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October 10, 2013

Examining the Civil War’s toll

HSLS exhibit, lecture series

The “Life and Limb” exhibit will be on display in Falk Library through Oct. 26.

The “Life and Limb” exhibit will be on display in Falk Library through Oct. 26.

“The heroism and brutality of battlefield operations” during the American Civil War, said Jeffrey Reznick, is “an aspect of this war that has not received enough attention.”

Reznick, chief of the history of medicine division of the National Library of Medicine (NLM), spoke here Sept. 24 in conjunction with a current Falk Library exhibit, “Life and Limb: The Toll of the American Civil War,” sponsored by the NLM.

Three million people fought this war, leaving a million casualties, half of whom died. That disease took more soldiers’ lives than the battlefield merely confirms the primitive state of medicine at the time.

There were no antibiotics, X-rays, blood typing or blood transfusions. Ether and chloroform were the only known anesthetics. It was the era of patent medicines full of suspect ingredients and untested effects.

New, softer ammunition compounded the battle injuries, hitting bone and then changing shape, dragging clothing and skin into wounds, increasing the risk of infection. Limbs were regularly sacrificed to avoid gangrene and save lives. There were 60,000 surgeries involving amputation during the Civil War, accounting for three quarters of all operations.

These procedures were performed by doctors with very little training. “This was a whole new experience for them,” Reznick said. Perhaps they had seen a railroad or farm accident that required an amputation back home. But they had never seen the damage from Minie balls or cannon balls.

By 1862, Union veterans with amputations were receiving $75 to buy artificial legs and $50 for arms. Between 1861 and 1873 there were 173 patents for prostheses and the apparatus surrounding them. James Edward Hanger, a Confederate soldier who had lost a leg in the fighting, patented the Hanger limb with rubber bumpers on the ankle and a rubber foot; Hanger Orthopedics Group still prospers in Bethesda, Md. Hanger’s biggest rival was A. A. Marks of New York City, who certainly bested Hanger in advertising. Marks’s ads included inspiring testimony from veterans about the utility of artificial limbs, as well as illustrated guides to his factory process.

“These positive testimonials obscured the reality of life with and without artificial limbs,” Reznick said. Ragged tissue and bones protruding or close to the skin surface made for a painful existence.

Some injured men chose to return to military service, entering the Invalid Corps, established by the North in 1863. It was divided into two battalions: One carried weapons and fought; the other served as nurses, cooks, prison guards and military police in U.S. cities, overseeing the draft.

“The Invalid Corps was at one point twice as large as the pre-war army,” Reznick said. But they did not always command respect. “They were, in fact, nicknamed ‘Inspected, Condemned,’ after words stamped on expired goods.”

Soldiers’ selflessness commanded citizens’ respect right after the war, but their image soon changed. The stigma of having a disability and relying in part on the charitable goodwill of the government took a toll on amputees’ public image. Government officials began to express concerns: Would these injured veterans lapse into idleness? Would they become an economic burden to their fellow citizens? What jobs would be suitable for them? Who would pay for their pensions and old-age care?

“The image of the wounded soldier became one of the money-grubbing dependent,” Reznick said.

War, medical research and the NLM

In the midst of the Civil War, in 1862, Surgeon General William A. Hammond told medical officers in the field to collect medical specimens, and the projectiles that caused them, from the wounded and the dead. Union surgeons collected medical specimens from the ill as well.

By 1888, this resulted in a 3,000-page “Medical and Surgical History of the War of the Rebellion,” which was the first large-scale medical study, Reznick noted.

The specimens also added much to the Army Medical Library collection in Washington D.C., which eventually turned into the NLM, one of only three national libraries in the U.S., alongside the Library of Congress and the National Agricultural Library.

The NLM was started by U.S. Army surgeon Joseph Lovell in 1818 as the library of the Surgeon General’s Office. After the Civil War, it acquired journals and books from the Army’s temporary hospitals, but still only had enough material to fill a large bookcase. Then, in 1865, it was taken over by the man destined to build it into a world-class facility, Army Lt. John Shaw Billings.

Billings undertook a campaign of writing directly to medical officials and doctors across the country, asking them to contribute materials. Reznick labeled him “one of the most learned men in Gilded Age America.”

Under Billings, the NLM’s predecessor grew to 124,000 bound volumes. By 1895, it was the largest medical library in the Americas and possibly the world.

Billings created two landmark search aids, known today as Index Cat and Index Medicus, in the 1870s. Today, they are subsets of PubMed, a central source for biomedical literature citations.

In 1887, the facility was recast as the Army Medical Library and continued to grow exponentially. It was shipped to Cleveland during World War II, then returned to Washington, D.C., and its current home on the campus of the National Institutes of Health in Bethesda. Its current building, designed during the Cold War in 1962, has extremely thick walls, Reznick said, to withstand an attack: “The idea was that the roof would collapse in, killing everybody inside but preserving the collection.

“The collections of the NLM are still growing, thankfully, despite the budget situation, despite the sequestration,” he added. But, he asked, have we learned enough from the history of veterans’ medical and societal treatment during and immediately after the Civil War?

Do today’s veterans, he said, “have the social support that they need and deserve? To what extent is our cutting-edge research informed by our understanding of history?” Does the government do a good job, he concluded, as “we continue to grapple with fulfilling the needs of our veterans?”


Reznick’s talk was sponsored by the Health Sciences Library System.

On Oct. 8, Laura P. McLafferty, chief resident for education at Western Psychiatric Institute and Clinic, also spoke as part of this lecture series, addressing the topic “Hurting for Home: Nostalgia in American Military Psychiatry From the Civil War to WWII.”

On Oct. 22, the series concludes with a talk by Rory Cooper, director of the Human Engineering Research Laboratories in the School of Health and Rehabilitation Sciences, on “Advances in Prosthetic Devices, Engineering and Treatment.”

The “Life and Limb” exhibit will be on display in Falk Library through Oct. 26.

—Marty Levine

Filed under: Feature,Volume 46 Issue 4

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