Gangrene and Glory, Medical Care during the American Civil War (review)

Students of medical services during the American Civil War have been recently blessed by several health professionals, such as Alfred Jay Bollet, Jack D. Welsh, Gordon Dammann, and Peter J. D'Onofrio, who have directed their excess energy and effort toward producing very good books and journals on the topic. Joining this group is Frank R. Freemon, a physician with the Veterans Administration who completed his doctoral work in history in recent years. He previously published an extensive annotated bibliography of sources for Civil War medicine, Microbes and Minie Balls (London and Ontario: Fairleigh Dickinson University Press, 1993). Now, he has produced an excellent overview of the subject.

In 24 chapters, covering 228 pages, Dr. Freemon reviews such topics as important physician participants, the introduction of women nurses, transportation of the sick and wounded and the Letterman system, hospitals, medicine at sea, the death of President Lincoln, and the aftermath of the war. Included are thirty-three tables that show primarily the number of sick and wounded in various hospitals or during particular campaigns. This book is the best illustrated of its type that I have encountered. There are 114 photographs (the American Civil War was the first war to be extensively photographed), drawings, graphs, maps, and radiographs (one soldier survived long enough to be x-rayed). Freemon is at his best using case reports and diary entries. The book is enlivened by these anecdotes. Such was the case of Private W. W. Pease, who during the battle of Gettysburg in July 1863 was struck by a minie ball in the right thigh, fracturing his femur. He underwent three operations: The first removed the minie ball, the second removed bone spicules, and the third drained an abscess of the thigh. He was still in the hospital at Gettysburg to be present for Lincoln's Gettysburg Address in November. After a fourth operation because of continuing discharge of pus, he was discharged on 8 August 1864. Home in Indiana, another abscess was drained in 1868. In 1871, a sixth operation removed several inches of necrotic femur. A seventh operation in 1877 removed even more bone—Pease's right leg then was ten inches shorter than the left. He became Deputy Marshall in Indianapolis. A pen-and-ink drawing of Pease wearing a six-inch lift applied to his right boot appears in The Medical and Surgical History of the War of the Rebellion (Washington, D.C.: Surgeon General's Office, 1875–1885). Freemon also should be applauded for including a glossary of terms, as many of these medical terms are now archaic, although it is unclear as to what audience this book is directed—medical professionals, historians, or the public. Freemon has brought to light new or interesting information, such as a clinical trial testing quinine as a prophylactic for malaria (it worked).

Yet this book's coverage of some critical aspects is insufficient or lacking. Several points are mentioned and then passed over. For instance, there is minimal discussion of anesthesia. Both chloroform and ether were widely available and widely used, as was morphine. Little attention is paid to medical and surgical equipment. Nor are surgical techniques addressed. The discussion of malaria could have benefited from reproduction of the graphic plot of summer versus winter incidences/deaths that is produced in the Medical and Surgical History. There are a couple errors of fact. This book peaks in the final three chapters, where Freemon discusses the overall impact of medical knowledge, as applied from 1860 to 1865. Yet even here, one fails to sense the vastness of disease, wounds, death, and misery that were inflicted during the war. Six hundred and seventeen thousand soldiers died! Everyone was sick. Medicine had so little to offer.

Where does the current work stand in comparison to other works on this topic? As reproduced on the book cover, highly respected Civil War historian James I...