The Marrow of Tragedy: Disease and Diversity in Civil War Medicine

Today’s guest post is written by Dr. Margaret Humphreys, Josiah Charles Trent Professor in the History of Medicine at Duke University. She is the author of Yellow Fever and the South (Rutgers, 1992) and Malaria: Poverty, Race and Public Health in the United States (Johns Hopkins, 2001), Intensely Human: The Health of the Black Soldier in American Civil War (2008) and Marrow of Tragedy: The Health Crisis of the American Civil War (2013). On Tuesday, February 21 at 6pm, Humphreys will give The John K. Lattimer Lecture: “The Marrow of Tragedy: Disease and Diversity in Civil War Medicine.” To read more about this lecture and to register, go HERE.

In a memorable scene from the movie Gone with the Wind, Southern belle, Scarlett O’Hara, picks her way through the battle-wounded men lying on the ground near the train station in Atlanta, frantically seeking Dr. Meade to help her with her sister-in-law Melanie’s imminent delivery.  Meade brushes her off and turns to a screaming soldier, telling him that his leg would have to come off, and without anesthesia.  The man’s screams echo as Scarlett heads back to Melanie’s bedside.  This cinematic portrayal of Civil War medicine reflects a wide belief that there was no anesthesia at that time.  Indeed, it was said that the war occurred “at the end of the medical middle ages.”  (This quotation is widely attributed to Union Surgeon General William Hammond, but without citation).

atlanta

Scene from Gone with the Wind (1939).

In my book, Marrow of Tragedy: The Health Crisis of the American Civil War, I begin from a different perspective, recognizing that there was such a thing as “good medicine” and “bad medicine” during the War.  Medical care could be effective, and it could make a difference in disease and injury outcomes.  For example, chloroform and ether anesthesia meant most surgery occurred with the patient unconscious (although Confederate surgeons did run out of these supplies in desperate circumstances, such as the siege of Atlanta near the end of the war).

Alarming as the notion of amputation completely without anesthesia, are the revealing mortality rates from disease at this point in the war. Put simply, for every one white Union soldier who died of disease during the War, a little over two black Union soldiers died, and almost three Confederates succumbed.[i]

hospital-scene

Image source: Getty Images.

How can we account for these differences?  A major factor was the quality and quantity of food, a core ingredient of the modern concept of “social determinants of health.”  White Union troops also received better hospital care, calling on part of the strong social networks of the folks back home and their political impact.  The Union hospital system was much better funded, with full access to important medicines, such as quinine, opiates, and anesthetics; and the technology of cleanliness, which included clothing, soap, and disinfectants.  Nursing care was key, as well, with northern hospitals staffed by volunteer nurses, while those in the south were often civilians or slaves challenged by lack of formal training as well as lack of resources.

To learn more about Civil War medicine, join us on Tuesday, February 21 at 6pm. Register HERE.

sanitary-commission

Image source: Harper’s Weekly, April 9, 1864.

 

Note:

[i] Actual numbers, per 1000, were 63, 143, and 167, respectively.

From Central Park to the Front Lines: Frederick Law Olmsted and the Sanitary Commission

By Paul Theerman, Associate Director, Center for the History of Medicine and Public Health

We are fortunate at the Academy to look out over Central Park—one of the jewels of the city of New York. The park got its start in the 1850s, and took shape due to the visionary efforts of two men, landscape architects Calvert Vaux and Frederick Law Olmsted (1822–1903). In the 1860s Olmsted—whose birthday we celebrate today—was instrumental in one of the great medical and public health efforts of the 19th century: the organization of relief to Union soldiers in the Civil War. As executive secretary of the U.S. Sanitary Commission, he coordinated voluntary efforts to support the Army’s medical department in the war effort.1

Olmsted was a restless person, continually trying on new roles. He first made his mark in journalism, publishing his observations of life in the South after three tours through the region in 1850s.2 He offered a scathing depiction of slavery, the resistance of southern society to change, and the degrading effects of the institution on society as a whole. Olmsted became an abolitionist when that was still a minority position, and a reformer throughout his life.

At the outbreak of the Civil War, Olmsted’s superintendence of the Central Park project was limited due to disputes with the city, and he contacted Henry W. Bellows, a New York Unitarian minister, for help in securing a position. Bellows drafted him to head up, as executive secretary, a newly chartered private institution, the U.S. Sanitary Commission, of which Bellows was a founding Commissioner. Broadly modeled on the British example in the Crimean War, the Sanitary Commission addressed two persistent needs in the delivery of medical services in wartime. The first was that the standing army of the United States was relatively minuscule, and its medical department equally so. At the outbreak of the war, the army had some 16,000 men at arms, a portion of whom defected to the Southern cause. Through volunteers and conscription, the number of men serving eventually reached 2.5 million over the four years of the war, with perhaps half a million in uniform at the height of the conflict. As the volunteer army geared up so did the medical corps, but by any measure the medical service of the army was largely inadequate for the task.

And the medicine of the army seemed inadequate as well. The Sanitary Commission as he organized it had a paid professional staff and a corps of medical inspectors to review military camp conditions and advise military physicians. The inspectors also relayed requests for supplies back to the Commission’s offices in Washington, where central office staff would work to fill requests from donations.

Olmsted also lobbied to induce Congress and Cabinet officials for assistance through reformed laws and sympathetic appointments. He put his work into the overall context of reform for the good of the nation: “service on the Commission was part of his patriotic duty. It would strengthen the fighting power of the nation by assuring the health of the soldiers and by making the best use of goods and money contributed by the public.”3

“The Sanitary Commission used the side-wheel steamboat Wilson Small as its headquarters for much of the Peninsula campaign.” Olmsted Papers, 4:331, n1. This drawing, from the collections of the Library of Congress, portrays the ship at harbor in Aquia Creek, Virginia, March 12, 1863.

“The Sanitary Commission used the side-wheel steamboat Wilson Small as its headquarters for much of the Peninsula campaign.” Olmsted Papers, 4:331, n1. This drawing, from the collections of the Library of Congress, portrays the ship at harbor in Aquia Creek, Virginia, March 12, 1863.

Though Olmsted thought his service—and the war for that matter—would last a matter of weeks, it did not. Several times he was called to the field. During the series of battles that constituted the Peninsula Campaign—Union General George B. McClellan facing Confederate General Joseph E. Johnston in the spring and summer of 1862—Olmsted found himself organizing the evacuation of wounded Union troops to ships, amid a chaos of competing orders and information. During this period, he wrote a series of letters back to the Commission, and over the next year he took his letters and those of another unnamed Commission member and edited them into Hospital Transports: A Memoir of the Embarkation of the Sick and Wounded from the Peninsula of Virginia in the Summer of 1862. Designed to lay out the work of the Commission and solicit donations, the book also provided a gripping account of life just behind the front lines. The Academy’s copy was donated from the English branch of the U.S. Sanitary Commission—set up in London to coordinate donations from Americans abroad and sympathetic Britons—and is inscribed by Edmund Crisp Fisher, the Secretary of the branch.4

Title page of Olmsted's Hospital Transports. Our copy is inscribed by Edmund Crisp Fisher, the Secretary of the English branch of the U.S. Sanitary Commission, whose cancelled stamp is also on the page.

Title page of Olmsted’s Hospital Transports, 1863. Our copy is inscribed by Edmund Crisp Fisher, secretary of the English branch of the U.S. Sanitary Commission, whose cancelled stamp is also on the page.

Olmsted’s work with the Commission ended in the fall of 1863. He was not able to maneuver among the competing factions, especially between eastern and western branches of the Commission, nor readily subject himself to the control of the Commission’s executive committee. He went to California to manage a ranch caught up in the confusion of competing gold rush claims; when he returned to the East two years later, he devoted himself to landscape architecture. But as he left, he knew that he had tried, and at times succeeded, in providing a trained professional cadre of medical doctors and reformers to coordinate care to wounded soldiers and to better their conditions under arms. His work prefigured broader efforts leading into World War I—in such organizations as the Red Cross—in the scope of their ambition and in the vision of their success.5

References

1. I acknowledge the excellent introduction to The Papers of Frederick Law Olmsted, Volume 4: Defending the Union: The Civil War and the U.S. Sanitary Commission, 1861–1863, ed. Jane Turner Censer, with Charles Capon McLaughlin, editor in chief, and Charles E. Beveridge, series editor (The John Hopkins University Press, 1986), pp. 1–69, which is a major source for this account.

2. Olmsted published his accounts as A Journey in the Seaboard Slave States, with Remarks on Their Economy (1856), A Journey Through Texas (1857) and A Journey in the Back Country (1860) and then reissued them as a two-volume work titled The Cotton Kingdom: A Traveller’s Observations on Cotton and Slavery in the American Slaves States (1861).

3. Olmsted Papers, 4:7.

4. A copy is available online, and the book has been recently edited by Laura L. Behling and re-released.

5. There are many excellent books on Frederick Law Olmsted: for further reading, consider Witold Rybczynski, A Clearing in the Distance: Frederick Law Olmsted and America in the 19th Century (1999), and Justin Martin, Genius of Place: The Life of Frederick Law Olmsted (2012).

Beyond “The Yellow Wallpaper”: Silas Weir Mitchell, Doctor and Poet

By Johanna Goldberg, Information Services Librarian

To celebrate National Poetry Month, we are sharing poems from our collection throughout April.

Today, Silas Weir Mitchell (1829–1914) is best known as the purveyor of the Rest Cure, made infamous by Charlotte Perkins Gilman’s short story “The Yellow Wallpaper.” But while he was alive, he was renowned as a pioneering doctor of nervous diseases and a successful author.

Mitchell began his medical career researching rattlesnake venom. With the outbreak of the Civil War, he shifted focus, beginning work as a contract surgeon at Philadelphia’s Turner’s Lane Hospital, specializing in nervous diseases.

"Ward at the Civil War Hospital." In Burr, Weir Mitchell: His Life and Letters, 1929.

“Ward at the Civil War Hospital.” In Burr, Weir Mitchell: His Life and Letters, 1929.

Here, he treated and studied patients with nervous system injuries and syndromes, including one he named causalgia (a form of neuropathic pain). These studies informed his numerous pamphlets and books and helped establish his reputation as a father of American neurology.1–3 After the war, Mitchell continued his research at the Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases. He determined that eyestrain could cause headache, and also discovered the rare vascular pain disorder erythromelalgia, or Weir Mitchell’s disease.1

Dr. Mitchell examining a Civil War veteran at the Clinic of the Orhopaedic Hospital, Philadelphia. In Burr, Weir Mitchell: His Life and Letters, 1929.

“Dr. Mitchell examining a Civil War veteran at the Clinic of the Orthopaedic Hospital, Philadelphia.” In Burr, Weir Mitchell: His Life and Letters, 1929.

More controversially, Mitchell also developed the Rest Cure, a treatment for the now passé diagnoses of neurasthenia (physical and mental exhaustion) and hysteria. Women most often received the Rest Cure, which typically involved six to eight weeks of isolation, bed rest, a high calorie diet, massage, and electrotherapy.4 Though the Rest Cure seems problematic to modern eyes, it was an accepted and popular practice for decades, seen as a valuable alternative to drug treatment.3

And what about men experiencing neurasthenia? For them, Mitchell developed the West Cure. Men—including Walt Whitman and Theodore Roosevelt—were sent West to “engage in vigorous physical activity … and to write about the experience.”5 The different treatments used for the same diagnosis—neurasthenia—speak volumes to how differently men and women can be viewed and medicalized.5

The Sargent portrait of Dr. Mitchell. In Burr, Weir Mitchell: His Life and Letters, 1929.

“The Sargent portrait of Dr. Mitchell.” In Burr, Weir Mitchell: His Life and Letters, 1929.

In addition to his medical research and private practice, Mitchell also enjoyed a career as an author. He published numerous short stories, 19 novels, a biography of George Washington, and 7 books of poetry.3 We have one of these poetry books, A Psalm of Deaths and Other Poems (available in full online), in our collection. We feature two poems from the volume here.

When Mitchell wrote “Of Those Remembered” in 1899, he was no stranger to loss: he had experienced the death of his father (1858), his first wife (1862), his mother (1872), and his sister (1874) in quick succession, along with the deaths of so many Civil War soldiers.2

Of Those Remembered

There is no moment when our dead lose power;
Unsignaled, unannounced they visit us.
Who calleth them I know not. Sorrowful,
They haunt reproachfully some venal hour
In days of joy, and when the world is near,
And for a moment scourge with memories
The money changers of the temple-soul.
In the dim space between two gulfs of sleep,
Or in the stillness of the lonely shore,
They rise for balm or torment, sweet or sad,
And most are mine where, in the kindly woods,
Beside the child like joy of summer streams,
The stately sweetness of the pine hath power
To call their kindred comforting anew.
Use well thy dead. They come to ask of thee
What thou hast done with all this buried love,
The seed of purer life? Or has it fallen unused
In stony ways and brought thy life no gain?
Wilt thou with gladness in another world
Say it has grown to forms of duty done
And ruled thee with a conscience not thine own?
Another world! How shall we find our dead?
What forceful law shall bring us face to face?
Another world! What yearnings there shall guide?
Will love souls twinned of love bring near again?
And that one common bond of duty held
This living and that dead, when life was theirs?
Or shall some stronger soul, in life revered,
Bring both to touch, with nature’s certainty,
As the pure crystal atoms of its kind
Draws into fellowship of loveliness?

The volume closes with a poem perfect for National Poetry Month: “Of a Poet” (1886).

Of a Poet
Written for a child

He sang of brooks, and trees, and flowers,
Of mountain tarns, of wood-wild bowers
The wisdom of the starry skies,
The mystery of childhood’s eyes,
The violet’s scent, the daisy’s dress
The timid breeze’s shy caress
Whilst England waged her fiery wars
He praised the silence of the stars,
And clear and sweet as upland rills
The gracious wisdom of her hills.
Save once when Clifford’s fate he sang,
And bugle-like his lyric rang,
He prized the ways of lowly men,
And trod, with them, the moor and fen.
Fair Nature to this lover dear
Bent low to whisper or to hear
The secrets of her sky and earth,
In gentle Words of golden Worth.

References

1. Silas Weir Mitchell, Papers, 1788; 1850-1928; 1949. Available at: http://www.collegeofphysicians.org/FIND_AID/hist/histswm1.htm. Accessed April 7, 2016.

2. Bailey P. Silas Weir Mitchell, 1829-1914. National Academy of Sciences; 1958. Available at: http://www.nasonline.org/publications/biographical-memoirs/memoir-pdfs/mitchell-silas.pdf. Accessed April 7, 2016.

3. Todman DH. History of Neuroscience: Silas Weir Mitchell (1829-1914). IBRO Hist Neurosci. 2008. Available at: http://ibro.info/wp-content/uploads/2012/12/Mitchell-Silas-Weir.pdf. Accessed April 7, 2016.

4. Science Museum, London. Rest cure. Brought to Life. Available at: http://www.sciencemuseum.org.uk/broughttolife/techniques/restcure. Accessed April 7, 2016.

5. Stiles A. Go rest, young man. Monit Psychol. 2012;43(1):32. Available at: http://www.apa.org/monitor/2012/01/go-rest.aspx. Accessed April 7, 2016.