Invalid teenager Leroy Wiley Gresham left a seven-volume diary spanning the years of secession and the Civil War (1860-1865). He was just 12 when he began and he died at 17, just weeks after the war ended. His remarkable account, recently published as The War Outside My Window: The Civil War Diary of LeRoy Wiley Gresham, 1860-1865, edited by Janet E. Croon (2018), spans the gamut of life events … events that were of interest to a precocious and well-educated Southern teenager—including military, political, religious, social, and literary matters of the day. This alone ranks it as an important contribution to our understanding of life and times in the Old South. But it is much more than that. Chronic disease and suffering stalk the young writer, who is never told he is dying until just before his death.
Dr. Rasbach, a graduate of Johns Hopkins medical school and a practicing general surgeon with more than three decades of experience, was tasked with solving the mystery of LeRoy’s disease. Like a detective, Dr. Rasbach peels back the layers of mystery by carefully examining the medical-related entries. What were LeRoy’s symptoms? What medicines did doctors prescribe for him? What course did the disease take, month after month, year after year? The author ably explores these and other issues in I Am Perhaps Dying to conclude that the agent responsible for LeRoy’s suffering and demise turns out to be Mycobacterium tuberculosis, a tiny but lethal adversary of humanity since the beginning of recorded time.
In the second half of the nineteenth century, tuberculosis was the deadliest disease in the world, accounting for one-third of all deaths. Even today, a quarter of the world’s population is infected with TB, and the disease remains one of the top ten causes of death, claiming 1.7 million lives annually, mostly in poor and underdeveloped countries.
While the young man was detailing the decline and fall of the Old South, he was also chronicling his own horrific demise from spinal TB. These five years of detailed entries make LeRoy’s diary an exceedingly rare (and perhaps unique) account from a nineteenth century TB patient. LeRoy’s diary offers an inside look at a fateful journey that robbed an energetic and likeable young man of his youth and life. I Am Perhaps Dying adds considerably to the medical literature by increasing our understanding of how tuberculosis attacked a young body over time, how it was treated in the middle nineteenth century, and the effectiveness of those treatments.
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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 nineteeth century, read this. If you have no interest in medicine in the eighteenth 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 evidenced 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.