HISTORY * PROMENADE DANS LE PASSE
The Civil War comes to Queen's
Frederick J. McEvoy W hen the winter session ended at the Queen's College medical school in Kingston, Ont., in March 1863, the Civil War was still raging in the United States. The lure of adventure proved too strong for one medical student. In a memoir now held at the Queen's University Archives, Francis Wafer would recount how he wanted to study practical surgery and see for himself the reality of war. Wafer's forebears were Loyalists from Vermont who had settled on a farm about 15 km from Kingston, where he was born in 1830. He was forced to leave school at 13 to help his father, but used his spare time to study and obtained a grounding in the classics, French and German, and the physical sciences. He entered medical school in 1861 and had finished his second year when he joined the Union army. Lack of a degree was no handicap because the Northern forces were desperate for doctors. Armed with a recommendation from one of his professors, Wafer travelled through a blizzard to Frederick McEvoy is a freelance writer living in Gloucester, Ont. NOVEMBER 1, 1991
The next night Wafer slept soundly beside the body of a dead officer: "I was then almost indifferent to life or death myself, and saw nothing repulsive in the inanimate form by my side." Albany, where he presented him- cept for the hot cinders driven
self to the surgeon general of New York on Mar. 11, 1863. He was examined orally by the censors of the New York State Medical Society and deemed worthy of a diploma, the prerequisite for attempting the army's medical examination. He spent 7 hours answering 16 questions on "all the principal branches of medicine." On Mar. 13 he was recommended for appointment as assistant surgeon to the 108th Regiment, New York Volunteers. Finding his regiment in Virginia proved an adventure. He travelled by train, riding on top of a box car packed with soldiers. The ride was pleasant enough ex-
into the clothes and bodies of passengers. He finished the search on foot, seeking the regiment's whereabouts as he went. On arrival he bought a horse for $90. He had to carry both feed for the animal and supplies for himself. Wafer first saw action at the Battle of Chancellorsville, Virginia, in May 1863. Despite being ill, he served in a temporary field hospital "made of pine boughs supported on forked sticks, driven into the ground." Even here they came under fire from Confederate artillery. Although "well nigh prostrated," Wafer undertook night duty and ensured that none of the wounded "[suffers] from CAN MED ASSOC J
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thirst. [I kept] their wounds quite the reverse." He admitted cooled with water, or [adminis- that such exposure does "[look] tered] an anodyne to those who cruel to unprofessional persons." In August Wafer developed were suffering much pain." The dead mingled with the pleurisy after bathing in a river. living, "their calm and ghastly He was "already much debilitated features being painfully distinct by irregular living & want of rest even in the darkness." The next of mind & body." Although his night Wafer slept soundly beside condition slowly improved - at the body of a dead officer: "I was one point he had been prescribing then almost indifferent to life or for his patients from his bed - he death myself, and saw nothing was clearly unable to face the repulsive in the inanimate form rigours of a campaign and was sent on sick leave. by my side." Care was always provided in primitive conditions, often in the face of considerable personal danger. Wafer felt it his duty to stay near the wounded, even though field hospitals were often exposed to enemy fire. He had a close call at GettysAt Gettysburg he burg - a shell, its fuse still burntwo Canadian treated ing, singed his whiskers. Another officers, one of whom shell "burst directly over my head, the hot flash plainly felt on my ''expired on my knee in face, while another ricochetted about 20 minutes." from the ground within three feet of me." At Gettysburg he treated two Canadian officers, one of whom "expired on my knee in about 20 He spent 17 days recuperatminutes" because of a head in a hospital in Georgetown, ing "after survived wound. The other the opportunity to see used and was perthe operation of resection in nearby Washington. sights the formed on his shoulder." impressed, describing wasn't He estabwas A field hospital as "the resort of all US capital the lished in a small stone farmhouse in iniquity from all adepts the a few hundred metres to the rear, that could continent the of parts and it came under intense artillery Though evade justice." possibly fire. The roof was destroyed and on insisted he recovered fully not of the wall broken: "The hum of sick heartily discharged, being fragments of shell around us was comhis for and longing the city incessant & no one knew the morades and the excitement of the ment he would be struck down." Soon a "large & hopeless campaign. There was no shortage of exmass" of wounded began to pour He came under fire citement. the in, covering the ground about once, but did his best than more ran farm house. When bandages wounded in trying the treat to the were used; out linen sheets He wrote to his circumstances. could little and only well ran dry that he tried and explained family with ease pain be done except would go but danger, avoid to were wounded The morphine. evacuated throughout the night where duty called. In another letdespite a violent rainstorm. "Un- ter home he disingenuously less very cold," Wafer wrote, claimed that he was no more exposed to injury "than many men "[rain] never injures wounded 1158
CAN MED ASSOC J 1991; 145 (9)
in civil life are exposed to violent accidents." Meanwhile, he experienced moments when bullets "whizzed uncomfortably near my head" or when "a shell struck and burst in a muck hole ... covering me from head to foot with dirt." His loyalty to his fellow soldiers meant that he preferred to stay close to the action "in order to render what little assistance would be possible in case of their being wounded." In February 1864 he received 15 days of home leave. By now he had seen enough of the war and his return to duty was "entirely devoid of the novelty and adventure of the first and the prospect had nothing attractive in it to me beyond the firm determination to see the end of the war or of myself." This grimness could be broken by moments of lightheartedness, such as the St. Patrick's Day celebrations that involved such events as races and "catching the soaped pig." The horrors of the war could not be evaded for long. This was, in many ways, the first modern war: it featured massive armies with immense firepower that could inflict casualties at a rate that foreshadowed the slaughter of World War I. The result was "plenty of work" for military doctors as the North began to use its superior numbers to wear down the Confederate army, regardless of the cost. On night shift during the Battle of the Wilderness, Spotsylvania County, Virginia, in May 1864, he found it "as painful a night's duty as ever I performed, so many wounded came in cold, drenched with rain and in a dying state." He snatched a few hours sleep, then spent a busy day "at the amputating table preparing the wounded to be transported to general hospital by wagon train, as sufficient ambulance wagons could not now be spared for this duty." LE Ier NOVEMBRE 1991
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"ALTHOUGH THE DARKEST PAGES IN THE ANNALS OF HUMAN MISERY ARE CONTINUALLY OPEN BEFORE ME, I MANAGE TO REMAIN CALM AND HELPFUL THROUGHOUT ALL THOSE TRYING TIMES." -
NOVEMBER 1,
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Dr. Francis Wafer CAN MED ASSOC J 1991; 145 (9)
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Unfortunately, the remainder of Wafer's memoir is missing. However, further glimpses of the man can be gleaned from his letters home. At the end of May 1864 he provided a rare expression of personal feelings in a letter to his sister: "Although the darkest pages in the annals of human misery are continually open before me, I manage to remain calm and helpful throughout all those trying times." Although Francis Wafer survived the war, he died an early death because of its aftereffects. He served until the end and was mustered out at Rochester, New York, in 1865. He returned to Queen's to finish his medical degree, graduating in 1867. Unfortunately, he had contracted tuberculosis during the latter part of the war and for a year after graduation was too ill to practise. He recovered enough to open a practice with anotherdoctor and was appointed a demonstrator in anatomy at Queen's. In 1875 he was named professor of medical jurisprudence but died shortly after, on Apr. 7, 1876. He was 45, and as much a victim of the war as any of the wounded he had attended. His obituary in the Kingston Daily News paid a well-deserved tribute to this little-known Canadian: "An accomplished anatomist, he took special delight in directing the dissections of the students, and spent all his spare time in the dissecting room. He enjoyed a constantly increasing practice, but what is too often the fate of the over worked physician, died poorer by some thousand dollars than when he began. Honourable and upright in his intercourse with his fellow practitioners, he secured their unanimous respect and friendship, and no one who enjoyed his acquaintance will hesitate to accord to the late Dr. Wafer the merit of sterling worth."u
V
THERAPEUTIC INDEX INDEX THERAPEUTIQUE
amoxicillin: clavulanate potassium Antibiotic and 1-lactamase inhibitor
Allergic rhinitis therapy Beconase
1082,1083, 1156
Analgesic 1072, 1073,
Anaprox DS
Antianginal Cardene
1128
agent
1140 A,B,C,D
1161, Outside Back Cover
Transderm-Nitro
Antibiotic Ceftin Clavulin
1117, 1168 1078, 1079, 1160
Anti-inflammatory agent Mobiflex 1146, 1147, 1148, 1151, 1165 NaprosynSR
1149, 1150,
1088, 1143
Antiviral agent Zovirax
1086,1087,
1133
Gastrointestinal prokinetic agent Prepulsid105, 1164
INDICATIONS: Infections caused by susceptible 1-lactamaseproducing strains of designated bacteria: Upper Respiratory Tract and Skin and Soft Tissue Infections due to S. aureus, Lower Respiratory Tract Infections due to H influenzae, K. pneumoniae or S. aureus; Otitis Media due to H influenzae and Urinary Tract Infections due to E. coli, P. mirabilis or Klebsiella species. CONTRAINDICATIONS: History of hypersensitivity to the penicillins, clavams or cephalosporins, infectious mononucleosis suspected or confirmed. WARNINGS: Before initiating therapy, careful inquiry should be made concerning previous hypersensitivity reactions to penicillins, clavams, cephalosporins or other allergens, as serious and occasionally fatal hypersensitivity (anaphylactoid) reactions have been reported. If an allergic reaction occurs, discontinue CLAVULIN and initiate appropriate therapy. Serious anaphylactoid reactions require immediate emergency treatment with epinephrine. Oxygen, i.v. steroids and airway management, including intubation, should also be used as indicated. PRECAUTIONS: Periodic assessment of renal, hepatic and hematopoietic function should be made during prolonged therapy. CLAVULINis excreted mostly by the kidney. Reduce the dose or extend dose interval for patients with renal dysfunction in proportionto the degree of loss of renal function. The possibility of superinfection (usually involving Aerobacter, Pseudomonas or Candida) should be kept in mind. If it occurs discontinue CLAVULIN andinstitute appropriate therapy. The occurrence of a morbilliform rash following the use of ampicillin in patients with infectious mononucleosis is well documented. This reaction has also been reported following the use of amoxicillin. A similar reaction would be expected with CLAVULIN. Use in pregnancy is not recommended unless the anticipated benefit justifies the potential risk to the fetus. Penicillins have been shown to be excretedin human breast milk. It is not known whether clavulanic acid is excreted in breast milk. Caution should be exercised if administered to a nursing mother. ADVERSE REACTIONS: Gastrointestinal: Nausea, vomiting, diarrhea, abdominal cramps, flatulence, constipation, anorexia, colic pain, acid stomach and colitis. The effects tends to be proportional incidence of gastrointestinal sidepseudomembranous to dose and tends to be greaterin children than in adults. Hypersensitivity Reactions: Erythematous maculopapular rash, urticaria, anaphylaxis and pruritus. A morbilliform rashin patients with mononucleosis. Rarely erythema multiforme and StevensJohnson syndrome have been reported. Liver: Transient hepatitis and cholestatic jaundice have been reported Moderate rises in SGOT, alkaline phosphatase and lacticrarely. dehydrogenase. The significance of these findings is unknown. Hemic and Lymphatic Systems: Anemia, thrombocytopenia, thrombocytopenic purpura,eosinophilia, leukopenia, lymphocytopenia, basophilia, slight increase in platelets, neutropenia and agranulocytosis have been reported during therapy with the penicillins. These reactions are usually reversible on discontinuation of therapy and are believed to be hypersensitivity phenomena. Other- Vaginitis, headache, bad taste, dizziness, malaise, glossitis, black hairy tongue and
Haemophilus influenzae type B vaccine PedvaxHIB 1166, 1167, Inside Front Cover
HistamineH1 Reactine
receptor
antagonist
1096 A,B,C,D
Nutritional supplement Enercal
1068
stomatitis.
CAN MED ASSOC J 199 1; 14 5(9)
ADMINISTRATION:
48-72
NNB.
DIFFERENT.
Smoking cessation aid Nicorette 1106,1163
Urinary bacterial agent Noroxin
1118, 1162, 1163
Vasoactive agent Trental
1066,
1163
SUPPLIED: CLAVULIN-250 Tablets 1250 mg amoxicillin, 125 mg clavulanic acid) in bottles of 100; CLAVULIN-500 F Tablets (500 ii amoxicillin, 125 mg clavulanic acid) in bottles of100. 30, Oral Suspension (125 mg amoxicillin, 31.25 mg clavulanic acid per 5 mL) and CLAVULIN-250F Oral Suspension mg amoxicillin, 62.5 mg clavulanic acid per 5 mLl in bottles (250 of 100, 150 mL. Product Monograph available on request. REFERENCES: 1 Wallace RJ, Nash OR, Steingrube VA. The American Journal of Medicine 1990,B8(suppl SAl:46-500 Wallace RJ. Postgraduate Medicine 1984 (Sept/Oct)-121-126. Esposito A. Hospital Therapy November 1989:67-755
CLAVULIN-125F
223
SmithKline Beecham
aLAwim
Pharma
SmithKline Beecham Pharma Inc. 199t Oakville, Ontario L6H
5V2
1160
DOSAGE AND
The absorption of CLAVULIN is unaffected by food. Adults- For Urinary Tract, Upper Respiratory Tract, Skin and Soft Tissue Infections which are mild to moderate, One CLAVULIN-250 tablet every B hours. For severe infections and Lower Respiratory Tract Infections, One CLAVULIN-50OF tablet every B hours. Children: For Urinary Tract, Upper Respiratory Tract, Skin and Soft Tissue Infections which are mild to moderate, 25 mg/kg/day of CLAVULIN in equally divided doses every B hours. For severe infections,Otitis Media or Lower Respiratory Tract Infections, 50 mg/kg/day of CLAVULIN in equally divided doses every B hours. Treatment should continue for hours beyond the time the patient becomes asymptomatic or bacterial eradication is 10-day treatment is recommended, for obtained. At least infections caused by 10hemolytic streptococci, to prevent acute rheumatic fever or glomerulonephritis. 00 NOT SUBSTITUTE 2 X 250 TABLETS FOR X 5OOF TABLET. RATIO OF AMOXICILLIN TO CLAVULANIC ACID IS
I'AAB
1991 LLE Ieer NOVEMBRE OEBE19