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| Photo Courtesy Dr. Guy Hasegawa |
. 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?
. 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 (books@edinborough.com) or contact me through my website
(www.cwmedicine.com).
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.
Please see my review of Dr. Hasegawa's book here.
