Synopsis
Book by Ira Rutkow
Extrait
Chapter 1
“It was like the days when there was no King in Israel”
When William Williams Keen, an assistant surgeon for the Fifth Massachusetts Infantry, walked into Sudley Church, he was startled by what he saw. The small house of worship, located on the northern fringe of the Bull Run battlefield, had been transformed into a field hospital for Union troops. This makeshift treatment facility, along with its outbuildings, was overflowing with the wounded and dying. The church’s pews were piled outside, and the building’s floor was covered with hay and blankets for emergency bedding. Buckets of dirty water, wooden boxes with surgical instruments, and paper packages containing beeswax-coated sutures and dressings were strewn about. The operating table, little more than a few boards laid on crates, stood in front of the pulpit. A bloodied communion stand served as a resting spot for the weary.
Both inside and outside the hospital, medical activity was frenetic and groans filled the air. From their perch in a small upstairs gallery, those with minor injuries craned their necks to observe the physicians, aided by a number of local women, go about the messy work of cutting. Amputations were performed in full view of the assembled, with blood splattering those too near, including the next victim of the surgeon’s scalpel. Keen, assisting at an amputation of a shoulder, quickly realized that the operating surgeon had little knowledge of the anatomy of the upper arm. To keep the soldier from bleeding to death, Keen had to tell the surgeon where to cut and sew.
In his memoirs, Keen explains that his clinical discomfort was compounded by the unnerving realization that “up to that time, and, in fact, during the entire [Bull Run] engagement, I never received a single order from either Colonel or other officer, Medical Inspector, the surgeon of my regiment, or any one else.” Keen acknowledged, “It was like the days when there was no King in Israel, and every man did that which was right in his own eyes.” Indeed, just two weeks earlier, twenty-four-year-old Keen had been a first-year medical student at Philadelphia’s Jefferson Medical College. Keen, who later became professor of surgery at his alma mater and eventually fifty-second president of the American Medical Association (AMA), had begun the study of medicine only in September 1860 and was hastily recruited to join the army’s medical corps several months later. “My preceptor, Dr. John H. Brinton, had received a telegram from a former student (let us call him Smith) who had graduated in March 1861, and was Assistant Surgeon of the Fifth Massachusetts, saying that he was going to leave the regiment.” Under orders to replace this assistant surgeon, Brinton “very kindly offered the place to me.” Immediately, Keen confided his concerns about his clinical capabilities to Brinton. The preceptor replied, “It is perfectly true that you know very little, but, on the other hand, you know a good deal more than Smith.” With just fourteen days of military service to guide him, Keen considered himself to be “as green as the grass around me as to my duties on the field.”
The battle at Bull Run had not gone well for the Union troops. With defeat imminent, the North’s evacuating columns moved rapidly by Sudley Church as Keen applied a splint and eight yards of bandage to a man who had been shot in the upper arm. The passing soldiers yelled, “The rebs are after us,” and Keen’s charge, despite a potentially mortal wound, “broke away from me,” Keen noted, “rushing for the more distant woods. As he ran, four or five yards of the bandage unwound, and I last saw him disappearing in the distance with this fluttering bobtail bandage flying all abroad.”1 With Keen ordered to retreat to Washington, it became obvious to all concerned that no exiting strategy or armed protection had been arranged for the field hospital’s wounded. By early evening, with Confederate forces swarming over the church grounds, the three hundred or so Union injured, along with several medical personnel, faced a very uncertain fate.
If ever an event served as a harbinger of medical misery, it was this July 21, 1861, First Battle of Bull Run (Manassas, in Southern parlance). Evidence of much that was wrong with mid-nineteenth-century American medicine, Bull Run, with its 750 killed, 2,494 wounded, and more than 1,500 missing, was essentially a savage military engagement fought by poorly trained troops who received treatment from inadequately prepared physicians in a chaotic setting. According to one contemporary account, “The conception was unwise; the plan faulty; the execution imperfect.”2 From the wretched state of the wounded to the disorganized scattering of surgeons over the rolling battlefield, Bull Run became a tragic lesson in military medical hubris. With few available surgical supplies and no plans in place to evacuate casualties, the injured lay for days on the ground where they fell, suffocating on their own vomit and delirious from infection. Many received neither medical attention nor so much as a mouthful of water.
“The profession, as the conservator of life, asks in the name of the Republic why the wounded were not brought off the field, and why the hospital was not guarded?” editorialized one physician. “It asks why the surgeons were not sustained and protected in the discharge of their duty?”3 By proclaiming his indignation, this doctor drew attention to a concern that was developing among America’s physicians over the part they would play in the nation’s civil conflict. But medical doctors were not the only ones anxious about the government’s role in the rapid expansion of military medicine. Every day, ordinary citizens attempted to reckon with the growing number of battlefield and illness-related deaths, as well as the attendant suffering that soldiers endured. One New York woman wrote, “We ought to remember that for every one that falls on the battlefield or suffers a languishing death in the hospitals, some friends mourn and weep their lives away.”4
After Bull Run, America’s physicians called for organizational reforms and urged President Lincoln, the United States Congress, and state legislatures to respond to the medical tragedies of the internecine struggle. “The lives of thousands of citizens, the strength of the State, and the efficiency of the armies of the Republic, demand new, enlightened, and liberal legislation,” wrote one physician activist.5 The doctor’s concerns were well-founded. What would happen to sick and wounded soldiers if politics controlled camp and battlefield medical care? Who would be held accountable: politicians, physicians, or society as a whole?
In 1860, many Americans had a romantic idea of war that ignored the day-to-day medical horrors of armed conflict. This was revealed when, following the fall of Fort Sumter in April 1861, Abraham Lincoln issued a proclamation calling for seventy-five thousand state militiamen to provide ninety days of voluntary national service to put down the secessionists. Patriotic fervor swept the land as citizens rallied to the cause and all manner of physicians enthusiastically offered their services. According to an article in The New York Times, even renowned medical professors forsook “their luxurious chairs to join the hardships of a soldier’s life,” leaving “a practice worth tens of thousands, that they may go to alleviate the sufferings of the camp.”6 From the most humble hamlets to the largest cities, state military regiments were organized, funds raised, flags unfurled, food stocked, and equipment supplied, but little consideration seemed to be given to the medical realities of military life.
These early volunteer troops followed the well-established militia tradition whereby a prominent businessman or a politically influential individual would, under a governor’s authority, recruit a fighting force and, in return, be named the unit’s commander, usually with a rank of “colonel.” This often meant that an individual of wealth or celebrity became a wartime leader simply by purchasing uniforms and providing supplies to a ragtag collection of men and sometimes boys. As one young Pennsylvanian recruit wrote home to his mother in the summer of 1861, “Col. Roberts has showed himself to be ignorant of the most simple company movements. There is a total lack of system about our regiment. . . . Nothing is attended to at the proper time, nobody looks ahead to the morrow, and business heads to direct wanting. . . . We can only be justly called a mob & not one fit to face the enemy.”7
President Lincoln directed state governors to also appoint a surgeon and an assistant surgeon for each of the new volunteer regiments, “after having passed an examination by a competent Medical Board . . . the appointments to be subject to the approval of the Secretary of War.”8 Despite the law’s intent, when companies of one hundred men and even whole regiments of one thousand individuals consisted entirely of enlistees from a single village, township, county, or city, it frequently came down to little more than asking the amiable local doctor to accompany the troops. “He may have been a good family medical attendant in the town where he resided and perhaps has given some attention to domestic hygiene, but he knows nothing of the habits of soldiers; of their diet; of the sites, choice, and ventilation of tents,” groused one physician. Furthermore, the same doctor added, even if he enjoyed an enviable reputation as a surgeon, he may “never have met an accident peculiar to the field of action.”9
Eventuall...
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