We approach the final act

September 25th, 2015

As usual, Belmont Club has the clearest view of what is coming. It will not be pleasant. I have just returned from Europe from what will probably be my last trip. We were going to go to Greece but cancelled due to the financial unrest and the “migrant” crisis. Instead, we went to Britain and to Belgium where we did some history. We also saw a small portion of the migrant invasion.

The Washington Post, a reliable indicator of leftist thinking in Washington, reports that the Syrian Crisis has “forced” Obama to meet with Putin in New York.

White House press secretary Josh Earnest said that the meeting came at Putin’s request and that at the top of the agenda for Obama will be Ukraine, where, he said, Russian separatist troops remain in “clear violation of the territorial integrity of that sovereign nation.” …

Earnest said that when the two leaders talk about Syria, Obama would encourage Russia to join coalition efforts to combat the Islamic State but warn that “doubling down on the Assad regime is a losing bet.” He added that “a face-to-face sit-down seems appropriate at this juncture.”

There is, of course, no reason to believe that this statement is true. Earnest is well known to lie for his master.

Willing or not, Obama’s been dragged to New York to meet a man he would rather not. The Russians and Syrians for their part, are pushing the story that Obama has already pre-surrendered to Putin and is merely looking for a way to put the best face on it. AFP reports: “Russia and the United States have reached a “tacit agreement” on ending Syria’s bloody crisis, a senior adviser to Syrian President Bashar al-Assad has said.”

Allegations that it’s all over bar the shouting were half-heartedly denied in the Washington Post story which said, “the administration says it has no interest in Putin’s still-vague proposal for Syria — that the West drop its insistence that Assad must go and that all parties join together to defeat the Islamic State. But administration officials still believe there are grounds for U.S.-Russian cooperation there, if Putin is willing.”

Long ago, when the USA was still run by realists, this would be called “surrender.”

The Russians are working behind a fait acompli and that is a strong card. Moreover, Moscow is amping up the pressure by sending a fleet for “drills” into the Eastern Mediterranean. The message is: we’re here to stay and you’re not man enough to push us out. Sources told Bloomberg that Putin will go it alone if Obama balks. “President Vladimir Putin, determined to strengthen Russia’s only military outpost in the Middle East, is preparing to launch unilateral airstrikes against Islamic State from inside Syria if the U.S. rejects his proposal to join forces, two people familiar with the matter said.”

The Europeans, beset by the Islamic invasion (where is Charles Martel when you need him ?) are of no use.

In a statement that surprised many, German Chancellor Angela Merkel said early Thursday that Syrian President Bashar al-Assad should be part of negotiations with the West.

“We have to speak with many actors, this includes Assad, but others as well,” Merkel was quoted as saying at a news conference following an E.U. summit in Brussels. Many German commentators and journalists described the statement as groundbreaking. “Approaching Assad would be an about-face in the way the West is dealing with Syria,” Der Spiegel concluded in its online edition….

Merkel’s willingness to bring Assad and Iran to the negotiating table will be met with skepticism in other Western countries, primarily in the United States and France. Last weekend, Secretary of State John F. Kerry said that the United States was “prepared to negotiate” but that “Assad has to go.”

These developments must certainly create unease in the Leader of the Free World, who looking behind him at his expected support, has found them all dwindling away.

This farce began with the overthrow of Libyan dictator Gaddafi and the threat to cross a “red line” if Assad used chemical weapons on his own people. Here we are after years of Obama, Hillary and Kerry running our foreign policies. What did you expect ?

The Russian moves appear to be part of an deliberate plan prepared long in advance to bring the Western Alliance into an ambush zone. The most disturbing aspect of it is that president Obama didn’t even see it coming. Not even close. He walked into it, got up, asked for the number the truck and walked into it again. When he comes to himself he’ll be ready to ask a boy about a clock. Maybe that way he’ll get the time of day.

Charles Krauthamer notes that Putin always seems to be one step ahead of the Obama. Yet despite the apparant truth of that assertion, it is hard to actually test the proposition. Obama’s position on Syria has been so vague that he can plausibly convince his followers that, whatever the result, it was what he intended to begin with. It’s pitiful to watch.

Obama has truly achieved a fundamental transformation in America.

Growing old is not a pleasure when one considers the pain of arthritis and the loss of pleasures like golf and sailing but there is the positive aspect of not having to live long with the consequences of Obama’s regime.

Going via Dunkirk and returning via Calais

September 24th, 2015

When we originally planned to go to Brussels, we were going to take the the Eurostar to Brussels, which is rather cheap and takes only two hours. However, a Eurostar train was stranded in June by rioting “migrants” in Calais.

Anarchy erupted in the French port yesterday as striking workers started fires blocking both ferry and train routes.

As ferry workers shut the port gates, trapping some lorry drivers inside, monstrous queues built up around the train entrace, as passengers and truckers became desperate to get to Britain. The queues still haven’t dissipated.

Madness continued after strikers, protesting feared job cuts, also made it onto the tracks setting more tyres alight.

Both Eurotunnel and Eurostar suspended their services due to the disruption.

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After reading that, and at the invitation of our friends, we decided to take the older surface ferry to Dunkirk. The riots were a combination of rioting migrants and rioting French workers who were complaining about the migrants.

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This was much more peaceful and gave us the opportunity to see the site of the 1940 evacuation of the British Army.

Our return from Brussels was via Calais but also by surface ferry. The reason was interesting.

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This is an enormous wine market, the size of a Costco or WalMart in the states. It turns out that Britain taxes the sale of wine so heavily that most middle class wine lovers travel to France to buy wine and bring it home on the ferry in their cars. Our hosts assured us that this is legal and one wonders what the British government thinks about the incentives they have created. That was one of three or four such wine superstores in the area near Calais.

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Here is a sign in the wine store offering to pay the fare for the ferry round trip if wine is ordered online and picked up at the store by the buyer. Since the ferry fare is about 100 pounds, this is a huge promotion, although one our friends were unaware of until I called it to their attention. They bought a year’s supply of wine and loaded it into the VW camper van we were using. The cost was around a thousand pounds and, unfortunately, the offer required advance online purchase so they did not get the deal.

We then drove on to Calais, passing migrant camps by the road.

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Here is a migrant shanty town seen through the car window in passing. The camps are walled off from the highway by new high fences along the motorway to Calais ferry terminal. The fences are tall and topped with razor wire.

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Here is the fence along the motorway which seems intended to keep the migrants from trying to break into trucks (lorries) on the highway.

In the Calais terminal, we did see some people who looked like migrants although they could have been legal residents waiting for the ferry.

Ferry Terminal

These small groups were walking through the parked trucks and cars waiting for the ferry. I did not see them enter a car of truck. When we reached Dover again, our friends took us to the train station and we took the train to London. It was an enjoyable and informative trip. We spent another four days in

Waterloo

September 22nd, 2015

We spent the day yesterday ( the 16th) at Waterloo. The battle field is largely preserved and reminds me a bit of Gettysburg. There is an excellent museum and we spent an hour or so at Hougoumont Farm where the battle really began.

Napoleon planned to draw Wellington’s reserve to Wellington’s right flank in defence of Hougoumont and then attack through the centre left of the British and allies’ front near La Haye Sainte.

Before the battle started, Hougoumont and its gardens, located on the allies’ right flank, were garrisoned and fortified by the 1st Battalion, 2nd Nassau Regiment, with additional detachments of jägers and landwehr from von Kielmansegge’s 1st (Hanoverian) Brigade. The light company of the 2nd Battalion, Coldstream Guards under the command of Lt-Colonel Henry Wyndham, was also stationed in the farm and chateaux, and the light company of the 2nd Battalion, Third Guards, under Lt-Colonel Charles Dashwood in the garden and grounds

The fighting here lasted all day and ended finally when the defenders were forced out as the buildings burned. It was too late for the French which had been reenforcing failure all day.

The French eventually committed 14,000 troops to Hougoumont Farm, of whom 8,000 were killed. The most famous encounter was The Battle of the Closing of the gate. The French had surrounded the farm which was an enclosed bastion of brick and stone walls with a gate access to the rear. They managed to force open the gate with axes into the yard but a few British soldiers managed to close it again and all the French who had gained the yard were killed. The few who closed the gate, were to be famous after the battle.

Sous-Lieutenant Legro, of the French 1st Light Infantry, broke through the wooden doors with an axe, allowing French soldiers to flood the courtyard. Graham’s commanding officer, Lieutenant-Colonel James Macdonnell, led his men through the melee in the courtyard to the gates, in an attempt to shut them against the pressing French. This was done with the help of three officers (Captain Wyndham, Ensign Hervey, and Ensign Gooch), Corporal Graham, and a few other soldiers including Graham’s brother Joseph. James Graham was the one to slot the bar in place. Flagstones, carts, and debris were then piled against the gates to hold them secure. The Frenchmen trapped within the courtyard were all killed, apart from a young drummer-boy.

hougoumont-doors-560

The crucial mistake made here was by Napoleon’s brother, Prince Jerome, who commanded the first French troops to attack Hougoumont Farm. When they were repulsed, Jerome kept reenforcing the attack and drew the French focus to the strong point which resisted all day.

waterloo-map-1-560

The farm is to the left and in advance of the British lines. La Haye Sainte is in the middle and both were to be crucial strong points for the British. A word about British tactics here.

Wellington was outnumbered and the hard center of his force was his British Peninsula Campaign veterans. He stationed them on the “military crest” of the low hill behind Hougomont and La Haye Sainte. This sheltered them from French cannon fire. Direct fire cannon fired cannon balls which would skip and were devastating for infantry in squares. It was important to disperse these squares when under fire by cannon. Napoleon was a master of artillery and had won many battles with it. Wellington, in Spain, had learned to shelter his infantry. He even had them lie down in the grass behind the crest of the hill to rest and make them invisible to French cannons.

The fact that it had rained hard the night before the battle, a reason often given for the late hour of the French attack, made the ground soft and the cannonballs often dug in rather than skip along the surface.

Infantry squares were almost impervious to cavalry assault so the wise commander attacking such a force would combine artillery and cavalry to weaken and disperse the defenders. Napoleon knew this but his brother drew the center of gravity to the strong point.

The two battalions that defended Hougoumont suffered 500 dead and wounded out of strengths of 2,000.

The French lost 8,000 of 14,000 men. The courage of the men who closed the gate is still celebrated in England.

The same occurred at La Haye Sainte, another fortress in the center. It was well in advance of the infantry lines at the hill crest. The French attacked and the result was the destruction of The King’s German Legion, which had not prepared the farm as well for defense. However, they did hold it until afternoon.

It was the scene of a famous charge by Marshall Ney who led the French cavalry on a futile charge that destroyed the center of Napoleon’s army.

the French could not see the squares until they were almost on top of them.
Here then they came over the ridge at a steady canter, to be decimated by grapeshot from Mercer’s and other batteries, and by musketry from the squares, at an opening range of about 50 paces.

Pressed on by the ranks behind, they charged past between the squares, losing their formation as they did so. Lord Uxbridge came up with the survivors of the Household Brigade, and the infantry watched a bloodthirsty cavalry battle which raged all round them. At least ten times the French cavalry retreated down the hill, or round by the Nivelles road, reformed their ranks and attacked again, until all this ground between the lane and the ridge was so covered with dead men and horses that they could not ride over it.

Uxbridge lost his leg in this battle and it is buried, in the town.

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It is buried here, behind Wellington’s headquarters in Waterloo town. He had a very good prosthesis made which is displayed in the museum at Wellington’s headquarters in Waterloo town.
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The La Haye Sainte farm is still there although it is not open to visitors.

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The farm lies in the center and is at present privately owned. I understand there is a pending sale to add it to the museum.

Brussels

September 14th, 2015

We are here in Brussels staying in a business hotel near the center city. Not far is The Grand Place, where the Hotel de Ville and the Guildhalls are located.

At the beginning of the 13th century, three indoor markets were built on the northern edge of the Grand Place; a meat market, a bread market and a cloth market.[3] These buildings, which belonged to the Duke of Brabant, allowed the wares to be showcased even in bad weather, but also allowed the Dukes to keep track of the storage and sale of goods, in order to collect taxes. Other buildings, made of wood or stone, enclosed the Grand Place.

It has been destroyed in several wars since then and always rebuilt.

Town Hall

The Hotel de Ville is the town hall and dominates the square.

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Here we stand in the Grand Square. It was raining and the rain stopped for a hour or so, then resumed.

Museum

The “Museum” which began as the “Bread house” and then became the palace is now partially covered by plastic cloths as work seems to be going on. We were there on a Monday so the museums were all closed. We walked about and Jill found a Starbucks coffee place so she was content.

We did quite a bit of walking and found The Black Tower, which is the only remaining remnant of the city wall.

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The Black Tower is near the St Catherine’s Church and was on our walk. Naturally, any visit to Brussels must include Manneken Pis, the statue of the small boy urinating. Why this is an attraction, I:m not sure but it was surrounded by Chinese tourists snapping their pictures with it. We of course, had to follow suit.

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Today we go to Waterloo Battlefield.

The Medical History of the American Civil War. VI

September 4th, 2015

This will be the final installment of the history. It is in parts because WordPress starts to drop text if the pst gets too long.

Slide57

Amputations were the most common procedures for war wounds. Below knee amputations had about a 33% mortality. Most deaths were from infection and wound shock, which was a mystery until World War I.

Slide58

Abdominal wounds were mostly fatal although there were survivors. One of the survivors was Joshua Chamberlain, who was awarded the Medal of Honor for conspicuous bravery at the Battle of Gettysburg.

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Chamberlain was a survivor of an abdominal wound and, like many, was left with life-long disability. He had a bladder fistula that continuously drained urine the rest of his life.

Chamberlain offered his services to the governor of Maine who appointed him Lieutenant Colonel of the newly raised 20th Maine regiment. The scholar-turned-soldier would take advantage of his position as second-in-command and studied “every military work I can find” under the close tutelage of his commander, West Point graduate Col. Adelbert Ames.

Though present at Antietam, Chamberlain and his regiment saw their first trial by fire in one of the doomed assaults on Marye’s Heights at Fredericksburg but missed a chance to be involved at the Battle of Chancellorsville due to an outbreak of smallpox. Losses at Chancellorsville elevated Col. Ames to brigade command, leaving Chamberlain to command the regiment in the next major engagement of the war, the Battle of Gettysburg.

On July 2, 1863, Chamberlain was posted on the extreme left of the Federal line at Little Round Top—just in time to face Confederate General John B. Hood’s attack on the Union flank. Exhausted after repulsing repeated assaults, the 20th Maine, out of ammunition, executed a bayonet charge, dislodging their attackers and securing General Meade’s embattled left. Though the exact origin of the charge is still the subject of debate, Congress awarded Chamberlain the Medal of Honor for “conspicuous gallantry.”

He received a bullet wound in the battle of Petersberg that left him with a permanent disability. Even so, he had a successful career. He was wounded six times in all.

After the war, Chamberlain returned to Maine, where he served four terms as the state’s Governor. He later served as president of Bowdoin College alongside former general and Bowdoin alum, Oliver Otis Howard. Prolific and prosaic throughout his life, Chamberlain spent his twilight years writing and speaking about the war. His memoir of the Appomattox Campaign, The Passing of the Armies was published after his death in 1914.

His wound was ultimately fatal.

His old wound became infected in 1914, and on Feb. 24, at age 85, Joshua Chamberlain, the very model of a citizen soldier, died. He was the last Civil War veteran to die of wounds sustained in battle.

He wrote that Army Manual of Leadership, FM -6-22 which is still in use.

Slide59

Another example of a survivor is Major Henry A. Barnum, a Major of Volunteers who ended the war as a Major General.

Slide61

The Western Campaign brought forth General William T Sherman, who is in my opinion the greatest American general since Washington, who was really more of a political leader.

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Sherman led his army across Georgia after the successful siege of Atlanta which assured Lincoln’s re-election in 1864.

Slide62

The Siege of Atlanta, which was followed by the burning as depicted in “Gone With The Wind.”

Slide63

During the siege, instances of Scurvy rose among Sherman’s soldiers and in the residents under siege, Once the siege ended and trains resumed bringing fresh fruit and vegetables, the scurvy declined.

Slide64

Women played various roles in the war. One captured Confederate officer, while in a prisoner of war camp in Ohio, delivered a child in spite of the fact that she had campaigned and been captured as a male officer. Her husband was also a Confederate officer.

Slide65

Elizabeth Blackwell was the first American female medical school graduate. She was instrumental in the founding of the US Sanitary Commission, which was modeled on a similar British Commission during the Crimean War. Her organization was called, “the Women’s Central Relief Association of New York,” and had Dorothea Dix as its head.

Slide66

Dix was a well known health reformer who had previously worked on the treatment of mental illness. She began to recruit female nurses although most nurses during the war were male.

Slide67

Clara Barton was working in DC when she saw wounded men making their own way into the city after the battle of Bull Run. She organized relief supplies. The Surgeon General, William Hammond, placed her in charge of distributing donated goods to the wounded in 1862.

In 1881, she organized the American Red Cross.

Slide68

Mother Bickerdyke is a little known but hugely important member of Sherman’s army. She began as a volunteer in Illinois, joined his army and marched all the way to Savannah with the army. They insisted she accompany them in the Grand March in Washington City after the war. She organized field kitchens and bakeries to feed the troops. She organized freed slaves to build her kitchens and field hospitals. It was she who discovered that black berries, growing wild in the South, would prevent scurvy.

After the war ended, Bickerdyke was employed in several domains. She worked at the Home for the Friendless in Chicago, Illinois in 1866. With the aid of Colonel Charles Hammond who was president of the Chicago, Burlington, and Quincy Railroad, she helped fifty veterans’ families move to Salina, Kansas as homesteaders. She ran a hotel there with the aid of General Sherman. Originally known as the Salina Dining Hall, it came to be called the Bickerdyke House. Later, she became an attorney, helping Union veterans with legal issues including obtaining pensions.

Congress had made no provision for pensions or the care of wounded veterans. Mary Ann Bickerdyke worked with Sherman to employ veterans on the railroad that was crossing the plains and to provide care of those wounded and the families of the dead. She and Sherman establish what would eventually became the Veterans Administration. Sherman’s friend and associate General Grenville Dodge was the Chief Engineer for the Union Pacific Railroad.

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In May 1866, he resigned from the military and, with the endorsement of Generals Grant and Sherman, became the Union Pacific’s chief engineer and thus a leading figure in the construction of the Transcontinental Railroad.[3]

Dodge’s job was to plan the route and devise solutions to any obstacles encountered. Dodge had been hired by Herbert M. “Hub” Hoxie, a former Lincoln appointee and winner of the contract to build the first 250 miles of the Union Pacific Railroad. Hoxie assigned the contract to investor Thomas C. Durant who was later prosecuted for attempts to manipulate the route to suit his land-holdings.[3] This brought him into vicious conflict with Dodge and Hoxie. Eventually Durant imposed a consulting engineer named Silas Seymour to spy and interfere with Dodge’s decisions.

Seeing that Durant was making a fortune, Dodge bought shares in Durant’s company, Crédit Mobilier, which was the main contractor on the project. He made a substantial profit, but when the scandal of Durant’s dealings emerged, Dodge removed himself to Texas to avoid testifying in the inquiry.

The Medical History of the American Civil War V

September 4th, 2015

This series is a slightly annotated version of a lecture I have given in several places. One of them was at the Royal Army Medical Corps Museum in the Salisbury Plain.

Slide42

Two major diseases at the time of the war were Smallpox and Malaria. Both affected large bodies of men in close quarters. Both were infectious but not water borne. Vaccination had been discovered by Edward Jenner in 1796.

In the years following 1770, at least five investigators in England and Germany (Sevel, Jensen, Jesty 1774, Rendell, Plett 1791) successfully tested a cowpox vaccine in humans against smallpox.[20] For example, Dorset farmer Benjamin Jesty[21] successfully vaccinated and presumably induced immunity with cowpox in his wife and two children during a smallpox epidemic in 1774, but it was not until Jenner’s work some 20 years later that the procedure became widely understood. Indeed, Jenner may have been aware of Jesty’s procedures and success.

By the early years of the Napoleonic Wars, Larrey had vaccinated the French Grand Army. By 1870, the French army had forgotten Larry’s work and they were decimated by smallpox while the Prussian army had been vaccinated by Billroth.

Malaria could be treated with Quinine, an extract of Cinchona bark.

Quinine occurs naturally in the bark of the cinchona tree, though it has also been synthesized in the laboratory. The medicinal properties of the cinchona tree were originally discovered by the Quechua, who are indigenous to Peru and Bolivia; later, the Jesuits were the first to bring cinchona to Europe.

The Union Army used 19 tons of cinchona bark to treat malaria in the troops. The Confederates were blockaded and had little to use. The Germans were blockaded in World War I and used their new organic chemistry industry to find alternatives, chiefly from organic dyes, like Methylene Blue.

Slide43

There obviously was some understanding of the role of mosquitoes in transmission of malaria as we see with the use of mosquito nets in hospitals.

Slide44

Other infectious disease were scourges although nothing was known about the cause. Tonsillitis was seasonal and diphtheria was treated with tracheostomy although I don’t know how many were done. The story of diphtheria is the story of the great triumph of bacteriology in the late 19th century. In the Civil War the only treatment was tracheostomy.

Wounds were always assumed to be infected and treated accordingly.

Slide45

The treatment of extremity wounds was almost always amputation as there was no understanding of infection.

Here is an amputation tent with a pile of amputated limbs nearby. Baron Larrey, Napoleon;s surgeon personally amputated 200 limbs in 24 hours at the battle of Borodino. That was one amputation every seven minutes and was prior to the discovery of anesthesia.

There was little treatment available for wounds of the head or the body.

Slide49

The wounds from a small battle are listed in The History. Head wounds were mostly fatal although a few survived.

Slide50

Early wound care was mostly in the open as the dressing stations were overwhelmed easily.

Slide51

Saber wounds, inflicted by mounted cavalry were survivable if the skull was not penetrated and they did not become infected.

Slide52

The Battle of Chancellorsville was a success for Lee but a great loss resulted as Jackson was lost.

Slide53

Many believe that all chance of success in the war died with Jackson.

Slide54

Jackson was shot by his own men as he reconnoitered the battlefield. His left arm was amputated but he did not survive. His wife was with him when he died.

Slide55

Gunshot wounds of the extremities were most of the survivors. The mortality rate of amputation was 27%. In the Franco-Prussion War, the incompetent French military surgeons had a 50% mortality rate even though antisepsis had been described three years before by Joseph Lister. Lister was treating tuberculosis of the joints, which was a common condition at the time. He found that infection was prevented by carbolic acid.

In August 1865, Lister applied a piece of lint dipped in carbolic acid solution onto the wound of a seven-year-old boy at Glasgow Infirmary, who had sustained a compound fracture after a cart wheel had passed over his leg. After four days, he renewed the pad and discovered that no infection had developed, and after a total of six weeks he was amazed to discover that the boy’s bones had fused back together, without the danger of suppuration. He subsequently published his results in The Lancet[8][9] in a series of 6 articles, running from March through July 1867.

He instructed surgeons under his responsibility to wear clean gloves and wash their hands before and after operations with 5% carbolic acid solutions. Instruments were also washed in the same solution and assistants sprayed the solution in the operating theatre. One of his additional suggestions was to stop using porous natural materials in manufacturing the handles of medical instruments.

The Germans adopted “Listerism” and the French did not. His reports were after the American Civil War although Semmelweis had tried to introduce hand washing in 1846.

Slide56

Vascular injuries were untreatable and would remain so until Vietnam, when new techniques resulted in salvage of most arterial injuries.

To be continued.

The Medical History of the American Civil War IV

September 4th, 2015

More of the series on my lecture on the Civil War.

Slide30

The Ambulance Corps were organized and the photo shows one group during the war.

Slide31

The next Army Surgeon General was Letterman who changed Tripler’s organization and built larger hospitals and worked on sanitation projects that had been ignored by the early medical services. Disease was a greater risk to soldiers than wounds and had been since Classical Greece. When large numbers often were accumulated without proper sanitation, disease was rampant. Florence Nightingale was one of the first to realize the importance of cleanliness.

Slide32

One of the greatest medical pioneers of the Civil War was John Shaw Billings who designed hospitals, including The Johns Hopkins Medical Center. He was never Surgeon General but he did organize what became the Public Health Service.

Slide33

One of Letterman’s new hospitals was this one which was constructed in time for the battle of Gettysburg.

Slide34

One of the brilliant surgeons who joined up and contributed was this man, John H. Brinton. Typically, he was dismissed by the politicians around Lincoln because McClellan had appointed him.

Slide35

The most common medical problem was chronic diarrhea.

27,558 Union soldiers died of chronic diarrhea. Without bacteriology, still unknown in 1865, it is impossible to trace the causes.

Typhoid fever killed another 27,056 soldiers.

In the Boer War, in 1899 to 1902, typhoid fever killed thousands of British troops.

of the British Force of 556 653 men who served in the Anglo-Boer War, 57 684 contracted typhoid, 8 225 of whom died, while 7 582 were killed in action.(11) As had been the experience in America, the disease was found to be one which occurred in static camps.

This occurred years after infectious diseases had been identified and the cause of illnesses had been described.

The First Word War was the first war in which more men died of wounds than of disease.

Slide36

This slide, from the “Medical and Surgical History of the War of the Rebellion, shows the seasonal nature of the disease. The nutritional aspects are seen in the incidence during the siege of Atlanta.

Slide37

One example of another page of the History. There were over a million cases of acute diarrhea during the war. “Colored Troops” only appeared after 1863.

Slide38

Diseases were classified according to the medical knowledge of the time. “Miasma” were those which we now know to be infectious. Malaria, for example, mean “Bad Air” in Latin.

Slide39

Tuberculosis was a severe chronic disease which would not be curable until Streptomycin came along in 1946. There were two forms, “consumption” which was the pulmonary form, was not known to be contagious. “Scrofula” is the cervical lymph node form and is associated with milk from infected cows. This was the form studied by Louis Pasteur who recognized that it was transmissible and that heating milk prevented it.

Slide40

Treatment of disease was as primitive as one might expect although quinine was known and used by the Union Army. The blockade of the South prevented its use there. Vaccination was widely practiced and opium was used for pain. There was anesthesia since 1846 and chloroform was more common than ether.

Slide41

Malaria was widespread in the US at the time. Mosquitoes were vaguely known to be associated. Mosquito nets were used although the mechanism was not well understood.

The Medical History of the American Civil War III

September 4th, 2015

This continues the series from a lecture I have given a few times.

Slide23

William W Keen was a student when he first served as an Army surgeon at Bull Run. That experience changed the Army medical services and gave a great deal of power to the volunteer organizations.

Slide24

William Hammond quickly replaced the incompetent surgeons who had been in place when the war began. He was competent but argumentative and clashed with Stanton who became Secretary of War.

Hammond met Jonathan Letterman. Hammond worked with Letterman and Rosecrans on the design of a new ambulance wagon.

The atmosphere in the upper levels of medical services was then one of internal strife and personal conflicts. Hammond—a tall and imposing young man[12]—was no man of intrigue, nor even, according to all accounts, a very flexible person. However, the situation offered him the possibility for advancement. When Finley, the 10th Surgeon General, was fired after an argument with Secretary of War Edwin M. Stanton, Abraham Lincoln, against Stanton’s advice and the normal rules of promotion, named the 34-year-old Hammond to succeed him with the rank of brigadier general. Hammond became Surgeon General of the Army on 25 April 1862, less than a year after rejoining the army.

Lincoln liked “Men who fight” and defended his choices but Hammond was just too hard headed.

On his initiative, Letterman’s ambulance system was thoroughly tested before being extended to the whole Union. Mortality decreased significantly. Efficiency increased, as Hammond promoted people on the basis of competence, not rank or connections, and his initiatives were positive and timely.

On 4 May 1863 Hammond banned the mercury compound calomel from army supplies, as he believed it to be neither safe nor effective (he was later proved correct). He thought it dangerous to make an already debilitated patient vomit. A “Calomel Rebellion” ensued, as many of his colleagues had no alternative treatments and resented the move as an infringement on their liberty of practice. Hammond’s arrogant nature did not help him solve the problem, and his relations with Secretary of War Stanton became strained. On 3 September 1863 he was sent on a protracted “inspection tour” to the South, which effectively removed him from office. Joseph Barnes, a friend of Stanton’s and his personal physician, became acting Surgeon General

Stanton later died of an asthma attack so his “personal physician” was important to him. Calomel was “The Blue Pill” that had been advocated by Benjamin Rush. It was an ancient remedy based on the success of mercury in the treatment of syphilis dating back to Paracelsus in the 14th century. Medicine until the 20th century was quite primitive and many remedies were tried for wildly inappropriate indications.

van gogh

For example, a Van Gogh painting of his doctor shows evidence of digitalis intoxication which might have caused his death. Yellow vision is one indication of overdose of digitalis (sudden death is another) and a Van Gogh painting, Portrait of Dr. Gachet shows the characteristic yellow tint plus an example of the plant held by the doctor.

Anyway, Hammond was replaced after some of his innovations including evacuating the wounded from the Peninsula Campaign of McClellan. They were taken by ship back to large hospitals near DC.

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Treatment of the wounded early in the war was primitive and would soon improve under Hammond’s reforms.

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The volunteer organizations began to make their influence felt and the Army was unable to resist the reforms.

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Tripler, for whom the great Army hospital in Hawaii is named, was chosen by McClellan to be the chief surgeon for the Army of the Potomac. His great innovation was the “Ambulance Corps.”

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The “Ambulance Corps” restored the invention of Baron Larrey and began the reforms of the Union

To be continued

The Medical History of the American Civil War II

September 4th, 2015

This continues the story of medicine in the Civil War. Samuel Gross, a Professor of Surgery at Pennsylvania Hospital in 1860, realized that no textbook of military medicine and surgery existed so he wrote his own in 60 days. It is shown in this exhibit at the Warren Collection at Harvard’s medical library.

manaual of mil surg

The Confederate Army also had no manual so the Gross manual was used by both sides in the war. It was quickly copied for Confederate Military surgeons. A copy of the manual, which was identical to the Union Army manual is preserved at Jefferson Medical College in digital form.

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The first battle, famously, was at Fort Sumpter where the commanding office during the battle was actually the medical officer, Samuel Crawford.

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The woeful state of the army medical department was recognized immediately and a volunteer organization quickly organized. The first was the US Sanitary Commission. It was rebuffed by the Army but quickly became very powerful. This was a people’s war and the Army was incompetent, as everyone knew.

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Here is the cover of Gross’s book. It was used throughout the war, which had enormous influence on American and world Medicine. The book from which this lecture is taken was used by Theodore von Billroth to design the Prussian Army medical corps for the Franco-Prussian War in 1870. The French had forgotten Baron Larrey’s lessons and suffered terribly.

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The cover of the Confederate version of Gross’s textbook.

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Joseph Woodward was an academic surgeon, such as it was known at the time.

“Woodward was the first scientist to establish photomicrography as a tool for both scientific and medical investigations.” According to an article in the Archives of Pathology and Laboratory Medicine:[2] “In addition to collecting specimens for the museum’s archive, he co-authored the definitive medical history of the Civil War in the 6-volume 1870 publication of the MSHWR.4 Woodward’s technique using aniline dyes for staining thin sections of tissue, along with his pioneering work in photomicroscopy, helped prepare the groundwork for modern surgical pathology.”

The “History” is “The Medical and Surgery History of the War of the Rebellion” of which there are six existing full copies. I found one copy in the USC Medical Library and asked the library staff, who had no idea of its value, to place it in a locked collection room. It would be like finding a copy of “De Revolutionibus” on the shelves of an open university library.

Slide21

The design of Union Army Hospitals was entrusted to Frederick Olmsted, who had designed New York City’s Central Park. He was, after the war, very involved in establishing The National Park Service.

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The first battle of the war illustrated the appalling condition of the medical services of both sides. There were no ambulances and the wounded and to walk back to Washington City, as DC was known then.

A famous American surgeon, who would write one of the world’s great medical textbooks, William W Keen acted as a young army surgeon at the battle.

He studied at Brown University, where he graduated in 1859. He graduated in medicine from Jefferson Medical College in 1862. During the American Civil War, he worked for the U.S. Army as a surgeon. After the war, he spent two years studying in Paris and Berlin.

His “An American Textbook of Surgery” was a hugely influential text and the 1905 edition had a chapter on brain surgery by Harvey Cushing and a chapter on “Appendicitis,” the first use of the term in medical literature, written by John B Murphy, who was the first advocate of early appendectomy for appendicitis.

To be continued.

The Medical History of the American Civil War.

September 2nd, 2015

Slide01

This is a lecture I have given a few times and am converting to a long blog post. The American Civil War was the first major war since a number of major advances of medicine had occurred. Sanitation had been studied by John Snow and Florence Nightingale. Anesthesia had been discovered by two Americans, Morton and

Unfortunately, antisepsis would not be described until, 1867, after the war. Infection than was the great scourge of the wounded.

Slide02

The state of medical art before the war was limited.

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Baron Larrey was the greatest army surgeon of the Napoleonic Wars. He invented the ambulance and pioneered some sanitary advances but the cause of infection was still obscure.

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Benjamin Rush was a famous American physician but little of what he knew or advocated was of use.

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The discovery of Ether anesthesia was momentous but it did add the factor that more operations would be attempted before infection was understood.

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Semmelweiss was tragic figure who realized that infection was transmissible from physicians’ hands to patients but he was unable to convince his colleagues. His discovery of the uses of hand washing were ignored.

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Florence Nightingale discovered the use of hand washing in caring for the wounded but she did not know why it worked. She is a great hero of the British Army and her apartment in Scutari Barracks in Istanbul is preserved in a shrine.

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The Scutari Barracks from across the Bosphorus.

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I visited the museum about ten years ago and visited her quarters which the Turkish Army preserves.

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The history of Military Medicine really begins with Ambrose Pare’ who served several French Kings and who invented the hemostat.

200px-Ambroise_Paré

His methods were a huge improvement on the Greeks but not much else can be said for their efficacy.

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The American Army in 1860 was tiny and the medical establishment was a joke.

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The war resulted in many of the army surgeons resigning to join the Confederacy. The lack of military medical texts resulted in Samuel D Gross, professor of surgery at Jefferson Medical College, writing his own textbook.

To be continued.