years &suffering · 2011-07-11 · known all too well by the dms alumni who signed up. dr....

online at dartmed.dartmouth.edu—Dartmouth Medicine 37Summer 2011

This April marked

the sesquicentennial

of the start of the

Civil War. Here’s a

look back at those

four bloody years—

at how they altered

the practice of

medicine and at

contributions made

by soldiers and

doctors from the

Granite State and

from Dartmouth.

36 Dartmouth Medicine—online at dartmed.dartmouth.edu Summer 2011

Schmidt, who by day is a research scientist with a biotechnologyfirm near Houston, Texas, has an avocational interest in CivilWar history. He is the author of two books on the Civil War andthe coeditor—with Guy Hasegawa, Pharm.D.—of Years ofChange and Suffering: Modern Perspectives on Civil WarMedicine (Edinborough Press, 2009), a series of invited essays.He recently added to his personal collection of Civil War-era mem-orabilia the 1866 letter and card pictured on page 41.

O n May 14, 1864, 22-year-old Samuel Hin-gley was on the outskirts of the Confeder-ate capital of Richmond, Va., far from his

adopted home of Boston and farther still from hisnative Nova Scotia. He was there with his com-rades in the 3rd New Hampshire, the volunteerUnion infantry regiment he’d joined the previousfall. He was about to “see the elephant”—soldierslang for being under fire—for the first time.Early that day, Hingley’s unit had been ordered

to reconnoiter the enemy’s position. “We had beenmarching through a forest for over an hour when allat once we came upon the enemy’s pickets whichwere stationed near the edge of the wood,” Hingleyrecalled some years later in an account titled “AClose Shave In the Civil War of the U.S.” TheConfederate soldiers fired a volley and then retiredbehind their works. The New Hampshire unitwheeled into line, advanced, and soon reached theedge of the forest, where they saw the enemy about500 yards off.“As soon as our presence was known they open

a murderous fire on us, but we advanced a hundredyards or so and commenced firing. . . . We couldonly see a man’s head once in a while when heraised himself to fire but we had no shelter and suf-fered terribly,” Hingley continued. Soon, he wasstruck by a bullet, but it hit a fortuitously placed

The efficient removal of wounded troops from the battlefield was one of the medicaladvances that came out of the Civil War.

By James M. Schmidt

For a with a link to thesources for this article and to further readings on Civil War medicine, see dartmed. dartmouth.edu/su11/we02.

WEB EXTRA

Faithful, indeed, is the spirit that remembersAfter such years of change and suffering!

—“Remembrance” by Emily Brontë

Yearschangesuffering&

of

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Civil War left more than 600,000 soldiers dead;two-thirds of them succumbed to disease ratherthan to shot, sword, or shell. The war also put thou-sands of wounded and sick soldiers in the hands ofsurgeons, nurses, and hospital stewards, who wit-nessed suffering on an unprecedented scale. Amongthe 600-some Dartmouth enlistees were over a hun-dred graduates of its medical school, most of whomserved as surgeons. (About a hundred more CivilWar veterans earned a medical degree from Dart-mouth during or after the war.) Among the DMS graduates who served was Dr.

Luther Bell, Class of 1826. He was 55 years old—well beyond the age at which service was expected—when he volunteered for the Union Army. “Thewhole volume of military surgery was opened to me. . . with illustrations horrid and sanguinary,” wroteBell in a letter to a friend soon after the First Bat-tle of Bull Run in the summer of 1861. “[The] hun-dred wounded victims will form a picture in my sickdreams as long as I live,” he continued. Even though Bell suffered from a pulmonary dis-

ease, he had signed on as a surgeon for a Massachu-setts regiment and soon advanced to the post of di-vision medical commander in General George McClellan’s Army of the Potomac. Unfortunately,Bell died only a few months after writing that let-ter, on February 11, 1862, from a severe attack ofpulmonary distress. (Before the war, Bell had playeda seminal role in founding the field of psychiatry.For a web-extra with a link to an article about hiscareer, see dartmed.dartmouth.edu/su11/we02.)At the start of the war, the Union Army’s med-

ical department was ill-equipped and overwhelmed.The old-school leadership in place in 1861 wasmore concerned with politics and budgets thanwith improving the existing system. The Confeder-ate States were in even worse shape, since they hadto build a medical service from scratch. The bitter fruit of this lack of foresight—on both

sides—was unmistakable after the war’s first majorbattle, at Bull Run in July 1861: wounded soldierswere left unattended for hours, ambulance servicewas nonexistent, and regimental surgeons often re-fused to treat soldiers from other units.Many histories of the war are critical of the med-

ical care that soldiers received—one historian con-sidered it “one of the war’s most dismal failures”—but a true appreciation of the situation requires anunderstanding of medicine in the middle of the19th century. Medical knowledge, as we know itnow, was still emerging; basic medical theories andsurgical techniques had remained relatively un-changed for hundreds of years. Awareness of thelink between infectious organisms and wound con-tamination—including the work on pathogens and

sepsis by Pasteur and Lister—was not reported un-til after the war’s end. Doctors of the day still be-lieved in “miasmas”—foul odors and vapors in theair that supposedly spread infection. These misun-derstandings were compounded by a lack of basichygiene in camps and hospitals.It was also an era of “heroic medicine.” Physi-

cians believed in older treatment methods such asbleeding and purging and in the healing power of acomplex array of drugs administered in massive dos-es. Indeed, the Union Army’s drug supply table in-cluded over a hundred distinct pharmaceuticalpreparations, including an infamous mercurial pur -gative known as “blue mass.” That concoction ledthe famous poet-physician Dr. Oliver WendellHolmes—a member of the Dartmouth medical fac-ulty from 1838 to 1840—to remark, “I firmly be-lieve that if the whole materia medica as now usedcould be sunk to the bottom of the sea, it would beall the better for mankind and all the worse for thefishes.”Real improvement in care of the war’s wounded

and sick would come, but it called for facing a num-ber of challenges, including advances in militarytechnology, removal of wounded troops from thebattlefield, hospital design, trauma surgery, medicalsupply acquisition and distribution, and more.

Dangerous dutyBeing a surgeon, indeed any medical officer, duringthe Civil War was a dangerous assignment—a factknown all too well by the DMS alumni who signedup. Dr. Moses Evans, Class of 1843, for example,was a surgeon with the 96th Illinois Infantry. Hecame in for mention in official reports for his brav-


of my thigh and took out the ball,” Hingley wrote.One side of the bullet was flattened where it hadgrazed his thigh bone in passing. A few weeks lat-er, gangrene invaded Hingley’s wound. “Before thegangrene was checked it had nearly eaten all theflesh off the side of my thigh,” he went on. Latethat year, Hingley was transferred to Webster Gen-eral Hospital in Manchester, N.H.When Hingley was discharged in September

1865—almost a year and a half after he was wound-ed—he could walk only with the aid of a crutchand a cane. “[My wound] was a long time healing,”Hingley concluded. “It was several years before ithealed up altogether.”

Into the Union ranksAlthough Hingley was not a graduate of eitherDartmouth College or Dartmouth Medical School,his account offers a window into the experiences ofthe more than 600 Dartmouth alumni who servedin the Union Army and Navy during the Civil War.One Dartmouth history maintains that the schoolsent a greater proportion of its students and gradu-ates into the Union ranks than any other institu-tion of higher education. (Not all of the combatantsfrom Dartmouth fought for the Union, however;more on that later.)The four years of fighting during the American

looking glass that hung just above his belt. He con-tinued to discharge his carbine in the direction ofthe enemy. “About five minutes later I was struckin the left thigh with a minié bullet. It did not hurtmuch, but my leg appeared parralized [sic] or stiff,”Hingley wrote.He started for the rear, using his carbine for sup-

port. “The ground was covered with dead and dy-ing men,” Hingley remembered. “The firing of ri-fles, the whistling of the bullets, the boom of can-non . . . the bursting of shells, and groans and wail-ing of the wounded and dying was simply terrifying.No words can give any adequate idea of the awfulscene.” He made his way as fast as he could and atlast reached the shelter of the forest, where surgeonswere at work at a field dressing station.The doctors examined Hingley’s wound and

found that the ball had lodged in the back of histhigh. They bandaged his leg, and Hingley startedagain for the rear to get out of the range of enemyfire. He found a church, went inside, and was soonsound asleep from sheer exhaustion. Around mid-night, he was taken to a field hospital by ambulanceand the next day conveyed by a floating transporton the Potomac River to a general hospital at PointLookout, Md.“Shortly after entering the hospital . . . they put

me under chloroform, made an incision in the back

Above are members of anothercompany in the 3rd New Hampshireregiment, in which Hingley served. And below is Luther Bell, a DMSalumnus who enlisted at age 55.

“The ground was covered

with dead and dying men,”

Hingley remembered.

“The firing of rifles, the

whistling of the bullets,

the boom of cannon . . .

the bursting of shells, and

groans and wailing of the

wounded and dying was

simply terrifying. No words

can give any adequate

idea of the awful scene.”

These soldiers were wounded at the Battle of Fredericksburg, 17 months before Hingley’s New Hampshire regiment cameunder fire on the outskirts of Richmond, Va.

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pelled to resign from the presidency in 1863, aftercoming in for criticism from the DartmouthTrustees and the Merrimac County Conference ofCongregational Churches. To be fair, a similar stig-ma was attached to the leaders of many other aca-demic institutions.Southern parents often sent their sons to north-

ern colleges, so it is not surprising that students andgraduates from institutions as far north as Bowdoinin Maine and as far west as Notre Dame in Indi-ana, plus many others in between, joined the Con-federate forces. Some sons of Dartmouth served theConfederate cause as well. Although the exactnumber has never been tallied, published “classsketches” and alumni bulletins tell of young menfrom Dartmouth who served the Confederacy withdistinction, or at least were content to do their dutyfor the South. One of the most interesting Dartmouth rebels

—perhaps a reluctant one—is Dr. Addison Bridg-man. Born in 1832 in Hanover, N.H., he was thefourth of nine children of Daniel and HarmonyBridgman. The family was struck with scarlet feverin 1832, and two of Addison’s older sisters died.(The disease left another of his sisters, Laura, deaf,blind, and mute and with no sense of smell or taste.She later became a nationally noted personalitythanks to the intervention of a member of the DMSfaculty, Dr. Reuben Mussey, who referred her to Dr.Samuel Gridley Howe, the founder of the PerkinsSchool for the Blind. Howe taught her to write anddo arithmetic, making her the first educated deaf-blind person in the country. Several decades later,an account by Charles Dickens of Laura Bridgman’slife prompted Helen Keller’s mother to seek treat-ment for her daughter.)Addison Bridgman attended Thetford Acade-

my, across the Connecticut River from Dartmouthin Thetford, Vt., and Kimball Union Academy, 15miles south in Meriden, N.H. He enrolled next inDartmouth College, from 1852 to 1854, and thendid a year of medical studies at Dartmouth. In 1856,for unknown reasons, he settled in Georgia, teach-ing at schools in Macon and Hawkinsville beforeopening his own school in Screven County. In the1860 census, Bridgman is listed as a teacher inScreven County, but his birthplace is shown asNorth Carolina rather than New Hampshire. It’sinteresting to consider whether he represented him-self as being from the South so locals wouldn’t sus-pect him of having Union sympathies.After the war, Bridgman wrote to a New York

department store magnate named A.T. Stewart. “Iwas formerly a teacher,” Bridgman declared, “a na-tive of N.H., but Sherman in his grand march com-pletely ruined me. But on that ruin I am struggling

to build myself again. Our country is just now bad-ly bankrupt and I am trying to make an honest liv-ing by the practice of medicine.” He closed the let-ter by asking Stewart to send him some medical in-struments on credit.Bridgman left out of this letter a very important

piece of information, however. In simply statingthat “Sherman . . . completely ruined me,” Bridg-man failed to mention that while Sherman wasmarching through Georgia in the late fall of 1864,Bridgman was fighting in the 25th Georgia regi-ment of the Confederate infantry! Whether or notBridgman himself was shooting at troops from theGranite State is hard to say. Although the 25th sawsignificant action during the latter part of the war,Bridgman’s service records indicate that he spentmost of the war away from the battlefield.In early 1862, Bridgman was reported as being

on sick leave back in Screven County. Later thatyear, he was detailed to work on a “floating battery”at Savannah. In November of 1863, he appearedon the rolls of the Ocmulgee Hospital in Macon,Ga., with the complaint of “anasarca,” also known


dier tried to attack him with a bayonet, Cutter de-clared that he was a surgeon and thus protected,but the rebel pointed to the sword that Cutter hadused to rally the troops. He was taken prisoner butwas treated well, and eventually he was allowed toreturn to his unit. It was surely patriotic fervor that inspired two

of the oldest Dartmouth medical graduates—Drs.Ebenezer Hunt and Benjamin Walton, both in theClass of 1822 and both in their sixties—to serve assurgeons in the Army and Navy, respectively.A very unusual unit was the “Dartmouth Cav-

alry,” composed almost entirely of Dartmouth alum-ni, plus a few additions from Norwich Universityand Bowdoin, Williams, and Amherst Colleges.The unit served in Virginia for three months inmid-1862.

Rebels from the NorthBut despite Dartmouth’s Yankee bona fides, not allof the College’s alumni chose to join Union forcesor to support its cause. Indeed, Dartmouth had alargely unearned national reputation for being pro-slavery, mostly owing to the sympathies of its long-time president, the Reverend Nathan Lord. Lord—who was described in pro-Union New Englandnewspapers as a “most profound worshipper of theSouth and slavery”—at least held an ultraconserv-ative Biblical interpretation of slavery. He felt com-

ery in attending to the wounded on the battlefield,and he was even wounded himself when his ambu-lance train was fired upon. Over the course of the war, hundreds of medical

officers were killed in action or died in prison, in ac-cidents, or due to sickness or exposure. Among theDartmouth medical graduates was one surgeon whowas killed by guerrillas in North Carolina while rid-ing with some other officers. And another—Dr. Ru-fus Gilpatrick, Class of 1834—was killed in actionin 1863 in a battle in the Indian Territory (present-day Oklahoma) while attending to wounded sol-diers. Other Dartmouth surgeons, such as Bell, diedof disease during the war or shortly thereafter fromthe privations of their service.Although surgeons were recognized as noncom-

batants, patriotic fervor sometimes compelled themto act in a more martial manner. Dr. Calvin Cutter,Class of 1832, was a surgeon with the 21st Massa-chusetts Infantry and was involved in many of thegreat battles during the war’s first years. At the Sec-ond Battle of Bull Run, in the summer of 1862, Cut-ter was acting division surgeon. When one of theregiments in the division broke and retreated, Cut-ter tried to rally the men and was seen falling andwas assumed dead. But a few days later he walkedinto camp quite healthy and told his tale: he had infact been hit, but the bullet had struck his waist-belt, and he fell senseless. When a Confederate sol-

In the 1860 census,

Bridgman is listed as a

teacher in Screven County,

but his birthplace is shown

as North Carolina rather

than New Hampshire. It’s

interesting to consider

whether he represented

himself as being from the

South so locals wouldn’t

suspect him of having

Union sympathies.

A very unusual unit was

the “Dartmouth Cavalry,”

composed almost entirely of

Dartmouth alumni, plus a

few additions from Norwich

University and Bowdoin,

Williams, and Amherst

Colleges. The unit served

in Virginia for three

months in mid-1862.

Above is Dartmouth PresidentNathan Lord, who was compelled tostep down from the presidency dueto his sympathies for the South.And at left is a letter, as well as abusiness card enclosed with it, thatwas written by Addison Bridgman,a DMS alumnus who served in aConfederate infantry regiment.

The 5th New Hampshire regiment poses here on a bridge they just finished building over the Chickahominy River in Virginia (thediagonal line is a break in the glass negative).

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tremendous injury to soft tissue and even worsedamage when it hit bone; in such cases, amputa-tion often offered the only chance of saving the lifeof the patient.

Picture of practiceIt is ironic, then, that if asked to conjure up a pic-ture of Civil War medical practice, many people to-day imagine callous surgeons indiscriminately hack-ing limbs off of soldiers whose only medication wasa swig of whiskey. Even during the war, the increas-ingly common sight of amputees led many citizensto conclude that limbs were being removed too of-ten. In fact, it was the most successful major oper-ative procedure of the time. Despite the criticismthat surgeons came in for from the public, theircontemporaries in medicine, as well as more recenthistorians, have concluded that too few amputa-tions were performed, not too many.The popular conception of Civil War medicine

is also at odds with the conditions under which am-putations were performed. Hingley wrote of beingunder the influence of chloroform when surgeonsremoved the bullet from his thigh. Contrary tocountless misinformed Hollywood dramatizationsof 19th-century soldiers “biting the bullet,” anes-thetics, such as chloroform and ether, did exist andwere in regular use back then. And despite Holmes’squip about dumping the medicaments of the day inthe ocean, many medicines used during the CivilWar actually had therapeutic benefit. Opium andmorphine, for example, were used to relieve painand make patients comfortable following surgery.Perhaps the most effective and popular drug wasquinine, which was routinely given to soldiers toprevent and treat malaria.In fact, the war hastened the development of

the burgeoning American drug industry. Accord-ing to a journal article published in early 1865, “Itis altogether certain that no gigantic pharmaceuti-cal operations have ever been carried on in Europe,as the past three years have witnessed in the supplyof the armies of the United States.” Many firms thatbecame household names in the 20th century—Squibb, Pfizer, Wyeth, Lilly, Merck, Warner, Parke-Davis—can trace their roots to the Civil War or tothe boom that followed, in no small part due to thetraining that talented chemists received during thewar in industrial or government laboratories.Improvements were also made in the accommo-

dations for wounded soldiers on and near the bat-tlefield, as well as in the design of hospitals behindthe lines. Hingley’s journey from a field-based firstaid station to a general hospital reflects thatchange. The most significant improvement wasknown as the Letterman system, named for Dr.

Jonathan Letterman, the medical director of theUnion’s Army of the Potomac. Letterman’s system,which was in use by late 1862, involved forwardfirst-aid stations, where the principles of triage werefirst instituted; mobile field hospitals; an efficientambulance corps; and a process for the positioningand distribution of supplies. Letterman is consid-ered the “Father of Battlefield Medicine,” and hissystem is still used today in both battlefield andcivilian settings.General hospitals—such as Point Lookout in

Maryland and Webster in New Hampshire, both ofwhich claimed Hingley as a patient—were anoth-er wartime innovation. At first, existing structuresnear battlefields or in cities were used as hospitals;however, they proved too small and dirty for long-term use. So both sides developed “pavilion-style”general hospitals: single-story barrack-type wardsfanning out from a central administrative structurethat housed laundry, pharmacy, kitchen, and bak-ing facilities; sometimes there was even a garden tosupply fresh produce for the patients. There was nota single general hospital in the United States whenthe war began; by its end, there were nearly 200,with a capacity of more than 100,000 beds.Hingley’s lament that his wound “was a long

time healing” makes the point that many veteranscontinued to live with wounds and diseases theycontracted during the war. In 1862, the federal gov-ernment passed legislation to compensate disabledveterans, widows, and orphans of the Civil War(and Hingley received a disability pension upon hisdischarge from the hospital in 1865). Revisions tothe law over the next dozen years increased the pay-ments for certain disabilities and added coveragefor other conditions. While providing compensa-tion for disabled veterans, the pension system alsogenerated a complicated tangle of medical and le-gal regulations that could make applying for and se-curing benefits difficult.

Emotional scarsHingley also commented on the terrifying sightsand sounds of combat. Today, we take it for grant-ed that psychiatric casualties are an inevitablebyproduct of warfare. But whatever we call the af-fliction—shell shock, combat fatigue, post-traumat-ic stress disorder (PTSD), or something more poet-ic, such as “soldier’s heart”—it is clearly not limit-ed to modern combat. Consider the views of Dr. Thomas Crosby, an

1841 graduate of Dartmouth College who duringthe war was chief of the Union Army’s ColumbianGeneral Hospital in Washington, D.C., and afterthe war returned to join the faculty at his alma


with her parents when war broke out. Prohibitedfrom shouldering a musket, she instead volunteeredas a nurse with the 2nd New Hampshire, a volun-teer infantry regiment. Although almost all femalenurses worked in hospitals, Dame had the distinc-tion of serving very close to the battlefield—with-in earshot of hostile gunfire—and she was even re-ported to have been taken prisoner. After the war, she was invited to veterans’ re-

unions, and the state of New Hampshire gave herfor her service a gift of $500—quite a sum at thattime—which she donated to help build a home forGranite State veterans.The Dartmouth alumni and other New Hamp-

shire men—and women—who served as surgeonsand nurses during the Civil War witnessed signifi-cant changes in their discipline. The same held truefor their patients. Indeed, from beginning to end,Samuel Hingley’s medical journey was something ofan everyman experience; luckily for him, by thetime he was wounded in mid-1864, many of the ear-ly mistakes in the care of the war’s wounded andsick had been corrected.The wartime years also saw many changes out-

side the realm of medicine that had an impact onmedical practice. Numerous technologies—such asrailroads, telegraphy, ironclad warships, machineguns, and mines—were used effectively in a majorconflict for the first time during the Civil War. Themost devastating new missile was quite small: theminié bullet, which struck Hingley in the thigh.Named for a French captain, Claude Minié, thesoft, leaden, conical “Minié ball” was fired from arifled musket and struck with a force that caused

as “dropsy,” a generalized swelling of the body dueto fluid buildup. For most of 1863—and to the endof the war—Bridgman made use of his year of for-mal medical education by working as a nurse andthen as “acting hospital steward,” first at City HallHospital in Macon and later at Lee Hospital inColumbus, Ga.When the war ended, Bridgman returned to

New Hampshire and took another year of medicalcourses at Dartmouth, earning his M.D. in 1866.He then returned to Screven County to practicemedicine, teach, and serve as postmaster. In 1874, Bridgman and his wife moved to De-

catur, Ill., where he resumed his medical practiceuntil passing away in 1916.

Granite State contributionsAlthough Dartmouth alumni made impressive con-tributions to the Civil War, they constitute only afraction of the more than 35,000 residents of theGranite State who joined the Union ranks. Nearly2,000 New Hampshire troops were killed or mortal-ly wounded in battle, and nearly 3,000 died fromdisease. The 5th New Hampshire, a volunteer in-fantry regiment, was distinguished for having lostthe greatest number of soldiers in battle of anyUnion regiment. And an untold number of menfrom New Hampshire—at least 200—served as sur-geons for Granite State regiments, as well as forunits from other states.New Hampshire women also served the Union

in a medical capacity during the Civil War. Amongthe most famous was Harriet Dame. Born in Barn-stead, N.H., in 1815, she was living in Concord

This major in the New Hampshire5th was one of more than 35,000residents of the Granite State whoserved in the Union ranks.

Nearly 2,000 New

Hampshire troops were

killed or mortally wounded

in battle, and nearly 3,000

died from disease. The 5th

New Hampshire volunteer

infantry regiment was

distinguished for having

lost the greatest number

of soldiers in battle of

any Union regiment.

continued on page 60

Much military medicine was delivered in tents. These are part ofColumbian General Hospital in Washington, D.C., which was overseenduring the war by Thomas Crosby, a graduate of Dartmouth College.

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Both sides developed

“pavilion-style” general

hospitals: single-story

barrack-type wards that

fanned out from a central

administrative structure.

There was not a single

general hospital in the

United States when the

war began; by its end,

there were nearly 200,

with a capacity of more

than 100,000 beds.

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beginning to hold joint encampments at ma-jor battle sites where for the first time theyfound it possible to salute each other’s valorand honor.”Today, 150 years later, the Civil War still

maintains an almost unmatched hold on theimagination of Americans. Each year, mil-lions of people visit Civil War battlefieldsand museums, research ancestors who foughtin the war, participate in re-enactments,watch Civil War-related films and televisionprograms, read a seemingly unending streamof books and magazine articles (includingthis one!), and collect artifacts, photographs,and ephemera.The Civil War sesquicentennial, which

runs from 2011 to 2015, will likely spark, re-new, and intensify interest in the now long-ago struggle. Thankfully, recent scholarshiphas resulted in a shift in attitude among in-formed Civil War enthusiasts toward theconflict’s medical casualties and caregiversand the challenges they faced. Nevertheless, myths still prevail among

the general public. There is more yet thatcan be learned, and shared, about those“years of change and suffering.”

online at dartmed.dartmouth.edu—Dartmouth Medicine 61Summer 201160 Dartmouth Medicine—online at dartmed.dartmouth.edu Summer 2011

Years of change & sufferingcontinued from page 43mater. Like most surgeons of the day, Crosbyalmost certainly entered wartime serviceholding conventional, even primitive, ideasabout the nature of psychological illness. Yet by 1864, he was able to recognize

these invisible wounds of war, writing in aletter to a colonel that one of his patientshad a disease “rather mental and moral thanphysical” and that he did not recommend re-leasing the soldier from the hospital. And many soldiers continued to bear

emotional scars when they returned to civil-ian life. Anecdotal evidence of associatedproblems abounds: domestic abuse, divorce,alcohol and drug abuse, and more. It is clearthat Civil War veterans’ combat-relatedmental-health tribulations did not stop withthe end of the war. Recent research has made us even more

aware of just how debilitating such injuriescan be. (And it bears mentioning that muchof the research about what we now callPTSD has come from the Veterans AffairsNational Center for PTSD, which is housed

continued from page 48 doctors how their patients fare compared topatients cared for by other doctors is a pow-erful way to inspire changes that can lead tobetter care. “The value of an electronichealth record is that you are able to acquirethat actionable data and then feed it back tothe clinical community for them to makechanges,” Gettinger says. He notes that CISwas able to track some basic measures, suchas a list of medications and a patient’s height,weight, and other similar information, but itcould not be used for more sophisticateddata-gathering. The ability to collect and analyze data is

also integral to DH’s involvement in a newnational group—the High Value HealthcareCollaborative, a collective effort by 14 lead-ing health systems to compare the quality,outcomes, and costs of care for a number ofcommon conditions, such as knee replace-ments. (For more about this initiative, seedartmed.dartmouth.edu/sp11/v02.)Following go-live for eD-H, Bernat said

that the transition had gone about as he had

DartmouthCENTER FOR CONTINUING EDUCATION IN THE HEALTH SCIENCES Educational Opportunities: Fall 2011

The Dartmouth-Hitchcock Medical Center is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.Dartmouth-Hitchcock Medical Center’s Nursing Continuing Education Council is accredited as a provider of continuing nursing education by the

American Nurses Credentialing Center’s Commission on Accreditation.

F o r m o r e i n f o r m a t i o n a n d t o r e g i s t e r o n l i n e v i s i t : h t t p : / / c c e h s . d a r t m o u t h - h i t c h c o c k . o r g

SEPTEMBERSeptember 12, 13, 19, 20, 26, 27, 2011

Hematology Oncology Mini-Course (N)Dartmouth-Hitchcock Medical Center, Lebanon, NH

September 12, 19, 26, October 3 & 10, 2011 Diabetes Education Update:

Content and Process (N)Dartmouth-Hitchcock Medical Center, Lebanon, NH

September 20 − 21, 2011 Northern New England Rural Emergency Services

and Trauma Symposium (M & N)Dartmouth-Hitchcock Medical Center, Lebanon, NH

September 30, 2011 11th Annual Dartmouth Conference on Liver,

Pancreas and Biliary Diseases (M & N)Dartmouth-Hitchcock Medical Center, Lebanon, NH

September 30, 2011The Third Annual C. Everett Koop, MD Tobacco Treatment Conference: Strategies to Accelerate

Progress in Tobacco Control (M & N)Lake Morey Resort, Fairlee, VT

OCTOBEROctober 10 − 11, 2011

First Dartmouth Autumn in New England Otolaryngology Update (M)

Dartmouth-Hitchcock Medical Center, Lebanon, NH

October 15, 2011Clinical Echocardiography Update 2011 (M)


October 17, 2011The 34th Meeting of the New Hampshire-Vermont

Hospital Ethics Committee Network (M & N)Dartmouth-Hitchcock Medical Center, Lebanon, NH

October 20, 2011Grace and Gratitude: Holistic Nursing Series (N)


October 24, 2011 The Dartmouth Conference on Sleep Disorders

2011: In Search of a Good Night’s Sleep - Consequence of Sleep Disorders

(M & N)Dartmouth-Hitchcock Medical Center, Lebanon, NH

NOVEMBERNovember 7, 2011

Pediatric Issues: Children at Risk - Do You Know Who They Are? (N)


November 10, 2011(Back by Popular Demand) What’s New in

Psychiatry? For Non-Psychiatric Physicians and Nurses (M & N)


November 16 - 18, 2011Great Issues in Medicine and Global Health Symposium:

Investing in Women and Girls (M & N)Dartmouth College, Hanover, NH &


DECEMBER December 1 − 3, 2011

The Society of Gynecologic Surgeons 21st Annual Postgraduate Course in

Advanced Gynecologic Surgery (M)The Hilton San Francisco Financial District, San Francisco, CA

December 5, 2011 DHMC Cardiovascular Disease Update Symposium 2011 (M)


Accreditation available for conferences marked (M) for Medicine and (N) for Nursing

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RemembranceThe nation was not long in waiting to com-memorate the Civil War after the cessationof hostilities. Memorials were built and en-comiums were offered to the living and thedead of both the North and South. In 1913, the Dartmouth Class of 1863

raised funds for a large bronze plaque listingthe name, rank, and unit of all 56 classmateswho had served in the Civil War—includingthree who had fought for the Confederacy.The College then had a similar plaque made,as a companion piece, listing by class the 73alumni who had died in the war—63 for theUnion cause and 10 for the Confederacy. In-cluding the names of troops from both sidesis “very rare on war memorials,” according tothe late Charles Wood, Dartmouth’s DanielWebster Professor of History, in A Guide toDartmouth’s War Memorials. “It must be re-membered, though,” Wood explained, “thatthis memorial was created only in 1913, ahalf-century after the event and at a timewhen the elderly veterans of both sides were

expected. It was taking time to master all ofthe features available in eD-H and to figureout how to use the system efficiently. But, headded, “once we all learn how to use it well,I’m sure it will go smoothly.”

A n early test of eD-H will come whenthe organization attempts to qualify forfederal “meaningful use” payments lat-

er this year. The initial standards that mustbe met in 2011 and 2012 include keepingtrack of patients’ demographic information,as well as safety features such as checking forpotentially dangerous interactions amongthe medications a patient is taking. Starting in 2013, there will be still more

requirements, which could earn DH and oth-er institutions additional payments. And, by2015, the Centers for Medicare and Medic-aid will likely penalize organizations that remain unable to meet the meaningful userequirements.Vogt says eD-H has everything needed to

earn meaningful use payments—it’s up tostaff to be sure the system is used effectively.“It’s not a technical issue, it’s getting folks tochange the way they deliver care,” he says.

“And I think we’re going to be successful.”Gettinger admits, as he shows off his iPad

and smartphone, that he’s a technophile. Hebelieves technology can be used to evengreater effect in health care in the future.“Technology is going to become much moreuser-friendly,” he says. “It’s going to be mucheasier to bring it in to clinical care.”“This is a golden opportunity,” agrees

Vogt. “You don’t often get the funding andthe staff for two years to think about howyou want to improve what you’re doing. . . .I think we’ve done a good job of reallyleveraging all of the resources that Dart-mouth has committed to making this a suc-cessful project.”Despite the difficulty of the transition,

Bernat points out that the limitations of CISmade it essential to change. “There are manyreally valuable features in eD-H,” Bernatadds, mentioning the evidence-based ordersets as but one example.And Merrens believes that merely mak-

ing the transition was beneficial. “You lookfor challenging experiences to test yourgroup,” he says. And this one, he maintains,“has strengthened our culture.”

years &suffering · 2011-07-11 · known all too well by the dms alumni who signed up. dr....

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