CIVIL WAR MEDICINE BOOK INCLUDES PHOTOS FROM MUSEUM
By Alan Hawk

Following is a review of Civil War Medicine, Challenges and Triumphs (Tucson: Galen Press, Ltd., 2002. ISBN 1-883620-08-2--hardcover; ISBN 1-883620-03-01-soft cover), by Alan Hawk, manager of the museum's historical collections. The book uses the museum as a resource and includes photos and illustrations of specimens in the museum's collections.

The surgeons of the Civil War generally do not have an enviable reputation. But there is a growing body of literature about Civil War medicine ranging from George Adam's "Doctors in Blue" and H. H. Cunningham's "Doctors in Gray," to Frank Freeman's "Gangrene and Glory." In addition, there are first person accounts, either reprints of books published in the nineteenth century or modern publications of recently discovered diaries. There is even one account from the point of view of a Civil War patient and a study of the court martial records of proceedings against military surgeons.

While all of these books are worthwhile accounts of Civil War medicine, Alfred Bollet's "Civil War Medicine" provides a unique insight into the medical care of the sick and wounded during the war. Unlike most books that discuss military medicine as a part of a military campaign, Bollet recognizes that military medicine exists in the context of general medical practice and theory as well as a disease process that the Civil War surgeon was only dimly aware of. He skillfully weaves both nineteenth-century and twentieth-century science and medicine into a very readable narrative filled with fascinating anecdotes. Bollet is impressed with the skills, intuition and knowledge exhibited by physicians, acknowledging, but not condemning them for, what they didn't know.

What this book provides to the general military historian is an insight into the everyday lives of soldiers that is often overlooked in many military histories. While most historians tend to focus on soldiers wounded in battle, disease claimed far more lives. Chronic diarrhea claimed 27,558 lives during the war, the single most common cause of death. Virtually every soldier suffered from chronic diarrhea, resulting in the term that it takes good 'guts' to be a soldier. Bollet examines the nineteenth-century accounts of diarrhea, comparing them with twentieth-century knowledge of the disease. While modern literature emphasizes the infectious origin of the diarrhea, Civil War physicians attributed it to poor nutrition. While infection caused some of the Civil War cases, he concludes that the diarrhea suffered by the troops also had a nutritional component. He notes that soldiers with chronic diarrhea considered blackberries beneficial, sometimes spontaneously getting into a battle formation to 'take' a blackberry patch! Blackberries, it is now known, contain folic acid, which, along with antibiotics, are used to treat tropical sprue. One of the symptoms of tropical sprue is chronic diarrhea.

Although disease usually kills more soldiers than bullets, surgery gets the most attention in any discussion of military medicine. Popular culture frequently depicts Civil War surgeons as butchers that are too eager to perform amputations, often without anesthesia. Bollet points out that this is a myth, anesthesia was widely administered, even in the confederacy that was notoriously short of medical supplies, and that, in a era before antibiotics, amputation of a damaged limb soon after wounding increased the patient's chances of survival. The problem was that surgery was performed in the open to take advantage of the good light, but in plain sight of observers as well as pre and post- operative patients. Anesthesia was not an exact science and patients were administered enough to render them insensitive to pain. At this superficial level of anesthesia, patients remained in a state of excitement or delirium, frequently moaning, thrashing or shouting, giving the passerby the impression that they weren't anesthetized. It is true that surgeons were quick to amputate, but that saved lives by preventing septicemia (blood poisoning) from setting in. The mortality rate of the 29,980 recorded amputations was 26.3 percent, compared with the 50 percent mortality rate of civilian amputations, which were frequently delayed until 48 hours after the injury.

Bollet offers the reader a needed reassessment of the skills and knowledge of Civil War surgeons. Like the story he includes of Civil War nurse Mary Pinney, the Baroness von Olnhausen, who was not know for being complimentary to the surgeons she served with. She later served as a nurse for the Prussian Army during the Franco-Prussian War. She wrote, "…I have been to other hospitals today, and I can hardly contain myself to see the treatment of the wounds. It seems like actual murder. We never treated amputations so badly …I can now see how good our surgeons were." (p.422). Thanks to Bollet's diligent research, we too can, in retrospect, see how good these surgeons were.