Learning from the Wounded: The Civil War and the Rise of American Medical Science by Shauna Devine (review)

Shauna Devine’s Learning from the Wounded is a major, ambitious, and on the whole successful effort in bridging the gap between two relatively discrete historiographies: that specific to Civil War medicine, and the larger body of work on the nineteenth-century American medical profession and medical science. Focusing on the Union side (leaving the Confederacy for her next book), Devine argues that the war “was more than a broad school of experience; it was also a conduit for the production, development, and dissemination of new medical ideas” (5). Government support for the collection of medical information, the rise of laboratory and clinical research and experimentation, increased medical specialization, and emerging techniques for the management of infectious diseases characterize what she terms the “Civil War medical model,” which would have a profound effect on American medicine (5).

Devine begins by discussing William Hammond’s ascension to the position of surgeon general, his strict standards for military surgeons, and “Circular No. 2,” a one-page directive instructing medical officers to prepare case reports and specimens for the new Army Medical Museum. Further directives reinforced this project, and the dividends of such institutional support for the creation and dissemination of medical knowledge were rich. Devine argues that surgeons’ efforts to dissect bodies (to which they had unprecedented access) and produce such reports developed both their practical skills and an increasingly critical approach to physiology and pathology, especially if they were among the eager few with access to microscopes. In contending that Civil War physicians were primed to query the nature of disease, Devine provides a fuller context for developments in laboratory medicine and bacteriology later in the century. Indeed, she traces in fresh detail the study of gangrene and erysipelas, observing “epistemological innovation” as physicians explored and debated these infections’ causation, pathology, transmission, and treatment through microscopy, pathological chemistry, and even “clinical trials” with different therapies and prophylactics (101, 114).

Devine then turns to other trends in medical history. She observes new opportunities for specialization, focusing on Silas Weir Mitchell’s well-known leadership in neurology, along with experts on cardiac diseases and facial surgery. Facilitated by larger patient volumes and dedicated hospital divisions, specialization’s success during the war, Devine argues, secured its place in the postbellum period. She also examines sentiment around soldiers’ dead bodies, which fell under military control. The Army Medical Museum, open to the public, framed these specimens as significant national contributions, both for their personal sacrifice and for their value to orthodox medical practice, scientific discovery, and the country’s international reputation. Devine, moreover, considers how the Civil War medical model changed public health practice. Revisiting the 1866 cholera epidemic, she witnesses a more authoritative medical profession, the maturation of wartime techniques in disease investigation and management, and the Surgeon General’s Office as a hub for sharing information across civilian and military lines.

Learning from the Wounded’s aim to map the relationship between the Civil War and these larger issues of nineteenth-century medical knowledge, research, and professional authority—a relationship that other historians have explored but never fully expounded—is laudable and much needed, and Devine’s research is impressive. Rather than relying on the predigested Medical and Surgical History of the War of the Rebellion, she returns to individual physicians’ dynamic, inquisitive, and ultimately revealing case notes, memoirs, and correspondence, as well as government publications and medical texts. The results are persuasive. With a firm grasp of contemporary medical understanding, she emphasizes the war’s extraordinary opportunities and commensurate impact on the orthodox profession. In Devine’s words, the war “had contributed to a new identity as producers of medical knowledge for many American physicians and provided an important catalyst for the development of American scientific medicine” (272).

Of course, like all “rise of” books, Devine’s text bears an innate teleology: she seeks out examples that...