DR. MAXWELL'S book fills a place which has too long been left vacant. It is the result of a vast labor in the huge neglected archive which the United States Sanitary Commission, long ago placed in the Astor Library, and which was taken into the New York Public Library when the Astor, Tilden, and Lenox foundations were united. With scholarly thoroughness and penetrating judgment, yet with unfailing narrative interest, it treats of almost the darkest side of the Civil War---the sufferings of the wounded and sick---and of the great philanthropic organization which did so much to save lives and alleviate agony during the four years of conflict. Yet its range is wider than these two themes. It furnishes fresh material of the first value on many aspects of the war: on camp arrangements, on the diet of soldiers, on home relief, on drill and morale, on sutlers, recreations, and the traits of officers high and low. A broader work than George Worthington Adams's Doctors in Blue, it takes its place alongside that volume as an essential contribution to our understanding of the struggle.

"The Sanitary Commission," wrote Katherine Prescott Wormeley in a little book of that title which she published anonymously in 1863 in Boston to aid a Sanitary fair, "is the great artery which bears the people's love to the people's army." Miss Wormeley, an active worker in the Hospital Transport Service of the Commission, wrote another volume called The Other Side of War, memorable for its ghastly pictures of the human debris of the Peninsular campaign, and its admiring portrait of that remarkable administrator Frederick Law Olmsted. Until now her two books, fragmentary as they are, the dry if very useful official compendium by Charles J. Stillé, and the vivid glimpses of Sanitary Commission work in the diary of George Templeton Strong, its treasurer, have been our only dependable sources for the work it did. Dr. Maxwell, using sources never before scrutinized by a historian, has brought together all the important facts, and made of them a story as moving as it is instructive.

What a story it is! The title Lincoln bestowed on the Sanitary Commission, the "Fifth Wheel," was not truly accurate. The Army wagon always requires four wheels: the quartermaster's services, the commissary, transportation services, and medical and surgical care. This wagon after Fort Sumter was limping along on three wheels and a pole---the pole being the little, rickety, antiquated, incompetently led Army Medical Bureau. After weary months of shoving and pulling, the Army Medical Bureau was greatly strengthened. The appointment of the redoubtable William A. Hammond as surgeon-general was a decisive turning point in its history. To the end, however, the Sanitary Commission remained absolutely indispensable. All told, it raised not less than twenty-five millions in money, goods, and personal help, much of it coming from poor farmers, mechanics, and clerks who could give but a dollar apiece. In a nation which had no medical association, no nursing schools, no apparatus for meeting a sudden strain on hospital facilities, it mobilized the best talent available for the war emergency. Et was truly a fourth wheel, and the labors it performed under Dr. Henry W. Bellows and Olmsted were as important as the equally neglected labors of Montgomery C. Meigs as head of the Quartermaster's Bureau.

The Civil War was one of the bloodiest conflicts of history, the total deaths in the Union and Confederate armies being authoritatively computed at about 625,000. The butchery began on an unexpectedly heavy scale in the early part of 1862. One of the facts which most appalls the student is the enormous amount of suffering on the field and in the hospitals. Armies the world over were probably worse provided in 1860 with medical and surgical resources than European armies had been when Napoleon's wars ended in 1815; the standard had deteriorated. The work of Pasteur and Lister lay, so far as any application to surgery went, well in the future. Almost every abdominal wound meant death. Any severe laceration of a limb meant amputation with a good chance of mortal gangrene or erysipelas. The North systematically prevented shipments of drugs and surgical instruments to the South, a piece of barbarity which did not shorten the war by a day, but on the Confederate side added greatly to its sufferings. Little was known about the best means of erecting field and base hospitals. So rudimentary was the knowledge of hospital sanitation that surgeons marveled when tent hospitals, open to the clean winds and sunshine, proved healthier than wooden buildings with dirty walls and filth-soaked floors.

Any careful reader of the literature of the war is stricken by the often casual but cumulatively horrifying notes he finds on battlefield scenes. Story after story is the same. Night would fall on a field ringing with cries of anguish: Water! Help!; if in winter. Blankets! Fire! Yet water, blankets, help did not come. Frequently they did not come for long days. Shiloh was fought on a Sunday and Monday. A cold April rain set in on Sunday night, and continued intermittently through Tuesday night. On Tuesday morning the great majority of the wounded lay where they had fallen. Some had been there forty-eight hours without attention; many had died of exhaustion or shock; not a few had drowned in rain-filled depressions from which they could not crawl. Every house in the area was converted into a hospital, where the floors were covered with wretches, sometimes with arms or legs torn off, who, after the first bandages, got no medical care, no nursing, not even nourishment. "The first day or two," wrote a reporter, "the air was filled with groans, sobs, and frenzied curses, but now the sufferers are quiet; not from cessation of pain, but mere exhaustion." Yet the war at this time was a year old.

Even more poignant versions of the same story might be given. The battle of Second Manassas was fought on Friday and Saturday so near Washington that people on housetops in the capital plainly heard the roar of cannon. The field, five miles long and three wide, was thickly strewn with dead and wounded. Pope retreated in confusion, while many in Washington feared the city might be taken. In these circumstances, as late as the following Wednesday one member of the inadequate body of surgeons on the field estimated that two thousand wounded had received no attention. Many had not tasted food for four days; they were actually dying of hunger and thirst. On Friday, a week after the battle began, a correspondent of the New York Tribune wrote of heart-rending scenes as the doctors searched among heaps of putrefying dead for men yet clinging to life---men who, if anyone approached, would cry: "Doctor, come to me; you look like a kind man; for God's sake, come to me." Let anyone who would understand what a great battle means, not in cheap pageantry and empty glory, but in agony and despair, turn to the pages in Battles and Leaders where General John D. Imboden describes the sufferings of the Confederate wounded after Gettysburg as they were transported back into Maryland.

The pain and anguish, the callous neglect, the needless loss of life, would have been far greater but for the heroic labors of the Sanitary Commission. Its leaders, agents, and doctors, few at first and inadequately financed, toiled indefatigably. According to the lights of their day, as Dr. Maxwell shows, they put a scientific temper into their exertions; their reports probed to the bottom of error and inefficiency; their recommendations struck basic principles in advance of their time. They accomplished their great results, as he also shows, not merely without proper government cooperation, but in the face of much government opposition. The generals in the field, quickly learning how unselfish and efficient their efforts were, raised a unanimous chorus of praise. Not a single leader of high rank withheld his commendation; not one officer so placed as to judge expertly of the Commission's work ever criticized it. Yet the War Department under Stanton continually impeded it. One of the unhappiest pages of Civil War history is that which records how Stanton, out of mere jealous prejudice, accomplished the downfall of Surgeon-General Hammond, who had been appointed at the instance of the Commission, and who had wrought an almost superhuman renovation of medical work in the Army. Other unhappy pages record his neglect and indifference in dealing with one of the most admirable creations of the war period.

For the Commission became an instrumentality in which Americans might well take the deepest pride. It was by 1864 the most powerful organization for lessening the horrors and reducing the losses of war which mankind had thus far produced. It was the forerunner, and to some extent the parent, of the American Red Cross. Its influence for the betterment of hospitals, nursing, and medical and surgical practice was felt long after the war ended. It did not a little, as its historian indicates, to nourish among Americans a more national spirit. Altogether, Dr. Maxwell, putting his own consecration of spirit into a task prosecuted against many disadvantages, has an almost epic story to tell.

ALLAN NEVINS

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