Bleeding Blue and Gray : Civil War Surgery and the Evolution of American Medicine

A landmark chronicle of Civil War medicine, Bleeding Blue and Gray is a major contribution to our understanding of America’s bloodiest conflict. Indeed, eminent surgeon and medical historian Ira M. Rutkow argues that it is impossible to grasp the harsh realities of the Civil War without an awareness of the state of American medicine at the time.

At the outset of the war, the use of ether and chloroform remained crude, and they were often unavailable in the hellish conditions at the front lines. As a result, many surgical procedures were performed without anesthesia in the compromised setting of a battleground or a field hospital. This meant that “clinical concerns were often of less consequence,” writes Rutkow, “than the swiftness of the surgeon’s knife.”

Also, in the 1860s, the existence of pathogenic microorganisms was still unknown–many still blamed “malodorous gasses” for deadly outbreaks of respiratory influenza. As the great Civil War surgeon William Williams Keen wrote, “we used undisinfected instruments from undisinfected plush-lined cases, and still worse, used marine sponges which had been used in prior pus cases and had been only washed in tap water.”

Besides the substandard quality of wartime medical supplies and techniques, the combatants’ utter lack of preparation greatly impaired treatment. In 1861, the Union’s medical corps, mostly ill-qualified and poorly trained, even lacked an ambulance system. Fortunately, some of these difficulties were ameliorated by the work of numerous relief agencies, especially the United States Sanitary Commission, led by Frederick Law Olmsted, and tens of thousands of volunteers, among them Louisa May Alcott and Walt Whitman.

From the soldiers who endured the ravages of combat to the government officials who directed the war machine, from the good Samaritans who organized aid commissions to the nurses who cared for the wounded, Bleeding Blue and Gray presents a story of suffering, politics, character, and, ultimately, healing.

Ira M. Rutkow is a clinical professor of surgery at the University of Medicine and Dentistry of New Jersey. He also holds a doctorate of public health from Johns Hopkins University. Dr. Rutkow’s Surgery: An Illustrated History was a New York Times Notable Book of the Year. He and his wife divide their time between New York City and the Catskills.