Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine (review)

The medical history of the Civil War has been relatively sparse. Historians of this event have often focused on the organization of the military, the great battles, the great men. While statistics about medical matters are available, even the Medical and Surgical History of the War of the Rebellion—the six government-sponsored volumes containing some three thousand pages of densely printed text, published soon after the war ended—does not tell us what actually happened to the sick and wounded once their battle was over.¹ Comes now a book that purports to fill this gap, a book of exuberant strengths and disturbing weaknesses. Bleeding Blue and Gray intends to do no less than evoke the suffering of the Union soldiers and probe the war's impact on the nation's subsequent medical history.

Ira Rutkow retells some familiar stories—for example, Surgeon General William Hammond's feud with Edwin Stanton, Lincoln's secretary of war. But what sets this book apart is its engaging narrative—writing that surpasses the standard set by George W. Adams's Doctors in Blue and H. H. Cunningham's Doctors in Gray—and superior integration of material.² Even Frank Freemon's Gangrene and Glory, which contains more specific medical information than Rutkow's book, lacks the organizational and narrative coherence of Bleeding Blue and Gray.³ Rutkow makes good use of the thousands of clinical case reports in the Medical and Surgical History, personalizing the history and heightening its drama. His achievement is in taking massive amounts of data, many stirring events, and the geopolitical and economic context—and fashioning them into a riveting story.

But the value of this book is seriously diminished by its faults. Even the title is misleading. The book itself emphasizes the North; this is an understandable choice, because so many of the Confederate records were lost in the fires of Richmond just before the war ended in April 1865, but why then choose a title that includes the South? In addition, an unwarranted presentist tone surfaces throughout the book. Rutkow claims, for example, that "surgery, despite the performance of tens of thousands of operations, remained as barbaric and crude in 1865 as it was in 1861" (p. 318). This is a judgment from the present, not from the 1860s. And it is presentism at its worst, as well as a lack of understanding of humoral theory, to dismiss springtime phlebotomy as a "treatment for nothing more than seasonal allergies and symptoms of nasal stuffiness and post-nasal drip" (p. 47). Springtime bleeding had been popular for centuries because, according to humoral theory, at that time of the year blood was in natural excess; a prophylactic bleeding was designed to bring the humoral system back into a state of balance.

Rutkow also misleads readers by claiming that the heroic therapy advocated by Benjamin Rush was still in vogue during the Civil War (pp. 41–54), a judgment put to rest by medical historians such as Alex Berman and Richard Shryock a half-century ago.⁴ And, indeed, Rutkow contradicts himself, writing: "By the 1840's, criticism of Rush's theories had become part of everyday conversation in sophisticated medical circles" (p. 54).

Rutkow's failure to engage with many existing sources leads him to errors of fact and interpretation. Had he consulted Donald Hopkins's book on smallpox, he would not have claimed that the vaccination used on Civil War soldiers to protect them from smallpox consisted of "unadulterated pus from an active smallpox scab" (p. 16). This is in fact inoculation, the older form of immunization. Hopkins describes in detail the use of scabs from children, often slaves, or from fellow soldiers who had been vaccinated with material from cows.⁵ Historians of medicine will recognize the difference, but readers without a knowledge of this history will...