Most of Mitchell’s significant medical work on nerve injury and malingering was written during his two-year stint as head army surgeon at Turner J. Lane Hospital, an institution created by his friend Surgeon General William A. Hammond to explore the increasing number of puzzling maladies produced by the war.6 Gunshot Wounds and Other Injuries of Nerves, the first product of his war-era medical research, has been dubbed the major treatise of the nineteenth century on nerve damage. In the words of one recent critic, it was so “truly revolutionary” that it remained the definitive work on nerve damage for at least a generation, resurfacing in Paris hospitals during World War I.7 Mitchell’s pamphlet “On Malingering, Especially in Regard to Simulation of Diseases of the Nervous System,” also published in 1864, was, like Gunshot Wounds, coauthored by Mitchell and his Turner J. Lane colleagues, Drs. Keen and Morehouse. This formidable trio confronts the difficulties of assessing personal character as a necessary aspect of medical practice, perhaps unwittingly presenting the doctor as an object of assessment as well.8 Finally, in his anonymously published short story “The Case of George Dedlow” Mitchell’s main character, who is both doctor and patient, confronts the psychic cost of wartime service.9 Readers of the Atlantic Monthly were moved by the story of army surgeon George Dedlow, who after losing more than 80 percent of his body mass through the amputation of all of his arms and legs, experiences a short-lived spiritual reembodiment of his limbs at a seance. The imaginative resolution of Mitchell’s story implies that rhetorical rehabilitations offered the only hope of recovery.
Two decades later, Mitchell’s fictional imagination was still trained upon the Civil War. His first novel, In War Time, was serialized in the Atlantic Monthly in 1884 and subsequently appeared in book form. In it Mitchell returns to the Civil War hospitals and home fronts of his early career, places he revisited again and again in his fiction. It is in those historical and psychic spaces, as one of his characters proclaims, that men discovered “[what is true of] disease is true of war. It ruins some men morally, and some it makes nobler.”10 Perhaps not surprisingly, it is not the patients’ demoralization or nobility that are the main focus of In War Time but, rather, the Civil War doctor’s. Mitchell’s Dr. Ezra Wendell clearly suffers from nerve disease, and the novel charts his incompetence and the mortal danger he poses to his patients. Mitchell’s Civil War medical texts demonstrate that he was deeply invested in the emergence of a postbellum medical culture based on the practitioners’ objectivity and the superiority of scientific methodology with its tenet of repeatable results. His fatally flawed fictional doctors often struggle with the disabling expectations this new medicine demanded. Wendell is rendered professionally and psychologically impotent by his inability to control his own senses and, then, consistently and fully rehabilitate his patients’ bodies. Put another way, Mitchell’s Civil War fiction demonstrates the futility of employing a method premised on producing objective results apart from the human beings who also embody those results. Doctors are always patients as well, subject to the science that they practice.
Thus Mitchell’s Civil War texts provide a multifaceted picture of the convolutions of medicine, of narrative, of bodies, and of self that are completely integrated in the trope of the Civil War. This is not to say that his medical texts are primarily imaginative pieces or that they may be taken figuratively because the medical treatment and political views they espouse are largely outmoded. First and foremost, they must be read as serious efforts on the part of the medical community to cope with the very real injuries of Civil War soldiers and the doctors’ abilities to serve their patients. Yet Mitchell himself seems aware that his texts not only attempt to heal patients but that they also construct crucial cultural narratives of body and selfhood. In particular, this chapter on Mitchell’s war work reveals the psychological labor entailed in both the patient’s recovery and the doctor’s profession. The Civil War era, with its masses of diseased participants, established that all postbellum survivors would be long-suffering malingerers.
“When the Sensation Lenses … Become Destroyed”
In his war-era science and fiction Mitchell portrays patients at odds with their bodies, distanced, even alienated, from their unfamiliar, painful, and ultimately grotesque physical manifestations. In short, Mitchell explores how patients and doctors cope when “the sensation lenses” and the bodies that express them “become destroyed,” as his George Dedlow puts it (“Dedlow” 8). Yet patients classified as nerve injured were impaired in an astounding variety of ways. In the most straightforward cases, the men described feeling detached, numb, and out of sync with normal body functions. The patients were fully conscious of what was happening to them, yet they did not feel at all, or felt partially or incorrectly. Mitchell focuses on men such as “Lieutenant G” who felt no pain when he was shot in his leg but eventually felt pain in the other leg (Gunshot 15). Another man could discriminate compass points equally well on injured and healthy tissue, “but when his eyes were covered, a large needle could be run nearly through the palm without pricking” (Gunshot 128). Their pains do not correspond to presumed physical sources and thus suggest that bodily damage does not hold as an originary source for nerve injury. There is not a necessary correspondence between the visible wound and the interior pain, as medical wisdom of the time would have it. What is clear is that these men do not feel the way they did before their war injuries.
Although some patients maintained a conflicted and alienating attachment to their pain and the corporeal or phantom body parts that expressed the pain, others were so overloaded with pain that they were overwhelmed by it. Mitchell describes patients to whom “touch is interpreted or felt as pain … the sense of tact not lost but practically defective, by the overwhelming influence of the pain” (Gunshot 95). These patients feel so much that it hurts; the faculty of touch is “constantly exercised” and obliterates all other types of sensation. The symptom of “too much sense” or hyperaesthesia may also be interpreted as an inability to feel. A patient’s hypersensitivity to pain can cause one, in medical parlance of the time, to become “hysterical.” As Morris phrases it, “Prolonged chronic pain threatens to unravel the self,” ushering in not death, but insanity.11 In Gunshot Wounds one patient is “nervous and hysterical to such a degree that his relatives suppose him to be partially insane” (89): “The temper changes and grows irritable, the face becomes anxious and has a look of weariness and suffering … at last the patient grows hysterical, if we may use the only term which covers the facts. He walks carefully, carries the limb tenderly with the sound hand, is tremulous, nervous, and has all kinds of expedients for lessening his pain” (Gunshot 103). Hysteria had not, of course, in 1864 attained the cultural significance that it would enjoy later in the century as a catchall for ills of the body and spirit plaguing modern Americans.12 Yet this patient’s hysterical body has come to be his entire sphere of existence, swallowing up all other concerns and perceptions. As Mitchell explains it, the diagnosis of hysteria is the only chance of “cover [ing] the facts” of this man’s case, by organizing his disorder and offering the possibility of rehabilitation.
In describing such cases as hysterical, Mitchell contends that the body’s uncontrollable susceptibility to sensation spills directly into social behavior. Mitchell wishes to rehabilitate the patient’s body not only by measuring and standardizing how he feels but also by bringing him to his senses, restoring him to acceptable patterns of behavior. The seeds of a modern understanding of selfhood, in which the bodily economy is interpreted as out of control and in constant need of rehabilitation, were sown in Civil War hospitals. Not surprisingly, then, Mitchell concentrates on bringing the will to bear on the patient’s body so that he will avoid becoming demoralized. Mitchell defers to martial law in his description of one patient, arguing, “Had he been abandoned to his own wishes, he certainly would have remained a helpless cripple; but it is quite sure that nowhere, except under military rule, could he have been relieved” (Gunshot 27). Self-discipline becomes a key component of the patient’s physical rehabilitation. Because nerve injuries were so poorly understood, patients were often excoriated for lacking the will