Dr. Marcy’s March

By Daniel J. Vivian, 2-13-15

As January 1865 drew to a close, Lt. Gen. William T. Sherman readied his army, then camped around Savannah, Ga., to march north into South Carolina. Some 60,000 men strong, Sherman’s troops sensed the Confederacy’s flagging will. Four years of carnage had cost Southerners dearly, and Sherman’s campaign across Georgia had dealt the Confederacy a devastating blow. With the Army of Northern Virginia crouched in defensive positions around Richmond and Confederates scrambling to defend the Palmetto State, Sherman’s men prepared to push on, determined to bring the long and bloody war to an end.

No one better captured the drama of the moment than Capt. Henry Orlando Marcy, a surgeon assigned to the 35th Regiment of the United States Colored Troops, who kept a keen-eyed diary throughout the campaign. Marcy, a Massachusetts native, had enlisted upon graduating from Harvard University in the spring of 1863. Abolitionist sentiments made him a minority among Union officers and a keen observer of race and class. As his unit moved into South Carolina, he took note of conflicts at the heart of Southern society. Marcy’s powers of perception, however, did not extend to his own prejudices. He held deep commitments to the men of the 35th but viewed slaves with a combination of paternalism and pity, and at times he showed affinity for Southerners of comparable social rank. Marcy’s writings simultaneously revealed the nobility of the Union cause and its limits.

The Carolinas campaign began in the early morning hours of Feb. 1, when Union troops broke camps in lower Beaufort County, S.C., and surged into the interior of the state. Sherman divided his army into two formations. The 14th and 20th Corps marched along the Savannah River before turning north, a move designed to confuse the enemy. The 15th and 17th corps, which included the 35th U.S.C.T., marched from the vicinity of Beaufort in the direction of Branchville and Fort Motte. They met somewhat greater resistance than their counterparts, but nowhere did Confederates mount a strong defense. Outmanned and caught off-guard by Sherman’s erratic movements, rebel forces found themselves unable to do more than slow the Union advance.

Marcy’s duties included more than medicine. Although he tended to the sick and wounded and administered vaccines, he also supervised foraging parties, destroyed rebel property and carried out patrols. Save for front-line combat, he handled the full range of duties expected of midlevel officers.

As the 35th marched forward, Marcy took note of the changing landscape. Like other Union officers, he viewed the plantations of the coastal region with awe. East of Salkehatchie, he saw a spectacular expanse of rice fields “divided and subdivided into squares as regularly as a city.” Beyond lay “a range of low hills … all cleared and under cultivation.” Several groups of buildings appeared as “distinct villages.” “These are the finest plantations I have ever seen,” Marcy wrote.

Nearly three weeks later, as his unit moved along the Ashley River, Marcy saw some of the oldest plantations in the state. Here he encountered the stately mansion at Drayton Hall and the plantation of Henry Middleton, a one-time minister to Russia. Carefully ordered landscapes, handsome houses, and well-kept grounds demonstrated the authority and power the planter class had traditionally wielded.

Slaves rejoiced upon realizing that the moment of emancipation had arrived. At one plantation, Marcy encountered “slaves overjoyed at our coming. They thank God, and say they have long prayed for coming. Say they don’t want Massa anymore.” On another occasion, Marcy found himself surrounded by slaves giving “various demonstrations of joy.” “All wanted to ‘shake hands.’ Guess this is a custom of theirs,” he mused. Slaves looted the houses of former masters and quickly organized themselves. After watching a group clear land at a Cooper River plantation, Marcy noted, “They are willing to labor hard if they can have reasonable recompense. I encouraged them, promising they should have a part of the crop.”

Even as Marcy admired slaves’ enthusiasm and self-reliance, he sympathized with the planter class, even those he identified as “bitter rebels.” He chafed at an order to burn the house of Charles Heyward, a wealthy planter. “The destruction of such property seems a great pity,” Marcy remarked. In another instance, seeing a grand house in ruins left him despondent. “Tis very sad,” he wrote. “Yesterday it was the finest place I ever saw, now all destroyed. The house was erected before the Revolution and was in splendid keeping.”

The most revealing encounter that Marcy recorded occurred at the Stoney Plantation on Back River, in the vicinity of Goose Creek. As a small group of his men foraged nearby, Marcy found several members of the Stoney family at home. “Intelligent, but bitter rebels,” he noted. “The ladies plainly spoke of their sentiments and gloried in their struggle.” The only male present was “a lame son-in-law.” The family patriarch, Peter Gaillard Stoney, and five of his sons were serving in the Confederate army. The Stoney women invited Marcy and another officer to stay for dinner. “The ladies were so attractive, we accepted,” Marcy explained.

During the meal, Mrs. Stoney mentioned strained relations with the family’s slaves. “Mrs. S. said the niggers had become unruly and she feared trouble with them,” Marcy wrote. The difficulty had begun after a visit by a Union gunboat a few days before. A Union officer had told the slaves to remain on the plantation and continue working as before. Marcy surmised that the man must have been “overcome by the charm of the ladies, or some other motive.” The slaves protested. “This was not what … they had heard Massa Linkinn had promised them,” Marcy noted. Understandably, “They couldn’t exactly see how they were free if they must do just as before.”

Marcy agreed to speak to the Stoney slaves. From a small porch he addressed an audience of about 150 “colored people of all ages and sizes.” They stood “clothed in all sorts of garments, from the ordinary homespun to whole suits made of old carpets and blankets.” Nearly all had “feet and heads bare,” and few “were clothed sufficiently to prevent them from suffering.” No record of his remarks survives, but he noted that the slaves “seemed appreciative and happy, thanked God for freedom and promised to make good use of it.” The Stoneys took a different view. They retreated to a parlor “in silence.” When Marcy joined them, Mrs. Stoney made it clear that “she esteemed my remarks of less value than the colored people.”

The episode at the Stoney plantation revealed conflicts at the heart of the struggle over slavery. Even as emancipation arrived, masters expected blacks to remain subordinate and continue laboring without complaint. Freedpeople demanded autonomy and the ability to shape the circumstances of their lives. Fierce conflicts erupted. For their part, Northerners such as Marcy wavered in their commitment to black equality and large-scale social reform. Most Northerners celebrated slavery’s destruction but opposed African-American equality. Even the minority who supported black civil rights questioned what federal authorities could and should do to reshape the Southern social order.

In the months and years that followed, conflicts over Reconstruction gripped the nation. The untimely assassination of President Abraham Lincoln on April 15, 1865, left federal policy toward former Confederate states unsettled, and the lenient policies enacted by his successor, Andrew Johnson, enraged the northern public. Congressional Republicans quickly seized control of Reconstruction. For a time, it appeared that federal action might ensure voting rights, full civil rights and possibly even access to economic resources for former slaves. Yet support for such measures quickly faded, and by the time Ulysses S. Grant became president in March 1869, the bid to remake the nation in the name of liberty and equality for all had lost steam. Racialized terror, electoral strife and inadequate support by federal authorities sounded the death knell for a South where blacks rose above the status of a marginalized class.

Marcy’s view of affairs in the spring of 1865 hinted at reasons for the boldness of Reconstruction, and why it ultimately failed. The sincerity of his commitment to the men of the 35th and the cause of racial equality cannot be doubted. When he received his discharge orders on June 1, he professed his love and respect for the “honest, true faithful black men” with whom he had “labored for so long.” The following spring he returned to South Carolina with plans to buy and operate a plantation, a measure intended to help African-Americans “obtain justice.” Although the project failed, it nonetheless demonstrated his desire to create a more equitable South. Yet Marcy’s admiration for the planter class also showed inclinations that undermined the aim of wholesale social reform. When he admired grand houses without recognizing them as products of forced labor, he ignored crucial dimensions of the Union cause. The episode at the Stoney plantation showed how class interests conflicted with the aim of black empowerment. No matter how earnestly Marcy believed in racial equality, he identified more closely with the Southern elite than with newly freed slaves. Between him and the latter lay a social distance that would ultimately undermine efforts to secure black civil rights.

Marcy spent the remainder of the Carolinas campaign in Charleston, where the 35th U.S.C.T. acted as an occupying force. The news of Lincoln’s assassination left him shocked and angry, and he soon found himself questioning the price of victory. “At what terrible cost have we purchased the priceless jewel of liberty?” he asked. In the weeks that followed, he cared for freedpeople on nearby plantations, surveyed the condition of the Medical College of South Carolina, and vaccinated orphans at the Charleston Orphan Asylum. On June 8 he sailed from Charleston on the steamer Clyde. The view from the harbor led him to exclaim: “The war here began is finished, the object of our four years of fighting accomplished. The rebellion dead, arm[ed] treason sinking out of sight and slavery a thing of the past!”

Marcy reached his home in Cambridgeport, Mass., on June 15. He spent the remainder of the year caring for his ailing mother and practicing medicine. New Year’s Eve found him thinking about becoming a missionary in the South. After the failed bid to purchase the plantation in the spring of 1866, he returned to the North and then went abroad. He did postgraduate studies in medicine in London, in Scotland and at the University of Berlin. In 1870 he returned to the United States, having decided to specialize in gynecology. He went on to serve as president of the American Medical Association in 1891-92, became a founding member of the American College of Surgeons and published extensively in medical journals during a long and productive career. He died in 1924.

Marcy played only a small role in the Carolinas campaign, and he had little influence on Reconstruction. Yet his views illustrate the problems that beset the nation as Union victory gave way to new struggles over the postwar order. Reconstruction set bold ambitions for a nation that had always tolerated slavery within its borders, and the failure to achieve its loftiest goals revealed the limits of Northerners’ commitment to social reform in the South. Four years of horrific bloodshed left Americans weary and eager to resume whatever sense of normalcy they could find.

Marcy’s personal story mirrored the broader currents of the era. Though committed to slavery’s destruction, he found racial equality a step too far. In due course, the nation did too. Hence the need for a “Second Reconstruction” – the phrase historians sometimes use in referring to the civil rights movement – a century later. His diary shows the irony and the tragedy of a nation that freed 4.5 million slaves but could neither envision people of color as equals or a society where race did not divide haves from have-nots.

Sources: Henry O. Marcy, “Diary of a Surgeon: U.S. Army, 1864-1866”; Irving A. Watson, ed. and comp., “Physicians and Surgeons of America”; Journal of the American Medical Association, Jan. 19, 1924; Henry O. Marcy, “The Semi-Centennial of the Introduction of Antiseptic Surgery in America,” in Transactions of the Southern Surgical Association 33 (1921); John G. Barrett, “Sherman’s March Through the Carolinas”; Eric Foner, “Reconstruction: America’s Unfinished Revolution, 1863-1877”; David Blight, “Race and Reunion: The Civil War in American Memory”; Michael W. Fitzgerald, “Splendid Failure: Postwar Reconstruction in the American South;” Anne S. Rubin, “Through the Heart of Dixie: Sherman’s March and American Memory.”

Daniel J. Vivian is an assistant professor of history at the University of Louisville.

Image: Soldiers under Gen. William T. Sherman burn McPhersonsville, S.C. on Feb. 1, 1865.Credit Library of Congress

From: opinionator.blogs.nytimes.com

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Civil War Gynecology: The Medical Ethics of Dr. J. Marion Sims: A Fresh Look at the Historical Record

By L. L. Wall
From: Journal of Medical Ethics

Abstract
Vesicovaginal fistula was a catastrophic complication of childbirth among 19th century American women. The first consistently successful operation for this condition was developed by Dr J Marion Sims, an Alabama surgeon who carried out a series of experimental operations on black slave women between 1845 and 1849. Numerous modern authors have attacked Sims's medical ethics, arguing that he manipulated the institution of slavery to perform ethically unacceptable human experiments on powerless, unconsenting women. This article reviews these allegations using primary historical source material and concludes that the charges that have been made against Sims are largely without merit. Sims's modern critics have discounted the enormous suffering experienced by fistula victims, have ignored the controversies that surrounded the introduction of anaesthesia into surgical practice in the middle of the 19th century, and have consistently misrepresented the historical record in their attacks on Sims. Although enslaved African American women certainly represented a “vulnerable population” in the 19th century American South, the evidence suggests that Sims's original patients were willing participants in his surgical attempts to cure their affliction—a condition for which no other viable therapy existed at that time.

J. Marion Sims (1813–1883) was arguably the most famous American surgeon of the 19th century and today he is generally acknowledged as the founder of modern surgical gynaecology. His rise to prominence began with his development of the first consistently successful operation for the cure of vesicovaginal fistula, a catastrophic complication of childbirth in which a hole develops between a woman's bladder and her vagina and leads to constant, unremitting, and uncontrollable urinary incontinence. Attempts to cure this condition had eluded many previous generations of surgeons who had tried to repair these devastating injuries time and again, but without significant success.

Lauded as a conquering surgical hero in his own time and generally admired by succeeding surgeons in the decades following his death, Sims's reputation diminished considerably in the mid‐twentieth century as it was assaulted by a series of strident critics who condemned him for his reputedly unethical behaviour. The primary reason for these attacks on Sims is that his initial attempts to cure vesicovaginal fistulas were carried out on a group of enslaved African American women whom he quartered in a small hospital behind his house in Montgomery, Alabama. Between late 1845 and the summer of 1849, he carried out repeated operations on these women in a dogged effort to repair their injuries. One young woman, a slave named Anarcha with a particularly difficult combination vesicovaginal and rectovaginal fistula, underwent 30 operations before Sims was able to close the holes in her bladder and rectum.

In interpreting these historical events, some modern writers have denounced Sims with the kind of righteous indignation that is usually heard only from pulpits. Durrenda Ojanuga—for example, writing in the Journal of Medical Ethics—has castigated Sims for achieving fame and fortune as “a result of unethical experimentation with powerless Black women” and refers to his attempts to cure vesicovaginal fistulas as “a classic example of the evils of slavery and the misuse of human subjects for medical research”. Ojanuga and like minded critics present a picture of Sims as a cold, brutal, calculating misogynist who carried out a series of unwarranted surgical experiments on unwilling but helpless slaves in pursuit of his own self advancement. This paper will demonstrate that the attacks launched against Sims by these modern writers are actually not substantiated by the primary historical sources relating to the case, nor are their charges consistent with any deep clinical understanding of the predicament faced by women who have developed a vesicovaginal fistula from obstructed labour; rather, their analysis of Sims's early surgical operations on vesicovaginal fistulas can be seen as a striking example of Herbert Butterfield's observation that “for the compilation of trenchant history there is nothing like being content with half the truth”.

Distilled to their essential points, Sims's modern critics make three major claims about Sims and his early operations for vesicovaginal fistula. The first assertion is that it was unethical “by any standard” to perform experimental surgical operations on slaves because slaves, by definition, could not have given voluntary informed consent for surgery. Underlying this assertion is the hidden presupposition that enslaved women with fistulas did not want surgical care for their condition (vesicovaginal fistula) and that they were therefore coerced into having unwanted (and perhaps, unnecessary, surgery). The second assertion is that Sims's failure to use ether anaesthesia during these operations was racist: that he did not use anaesthesia when performing fistula surgery on black women, but later, after he had developed his operation and moved to New York to found the Woman's Hospital there, he routinely used anaesthetics when operating on white women who, it is alleged, unlike blacks, were unable to stand the pain involved.

The third assertion is that the use of slaves for medical experimentation was unnecessary because substantial advances in medical care were made in the 19th century by Southern physicians who experimented in an ethical manner using white women from whom they obtained “informed consent”, a circumstance that modern critics assert did not exist with regard to Sims's operations on these early slave women. Close examination of primary source material demonstrates that each of these claims about Sims is either unsubstantiated or demonstrably false. The inevitable conclusion seems to be that the accusations levied against Sims by modern authors are largely the result of the unquestioned presuppositions that these authors have made regarding the clinical problem Sims and his first patients faced; shoddy historical research, and an abysmal lack of understanding of the future life prospects faced by a woman who had a vesicovaginal fistula in 1845.

What is a vesicovaginal fistula and how does it originate? Obstetric vesicovaginal fistulas do not arise, as many authors commonly state, as the result of “tears” to the bladder during labour; rather, they are the result of a massive crush injury to the soft tissues of the pelvis. Obstetric vesicovaginal fistulas develop during prolonged obstructed labour when the fetus will not fit through its mother's birth canal. In the presence of absolute cephalopelvic disproportion, the contracting uterus tries to force the fetus through the birth canal but only succeeds in gradually wedging the fetus more and more tightly into the maternal pelvis until eventually it can no longer be moved at all. At this point, the soft tissues of the woman's bladder, cervix, and vagina are trapped progressively more and more tightly between two immovable bony plates—the fetal skull and the mother's pelvic bones—and the blood supply to the entrapped tissues is shut off. In such cases the fetus almost invariably dies from asphyxiation, and if the mother lives through her ordeal and does not herself die from uterine rupture, sepsis, haemorrhage, or the sheer exhaustion of labouring in this fashion for days on end, a day or two later the fetus decays, macerates, and finally softens enough to slide out of its mother's vagina. Some time thereafter, a slough of necrotic tissue comes away from the injured woman's vesicovaginal septum, and a fistula forms. To the agony of days of unrelieved labour and the sorrow of delivering a dead child is now added the physical and social calamity of complete loss of urinary (and often faecal) control.

The injuries that women receive from prolonged obstructed labour are not limited to vesicovaginal and rectovaginal fistulas. These injuries form only a small part of a broader spectrum of injuries known as the “obstructed labour injury complex”. In addition to the continuous stream of urine (and sometimes faeces) to which they are subjected, these victims of prolonged obstructed labour also often suffer from secondary infertility; loss of vaginal function due to extensive scarring of the birth canal; damage to the pubic bones; contractures of the lower extremities from neuromuscular damage; recurring pelvic and urinary tract infections; horribly diminished self esteem, damaged body image, and, not infrequently, severe depression, even suicide. The cumulative devastation wrought by this process can be appalling. It is hardly the “relatively minor condition” referred to by historian Deborah Kuhn McGregor.

In alleging that it is unethical for slaves to participate in any form of medical experimentation, Ojanuga and other writers seem to imply that it would never have been appropriate for slaves to undergo innovative surgical operations, no matter what their problems might have been. Critics of this stripe conveniently ignore the differences between non‐therapeutic and therapeutic medical experimentation. In the former case, participants can have no reasonable expectation of obtaining direct personal benefit from whatever is done, but in the case of therapeutic experimentation research participants may gain direct—and sometimes substantial—medical relief as a result of their participation in a clinical trial. At the time Sims began his attempts to repair the fistulas afflicting his African American slave patients, there was no effective therapy for a vesicovaginal fistula. Many surgeons in different countries had made repeated but unsuccessful attempts to close vesicovaginal fistulas and put an end to the tormenting loss of urine that these suffering women experienced. With rare exceptions, all such attempts failed. The French surgeon Alfred Velpeau, writing in 1847, maintained that the medical community had not accepted a single reported case of successful cure of a vesicovaginal fistula without dispute.  The common experience of surgeons who undertook the care of women with vesicovaginal fistulas was a repeated series of failures, with the desperate patients returning again and again, begging that another attempt be made to give them some relief.

Because Sims's patients had a condition that was generally acknowledged to be incurable, they had only two therapeutic choices: they could continue as they were, with whatever palliative treatment might be provided, or they could agree to undergo experimental surgical operations that might offer them some relief, perhaps even a total cure, for their condition. What would the first alternative have been like? What “palliative treatments” were available to fistula sufferers at this time? Is it true, as Diane Axelson has charged, that both Sims and his subsequent biographer, Seale Harris, portrayed the physical condition of women with fistulas with “unjustified exaggeration”? Is it reasonable to suppose, as Patricia King has speculated, that “given the other aspects of slave life, it is not clear that these women would have ranked this problem high on their list of medical problems that needed attention”? Consider the following description of what it was like to be a woman with a vesicovaginal fistula in the mid‐19th century, given by Dr P M Kollock at the annual meeting of the Georgia State Medical Society in April, 1857:

"The poor woman [with a vesicovaginal fistula] is now reduced to a condition of the most piteous description, compared with which, most of the other physical evils of life sink into utter insignificance. The urine passing into the vagina as soon as it is secreted, inflames and excoriates its mucous lining, covering it with calcareous depositions, and causing great suffering. It trickles constantly down her thighs, irritates the integument with its acrid qualities, keeps her clothing constantly soaked, and exhales without cessation its peculiar odour, insupportable to herself and those all around her. In cases where the sloughing has been extensive, and the loss of substance of the tissues great, and where neither palliative nor curable means have availed for the relief of the sufferer, she has been compelled to sit constantly on a chair, or stool, with a hole in the seat, through which the urine descends into a vessel beneath."

Given the choice between living the rest of their lives in this manner or of taking a chance—however remote—that Sims might be able to cure them, it is not surprising that these patients, even though they were enslaved, would have jumped at the opportunity to have surgery. That patients with a vesicovaginal fistula are desperate for a cure and will willingly submit to almost any therapy that is proposed to them is the universal experience of surgeons who have worked with this condition, both in the 19th century and today.

In her article, which is critical of Sims, Durrenda Ojanuga states that: “The enslaved women were not asked if they would agree to such an operation as they were totally without any claims to decision making about their bodies or any other aspect of their lives”. This statement is untrue. Sims gave numerous accounts of these early fistula operations during the course of his career, and, although they differ in some details, they all state quite plainly that he discussed what he proposed to do and obtained consent from the patients themselves before undertaking any operations. Writing in the New York Medical Gazette and Journal of Health in January, 1855—for example, Sims declared:

"For this purpose [therapeutic surgical experimentation] I was fortunate in having three young healthy colored girls given to me by their owners in Alabama, I agreeing to perform no operation without the full consent of the patients, and never to perform any that would, in my judgment, jeopard life, or produce greater mischief on the injured organs—the owners agreeing to let me keep them (at my own expense) till I was thoroughly convinced whether the affection could be cured or not."

It is true that under Southern law, slaves were the property of others and Sims could not have legally operated on them without the consent on their owners; however, this cannot be taken as a priori proof that these slaves were unwilling patients. As a matter of surgical practicality, considering the delicate and tedious requirements of performing surgery inside the vagina and the exceedingly difficult circumstances of exposure and inadequate lighting under which he was forced to operate, Sims could not have carried out these operations successfully without the cooperation of the women involved. Even the slightest movement, much less the active resistance of these patients, would have rendered it impossible for him to have completed his operative procedures. Indeed, when his regular medical assistants tired of working with him, Sims trained the patients themselves to act as his surgical assistants and they thereafter helped him operate on one another in turn! In fact, in a passage in his autobiography that his modern critics have apparently not understood, Sims wrote that at a time when he had stopped attempting surgery on these women due to his repeated failures and was wondering how best to proceed, they “clamoured” for operations, insisting that he keep trying to cure their injuries. No wonder he owed these women a debt of gratitude for their persistence and their cooperation—a debt that he readily acknowledged publicly on numerous occasions.

Why did Sims not use anaesthesia when carrying out these operations? Was he an “anaesthetic racist,” as has some authors allege? Vanessa Northington Gamble—for example, maintains that, in contrast to the way he treated slaves, Sims only operated on white women using anaesthesia.4 The chronology of events is extremely important here. Sims grew up as a surgeon in the days before anaesthetics and was accustomed, as were all of his contemporaries, to the pitfalls and requirements of preanaesthetic surgery. Durrenda Ojanuga writes: “He performed his first operation on a slave woman named Lucy. Lucy was operated on without anaesthetics as Sims was unaware of the advances which had been made in this area of medicine.” This statement is not true. Sims began his fistula operations on his enslaved patients in late 1845, before the anaesthetic properties of ether were known. Ether anaesthesia was not discovered and publicly demonstrated in Boston until October 16, 1846, nearly one year later.  Although the use of anaesthesia spread rapidly, its acceptance was not universal, and there was considerable opposition to its introduction from many different quarters, for many different reasons. As historian Martin Pernick has written:

"Our twentieth century sensibilities recoil at the thought that sane, responsible physicians could ever have opposed the use of anaesthetics. Today, the concept of operating on a fully sentient patient conjures up only hellish images of concentration camp doctors. Yet in mid‐nineteenth century America, humane, conscientious, highly reputable practitioners and ordinary lay people held many misgivings about the new discovery. Neither sadists nor fools, these critics alleged a variety of rational drawbacks to the use of anaesthesia."

Many 19th century surgeons felt that attempts at repairing vesicovaginal fistulas were neither serious nor painful enough operations to warrant the risks of general anaesthesia. Sir James Young Simpson, the discoverer of chloroform and probably the most vigorous advocate of the use of anaesthesia on women during the 19th century, was one of these people. Writing about the use of anaesthesia during fistula surgery in 1859, a full decade after Sims's initial surgical experiments had been completed, this champion of anaesthesia could declare that chloroform was not absolutely necessary in the performance of fistula operations, since “The mere amount of pain endured by the patient is perhaps less than in most surgical operations, as the walls of the vesicovaginal septum are far less sensitive than you would a priori imagine”.

Ojanuga further states that: “Many white women came to Sims for treatment of vesicovaginal fistula after the successful operation on Anarcha. However, none of them, due to the pain, were able to endure a single operation.” This allegation, often repeated, is also false. For example, Sims published a detailed case study of a white woman who came to him with a fistula in 1849, which he was eventually able to repair after three operations, none of which involved the use of anaesthesia. Terri Kapsalis, writing with reference to Sims's later career in New York, declares that “the widespread use of anesthetics finally allowed Sims to bring his surgeries to white women and allowed for the establishment of places such as the Woman's Hospital”. Sims himself, however, in a public lecture to the New York Academy of Medicine given on November 18, 1857, at a time when he was actively engaged in the practice of surgery at the Woman's Hospital in New York (whose clientele were almost exclusively white and many of whom were of middle or upper middle class origin), noted that he never resorted to the use of anaesthetics in fistula operations “because they are not painful enough to justify the trouble, and risk attending their administration”.  In retrospect this was certainly an unfortunate error in clinical judgment—a mistaken “calculus of suffering”—but it was not anaesthetic racism. It is also worth pointing out that if Sims had used anaesthesia in operating on his first fistula patients before the safety and efficacy of ether and chloroform had been sufficiently established for routine clinical use, this, too, would have constituted another therapeutic experiment on slaves.

In her final assault against Sims, Durrenda Ojanuga maintains that significant medical breakthroughs were achieved in the antebellum South without using slaves in therapeutic experiments. To buttress her argument, she compares Sims unfavourably with Dr Ephraim McDowell (1771–1830) of Danville, Kentucky, and with Dr Crawford W Long (1815–1878) of Georgia. McDowell was the first surgeon to successfully open the peritoneal cavity and carry out a major intra‐abdominal operation. With her consent, McDowell removed a 22 pound benign ovarian tumour from Jane Todd Crawford, a white woman, on December 13, 1809, without anaesthesia, carrying out the operation on a kitchen table. She recovered completely and survived to a ripe old age. Crawford Long was a Georgia dentist who noticed the intoxicating effects of sulfuric ether that the youth of his community were using as a recreational drug during periodic “ether frolics”. He decided to try ether as an anaesthetic agent during surgical operations. In 1842 he successfully removed a small tumour from the neck of James Venable, a white man, who had given his consent to the procedure.

These examples are true as far as they go, but both accounts given by Ojanuga selectively omit major pieces of information that, once known, completely deflate the case she is attempting to make against Sims. Although it is true that McDowell performed his first ovariotomy on Jane Todd Crawford, a white woman, Ojanuga neglects to inform her readers that McDowell performed this operation at least seven more times during his lifetime and that four of these patients were black slave women, one of who died from complications. With respect to Crawford Long, Ojanuga omits to mention the fact that he also used ether anaesthesia in a number of other surgical experiments in addition to the initial operation he performed on James Venable. For example, Long wrote the following in his article on the anaesthetic use of ether in the Southern Medical and Surgical Journal of December, 1849:

"Surgical operations are not of frequent occurrence in a country practice, and especially in the practice of a young physician; yet I was fortunate enough to meet with two cases in which I could satisfactorily test the anaesthetic power of ether. From one of these patients I removed three tumours the same day: the inhalation of ether was used only in the second operation, and was effectual in preventing pain, while the patient suffered severely from the extirpation of the other tumours. In the other case, I amputated two fingers of a negro boy: the boy was etherized during one amputation, and not during the other; he suffered from one operation, and was insensible during the other."

Both free whites and enslaved blacks were involved in all of these experimental surgical operations. McDowell's operations were clearly performed with therapeutic intent, although it is unclear to what extent some of these black patients consented to surgery. If one assumes that the amputations performed by Long were clinically indicated, then he was performing necessary surgery while conducting a rather brutal (and probably unnecessary) comparative trial of the effects of ether on surgical pain.

Conclusion
It is difficult to make fair assessments of the medical ethics of past practitioners from a distant vantage point in a society that has moved in a different direction, developed different values, and has wrestled—often unsuccessfully—with ethical issues of sex, race, gender, and class that were not perceived as problematic by those who lived during an earlier period of history. J Marion Sims was a dedicated and conscientious physician who lived and worked in a slaveholding society. As such, he was often called upon to care for slaves with legitimate medical needs. Among the needs that many 19th century women faced—both white and black—was the need for treatment of catastrophic complications of childbirth such as vesicovaginal fistulas. The operations carried out by Sims on black slave women from 1845–1849 represented his attempt to cure them of an odious and devastating condition that was then considered incurable. His operations, which at first were unsuccessful, were performed explicitly for therapeutic purposes and, as far as we can tell from the surviving sources, were carried out with the patients' cooperation and consent. At the time Sims began his efforts to close vesicovaginal fistulas, there was no effective alternative to surgical treatment and the quality of life to which such patients were reduced by their injuries was acknowledged by all medical writers of the time as unendurable. There is no doubt that slaves in the mid‐19th century American South were a “vulnerable” population who were often subjected to significant abuse by the slaveholding system. To suggest, however, that for that reason alone no attempts should have been made to cure the maladies of such enslaved women, especially when they were desperate for help and no other viable alternatives existed, seems ethically bankrupt itself. Whatever his other failings may have been, J Marion Sims pursued this clinical goal with vigour, determination, and perseverance, and both his patients then and countless thousands of women since, benefited from his success.

Acknowledgements
The author gratefully acknowledges the support of the Reynolds Historical Library of the University of Alabama at Birmingham for the award of a Reynolds Historical Research Fellowship and the support of the American College of Obstetricians and Gynecologists, for the award of the ACOG‐Ortho Fellowship in the History of American Obstetrics and Gynecology, both of which helped support the research on which this paper is based.

From: ncbi.nlm.nih.gov

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Civil War Gynecology: Scholars Argue Over Legacy of Surgeon Who Was Lionized, Then Vilified

By Barron H. Lerner, 10-28-03

One would be hard pressed to find a more controversial figure in the history of medicine than J. Marion Sims. Originally lionized as the ''father of gynecology,'' Sims was later reviled by a generation of critics as racist and sexist.

Today, as an operation introduced by Sims is bringing relief to thousands of women in the developing world, a few scholars are quietly hoping to rehabilitate his name. But it is not going to be easy.

Sims, who was born in South Carolina in 1813, was not destined for greatness. He was a lackluster student who showed little ambition after receiving his medical degree.

But he changed after a chance event in 1845. While evaluating a woman with a slipped, or prolapsed, uterus, Sims, then living in Alabama, had her kneel and place her chest close to her knees. This position not only moved the woman's uterus back into place, but it afforded him an excellent view of how childbirth had damaged her anatomy.

Sims used this insight to tackle a most dreaded complication of childbirth, usually caused by prolonged labor. With this disorder, known as the vesico-vaginal fistula, connections develop between a woman's bladder and vagina.

Afflicted women continually drip urine from their vaginas, producing, in the words of one 19th-century physician, ''a most intolerable stench.'' Even worse, fistulas sometimes develop between the bowels and the vagina.

By placing women in his new position, Sims reasoned, he could better visualize the damaged tissues and could surgically repair the fistulas. The logical women to test his theory, he believed, were slaves.

By all accounts, Sims, like a vast majority of his antebellum Southern white counterparts, was a strong proponent of slavery.

Thus, when Sims wanted fistula patients, he simply bought or rented the slaves from their owners.

Sims operated on at least 10 slave women from 1846 to 1849, perfecting his technique. It took dozens of operations before he finally reported success, having used special silver sutures to close the fistulas. Three of the slaves -- Lucy, Anarcha and Betsy -- all underwent multiple procedures without anesthesia, which had recently become available. Sims's records show that he operated on Anarcha 30 times.

Sims's persistence aroused some alarm, and several physicians urged him to stop experimenting. In response, he later reported that the slave women had been ''clamorous'' for the operation and had even assisted him with surgery.

Sims's contemporaries and early biographers heralded his feat. His skillful experiments, according to his obituary in The New York Times in 1883, ''were of great advantage to members of his profession in the treatment of female diseases.'' An inscription near Sims's birthplace termed him ''a blessing and a benefactor to women.''

Statues of Sims were erected in South Carolina, Alabama and New York City, where in 1855 he opened the first hospital exclusively for women. The New York statue stands in Central Park at Fifth Avenue and 103rd Street.

One of Sims's modern legacies is the almost total absence of vesico-vaginal fistulas in the developed world, because of advances in childbirth and the operation he pioneered.

From this lofty perch, Sims had a long way to fall. And fall he did, beginning in the mid-1970's, as Americans dealt with the volatile issues of racial and sexual equality. Historians, many of them sympathetic to the civil rights and women's movements, saw an urgent need to revise Sims's history.

One of the first scholars to weigh in was Dr. Graham J. Barker-Benfield, then a historian at Trinity College in England, who argued that Sims had used slave women as guinea pigs to advance his career.

The women, Dr. Barker-Benfield wrote in 1974, had ''endured years of almost unimaginable agonies'' undergoing repeated surgery. Rather than being willing participants, the women had been powerless to refuse.

Writing in 1985, Diana E. Axelsen, a philosopher at Spelman College, described Sims's patients as ''victims of medical experimentation.'' Wendy Brinker, a South Carolina filmmaker, nicknamed Sims ''Father Butcher'' and asked why the state's monument to him still stood.

Underlying these pronouncements was the belief that Sims's early biographers had been guilty of ''presentism,'' evaluating past events based on their own values at the time. Living in an era that uncritically celebrated white male doctors, the historians contended, these writers had viewed Sims far too favorably.

More recently, a few scholars have been trying to revise this revisionist history. ''To deify or vilify Sims is not the answer,'' said Dr. Deborah Kuhn McGregor, a historian at the University of Illinois at Springfield. Dr. McGregor uses Sims's story in her book ''Sexual Surgery and the Origins of Gynecology'' to discuss the complex ways that race and sex influence medical practice.

One of Sims's strongest defenders these days would have to be Dr. L. Lewis Wall, a Washington University surgeon who believes that the scholars who pilloried Sims were guilty of the same presentism they had identified in others' work.

Dr. Wall has a special reason for coming to Sims's defense. He routinely travels to Africa to repair vesico-vaginal fistulas. Contending that the rest of the world has lost interest in the victims of this disorder, who may still number in the millions, he has founded the Worldwide Fund for Mothers Injured in Childbirth (www.wfmic.org).

''These kinds of pathologies no longer exist here,'' Dr. Wall noted. But women with fistulas are ''absolutely miserable and absolutely outcasts, reeking of urine 24 hours a day,'' he said, noting that he can restore both the health and dignity of such women.

But does this justify what Sims did? Many do not think so. When Dr. Wall made a presentation on Sims at a recent meeting of the American Association for the History of Medicine, members of the audience challenged the idea that his admirable efforts as a surgeon gave him valid historical insights.

Ms. Brinker is not even sure that Sims's procedure worked, pointing out that his logs do not have follow-up data of his ''cured'' patients. ''It was all about his glory,'' she argues.

Probably the only way to definitively resolve the debates over Sims would be to hear the voices of the slave women who were his subjects. But aside from Sims's statements, their words have not been preserved.

At the very least, Dr. Wall suggests on his Web site, someone should build a statue to Lucy, Anarcha and Betsy.

The story of J. Marion Sims is a reminder of how history gets rewritten over time. The hope, of course, is that each new account gets closer to the truth.

Correction: November 7, 2003, Friday An article in Science Times on Oct. 28 about scholars' views of the medical contributions of a pioneer gynecologist, Dr. J. Marion Sims, misstated the affiliation of one historian and the dates of his writings on the subject. It was in his 1968 dissertation, when he was at the University of California at Los Angeles, not in 1974 and not while he was at Trinity College, that the historian, Dr. Graham J. Barker-Benfield, first wrote that Sims had used slaves as guinea pigs.

Image: Spéculum de Sims. J Marion Sims

From: nytimes.com

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The Plot to Kill Jeff Davis

By Ronald S. Coddington, 3-8-14

Samuel Kingston, a Union soldier and prisoner of war, languished in a dungeon on a late winter’s day in March 1864. The cell was in the basement of infamous Libby Prison in Richmond, Va., the capital of the Confederacy. A severe cough and cold racked his body. His cellmates were similarly affected. Ten in all, they were crammed into a dank, drafty cell not much larger than a common tent. Rebel guards provided Kingston and the others with nothing more than scraps of food for subsistence and an open bucket for a toilet. If some of the guards had had their way, the prisoners would be left to rot in the filth and cold of the converted brick warehouse.

Four of the cellmates were enlisted men of color, who were often abused, if not executed, by their Southern captors. But in the minds of the guards, the other six, including Kingston, had done something even more heinous: They were implicated in an alleged assassination attempt against the Confederate president, Jefferson Davis and members of his cabinet.

The mysterious plot to take out the senior leadership of the South was uncovered in papers found during a Union cavalry raid on Richmond. The stated purpose of the coup de main was to free federal troops held in Libby Prison and the nearby Belle Isle camp.

The raid began on the evening of Feb. 28, 1864. A column of handpicked troopers, 3,584 sabers strong, crossed the Rapidan River at Ely’s Ford, about 65 miles north of Richmond. A half-dozen artillery pieces and a few supply wagons and ambulances accompanied the cavalrymen.

The brain behind the audacious operation was a junior cavalry commander in the Army of the Potomac who worked back channels to sell the plan to the Lincoln administration. Hugh Judson Kilpatrick, a West Point-educated brigadier driven by reckless personal ambition, had a penchant for suicidal charges and pushing his troopers to exhaustion. “Kill Cavalry,” as he became known, had started his career as a horse soldier in the summer of 1861 when he was named lieutenant colonel of the Second New York Cavalry. An amalgamated regiment composed of recruits from New York, New Jersey, Connecticut and Indiana, six of the 10 companies hailed from the Empire State.

Kingston was a latecomer to the regiment. A meticulous bachelor who worked as physician in the bustling community of Oswego, N.Y., he joined the Second as an assistant surgeon in May 1863. He had his baptism to war during the seven-week-long Gettysburg Campaign, although the regiment did not fight in the eponymous three-day battle that broke an unprecedented streak of victories by Confederate Gen. Robert E. Lee and his Army of Northern Virginia.

Half a year later, Kingston mounted his horse and joined his comrades on Kilpatrick’s Raid. Word of the incursion arrived in lightly defended Richmond before the Yankees. The Confederate War Department mobilized an irregular force of soldiers, government workers and volunteers to resist the invaders.

On Feb. 29, during the first full day of the raid, Kilpatrick divided his troops into two columns. He rode hard with the main body of about 3,000 men south to Richmond, while a second, smaller column of 500 men headed to Goochland, northwest of the capital.

Kingston and the rest of the Second were part of the smaller column. It was under the command of Ulric Dahlgren, a 21-year-old colonel and son of a career Navy officer, John Dahlgren. “Ully” spent his boyhood steeped in all things military, and distinguished himself in Union blue. He had led a successful reconnaissance raid into Confederate-held Fredericksburg on Nov. 9, 1862; later, at Gettysburg, he had suffered a severe wound in the foot that resulted in the amputation of a leg below the knee. Still, he soldiered on.

Kilpatrick and his men encountered Richmond’s outermost defenses on March 1 and found them stronger than anticipated. “Kill Cavalry” balked. He turned east and skirmished with Confederates while he waited for Dahlgren’s column to arrive.

Dahlgren, unaware of Kilpatrick’s withdrawal, continued on to Goochland and made a dash for Richmond. According to Lt. Col. Mortimer B. Birdseye of the Second, “This regiment has the honor of being the only Union regiment that passed the outer line of defenses surrounding Richmond during its occupation by Confederate forces.” But Dahlgren and his men ran into stiff resistance as they closed in on the capital. Casualties mounted, and Kingston went to work to save as many men as he could.

Dahlgren pressed to within two-and-a-half miles of the heart of the capital when the defenders finally broke their momentum. Dahlgren acted to save his command. “It soon got too hot, and he sounded the retreat, leaving forty men on the field” stated one of Dahlgren’s aides, 2nd Lt. Reuben Bartley. Kingston, who was uninjured, remained with the wounded as Dahlgren and the survivors fled.

Dahlgren continued on. By now night had fallen, and in the confusion caused by the darkness and enemy activity the column became separated. One section eventually made its way back to Kilpatrick. The other section, under the command of Dahlgren, rode into an ambush arranged by about 150 Confederate cavalrymen and other local volunteers. They descended on the Yankee raiders. Dahlgren was struck and killed by four bullets, and the rest of his troopers were dispersed or captured.

Victorious Confederates found Dahlgren’s lifeless body and stripped it of clothing and valuables, including his wooden artificial leg. One man hacked off one of Dahlgren’s fingers to take a ring. Another, 13-year-old William Littlepage, came away with a cigar case, a memorandum book and a few papers.

Littlepage and his comrades read one of the papers with fascination. “Special Orders and Instructions” provided details about the raid. One statement stood out among the rest: “The men must be kept together and well in hand, and, once in the city, it must be destroyed and Jeff Davis and his cabinet killed.”

The papers were forwarded through military and political chains of command and ultimately to Davis. Publication of the contents days after they were discovered rocked Richmond. Calls for retribution and retaliation rippled across the South. The North promptly denied any assassination plans and declared the documents to be forgeries.

Dahlgren’s body, which had been unceremoniously dumped in a muddy grave near the place he fell, was disinterred and put on display in Richmond. “Large numbers of persons went to see it. It was in a pine box, clothed in Confederate shirt and pants, and shrouded in a Confederate blanket,” reported The Richmond Whig on March 8, 1864.

While this circus played out on the streets of the capital, Kingston and his white cellmates were informed that they had been condemned to death as felons for their role in the alleged assassination attempt. “This news appeared to have a very depressing effect on Dr. Kingston,” noted Lieutenant Bartley, a fellow prisoner.

Kingston’s cough and cold worsened, and he lost his appetite. On March 21, as he lay near death, the Confederates removed him from his cell and sent him North. He survived the trip home, and with good food and care came back to life. He eventually returned to the regiment, was promoted to full surgeon, and served in this capacity until the end of the war.

The Confederates never followed through on their promise to execute the prisoners, which was most likely an idle threat by overzealous guards. But their ill treatment exacted a grim toll. According to Bartley, of the six officers imprisoned in the dungeon at Libby Prison, only three survived. He did not mention the fate of the four black soldiers.

Kingston was forever damaged by the ordeal. Back home in Oswego, he was frequently incapacitated by illness, and often doctored himself. His mental health appears to have suffered as well. An acquaintance described him as “a very odd & peculiar person.” Still, he managed to practice medicine and work as a druggist. A cerebral hemorrhage ended his life in 1889, at age 53. His wife, Anne, whom he had married in 1875, and two daughters survived him.

Follow Disunion at twitter.com/NYTcivilwar or join us on Facebook.

Sources: Samuel T. Kingston military service record, National Archives and Records Administration; New York Monuments Commission, “Final Report on the Battlefield at Gettysburg”; John Dahlgren, “Memoir of Ulric Dahlgren”; Philadelphia Inquirer, March 4, 1864; Frank Moore, “The Rebellion Record: A Diary of American Events”; Richmond Whig, March 8, 1864; The New York Times, March 10, 1864; The War of the Rebellion: A Compilation of the Official Records of the Union and Confederate Armies; Anne E. Kingston pension record, National Archives and Records Administration.

Ronald S. Coddington is the author of “Faces of the Civil War” and “Faces of the Confederacy.” His most recent book is “African American Faces of the Civil War.” He writes “Faces of War,” a column for the Civil War News.

Image: Artist Edwin Forbes sketched Kilpatrick's Raid to Richmond, circa Feb. 28 to Mar. 11, 1864.Credit Library of Congress

Photo: Samuel Kingston sat for this portrait in the photographer Mathew Brady’s New York City studio, circa 1863.

From: opinionator.blog.nytimes.com

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Wounded Warriors: Civil War Amputation

Compiled by Laura June Davis

In the heat of battle, Civil War doctors often had to make quick diagnoses of soldiers’ injuries. According to The Medical and Surgical History of the War of the Rebellion, 1861-65, 70% of all wounds were to the extremities—35.6% to the upper extremities and 35.2% to the lower extremities. These statistics help explain why surgeons performed so many battlefield amputations; if they couldn't save the limb, they wanted at least to save the soldier’s life.

When deciding whether or not to amputate a limb, a cursory probe of a wound was often the only examination a doctor had the time (or the ability) to conduct before beginning surgery. The high frequency of amputation was often attributed to the damage created by minié balls, which shattered bones and mangled tissue, but the high risk of bleeding, infection, and gangrene were deciding factors as well. By war’s end, Union and Confederate surgeons had performed an estimated 60,000 amputations.

Image: Though staged after the war, this image is one of the few existing photographs of a Civil War era amputation surgery. This "surgery" was staged outside of a Gettysburg hospital tent. (Image credit: Library of Congress.)

From: civilwarmonitor.com

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The Dangers of Amputation Surgery

From: civilwarmonitor.com

This drawing of Union soldier Milton E. Wallen highlights the dangers of amputation surgery. After having his arm removed by Confederate doctors, Wallen headed toward Union lines for medical attention. While recuperating at the Navy School Hospital in Annapolis, Wallen’s stump became infected with gangrene. “Hospital gangrene” was a chronic problem during the war. A small black spot would appear in the wound and slowly expand, resulting in loosened skin, necrosis of body tissue, and corresponding putrid smells. The likelihood of gangrene increased the longer an amputation surgery was delayed—thereby increasing the likelihood of death post-surgery. However, by 1864, Union surgeons learned to control gangrene by pouring carbolic acid—a painful but effective antiseptic—over the infection. (Image Credit: National Museum of Health and Medicine.)

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Andersonville Amputation

From: civilwarmonitor.com

This photograph of Corporal Calvin Bates of Co. E, 20th Maine Infantry, reminds us that not all amputations resulted from bullet wounds. A prisoner at Andersonville, Bates suffered inhumane treatment at the hands of his prison guards. His maltreatment resulted in illness, decay, and ultimately the amputation of his feet.

Learn more about Civil War prison conditions at www.CivilWarRx.com.

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The Civil War and P.T.S.D.

By Dillon Carroll, 5-21-14

Edson Bemis was a hard man to kill. Rebel soldiers tried three times, and three times they failed. At the Battle of Antietam, a musket ball ripped through his left arm. Two years later, in the horrible fighting in the Wilderness, he was shot in the abdomen, just above the groin. The ball was never extracted, remaining in his body until the day he died.

The Confederates came the closest to killing Bemis in February 1865. At Hatcher’s Run, Va., a Minié ball struck him in the head. He lay near death for several days, his skull cracked and leaking brain matter. Most passed him off for dead. Dr. Albert VanDevour, however, did not, and instead performed a risky surgery to remove the bullet from his skull. Bemis improved immediately, eventually recovering, much to the shock of everyone.

The war was finally over for Bemis. He moved to Suffield, Conn., with his wife, Jane, where they hoped to start a new life. He began working for W.W. Cooper’s, a local merchant house, but very quickly it became clear to everyone that Bemis was not right. One of his colleagues at W.W. Cooper’s, George N. Kendall, described his health as “never very good,” and Bemis began to suffer from “spells of vertigo” or “something that afflicted his head” so much so that he frequently could not work.

Kendall noticed that Edson was also “very forgetful.” He had wild mood swings, and Kendall wrote “any little thing irritates him.” He was increasingly subject to memory loss. Sometimes, for several hours each day, he had no memory of where he had been or what he had done. Eventually he had to stop working at W.W. Cooper’s because of his condition.

In 1890, Bemis suffered what appeared to be a stroke, and his condition, which was already bad, got exponentially worse. A pension official came to Suffield to interview the Bemis family and friends, and immediately noticed that although Bemis was only 55 in 1895, he walked “like a man of 80!” His wife had to assist him in dressing, she had to “cut his meat and wash his potatoes” and she described him as being “like a child.” The pension official wrote that Bemis’s only job each day was to go to the post office “right below here for the mail and to a few houses above for a pail of milk every day this is all he can do.”

In 1900, Jane had apparently had enough, and Bemis was examined and institutionalized in Westboro Insane Hospital in Westboro, Mass. By this time, his condition had spiraled even further. A doctor at Westboro, Lewis Bryant, wrote that Bemis believed he was “thirty years old” but he could not recall the present “year month or day of the week.” Bemis believed that “the civil war is still going on” and, occasionally, would “see dogs in the room.” Bryant described him as “silly, emotional, crying and laughing without apparent cause” and having “little memory confusing the present with the past…soils his clothing has had delusions and false sights, and at times requires the care and attentions usually given a child.”

Celestia Bemis, his sister, who coincidentally married a man with the last name Bemis, came to Westboro and took charge of Edson, taking him to her farm in North Brookfield. Celestia and Jane did not get along, and their feud spilled over into the notes of the pension official who occasionally checked up on Bemis. Jane claimed that Celestia ordered her to stay away from him, because her presence excited him too much, while Celestia claimed that Jane had never once tried to visit Bemis, and was content to keep cashing his pension checks without ever seeing him. Jane last saw her husband in August of 1900; he died two months later. She continued collecting a pension until her death in 1917.

Bemis’s story was not an uncommon one among Civil War veterans. Historians are beginning to uncover what was a virtual epidemic of emotional, psychological and neurological trauma that afflicted soldiers after the war. Veterans labored under emotional and psychological stress in ways that are disturbingly similar to the present. Alcoholism was rampant, as was unemployment. Suicide was endemic. Civil War veterans dotted the wards of insane asylums across the country.

Modern science would most likely have given Bemis a diagnosis of traumatic brain injury, caused by a blow to the head or a penetrating injury of the skull. Such injuries are all too common among veterans of Iraq and Afghanistan today. Symptoms of T.B.I. range from headaches, confusion, lightheadedness and dizziness to fatigue, mood changes, depression, changes in sleep patterns, restlessness and agitation. That seems to be consistent with Bemis’s litany of postwar complaints.

If so many Civil War veterans were troubled with emotional and psychological trauma, why has it taken us so long to discover them? Veterans were loath to admit they were traumatized. In the 19th century, mental illness carried a tremendous stigma, and most veterans fought a private battle rather than disclose their trauma.

Additionally, most families preferred to care for mentally ill loved ones at home. Bemis’s care as his mental health declined became a community project. Jane certainly performed the lion’s share of the work. She dressed him, fed him, and sometimes had to help him in the bathroom. But she could not watch him all the time. A.P. Sherwin, a local doctor, later testified that everyone “in town knows soldier to be mentally afflicted” and all the people in Suffield near the Bemis household “watch him closely.” Jane Bemis testified that she did not watch him “on the street” because “everybody knows him” and that he only “goes a short way from home.”

Finally, the relationship between warfare and psychological trauma has only recently become better understood. War trauma has distressed veterans in nearly every war, but the whispers of shell shock and combat fatigue never really entered the public consciousness. It was not until after Vietnam that veterans’ groups successfully lobbied the American Psychiatric Association to include post-traumatic stress disorder in the Diagnostic and Statistics Manual of Mental Disorders. Since then, our understanding and empathy for veterans afflicted with psychological trauma has grown rapidly. Bemis’s life demonstrates that combat has been damaging to the human brain and the human psyche long before we were willing and able to give the maladies a name.

Follow Disunion at twitter.com/NYTcivilwar or join us on Facebook.

Sources: Soldier’s Certificate No. 59,267, Cpl. Edson D. Bemis, Company K, 20th Massachusetts Volunteer Infantry, National Archives; Case Files of Approved Pension Applications of Veterans Who Served in the Army and Navy Mainly in the Civil War and the War with Spain, 1861-1934, National Archives; Steven T. DeKosky, “Traumatic Brain Injury: Football, Warfare, and Long-Term Effects,” in the New England Journal of Medicine 363, No. 14 (Sept. 30, 2010); Rebecca J. Anderson, “Shell Shock: An Old Injury with New Weapons,” Molecular Interventions 8, No. 5 (Oct. 2008); Emily Singer, “Brain Trauma in Iraq,” Technology Review 111, No. 3 (May–June 2008); Jeanne Marie Laskas, “Game Brain,” GQ, Oct. 2009; Ben McGrath, “Does Football Have a Future?” New Yorker, Jan. 31, 2011.

Dillon Carroll is a graduate student in history at the University of Georgia.

From: opinionator.blog.nytimes.com

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