Marrow of Tragedy: The Health Crisis of the American Civil War by Margaret Humphreys (review)

In the introduction to Marrow of Tragedy, Margaret Humphreys takes care to note how the tragic events of the American Civil War continue to resonate personally, with at least two of her forebears losing their lives during the conflict. This “foolish, overwhelming cataclysm” exacted a cruel toll from its participants, not only in terms of lives lost to battle and disease, but also in the long suffering of the war’s sick and wounded survivors, not to mention the anguish of the surviving families of those who marched to the drum (19). And yet Humphreys—Duke University’s Josiah Charles Trent Professor of the History of Medicine—takes inspiration from this familial legacy to craft something long overdue for scholars, students, and aficionados alike—an intelligent, insightful, and comprehensive study of the human dimension of the Civil War’s impact on both the individual soldier and the larger communities affected and influenced by the war.

Building on the framework of the “war and society” perspective—what some have also called the “new ‘new military history’”—Humphreys seeks to present the Civil War as an event transpiring on several existential planes simultaneously. Rather than focus exclusively on the well-defined threads of the American Civil War as a blood-soaked contest populated by soldier victims and caregivers of varying degrees of competency, she strives to link the home front—a generally feminized space where philanthropies competed with the state for access to the resources needed to treat the war’s victims—with the larger questions of professional expertise and legitimate authority in matters of medicine and public health that were arising over the course of the war.

This is no easy task. While military history as a field has made great strides in recent years, numerous practitioners still resist calls for incorporating social- and cultural-based historical analysis, particularly if such approaches challenge long-established conventions. Even within the context of military medicine studies, mainstream popular histories continue to focus on the heroic therapeutic narratives, ignoring more salient trends in public health, institutional management, and the lingering residual effects of war on its participants.

These are but a few of the challenges Humphreys confronts in her well-conceived study. Operating from the premise that war and the work of healing and treating its damaged participants is a deeply intimate social exchange, Humphreys considers Civil War medicine as an exchange dominated by existing concepts of gender identification. The military physician and the uniformed enlisted hospital orderly both performed services—nurturing, succoring, salving—that were long identified in antebellum society as feminized activities. Only after the full scope of the human disaster was realized did attitudes change, when in 1868 military physicians were granted rank with its full prerogatives and privileges. In acquiring rank, the army doctor likewise acquired legitimate authority as a peer officer—with his practice and duties likewise recontextualized as being sufficiently masculine to warrant formal recognition by the line establishment and the War Department.

The transformative experience was not limited to military personnel, however. Humphries addresses the civilian interactions with the Union military establishment relatively early in her narrative. Beginning with the question of female participation in the military medical effort, she very quickly dispenses with the largely resolved arguments about nursing. Instead she considers the more serious issues of female physicians in the military hospital, describing this encounter as the more genuine venue for anticipated change by feminist reformers. Female physicians were not always welcomed in military hospitals, nor were they accepted by their uniformed male peers—the backlash against Dr. Mary Walker’s award of the Congressional Medal of Honor presented as the most egregious example—but the very fact of the female expert presence in military hospitals served to advance their postwar efforts to claim legitimacy. Other civilian encounters with the military establishment—those involving the U.S. Sanitary Commission, local health committees in occupied southern...