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Civil War Medicine: David Price
41 Plays1 year ago
Season 2, Episode 16: David Price is the executive director at the National Museum of Civil War Medicine in Frederick, MD. Listen to David discuss the medications used by Civil War physicians, the legacy of Dr. Jonathan Letterman and the similarities between the Civil War and the COVID-19 pandemic.
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Transcript
Origins of the Museum & Notable Artifacts
00:00:09
Speaker
You're listening to The Wound Dresser, a podcast that uncovers the human side of healthcare. I'm your host, John Neery.
00:00:22
Speaker
Today, my guest is David Price. David is the executive director of the National Museum of Civil War Medicine in Friedrich, Maryland. He also oversees the Clara Barton Missing Soldiers Office in Washington, DC, and the Pry House Field Hospital Museum in Keatiesville, Maryland. David, welcome to the show. Hey, thanks for having me. Pleasure to be here.
00:00:46
Speaker
So can you first tell our listeners how the National Museum of Civil War Medicine got started and about its mission and values today? Yeah, so there's a lot of collectors out there of Civil War memorabilia, and our founder, Dr. Gordon Domen, who is a retired dentist from Illinois,
00:01:06
Speaker
was one of those collectors and he came across a few unique items that were medically oriented and being a trained dentist kind of struck a chord with them. Two in particular, one had to do with Dr. Jonathan Letterman
00:01:24
Speaker
who is our rock star here today, known as the father of battlefield medicine. And another one with a gentleman named Peilig Bradford, who was just a common soldier from Maine, who experienced everything that we interpret here.
00:01:41
Speaker
So as a common soldier, he enlists, thinks he's going to be a hero, short war, going to come back with ribbons and medals and stories. But the truth of the matter is he enlists, goes to camp, gets the measles, recovers, sees his first action, is wounded, has to have his leg amputated, and is afraid that his hometown sweetheart won't accept him when he returns as less than a man.
00:02:09
Speaker
though the good news is she does, and they have seven grandkids. So he goes through the entire process of medical care in the Civil War and what most soldiers experienced. And Gordy was lucky enough to get his cap, and he said that pay like Bradford would just show up at some of these shows he would go to buy memorabilia with.
00:02:32
Speaker
He then gets a piece from Jonathan Letterman, who was the medical commander of the Army of the Potomac. His story is just incredible and affects your life today. Those two combinations of artifacts
00:02:51
Speaker
that he acquired really led him to dive into a specific area of Civil War history and then it was focused on Civil War medicine and the experience of the common soldier and how
00:03:10
Speaker
woefully unprepared the army was for this type of conflict. He had a group of friends out there that were also Civil War collectors, but Gordy just focused on medicine and then they would look out for things for him. So the majority of our collection is from his personal quest.
00:03:38
Speaker
Yeah, as I understand, you have a collection of over 5,000 artifacts or so, right? We do. And could you just tell our listeners about some of the notable items on display? Oh, wow. So we have so many cool things. One of the highlights that we have on exhibit, because with any museum, you struggle to have enough room to put all the cool stuff out.
Medical Challenges & Innovations of the Civil War
00:04:03
Speaker
And one of the coolest things we have is a surgeon's tent from the Civil War, from a gentleman named Surgeon John Wiley. And what's so cool about it is that there are many tents that exist from the Civil War, but we know what we have is a surgeon's tent because it was handed down
00:04:25
Speaker
to his descendants, along with his personal effects. So in the exhibit area, you see his tent plus a picture of the surgeon in front of that buried tent during the Civil War, plus a CDB of him and his personal effects and a small kit that he had. And that's one of the cool objects we have. One of the ones that's not on display that we plan on putting out there this year at the Clara Barton Museum
00:04:55
Speaker
is Clara Barton's camp stove. It still has soot in it from when she used it. And that is just so cool when you touch that thing and you end up with soot on your fingers. She writes about how much she loves her little camp stove when she goes to several battlefields. And it's almost like a Boy Scout will have because the way they built it, all the components fit inside each other and it almost carries like a little suitcase.
00:05:24
Speaker
And we had the pleasure of having Vanderbilt University come down and 3D scan the image and as we put it together. So we'll have that up online as well. But boy, man, there's just.
00:05:40
Speaker
Every few weeks, we just get tremendous opportunities with artifacts and material culture, the latest of which is a CDB of Walt Whitman that signed along with a gentleman that he cared for
00:05:57
Speaker
and the gentleman wrote about his experience with Walt Whitman and Walt Whitman wrote to him. So those in combination lead to this incredible story that you can just sit there and get chills when you hear it and see those things. So we got a lot of cool stuff.
00:06:16
Speaker
Yeah, I'm glad you brought up a lot women. He's definitely like a hero where where I go to school in Camden. So I we've kind of, you know, read some of his poems about the Civil War. I was going to read an excerpt later on, I will get to that. But just just a really cool storyteller when when he talks about the the Civil War in general, but really Civil War medicine too. Oh my gosh, yeah. In terms of
00:06:41
Speaker
kind of thinking about the medicine that was being practiced, what were the biggest medical issues that were facing the North and the South during the Civil War?
00:06:54
Speaker
That's a big question. There's like three components of your question there. One, were there differences between the North and the South? Not as many as you would think, because like all the stories that you hear of generals who had studied together at West Point, ending up meeting at the battlefield,
00:07:12
Speaker
That means that they studied in the same schools, learned the same tactics, and then, you know, implemented them against each other. The same holds true for surgeons. They all went to school together, whether Southerners went North, Northerners went South. They had the basic same knowledge, and they knew each other.
00:07:36
Speaker
So they would exchange information when they encountered each other on the battlefield, because the lines of battle would often shift one way or the other, and the hospitals wouldn't be able to move like the soldiers would, and the patients wouldn't be able to move. So a lot of times these surgeons stayed behind, and they would see people they know. And they would exchange information based on what was working, what wasn't. And so keep that in mind. Overall, bigger picture.
00:08:06
Speaker
Prior to the Civil War, we had more in common, American medicine had more in common with the Greeks, with biles, with fluids, with phlegm, you know, wonderful stuff like that. They were treating the symptoms rather than the causes. As the Civil War progresses, those four years, we end up totally adopting the scientific method of medicine, scientific method of medicine as we know it today.
00:08:37
Speaker
This is due to the fact that you had more mass casualties than you'd ever seen before and you as a medical care professional are just trying to save the lives of your fellow man and you're gonna innovate and you're going to try to use the latest techniques. There's also a transformation from the organizational level as far as the Army's concerned and that you have
00:09:05
Speaker
folks from the old school of thinking, the Greeks, and then they're slowly replaced due to their ineffectiveness, quite frankly, with modern thinking scientific method folks like Surgeon General William Hammond, who's half the age of his predecessor when he takes over as Surgeon General of the Army.
00:09:27
Speaker
So it's a total transformation of American medicine and really the birth of the modern healthcare system as we know it. Down to the ambulance level, there was no ambulance corps at the beginning of the war. There was at the end, there was no nursing corps at the beginning of the war. There was at the end the role of women in medicine. There were no women in medicine unless you were a nun.
00:09:54
Speaker
And then at the end of the Civil War, you've got women leading the way. I mean, it's just a transformational time in medicine. And what is so strange is you can thank the Civil War, the bloodiest conflict in American history on our soil for that transformation. And it's basically because there was such a need for care and compassion.
00:10:20
Speaker
I think often Civil War medicine can get a bad rep if you're watching Gone with the Wind or something and you see the field hospitals and the amputations. But from what I've gathered from some of the resources on your website, that wasn't necessarily the case.
00:10:37
Speaker
Yeah, so there's like three things we try to instill in everyone that visits here either virtually or in person. Number one, 95% of all operations were performed under anesthesia.
00:10:54
Speaker
chloroform and ether had been discovered many, many years before that and had been in use. Now, in fairness, there weren't a lot of surgeries performed in America because there wasn't a lot of need for it. But they did use it in some dentistry, which they still do today, and that ties into our founder as well.
00:11:15
Speaker
So that goes against every movie you've seen. Kevin Costner, Bite and the Stick, and Dances with Wolves. We have a lot of fun critiquing and tearing apart medicine as it's portrayed back then. So 95% under anesthesia and two-thirds died of disease. So that means twice as many died of possibly preventable conditions rather than bullet wounds.
00:11:40
Speaker
So the latest statistics are 750,000 casualties during the Civil War. That means half a million died of diseases and only 250,000 from artillery wounds or bullet wounds, bayonet wounds, those kind of things.
00:11:56
Speaker
So those two things and then the third is bureaucracy is not necessarily a bad thing because the only way we can tell our story about the transformation of medicine is that the surgeon generals and the higher ups in the military required doctors to send in reports and specimens to Washington so that we could gain that knowledge and have that to move forward in medicine.
00:12:24
Speaker
So it basically takes us from last place in the world in medicine on the battlefield to first place because of that gathering of information and reports that ends up being the basis of the National Museum of Health and Medicine.
00:12:41
Speaker
Zonian, more on the amputations, I understand that a lot of soldiers dealt with gangrene. That was a really common problem that soldiers had. Can you describe the process of treating that and the decision making process into whether or not to give an amputation?
Evolution of Medical Practices & Education
00:13:00
Speaker
Yes. About 60,000 amputations are performed. Had more been performed, more lives would have been saved.
00:13:08
Speaker
The main culprit or cause of that capital operation is the miniball. The bullets they were using were large, 58 caliber. They were made of lead, which means when they hit bone, they splattered and scattered inside your arm, inside your leg. So there was no way to retrieve all of those particles. So the best way to do it would be to amputate.
00:13:37
Speaker
Gangrene, hospital gangrene in particular, you talk about a morale demoralizer. If you ended up in the hospital, you were scared to death of hospital gangrene. It smelled, there's many stories of you could actually look at your wound and see it progressing up towards the upper part of your body or wherever it was originating from, it was spreading.
00:14:06
Speaker
they knew they had to figure out what to do with that. So one of the solution was bromine and there were parallel tests that they came up with and they did it in, I think it was Philadelphia, Nashville, and here in Frederick, Maryland.
00:14:23
Speaker
And they tested bromine in cans with a little bit of water, sometimes just bromine, and it would go in the air. Then they decided to try to dip it on the actual wound, and lo and behold, it stopped the spread of hospital gangrene. And they disseminated that information to the entire army, and it almost became non-existent because they found the solution with those tests. You talk about a morale booster at that point.
00:14:51
Speaker
Then all of a sudden, soldiers aren't scared to death to go into a hospital and recuperate from an amputation because, you know, initially they're thinking, oh, my God, this is a death warrant. Gangrene is going to set in. I'm seeing it next door to my buddy. Oh, my gosh, I'm just going to die. Now you're in the hospital. You don't have to fear that. And by the end of the war, the the the pavilion hospitals and the
00:15:20
Speaker
the brick and mortar hospitals in the big cities had a 92% chance of survival, only an 8% mortality rate. And it's mainly because, now you went through hell to get there, don't get me wrong, but you didn't have to fear gangrene. You mentioned bromine. What were some of the other medications that were in toolkits for medical professionals at that time? So you had a couple of different kinds of kits.
00:15:48
Speaker
Letterman, our rock star here, the father of battlefield medicine, develops a system, echelons of care basically. So the first battle of Manassas in 1861 is the first major conflict. The wounded lay on the battlefield from 48 hours to two weeks. Many died of exposure rather than initial wounds.
00:16:13
Speaker
Letterman is put in charge, new generation of thinking, and he basically brings order out of chaos.
00:16:21
Speaker
So he instills several levels of care. The first one being a field dressing station, where your main job is to stop the bleeding. You are finding a spot near enough to the battle that you can help those who are recently wounded. And you have the golden hour, the golden 15 minutes people talk about to get to a patient who's in critical care. This was like the golden 24 hours, let's say.
00:16:51
Speaker
But you would try to be as close to the action without being wounded yourself. And you would basically have a small little suitcase and you'd have laudanum, you've had opium, you'd have water, you'd have whiskey probably. These are like a lot of comfort.
00:17:07
Speaker
level items, but your main job would be to tourniquet any bleeding off and if you were terminally wounded they would try to give you an opioid, laudanum kind of mixture which would be an opium with whiskey or some sort of liquid to make you as comfortable as possible. So there was pain medication to try to help people alleviate most of the pain.
00:17:34
Speaker
Once you're treated there, the ambulance system, which was newly invented, thank you Jonathan Letterman and William Hammond, and they would come to that field dressing station, which was a specified place, and they would take you to a field hospital where the amputations would be performed. And there you would have
00:17:52
Speaker
more, instead of a suitcase, you'd have a wagon full of stuff, medications. And there's a wagon that we have a replica, a small section of called the Autneries Wagon, and I call it a rolling CVS that would roll up with
00:18:08
Speaker
a lot more medications. But those medications might be sulfur. They might be coffee, literally. It just runs the gamut. Mercury was applied liberally for almost everything. That would be in that wagon. And then the next level, after you are treated there, you would go to the Pavilion Hospital or you would be evacuated
00:18:38
Speaker
via the highways of day, which were rivers or railroads, and you would be taken to a major city where you would have even more choices of medications and treatments and hopefully, like I said, 92% of chance of survival there. Those would be in, like I said, in major cities and they would have access to a ton of medications and the latest procedures and really more knowledge as well in those locations.
Understanding Medical Practices & PTSD
00:19:08
Speaker
Going off that, I'd like to ask about a lot of the sterile practices that were in use at that time. I just read a really cool book about James Garfield and his assassination, and it sounded like a big role in his actually dying was not necessarily the wound, but the lack of sterile knowledge he had at the time.
00:19:30
Speaker
I think early 1880s. So you're looking back, Civil War is like, you know, 15 years or so before. So where were they kind of at? What precautions were doctors and nurses taking to kind of, you know, keep the areas of care clean and sterile? Yeah, the Garfield story is great. We have a former staff member who developed a talk called How Civil or Medicine Killed Garfield.
00:19:55
Speaker
You know, germ theory is probably 15 years too late for the Civil War. It was around, but no one had adopted it over here. Again, we're trailing Europe in medical knowledge and medical practices.
00:20:14
Speaker
didn't understand that washing your hands was a good thing. Most of the surgeons who washed their hands were doing it because they had so much blood on the hand to get it off so their instruments wouldn't slip out. Your most effective probe wasn't in your surgical kit. It was the appendage on your hand. It was your finger. You were feeling around a lot in there. And that and the fact you're not washing, predictable results, right?
00:20:40
Speaker
And that was kind of Garfield saying the same with Lincoln, actually, in his assassination. They talk about probing around in his head for the bullet with their fingers. And to us, it's like crazy that they would do that. But in the day, it was their base of knowledge. And you have to judge them by the context of their time.
00:21:08
Speaker
One thing that's a great story is the South, the Confederacy ran out of sutures. Instead of having silk sutures, they had to improvise. One of their improvisations was using hair from a horse's tail, using horse hair. But in order for it to be malleable, they had to boil it.
00:21:30
Speaker
which then has the predictable effect of it's sterilized. So then they noticed that their operations that had to use those sutures to stitch them up had less infection than they did with the store-bought stuff. So they're constantly innovating and giving feedback. There's a couple of Hollywood movies that have, I forget what it is, a John Wayne movie where he's,
00:21:59
Speaker
He actually has a freaking stethoscope around his neck, and there's no way he had that. And he's got a white apron on. These guys were sometimes operating in their coats or their street clothes. They did have aprons, but they weren't white, and they were really to have pockets in them to hold their kit or just to wipe your hands off on your chest and stuff. They didn't have the base knowledge of the causes of infection, bacteria, and those kind of things.
00:22:29
Speaker
So seeing they didn't have the knowledge of the bacteria, germ theory, I just read a really cool post on your website about, I think it came out a couple days ago about medical education during that time. You said guys from the North were going South and people from the South were going North for medical education. They all kind of had similar training, but what was that training like at the time of the Civil War?
00:22:52
Speaker
So you would appreciate this. You only had to go to school for two years. And it's not a full two years, mind you, because it's only a couple months out of that because of the weather. And we're still an agricultural society. So you're really only talking a couple months per year.
00:23:09
Speaker
And it was basically a group of doctors that got together and said, hey, let's start a medical school. And this is definitely simplifying it. And they would go to an existing institution, a college, and say, hey, we want to start a medical school, and we're going to use your facility to do it. And they'd say, OK. So basically, the institution would get rent from it, right? But we as the doctors who formed the school would be responsible for collecting tuition
00:23:37
Speaker
administering the tests and giving a diploma. There was really no medical board that had a universal test. So what I tell a lot of eighth grade groups that come through is like, how would you like to repeat eighth grade with the same teacher, the same tests, the same seat, the same movies you're watching? And they thought repetition was the way to educate.
00:24:00
Speaker
In Europe, you would actually be able to see a patient because they actually had hospitals as we know it. In America, hospitals were really death houses. Healthcare was delivered to your home, which sounds awesome today, but the doctor was coming on horseback.
00:24:20
Speaker
He was tying up his horse in front of your house. He would smack the horse on the rear, rub its mouth and nose and say, thanks, buddy, for getting me here. And then he'd come and give you an oral exam and check you out with all those germs on it. But health care was coming to your home. If you ended up in the hospital in America, it was usually because you were poor, didn't have family, and they were known as death houses, really.
00:24:44
Speaker
So if you wanted a good education and to actually treat patients, you would have to have enough money and resources to go study in Europe and France and England and Germany. And they were really leading the way at that time.
00:25:00
Speaker
After you graduate, you get your diploma, you try to find an apprenticeship somewhere with a doctor, you spend time with them. How do you decide when you're ready to practice on your own? A lot of times it was when an opportunity presented itself. If you heard about a town maybe 10 miles away that needed a doctor, you might go there and set up your shop and just stick around for a while and start practicing medicine. So it's nothing like we know today. It was in its formative years, which is a kind of a kind way to put it.
00:25:31
Speaker
Was there any real specialization or was it like the guy who was doing brain surgery was inspecting your feet, inspecting your eyes, just kind of doing the whole thing? Yeah, yeah. You were definitely a general practitioner, shall we say. You were covering every base there was. The specialization starts to occur during the Civil War because you had a lot of similar wounds.
00:26:01
Speaker
And remember, hospitals, as we know them today, really hadn't been invented yet. So Hammond, the young surgeon general, who ends up being court-martialed because he, though he transformed the entire medical system to great success, ends up being court-martialed because he has the crazy idea that, hey, we shouldn't prescribe mercury. Mercury is bad. The old timers hated that. Court-martial him.
00:26:30
Speaker
you know, after review and time that is rescinded and he is put back in his private place in history. But yeah, specialization occurs because they had to, some of these pavilion hospitals like Chimborazo and Richmond had 8,000 patients
00:26:54
Speaker
So to organize them, they would put, say, all leg wounds in one building, and they would put all nervous wounds, meaning PTSD potentially or shock, in another ward. And that is truly the beginning of specialization.
00:27:14
Speaker
It really didn't exist prior. Most people thought of anyone who said they specialized in something as someone who didn't know enough to be a general practitioner. It's kind of backwards to what we think of today. Brain surgeon, that guy's really smart because he knows all about the brain. I'm going to go see him from my brain. Back then, a guy said he's brain surgeon. He's like, man, I have a stomach ache. You can't treat me? You must be an idiot.
00:27:44
Speaker
It's just a different time, so you kind of have to judge everything from that time period. What was the understanding of PTSD at that time? I think I've heard a term before, like, battle fatigue was kind of the term they threw around. What was the state of mind around that kind of trauma associated with war? So what we say here is PTSD is
00:28:13
Speaker
has had to have been around any time anyone has gone to war with each other because there are psychological effects to that activity. And you're right, battle fatigue was one term they used during that time period. Nostalgia was another. Soldier's heart, which I think is kind of an enlightening term if you really think about it.
00:28:38
Speaker
The homesickness even was a term they used for it. They just did not understand it. And regrettably, a lot of those guys suffering from what we now know as PTSD and identify
00:28:51
Speaker
um, were put into insane asylums. And, um, you know, there's, there's tons of tragic stories about that. And a lot of them went to St. Elizabeth in DC, which, which still is operating as a hospital, small portion of it. Um, and they, they really, suicide was a huge problem then as it is now today. Um, you know, and when you're, when you're in that state of mind,
00:29:17
Speaker
The cool thing about studying the Civil War is that it was a very literate society, so there's a lot of journals and a lot of letters that are even being found today in families' causes. A lot of those with the veterans in particular, you can recognize their suffering in just a sentence or a comment. You got a two-page letter, and then you see a sentence or two about their experience, and you're like,
00:29:47
Speaker
That guy was hit hard and it affected him.
00:29:51
Speaker
Regrettably, a lot of tragic stories about people who couldn't come back and reenter society with just a job and their families. They just didn't understand it and they did use those terms. But inevitably, you either faked your way through society or if you couldn't, you would be probably put in an insane asylum or dismissed from society in some way.
Whitman's Perspective on Civil War Care
00:30:22
Speaker
I think that was actually a good time. I was gonna read you a little excerpt from the, I'm sure you've heard it a hundred times, but maybe our listeners haven't, the wound dresser by Will Whitman, just like a great poem that kind of illustrates a lot of the realities of war and what people were going through. So here's a quick excerpt from that. Bearing the bandages, water and sponge, straight and swift to my wounded I go, where they lie on the ground
00:30:51
Speaker
after the battle brought in, where their priceless blood reddens the grass, the ground, or to the rows of the hospital tent, or under the roofed hospital. To the long rows of cots up and down, each side I return. To each and all, one after another, I draw near. Not one do I miss.
00:31:14
Speaker
and the tenant follows holding a tray. He carries a refuse pail, soon to be filled with clotted rags and blood, emptied and filled again. I onward go, I stop, with hinged knees and steady hand to dress wounds. I am firm with each, the pangs are sharp yet unavoidable. One turns to me, his appealing eyes, poor boy, I never knew you, yet I think,
00:31:43
Speaker
I could not refuse this moment to die for you, if that would save you. So some pretty powerful stuff, like what kind of comes to mind when you hear that? Oh my gosh, just the intimacy of that care.
00:32:01
Speaker
Every line is about the intimacy of another human being and trying to care for them. And the things that stick out to me are in the beginning of that that says he's got water and a sponge. That's his kit. He's got water, a sponge, and a bucket in his heart. That's it.
00:32:30
Speaker
And it reminds me of Clara Barton's experience and anyone else, Laura Ingalls Wyatt or Dorothea Dix, anyone who nursed during the civil war, that was their role, was to really come and give any comfort they could. So what I think, and then the other thing before I extrapolate on that, the other line in that is blood on the ground.
00:33:01
Speaker
We see our experience with medicine is the blood's always spilled over a shiny floor that's been mopped and will be mopped afterwards. But the ambulance trains that were coming in battle after battle, especially here in Frederick, there are many local diarists who write about the roads turning red with blood, the clay being red clay that wasn't red before.
00:33:30
Speaker
It's a reminder that we are of the earth and it's powerful. What a blessing it is to have someone, a poet like that, that did that, that could convey that over generations. And I think that's why our museum does so well and really sometimes transforms people. It always blows their mind to come here.
00:33:55
Speaker
because they have that preconception, as probably Whitman did, and any of those caregivers, that this war is gonna be over short, and it's gonna not be bloody. Nobody was prepared for what they saw. And then they all experience it, and Whitman's able to write about
00:34:15
Speaker
that powerful experience. And hopefully people read more of it so that they want to avoid war and its repercussions. That's a constant battle. But that's Whitman.
00:34:30
Speaker
times thousands because you had folks like Clara Barton doing the same thing. She shows up at Antietam when the doctors are using corn husks for bandages. She becomes an angel of the battlefield because that woman was a one-woman army of logistics and supplies, and she would take those as a woman
00:34:56
Speaker
straight to the front lines of the battlefield where she nurses a soldier. And when I say nurses a soldier, it harkens back to that sponge in water. She's giving a soldier who is dying a last cup of water. And she's so close to the action that a bullet goes through her sleeve of her dress and it kills the man she's giving a drink of water to.
00:35:18
Speaker
I mean, that experience, and she does that over and over again, and Whitman does this over and over again in his line about, you know, he has to stop on bended knee, but there's so many of them, you know, repeats over and over and over again. I mean, mass casualty event, after mass casualty event, after mass casualty event, it's just, I can't imagine. And, you know, I think the lesson of Whitman and Barton is
00:35:47
Speaker
Even though the situation is overwhelming, that individual care to another human being is incredibly important to the person you're giving the care to, but also the one next to them who sees that there's hope. There's so many stories about that.
00:36:08
Speaker
And Whitman, one of the biggest things he did for soldiers was to write letters home so that there'd be closure for families. I mean, it's just really powerful stuff. And Whitman, of course, is a master. So it's a cool poem.
00:36:28
Speaker
I definitely resonate with a lot of the things you said. I love that word intimacy that you use. I feel like that's such a on point word for a lot of the nurses and what people, those caregivers really did in those moments that they couldn't necessarily cure them or fix their situation, but that they were kind of just there for them and comfort them.
00:36:51
Speaker
It's really, really beautiful and really model behavior when we kind of think about healthcare. It's today, too. My dad has passed, my mom is aging, and when we have to go into the healthcare system, those nurses and doctors who show caring
00:37:10
Speaker
and then that caring is intimacy. When you can feel that, you've got a better shot of feeling better. You've got a better shot at recuperation. If you've got somebody who's kind of phoning it in, and in modern situations, you still have healthcare folks who are so busy with workloads or whatever, that they don't project the intimacy that probably got them to that point, I truly believe they're not as effective.
00:37:42
Speaker
Oh, absolutely. Yeah. Yeah. You were kind of leading right into my next question there, which was like, what can sort of the legacy of Civil War medicine give to our current health care system? Yeah. I mean, those examples of what Whitman writes about, I mean, if you really read it and it gets to you, they are armed with nothing but
00:38:04
Speaker
care in their hearts. The tools they have are that sponge and water. Regrettably, our past conflicts in America, if a soldier gets wounded,
00:38:21
Speaker
Within three hours, they can be back in Germany. Instead of horses, it's helicopters. Instead of horses, it's Humvees, then helicopters. And they can be evacuated straight to this top-notch medical facility, right? Well, the military right now, which is why we do a lot of military programs, is preparing for conflicts where we do not have air superiority and the ability to evacuate patients.
00:38:49
Speaker
Think about what that means. That means if you and I are in a unit, we get wounded. The Calvary is not gonna come and save us and get us out of there and get us to Germany in a level one trauma care center. We're gonna have to take care of each other and we're gonna have to deal with a first aid kit. We're gonna have to stop the bleeding and then we're gonna have to figure out how we keep each other alive.
00:39:18
Speaker
with minimal resources, which if we're lucky will be water and a sponge. So I think Civil War medicine, Civil War nursing teaches us that first of all, we have to bring compassion
00:39:39
Speaker
And then secondly, we just need to use whatever we have to either alleviate pain or to keep people alive. It's not going to be pretty. Now, having said that, we like to say there's hope in history if you learn from it. And again, it goes back to Walt Whitman and Clara Barton.
00:40:08
Speaker
And a lot of the surgeons, there's a preponderance of Medal of Honor that go to surgeons that perform unbelievable feats. And particularly military health care professionals, I am just constantly amazed because you're talking about nurses and doctors who are carrying guns, who have taken the Hippocratic Oath, and their ethical lines are entirely different from the common infantry soldier.
00:40:38
Speaker
There are different rules of engagement, just a whole other way of having to think about war conflict and saving lives. So there are lessons of that in the Civil War over and over again of people showing compassion to their enemy and their friends.
00:41:03
Speaker
I really liked two of the things you said there. One being, I guess, you know, you kind of just assume, right, that like in 2023, soon to be 2024 that, you know, in sort of all these different military clinical scenarios that they can get back to some sort of like, you know, advanced healthcare setting. But even now today, there are scenarios where it's literally, you know,
00:41:29
Speaker
people have to step up to the plate and just be Walt Whitman or Clara Barton or any of those heroes from the Civil War. The other thing is just like the ethical lines. I've thought about this a lot too. Certainly physicians have different, it's just a different headspace when you're thinking about what they're doing. Because in some ways, you were talking about how the doctors from the North and the South were talking.
00:41:56
Speaker
the military personnel weren't talking, but the physicians were and they were collaborating because their kind of goals were a little bit different because of their perspective as physicians. And I think that also shows up a lot with when you think about like pastoral care, like if you have chaplains in the military who kind of have a similar situation where the lines are a little more blurred, it's not us against you, it's kind of like we're all on the same team in a way. But yeah, thanks for sharing those two points.
Parallels Between Civil War Medicine and COVID-19
00:42:28
Speaker
The topic I kind of wanted to close with is just thinking about COVID and the Civil War. I mean, when I was thinking about it before this show, in a lot of ways you could see some similarities, right? Where you just have a national crisis where people don't think it's gonna be as bad as it is and it just kind of extends as a long period of hardship. When you think about
00:42:54
Speaker
how we weren't really prepared. We weren't prepared for the Civil War and we weren't prepared for COVID. Can you just talk about kind of like the similarities of those two things and how you as a Civil War historian kind of can reflect on COVID as it relates to the Civil War? Yeah, I mean, that's a great insight. I will tell you that COVID
00:43:24
Speaker
as jumping to an operational level of a museum at this museum. In a sick, weird way, it was good for us.
00:43:38
Speaker
because we, a museum, you depend on people to come in in person to see old stuff that resonates. I don't mean to dismiss material culture, but let's be real. You go into a museum, you wanna see some old stuff with some stories behind it, right? We couldn't have that. That was not possible. So we converted to digital virtual online, and that was a long-term plan for us like it was for everybody, but we really turned our entire staff onto it.
00:44:08
Speaker
And we weren't prepared, but we adjusted. We threw all our resources at it, and it was successful. And it was successful because of the similarities you just talked about. This country and the world was not prepared for what was happening. There were probably a few people that did, and they were like voices in the wind, right? So then,
00:44:35
Speaker
It's very similar to the fact that you've got to care, like I talked about that battle of bull run and menaces. You have to care for the immediate injuries, but there has to be a level of folks who are trying to solve the problem on an organizational, long-term, strategic way.
00:44:54
Speaker
We do a lot of programs with modern military groups here. We have Fort Detrick here, which is like the leader in military medicine, whether it's dealing with biological, cancer, whatever. And they come over and do a lot of military programs with us. And one of the things we talk about is how innovation was a culture after the battle bull run when you had the new generation coming in.
00:45:22
Speaker
you had to transform systems, you had to bring order out of chaos. And what was fascinating about COVID was, I don't know if you remember, I mean, everybody remembers little things, but instances, but I really remember the portable morgues they had to set up, you know, refrigerated trucks.
00:45:43
Speaker
And it totally reminded me of the Civil War. You've got to deal with treating people. You've got to deal with the repercussions of those who die. You've got to prevent so many levels of care that you've got to tackle all at once because it's affecting hundreds of thousands or millions of people. So the systems that were put in place to tackle COVID
00:46:12
Speaker
or identical to what they did in the Civil War. Jonathan Letterman's system, it becomes known as the American system in Europe during World War I. That's what you saw in the response to COVID, whether it was setting up football stadiums to be field dressing stations,
00:46:39
Speaker
Whether it was you're waiting in line in your car to get a COVID shot or a COVID test, that is a field dressing station. You got field hospitals of the temporary facilities that were built beside hospitals. You've got them in the hospitals and then you got to bury them and embalming comes back in the Civil War because they're dealing with death away from home at the same time.
00:47:04
Speaker
Death was occurring away from home. It changed the way you mourned. The Civil War changed the way you mourned. COVID changed the way we mourned. You couldn't have a funeral and get together with your friends and family to mourn the loss of your loved one. Same thing happened in the Civil War. There's hope in history if you learn from it.
00:47:26
Speaker
During the Civil War, there were observers from other countries like all wars, France, England, Germany. They're all coming over to watch the latest tactics and they're also watching the medical response. So they learn the Letterman system and they take it back to their countries and they adopt it in the next conflict. As Americans do, we forget it.
00:47:49
Speaker
We go over to World War I and we see what the Europeans are doing with medical evacuation and we go, oh my gosh, that's a cool system. Where'd you learn that? And they're like, well, it's the American system. So the same, what I'm afraid of is the same thing happens with COVID. People will forget very soon how that experience was. And if you really think about the effectiveness
00:48:18
Speaker
that of the things that were improvised and implemented then, it's, you know, get inoculated if you can, wear a stinking mask, stay six feet away, wash your hands, you know, but we'll forget all that, I guarantee it, and we'll have to relive, you know, and our mission at this museum is simply to
00:48:44
Speaker
help avoid that. Whether it is a civilian epidemic, like you're describing, or whether it's a battlefield care scenario,
00:48:58
Speaker
People forget fast and also specifically in military medicine, most of those surgeons who were involved in the Iraq-Afghanistan conflict, they're aging out and they're now in the classroom or leading medical programs. So the young students today or the young surgeons and nurses have never seen action, have never seen combat.
00:49:23
Speaker
That group of teachers and those who have seen it are worried about that and lean on us to try to at least give a glimpse of the fact that whether it's the Civil War or Iraq, Afghanistan,
00:49:38
Speaker
The system of military medicine is the same and you have to put yourself in those shoes and imagine yourself with a sponge and a bucket of water and hopefully you get them to a higher level of care.
00:49:55
Speaker
And you don't think about that as a student. And I wouldn't have if I was you or first year military medical, I wouldn't. But hopefully we can at least plant that seed. There's a great quote by a guy in World War II, a general who was in charge of the medical command in Europe, who says, there was not a day that went by that I did not thank God for Jonathan Letterman.
00:50:23
Speaker
And it's because he was facing kind of the same thing, but Letterman put a system in place, and we're gonna have to improvise that in the next conflict, because we won't be able to evacuate as much. And as downer as that sounds, those Walt Whitman stories, the individual soldier stories, the surgeon stories, it's really about, our quote here is also divided by conflict, united by compassion.
00:50:49
Speaker
And really, it's compassion that's going to save the day. And that is a medical professional right there. 100%, yeah. When in doubt, look to lettermen. When in doubt, look to compassion. Those are two huge lessons that hopefully we listen to going forward. Yeah.
David's Personal Insights
00:51:10
Speaker
All right, now it's time for a quick lightning round. This is a series of fast-paced questions that tell us more about you. So just to preface this question, are you a baseball fan? You know, I watch it to nap. OK. Or for an in-person to eat hot dogs.
00:51:29
Speaker
Yeah, that's always good, too. I was going to ask you since you're right, like you're kind of in the Baltimore area, kind of in the D.C. area in Frederick. Are you are you a Nationals fan or Orioles fan? You know, it depends on who has the best. It depends on who has the best seats. Like we were lucky enough to see a Nationals game in a suite. And it's kind of like flying first class. I never want to go anywhere.
00:51:50
Speaker
you know, without being in first class or in that suite. But I like both of them. I just, the Orioles with the resurgence, I'm an Orioles fan. I'm both. I just like a good game. What's a hobby you enjoy pursuing? Oh my gosh. I love being with my family. I read, I go to the beach. I love being at the beach. What's your least favorite food? Oh my gosh. Cauliflower? Liver?
00:52:20
Speaker
Anything green? Anything that looks gangrenous. Favorite place to hang out in Frederick, Maryland? Oh, man. Anywhere in the downtown, we are blessed with restaurants and music on the streets and art anywhere downtown in the historic district. All right. And lastly, what's one change you'd like to see in health care?
00:52:50
Speaker
Oh, man. There's like hundreds of millions. You know, I'm a fan of the why not universal health care, you know, this this private industry. I was on a plane one time many years ago with a bean counter in the health industry. Right. And every year I've been self-employed. I've had corporate insurance, et cetera.
00:53:17
Speaker
And every year, no matter what scenario it is with needing healthcare or insurance, the price has gone up. So I asked him, how do we get control of that? And he said, the only way to get control of healthcare costs is to arrest technology. Because if there's a way to save a person with a new machine that costs $10 million, people are going to want to do it. And he was like, you have to draw the line.
00:53:46
Speaker
Basically, you have to triage people with health care. You almost have to bring the triage system into the health care system. It's not an easy thing. I don't even like hearing myself say it, but he was a bean counter and that's what he said. When I hear people complain about the European universal health care system of having to wait and things like that, it's like, well, we all either get a little bit of care or a few of us get exceptional care and the others get
00:54:15
Speaker
below park air. And it's no reflection on the people delivering it. It's really about the machines and the larger companies. So yeah, that's a roundabout non-answer, but that's it. Yeah, no, we could certainly do, I'm sure we could do 10 episodes just on that last tidbit there. Yeah, yeah, yeah. David Price, thanks so much for joining the show.
00:54:46
Speaker
Hey, thank you, and good luck with school, and man, more power to you. I am just so impressed with folks who go into caring for other people as a profession, and I'm always impressed with them, so thank you.
00:55:13
Speaker
Thanks for listening to The Wound Dresser. Until next time, I'm your host John Neery. Be well.