>> robert caro on the passage of power, volume four in the years of lyndon johnson, his multivolume biography of the 36th president this sunday at 8:00 on cspan's q and a. look for the second hour with robert caro, sunday, may 20th. coming up, dr. ira rutkow, discusses how the civil war changed medicine. a clinical professor of surgery at the university of medicine and dentistry of new jersey. as well as the author of "bleeding blue and gray:civil war surgery and the evolution of american medicine." the new york ascad cademy of medicine. there are graphic photographs shown during the program, and some viewers might find this disturbing. >> that's great. you are welcome. thank you for coming. i'm getting over a cold, so i've

have a coughing jag, you will understand the reason why. i appreciate the opportunity to be here, chris has take any way by third slide. so, i will start with number two. i want to thank the academy for inviting me. it is always a pleasure to come back here. arlene chainer, deserves many thanks for helping me out. i have spent many months, multiple months, working the rare book room within the library. a unique place. a wonderful institution. i look forward to the rest of its history and various reincarnations that happen. it holds a unique place in american medicine and especially in medicine relative to new york city. so, i appreciate the invite. well, i guess i should say, a little bit about dr. lattimer, the john k.lattimer memorial lecture. as professor warren mentioned, dr. lattimer was a product of new york city.

went to columbia undergrad, columbia medical school, lanky 6'4", gentleman. a hurdle star in college. he was an eclectic individual. he was really quite varied in his interests. he was chairman of surgery at columbia for almost 25 years. he really placed pediatric neurology on the map. aside from his professional endeavors including 375 scientific papers he was really involved in many other subjects. that were outside the realm of academia. most important were -- military weapons. as a very young man he graduated medical school in 1938. during world war ii, at the time of the nuremberg trials he was part of the medical team that took care of the nazi war criminals. he got to know many of them. and through his knowledge about them and whatever, he published this book, "hitler's fatal sickness." it engendered a lot of criticism and a lot of discussion.

he hypothesized that adolf hitler had parkinson's following a disease, whether he gotten -- got encephalitis during world war i. this was the discussion. he said the war happened the way it did because of parkinson's and hitler making what he called bizarre judgments. having said that, dr. lattimer was also a ballistics expert, the first nongovernmental, nongovernmental, medical individual, allowed to view the--the photographs and the transcripts from the kennedy assassination. and this is back in the -- in the '70s, and he came out and agreed with the findings of the warren commission, that there was a single assassin. now the most interesting thing is this right here. he was a collect our of historical relics. professor warren used some nice language about what he collected and what he didn't collect.

let me just go through a couple of them and then we will get into the civil war. well, the first thing was he owned lincoln's blood-stained collar from the night of the assassination which was later sold at auction. he also owned varying cyanide capsule, glass capsule that contained the cyanide when there was a suicide at nuremberg. he also owned napoleon's penis. now how did he own napoleon's penis? he owned napoleon's penis, the story goes, he was receiving last rites, the priest amputated his penis, i know nothing more than that. and somehow through the years the was placed in a wood encase and later on, was eventually sold at public auction. dr. lattimer bought it in 1969 and assured everybody now, i never met dr. lattimer, i wish i had. he assured everybody that the

napoleon's penis was airtight. he was the proud owner of ethan allen's sword. ethan allen, took over in the american revolution. in 1975, dr. lattimer, re-enacted ethan allen's sword. that is the story of dr. lattimer and ethan allen's sword. i wish i had gotten to know him. i did not. i became interested in the civil war as a very young man. when i wore a lot younger man's clothing the i always write about the civil war throughout the years. th these are examples, of famous books, allen nevin'strilogy,

and this is my copy, it says 1962 inside. i was a lot younger. and the -- i followed up with shelby foote, and son and father. these are all fantastic writers. nobody can compete with their writing style. but through the years, and certainly, as i went into medicine, i graduated medical school in 1975. and through my training in the '70s and early part of the '80s as i was reading more and more about civil war, it became obvious, at least to me, that combat and suffering and death were glorified. and that pomp and circumstance, masked deadly ferociousness of the battlefield. this reached at least in my mind, the zenith with mcpherson's, "battle cry of freedom" 1989 when he won the pulitzer prize. 1990, ken burns' documentary, famous documentary on the civil

war. well, for me as a physician, and an historian, despite the brilliance of the writing in my mind something was always missing. and an understanding of the brutality and medical realities inherent to the war, i wrote this back about, seven, eight years ago. surely if a description of armed conflict is ever to be considered faithful than the brutality of combat as well as the painful physical and mental restoration needs to be spoken about, the description of a combattant's death following a surgical procedure. having said that, the question always need to be answered, why do these wonderful writers, who have won all these awards, why do they not write about medicine during the civil war? if you go on mcpherson's book,

600 page there is are two pages on medicine during the civil war. a very interesting phenomenon. i can only give you my opinion. that is, medicine as those of uh in the audience who are physicians understand is a very tough discipline to get to know. it takes us multiple years. and many writers just feel uncomfortable writing about medicine. the result is -- that they do not have a lot of input in their books relative to medical care. so i leave you with this quote from richard shryock. he wrote in 1962, if medical aspects of the civil war are omitted the story is not only incomplete but is unrealistic as a total picture. and i just leave you with this thought. i think this is very important whenever we talk about the civil war. we can glorify it. we can talk about all the economics and politics and

sociology and anthropology. but ultimately it was a -- a tough war for the combatants to be in. we should always keep this in mind. well, having said all this -- let's talk about medicine. now i actually titled this lecture, the big bang theory. now, why do i call this the big bang? i'm not talking about the television show with sheldon -- and leonard and penny. i am talking about the big bang theory as it involves the beginnings of the evolution of the university. because i truly believe and -- and dr. warren actually said an important phrase when he was introducing me. he said turning point. i believe that the civil war acted as the big bang for american medicine as we know out today. that there is stuff going on before, and that's what we are going to talk about. but that, that big bang, that created everything that we know today -- that hospital just over there, down the street. it all -- really started at the

time of the civil war. that's what i want to discuss with you. not actually the specifics of civil war medicine, but the impact the civil war medicine on, the future of american medicine. these are just some individuals. 1840, 1830. this is your typical doctor. two more, this is the mexican war. i don't know if you can see over here for those of you. but this gentleman is holding what? he is holding a saw. and a bone. and the old slang term, old saw bones. i'm not telling you that it came from this picture because it didn't. if you read this, around 1842. if you read charles dickens pickwith papers he uses the term saw bones that was published in 1837. not certain where it started. i thought it was a great picture to have. i am going to start with two quotes. the first by nathan smith davis. who is nathan smith dave this?

a very important man. some times the passage of time is like a big eraser. it just rerace erases things. in this particular case he has probably been erased because of the passage of time and the fact he was prominent but did not write all that much. nathan smith davis founded the american medical association, two time president, and founded journal uf"journal of the ameril cal association. he was a very astute individual of the american medical scene. he wrote this book on medical education. before the big bang theory. so he wrote, this is a great quote. the great mass of the profession were like unsocial and ungoverned by ethical laws, and consequently, without harmony of action or true dignity of professional character. key word professional character. what do we mean by profession? and what are we talking about as, as medicine exists today?

well, how do we define a profession it? is very simple. a profession back then, mostly the ministry, law, medicine the those are the professions. a profession is a group of people who have specialized education and training. however you want to define it in today's world. there is also the question of medical licensure. we will get into that. specialized licensure and certification. there is ethics. professionals have a series of ethics they have to follow. and then there is just the entire concept of organization of the profession. national societies. local societies. all that. that is what goes into making a profession. those four things. well, i am sorry to break the news to you, but, none of that existed in antebellum before civil war america. in fact, if you can think of the words anarchy and chaos --

anything else you want to use that is a synonym of them. that is where we are. that was american medicine at the time. and one more quote, 1824 -- "no body of men are less in concert or seem less influenced by espirit du corps than physicians. the quarrels of physicians are pro verbally freak when and bitter and their hatred in intensity exceed that of other men. >> i leave you two quotes. this was american medicine in the first half of the 19th century. let's talk about what is going on, how the men were educated, what they diagnosed, what they treated. so we understand american medicine at the tomb ime of the civil war. well, at the beginning of this country's founding in the 18th century and through around the first two decades of the 19th century, there were what they called apprenticeships.

apprenticeships was exact plea wh -- exactly what you think they are. if i was a doctor in 1793 in upstate new york and some young man -- i use the word man throughout the lecture. in truth there were no women involved in american medicine. the first md from an american medical school, female, elizabeth blackwell in 1849. in reality, putting political correctness aside there were no women to speak of going into american medicine at the time of the civil war. these men, i would have somebody come to me and they would say, i want to learn about medicine. i would say, fine. here are my books. your father need to pay me 100 pound. i will take care of you. that was an apprenticeship. and if you read these, this is the articles, of indenture of joseph lemmon. he paid zab dim. el boylstum.

it is what you think. they read books. listened to the doctor. doctor would tell them what to do. some times more than medicine. often they were ser vanlt vants house. there were no standards. there were no regulations. there was minimal licensure. well one thing that they did, the apprentices. was that they would some times augment their apprenticeships with lectures in anatomy, surgery and whatever. this happens to be a certificate of one young man who went and attended lectures up in harvard, actually. and i want to show you this. it is tough to see. but right over here -- and i apologize. there are the initials p.r. and i leave it to anybody in the audience who wants to tell me who p.r. was. but this is a paul revere engraving. so this is very famous. and -- paul revere was an engraver at the time. he engraved this.

one of the many things that he did. so these young men were apprentices. and they learned. they did whatever they want. in the 1820s. like, mushrooms on a forest floor after a dewy ravenin, the popped up all over the place. these are proprietary medical schools. these medical schools were exact plea what they sounded like. they were proprietary, pecuniary, started by doctors. doctors began to realize they can make a lot of money instead of having one-on-one, i can make a lot of money, if -- if chris and i join together, with dr. ruben, and we owned our own medical school and instead of now having three apren diprenti thousands, i could have 40 in the audience. there was only one criteria to get into these medical schools. what do you think it was? it was money. money is what counted. and what talked. if you'd pay dr. rubens and dr.

rutkow's fee, congratulations you are about to become a doctor. so this is rutgers medical school. happened to be in new york city on dwayne street. an interesting story in itself. because all of you know rutgers is from what state? from new jersey. yet it was chartered in new york but giving a license in new jersey. it is totally mixed up. and it foelded after two years. a famous medical school. proprietary medical schools existed all over the united states. in the 1860s in 40 years. close to 06 established. from point wisconsin, prubrunsw, maine, new york, lexington, kentucky. and all the major stiltijor cit had two and three. they were all fighting one another. so the medical schools grew larger and larger. and like anything else, you know, citizens united, they became great lobbying efforts.

and the reason was, was there wasn't a government that was involved with medical licensure. the federal government, state governments. told doctors, listen, we don't want to be bothered. we have enough problems as politicians. so the county medical society, your own groups can tell us if somebody is good enough to receive a license. that's how people were licensed back then. so you had these schools. this is nathan smith talking about the schools. if a student applies for admission into one of our colleges, i.e., pro-pprietary medical schools, the faculty lest me turn on his heels and walk in the halls of a rival institution. it was all pecuniary. these men would sit there in upright chairs for six to eight hours of monotonous lecture, over and over and over again. day after day. and this would go on for months.

they would listen to their preceptors, turned pedagogues. precementptors might not have k much. the school may not have known hut much. there was no science. they may have had a skeleton. they would not do dissection. this is a pap papier-mache mode. if you look closely there are paper things. that told you this its the lungs. and this is the shoulder. and this is the brain. that's how they learned anatomy. this is a real object. a papier-mache anatomical model. so chris cox, chris cox was chairman of the american medical association's committee on medical education, who is chris cox? another one of the people, the eraser took care of. you've don't really know much about him. the surgeon general of statement

of maryland. he was vice president of the ama and helped of this committee. so he is now -- all of the students have paid dr. ruben and dr. rutkow and dr. warren all this vast amount of money. we are wealthy guys counting our money from all these students. this is what surgeon general cox had to say. a great quote. each role of parchment endorses its possessor as a man of distinction. and he goes forth amid the sound of marshal music and rich bouquets showered upon him by the hand of fair ones. and accredited agent for life or death endowed with all the paraphernalia of a doctor of medicine but destitute of the brains. this its what is going on. and cox tells another story. in 1863, one of the premier proprietary medical schools, half of the graduates, about 25 men, wanted to go fight in the

whiffle wa civil war. wanted to fight in the medical department. and by 1863, had to take an examination to get into the army. by then. not one was able to pass the exam to get into the army. this was the state of american medical education. so there wasn't a lot of discipline in the discipline. it did not exist. it was chaos and anarchy. but this is what the civil war changed. let's talk about hospitals from this period. this is new york hospital, early 19th century. the best of the best. hospital were for the destitute, insane, murderermurderers, for . you went there for one reason -- not to get better -- you want there to die. wealthy people, whatever that meant back in the 18th. 19th century they, avoided hospitals. hospitals were not something

that you and i would go to at the time. and this was going to change with the civil war. that's what we are going to talk about. then finally, let's just talk real fast about treatments and diagnoses. diagnoses were very simple at the time of the civil war. because they had no ability to differentiate diseases. every disease was the same. if you had lupus or if you had lung cancer or hepatitis, you had a fever. simple as the all that. pathology did not exist. they did not know about the differentiation of diseases. so the end result, one big mish-mash of just everybody being sick, with no differentiation. benjamin rush, one of my favorite individuals i have written about in the past, a very famous doctor at the end of the 18th century going into the 19th century, signed declaration of independence. he cam up wie up with this thest that original. it was his thesis, very well

known. it got propagated throughout america. it was that the cause of diseases what he called stimulus? what did he mean by stimulus? very simple. he meant that blood vessels in the body were -- congested. filled up with fluid. and that there was only one thing that we could do to make you and i better. obviously if we have too much fluid, what does that mean? we are getting rid of the fluid. so that is now called the bleed, the blister, the puke, the purge, that is how heroic theory call out. they would bleed people. i am not going to go into the specifics of bleeding. not telling you the puking, and purging and what they use to give you other than to say that it was not a lot of fun i was called heroic theory because of the potency of its action. whether it was heroic, i would say, it probably wasn't. and caused a lot more harm than

good. so -- through this anarchy and chaos that existed in american medicine, we now have another group of physicians, doctors, maybe not mds, doctors nonetheless in the eyes of the public who also wanted to heal people. and what did they do? very simple. these were nontraditional practitioners, they were called sectarians and irregulars, unorthodox cultists. and who were these men? and some times more women than men. they were thomsonians. they did not believe in benjamin rush. they thought you needed hot things put all around you, or in your body. hydropaths, they gave it to you externally and internally. eclectics, botanical equivalent of hero iic drugs.

and my favorites, vegetarians and crackers. i want to tell you a little story. you know the name, graham and cracker. grahamcrackers. they believe if you ingested these graham crackers it would not sexu not -- stop sexual urges, and prevent masturbation and premarital sex. that was their belief. i leave it to you to determine if that is true or not. however i relate to you one little personal story, this is the truth. in 1975 when i began my internship and residency i was at boston city hospital, as harvard was leaving, and bu was coming in. and i distinctly remember this, absolutely true. all i remember is that at every nurse's station in boston city hospital and on every ward there were boxes and boxes of graham crackers. and that we all were eating

graham crackers. i was married at the time. leave it to my wife to determine anything. we were eating graham crackers, right and left as residents. finally the home yo paths. like is cured by like. minuscule doses of drugs. you had all these people. you had the mds, the allopaths, a big mess of what was going on. and that was american medicine at the time. well, nathan davis again, the last picture of hum that yim the going to see. every in other words we, had no idea what we were doing. so, having now bashed doctors. as i have done for the last ten minutes. we are now going to spend ten minutes going forward. i don't want you to think there

were no good things going on in american medicine. there were some very famous things going on. william beaumont and his very famous book, 1833. and of course, anesthesia, the beginnings of anesthesia. john collins warren. he is going to operate on this young man. this was taken -- about seven months after the initial event of an these ye anesthesia. there were no cameras for the initial event. there was -- everything was posed later. you see if you look at his leg over here. watch the next picture. there is the blood and bandage. early use of anesthesia. at the time no doctor could conceive of diseases or treatments in anything resembling today's scientific terms. mid 19th century drugs and therapeutic substances consisted of herbal and mineral concoctions.

the fact that there would soon be fundamental developments such as radiology, anti-sepsis, bacteriology. and scientific attitude, a willingness to question authority, a destrive to modify therapeutic practices that these will become mainstays of late 19th century medicine. in the 1860s, medicine might have stood on the cusp of a great revolution which would be heralded with -- with shortly thereafter by the likes of men like, lister and pasture, and bernard. for civil war era physicians and combatants they would not benefit one iota. filth, diseases and ancient remedies prevailed. well let's talk about the civil war. so here is william goodell.

here is william good spechltell. let me tell you. 40 years old. private. vermont infantry. white oak swamp. 1862. gets knocked unconscious. knocks his knapsack off his back. his shirt gets ripped. he gets knocked to the ground. on sx no external lesion was discovered. he had no paralysis, anywhere, he could move his tongue perfectly in every way. but he could not speak and he was totally incensable to all sound. he was in a word, deaf and dumb. this is from his report. so what happened to mr. goodell. congestion of the brain. and he gets admitted to the hospital, later in philadelphia. treatment, blood taken by cups from the back of the neck and ears. cupping meant they would put a cup on the back of your neck.