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Silas Weir Mitchell's The Case of George Dedlow
Perspectives
The art of medicine Silas Weir Mitchell’s The Case of George Dedlow
Wellcome Library
On June 29, 1864, a military surgeon in the 21st Kentucky Infantry wrote to his wife. “It has been almost one continued stream of carnage”, he explained, adding that “My hands are constantly steaped [sic] in blood. I have had them in blood and water so much that the nails are soft and tender. I have amputated limbs until it makes my heart ache to see a poor fellow coming in the ambulance…the horror of this war can never be half told.” The American Civil War was a conflict of utmost savagery. Over 600 000 American soldiers died. 30 000 limbs were amputated. The new conical bullet or minié proved to be more damaging to muscle and bone than its predecessors. Made of soft lead, the minié tended to flatten out when it entered a body, leading one surgeon writing in the Confederate States Medical and Surgical Journal in 1864 to argue that soldiers were wrong to fear “cold steel” since “bayonet wounds are almost harmless when compared to the ploughed tracks which the terrible Minnie [sic] bores through the tissues”. Surgeons were right to despair: how could the “horror of this war” be adequately told? Some military surgeons believed that fiction could be more “true” to the terrors of war than objective medical texts. Less than a year after the war was over, a 37-year-old neurologist who had enlisted with the Union forces published a short story that entranced thousands of Americans. The Case of George Dedlow came out in The Atlantic Monthly in July, 1866. Its author was Silas Weir Mitchell, later to become a renowned neurologist and the inventor of the “rest cure” for “nervous” patients. Because the short story was published anonymously, many readers believed that it was the
Return of wounded Confederate prisoners, under a flag of truce, during the American Civil War
1332
autobiography of its narrator, George Dedlow. Dedlow’s fate was unusual, but imaginable to readers still reeling from the carnage of the war. While serving as assistant-surgeon in the Seventy-Ninth Indiana Volunteers, Dedlow had been injured: all of his limbs had been amputated. “Of my anguish and horror of myself I dare not speak”, he stuttered. In searing prose, Dedlow described how he “screamed, cried, and yelled in my torture” after being first wounded. His arm felt as if it was being “perpetually rasped with hot files”. Even without anaesthetic, amputation was a blessing: the “strange lightning of pain” was followed by “instant, unspeakable relief”. Looking at his arm lying on the floor, Dedlow’s first thought was: “There is the pain, and here am I”. Subsequent wounding and a gangrene infection eventually led to the amputation of his other three limbs. He lost fourfifths of his bodyweight, becoming, in his words, nothing more than “a useless torso, more like some strange larval creature than anything of human shape”. At this stage in the story, Mitchell uses his fictional character to muse on the neurological phenomenon of phantom limbs. Phantom limbs had been described in the mid-16th century by French military surgeon Ambroise Paré, but very little was known about what caused stump neuralgia (in the 1860s, the only treatments were electrotherapy, leeching, irritation of the surface of the stump, and re-amputation, none of which were very successful). In The Case of George Dedlow, Mitchell speculates freely about what caused absent limbs to itch and feel pain. According to him, sensory impressions were transmitted through nerves to spinal nerve-cells and then to the brain. When a limb was removed, and until the stump healed, nerves continued to accept sensory impressions and to convey these impressions to the brain. If the stump never fully recovered, the result was constant irritation or a burning neuralgia. As Mitchell later explained in his famous textbook, Injuries of the Nerves and Their Consequences (1872), phantom limbs made “the strongest man…scarcely less nervous than the most hysterical girl”. Phantom limbs were related to broader problems of defining the boundaries of the self. In Dedlow’s words, “I found to my horror that at times I was less conscious of myself, of my own existence, than used to be the case”. It was, he explained, “a deficiency in the egoistic sentiment of individuality”, as though one half of himself was “absent or functionally dead”. In the climax of the story, this atrophy of the self was briefly reversed when, during a spiritualist séance, his legs were physically conjured up. They had been in storage at the US Army Medical Museum in Washington, where army surgeons during the American Civil War had routinely sent amputated limbs for study. “I was re-individualized, so to speak”, Dedlow insisted, and “I arose, staggering a little” www.thelancet.com Vol 373 April 18, 2009
Perspectives
and “walked across the room on limbs invisible to them or me”. It was only a brief reunion. At the end of the story, the limbless Dedlow is simply awaiting death, “eager for the day when I shall rejoin the lost members of my corporeal family in another and happier world”. Today, this spiritualist vignette seems slightly ridiculous, but in the immediate aftermath of the Civil War readers were entranced by it, generously denoting money to the “stump hospital” in which Dedlow was supposed to be residing. For many, the supernatural reunion of George Dedlow with his legs was strangely comforting. To the 30 000 amputees and their families and friends the spiritualist promise of “wholeness” was reassuring. Even Louisa Alcott, later known as the author of Little Women (1868) but whose experiences in a Civil War hospital were published in Hospital Sketches (1863), also described a “nice looking lad” who expressed the desire for reunion with his amputated leg and arm after death. “Lord!”, the young patient exclaimed: “What a scramble there’ll be for arms and legs, when we old boys come out of our graves, on the Judgment Day: wonder if we shall get our own again? If we do, my leg will have to tramp from Fredericksburg, my arm from here, I suppose, and meet my body, wherever it may be.” In séances throughout the USA, spiritualists assured people that in the Other World gaping wounds left by bayonets or minié bullets were instantly healed; amputated limbs were returned to their rightful owners. After death, as Dedlow noted, he would no longer be a “fraction of a man”, but would be made whole again. Both literally and metaphorically, the fractures of the Civil War would be healed. Medical accounts like those of Mitchell and Alcott were important for another reason as well: they were early attempts to tell the history of surgery from the patient’s perspective. Both these writers were appalled both by sufferings of ordinary men in war and the fact that medical services were so primitive. Until 1862, there were not even adequate field hospitals or ambulance services. Alcott described how wounded men would drag themselves to the medical stations, “ragged, gaunt and pale, mud to the knees, with bloody bandages untouched since put on days before”. Surgery was not a medical specialism at that time, so many physicians were also totally unprepared. In overcrowded field hospitals, amputations were carried out in rough circumstance. Beds would shake “with the irrepressible tremor of their tortured bodies” as men had their limbs cut away, Alcott lamented. After the Battle of Gettysburg, another observer watched as wounded men would be lifted onto a table (“shrieking with pain”), to be examined by a surgeon. Deciding on amputation, the surgeon “snatched the knife from between his teeth, where it had been while his hands were busy [examining the patient], wiped it rapidly once or twice across his blood-stained apron, and the cutting began. The operation accomplished, the surgeon would look around with a deep sigh, and then: ‘Next!’” www.thelancet.com Vol 373 April 18, 2009
Since the germ theory of disease did not become widespread until Robert Koch’s experiments of the 1870s, many surgeons in the 1860s still believed that infections were caused by “noxious miasms”. Death was literally “in the air”. As Philadelphian surgeon W W Keen recalled decades later: “We operated in old blood-stained and often pus-stained coats…with undisinfected hands…We used… marine sponges which had been used in prior pus cases and only washed in tap water”. The “sweet”, “mouse-like” smell of gas gangrene was all too familiar. Although, as one civil war surgeon admitted, patients who bore the signs of gangrene were instantly “removed to the open air of tents” where they faced “etherisation, savage cautery with pure nitric acid or bromine, and dressings of powdered charcoal”; the mortality rate was more than 45%. For Mitchell, fiction was one way he was able to explore that terrible paradox: in war, doctors and nurses heal in order to enable mutilation and death. Even the Cincinnati Lancet and Observer admitted in 1863 that army surgeons were known for their “inefficiency, gross carelessness, heartlessness, and dissipation”. Apocryphal stories about patients who “in the last agony” would raise themselves in bed, strike the surgeon, then sink back to die “with a smile of contentment” were based on that reputation. Both Alcott and Mitchell castigated military physicians for heartlessness. In her Hospital Sketches, Alcott claimed that one surgeon revelled in dealing with particularly gross mutilations: “A poor private, with both legs off, and shot through the lungs, possessed more attractions for him than a dozen generals, slightly scratched in some ‘masterly retreat’”, she recalled. Similarly, in Mitchell’s novel In War Time (1884), the military surgeon was more upset when he broke his meerschaum pipe than when a soldier patient died. At the end of this novel, the surgeon (unintentionally) kills one of his patients. For Mitchell, this was a poignant symbol of medicine’s true function in wartime. In fiction, therefore, Mitchell was able to reconcile different sides to his character: the neurologist whose interests were in objective signs of disease and the civil war physician who cared deeply for the all-too-subjective sufferings of the men he had ministered to. It was only a partial reconciliation. In January, 1914, as Mitchell lay dying of influenza complicated by pneumonia, he was tormented by ghostly appearances of the maimed soldiers he had encountered half a century earlier. As a close friend reported, on his deathbed, Mitchell’s “wandering mind returned to those scenes; his wandering talk was of mutilation and bullets”. When we read The Case of George Dedlow and his other works of fiction, “every drop of ink is tinctured with the blood of the Civil War”.
Joanna Bourke Department of History, Birkbeck College, University of London, London WC1E 7HX, UK [email protected]
Further reading Bourke J. Dismembering the Male: Men’s Bodies, Britain, and the Great War. London: Reaktion, 1996. Mitchell SW. The Case of George Dedlow. The Atlantic Monthly, July, 1866. The text can be found at http://www. gutenberg.org/etext/693 (accessed April 2, 2009).
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The art of medicine Silas Weir Mitchell’s The Case of George Dedlow
Wellcome Library
On June 29, 1864, a military surgeon in the 21st Kentucky Infantry wrote to his wife. “It has been almost one continued stream of carnage”, he explained, adding that “My hands are constantly steaped [sic] in blood. I have had them in blood and water so much that the nails are soft and tender. I have amputated limbs until it makes my heart ache to see a poor fellow coming in the ambulance…the horror of this war can never be half told.” The American Civil War was a conflict of utmost savagery. Over 600 000 American soldiers died. 30 000 limbs were amputated. The new conical bullet or minié proved to be more damaging to muscle and bone than its predecessors. Made of soft lead, the minié tended to flatten out when it entered a body, leading one surgeon writing in the Confederate States Medical and Surgical Journal in 1864 to argue that soldiers were wrong to fear “cold steel” since “bayonet wounds are almost harmless when compared to the ploughed tracks which the terrible Minnie [sic] bores through the tissues”. Surgeons were right to despair: how could the “horror of this war” be adequately told? Some military surgeons believed that fiction could be more “true” to the terrors of war than objective medical texts. Less than a year after the war was over, a 37-year-old neurologist who had enlisted with the Union forces published a short story that entranced thousands of Americans. The Case of George Dedlow came out in The Atlantic Monthly in July, 1866. Its author was Silas Weir Mitchell, later to become a renowned neurologist and the inventor of the “rest cure” for “nervous” patients. Because the short story was published anonymously, many readers believed that it was the
Return of wounded Confederate prisoners, under a flag of truce, during the American Civil War
1332
autobiography of its narrator, George Dedlow. Dedlow’s fate was unusual, but imaginable to readers still reeling from the carnage of the war. While serving as assistant-surgeon in the Seventy-Ninth Indiana Volunteers, Dedlow had been injured: all of his limbs had been amputated. “Of my anguish and horror of myself I dare not speak”, he stuttered. In searing prose, Dedlow described how he “screamed, cried, and yelled in my torture” after being first wounded. His arm felt as if it was being “perpetually rasped with hot files”. Even without anaesthetic, amputation was a blessing: the “strange lightning of pain” was followed by “instant, unspeakable relief”. Looking at his arm lying on the floor, Dedlow’s first thought was: “There is the pain, and here am I”. Subsequent wounding and a gangrene infection eventually led to the amputation of his other three limbs. He lost fourfifths of his bodyweight, becoming, in his words, nothing more than “a useless torso, more like some strange larval creature than anything of human shape”. At this stage in the story, Mitchell uses his fictional character to muse on the neurological phenomenon of phantom limbs. Phantom limbs had been described in the mid-16th century by French military surgeon Ambroise Paré, but very little was known about what caused stump neuralgia (in the 1860s, the only treatments were electrotherapy, leeching, irritation of the surface of the stump, and re-amputation, none of which were very successful). In The Case of George Dedlow, Mitchell speculates freely about what caused absent limbs to itch and feel pain. According to him, sensory impressions were transmitted through nerves to spinal nerve-cells and then to the brain. When a limb was removed, and until the stump healed, nerves continued to accept sensory impressions and to convey these impressions to the brain. If the stump never fully recovered, the result was constant irritation or a burning neuralgia. As Mitchell later explained in his famous textbook, Injuries of the Nerves and Their Consequences (1872), phantom limbs made “the strongest man…scarcely less nervous than the most hysterical girl”. Phantom limbs were related to broader problems of defining the boundaries of the self. In Dedlow’s words, “I found to my horror that at times I was less conscious of myself, of my own existence, than used to be the case”. It was, he explained, “a deficiency in the egoistic sentiment of individuality”, as though one half of himself was “absent or functionally dead”. In the climax of the story, this atrophy of the self was briefly reversed when, during a spiritualist séance, his legs were physically conjured up. They had been in storage at the US Army Medical Museum in Washington, where army surgeons during the American Civil War had routinely sent amputated limbs for study. “I was re-individualized, so to speak”, Dedlow insisted, and “I arose, staggering a little” www.thelancet.com Vol 373 April 18, 2009
Perspectives
and “walked across the room on limbs invisible to them or me”. It was only a brief reunion. At the end of the story, the limbless Dedlow is simply awaiting death, “eager for the day when I shall rejoin the lost members of my corporeal family in another and happier world”. Today, this spiritualist vignette seems slightly ridiculous, but in the immediate aftermath of the Civil War readers were entranced by it, generously denoting money to the “stump hospital” in which Dedlow was supposed to be residing. For many, the supernatural reunion of George Dedlow with his legs was strangely comforting. To the 30 000 amputees and their families and friends the spiritualist promise of “wholeness” was reassuring. Even Louisa Alcott, later known as the author of Little Women (1868) but whose experiences in a Civil War hospital were published in Hospital Sketches (1863), also described a “nice looking lad” who expressed the desire for reunion with his amputated leg and arm after death. “Lord!”, the young patient exclaimed: “What a scramble there’ll be for arms and legs, when we old boys come out of our graves, on the Judgment Day: wonder if we shall get our own again? If we do, my leg will have to tramp from Fredericksburg, my arm from here, I suppose, and meet my body, wherever it may be.” In séances throughout the USA, spiritualists assured people that in the Other World gaping wounds left by bayonets or minié bullets were instantly healed; amputated limbs were returned to their rightful owners. After death, as Dedlow noted, he would no longer be a “fraction of a man”, but would be made whole again. Both literally and metaphorically, the fractures of the Civil War would be healed. Medical accounts like those of Mitchell and Alcott were important for another reason as well: they were early attempts to tell the history of surgery from the patient’s perspective. Both these writers were appalled both by sufferings of ordinary men in war and the fact that medical services were so primitive. Until 1862, there were not even adequate field hospitals or ambulance services. Alcott described how wounded men would drag themselves to the medical stations, “ragged, gaunt and pale, mud to the knees, with bloody bandages untouched since put on days before”. Surgery was not a medical specialism at that time, so many physicians were also totally unprepared. In overcrowded field hospitals, amputations were carried out in rough circumstance. Beds would shake “with the irrepressible tremor of their tortured bodies” as men had their limbs cut away, Alcott lamented. After the Battle of Gettysburg, another observer watched as wounded men would be lifted onto a table (“shrieking with pain”), to be examined by a surgeon. Deciding on amputation, the surgeon “snatched the knife from between his teeth, where it had been while his hands were busy [examining the patient], wiped it rapidly once or twice across his blood-stained apron, and the cutting began. The operation accomplished, the surgeon would look around with a deep sigh, and then: ‘Next!’” www.thelancet.com Vol 373 April 18, 2009
Since the germ theory of disease did not become widespread until Robert Koch’s experiments of the 1870s, many surgeons in the 1860s still believed that infections were caused by “noxious miasms”. Death was literally “in the air”. As Philadelphian surgeon W W Keen recalled decades later: “We operated in old blood-stained and often pus-stained coats…with undisinfected hands…We used… marine sponges which had been used in prior pus cases and only washed in tap water”. The “sweet”, “mouse-like” smell of gas gangrene was all too familiar. Although, as one civil war surgeon admitted, patients who bore the signs of gangrene were instantly “removed to the open air of tents” where they faced “etherisation, savage cautery with pure nitric acid or bromine, and dressings of powdered charcoal”; the mortality rate was more than 45%. For Mitchell, fiction was one way he was able to explore that terrible paradox: in war, doctors and nurses heal in order to enable mutilation and death. Even the Cincinnati Lancet and Observer admitted in 1863 that army surgeons were known for their “inefficiency, gross carelessness, heartlessness, and dissipation”. Apocryphal stories about patients who “in the last agony” would raise themselves in bed, strike the surgeon, then sink back to die “with a smile of contentment” were based on that reputation. Both Alcott and Mitchell castigated military physicians for heartlessness. In her Hospital Sketches, Alcott claimed that one surgeon revelled in dealing with particularly gross mutilations: “A poor private, with both legs off, and shot through the lungs, possessed more attractions for him than a dozen generals, slightly scratched in some ‘masterly retreat’”, she recalled. Similarly, in Mitchell’s novel In War Time (1884), the military surgeon was more upset when he broke his meerschaum pipe than when a soldier patient died. At the end of this novel, the surgeon (unintentionally) kills one of his patients. For Mitchell, this was a poignant symbol of medicine’s true function in wartime. In fiction, therefore, Mitchell was able to reconcile different sides to his character: the neurologist whose interests were in objective signs of disease and the civil war physician who cared deeply for the all-too-subjective sufferings of the men he had ministered to. It was only a partial reconciliation. In January, 1914, as Mitchell lay dying of influenza complicated by pneumonia, he was tormented by ghostly appearances of the maimed soldiers he had encountered half a century earlier. As a close friend reported, on his deathbed, Mitchell’s “wandering mind returned to those scenes; his wandering talk was of mutilation and bullets”. When we read The Case of George Dedlow and his other works of fiction, “every drop of ink is tinctured with the blood of the Civil War”.
Joanna Bourke Department of History, Birkbeck College, University of London, London WC1E 7HX, UK [email protected]
Further reading Bourke J. Dismembering the Male: Men’s Bodies, Britain, and the Great War. London: Reaktion, 1996. Mitchell SW. The Case of George Dedlow. The Atlantic Monthly, July, 1866. The text can be found at http://www. gutenberg.org/etext/693 (accessed April 2, 2009).
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