Learning from the Wounded: The Civil War and the Rise of American Medical Science
Learning from the Wounded: The Civil War and the Rise of American Medical Science
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向伤员学习：内战与美国医学的崛起
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发表时间：
2014
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通讯作者：
Frank Freemon
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作者：
Frank Freemon
尽管南北战争中大约三分之二的死亡是由疾病而不是战斗造成的，但自从乔治·沃辛顿·亚当斯1952年在《蓝色》杂志上发表了他的基本上是描述性的医生以来，很少有学者试图对内战医学进行全面的重新评估或解释性的综合。1亚当斯描绘了一幅残酷的图景，前现代医生被迫与他们不了解的力量作斗争，但没有多少成功，包括细菌、传染病和感染。在接下来的几十年里，出现了几本关于参与战争的个别医生的专著，偶尔还会有关于特定医学主题的文章。但亚当斯的描述仍然是标准的概述。只是在过去的十五年里，学者们才开始全面重新评估内战的医学史。例如，迈克尔·弗兰纳里调查了战争期间药物的供应和使用，艾拉·鲁特科夫3重新评估了内战期间的外科实践。弗兰克·弗里蒙(Frank Freemon)和阿尔弗雷德·博莱特(Alfred Bollet)都得出结论，许多医生在异常困难的情况下表现得相当好，并热衷于接受任何似乎有效的技术。即便如此，对南北战争医学史的主要叙述仍然是一个惨淡的故事：绝望地笨手笨脚的医生们无法做太多事情来减轻美国历史上独一无二的痛苦。因此，两本优秀的新书几乎同时出版，为南北战争的整体医学史提供了新的视角，值得关注和庆祝。其中一项新的研究是玛格丽特·汉弗莱斯的《悲剧的骨髓》6，它首次将南北战争的医学史置于公共卫生的更大背景下。这使得汉弗莱斯能够超越传统的对团外科医生和作战行动的关注，将战争的医学史理解为几个与健康相关的机构之间广泛、松散组织的一系列互动，无论是军队内部还是外部。她认为，最重要的医疗保健形式--比如干净的床和新鲜的食物--往往是由非战斗人员提供的，尤其是女性。因此，主导旧叙事的悲剧性无助的军医成为了一个更大的故事中的角色，这个故事讲述了美国社会作为一个整体对美国历史上最大的公共卫生灾难的反应。这两本新书中的第二本是这次评论的主题。《向伤者学习》，肖纳·迪瓦恩(大学)西安大略省舒利奇医学和牙科学院)保留了对该领域医生的传统关注。她并不试图辩称这些医生在某种程度上比亚当斯和其他人所说的更有效，尽管她正确地指出，联邦军医生在南北战争期间取得了比几年后的法国普鲁士战争期间更好的结果。相反，迪瓦恩认为，南北战争的医疗经历对后来的美国医学实践产生了深远而持久的影响。她认为，可怕的条件和缺乏有效的治疗干预，迫使联邦军队
Although roughly two-thirds of the deaths in the Civil War resulted from disease rather than combat, few scholars have attempted a comprehensive reassessment or interpretive synthesis of Civil War medicine since George Worthington Adams published his essentially descriptive Doctors in Blue in 1952. 1 Adams painted a grim picture of pre-modern physicians forced to struggle without much success against forces they did not understand, including bacteria, contagion, and infection. A few monographs about individual doctors involved in the war appeared during subsequent decades, along with occasional articles about specific medical subjects. But Adams’s account remained the standard overview. Only in the last fifteen years have scholars begun to reassess Civil War medical history holistically. Michael Flannery, 2 for example, surveyed the supply and use of medicinal drugs during the war, and Ira Rutkow 3 reevaluated Civil War surgical practices. Frank Freemon 4 and Alfred Bollet 5 both concluded that many doctors performed reasonably well under extraordinarily difficult circumstances and eagerly embraced any techniques that seemed effective. Even so, the dominant narrative of Civil War medical history remained a bleak story of desperately fumbling physicians unable to do much to alleviate a level of suffering unique in American history. Consequently, the nearly simultaneous appearance of two excellent new books that offer fresh perspectives on the overall medical history of the Civil War merits both attention and celebration. One of the new studies is Margaret Humphreys’s Marrow of Tragedy, 6 which for the first time places the medical history of the Civil War into the larger context of public health. This allows Humphreys to go beyond the conventional focus on regimental surgeons and combat operations to understand the medical history of the war as a vast, loosely organized series of interactions among several health-related agencies, both within and outside the armed forces. She argues that the forms of health care that mattered most— like clean beds and fresh food—were often provided by noncombatant personnel, especially women. The tragically helpless army doctors who dominated the old narrative thus become characters in a larger story about the way American society as a whole responded to the greatest public health catastrophe in the history of the United States. The second of the two new books is the subject of this review. In Learning from the Wounded, Shauna Devine (Univ. of Western Ontario Schulich School of Medicine and Dentistry) retains the traditional focus on physicians in the field. She does not attempt to argue that those doctors were somehow more effective than Adams and others made them out to be, though she correctly notes that Union army doctors achieved better outcomes during the Civil War than their European counterparts achieved during the FrancoPrussian War a few years later. Instead, Devine argues that the medical experiences of the Civil War had profoundly important and long-lasting effects on the subsequent practice of American medicine. The horrific conditions and lack of effective therapeutic interventions, she contends, forced the Union army’s