History: Medicine and Memory

On this day in 1861 the American Civil War official began. A bleak and unfortunate conflict in which thousands lost their lives in bloody battle that raged not only on land but also at sea, the Civil War is nonetheless the most written about, remembered and reenacted of all wars in which the U.S. has participated. The problem, at least for me, is that memory serves in much of this specific case very, very poorly.


A small example is this article from Discovery News entitled Civil War Changed Medicine. There is no question that some of the points made in the article are valid beyond question. It was during the American Civil War that doctors – at least those attached to the armies – began to question the efficacy of sanitation. As more and more men died not just of wounds but of infections that developed after those wounds had been dealt with, experts took note. The idea that things like a scrubbed work surface, instruments that had not just been wiped on a bloody apron to “clean” them and washed hands might at least give a patient a fighting chance began to take root. Specialized fields of medicine also grew up around the injuries and traumas of the war including anesthesia, plastic surgery and neurology. Unmentioned in the article but important to remember as well is the beginning of post-traumatic psychology. Men who had been exposed to horrific conditions on battlefield or, in particular, as prisoners of war in places like Andersonville and Camp Douglas needed more than a little help to readjust to civilian life, and medicine began to take note.

The article, though, focuses most specifically on the innovations proposed and implemented by Union Army surgeon Jonathan Letterman, and it is here that more than one contribution by men – and women – who went before Letterman are surprisingly glossed over. You should read the article at your leisure to get a feel for where the author is going with it but allow me to point out a few historical notes that slip completely from view in this case.

First, I feel it is important to mention Florence Nightingale’s groundbreaking work during the Crimean War in the 1850s. Miss Nightingale proved that sanitation and hygiene could improve potential mortality rates in injured soldiers. It goes without saying that the U.S. did not exist in a vacuum and that Nightingale’s findings, and those of others, would have been known to Letterman and his fellows.

The article goes on to completely discount lessons learned during prior U.S. wars. From the article:

Medically, the United States was woefully prepared when the Civil War began… Nearly 80 years had passed since the end of the American Revolution, the country’s last major war.

This aggravatingly off-handed remark, thrown to the author by an expert no less, ignores one of the most vital contributing forces to the revolutionary strides in medicine currently attributed to the Civil War: the Navy.

Between the Revolutionary and Civil Wars the U.S. was involved in the Quasi-War with France and the First and Second Barbary Wars with Tripoli and Algiers. These wars were largely naval in nature and, unlike the remark quoted above, did not see Navy surgeons lacking in injuries to treat or innovations in treatment. The U.S.’s second war for independence, the War of 1812, also goes unaddressed. A bloody conflagration fought on American soil and at sea, this shamefully forgotten conflict also pushed medicine to new discoveries.

Letterman himself was impressed by the Navy surgeons he knew, who were able to “… apply vinegar, set bones and dose with laudanum…” without injured men having to lie in the muck of a battlefield waiting desperately for first transport and then assistance. It was this urgency of treatment and relative hygiene, which saw sailors recovering from injuries far more frequently than soldiers, that probably led Letterman to his “eureka” moment. If he set up triage and treatment tents on battlefields he could help and perhaps even save men whose lives would have been lost in prior wars. Letterman’s system, as the article notes, was a medical breakthrough and is still in use today.

Of course I could go on, but that kind of stomp your foot vexation never proved a valid point. Suffice it to say that we are missing a lot of history, and doing our ancestors a grievous disservice, when we imagine that the sum and all of the American experience culminated at Gettysburg. Those who came before, and those who chose life on the wave, contributed just as much.

Header: Jonathan Letterman via Wikimedia Commons