Book Review 412: Bad Doctors

BAD DOCTORS: Military Justice Proceedings against 622 Civil War Surgeons, by Thomas P. Lowry and Terry Reiamer. 126 pages. National Museum of the Civil War Medicine Press paperback.

In 1861 as the nation headed toward dissolution and war the surgeon general of the army lay in a coma, the result of a stroke. Such was the idiocy of the military mind that he could neither be retired nor replaced.

The tiny scattered army would've had difficulty in any event even with leadership. There were hardly any physicians, no field ambulance service, no system of procuring medical supplies, no hospitals -- really no nothing.

There was not even any agreed concept of standard care. In the United States of those days there were numerous competing systems of medical care, all of them more or less humbug.

By a curiosity of history, the small city of Frederick in Maryland was and is the center of the problems of Civil War medicine. In 1862 and '63, it was the closest considerable settlement to the south of the two bloodiest battlefields of the war, Antietam/Sharpsburg  and Gettysburg. The wounded were collected in Frederick to be treated in numerous buildings suddenly declared to be hospitals.

A small private museum, the National Museum of Civil War Medicine, is housed in an old building within walking distance of several of these hospitals. Its staff has compiled some studies along with the exhibits about the conflict. "Bad Doctors" (which seems to be available only at the museum store) presents a curious picture.

About 6% of the surgeons inducted into or hired by the Union Army were court-martialed. "Bad Doctors" presents a precis of the proceedings as well as a few short chapters on extraordinary cases.

Such is idiocy of the military mindset that the famous disasters of medicine in the Crimean War just a few years earlier had no impact on the thinking or preparations of American officers. Combat should have focused their minds, but they still were more concerned with the heinous offense of officers messing with enlisted men than they were with officers who neglected, starved, mistreated or otherwise abused the men they were supposed to care for.

Part of this indifference no doubt can be laid the lack of consensus on what a standard of care was. Thomas Lowry and Terry Reimer note that in one way the Confederate soldiers were better off than the Union soldiers. The Confederacy faced all the problems the Union faced with fewer resources. But that included lack of access to calomel and other poisons that were commonly used as medicines in those days.

Southerners tried to make do by turning to traditional herbal remedies and not far from Fredrick in Keedysville, Maryland, at a branch of the museum, the Pye House which was the headquarters of Gen. Meade at the Battle of Antietam, volunteers are recreating a medicinal garden of the war. Some of the remedies produced there were less dangerous than calomel but not necessarily safe either.

Somewhat surprisingly, despite so many factors working against success, the two American armies, although they were much larger than most armies of former times, managed for the most part to avoid the typhus and other epidemics that have decided so many previous campaigns. The work of the United States Sanitary Commission -- a Civil War innovation hardly mentioned in Bad Doctors presumably accounted for this.

Lowry and Reimer conclude that on the whole Union doctors did a pretty good job considering. The numbers court-martialed for eating with the enlisted men, drunkenness, thievery, treachery etc. was not out of line with the numbers involved in later supposedly more enlightened times.

Whether military medicine really did get better, as they assert, is a matter for debate. My uncle Hugh was badly wounded and France in 1918. The army doctors wanted to cut off his leg. He refused because they were all drunk and he got away with it because he was an officer.

Records of the courts-martials sometimes show that the defendants were heroes, dedicated healers accused of peculation and theft who were actually working outside failed army logistical protocols in order to get enough food or medicine to keep their patients from starving and dying.

At other times, clearly incompetent doctors were forced back on the army by state governors who had great influence on an army organized my regimental volunteers raised in individual states.

At other times it appears that courts martial were convinced that a surgeon was incompetent or ineffective but kept him on because there was no one else. The sample is too small to permit a statistical study but judging by the percentage of colored troops in the army against the percentage of doctors who were in colored regiments and court-martialed, it looks like black troops had a hard time finding even incompetent medical help.

Their death rates, much higher than those of white troops, suggest the same thing.

Here is the book's notation of a surgeon chosen at random: Jacob Quick of the 22nd New Jersey Infantry which shows the kind of information available in "Bad Doctors":

"Refused to attend a private suffering from a 'severe purging of blood,' cursed him, told him to wait until morning. Guilty. Fined one moth's pay. Second trial: cursed and attacked his colonel and stole meat and potatoes. Acquitted."

They had learned at the Museum was that by the Civil War you rock. Battlefield surgery had ended. Soldiers no longer had to bite the bullet Wally sawbones cut off a limb 95% civil War Battlefield surgeries use ether as an anesthetic.

Today the American military has its own medical schools operating within a scientific background that permits of an actual standard of care and a budget that is essentially infinite. It also has responsibility for the dependents of soldiers, which was not the case in 1861-65.

Military medicoes are only somewhat slightly better prepared to handle these responsibilities than in 1861 as anyone who has had to depend on Tri-Care will attest.