Gangrene and Glory (review)

Gangrene and Glory. By Frank R. Freemon. Teaneck, NJ: Fairleigh Dickinson Univ. Press, 1998. Pp. 254. $52.50.

The Civil War was a defining moment in the history of the United States. The war established that the nation would not be a collection of individual states but rather these United States. The cost was high. For its time and place, the Civil War was comparable in duration, destruction, and casualties to the world wars of the 20th century. With a population of 21,000,000, the North suffered about 630,000 casualties, of whom 360,000 died. For the South, with a population of 9,000,000 (only 5,500,000 white), comparable figures were 483,000 and 258,000. In any conflict of this scope, medical services are a critical even if relatively little discussed aspect of the conflict. Frank R. Freemon's Gangrene and Glory is an attempt to document the medical services in both the Union and Confederate armies. The "coffee table" format of the book, with ample illustrations, could increase its general interest.

For anyone interested in the Civil War or American medical history, the book contains valuable discussions and facts, as well as vignettes of physicians, nurses, and wounded soldiers. Chapters include discussions of American medicine just prior to the conflict, the establishment and organization of the medical services in both the North and South, medical care during specific battles and campaigns, and whether this care made a difference. A table listing American medical schools in 1860, for example, highlights the discrepancies in medical education at the time. The size of the medical schools varied from a high of 514 students to a low of 34, with faculty-student ratios varying from a low of 1:2 to a high of 1:70. This was at a time when the rigor of medical education had largely declined and when, under the influence of Jacksonian democracy, the idea of medicine as a professional elite had almost disappeared. As any young physician today would appreciate, establishing a practice in the South prior to the Civil War was easier than in the North, due to the base income from retainers available from plantation owners for the care of themselves and their families, as well as their slaves.

We would consider much of the medical care during the Civil War primitive and even repulsive. Many of the practices were clearly harmful, such as the liberal use of calomel as a cathartic. A limb wound by the standard minié ball with an associated bone fracture almost always resulted in amputation. Wound infection spread readily in the generally crowded, unsanitary conditions of Civil War medical facilities. Working in such facilities required a strong stomach, including the ability to tolerate the nauseating stench of putrefying flesh. At the same time, the number of deaths in the Civil War from disease was almost twice that from battle deaths and wounds combined. The close congregation of large numbers of troops from isolated rural areas led to a high incidence of contagious illnesses such as measles, and the frequently unsanitary conditions made diarrheal illnesses rampant. For example, after the failure of the Peninsula campaign in 1862, about 40 percent of the Northern Army of the Potomac was disabled, but only about 4 percent of these were due to wounds.

Improvements did occur as the war progressed. This was particularly true for the North, due to better organization and more ample supplies; in the South, due to the Northern blockade, items such as quinine for treating malaria were in short supply. Much of the improvement in the North was due to the efforts of the civilian-controlled and privately run U.S. Sanitary Commission. There was also competent leadership in the Surgeon General's office of the Northern army: some of the names, such as Dr. Jonathan Letterman, are still familiar today. However, the main force behind effective change was the Surgeon General, Dr. William Hammond, and his reward was...