Tarnished Scalpels

Book excerpt: The Civil War surgeon faced a unique challenge: to answer to two very different authorities. On one hand, he was bound to uphold the principles of medical tradition, while on the other required to obey the regulations of the army. In the former realm, it was his duty to follow the customs and ethics of his profession and his responsibility to maximize his skills in the diagnosis and treatment of wounds and sickness. In the latter arena--a world unfamiliar to most doctors--he was to learn and follow the Articles of War, the Regulations of the Army, and the customs of military life. Not every doctor was able to rise to the challenge of these dual responsibilities and many Civil War surgeons ended up facing official sanctions for their alleged medical and/or procedural failures. it is all too easy today to look back on the medical practices of the Civil War era with the smug superiority of 135 years of hindsight. Modern medical knowledge and technology make the practices of late-nineteenth-century medicine seem downright primitive. But Civil War doctors and surgeons were no less knowledgeable than their civilian colleagues. The Civil War doctor did not think of bacteria because no one thought of bacteria. He did not strive for a sterile operating field because that concept would not arrive for another twenty years. For the same reasons, he did not x-ray his patients or order transfusions or examine their blood for parasites of prescribe antibiotics. We know of these things, but no one in 1861-1965 did. When Civil War surgeons arrived to perform their duty, they met a challenge for which medical training could not have prepared them: doing things the army way. The two main sources of information for enlisted men, The Articles of War and the Regulations of the Army, offered little or no guidance to Civil War surgeons. The customs of the army depended on an oral tradition, a learning by experience, but a vast citizen army raised almost overnight had no collective memory--and therefore no way to inform itself. This ignorance was the basis of several court-martials. Undoubtedly, some of these surgeons were guilty of negligence, perhaps even worse. But the great majority of Civil War surgeons did their duty. Even those who fell short raise the question: Could we, with the same challenges and the same limited knowledge, have done better? -- Inside jacket flaps.