FDA Pre-Approval Inspections for eSource Study

 

An NDA with 7 studies, all using Target Health’s eSource solution, Target e*Clinical Trial Record (Target e*CTR®), fully integrated with Target e*CRF®, was submitted to FDA in November 2015. To date, 5 clinical sites went through 3-4 days of FDA pre-approval inspections (PAIs), all with no issued FDA Form 483. Not only did the study use direct data entry at the time of the clinic visit, where > 90% of the data were entered in real time, Target Health, the full-service CRO monitoring the study, implemented risk-based monitoring (RBM). The message to the industry is that FDA accepts eSource data provided it complies with FDA eSource Guidance. To boot, over the course of the 12 month study, the clinical sites were monitored twice, on average, primarily to do protocol training at 2 critical time-points in the study. Of course, the key goal is now to get the product approved, but at least “new world“ operations tied in with “new world“ technology, were graciously accepted by the clinical sites, CRAs, Sponsor and regulators.

 

Biomed Israel May 24-26, 2016

 

The annual Biomed Israel meeting will be held at the David Intercontinental Hotel, in Tel Aviv, May 24-26. Dr. Mitchel, President of Target Health will be attending so let us know if you are attending.

 

ON TARGET is the newsletter of Target Health Inc., a NYC – based, full – service, contract research organization (eCRO), providing strategic planning, regulatory affairs, clinical research, data management, biostatistics, medical writing and software services to the pharmaceutical and device industries, including the paperless clinical trial.

 

For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 165). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website.

 

Joyce Hays, Founder and Editor in Chief of On Target

Jules Mitchel, Editor

 

QUIZ

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Test Your Knowledge of Civil War Medicine

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Ambulance drill being demonstrated at Headquarters Army of Potomac after the Battle of Antietam and the formation of the ambulance corps. (March 1864)

 

Source: By Unknown – Civil War glass negative collection (Library of Congress) This image is available from the United States Library of Congress’s Prints and Photographs division under the digital ID cwpb.03790.This tag does not indicate the copyright status of the attached work. A normal copyright tag is still required. Public Domain,https://commons.wikimedia.org/w/index.php?curid=1193205

 

Abraham Lincoln was sworn in (to the Presidency) one 1) ___ before the Civil War began. The state of medical knowledge at the time of the Civil War (Spring 1861 to Spring 1865) was extremely primitive. Doctors did not understand infection, therefore, could do little to prevent it. It was a time before antiseptics, and a time when there was no attempt to maintain sterility during 2) ___. No antibiotics were available, and minor wounds could easily become infected, and therefore, fatal. While the typical soldier was at very high risk of being shot and killed in combat, he faced an even greater risk of dying from disease.

 

Before the Civil War, the armies tended to be small, largely because of the logistics of supply and training. Musket fire, well known for its inaccuracy, kept casualty rates lower than they might have been. The advent of railroads, industrial production, and canned food allowed for much larger armies, and the Minie ball rifle brought about much higher casualty rates. The work of Great Britain’s Florence 3) ____ in the Crimean War brought the deplorable situation of military hospitals to the public attention, although reforms were slow in coming. In the North, hygiene of the camps was poor, especially at the beginning of the war when men who had seldom been far from home were brought together for training with thousands of strangers. First came epidemics of the childhood diseases of chicken pox, mumps, whooping cough, and, especially, measles. Operations in the South meant a dangerous and new disease environment, bringing diarrhea, dysentery, typhoid fever, and malaria. Because there were no antibiotics, surgeons prescribed coffee, whiskey, and quinine. Harsh weather, bad water, inadequate shelter in winter quarters, poor policing of camps and dirty camp hospitals took their toll. This was a common scenario in most wars from time immemorial, and conditions faced by the Confederate army were even worse.

 

When the war began, there were no plans in place to treat wounded or sick Union soldiers. After the Battle of Bull Run, the US government took possession of several private hospitals in Washington, D.C., Alexandria, Virginia, and surrounding towns. Union commanders believed the war would be short and there would be no need to create a long-standing source of care for the army’s medical needs. This view changed after the appointment of General George B. McClellan and the organization of the Army of the Potomac. McClellan appointed the first medical director of the army, surgeon Charles S. Tripler, on August 12, 1861. Tripler created plans to enlist regimental surgeons to travel with armies in the field, and the creation of general hospitals for the badly wounded to be taken to for recovery and further treatment. To implement the plan, orders were issued on May 25 that each regiment must recruit one surgeon and one assistant surgeon to serve before they could be deployed for duty. These men served in the initial makeshift regimental hospitals. In 1862 William A. Hammond became Surgeon 4) ___ General and launched a series of reforms. He founded the Army Medical Museum, and had plans for a hospital and a medical school in Washington; a central laboratory for chemical and pharmaceutical preparations was created; much more extensive recording was required from the hospitals and the surgeons. Hammond raised the requirements for admission into the Army Medical Corps. The number of hospitals was greatly increased and he paid close attention to aeration. New surgeons were promoted to serving at the brigade level with the rank of Major. The Surgeon Majors were assigned staffs and were charged with overseeing a new brigade level hospital that could serve as an intermediary level between the regimental and general hospitals. Surgeon Majors were also charged with ensuring that regimental surgeons were in compliance with the orders issued by the Medical Director of the Army.

 

In the Union, skilled and well-funded medical organizers took proactive action, especially in the much enlarged United States Army Medical Department, and the United States Sanitary Commission, a new private agency. Numerous other new agencies also targeted the medical and morale needs of soldiers, including the United States Christian Commission as well as smaller private agencies such as the Women’s Central Association of Relief for Sick and Wounded in the Army (WCAR) founded in 1861 by Henry Whitney Bellows, and Dorothea Dix. Systematic funding appeals raised public consciousness, as well as millions of dollars. Many thousands of volunteers worked in the hospitals and rest homes, most famously poet Walt Whitman. Frederick Law Olmsted, a famous landscape architect, was the highly efficient executive director of the Sanitary Commission. States could use their own tax money to support their troops as Ohio did. Following the unexpected carnage at the battle of Shiloh in April 1862, the Ohio state government sent 3 steamboats to the scene as floating hospitals with doctors, nurses and medical supplies. The state fleet expanded to eleven hospital ships. The state also set up 12 local offices in main transportation nodes to help Ohio soldiers moving back and forth.

 

Field hospitals were initially in the open air, with tent hospitals that could hold only six patients first being used in 1862; after many major battles the injured had to receive their care in the open. As the war progressed, nurses were enlisted, generally two per regiment. In the general hospitals one nurse was employed for about every ten patients. The first permanent general hospitals were ordered constructed during December 1861 in the major hubs of military activity in the eastern and western United States. An elaborate system of ferrying wounded and sick soldiers from the brigade hospitals to the general hospitals was set up. At first the system proved to be insufficient and many soldiers were dying in mobile hospitals at the front and could not be transported to the general hospitals for needed care. The situation became apparent to military leaders in the Peninsular Campaign in June 1862 when several thousand soldiers died for lack of medical treatment. Dr. Jonathan Letterman was appointed to succeed Tripler as the second Medical Director of the Army in 1862 and completed the process of putting together a new ambulance corps. Each regiment was assigned two wagons, one carrying medical supplies, and a second to serve as a transport for wounded soldiers. The ambulance corps was placed under the command of Surgeon Majors of the various brigades. In August 1863 the number of transport wagons was increased to three per regiment. Union medical care improved dramatically during 1862. By the end of the year each regiment was being regularly supplied with a standard set of medical supplies included medical books, supplies of medicine, small hospital furniture like bed-pans, containers for mixing medicines, spoons, vials, bedding, lanterns, and numerous other implements. A new layer of medical treatment was added in January 1863. A division level hospital was established under the command of a Surgeon-in-Chief. The new divisional hospitals took over the role of the brigade hospitals as a rendezvous point for transports to the general hospitals. The wagons transported the wounded to nearby railroad depots where they could be quickly transported to the general hospitals at the military supply hubs. The divisional hospitals were given large staffs, nurses, cooks, several doctors, and large tents to accommodate up to one hundred soldiers each. The new division hospitals began keeping detailed medical records of patients. The divisional hospitals were established at a safe distance from battlefields where patients could be safely helped after transport from the regimental or brigade hospitals. Although the divisional hospitals were placed in safe locations, because of their size they could not be quickly packed in the event of a retreat. Several divisional hospitals were lost to Confederates during the war, but in almost all occasions their patients and doctors were immediately paroled if they would swear to no longer bear arms in the conflict. On a few occasions, the hospitals and patients were held several days and exchanged for Confederate prisoners of 5) ___. Both the Union and the Confederate Armies learned many lessons and in 1886, it established the Hospital Corps. The Sanitary Commission collected enormous amounts of statistical data, and opened up the problems of storing information for fast access and mechanically searching for data patterns.

 

The Confederacy was quicker to authorize the establishment of a medical corps than the Union, but the Confederate medical corps was at a considerable disadvantage throughout the war primarily due to the lesser resources of the Confederate government. A Medical Department was created with the initial army structure by the provisional Confederate government on February 26, 1861. President Jefferson Davis appointed David C. DeLeon Surgeon General. Although a leadership for a medical corps was created, an error by the copyist in the creation of the military regulations of the Confederacy omitted the section for medical officers, and none were mustered into their initial regiments. Many physicians enlisted in the army as privates, and when the error was discovered in April, many of the physicians were pressed into serving as regimental surgeons. DeLeon had little experience with military medicine, and he and his staff of twenty-five began creating plans to implement army-wide medical standards. The Confederate government appropriated money to purchase hospitals to serve the army, and the development of field services began after the First Battle of Manassas. The early hospitals were quickly overrun by wounded, and hundreds had to be sent by train to other southern cities for care following the battle. As a result of the poor planning, Davis demoted DeLeon and replaced him with Samuel Preston Moore. Moore had more experience than DeLeon and quickly moved to speed the implementation of medical standards. Because many of the surgeons in the regiments had been pressed into service, some were not qualified to be surgeons. Moore began reviewing the surgeons and replacing those found to be inadequate for their duties.

Initially the Confederacy employed a policy of furloughing wounded soldiers to return home for recovery. This was a result of their lack of field hospitals and limited capacity in their general hospitals. In August 1861, the army began the construction of new larger hospitals in several southern cities and the furloughing policy was gradually halted. The earliest recruits for surgeons were required to bring their own supplies, a practice that was ended during 1862. The government began providing each regiment with a pack with medical supplies including medicines and surgical instruments. The Confederacy, however, had limited access to medicinal supplies and relied on their blockade-running ships to import needed medicines from 5) ___, supplies captured from the North or traded with the North through Memphis. Anesthetics were not in as short supply as medical instruments, something highly prized. Field hospitals were set up at the regimental level and located in an open area behind the lines of battle and staffed by two surgeons, one being senior. It was the responsibility of the regimental surgeons to determine which soldiers could return to duty and which should be sent to the general hospitals. There were no intermediary hospitals, and each regiment was responsible for transporting its wounded to the nearest rail depot, where the injured were transported to the general hospitals for longer term care. In some of the lengthier battles, buildings were seized to serve as a temporary secondary hospital at a divisional level where the severely wounded could be held. The secondary facilities were staffed by the regimental surgeons, who pooled their resources to care for the wounded and were oversaw by a divisional surgeon.

 

Before the formation of any organized ambulance system, a significant amount of Union and Confederate soldiers lost their lives on the battlefield in wait for 6) ___ aid. Even if an army were able to overcome the shortage of ambulances, it was really the lack of organization that made it difficult to recover the wounded on the battlefield. In some cases, those who manned the ambulances were corrupt and sought to steal from the ambulance wagon and the wounded passengers while in some situations they even refused to gather hurt soldiers. With an insufficient number of ambulances performing assigned tasks, the wounded looked to their comrades to carry them to safety and in essence this removed many soldiers from the battlefield. Due to the overall lightness of the ambulance the ride was very uncomfortable for wounded soldiers, with the terrain being torn up by shells and explosions the ambulance at times would overturn, further harming its passengers. It was obvious that the ambulance system needed work for both the Union and the Confederate armies, yet only the Union would fully prosper in this area with the help of Dr. Jonathan Letterman and the beginning stages of the ambulance corps. Letterman’s revolutionary ideas dramatically improved both the ambulance and the ambulance system. With new designs the common Union ambulance was now composed of a 750 lb. wagon that was powered by 2-4 horses and was made to carry 2-6 wounded soldiers. Other accessories that were standard for the improved ambulances included compartments to store medical supplies, stretchers, water, and even removable benches and seats to adapt to the number of passengers. Letterman’s ideas improved the ambulance system dramatically by setting standards to train the ambulance crew, by having routine ambulance inspections, and also by developing strategical evacuation plans to most efficiently save and transport fallen soldiers. Letterman’s system was so efficient that all wounded soldiers at The Battle of Antietam were removed from the battlefield and sent to care within one day so this new system saved thousands of Union lives. Soon after The Battle of Antietam began the formation of the 7) ___ corps and while the Confederates were also working out a similar system their constant shortage of ambulances was not adequate enough to summon such an effective force as even some their ambulances came by capturing Union ambulances.

 

The most common battlefield injury was being wounded by enemy fire. Unless the wounds were minor, this often led to amputation of limbs to prevent infection from setting in, as antibiotics had not yet been discovered. 8) ___ had to be made at the point where the wound occurred, often leaving men with stub limbs. Skin was taken from the amputated limb to cover the wound and stitched to the stump. Men were generally partially sedated with chloroform or alcohol before surgeries. When properly done, the patient would feel no pain during their surgery, but would not be totally unconscious. Stonewall Jackson, for example, recalled the sound of the saw cutting through the bone of his arm, but recalled no pain. Infection was the most common cause of death of injured soldiers.

 

It has been said that the American Civil War was the first “modern war” in terms of technology and lethality of weapons, but that it was simultaneously fought “at the end of the medical Middle Ages.” Very little was known about the causes of disease, and so a minor wound could easily become infected and take a life. Battlefield surgeons were under qualified and hospitals were generally poorly supplied and staffed. The most common battlefield operation was amputation. If a soldier was badly wounded in the arm or leg, amputation was usually the only solution. Surprisingly, about 75% of amputees survived the operation. Contrary to popular belief, few soldiers experienced amputation without any anesthetic. Heavy doses of chloroform were administered; in fact, a few soldiers died of chloroform poisoning, rather than their wounds. If a wound produced pus, it was thought that it meant the wound was healing, when in fact it meant the injury was infected. Roughly three in five Union casualties and two in three Confederate casualties died of disease.

 

North and South, over 20,000 women volunteered to work in hospitals, usually in nursing care. They assisted surgeons during procedures, gave medicines, supervised the feedings and cleaned the bedding and clothes. They gave good cheer, wrote letters the men dictated, and comforted the dying. The Sanitary Commission handled most of the nursing care of the Union armies, together with necessary acquisition and transportation of medical supplies. Dorothea Dix, serving as the Commission’s Superintendent, was able to convince the medical corps of the value of 9) ___ working in 350 Commission or Army hospitals. A representative nurse was Helen L. Gilson (1835-68) of Chelsea, Massachusetts, who served in Sanitary Commission. She supervised supplies, dressed wounds, and cooked special foods for patients on a limited diet. She worked in hospitals after the battles of Antietam, Fredericksburg, Chancellorsville, Gettysburg. She was a successful administrator, especially at the hospital for black soldiers at City Point, Virginia. The middle class women North and South who volunteered provided vitally needed nursing services and were rewarded with a sense of patriotism and civic duty in addition to opportunity to demonstrate their skills and gain new ones, while receiving wages and sharing the hardships of the men. Mary Livermore, Mary Ann Bickerdyke, and Annie Wittenmeyer played leadership roles. After the war some nurses wrote memoirs of their experiences; examples include Dix, Livermore, Sarah Palmer Young, and Sarah Emma Edmonds.

 

Several thousand women were just as active in nursing in the Confederacy, but were less well organized and faced severe shortages of supplies and a much weaker system of 150 hospitals. Nursing and vital support services were provided not only by matrons and nurses, but also by local volunteers, slaves, free blacks, and prisoners of war.

 

Based on their experiences in the war, many veterans went on to develop high standards for medical care and new medicines. The modern pharmaceutical industry began developing in the decades after the war. Colonel Eli Lilly had been a pharmacist; he built a pharmaceutical empire after the war. Clara Barton founded the American Red 10) ____ to provide civilian nursing services in wartime.

 

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Period painting of a US Civil War soldier, wounded by a Minie ball, lies in bed with a gangrenous amputated arm. This is a painting of Private Milton E. Wallen of Company C, 1st Kentucky Cavalry, wounded by a Minie ball while in prison at Richmond, July 4, 1863. He was being treated for gangrene in August 1863 when Edward Stauch traveled from Washington to make this sketch. Wallen survived the infection and was furloughed from the hospital in October 1863. Artist: Edward Stauch (1830-?) – displayed at “To Bind Up the Nation’s Wounds: Evacuation and Hospitalization” exhibit of the National Museum of Health and Medicine; Public Domain, https://commons.wikimedia.org/w/index.php?curid=5164545

 

ANSWERS: 1) month; 2) surgery; 3) Nightingale; 4) war; 5) Europe; 6) medical; 7) ambulance; 8) Amputations; 9) women; 10) Cross

 

Walt Whitman, Poet, Civil War Nurse, First American War Correspondent

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Walt Whitman as photographed by Mathew Brady; Source: Wikipedia Commons

 

Editor’s note: This piece is longer than usual, because of our well educated, history loving readers and because of the subject matter. Not only was the American Civil War, our bloodiest, but Walt Whitman is one of our best poets, war nurses and certainly the best war correspondent and medical historian, for this particular war. Putting together this “History of Medicine“ was a labor of love.

 

The Civil War was fought, claimed the Union army surgeon general, “at the end of the medical Middle Ages.“ Little was known about what caused disease, how to stop it from spreading, or how to cure it. Surgical techniques ranged from the barbaric to the barely competent. A Civil War soldier’s chances of not surviving the war was about one in four. These fallen men were cared for by a woefully under qualifled, understaffed, and undersupplied medical corps. Working against incredible odds, however, the medical corps increased in size, improved its techniques, and gained a greater understanding of medicine and disease every year the war was fought. During the period just before the Civil War, a physician received minimal training. Nearly all the older doctors served as apprentices in lieu of formal education. Even those who had attended one of the few medical schools were poorly trained. In Europe, four-year medical schools were common, laboratory training was widespread, and a greater understanding of disease and infection existed. The average medical student in the United States, on the other hand, trained for two years or less, received practically no clinical experience, and was given virtually no laboratory instruction. Harvard University, for instance, did not own a single stethoscope or microscope until after the war. When the war began, the Federal army had a total of about 98 medical officers, the Confederacy just 24.

 

By 1865, some 13,000 Union doctors had served in the field and in the hospitals; in the Confederacy, about 4,000 medical officers and an unknown number of volunteers treated war casualties. in both the North and South, these men were assisted by thousands of women who donated their time and energy to help the wounded. It is estimated that more than 4,000 women served as nurses in Union hospitals; Confederate women contributed much to the effort as well. Although Civil War doctors were commonly referred to as “butchers“ by their patients and the press, they managed to treat more than 10 million cases of injury and illness in just 48 months and most did it with as much compassion and competency as possible. Poet Walt Whitman, who served as a volunteer in Union army hospitals, had great respect for the hardworking physicians, claiming that “All but a few are excellent men.“ Contrary to popular belief there was anesthesia for soldiers during the war. The surgeons would apply a cloth soaked in chloroform. The surgeons knew enough to remove the rag often so that the patient would not get chloroform poisoning. There were few operations that the surgeon did not use anesthesia in. A patient only having a bullet to bite was basically a myth. The most common operation during the Civil War was amputation. Almost 3 out of every four operations were an amputation. Most amputations were necessary because when a Minie Ball struck a soldier, it carried into the wound dirt and bacteria. The Minie Ball also shattered the bone, so the surgeons had no other choice but to amputate. If after an operation thick pus (laudable pus) started to form, the surgeons thought this to be a good sign that the wound was healing. This however was not true. If pus stared to form it was a sign of a massive infection that a soldier was likely to die of. Doctors of that day had no real medical knowledge. For instance, one doctor suggested that each man should soap his socks in water each day, to avoid sores to the feet. Not only did this remedy not work, but also the soaps of that day were made of lye. Lye is very corrosive, and would have made the sores even worse. Another remedy that the doctor prescribed was that while soldiers were “on march“, he writes “bacon can be eaten raw, as on a march, whether time nor convenience exists for cooking it. Bacon raw in itself contained bacteria, and killed many soldiers. If a soldier did not die of a bacterial infection, then he was likely to die of malnutrition.. One of the improvements during the Civil War was Hospital design. Before the War, hospitals were just one building. In this building there was no separation by illness, so many died not of what they were in the hospital for, but of what someone else was suffering from. This changed during the Civil War. Hospitals were then divided into wards for certain illnesses. This helped stop the spread of disease within the hospitals themselves. One of the better things that came out of the war was that surgeons, and other medical staff were not fired upon, or taken hostage. At the start of the war there were only about 20 clinical thermometers. The modern microscope was not even invented until 1863. There were no stethoscopes or hypodermic syringes to administer medicine. The surgeons of the time knew of bacteria, but did not know that it was what was killing entire camps of soldiers. Yet all through this carnage, people died, but some did survive. Medicines only improved from the point of the Civil War and on to develop into our medical system today.

 

The unique path which Walt Whitman followed during the American Civil War (1861-1865) led to an insightful, poetic record which captures the turmoil of this era on an intimate level. Like all transformational events in history one must examine the literature of the time to reach an understanding of the day- to-day effects on common people. Unlike other wars, no major author was a military participant in the Civil War. Yet there were authors who had personal interaction with soldiers and experienced important events of the war. Herman Melville went on scouting rides in order to get a glimpse of the soldier’s lifestyle before writing his Battle Pieces and Aspects of War. Louisa May Alcott published Hospital Sketches (1863) after a brief time as nurse during December 1862 and January 1863. Her work was cut short when she became ill with typhoid fever and returned home. Besides firsthand diaries of soldiers, the most poignant scenes of the Civil War come from Walt Whitman’s wartime prose and most distinctly his book of poetry entitled Drum Taps (1865) Many of its poems resulted from his years in Washington, D.C., spent as a psychological nurse to sick and wounded soldiers. Whitman wrote to a friend in 1863, “The doctors tell me I supply the patients with a medicine which all their drugs & bottles & powders are helpless to yield“ in reference to the aid of his cheerful disposition and careful attention to the welfare of the soldiers.

 

During these hospital years Whitman was known to be constantly scribbling in little notebooks made of pieced together scraps of paper. These now prized notebooks are filled with bits of poetry, addresses of friends and notes concerning the needs of the wounded soldiers. The material in these notebooks is priceless to modern scholars’ understanding of Whitman’s experiences during the war. In one such notebook Whitman writes, “The expression of American personality through this war is not to be looked for in the great campaign, & the battle-fights. It is to be looked for in the hospitals, among the wounded.“

 

It was in these hospitals, and not on the battlefields, as some of the poems perhaps suggest, that Whitman’s work in Drum Taps was inspired. He brought to life the emotions and realities of the Civil War. Whitman was in his forties when the war began and did not participate as a soldier. Two of Whitman’s brothers did, however, join the Union Army. Andrew Jackson Whitman served only briefly but George Washington Whitman fought with the Fifty-first Regiment of New York Volunteers for most of the war. When George was wounded in the Battle of Fredericksburg in December 1862, Whitman made the trip to the nation’s capital and then to Falmouth, Virginia, across the Rappahanock River from Fredericksburg to find and care for his brother. George was only slightly wounded, but Walt’s errand of mercy would forever change his outlook on the war and life.

 

When Whitman arrived at the front and climbed the river bank to the Lacy House, a makeshift military hospital, his first sight was “a heap of feet, legs, arms, and human fragments, cut bloody, black and blue, swelled and sickening.“ Despite such grotesque scenes, he quickly became engrossed in the passion and pathos of the wartime hospitals. He remained in camp with George for eight or nine days and spent much of his time at the field hospital. In his diary of December 26, 1862, he writes, “Death is nothing here. As you step out in the morning from your tent to wash your face you see before you on a stretcher a shapeless extended object, and over it is thrown a dark grey blanket– it is the corpse of some wounded or sick soldier of the reg’t who died in the hospital tent during the night– perhaps there is a row of three or four of these corpses lying covered over.“

 

His compassionate nature was quickly overrun with a desire to help these wounded men. On December 28 Whitman left the camp at Falmouth with a trainload of wounded soldiers bound for Washington, D.C. Upon arrival in Washington he visited his friends, the O’Connors, with the intention to remain in the city for only a week to visit some hospitalized soldiers from Brooklyn. However, he quickly realized that he could not leave his new found and suffering comrades and return to his life in Brooklyn, which now seemed meaningless in comparison. He found a job in the Army Paymaster’s Office working a few hours a day. For the next three years he kept almost constant company with wounded soldiers and spent his small salary on food, gifts and tobacco for the lonely patients in wards all around Washington. He remained throughout the war, doing the best he could to be a friend to these forgotten men. William Douglas O’Connor wrote of Whitman’s hospital service in The Good Gray Poet (1866), suggesting that Whitman had grown gray in the service of his country: “His theory is that these men, far from home, lonely, sick at heart, need more than anything some practical token that they are not forsaken.“

 

To understand more fully Whitman’s Drum Taps, it is necessary to learn more about the hospitals of wartime Washington, many of which he earnestly patronized. They are the physical and psychological setting of some of Whitman’s greatest verse. The occurrences within their walls, or more often tent sidings, were the focus of Whitman’s life for four years during and after the war. Although many poems are set in charge or battle, he visited the front only twice–and witnessed no actual battles. His experience stems from his time spent listening to wounded soldiers, writing letters to their parents, and attempting to preserve individual identities for the anonymous and wounded men. To understand the man Whitman was, and to appreciate the full context of Drum Taps. We must begin with the history of wartime Washington and its military hospitals. Before the war began, Washington was a relatively rural town with limited medical accommodations. There were no military hospitals and very few medical facilities. Yet by the end of the Civil War there were approximately fifty hospitals marking the Washington landscape. Their beginnings were in the tents of regiments of soldiers. The regulations provided that there be a hospital tent in proportion to the number of men within each regiment. Whitman writes one of the most accurate descriptions of field hospitals in a letter to his mother in 1864:

 

I suppose you know that what we call hospital here in the field, is nothing but a collection of tents, on the bare ground for a floor, rather hard accommodations for a sick man–they heat them here by digging a long trough in the ground under them, covering it over with old railroad iron & earth, & then building a fire at one end & letting it draw through & go out at the other, as both ends are open–this heats the ground through the middle of the hospital quite hot.

 

Soldiers were kept in the field hospitals indefinitely and often sent on to Washington after their conditions had so worsened as to make surviving the trip almost impossible. When the regimental tent was full, a nearby home or building was usually commandeered and converted for medical care. Although intended as temporary units, these regimental tents and field hospitals were soon clustered together to make larger accommodations of hospital camps that eventually spotted the city. Following the early defeats of the Army of the Potomac in 1861 and 1862, Washington became a vast hospital complex with more than 20,000 wounded troops. The first military hospitals were opened in Washington, D.C. in 1861. The E street Infirmary and the Union Hotel both received patients in May 1861. The E street Infirmary’s first patients were soldiers in the Sixth Massachusetts Regiment who had been sent to quell a riot of Southern sympathizers in Baltimore. At the time the E Street Infirmary, or Washington Infirmary, was the only hospital in the District of Columbia. It remained steadily in operation until destroyed by fire on November 3, 1861. The military quickly realized that the current facilities were inadequate and many public buildings needed to be converted into hospitals. One wing of the Patent Office became the Patent Office Hospital from October 1861 to March 1863.9 Patients were cared for within the walls of the Capitol, and Reynolds Barracks Hospital was set up on what is now the south lawn of the White House. Other buildings temporarily used as hospitals include the Georgetown College, Water’s Warehouse, and Saint Elizabeth’s Insane Asylum. Many private buildings were taken over and used as hospitals as well, e.g., hotels and boarding schools, often for a monthly rental fee. Private medical practices, such as Desmarre’s Eye and Ear Hospital on the corner of Massachusetts Avenue and 14th Street, were used as well. Miss Lydia English’s Female Seminary became Seminary Hospital and was in operation between June 30, 1861, and June 14, 1865.“

 

Along with private buildings, churches opened their doors for the emergency. Boards were laid atop the pews to serve as the floors in these makeshift asylums for the military sick and wounded. Converted church hospitals in Washington included Ascension, Methodist Episcopal, Epiphany and Union Methodist Episcopal, all in the northwest section of Washington. Between 1861-1862, the U.S. Sanitary Commission urged the importance of building pavilion-style hospitals, instead of renting buildings ill-adapted to use as hospitals. As a result, Mount Pleasant and Judiciary Square hospitals were completed in April of 1862. In keeping with the informal setup of these military hospitals, security and privacy for the sick were virtually nonexistent. Anyone could wander in and out of the hospitals freely. There was a constant stream of people looking for wounded friends and family members, along with zealous pastors attempting to convert the wounded. Some helpless wounded were the victims of theft or were befriended in the hope of being named in a dying man’s will. More fortunate soldiers would sometimes receive gifts and food from the good Samaritans. Mothers, wives, or sisters of wounded men were allowed to care for their loved ones and were usually accepted and aided by the hospital nurses. On the negative side, visitors often ignored soldiers in adjacent beds in their zeal to comfort their loved ones. Others would help only those soldiers from a particular state or scoff at Confederate wounded also in the Washington hospitals. The hospitals averaged five hundred beds and the majority of buildings were neither heated nor well ventilated. Sanitation was of little concern. Before knowledge of microbes and infection, there was no concern for sterilization of instruments, and used bandages littered the floor. Doctors moistened stitching thread with their saliva before sewing wounds and sharpened surgical knives on the sole of their boots. The water supply was a serious consideration because the barracks were seldom participants in municipal conveniences. As a result, blood poisoning, tetanus and gangrene were extremely common.

 

It has been estimated that the hospitals killed as many as they saved. Whitman writes in one of his notebooks of two such needless deaths in Campbell Hospital. “Frederick Huse died 5th Jan.’63, overdosed by opium pills & laudanum, from an ignorant ward master. Joshua Ford, wardmaster gave him inwardly lead muriate of ammonia, intended for a wash for his feet.“ The nutritional deficiencies only added to the difficulties of hospital life. The food within the hospitals was no better than what was received in the field. Wounded soldiers were fed cornmeal and hard tack fried in pork grease. Fruit and vegetables were virtually never fresh and seldom available. Food was sometimes confiscated from civilians, yet by the end of the war there was a shortage everywhere. Scurvy and malnutrition was rampant. Between the poor diet and unhealthy hospital conditions, nature had very little support in aiding the soldiers’ healing process. Whitman may have made more than a psychological difference for some soldiers with his frequent gifts of fruit for the men. Doctors of this time had typically completed only two years of medical school, which consisted of basic principles and lectures and little or no practical training. Although medical breakthroughs were occurring in Europe, it took many years for new procedures to become common in America. Thermometers were being used throughout France, yet there were only twenty thermometers in the entire Union Army. The stethoscope was still a novelty and many surgeons would “dust“ wounds with morphine rather than using injections. Harvard University did not own a microscope until after the war. Rampant infection in extremity wounds rendered amputation as the most common Civil War surgery. According to Federal records, three of four operations were amputations. The most common operation was the ?guillotine’, in which the soft tissue was cut to the bone with a large knife. The bone was then cut with a hacksaw, and the arteries were clamped and tied with silk. Yet despite this crude procedure, incredible estimates suggest there was only a 26% fatality rate among amputees.

 

Along with the lack of medical knowledge, a great deal of animosity existed between the volunteer surgeons and the regular officers. The regulars found the volunteers to be unorganized and unable to take orders. At the same time, the volunteers considered the regulars arrogant and set in their methods of backward medical care. Additionally, the hospital doctors were regularly accused of cruelty and neglect of their patients. Many rumors and some specific cases claimed that patients were dying due to the drunkenness of surgeons. Nurses were especially quick to accuse doctors for being intoxicated on duty or drinking alcohol from supplies meant to ease the suffering of the patients. Alcoholic doctors, however, were probably less numerous than the rumors suggest. In Whitman’s many years spent visiting and observing hospital life, he found the majority of doctors to be good and hard-working men. The overload of patients was so great that the physicians were simply unable to give enough individual attention to the men. This is where Whitman’s time in the hospitals was so vital to the patients’ welfare. In Specimen Days Whitman explained, “I found it was the simple matter of personal presence, and emanating ordinary cheer and magnetism, that I succeeded more than by medical nursing, or delicacies, or gifts of money, or anything else.“

 

Unfortunately, although Whitman understood the psychological needs of the men, it appears that no one understood the basic need for cleanliness. The lack of sanitation in the hospitals resulted in typhoid, dysentery and malarial fevers as the leading diseases of the war. The first two were spread by contamination from bedpans left unemptied in wards or the general lack of adequate latrine facilities in many hospitals. Harewood Hospital, for example, in Washington began as a series of tents and was soon surrounded by refuse and excrement. As a result, Anopheles mosquitoes and flies abounded, spreading malaria and transporting other diseases. Most Washington hospitals were equipped with mosquito netting, but many patients found it hot and uncomfortable and would not keep it in place. Given their deplorable conditions, it is understandable that soldiers often dreaded being sent to the hospitals.

 

Judiciary Square hospital became known for its brutality as corpses were left naked on a vacant lot to await burial. One soldier wrote in November 1861 near Washington, “In the hospital men lie on rotten straw; in the camp we provide clean hemlock or pine boughs. In the hospital the nurses are convalescent soldiers, so nearly sick themselves that they ought to be in the wards, and from their very feebleness they are selfish and sometimes inhuman in their treatment of the patients.“ This is a common description of the hospital conditions in the first unbearable months of the war. Yet as the union slowly accepted the fact that the war was not to end quickly, responsibility was taken to improve medical conditions. The contributions of nurses in the Civil War are inestimable. Not only did hospital staffs, often voluntary, aid the wounded, but they forged a place for women working outside the home. Their presence added a kind, tender figure for the soldiers. In Memoranda During the War, Whitman expressed that “Middle-aged and healthy and good condition’d elderly women, mothers of children, are always best“ as nurses. His opinion was in agreement with Dorothea Dix, one of the most important figures in the nursing effort. Dix appeared at the office of the Secretary of War on April 19, 1861. She was familiar with the British Sanitary Commission and had visited the reformed hospitals of Florence Nightingale. Already known as the founder of insane asylums, she was quickly given the title of “Superintendent of Female Nurses.“ Miss Dix enforced strict standards for her nurses: they had to be over thirty, healthy, and extremely plain in dress and personal appearance. She also required impeccable moral conduct and took great pride in her nurses.

 

Unfortunately, Miss Dix’s administrative skills were not conducive to her high administrative position. She was known to take up for her nurses against doctors and administrators to a fault. Extremely particular that everything be done to her exact specifications, she often showed very little respect for the doctors. It must be noted that at the beginning of the war there was not a single medically trained female nurse in America. Often when surgeons disciplined or released nurses, it was with good reason. Yet Miss Dix forced surgeons to retain her nurses, often attempting to have the surgeon or administrator dismissed. In 1863, a general order was issued to deal with these constant confrontations between doctors and Miss Dix. If a nurse was dismissed, the hospital administrator had to offer reason; and no female nurses were to be carried on the muster role if not appointed by Miss Dix, unless approved by the Surgeon General. Yet, unfortunately for Miss Dix, the Surgeon General — Joseph K. Barnes– was known to enroll any woman requested of a hospital head. Much to Miss Dix’s dismay, many young and attractive women were employed as nurses, and quite a few eventually married soldiers whom they nursed. Along with the positive impact of nurses, the U.S.Sanitary Commission was established in June of 1861, for the purpose of giving advice based on the most current medical knowledge of the day. It became the organizing force of Civil War hospitals. Its goal was efficient, decent health care for the wounded. The directors were men of high professional standing and had the political means to apply pressure as needed. The members of the Sanitary Commission were volunteers, but the professional fundraisers and directors held paid positions. The Commission set up shelters for troops and bought and distributed medical supplies. They raised funds through donations, fairs. and auctions. At one such fair, President Lincoln donated a draft of the Emancipation Proclamation, which was purchased by Mr. T.B. Bryan of Illinois for $3,000 and donated to the Chicago Soldier’s Home.

 

Whitman writes in one of his notebooks, “I have been a good deal to Campbell and Armory Square Hospitals, and occasionally to that at the Patent Office. Every one of these cots has its history–every case is a tragic poem, an epic, a romance, a pensive and absorbing book, if it were only written.“ Although Whitman visited nearly all of the Washington hospitals, much of his time was spent at Armory Square Hospital. It was a pavilion hospital constructed in the summer of 1862 and was located on Seventh Street across from the grounds of the Smithsonian Institute, just beyond the canal. Today this is on the Washington Mall, where the Smithsonian Air Museum is located. At this time the canal was basically an open sewer, which rendered this location rather undesirable. The old City Canal was a “fetid bayou filled with floating dead cats, all kinds of putridity, and reeking with pestilential odors.“ However, the site was close to the major thoroughfares and was easily accessible to the wharves and the railroad depot. The hospital consisted of eleven long pavilions placed side by side with their gables facing the front and rear of the grounds. There was a main pavilion that constituted an administration building. It contained a reception room and offices for the surgeon in charge, the dispensary, a linen room, post office, and officers’ quarters. In the rear of this building was a general kitchen, laundry, and mess hall. The remaining ten pavilions were positioned five on each side of the administration building. These ten buildings served as wards for the soldiers. Each ward pavilion was 149 x 25 feet with an average height of about thirteen feet, and held about fifty beds. A section at the rear of each ward served as a dining room and lodging for female nurses before facilities were built to house them. At the opposite end of the ward were the bathroom, water-closet and wardmaster’s room.

 

Within the wards just described Whitman spent many hours at soldiers’ bedsides. He writes of ward K in Armory Square Hospital, “I am very familiar with this hospital have spent many days & nights in it– have slept in it often– have seen many die here, have seen the wounded brought here after battles, &c.“ Campbell Hospital was another in which Whitman spent many hours. Originally, it had been a barracks for cavalry and was located on the northern extremity of the city, near the end of Seventh Street. It consisted of long, low, narrow buildings made of rough boards. Six of these enclosed an oblong space with two buildings forming each long side and one building forming each short side with one building in the center. These buildings all served as wards. Jutting off perpendicular from one side of the oblong were five additional buildings. The center building served as dining room and kitchen with the other buildings also serving as wards. A building projecting from the short side was used for administration purposes. There were eleven total wards that had a combined capacity of six hundred beds. The small buildings at the top served as a series of outbuildings serving as nurses quarters, guard rooms, Negro quarters, and the dead house. Ridge ventilation was introduced after the barracks were turned over to the Medical Department. This type of ventilation refers to the clearing away of earth from the walls and laying open the ridge during summer for air movement. Louvered exits were used in winter with inlets near the stoves. Ten tent wards holding fifty beds each were soon added (not shown on the diagram). Many similar converted barracks hospitals were in poor condition because they were not connected with the municipal water supply. Campbell Hospital was more fortunate due to its location. The Potomac River water was distributed to the wards. The waste water was carried off by drains to sewers and every alternate ward had a bathroom and sinks that were kept clean by a running stream.

 

Methods of transporting the wounded from battlefields to the described hospitals were another challenge for which the military was unequipped at the beginning of the war. Wounded soldiers were roughly placed into the back of rickety two-wheeled vehicles which jostled and bumped them endlessly. The ambulance drivers were of the roughest class, described by a surgeon in 1862 as “the most vulgar, ignorant, and profane men I ever came in contact with such as would disgrace any menials ever sent out to the aid of the sick and wounded.“ Drivers had no concern for the cries of the soldiers and had not even the decency to get water for the wounded during the short stops on the journey. In battles such as the second Bull Run, however, wounded men were fortunate to be taken off the battlefield at all. Frequently, ambulance drivers fled at the first sound of gunfire. Of the ambulances which remained many had broken down, leaving military divisions without any transportation vehicles. Because the Union troops were defeated, wounded who had been left on the field were on Confederate ground. Three thousand soldiers remained where they had been wounded three days after the battle. These soldiers were starving and had received no attention. Miraculously, 600 still remained alive on the field five days after the battle. After seven days the last group of men were transported to hospitals in Washington, despite the fact that many of the ambulance drivers sent to retrieve these men drank the supplies of alcohol and never reached the battlefield. The deaths resulting from such a lack of organization are inestimable and abominable. In 1861, the U.S. Army Medical Department was headed by an eighty-year-old man whose methods hailed from his experiences in the War of 1812. It was April 1862 before he was replaced by William Hammond. Hammond was young and well educated, and the ambulance system eventually began to see improvement. Dr. Hammond appointed Dr. Jonathan Letterman as Medical Director of the Army of the Potomac to organize an ambulance corps. Letterman had ambulances manned with soldiers who received specific training for their positions. He set up division hospitals and regimental hospitals which were to merge into divisional units. The wounded were arranged so as to transport those less severely wounded to general hospitals– clearing the overcrowding and allowing the worst cases to receive care in the field hospitals. Ambulances moved constantly and on a set schedule. Antietam was the first battle after Letterman’s appointment, and the well-organized results were the most promising sign of improvement. The once quiet capital was soon abuzz with military hospitals and sick soldiers. In figure three, a map showing the location of fifty-six hospitals in use during the war shows the extent to which hospitals covered Washington. These hospitals only added to the wartime atmosphere of the city that already swarmed with regiments of soldiers. Army wagons and artillery tore up the unpaved streets and roads, and ambulances jolted by at all hours. Whitman’s Washington consisted of an unfinished Capital dome with blocks of marble and granite strewn about its grounds. The Washington monument was not yet half of its present height of 555 feet. The Treasury, Post-office, and Interior Department buildings were unfinished as well. There were few sidewalks and only one theatre. The years of war were a time of growth and change for Washington. The Union capital watched as the country was torn apart by war and restored by defeat and compromise. On March 2, 1863, Whitman writes, “This is the last day of the 37th Congress, the body during whose existence (1861, ?2, ?3) the most important, confusing and abnormal events in American history, (shall I not say in the history of the world?) have happened.“ Despite the many influential and important members of Congress, Abraham Lincoln is the figure which one views as most representative of the era of the Civil War. The tall, gaunt Westerner who spoke in country anecdotes and was seen to be lacking in social etiquette and grace possessed an honest nature, kind heart and shrewd wisdom.

 

Although opinions of Lincoln in the Capital were not unfavorable, Lincoln’s appearance in Washington was not greeted with the usual fanfare associated with a new president. Crowds of people, mostly men, poured into the city to watch the inauguration, but a serious tone filled the streets. There was little decoration for the parade and many businesses and residences along the route had closed up their windows and doors. Rumors floated that if Mr. Lincoln were inaugurated, Virginia horsemen would capture him later in the evening at the Union Ball. Lincoln’s carriage rode in a short almost military procession surrounded by cavalry on highstepping horses attempting to block all view of the man inside, assuring that an attempt on his life would be very difficult. To the surprise of many no trouble occurred during or after the inauguration. Clara Barton wrote, “The 4th of March has come and gone, and we have a live, Republican President.“ Possessing many of the same qualities — a gentleness of spirit, working-class background, and a burning love of America and democracy — Lincoln and Whitman held each other in the greatest respect. There is no record of their having ever met one another, but in his account of seeing Lincoln on his way to the Second Inaugural, Whitman wrote of “the old goodness, tenderness, sadness, and canny shrewdness, underneath the furrows“ of Lincoln’s face. In turn, Lincoln apparently read and enjoyed Whitman’s poetry. It is rumored that Lincoln picked up a copy of Leaves of Grass that was lying in the law office one day and after a moment began to read aloud, praising Whitman’s verses for “ their virility, freshness, unconventional sentiments, and unique forms of expression.“ Sadly, Whitman was to write some of his best poetry and the most famous of all American elegies, “When Lilacs Last in the Dooryard Bloom’d,“ upon Lincoln’s death in 1865.

 

“These hospitals–so different from all others–these thousands and tens and twenties of thousands of American young men badly wounded, operated on, pallid, with diarrhea, languishing, dying open a new world somehow to me, giving closer insights, new things, exploring deeper mines than any yet, showing our humanity tried by fearfulest tests, probed deepest, the living soul’s the body’s tragedies, bursting the petty bonds of art. “Whitman’s “new world“ was opened with his first step into the military camp at Falmouth in December 1862. Unknowingly, Whitman entered a new phase of his life that was to change the course of his writing and his outlook on the world. Separated from the war while living in Brooklyn for the first two years of fighting, Whitman’s experiences were vicariously imagined through the letters of his brother and the sight of young soldiers enthusiastically departing to do battle for the cause. Upon his entrance to Washington and the cruel realities of war, Whitman felt compelled to render aid to the wounded soldiers. His sensitivity and love of the American spirit created in him a desire to give identity and individual attention to the anonymous mass of young men who were bravely dying for their country. I feel to devote myself more and more to the work of my life, which is making poems. I must bring out Drum Taps. I must be continually bringing out poems– now is the heydey– I shall range along the high plateau of my life and capacity for a few years now, & then swiftly descend.4′ (Nov.17, 1863) The process of “bringing out“ Drum Taps was to be long and frustrating. Whitman could not find a publisher and finally had to borrow money to have his new volume printed privately. Adding to the delays, when Drum Taps finally came near to publication, Lincoln was assassinated. Whitman soon recognized that his book was now incomplete, and he wrote Sequel to Drum Taps, a series of eighteen poems beginning with the most famous of American elegies, “When Lilacs Last in the Door-yard Bloom’d.“

 

With the addition of the Lincoln poems, Whitman’s Drum Taps became a thorough psychological examination of the war– expressing the years of recruitment and patriotism and the harsh and bloody realities of the wounding and death of young soldiers, consummated in the sorrow and tragedy of Lincoln’s untimely death. Whitman’s poetry following the early recruitment poems, takes on a tone of pathos. These are the poems written between Whitman’s time in New York and his sequel poetry written after the death of President Lincoln. These powerful poems come from Whitman’s years in Washington, with his hospital life serving as the emotional center of the verse. The first such poem, “By The Bivouac’s Fitful Flame,“ renders a haunting account of a lonely soldier’s thoughts of home. In the dark and solitude of a nighttime camp when there is only an “occasional figure moving,“ the soldier’s mind turns to “life and death–of the home and the past and loved,/ and of those that are far away;/ A solemn and slow procession there as I sit on the ground,/ By the bivouac’s fitful flame.“ This melancholy poem expresses Whitman’s empathy for the young, homesick men and is based on stories from his wounded soldiers. Whitman’s evocative imagery signifies the emotion of the soldier’s experience and explains his plight in a way unknown to the separate world of civilians. Such lines reveal the inner change in Whitman–his metamorphasis from “Song of Myself“ to “The Dresser.“ Whitman’s years of hospital work in Washington represent his passage from “Walt Whitman, an American, one of the roughs, a kosmos to O’Connor’s “Good Gray Poet.“ “The Dresser“ is Whitman’s presentation of his personal role in the hospitals and the war experience. The narrator is the old man telling “Years hence of these scenes, of these furious passions, these chances“ as he requests the reader to “follow me without noise, and be of strong heart.“ As we enter the hospital, the tone quickly shifts from lethargic memory to an acute sense of duty and a fervent desire to ease the suffering of the men he so admires. We are shown the realities of the hospitals, “refuse pail,/ Soon to be fill’d with clotted rags and blood, emptied, and fill’d again.“ Whitman also reveals his own unbearable duties: “Cleanse the one with a gnawing and putrid gangrene, so sickening, so offensive.“ Yet grotesque reality is seen through the idealistic and loving eyes of the poet who says, “(poor boy! I/ never knew you,/ Yet I think I could not refuse this moment to die for you, if that would save you.)“ and who so mercifully thinks, “(Come, sweet death! be persuaded, O beautiful death!“ Whitman recalls the experience “sweet and sad“ which so altered his life by its effect.

 

The importance of the hospitals in Drum Taps is the importance of the hospitals in Whitman’s own psychological evolution. Without these emotionally intensive years of hospital work, Whitman might never have matured past Leaves of Grass and its focus on man as individual and all powerful. Through his proximity to war and death he comes to accept truths of the all encompassing human condition. It is this shift from the transcendentalist self to the common concerns of humanity which allows Whitman the depth to write some of his greatest poetry in Drum Taps. Years later Whitman wrote, “Curious as it may seem the War, to me, proved humanity. “ In “Come Up From The Fields Father,“ Whitman depicts both sides of a story with which he was painfully familiar. As the parents of a young soldier hurry from their farmers’ routine to read news of their son, thoughts flash through the mother’s mind, “O this is not our son’s writing, yet his name is sign’d;/ O a strange hand writes for our dear son– O stricken/ mother’s soul!“ The “strange hand“ belonged to Whitman in many cases as he so lovingly performed the rueful duty of writing to families of the suffering or death of their beloved soldiers. Whitman’s striking image of the grieving mother with “the little sisters huddle{d} around“ is effective because it is written through sincere empathy with the scene. Along with his role as the “strange hand,“ Walt and his family had many experiences of anxiety and fear while the fate of brother George, ultimately a prisoner of war, was unknown. They were, however. extremely lucky as they never received that letter– “they stand at home at the door, he is dead already“ –except in the deepest fears of their imagination.

 

Whitman’s practice of writing letters home for soldiers began during those first days spent in camp with George at Falmouth. Many of the soldiers were illiterate or simply inarticulate, and as a man of letters Whitman found great joy and responsibility in writing for his wounded men. Upon leaving the protected atmosphere of Brooklyn and arriving in the world of soldiers, Whitman realized the chasm that separated the soldier’s existence and that of the civilian’s world. Whitman’s writing– verse, letters, newspaper articles and notebooks– created a link between these two worlds and a better understanding of the unique suffering on each side. In some ways, Whitman’s role as psychological nurse to the wounded extends to a surrogate and psychological bridge between two distinct worlds during the Civil War. I have been sitting late tonight by the bedside of a wounded Captain, a friend of mine… in a large Ward partially vacant. The lights were out, all but a little candle, far from where I sat. I sat there by him occupied with the musings that arose out of the scene, the long shadowy Ward, the beautiful ghostly moonlight on the floor. Ralph Waldo Emerson, America’s great philosopher, was to assert after reading Leaves of Grass, that, Whitman was the poet for which America was searching (in the 1850’s). Whitman was patriotic but also free from society’s restrictions; he was not bound by class and reflected endless possibility within one’s self. Whitman, like many Americans of his day, was passionately searching for personal identity. Yet Whitman’s eminence survives not only because of his unmetered, passionate youth but because he changed as the needs of his beloved America changed. As the country searched in the 1860’s for its identity through means of war, Whitman turned from the physical examination of individual self and began the psychological exploration of the American wartime experience.

 

“A March In The Ranks Hard-Prest, And The Road Unknown“ couches a chilling description of Whitman’s Washington hospitals into a soldier’s narrative of a night march. He speaks of the “road unknown“ –literally the road of the exhausted soldiers, but more poetically that road of life all men follow into the unknown. Whitman describes the men in this “impromptu hospital“ as “Faces, varieties, postures beyond description, most in/ obscurity, some of them dead.“ This issue of obscurity was of great importance for Whitman’s hospital years and the resulting verse. He viewed his writing as not only a bridge between the two worlds of American society during the war, but as a calling to give identity to the lives of these neglected and anonymous young men. Becoming a voice to families and to the civilian world for these brave men was the great achievement of Whitman’s life. The opportunity to care for the rough and uneducated soldier and to befriend him intimately was the zenith of Whitman’s life as poet and man. As he told a friend many years after the war, “People used to say to me: Walt, you are doing miracles for those fellows in the hospitals. I wasn’t. I was doing miracles for myself.“ It is not surprising that Whitman was to voice “my book and the war are one“ years later. The tragic sights and sounds of the years in Washington were so moving as to alter his views of men in a democracy, where the common soldiers saved the day. His poem “Camp In The Day- Break Grey and Dim“ is a moving depiction of the earlier mentioned account of sights in the first few days of camp with George. The horrors which he encountered are enough to evoke a transformation in any man. The hospitals and wartime experience served to sustain and bolster his beliefs of democracy. Young men living and dying for one another and coming through the trials of war as friends was an ideal situation for Whitman. In “Over The Carnage Rose Prophetic A Voice“ he writes, “One from Massachusetts shall be a Missourian’s comrade. More precious to each other than all the riches of the earth.“

 

Whitman’s time as a Civil War nurse served to fulfill what for Whitman were his basic needs to love and nurture others, bringing joy to himself and the wounded. Whitman spent many years searching for his niche in the world where he could feel important and accepted. He craved more than an ordinary life, and the singular years of the Civil War coupled with Whitman’s uncommon experience as attendant to the wounded, served to provide him with the rare pleasure of “find[ing] myself in my element among these scenes.“ In “Hymn of Dead Soldiers“ Whitman depicts his peace of mind as he “chant[s] this chant of my silent soul/ in the name of all dead soldiers.“ He speaks of the companions he has known, many who died in the hospitals, asking that their memories “Follow me ever! desert me not, while I live.“ The memories of these men were never to be forgotten by Whitman. The last stanza of the poem reads “make me a fountain,/ That I exhale love from me wherever I go,/ For the sake of all dead soldiers.“ Such sentiments were to temper his life and writings from the years in Washington until his death. After writing, Speciman Days. Whitman was asked in 1888, “Do you go back to those days?“ and he is said to have answered, “I do not need to. I have never left them.“

 

Of these days Whitman refers to, the most tragic and indelible was April 16, 1865 when his beloved Lincoln was assassinated in the Ford Theatre. “Hush’d Be The Camps Today“ was written on April 19, 1865 to commemorate the day of Lincoln’s burial. It is the sole Lincoln poem included in Drum Taps (the others are included in Sequel to Drum Taps). Here Whitman retains his role as a voice for the common soldiers. Along with declaring his own particular sorrow, he places his emphasis on the tragic emotions of his comrades, “Sing, with the shovel’d clods that fill the grave– a/ verse,/ For the heavy hearts of soldiers.“ Although this poem focuses on the loss felt by the soldiers, Whitman’s sense of sadness over the death of Lincoln was profound. The details of Whitman’s relationship with President Lincoln are sketchy, yet the effect Lincoln had on the Good Gray Poet is undeniable. Lincoln was the ideal of the public man as civil servant, much in the same way that Whitman was the ideal of the private citizen. Lincoln embodied Whitman’s ideal of the common man: a strong, plain Westerner– an American through and through. In one of his many Washington notebooks Whitman recorded, “Mr. Lincoln on the saddle generally rides a good-sized, easy-going gray horse, is dress’d in plain black, somewhat rusty and dusty, wears a black stiff hat and looks about as ordinary in attire, &c., as the commonest man.“

 

Lincoln’s presidency bordered on a fulfillment of prophecy for Whitman. In his essay “The Eighteenth Presidency!“ (c.1854) Whitman described his model candidate:

 

I would be much pleased to see some heroic, shrewd, fully-informed, healthy-bodied, middle-aged, beard-faced American blacksmith or boatman come down from the West across the Alleghanies, and walk into the Presidency, dressed in a clean suit of working attire, and with the tan all over his face, breast, and arms.

 

This description uncannily applies to the backwoods lawyer, and it is no wonder that Whitman devoted himself to admiring Lincoln from afar during his Washington years. In a letter to Nathaniel Bloom and John F.S. Gray, Whitman describes the new president as having a face “like a hoosier Michelangelo, so awful ugly it becomes beautiful.“ Later in this same letter he addresses Lincoln as a “captain“ who is doing well “keeping the ship afloat.“ This image of Lincoln was to be developed in one of Whitman’s most famous, though uncharacteristic, poems “O Captain! My Captain!“ Lincoln’s death was a tragic moment in our country’s history and it came as a great shock to Whitman. He would forever refer to the assassination as Lincoln’s “murder“ in his speeches given in memory of Lincoln in the years to come. Considering the hope Whitman held concerning a unification of social class and geographies after the war, Lincoln’s assassination shattered many of his expectations. Through this devastation Whitman wrote the most famous of American elegies in remembrance of Lincoln, “When Lilacs Last In The Door-Yard Bloom’d“ which serves as the opening poem of Sequel To Drum-Taps.

 

The years Whitman spent in Washington, D.C., during the Civil War were the core of his greatest poetry after the first three editions of Leaves of Grass (1855-1860). Whitman’s journey to visit his brother George in December 1862 served to immerse him in “Quicksand years that whirl me I know not whither.“ Yet fate controlled these years of his life and by March 1863 Whitman had written to his brother Jeff, “I cannot give up my Hospitals yet. I never before had my feelings so thoroughly and (so far) permanently absorbed, to the very roots, as by these huge swarms of dear, wounded, sick, dying boys–.“ Out of the experience of his Washington years came not only some of Whitman’s greatest writing but his greatest, most democratic self. The earlier brash Whitman was so humbled and affected by these young men as to be “permanently absorbed“ in those memories for the remainder of his years. Perhaps the best summary for Whitman’s experience is given in his own words in “Not Youth Pertains To Me.“ He concludes Drum Taps by declaring his greatest achievement in life with these lines, “yet there are two things inure to me:/ I have nourish’d the wounded, and sooth’d many a dying soldier;/ And at intervals I have strung together a few songs,/ Fit for war, and the life of the camp.“ Sources: http://xroads.virginia.edu, Angel Price; Wikipedia; Walt Whitman chronicles; Walt Whitman biographical materials

 

Recently, a new essay by Walt Whitman, was discovered by a student, titled, Manly Health and Training. For more information on this newly discovered document, click on the links below: The complete essay on healthy living, by Walt Whitman, New York Atlas 21, No. 17 Sunday Morning, Sept. 12, 1858:1

Elevated Bladder Cancer Risk in New England and Arsenic in Drinking Water From Private Wells

 

Bladder cancer mortality rates have been elevated in northern New England for over half a century. The incidence of bladder cancer in Maine, New Hampshire, and Vermont has been about 20% higher than that in the United States overall. Rates are elevated among both men and women. A unique feature of this region is the high proportion of the population using private wells for their drinking water, which are not maintained by municipalities and are not subject to federal regulations. These wells may contain arsenic, generally at low to moderate levels. Previous studies have shown that consumption of water containing high concentrations of arsenic increases the risk of bladder cancer. There are two possible sources of arsenic in the well water in northern New England. Arsenic can occur naturally, releasing from rock deep in the earth, and arsenic-based pesticides that were used extensively on crops such as blueberries, apples, and potatoes in the 1920s through the 1950s.

 

A new study, published online in the Journal of the National Cancer Institute (2 May 2016), has found that drinking water from private wells, particularly dug wells established during the first half of the 20th century, may have contributed to the elevated risk of bladder cancer that has been observed in Maine, New Hampshire, and Vermont for over 50 years. Other risk factors for bladder cancer, such as smoking and occupational exposures, did not explain the excess risk in this region.

 

To explore the reasons for the higher rates of bladder cancer in northern New England, the authors conducted a large study in Maine, New Hampshire, and Vermont. They compared 1,213 people newly diagnosed with bladder cancer with 1,418 people without bladder cancer who lived in the same geographic areas as those who developed the disease. Information was obtained on known and suspected bladder cancer risk factors, including smoking, occupation, ancestry, use of wood-burning stoves, and consumption of various foods. According to the authors, although smoking and employment in high-risk occupations both showed their expected associations with bladder cancer risk in this population, they were similar to those found in other populations. The authors added that this suggests that neither risk factor explains the excess occurrence of bladder cancer in northern New England.

 

For the study, the authors estimated the total amount of arsenic each person had ingested through drinking water based on current levels and historical information. They found that increasing cumulative exposure was associated with an increasing risk of bladder cancer. When the investigation focused on participants who had used private wells, it was observed that people who drank the most water had almost twice the risk of those who drank the least. This association was stronger if dug wells had been used. Dug wells are shallow, less than 50 feet deep, and potentially susceptible to contamination from manmade sources. Most of the dug well use occurred a long time ago, during an era when arsenic concentrations in private well water were largely unknown. However, the risk was substantially higher if the dug well use began before 1960 (when application of arsenic-based pesticides was commonplace in this region), than if dug well use started later.

 

The major limitation of the study was the inability to precisely measure arsenic exposure in the water consumed by people over their entire lifetime, which made it challenging to accurately quantify the contribution of arsenic exposure to the excess risk of bladder cancer. In particular, there were no known measurement data on arsenic levels in well water in the region prior to the 1960s, when arsenic-based pesticides were in widespread use.

 

The likelihood of exposure to arsenic from dug wells has diminished in recent years because arsenic-based pesticides are no longer used. Also, dug well use is much less common now than in the past. However, possible current exposure to arsenic in drinking water through use of private wells drilled deeply into fractured bedrock is still a potential public health concern. For reference, the U.S. Environmental Protection Agency has established 10 micrograms per liter as the regulatory standard for arsenic in drinking water supplied by municipalities.

 

Genetic Links to Educational Attainment

 

According to an article published online in Nature (11 May 2016), an international team of researchers has identified 74 areas of the human genome associated with educational attainment. While it is well known that social and other environmental factors influence education, but these findings, reported by the Social Science Genetics Association Consortium (SSGAC) and supported in part by the National Institutes of Health, suggest that large genetics analyses may be able to help discover biological pathways as well.

 

The study found 74 separate areas (loci) on human chromosomes that are associated with more years of education. These loci are also associated with other areas that correlate with increased cognitive performance and intracranial volume, decreased levels of emotional instability (neuroticism) and decreased risk of Alzheimer’s disease. A genome-wide association study (GWAS) was supported by the National Institute on Aging (NIA) and the Office of Behavioral and Social Sciences Research, both part of NIH, on almost 294,000 people, of primarily European descent, from research across the globe. Genetic samples were obtained from several ongoing studies, including many funded by NIA: the Health and Retirement Study, the Age, Gene/Environment Susceptibility Reykjavic Study, and the SardiNIA Study of Aging, as well as dozens of other cohorts. Crucially, the team then replicated these findings in an independent sample of more than 111,000 people from the UK BioBank study.

 

Previous research has shown that genetic factors account for about 20% of variation in educational attainment. In this study, 74 single nucleotide polymorphisms (SNPs) were identified. The investigators noted that, as a group, these SNPs only account for a very small portion (0.43%) of the variation across individuals in the sample; individually, each SNP has a very small influence. The study team regarded this study as preliminary and exploratory. Because educational attainment is a complex phenomenon, there are many additional sources of molecular genetic variation to be discovered. Other genetic and environmental effects and their interactions are important topics for future research.

 

According to the authors, these study results will enable scientists to ask more refined questions about the genetic and environmental underpinnings of educational attainment and their health consequences. For example, it is known for quite a while that education appears to be a protective factor against Alzheimer’s. But, education is itself a very complicated outcome. It depends on genetic contributions to cognitive ability and other characteristics that motivate individuals to continue education, as well as substantial environmental contributions to educational success.

 

The size of the study made it possible to answer questions not able to be addressed previously. For example, the authors were able to identify many more loci that appear to contribute to cognitive ability than had been previously known because of the large number of participants. The study also has implications for future research, where these links can be further explored. Data on the level of education attained by participants is routinely collected. With that information and a DNA sample, investigators can conduct additional GWAS of other racial and ethnic groups, which could allow identification of new variants and genetic pathways associated with educational attainment and further validate the contribution of loci from the study reported today.

 

Pfizer Blocks the Use of Its Drugs in Executions

 

According to the NY Times, Pfizer has announced that it has imposed sweeping controls on the distribution of its products to ensure that none are used in lethal injections, a step that closes off the last remaining open-market source of drugs used in executions. More than 20 American and European drug companies have already adopted such restrictions, citing either moral or business reasons.

 

Pfizer’s decision follows its acquisition last year of Hospira, a company that has made seven drugs used in executions including barbiturates, sedatives and agents that cause paralysis or heart failure. Hospira had long tried to prevent diversion of its products to state prisons but had not succeeded; its products were used in a prolonged, apparently agonizing execution in Ohio in 2014, and are stockpiled by Arkansas, according to documents obtained by reporters.

 

According to Pfizer: “Pfizer makes its products to enhance and save the lives of the patients we serve“ and “strongly objects to the use of its products as lethal injections for capital punishment.“ Pfizer said it would restrict the sale to selected wholesalers of seven products that could be used in executions. The distributors must certify that they will not resell the drugs to corrections departments and will be closely monitored.

 

FDA Regulations of Tobacco Stricter

 

For decades, the federal government and the public health community have fought to protect people from the dangers of tobacco use. Since the first Surgeon General’s report on Smoking and Health in 1964, which warned Americans about the risks associated with smoking, significant progress has been made to reduce smoking rates among Americans. In fact, tobacco prevention and control efforts have saved at least 8 million lives in the last 50 years, according to the 2014 Surgeon General’s Report on the Health Consequences of Smoking. In 2009, Congress took a historic step in the fight for public health by passing the bipartisan Family Smoking Prevention and Tobacco Control Act (TCA) giving the FDA authority to regulate the manufacturing, distribution and marketing of tobacco products to protect the public health.

 

The FDA has finalized a rule extending its authority to all tobacco products, including e-cigarettes, cigars, hookah tobacco and pipe tobacco, among others. This historic rule helps implement the bipartisan Family Smoking Prevention and Tobacco Control Act of 2009 and allows the FDA to improve public health and protect future generations from the dangers of tobacco use through a variety of steps, including restricting the sale of these tobacco products to minors nationwide.

 

Tobacco use is a significant public health threat. In fact, smoking is the leading cause of preventable disease and death in the United States and responsible for 480,000 deaths per year. While there has been a significant decline in the use of traditional cigarettes among youth over the past decade, their use of other tobacco products continues to climb. A recent survey supported by the FDA and the Centers for Disease Control and Prevention shows current e-cigarette use among high school students has skyrocketed from 1.5% in 2011 to 16% in 2015 and hookah smoking, in which a single or multi-stemmed instrument is used for vaporizing and smoking flavored tobacco, has risen significantly. In 2015, 3 million middle and high school students were current e-cigarette users, and data showed high school boys smoked cigars at about the same rate as cigarettes. Additionally, a joint study by the FDA and the National Institutes of Health shows that in 2013-2014, nearly 80% of current youth tobacco users reported using a flavored tobacco product in the past 30 days – with the availability of appealing flavors consistently cited as a reason for use.

 

Before now, there was no federal law prohibiting retailers from selling e-cigarettes, hookah tobacco or cigars to people under age 18. Today’s rule changes that with provisions aimed at restricting youth access, which go into effect in 90 days, including:

 

1. Not allowing products to be sold to persons under 18 (both in person and online);

2. Requiring age verification by photo ID;

3. No selling of covered tobacco products in vending machines (unless in an adult-only facility);

4. Not allowing the distribution of free samples.

 

The actions taken will help the FDA prevent misleading claims by tobacco product manufacturers, valuate the ingredients of tobacco products and how they are made, as well as communicate their potential risks. Today’s rule also requires manufacturers of all newly-regulated products, to show that the products meet the applicable public health standard set forth in the law and receive marketing authorization from the FDA, unless the product was on the market as of Feb. 15, 2007. The tobacco product review process gives the agency the ability to evaluate important factors such as ingredients, product design and health risks, as well as their appeal to youth and non-users. Under staggered timelines, the FDA expects that manufacturers will continue selling their products for up to two years while they submit – and an additional year while the FDA reviews – a new tobacco product application. The FDA will issue an order granting marketing authorization where appropriate; otherwise, the product will face FDA enforcement.

 

The new ruling will subject all manufacturers, importers and/or retailers of newly- regulated tobacco products to any applicable provisions, bringing them in line with other tobacco products the FDA has regulated under the TCA since 2009. These requirements include:

 

1. Registering manufacturing establishments and providing product listings to the FDA;

2. Reporting ingredients, and harmful and potentially harmful constituents;

3. Requiring premarket review and authorization of new tobacco products by the FDA;

4. Placing health warnings on product packages and advertisements; and

5. Not selling modified risk tobacco products (including those described as “light,“ “low,“ or “mild“) unless authorized by the FDA.

 

Two Heads Are Better Than One Kale Salad

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This kale salad has such a delicious robust flavor, it’s good with red or chilled white, as well as a nice cool glass of our famous NY tap water, or (all the way from Adobe Springs, CA) Noah’s Sparkling Spring Water.  ©Joyce Hays, Target Health Inc.

 

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So delicious and healthy, you can’t go wrong. ©Joyce Hays, Target Health Inc.

 

Ingredients

 

The Dressing

 

3 anchovy fillets packed in oil, drained

4 fresh garlic cloves

Pinch Kosher salt

1 large egg yolk (boil egg for 1 minute and not longer)

Zest of 1/2 fresh lemon

2 Tablespoons fresh lemon juice, plus more (to your taste)

3/4 teaspoon Dijon mustard

2 Tablespoons excellent olive oil

2 Tablespoons canola oil

6 Tablespoons finely grated FRESH Parmesan +

Pinch black pepper

Worchester sauce (one drop)

 

The Croutons

 

1 cup torn 1″ (bite-size) pieces old bread, with crusts

1 Garlic clove, squeezed

2 teaspoons olive oil

 

The Kale

 

2 heads of fresh kale, rinsed twice, dried, leaves separated; then well chopped on a cutting board

 

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Even though the plastic bag may say, pre-washed, I always rinse any leafy veggie under cold water, anyway. Here the kale is draining. Beautiful green, fresh and crispy; just what you want. ©Joyce Hays, Target Health Inc.

 

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Cut the kale in small pieces. ©Joyce Hays, Target Health Inc.

 

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The reason you boil the egg for one minute, is to be sure there’s no salmonella. You never want to use a totally raw egg in anything. Boiling it for only one minute will not take away the rawness, or the flavor, that you want in this (or any other recipe calling for a raw egg), but you will kill any possibility for salmonella. Take the egg out of the fridge way before you use it. Let it get to room temperature, before you place it in the boiling water, or it will crack. ©Joyce Hays, Target Health Inc.

 

 

The Cheese

 

1 cup FRESHLY GRATED Parmesan, grate it yourself & leave extra on the dining table, so more can be added after serving. Although, you can buy pre-grated parmesan, it’s quite bland compared with the cheese you grate yourself, freshly grated for each recipe.

 

Directions

 

The Croutons, certainly, can be made the day before. Otherwise, make them first, before you make the dressing. Can you buy packaged croutons? Of course, but try to make them yourself. The flavor is so much better. If you’re going to make a good salad, you might as well make great tasting croutons. There is simply no comparison! Once you taste the richness of your own croutons, you’ll never buy them again. They’re not a peripheral ingredient, they make the salad better. That’s why they’re in the recipe.

Preheat oven to 375 degrees.

 

In a medium bowl, add the 2 teaspoons olive oil and the squeezed juice of one fresh garlic clove. Stir

Tear or cut any left-over bread, you have, into (1 inch) bite size pieces, enough for 1 cup (press the bread down a bit, in the measuring cup). Then put the pieces of bread, into the bowl with oil/garlic. My favorite bread for croutons is day old (or older) sour dough bread.

Now, toss the bread pieces or cubes and be sure that the bread cubes are all covered (as much as possible) with the oil mixture. Let them sit for a while to absorb the oil, like 30 to 60 minutes. Stir them around every once in a while

Arrange croutons on a baking sheet or large pan and bake, tossing occasionally, until golden, 10-15 minutes. Watch them carefully. Just a little too long in the oven, and they will burn and won’t be useable for the salad. When golden, remove from oven and set aside to cool.

 

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Croutons are about to go into the oven. You can see that some pieces have more oil than others. Doesn’t matter. Once added to the salad, dressing will rub onto the croutons and they’ll be delicious. The size of the croutons is up to you. In my photo above, they’re fairly large. Feel free to make them smaller. ©Joyce Hays, Target Health Inc.

 

The Dressing

 

Use a large salad bowl, wood is nice, but any salad bowl will do.

 

Boil one large egg for one minute and remove from heat after 1 minute. Immediately run the egg under cold water. Then carefully crack it open, so as not to break the yolk. You have to separate the yolk from the egg white and use only the yolk in this recipe. Separate and put the yolk into a small container, ready to use in the dressing. This is a precaution worth taking, to prevent salmonella. Never use a completely raw egg. Save the egg white for another recipe, like adding to an omelet or frittata, you plan to make over the weekend.

Now, mash all the garlic, right in the wood salad bowl, with a fork. Get it all evenly mashed.

 

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Starting to mash the garlic in our wooden salad bowl ©Joyce Hays, Target Health Inc.

 

 

Next, add the anchovy fillets (to the wood salad bowl) and mash them into the garlic, with the same consistency as the garlic, so you get a paste.

Now, with a small whisk, add the egg yolk and whisk it into the garlic/anchovy paste

Next, add the lemon zest, 2 Tablespoons of fresh lemon juice and whisk; then add the mustard and 1 drop of Worchester sauce, whisk again

Now, add the extra virgin olive oil and whisk it into the dressing.

Add the canola oil drop by drop, while you whisk it into the dressing.

Finally, add the freshly grated parmesan and black pepper (to your taste). Taste to see if the dressing needs more of anything (to your taste). With the anchovies, you may decide not to use any salt. You might want more lemon juice. This is the time to taste and decide.

 

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Freshly grated parmesan means doing it yourself. There’s no substitute. Buying a container that reads “freshly grated“ simply is NOT. After a while, you’ll see, there’s something satisfying about doing it yourself. ©Joyce Hays, Target Health Inc.

 

 

Whisk the dressing so it’s thick and glossy.

If you want, you can make the dressing 1 day ahead; however, I think serving right after making the dressing is the very best way to make this kale salad.

Just before serving, add the croutons and toss. Then add additional freshly grated parmesan and serve.

 

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I always add to the table, a dish with extra, freshly grated parmesan, just in case I didn’t use enough in the dressing. ©Joyce Hays, Target Health Inc.

 

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Just added the chopped kale to the dressing in the salad bowl. ©Joyce Hays, Target Health Inc.

 

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Added croutons, and about to toss. ©Joyce Hays, Target Health Inc.

 

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Tossing the salad. Just about to serve it. Will add more parmesan in a minute. ©Joyce Hays, Target Health Inc.

 

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The proof is in the eating. ©Joyce Hays, Target Health Inc.

 

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I bought a case of Noah’s sparkling water, because its magnesium content is the highest of any water, bottled or otherwise, that I know about; plus there’s calcium present, which is needed in order for our bodies to absorb the magnesium. Most Americans are deficient in magnesium and I’m trying to compensate for this, in our daily diet. Btw, there’s a good amount of magnesium in this kale salad recipe. ©Joyce Hays, Target Health Inc.

 

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We’re trying a super-Tuscan wine, Tignanello – which is a blend of 80% Sangiovese, 15% Cabernet Sauvignon, and 5% Cabernet Franc, from the highly regarded Antinori Estate of fine wines. Scroll down to read more about the history of this wine, worth trying, if you haven’t already. ©Joyce Hays, Target Health Inc.

 

We started our meal with glasses of full bodied Tignanello, a blend with complex aromas and a long finish, worth paying attention to. Then the Kale salad, which if made correctly, makes a bold statement to your taste buds. We thought that a white wine, would not push back enough and that this red would be the best to accompany the kale. This particular recipe is so-o good, that I made it my whole meal with seconds and thirds. Jules likes more than one dish at dinner, so I created another meatless recipe, spinach and mushroom patties; served with a nice chewy twisted pasta called, Gemelli. I would say that New Yorkers (following the lead of California) are now trending toward more and more meatless meals.

 

I was pretty sure that the richness of the fresh mushrooms (in the patties) would combine well with the Tignanello wine, and the two were made for each other. This whole meal was simple but beyond delicious. Call us OCDers, but for the thousandth time, we had our yummy lo-cal jello cake for dessert, slathered with cool whip.

 

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Gemelli pasta (Wikipedia Commons)

 

More about Tuscan wines from the Antinori Estate:

 

Giovanni di Piero Antinori joined the Florentine Guild of Vintners in 1385, beginning an oenological legacy that has lasted over 26 generations. Throughout the company’s history, it has remained family-owned and operated. Today, Marchese Piero Antinori directs the long-lived family vision, and his three daughters participate in various activities with the firm. Famed wine consultant Giacomo Tachis began his celebrated tenure with Antinori in 1961, a year that witnessed the inception of new vinification techniques (controlled temperatures, aging in bottle, and barrels comprising a range of types and styles) and the beginning of a revisionist period in the concept of Chianti (which was later actualized in various methods utilized to maximize extraction and aroma). This dynamic period of experimentation continued over the course of several years, with some of the pivotal initiatives including the use of maloactic fermentation for red wines, aging in barrique, and planting of several non-indigenous varietals. The most tangible and compelling evocation of these progressive efforts, of course, is captured in Antinori’s extensive portfolio, which features some of Italy’s most revered and sought-after bottlings. Piero Antinori desired not to recreate a Bordeaux-style claret, but rather, to convey the versatility and finesse of the noble Sangiovese. Drawing upon the consummate skill of Giacomo Tachis, Antinori realized his conception in the form of the second official Super-Tuscan – Tignanello – debuting in 1971 as a blend of 80% Sangiovese, 15% Cabernet Sauvignon, and 5% Cabernet Franc. While second in the Super-Tuscan timeline, its conception entailed several inaugural efforts: It was the first modern wine of Chianti to contain a nontraditional grape – Cabernet Sauvignon – while omitting white grapes, and the premiere wine to be aged in small barrels.

 

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Tastes good too. ©Joyce Hays, Target Health Inc.

 

 

Gabriel Byrne did some very fine acting, but Jules, Alex and I came away from this play feeling that it has become a bit dated and is now a museum piece, worth seeing, if you keep this in mind.

 

Alex liked the acting of (up and coming young actor,) Michael Shannon, who plays one of the sons (no doubt, Eugene O’Neil himself). The play is autobiographical, and Eugene O’Neil was certainly affected by his dysfunctional family, but when you compare this play to Fun House, another (Broadway play) autobiographical play where r son, Alex, we saw Eugene O’Neil’s great (too long) play, Long Day’s Journey Into Night.“ the playwright comes from a dysfunctional family, I would recommend the latter over the O’Neil play.

We had dinner at Candle79, which is a wonderfully creative vegan restaurant, that we go to frequently. Waiters are knowledgeable and very friendly. A dessert called Mexican chocolate is out of this world!

 

From Our Table to Yours !

 

Bon Appetit!