I AM PERHAPS DYING: The Medical Backstory of Spinal Tuberculosis Hidden in the Civil War Diary of Leroy Wiley Gresham
by Dennis Rasbach, MD, FACS
A scholarly yet imminently readable and fascinating account of a twenty-first century surgeon’s analysis and perspective on the medical care and musings of one Leroy Wiley Gresham. If you read nothing else about medicine in the nineteenth century, read this. If you have no interest in medicine in the nineteenth century, read this.
Leroy Gresham was a teenager during the American Civil War, and his fate paralleled that of the Confederacy. He died just over two months after that unfortunate institution itself failed.
But oh how he lived.
Young Leroy Gresham can only be described as a prodigy, and a most remarkable one at that. Who among us can imagine having a leg crushed in an accident at age eight (in a time before anything approaching even modestly effective medical care or even pain control was available; I am stunned he even survived the immediate aftermath of the event, a testimony, I am sure, to his youthful vigor) and spending the better part of the next nine years essentially bedridden and doomed to watch as your own body is consumed from the inside out (in November 1863, as the author informs us, the sixteen year old Leroy weighed just 63 pounds, and that was a year and a half before his death)? But that is not what makes Leroy and his diary remarkable. Under such circumstances–between the fits of coughing, bouts of diarrhea, pus purgings, constant headaches, intractable pain, incontinent toilet, and paralysis–who among us could imagine taking pen to hand and filling seven volumes with the musings of life?
And these were not just any musings, but the observations of country at war as seen through the eyes of an interested and passionate observer. Leroy was born a member of that privileged aristocracy, the pre-Civil War Southern Plantation owner. And although to sick to ever attend school, he seems to have had a keen mind and intellect focused well beyond his teenage years. Despite his terrible suffering, he was a keen observer of those around him (with the notable exception perhaps of the lives of his family’s slaves) and his diaries cover an amazing breadth of life in that vaunted but difficult time.
But that is not what this book is about. What concerns the author here is the nature of what laid Leroy Gresham low for all those years, for the boy was never told, and thus never penned, the exact cause of his affliction. Dr. Rasbach has scoured the diaries for clues, and the resulting book is a remarkable document in itself. If the diaries are window through which we may view what life was like for the civilians during that most onerous of conflicts, this book is portal on the medical care available during that same time period. Leroy’s family was well off, and it seems could afford the best care available at the time. One wonders what sort of care those much less situated received.
His care-givers were compassionate, loving people. That much is clear. But they labored under false assumptions, in a world wholly devoid of any scientific precepts that would hold up under today’s evidence based medicine. Dr. Rasbach’s account of all of this, as gleaned from the diaries, is utterly fascinating and never boring. Though learned, his delivery is easy to read and understandable to all.
Reading it is almost like walking through a museum of nineteenth medical practice, through rooms such as Frankenstein’s Pharmacopeia or Further Ways to Torture the Already Afflicted. His descriptions of the pharmacopeia available to the Greshams is a wonderful, if somewhat humbling tour through a nineteenth century medicine cabinet. In our day of miraculous antimicrobials, we have forgotten how utterly powerless mankind was against the scourge of infectious disease for something like 99.99% of recorded human history. This was only 150 years ago, and yet the best minds of the day had no concept whatsoever of what they were fighting, let alone how to fight it. The introduction of the Germ Theory of Disease was still a generation away.
Reading these pages is like walking an ancient battlefield in which the losing side knew nothing of the rules of warfare and were slaughtered for it. One wonders if our descendants will one day look back on our efforts against cancer with a similar observation.
If you have even the slightest interest in medicine, history, the American Civil War, pharmacy, the meaning of suffering, or are just a compassionate human being with empathy for your fellow man, you will not regret your time spent in reading this superb account of medical care and the scourge of TB in the nineteenth century. Highly recommended.