Marrow of Tragedy: The Health Crisis of the American Civil War

Afterword

Afterword Imagine that on July 21, 1861, there you stand, an observer near Manassas Junction, Virginia. Out of the smoke and noise staggers a man, clutching his arm, calling out in pain as blood drips onto his boots. He falls on the bare ground at your feet. What can you do for him? Tear up your petticoat to make a tourniquet to stop the bleeding? Cup some water in your hands from the nearby stream, for his dry lips? Search in vain for a doctor, for an ambulance , for any sort of official medical person? This is how it began. The calls for help were ultimately met by men and women on both sides who struggled to care for their soldiers, while at the same time taking advantage of the war’s exigencies to promote agendas of reform, research, and progress. Themes of gender have run throughout this narrative. Health care has always been a predominantly female activity, even if men held the higher professional positions that brought prestige (at least until recently). Women knew how to care for the sick, and when war put men in hospitals instead of home sickrooms, those women pushed to assume their competent role at the bedside, either directly or through surrogates. The U.S. Sanitary Commission both “channeled” this feminine force by organizing the conveyance of needed goods to the men and acted as a forceful nanny in teaching the men how to be clean and preserve their health. The best of Civil War hospitals, drawing on the work of Florence Nightingale, were healing environments precisely to the extent that the home sickroom could be recreated. Nutritious food and cheerful nursing were at least as important as the actions of physicians , and these essentials differentiate northern from southern success in healing the men. Historians of medicine have long been aware of the antebellum debates about reform within American medicine. Physicians pushed for the adequate collection of vital statistics so that the health of the people could be Afterword 311 ascertained; sanitary conventions argued over proper measures to prevent disease; professional associations sought to elevate the profession through improved education and research; medical students went abroad to have fulfilling learning experiences in foreign hospitals; women sought equal access to medical schools. What is less well known is how the war transformed these various reform impulses, much less how those changes played out in the decades following war’s end. Medical historians need to “put the war back in” to the history of nineteenth-century medicine in the United States. One way to approach this agenda would be through group biography. Of the 2,432 women who were listed as physicians in the 1880 U.S. census (see chapter 2), how many had served in some capacity during the war? The same question could be asked of the (male) leadership of medical societies and schools and boards of public health. American medicine changed rapidly in the years after the war, and it is highly likely that the leaders of that transformation had themselves been transformed by their wartime experiences. Germs love war, and this conflict was a field day for the parasites that prey upon humans. It is clear that certain microorganisms took advantage of all those young men gathered in filthy camps, to spread abundantly. Their story has yet to be told in all its glory. The tools of the “spatial humanities” would be helpful here, using geographic information systems to show how, for example, smallpox traveled over space and time. Like many other topics that I originally intended to cover in this volume, that one deserves, instead, a book-length treatment of its own. Elizabeth Fenn showed not only that smallpox was a major challenge for George Washington during the Revolutionary War, but that the war’s effects so amplified the epidemic that it reached the western Plains Indians and Mexico City. In a similar way, smallpox broke out among freed people in 1865 North Carolina and reached the Cherokee by 1868. Other diseases that need mapping are malaria, typhoid, and tuberculosis. I suspect that each of these diseases not only took their toll among soldiers but carried over into civilian epidemics.1 In this time of sesquicentennial “celebrations,” we would do well to remember this: The Civil War was a disaster that killed more than a million Americans. That some responded so grandly to the humanitarian challenge is small comfort amid such carnage. We live, still, with the war’s legacy. [3...