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Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine Hardcover – Deckle Edge, April 19, 2005
"Rebound" by Kwame Alexander
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From Publishers Weekly
During a 39-day period in the spring of 1865, 45,000 Union soldiers were killed or wounded. The wounded received the best care available at the time—care that by current standards is horrifying. In this fast-moving and informative book, Rutkow (Surgery: An Illustrated History) recreates the experience of the common Civil War soldier: it "was more sharply defined by agony, butchery, and loneliness than anything else." Simple gunshot wounds necessitated amputation; lack of antiseptics meant more soldiers died from postoperative infection than from their wounds. Communicable diseases ravaged the armies on both sides of the conflict. Rutkow charts the progress of the military medical system during the course of the war, focusing on the struggles (against political opposition) of Sanitary Commission director Frederick Law Olmsted to establish a humane and scientific system of care for the fallen. As Rutkow shows, such medical developments as the construction of hospitals and the specialization of surgery aided in the "professionalization of American medicine." With plenty of historical context, Rutkow's book should appeal beyond hardcore Civil War aficionados to a larger readership interested in a gritty, compelling story well told. 16 pages of photos not seen by PW.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
“Ira Rutkow takes his place as our leading authority on Civil War Medicine. Utilizing his historian’s gift of a perspective that is panoramic even while it is detailed, he has given us a gripping narrative that flows with the rhythms of the best of well-told stories. This is a book that will enrich the scholar and fascinate the general reader. As for the Civil War buff — Bleeding Blue and Gray is not only essential, but unforgettable.” -Sherwin B. Nuland, M.D.
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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.