Friday, January 4, 2013

Author Interview--Dr. Guy Hasegawa

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 Dr. Guy Hasegawa
It has been my great pleasure to correspond with Dr. Guy Hasegawa regarding his recently published book Mending Broken Soldiers: The Union and Confederate Programs to Supply Artificial Limbs. Please enjoy this interview!

CBR—Dr. Hasegawa thank you for taking the time to answer some questions for readers. Can you give readers a brief biographical sketch and what led to your interest in the Civil War?

You’re very welcome, Robert. I was born and raised in Santa Monica, CA. After attending UCLA (Go Bruins!), where I earned a B.A. in zoology, I received a doctor of pharmacy degree from UC San Francisco and completed a residency in hospital pharmacy at the University of Illinois at Chicago. After that, I was a hospital pharmacist in Ann Arbor, MI, with a clinical practice in a coronary care unit. I’ve been at my current job in Maryland, as an editor, since 1988. I’ve published articles in the pharmacy and medical literature since 1978, and my first historical article was published in 2000.

I’ve been interested in military history as long as I can remember—or at least I enjoyed playing soldier as a kid and loved army surplus stores. I didn’t really study history until I reached mid-career and had some time for leisure reading, much of which was about World War II. It was moving to Maryland and visiting sites like Antietam and Gettysburg that shifted my focus to the Civil War. I volunteered to do some research on 19th century medicinal herbs for the National Museum of Civil War Medicine in Frederick, MD, and that introduced me to primary documents of the time, to fantastic repositories like the NationalArchives and National Library of Medicine, and to specialists in Civil War medicine. I got hooked on the excitement of uncovering new information and sharing it in talks and articles. I concentrated at first on Civil War pharmacy but have taken on various other medical topics.

CBR—While your day job isn’t writing about the Civil War you are closely associated with writing and publishing. Can you tell us about your work as Senior Editor at the American Journal of Health-System Pharmacy? Did you find you journal experience a help or a hindrance in writing your own book?

The journal I work for publishes original articles—written by pharmacists and other health professionals—about drug therapy and pharmacy practice in hospitals and other institutional settings. I have numerous responsibilities, including planning journal content, but I spend the bulk of my time handling manuscripts. This includes evaluating them for suitability, selecting peer reviewers, discussing whether the submissions should be pursued for publication, determining how their authors can improve them, clarifying and restructuring them in preparation for copyediting, approving copyediting, and checking proofs.

I’m sure this experience helped in writing my book. I often have to decide how to improve the effectiveness and clarity of manuscripts—and usually how to shorten them—and doing this at work pays off when I do my own writing. I found it fairly easy, for example, to picture how I wanted my book organized and balanced. At work, we are ever mindful of structure, clarity, grammar, punctuation, and style, and I’m always observing how copyeditors improve what authors submit. I sometime have to redo parts of manuscripts, and it’s especially instructive to see how much better my own writing is after a copyeditor has tweaked it. I get a lot of practice as an editor; each year, I help prepare about 80 manuscripts for publication.

I have to believe that my experience was helpful in presenting a successful book proposal and collaborating with the folks at Southern Illinois University Press who worked on my manuscript. I understand the publication process, and I think I was able to communicate efficiently with my acquisitions editor, copyeditor, and production coordinator and anticipate their needs perhaps a little better than many other authors.

Editors also tend to be detail-oriented, respectful of the language, and—in certain specialties like medicine—fairly particular about backing up “facts” with documentation. I probably had these inclinations before becoming an editor. In any event, they proved useful for the type of book that I wrote.

Was my editorial experience a hindrance in any way? I don’t think so. Journals and books are not the same, but the same principles of writing and editing apply. Also, I was already acquainted with alternative ways of preparing manuscripts from my experience writing for various periodicals. There’s a saying that doctors make the worst patients, so I guess the corollary would be that editors make the worst authors. You’d have to ask the staff at SIU Press whether that was true in my case, but my impression is that things went pretty smoothly. I don’t think anyone there dreaded hearing from me unless it was during negotiations about the book title and cover design.

CBR—Your recent book, Mending Broken Soldiers, deals with a seldom discussed aspect of Civil War medicine: the artificial limb industry. Can you elaborate a bit on your book and what led to your interest in the subject?

Let me answer the second part of your question first. I didn’t have a preexisting interest in artificial limbs, but I’ve always been willing to research new topics, even if they had little or nothing to do with pharmacy. Several years ago, I became aware of records at the National Archives dealing with the Association for the Relief of Maimed Soldiers, a wartime civilian effort in the South to assist amputees. A number of projects intervened, but I eventually found myself looking for something new to investigate and decided to examine the ARMS records. I realized pretty quickly that the story contained in those documents needed to be told and that the corresponding Union program also needed to be researched. Once I started getting a view of the big picture, I knew there was way too much to fit into a magazine or journal article, so I decided to try a book, and the result was Mending Broken Soldiers.

The book, then, describes these wartime endeavors to supply military amputees with artificial limbs. This topic had previously received little attention, although there is some good literature on Southern postwar programs. Before the war, soldiers who had lost an arm or leg might receive a pension but had to procure artificial limbs on their own. The efforts described in the book were the forerunners of today’s prosthetics programs for military service members, and they were influenced by a multitude of human motives—altruism, patriotism, greed, and self-promotion, for example—and by the political and business environment. The men who administered the program on both sides were army surgeons who initially knew little about artificial limbs and had to find manufacturers and develop efficient ways to provide the devices to soldiers and sailors who needed them. The striking contrast between North and South in this endeavor illustrates how the sides differed in industrial capacity, manpower, and resources. The story features a diverse and unexpected cast of characters, including some renowned physicians and famous military officers. (That’s as close to a spoiler alert as I’ll get.) Appreciating the programs requires background knowledge of the limbs industry, so I provided that information in the text and in an appendix. The book has 23 illustrations, many of which have not previously appeared in print, and SIU Press has posted a couple of supplementary documents online. These are listings of more than 6000 Union soldiers and sailors who received a limb and several hundred Confederate soldiers who applied for a limb.

CBR—War is often credited with advancing medical technology. Can you discuss some of the advances in artificial limbs that came about due to the Civil War?

It’s important to realize that the limbs industry was growing and becoming increasingly competitive even before the war started. Railroads and machinery in factories, farms, and elsewhere were dismembering people at an alarming rate, and it was the age of invention, so folks who were mechanically inclined were designing and patenting all sorts of things. The war added a lot of customers for artificial limbs and intensified competition among manufacturers, but it’s hard to say whether specific developments were brought about by the war or would have occurred anyway.

Three particular innovations come to mind. The first was a ball-and-socket ankle joint that allowed the foot to move in all directions, not just up and down. The second was a solid rubber foot that was pliable enough to supposedly make ankle and toe joints unnecessary, and the third was a socket (the section receiving the stump) that was flexible rather than rigid. You’d have to consider the evolution of prostheses for decades after the war to determine whether these were true advances rather than just novelties, and I don’t think I’m qualified to do that. There certainly was a lot of disagreement at the time about the ball-and-socket ankle and the flexible socket. They seemed like good ideas in theory, but competing manufacturers claimed that they didn’t work in practice. A lot of designers came up with new concepts and materials and touted them as improvements, but even if the thinking was sound, a limb with these features might not work for a particular patient unless it met that individual’s specific needs and was corrected fitted.

CBR—There is still the view that doctors performed too many amputations during the war and also that there was a lack of anesthesia available. Would you care to address these myths and set the record straight?

It’s not surprising that people thought—and still think—that amputation occurred too often. There were all those boys returning from the war minus a limb, many of them claiming that their arm or leg could have been saved. Amputation was indeed the most common major operation of the war, and that fact prompts people to imagine that the typical surgeon had a one-track mind focused on sawing off limbs. What one must realize, though, is that physicians generally believed that other types of major operations—say, for penetrating wounds of the head, chest, or abdomen—were futile because if the wounds didn’t kill the patient, the surgery would. On the other hand, surgeons knew that removing a seriously injured limb could save a patient’s life, and that—plus the large number of limb wounds—accounted for the high frequency of amputation. I’d venture that the number of Civil War amputations about equaled the number of amputations that should have been done. The problem, though, was that some limbs were unnecessarily removed, and some remained that should have been removed. Keep in mind that most Civil War surgeons had recently been in civilian practice and may not have been adept at amputation or judging when the operation needed to be performed. So yes, physicians sometimes amputated limbs unnecessarily, because they didn’t know better or perhaps were eager to gain some experience performing the operation. On the other hand, surgeons sometimes elected not to amputate when doing so would have been best. This could doom the patient to a relatively quick death from overwhelming infection or to a lifetime of misery and debility with a natural limb that was chronically infected and less functional than an artificial one. Some learned physicians of the time concluded that more lives would have been saved had more amputations been performed. Of course, they meant that those additional amputations would have been in patients who needed them, because the operation was not benign; the overall mortality rate for all amputations was about 25%.

Using chloroform or ether as an anesthetic was the standard of practice for major operations and other painful procedures during the Civil War. Large quantities of these drugs were used by each side. There were times when the supply chain failed and the anesthetics were unavailable, and in those cases, an alternative such as alcohol or morphine may have been given. I suspect that Hollywood is largely responsible for the common belief that all a patient received in preparation for amputation was whiskey.

CBR—Mending Broken Soldiers has been out now for about three months. What has been the reaction so far?

The reception has been great. Reviews from bloggers and comments appearing on Amazon have been uniformly positive, and audiences hearing my talks about limbs have been eager to buy a copy of the book. It’s steadily making its way into libraries. I’ve been anxiously waiting for reviews to appear in Civil War magazines and other periodicals. I’m not yet ready to retire on my royalties, but that will change once your readers see this interview, right?

CBR—Prior to this book you were co-editor with Jim Schmidt on a work called Years of Change and Suffering: Modern Perspectives on Civil War Medicine. Can you give readers a thumbnail sketch of this book and what they could expect when reading it?

Years of Change and Suffering is a collection of eight essays on various aspects of Civil War medicine, each by a different author, including Jim and me. The contributions, which are fairly specialized, reflect current scholarship on topics that range from medical education to post traumatic stress disorder and from amputation to urological injuries. Although the book is not meant to provide a complete overview of Civil War medicine, it is still appropriate for general-interest readers. I like the idea of collecting essays, because most researchers have at least one project that is too limited in scope to serve as the basis for its own book. A compilation provides a place for such projects and is an alternative to publishing them as magazine or journal articles. The last time I checked, the book was not available through large online dealers like Amazon and Barnes and Noble. However, I just got a shipment of the paperbacks, so I know that the publisher, Edinborough Press, has at least that edition in stock. Folks who want to buy a copy might ask Edinborough about availability ( or contact me through my website (

CBR—I seem to recall on Civil War Talk Radio you mentioned the possibility of a second volume. Is that idea still out there?

Volume 2 remains a possibility but is not in the immediate future. The compilation concept is still a good one and can result in an important contribution to the literature. For now, though, I’d like to stick with my own research.

CBR—So what is up next for you? Will you continue writing about Civil War medicine?

Yes, I will. The research keeps me active and interested, and I’m a great believer in publishing one’s important findings. In fact, I usually don’t take on a project unless I think it has publication potential. Right now, I’m promoting Mending Broken Soldiers, attending Civil War medicine conferences, and keeping my eyes open for another research project. I’d like to try my hand at a book that will allow me to present a lot of information I’ve collected over the years dealing with medical purveying. The trick will be to convince a publisher and then an audience that what I have to say is worth reading. Until I figure out how to do that, I won’t know exactly what I’ll cover or what additional research needs to be done.

CBR—Dr. Hasegawa, I’d like to thank you again for answering these questions. I wish you continued success with your book.

It’s been my pleasure. Thanks for the opportunity to discuss my work.

Please see my review of Dr. Hasegawa's book here.

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