Civil War Medicine Challenges and Triumphs. (Book Reviews).

Author: Alfred Jay Bollet, MD

Publisher: Galen Press

"No man is an island"

John Donne

No major event such as the Civil War can be studied in isolation. History is a continuum: current events are modulated by past events and in turn shape future events. Although during the Civil War travel and communications were difficult, yet the medical profession in America capitalized from experiences gained elsewhere, especially during previous wars, and particularly the Crimean War.

That was the time when the impact of nonbattlefield injuries became as important, if not more important, than injuries sustained in the battlefield. That was the time when it became obvious that the management the wounded received during the first few hours following the injury were critical in determining their ultimate fate. That was also the time when Florence Nightingale revolutionized the art of nursing.

In America, the medical profession was illprepared and largely taken by surprise when the Civil War, which was meant to end within a few weeks, lasted about 4 years. The initial confusion and inertia, however, rapidly gave way to an efficient system that set the standards for the future practice of medicine. Efficient triage methods were established, different levels of hospitals were adopted to maximize their efficiency and the utilization of available resources, and an efficient ambulance system was developed to allow the transport of wounded in as comfortable a way as possible, given the state of the roads. Interestingly, too, standards were set and enforced by "inspectors" who regularly visited the various units. Was that an embryonic Joint Commission for the Accreditation of Health Care Organizations?

The time just preceding the eruption of the Civil War had witnessed great progress in medicine. On both sides of the Civil War, there were a number of "observers" from Europe. These observers probably sped up the adoption of recent advances, played an active role in the evolution of military medicine in America, and in turn enhanced the impact of this progress in Europe.

Reading Dr. Bollet's book is refreshing, interesting and enjoyable. He places the practice of medicine during the Civil War in the larger context of other medical and scientific events. He also strikes a right balance between battlefield surgery and non-battlefield medical conditions. Many pages are devoted to non-surgical problems such as diarrhea, malnutrition, smallpox, yellow fever, and even psychiatric problems. There is also a chapter on prison camps. The role of women during the Civil War is also not overlooked: about 30 pages are devoted to this topic. The book is highly recommended for anyone interested in the history of medicine.

The 489-page book is well organized. There are 17 chapters, 7 appendices, and an index. The book is appealing and easy to read. After each chapter there is a list of references, and at the end of the book there is a bibliography for those interested in a more in-depth study. Throughout the text several vignettes are included to liven the prose and to help the reader get a better understanding of the situation during the Civil War. A few illustrations, tables, and graphs further increase the appeal of the book. The appendices provide further valuable information, including a Civil War timeline. The index is helpful to those readers who wish to refer to specific issues addressed in the book.

The only weakness of the book is the last chapter, which is a re-evaluation of medical care during the Civil War. This is one of the shortest chapters: only 12 pages. The impact the Civil War had on the practice of medicine is tremendous. It is regrettable that this has not been further expanded in this chapter, although, in all fairness, it has been mentioned throughout the text. Maybe the author did not want to bore readers by restating these various impacts. On the other hand, it is like being invited to a delicious several course meal but then being short-changed on the dessert!