- “To Make Something Out of the Dying in This War”The Civil War and the Rise of American Medical Science
editor’s note: The following represents the acceptance speech for the Watson Brown Prize for the best book published on the Civil War era in the calendar year 2014. Tad Brown, president of the Watson-Brown Foundation, awarded the prize to Shauna Devine for her book Learning from the Wounded, published by the University of North Carolina Press. These remarks were given at the annual banquet of the Society of Civil War Historians (SCWH), held during the Southern Historian Association annual meeting on November 13, 2015, in Little Rock, Arkansas. The SCWH judges and administers the book prize.
Dr. Devine’s address employs a variety of medical terms; these are explained in a glossary at the end of this article.
On July 10, 1863, Pvt. Charles McElroy of Connecticut was transferred from the Eleventh Army Corps Hospital to the Jarvis USA General Hospital in Baltimore, Maryland. He was suffering from a wound to the left leg, received during the Battle of Gettysburg. The case report noted that the whole belly of the gastrocnemius and soleus muscles had been carried away by the fragment of a shell and that the limb presented a “frightful appearance,” its vitality having been destroyed far beyond the seat of the injury, “terminating in extensive suppurative inflammation and sloughing.”
For the next few weeks, the doctors at the Jarvis General Hospital monitored the patient daily and treated the inflammation in the hope that the wound would granulate. But on September 3, the case file noted that the patient was suddenly seized with violent constitutional disturbance, a high grade of fever; pains in his head, back, and limbs; and frequent chills. The doctors studied the abnormal inflammation, diagnosed gangrene, and quickly got to work. They opened the entire wound, moving the skin back, which revealed a pulpous slough, described as dark ash in color, which [End Page 149] seemed to liquefy the flesh every hour as it progressed. The discharge worried the doctors; it was described as a thin saneous liquid with an odor so pungent and offensive that the nurses and others in attendance could scarcely remain a moment without experiencing sickness of the stomach. The patient sank rapidly as the disease progressed, and he was monitored every hour, night and day. Hoping to stimulate the patient’s tissues and help counter the poisons, the doctor prescribed cold-water dressings, poultices, stimulants, tonics, and a nutritious diet.
In deciding how to proceed, the doctor had some resources to consult. A year earlier, U.S. Surgeon General William Hammond had sponsored a series of investigations in which physicians at field and general hospitals were ordered to study the causes, transmission, pathology and treatment of hospital gangrene.1 In these investigations, physicians were asked to submit their case histories to the new Army Medical Museum. Some case reports were also submitted for debate and discussion to local medical societies and medical schools, and a number of findings were published in medical journals. The approaches to the study of gangrene were highly individualistic, and the directive to study the diseases produced an epistemological innovation. Some physicians advocated studying bodily fluids and the products of disease with a microscope; others engaged in clinical trials that tested new methods and remedies; still others suggested studying the chemical processes of these diseases; and yet more engaged in new experimental methods trying to prove contagion. Many doctors concentrated on active prevention—using disinfectants to avoid the disease erupting in the first place, which added a new element to the practitioners’ clinical responsibility. There was a developing consensus that bromine appeared the most promising prophylactic and therapeutic remedy.2 The findings of these investigations were widely disseminated during the war. They were not only reported through the medical schools, societies and journals but also to medical inspectors and medical directors who then passed along the findings and recommendations, sometimes in the form of direct orders, to doctors in the general hospitals.
In treating Private McElroy, the physician had a variety of options. Though he had never looked through a microscope before...