic material" had found its way from a mortuary to the maternity ward.

It was such testing that led to the reforms of the medical system during the Civil War. Hospitals became more open aired and sanitary. Proper nutrition was emphasized. Linens were clean. Doctors and nurses began to develop a "shared practice experience" along with some certification of qualification. And ambulances began to be deployed in sufficient number to remove the wounded from the battlefield to the hospitals.

The Civil War occurred in the waning years of medicine before the scientific era. My one criticism of Dr Rutkow's book is that he does not do much to explain some of the efforts to control infection in the time before the discovery of bacteria.

It's obvious the author, an M.D. himself, has gone to great pains to research this subject exhaustively. I was riveted by the general Civil War history relating to and along with the medical history of the period. The personalities and politics were as interesting as the accounts of battles and medical cases. It's amazing that only a century and a half ago, medical professionals didn't know to wash their hands between patients or before performing surgery. I couldn't put this book down and finished it in two evenings. I recommend it heartily.