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 you and Union Positions who treated the wounded and dissected the dead. Despite considerable limitations in training, 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 ment but also new findings on the nature of disease, healing, indeed on Human Anatomy itself. In the process the war allowed physicians 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. As ambitious, compelling as an original asand anything in the informed by the third. 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. It grew from dr. Devines dissertation are at the produced at the university of western ontario, now known as western university, in 2010. They wisely held on to her there and she now serves as a professor and as a Research Fellow in the school of medicine and industry. Shes hard at work now on a companion volume addition in which she has moved her focus southward. 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 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. Thank you for allowing me to share it with you. 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 perry and mark simpson boss. I would also like to thank the great members of the watson brown book award jury, professor john, dane houston. Receiving this award is a tremendous award and im overwhelmingly grateful the grateful. 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 of both the audience and the speaker has particular resonance when the topic is medical. July 10, 1863, private douglas 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 a wide away by the fragment of the shell. For the next weeks, the staff monitor the patient and treated the inflammation in the hope the wound would granulate. But the patient was suddenly seized with a violet constitutional disturbance a , high grade of fever pain 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 rapidly as the disease progressed. The doctors prescribed poultiss, cold water dressings, and a patricias diet hoping to stimulate the patients tissues. Next,iding how to proceed the doctor had some resources. A year earlier dr. William , hammond had published an series of investigations in which field positions were ordered to study the treatment of gangrene. Through these investigations, physicians were asked to submit their case histories to the new Army Medical Museum. Some cases were also submitted for debate and discussion 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. The directive to study these diseases promoted innovation. Some advocated studying bodily fluids and the progress of the disease with a microscope. Shall others suggested studying others suggested studying the chemical processes of these diseases and some physicians engaged in new experimental methods, trying to prove contagion. Many doctors concentrated on active prevention, using disinfectant to avoid the disease erupting in the first place, which added a new development to the clinical responsibility. And there was a developing consensus that 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 directors who then passed on the findings, sometimes in the form of direct orders to doctors in the General Hospital. In treating private scott in jarvis General Hospital in 1863, the doctor had a variety of options. Though he had never looked through a microscope before the war, he now employed the new one issued to this hospital by the Surgeon Generals office. He studied the products of the patients disease. In trying to understand the status of inflammation, he examined the microscopic appearance of what he called diseased cells and molecules. He conducted a Clinical Trial in bromospital and agreed ine was the best prophylactic. He placed it in empty quinine bottles around the beds of patients and prepared the wound for the bride meant mirroring , the experimental uses of dr. Joseph lister. The wound showed signs of granulation. The patients appetite begin to improve. I early november, the world had granulated beyond expectation. The case history was submitted to the Army 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 employed in this case. The doctor initially identified the disease has a physiological abnormality, looking at the uncharacteristic movement of what he called diseased cells but through his moreiences, he moved to a oncological description of the disease. He use aid microzone study the products of disease in a physical location away from the bedside. He saw rotating animalcules under the mork scope. While he did not make the connection between them and the disease, seeing them gave new practice to medicine. He also constructed Clinical Trials, use experimental methods 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 19th century but is this civil war medicine . What one are historian said took place in the latter half of the middle ages. On the centennial of the civil war, richard noted other than the work of the civilian Welfare Organization especially the u. S. , the war Sanitary Commission the war , once you know we in medical disaster. 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 the medical modernization that would follow the study of civil , war medicine has arguably left a challenging historiography. It engages a critical method 0 methodological question about how we write medical history. With more than 12,000 practicing physicians, the majority of whom resumed civilian positions after the war and who were both causes and beneficiaries of some of the changes in and after the war, this is perhaps not susceptible to one overarching definition. I came into this process as a 19th 19th century historian. Byave always been fascinated how the interactions with certain diseases and developing ideas about germ science and bacteriology were used to guide and give meaning to levels to thew development of Public Health policy in the final third of the 19th century. In the mid 19th century we see a transforming medical profession but one that was struggling hard with theory of contagion disease, germ theory, how to study and structure medicine and the role of the medical sciences in medical education. At the outset of this project, i was not sure if the physicians address these in the wartime hospital or if practice in the civil war arfected or retarded the study. Degraded 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 most open medical market in the world. After decades of struggle only two states had anatomy acts on the eve of the civil war and they were more than 17 anatomy riots in the years leading to the civil war. There were a few hospital facilities for medical teaching, which meant it 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 Clinical School for the larger reform of american medicine 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, had never used a microscope, and most held a physiological conception of disease. What has been less well documented is the dramatic change that took place in the post war period. As early as 1867, societies established or strengthened licensing laws. The government sponsored epidemiological projects into Infectious Diseases. Reforms were initiated in medical school. Just after the war beginning with Pennsylvania State after , state began anatomy acts, making unclaimed bodies available to medical schools for teaching and research. These changes coincide with scientific pressures for reform. In studying the shift from the clinic to the laboratory, tracing the development of the medical sciences in the 19th century, historians have focused on the change from bedside medicine to pathological anatomy. They have examined the impact of and themedicine influences these educational interventions had on the american medical students and doctors who studied abroad. While historians agree that by the end of the 19th century, science had become a third estate with medicine, the transforming role of the medical sciences during the civil war this these larger history has otch be been relegated to a chapter 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 of physicians change through the war and the types of medical challenges that demanded support for newer and more scientific methodologists. Researching and writing in book i relied primarily on the unpublished primary sources. I remember the weekend before i left for my First Research trip to the oldest archiveal art chives then located at the walter reed , center in washington, d. C. I gave the curator a list of the sources i hoped to see 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 a dent. I found floortoceiling shelves with oversize letter books with case histories and everything in between. I had read the medical and surgical history of the war before beginning my Archival Research and was impressed with the scope of 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 history is a carefully edited history of the war published between 1870 and 1888 is. The actual sources used to compile the histories were often handwritten, 30 pages sometimes and they were often heavily pared down in the official history and many of questions, strides made, experiments uncertainties, failed attempts and new successes abounded in the sources. It was almost like reading about a 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 modes of teaching, studying, and the various attempts to learn from each other. Its hard to describe how impactful it was to see these interactions today within this center for the study of military wounds and disease, a resource for american medicine, doctors and physicians first conceived by William Hammond in 1862 during the civil war. The connection between war, society, and medicine is an interesting one. I gave the command generals lecture years after this First Research trip at fort sam how texas to a group of 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 were the similarities about war and medicine transcended any one war. One 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 biomedical researches studying malaria or dengue fever. The projects are more expansive. We have american doctors work at home while sharing Research Facilities across the globe. But in the context of war the medical challenges are always great and the opportunities for research perhaps unless. But in the history of medicine there has never been a war that mobilized americas memorandum americas medical profession quite like the civil war. With the system comprising 86,000 beds from maine to new to the gulf of mexico, the demands were great and farreaching. What struck me most was the dynamism i had not anticipated before i began this proclamation. The wartimes case records, narratives of Service Together revealed the transforming role in a waydical Sciences American medicine was studied, structured, practiced, recorded, understood during the war and after. Can beroader changes best understood in an International Context. Historians of 19th century medicine have celebrated the socalled great men of medicine and their discoveries. The civil war hospitals and laboratories did not produce one great man and no dr. Stands in the shadow. 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 . What role could medical specialization have an modern medicine . Should medical education be centered on the patient, laboratory, or hospital . The medical improvements 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 broadly 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 , 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 was studying in berlin and the curator be be of walter reed reached out to him with questions about the building of the microscopic no section of the museum in particular tools , discussed to study fevers and dysentery. Woodwards Subsequent Research project rivalled some of the best in the world at that time and the doctor later commented on the Impressive Research contributions American Physicians had made during the