A Grisly Wound, and a Question of Euthanasia in War

Carte de visite by Carl Caspar Giers of Nashville, Tenn. This portrait of two U.S. Army assistant surgeons in Union-occupied Nashville opens a window into the emerging field of neurology—the study of nervous disorders we know today as post traumatic stress disorder, or PTSD.

 

Both recent college graduates, their shared history traces back to medical school in Philadelphia, the same date of promotion in U.S. Army, and their assignment to military hospitals in Nashville, where they were exposed to difficult cases of battlefield wounds and disease.

 

For the taller officer standing on the left, Washington Benson Trull, his deployment marked the beginning of a military journey that went beyond the Civil War in America. Known as Ben to his friends, Trull was born in 1839 into a Massachusetts family that arrived in America during colonial times. His great-grandfather, the celebrated Capt. John Trull, led a company of Tewksbury minutemen against the British at Lexington and Concord in 1775.

 

Ben’s ancestors gravitated to higher education and the sciences, and he followed in their footsteps. He attended college preparatory school in Newton Centre, Mass., and, in 1857, entered Brown University. There he excelled in the chess club and as president of Alpha Delta Phi fraternity. Upon his graduation in 1861—the year the Civil War began—he joined Boston’s First Corps of Cadets for duty guarding the state house and arsenal.

 

Before the end of the year, Ben took a leave of absence from the Corps and embarked on the study of medicine at the Jefferson Medical College in Philadelphia, and finished his coursework at the University of Pennsylvania. During this period, he volunteered as a medical cadet at the U.S. Army General Hospital in West Philadelphia, and this allowed him to graduate early, earning his degree in 1863.

 

The intersection of his medical training and the need for surgeons to deal with the massive numbers of sick and injured opened up the next chapter in his life. Ben joined the ranks of acting assistant surgeons in the U.S. Army in Nashville, and passed the examining board to earn a commission as assistant surgeon on July 6, 1863, just a few weeks shy of his twenty-fourth birthday. He spent the rest of the war tending to soldier-patients in Nashville and Vicksburg.

 

Several of Ben’s cases, all fatal head injuries, are documented in the Medical and Surgical History of the War of the Rebellion.

 

Another case documented by Ben appears in a postwar letter published in the Boston Medical and Surgical Journal. Titled “Euthanasia in War,” the case involves an unnamed soldier who suffered a gunshot or shell fragment wound that destroyed his eyes and nose, obliterating a significant part of his face and head. Ben’s report raises questions about medical ethics and the possibility that the body’s immune system could be triggered by emotion and feeling to turn against itself.

 

Ben began by noting a study of Peyer’s glands, or Peyer’s patches, which are located in the small intestine and are part of the immune system’s defense against antigens in the gut. He also references an order about post-mortem exams.

 

Here’s Ben’s full report:

 

In the summer of 1864, we were making instructive studies of Peyer’s glands, with the hope of giving more successful treatment to the many cases of chronic diarrhea in the Cumberland U.S.A. General Hospital at Nashville. A senseless alarm was sent to the War Department about the “cutting up” of deceased comrades and the receipt of an order that forbade post mortem examinations. I was, therefore, unable, in the following case, to ascertain the deeper lesions, the condition of the optic commissure, etc.

 

The patient came to us with about 700 other acute cases of gunshot injuries, on the night of the first day’s fight at Nashville in December, 1864. Some of the men were brought in ambulances, but more in hay wagons without springs, a mile from the field, over frozen roads, deeply rutted by the wheels of batteries and supply trains of previous days. As acting executive officer, I was called to examine a man in one of the wards, who was persistently clamoring for euthanasia.

 

When I reached him, sitting on a stool in the midst of a crowd, he asked me to stoop down, look at him and then listen to his request. I found that considerable parts of both optic cones had been shot away, including the arch of the nasal bones. There was now no arterial hemorrhage, no complaint of pain beyond a sense of soreness, no special constitutional disturbance. Pulse was notably small.

 

Deformity of face was extraordinary. One eye ball had been carried off in the progress of the missile; the other rested on the cheek (half way down the face) held by its optic nerve.

 

He began at once to argue his claim, in a slow, deliberate and low voice. He exhibited no hysterical haste to die, though it was evident that for him life and not death was “the king of terrors.” He steadily maintained that life would be insupportable should he get about again. I listened as carefully as possible in the confusion of cries for attention of forty or more on the floor and the beds of the ward; doctors and nurses were embarrassed by their urgency.

 

Не was quiet. The clear working of the mind, the normal sequence of thought surprised me, looking down upon such ruin of structures in the very neighborhood of the anterior cerebral lobes. He politely paused for an answer. I cannot state verbatim what I said, but the gist of it was that none of us could previse the course of his case, nor be justified in hastening the approach of death by medical or surgical procedure.

 

He died that night in coma.

 

The pith of all this is in two points: First, the gravity of the injury so close to the supposed region of cerebration, the anterior lobes, without disturbing mentality. Second, the cause of death. The word coma explains nothing: was it the over-topping hopelessness, an object repulsive to look at and even more so, to think of: the state of mind, producing excessive secretion in certain glands, thrown into the circulation as a toxin paralyzing innervation?

 

There questions tucked into Ben’s narrative: Did patient’s state of mind produce a lethal toxin that killed him? Did he commit a form of suicide? Did he euthanize himself? Ben seemed to have no question on ethics: As a trained physician familiar with the Hippocratic Oath, he interpreted his role to do good for the patient and not cause harm. It is easy to imagine that he did not expect the man to live, which made I easier for him to deny the man’s request to be euthanized.

 

Ben remained in Nashville until the war’s end. He returned to Massachusetts and melted back into civilian life as a surgeon in practice with a cousin. His peers elected him to various state boards.

 

Ben might have remained in Boston for the rest of his days. However, he had one military assignment to fulfill. In 1870, at the outset of the Franco-Prussian War, the German Army needed surgeons. A number of German-born American physicians volunteered, and Ben joined them. He arrived in the village of Pont-à-Mousson and attended to French prisoners of war, many of whom had served in the Army of the Rhine under Marshal François Bazaine and been surrendered after the two-month Siege of Metz ended in Prussian victory. Ben spent about a year on duty before returning the United States.

 

Perhaps inspired by wanderlust from his travels during two wars, he spent time on the Pacific Coast before heading back East to New England. He married in 1874 and settled into medical practice in the Boston suburb of Brookline. Politically an independent and an Episcopal by faith, he died in 1925 at age 85.

 

For the officer standing beside Ben, Jerome Keating Bauduy, Nashville is where he met his future wife. Born in 1840 in Cuba, where his wealthy Philadelphia family of French descent had various business investments, the Bauduys associated with another family of French origins, the du Ponts, who had become prominent gunpowder manufacturers.

 

Jerome followed his father, Peter, into the study of medicine. Jerome’s higher education journey started at Georgetown College in Washington, D.C., then to the Université Catholique de Louvain in Belgium, the University of Pennsylvania, and finally Jefferson Medical College. The start of the Civil War briefly interrupted his studies. In the summer of 1861, his name appeared on a list of Regular Army appointments to second lieutenant in the 4th U.S. Artillery. However, evidence suggests he did not accept the opportunity, choosing instead to finish his education.

 

In early March 1863, Jerome graduated from Jefferson Medical College. His thesis, “Erysipelas as connected with Gunshot Wounds,” suggests he, like Ben, volunteered as a medical cadet at one of the Philadelphia military hospitals, which allowed him to compete his coursework early.

 

On March 12, two days after graduation, Jerome accepted a position as a contract surgeon in the U.S. Army and reported to Nashville for duty, tending patients with Ben in the wards of military hospitals, and passing the examination board to become a commissioned assistant surgeon.

 

Unlike Ben, Jerome did not serve out the entire war. Medical issues forced his resignation in December 1863. But rather than return to Philadelphia, he remained in Nashville. The likely cause was Caroline Bankhead. Her father, James, an Irish immigrant, had settled in Nashville and rose to prominence as a merchant with business interests in New Orleans. Jerome and Caroline met at some point and began a courtship that blossomed and led to their marriage in June 1864. Five months later, Caroline gave birth to a baby boy in St. Louis. Caroline and Jerome named him James K. Bauduy, likely for Caroline’s father and Jerome’s middle name, which was also his mother’s maiden name. The infant died a day after he came into the world, according to city death records.

 

After the war ended, Jerome and Catherine permanently relocated to St. Louis, where 10 more children were born to them, eight of whom lived to maturity. In 1865, Jerome accepted a position as attending physician at St. Vincent’s Institution for the Insane, a private facility established by the Catholic Sisters of Charity. It is possible that Jerome’s mother, Amelia, played a role in landing this job for Jerome. She had entered into monastic life as a Discalced Carmelite in Philadelphia following the death of her husband in 1856, becoming Mother Ignatius.

 

In St. Louis, Jerome prospered at St. Vincent’s. He became fascinated by the study of neurology, or the treatment of issues connected to the nervous system. Its western origins in Europe had first caught the attention of American physicians in the middle part of the century, and the Civil War played a significant role in neurology’s emergence as a distinct field. Battlefield wounds, particularly to the spinal column and head, and related emotional conditions that came to be known in the 20th century as PTSD, fueled intense interest in the American medical establishment during and after the war.

 

Jerome’s practical experience treating soldier-patients and postwar cases and research led to the publication, in 1876, of the clinical textbook Diseases of the Nervous System. The book launched him into the spotlight as a leader in the field.

 

In one passage, Jerome references the impact of war on the nervous system: “The excitements incident to war, and its disastrous consequences, have afforded ample evidences of insanity consequent upon undue violence of the emotions. In a word, whenever the mind of an individual is subjected to undue strain, or the passions are extraordinarily roused, other conditions being favorable, mental alienation may ensue.”

 

Jerome also lectured and authored a number of papers on the subject. In 1890, he released an updated edition of the book. The full catalog of Jerome’s research touched on depression and the use of cocaine as a treatment, alcoholism, multiple sclerosis, and much more. As chair of Diseases of Mind and the Nervous System at Missouri Medical College, he taught neurology and psychiatry for three decades. He also appeared as an expert witness in a number of murder cases and other sensational courtroom trials, and he received handsome pay for his testimony. He ended his career as emeritus professor at Washington University in St. Louis.

 

Jerome experienced his own violent streak, as evidenced in an 1894 report that he attacked a fellow physician who reportedly insulted or assaulted one of his daughters. Jerome reportedly struck the doctor several times with a heavy cowhide whip, while pointing a revolver at him.

 

This incident may suggest that Jerome’s pursuits in the field of neurology may have been driven, at least in part, by his own search for answers.

 

Tragically, and perhaps ironically, Jerome died in 1914 in an asylum in Buffalo, N.Y. He was 74.

 

It may be fairly stated that the Civil War service in Nashville’s hospitals profoundly shaped the futures of Jerome and Ben, whose careers intersected with neurology, albeit in very different and unexpected ways.

 

I encourage you to use this image for educational purposes only. However, please ask for permission.

 

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