Published 1/1/2015
Roxanne E. Wallace, MD

Hospital History Underscores Political, Medical Links

Book Review

New Haven’s Civil War Hospital
Ira Spar, MD
2013, 268 pages
ISBN-10: 0786476826
ISBN-13: 978-0786476824

In New Haven’s Civil War Hospital, AAOS fellow Ira L. Spar, MD, tells the story of the doctors, staff, soldiers, and families who were instrumental in the design and function of Knight U.S. General Hospital in New Haven, Conn. The military hospital was built in response to the tremendous need to care for the wounded soldiers of the Union Army during the Civil War, an era before the identification of bacteria, viruses, or universal protection from bodily fluids, when more soldiers died from noncombat-related diseases than from battlefield wounds.

The book details the accomplishments, challenges, and setbacks endured through the construction and staffing of the hospital from 1862 to 1865. Of note are the amazing leadership, empathy, and generosity of Dr. Jonathan Knight—for whom the hospital was named—and Connecticut Gov. William Buckingham to care for wounded soldiers and their families. The hospital became a “city within a city,” and attempted to attend to every need of the wounded soldier by including a cafeteria, library, and a newspaper, The Knight Hospital Record.

Dr. Spar brings a unique perspective to the telling of this story because he is not only a physician but also a military veteran, having served on active duty in the U.S. Army as a battalion surgeon during the Vietnam War. His interest in writing the book was spawned by the similarities he noticed in the Army reports he drafted and those of the surgeons from the Civil War.

Dr. Spar provides an amazing fact-filled story of the development of formal medical education, medical licensure, and the American Medical Association. He details the origins of field sanitation and offers many examples of Army regimental surgeons’ volunteerism, self-sacrifice, and expertise all while walking that fine line of serving two masters—the soldier patient and the Army. He also provides a behind-the-scenes look at American politics at the time.

In addition, Dr. Spar writes about the hospital steward, a noncommissioned officer who was literally responsible for everything. Even though no formal school existed for this position, the hospital steward was expected to perform minor surgery, administer medications, bandage wounds, cook, and handle all of the logistics of supply. Nursing duties—considered beneath the dignity of a proper lady—were often performed by nuns and convalescing soldiers. Civilian nurses were paid 40 cents and received one meal daily.

A few of the challenges we face in medicine today were present during the Civil War era. For example, in 1863 Dr. Gurdon Russell wrote, “It is only just to the public that it should be acquainted with our fees.” He called for transparency of pricing, which we still struggle with today. Similarly, Dr. B. H. Catlin told medical students in 1865 that, “a part of everyday should be devoted to professional reading.” This is the initial concept for today’s continuing medical education. Dr. Pliny Jewett, a staff physician at Knight U.S. General Hospital, was a pioneer of evidence-based medicine, constantly gathering information and results to advance the science of medicine.

Similarly, the impact of politics on health care also echoes through the pages of this book. For example, construction of Army hospitals accelerated as it became clear that such an investment might turn into votes and help the re-election of President Lincoln. The guidelines for construction and staffing of the hospital were established by U.S. Surgeon General William A. Hammond and Secretary of War Edwin M. Stanton.

I very much enjoyed reading the personal stories and the details of people involved in bringing Knight U.S. General Hospital to fruition. I was bolstered by the good of humanity and saddened by the evil and greed. I recognized the calling of medicine and service to humanity and country. I share with Dr. Spar the pride and gratitude of representing the heritage of those before us and the hope that the future brings.

Roxanne E. Wallace, MD, is a member of the AAOS Council on Research and Quality and a member of the AAOS Now Editorial Board.