Point, shauna devines learning from the wounded the civil war and the rise of american medical science, published by u. N. C. Press. Dr. Devine has produced a book that challenges many of not most of our assumptions about the state of medicine in the civil war. Learning from the wounded draws on close readings of reports issued by hundreds of army and Union Physicians and who treated the wounded and dissected the dead. These doctors rose to the challenges before them and made the most of this unprecedented opportunity to study and report not only on new methods of treat bement but also new findings on the nature of disease, healing, indeed on Human Anatomy itself. In the process the war allowed hysicians to elevate their skills, knowledge and methods to the level of europeans. Devines study is breathtaking in spoke scope be according to one of the committee members. Informed by the authors own scientific medical training and scientific and medical training her book is not only a major contribution to our understanding of the relationship between war and society, it also challenges generations of scholarship by taking the treatment of the union wounded as the major catalyst in this transformation of the american medical profession. Learning from the wounded has already won the wily silver prize by the university of Mississippi Center for the civil war and was named a choice outstanding academic title of 2014. T grew from dr. Devines dissertation are at the university of western ontario, now known as western university, in 2010. They wisely held onto to her there and she now serves as a professor and as a Research Fellow in the school of istility she is congratulations shauna and were very much looking forward to hearing what you have to say to us tonight. Thank you. [applause] shauna i would like to thank first of all my colleagues at western are are university, most especially shelby mckeller and Neville Thompson and one of the greatest supporters i ever have, gary, and i would also like to thank william layer, barbara and janey and the members of this society of civil war historians. I am thrilled to be here with you this evening. And honored by this recognition. I would also like to thank the great team at u. N. C. Press. I loved working with them through every stage of the publication of this book. Thank you especially to david per eand mark simpson boss. I would also like to thank the great members of the watson brown book award jury, com, and innots receiving this award is a tremendous award and im overwhelmingly grateful the thank you for your support and recognition for learning from the wounded. For reasons that will soon become obvious you will soon be glad that i am speaking after dinner and not before. The old joke about after dinner speeches ruining the digestion b people is has particular resonance when the topic is medical. 78 a private was transferred from the 11th Army Corps Hospital to the jarvis u. S. A. Medical hospital in baltimore, md. He was suffering with a wound of the left leg received in the battle of gettysburg. The case report noted that the whole belly of the gas trockneemious muscle had been carried way by the shell and it was noted that the limb praintd frightful appearance appearance, tirnlating in extensive sup ear tive sloughing. For the next weeks, the staff monday he toward the patient daily and treated him hoping that the wind would gran ule light. But the patient was suddenly seized with a high grade of fever and chills in his head, back, limbs, and the doctors diagnosed gangrene. They got to work, opened the entire wound, moving the skin back which are revealed a slough of discharge. It was described as having an odor so pungent and offensive that the nurses and others in attendance could scarcely remain a moment without sickness of the stomach. The patient sank rapid rapidly as the disease progressed. The doctors prescribed poultiss, cold water dressings, nutritious diet the in deciding how to proceed neck, the doctor had some resources with twoy consult. A year earlyier dr. William hammond had published an investigate egs investigation in which fgs in the field hospitals were ordered to study the treatment of gangrene. They were asked to submit their case histories to the new Army Medical Museum. Some cases were also submitted for debate and discuss to local medical societies and medical schools and a number of findings were published in medical journals. The approaches to the study of gangrene was highly individualistic. Some advocated studying poidly fluids and the progress of the disease with a microscope. Shall others suggested studying the chemical processes of these diseases and some physicians engaged in new experimental methods, trying to prove con tajeon. Many doctors concentrated on active prevention, using disinfectant to avoid the disease erupting in the first place. And there was a developing consensus that brohmine appeared to be the most bromine appeared to be the most promising prophylactic the the findings were widely disseminated throughout the war, not only through the medical societies and journals but to inspectors and medical drrs who otch then passed on the findings, sometimes in the form of direct orders, to doctors in the General Hospital. Treating private scott in jarvis medical hospital in 198 186 3, the doctors had a variety of options. He had never looked through through a microscope but but now looked through the new one that had been provided by the Surgeon Generals office the in trying to understand the status of inflammation he asked examined the microscopic appearance of what he called iseased cells and infuse orial elements. He agreed that bromine was the best shall medicine. E placed it in empty quinine bottles around the beds of patients and prepared the wound for debride ment, mirroring the experimental uses of dr. Joseph lifter. After 10 lister. After 15 10 days the patient began to aash improve and did i by early december it was reported the wound had granulated beyond expectation. And the case was submitted to the medical museum where i read it 100 years later. There are many fascinating aspects to private scotts case. Many of the tools we associate with modern scientific medicine were plode in this case. The doctor initially identified the disease, loork at the movement of what he called diseased cells but through his experience he moved toward a new conception of the disease. He use aid microzone study the products of disease in a physical location away from the bedside. Animalcules ng under the mork scope. While he did not make the connection between them and the disease, seeing them gave new practice to medicine. E used experimental method and developed antiseptic rituals in the hospital and surgical setting, all of which were bench marks in practice in the latter third of the 19th strrment but is this civil war medicine . Hat one are historian said took place in the latter half of the middle ages. . Ignorant of tors the most elementary are issues of hygiene . Are especially the u. S. Sanitary commission aside, but the war was generally a medical zafment until recently it was generally accepted that the war years fundamentally revealed the archaic nature of medicine although recent scholarship has begun to coalesce around the idea that the civil war laid the basis for what would follow, the study of civil war medicine has arguably left a challenging historyed and 0 graphy. It engages a critical method 0 logical question about how we write medical history. With more than 12,000 practicing physicians, the majority of whoom resumed as practicing physicians after the war and who were both causes and beneficiaries of some of the changes in medicine that took place during and after the warks this idea of civil war medicine is perhaps not susceptible to one overarching definition. I came into this process as a 19th history medicalian. I historian. Fains aide are by how the interaxes with certain diseases and developing ideas about germ germ science and backcourt erology were used to guide and give meaning to practice at new levels, to the development of Public Health policy in the final thirved the 19th century. In the mid 19th century we see a transforming medical profession but one that was struggling hard with theory of contagion, cause of disease disease, germ theory, how to study and structure medicine and the role of the medical sciences in medical education. At the outset of this pradge i was not sure if prosecutions physicians addressed these in the war tile hospital or more generally if practice in the civil war arfected or retarded the study. Degrade standards in medicine and medical education prior to the war have been well documented. In the 1830s and 1840s in response to the attacks on eliteism, most had abandoned state laws regulating medical society. The absence not only lowered education standards but encouraged the proliferation of competing sects, including unorthodox practitioners. This made the u. S. The 0 most open medical market in the world. After decades of struggle only two states had anatomy acts on the books and there have been anatomy rey ots in the years leading to the civil war. Medical School Teaching was almost entirely didactic. In the absence of better educational models and legal regulation for medicine at home, elite physicians increasingly looked abroad. But though these physicians wrote widely on the importance of intervention, such as the paris medical school, and made a convincing case, they were too few in number to make a significant change on the country. On the eve of the civil war, the bulk of American Physicians continued to practice bedside medicine, most had never used a mork scope. What has been less well documented is the dramatic change that took place in the post war period. S early as 1867, societies established or strengthened licensing laws. The government sponsored epidemiological projects into shse disease Infectious Diseases. State after state began anatomy acts, making unclaimed bodies available to medical schools for roifment these coincided with scientific pressures for reform. In studying the shift from the clinic to the laboratory, tracing the development of the medical skines sciences in the 19th century, historians have focused on the change from edside medicine with are being ones ed by ontolonlical toward the cloves the century. And the influence that these educational intervention interintentions interventions had on physicians who stud aide broad. The transforming rovel the medical sciences during the civil war this these larger history has otch be been relegated to a chapter note or not considered at all. As i began this project i wondered what accounted for some of the changes from the mid19th century to the late 19th century and in such a comparably short time. My book focuses more on processes than outcomes. How the questions physicianed made throughout the war demanded support for newer and more scientific methodologists. Researching and writing in book i relied primarily on the unpublished primary sources. I remember the week biff left for my trip to the oldest historical arceve, then located at the Walter Reed Center in washington, d. C. I gave a list of the sources, but did not hear back. I showed up at the museum on monday morning and was able to connect with him and i asked did you see my email and can i see the sources . He laughed and said how long are you here for . I said two or three weeks. He laughed and said given the time, you are not going to be able to make of a bent dent. I found floortoceiling shelves with oversize letter books with case histories and everything in 2we7b89 i had read the medical and surgical history of the war before beginning my Archival Research and was impressed with the scovene the work. I was fascinated by the efforts to preserve and document american medicine but after one long and actually really exhilarating day in the archives i found that the medical and surgical hiffs history is a carefully edited history of the warks published between 1870 and 1888 is. The actual sources used to compile the histories were often heavily pared down in the official history and many of president questions, strides made, untern uncertainties, failed attempts and new successes abounded in the sources. It was almost like reading bay different war. I spent weeks researching at walter reed. Sometimes i would ride in the shuttle up to the archives with the soldiers at the center rehabilitating after serving overseas, usually iraq or afghanistan and i would walk into the archives and pass them in a working histological laboratory and begin the day of research. I spent a lot of time reading the case and specimen histories aed there was so much in the case history that it sort of felt like i was going on a journey with the doctors as they worked day and night tirelessly trying to understand disease and wound trauma during the civil war. I would also see the doctors, nurses, support staff and patientsoldiers walk by the libraries and even hear about some of the new moveds teaching, studying and the various attempts to learn from each other. Its hard to describe how impactful it was to see these interaxes today within this center for the study of military wounds and disease, a resource for american medicine, doctors and commgses first conceived by william hand hammond in 1862 during the civil war. The connection between war, society and pedestrian syn is an interesting one. Years after this First Research rip at fort sam how the in texas, i gave this talk to about 140 physicians. I wondered what might be the resonance of my research on their experience overseas today. What was revealed in the q a was the similarities are that transcend any one war the the drive to understand unfamiliar kns caused in the feater theater of warks and Government Support for Research Projects that grow out of the demands of war. Today of course the focus is different, not gangrene and syphilis but p. T. S. D. And traumatic brain injuries or studying malaria or dengue fever. The projects are more expansive. We have american doctors work at home while sharing research with fassaltse cross the globe. But in the context of war the medical challenges are always great and the opportunities for research perhaps endless the but in the history of medicine there has never been a war that mobilized americas memorandum profession question like the civil war. With the system comprising 86,000 beds from maine to new mexico and the atlantic to the pave, the demands were great and farreaching. What struck me most as the hist amological dynamism i had not anticipated before i began this proclamation. Nartiveds of consider, contair publish clations revealed the troormtive role of american medicine in the way science was studied and recorded after the civil war the these broader changes can best be understood in an International Context. Historians of 19th century medicine have celebrated the socalled great men of medicine are achievements. The civil war laboratories did not produce one great man and no two doctors stand in the shadows shadow of pasture and others. However, we see physicians from around the globe struggling with the same medical challenges. What caused disease . How could medical technology be used to study disease . Should medical education be centered on the patient, laboratory, or hospital . The medical improve metropolitan in the last part of the century may seem stunning when compared to the civil war in which 2 3 of all deaths were the result of Infectious Diseases. However, in looking more bradley at the labors of civil war doctors, one of my goals in this book was to prompt the readers to reevaluate some of the myths surrounding medical practice during the war. I recount the similarities and interactions with 19th century med 1i7b89 one in 1847 made the connection that students were passing contamination in the dead bodies they autopsied to new mothers, research which was widely dismissed by American Physicians prior to the war. During the war some of the findings were not only debated and discussed, they were accepted and later adapted within the General Hospital as physicians worked to find the causes of gangrene and syphilis. At the same time, robert koch s studying in berlin and the curator be be of walter reed reached out to him with questions about the building of the microscopic study section of the museum, in particular fevers scussed to study and dysentery. Are woodwards Subsequent Research project rivalled some of the best in the world at that time and the doctor later commented on the Impressive Research contribute agses that American Physicians had made during the war. Woodward as curator of the medical museum fs also facilitated the exchange of specimens with medical School Schools in paris, vee ena, berl ane berlin, london and moss coufment the museum welcomed thousands of doctors and researchers during the postwar period. The arena of Infectious Disease was no less interesting the joseph lister, architect of the germ theory, conducted snerments the 1860s in hopes of finding ways of reducing infections in the hospitals. He later developed the practice of surgical instruments being soaked in car bolick acid. At the very same time elite civil war physicians were experimenting with bromine and nitric acid trying to find ways of reducing the spread of disease in hospitals the its not surprising that while many physicians around the globe, particularly in britain, were slow to accept listers methods. But many American Physicians ere quick to adopt one said, the kind reception that i received last year led me to know that before long it was taking roolt and bearing fruit there. As louis pasture conducted his experiments on fermentation in the 18 offs and those that it required the activity of living organisms, the american Benjamin Craig was conducting experimentation on the properties of cholera. A leader in the field of cholera research, it was widely disseminated to physicians charged with investigating cholera. And the results of the studies were included in the International Sanitary conferences, among others, at and the nich International Medical conference at vienna in 1873. The research and publications of American Physicians, so often ignored before the war as one lamented in 1856, were sought and read at various International Medical congresses and expositions and through many other channels. These examples could go on and on, but i do did want to emphasize in the book and this evening how important it was to me in coming to my conclusion to adopt an International Perspective to wartime medicine. Many of the medical transformations we shee see taking shape to manage wartime medicine during the war can only be investigated in an International Context and as a larger part of the 19th century medical story. Framing the stories about disease and wound trauma in a broader context lends new significance to the advances made in medicine generally. Even some of the failures during the war were sometimes productive. Are are the debates and dynamism of the war years for american medicine. We see in the course of the war new poments for change which could hardly have been foreseen in 1860. The war and its challenges provided new types of opportunities for American Physicians. Traumatic battlefield injuries which lead led to new surgical techniques, deadly diseases, but also new hospitals to study and treat them, technical and Institutional Support from the government and an Army Medical Department which demanded, facilitated and shaped the production of new forms of medical knowledge much the best of american medicine responded to the Health Crisis as the war raged past the initially forecast three months and fundamentally attered medicine in the next few years. The war fundamentally set american medicine on a new course as physicianed struggled infectious th disease. They strove to better understand the nature of disease and they central to the reforms introduced by William Hammond was the creation and expansion of medical knowledge. The Army Medical Museum was central to achieving this goal, a new institution devised to provide support for emerging specialties in scientific medicine. At the direction of the medical department, physicians who had never seen a governor were ordered to perform autopsies. , an instrument few american doctors would ever have used, were provided on a competitive basis to hospital physicians who would use the instrument for the benefit of medical science as long as the results were reported to the surgeon general. Suggest in the last few pages of my book, there were no simple answers about disease in the postwar period. Debate between the opponents and proponents of the germ theory raged for three decades after the war. The war years were important in preparing physicians for a new medical environment. Bacili for disease after disease were discovered, many were prepared for the new medical context. While it is still being studied abroad, the transforming of medical centers in new york, boston, philadelphia and d. C. Promoted the advancement of scientific medicine, research and medical education. Through the war, we see a new hierarchy and growing acceptance of leadership in institutions, such as the new Army Medical Museum and surgeon library, all facilitated new discoveries and ideas about disease long after the war. The civil war paved the way for transformation from open medical marketplace in jacksonian america to a scientific medical system that could respond to the changes in medical practice that took place with the bacteriological revolution. ,any of the wartime physicians a group united by their belief a belief thatared better knowledge about the body would lead to better practice. In a wartime hospital, physicians labored to understand diseases and wound trauma. Perhaps most important of all, thousands of physicians gained a medical identity constructed on the basis of the bodies they , the specimens they studied, and the case histories submitted to the medical museum. Thousands ofr, physicians worked together to develop a Truly American medicine. Up bywas best summed jonathan letterman, who wrote to hamilton, promising that he and their medical brethren would do everything in our power to make something out of the dying in the war. That is the north. The story is different but no less interesting in the south. I am well into the research of my next book, tentatively titled wounded, which will examine the south during reconstruction. The story follows the lives of southern doctors and in norm is challenges of doctoring to develop medical infrastructure during the war and after. Every medical school but one closed in the south during the war, and there was no comparable institution to the Army Medical Museum. Difficulties the of doctoring in the civil war south also prepared physicians for the challenges of managing medicine and navigating the medical landscape in the redeveloping nation after the war. In conclusion, i want to brownate my thanks to mr. And the entire watsonbrown foundation for their support of scholarships, which remain so important today. I thank you for learning from the wounded. I am so grateful and appreciative as i travel across the country, researching and writing this next book on the south. I would also like to thank the members of the society for the history of the civil war this evening. It is an honor to speak about my research and i appreciate your support. Thank you. [applause] [captions Copyright National cable satellite corp. 2015] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] americane watching history tv, all weekend, every weekend, only on cspan3. To join the conversation, like us on facebook. 100th anniversary of d. W. Griffiths birth of a nation. Next, the Smithsonian Institution hosts with the American History guys radio history program. This program is about 1. 5 hours. Hello. Im chris wilson, director of experience in Program Design here at the museum of American History. On behalf of the Smithsonian Institution and our partner at the National Endowment for the humanities, i