Surgery

CIVIL WAR SURGERY By Michaela Kanetoc

[[image:minie.JPG width="159" height="176" align="right" caption="Civil War Minnie Ball"]]
The American Civil War was fought from 1861 to 1865; a time when the killing efficiency of firearms was brought to an all-time high, and when the science of medicine was still pitifully lacking. There were over 40,000 operations done over the course of the war. Due to the discovery and integration of anesthetics in 1846, far more deliberate surgeries were done that would not have been considered possible only three decades ago. The leading cause for surgery was if a soldier was shot in battle. The most common ammunition used by soldiers at the time was the minnie ball; a spinning lead cylinder that would shatter bones on impact and tear huge gashes in flesh. Anyone hit in the head or torso was considered a dead man from either infection or the shot itself, so the surgeons mainly focused on fixing leg or arm wounds. Most surgeries were done in the open air to make use of the strongest light source the doctors had; sunlight, which was far more helpful than the candles or kerosene lamps used in tents. Operators would use anesthetics for the more painful wounds, and would generally resort to amputation as a "cure".

Amputation
Since most treatable wounds inflicted on Civil War soldiers were to the arms or legs, amputation was a common method for preventing infection and removing physical damage. More than 30,000 amputations were done on Union soldiers, and it is believed that a similar figure is true for the Confederates. Eighty-three percent of hip amputations were deadly, twenty-four percent of upper arm amputations were deadly, and the primary amputation mortality rate was twenty-eight percent. However, an incredible seventy-five percent of amputees recovered after their operations. The most common causes for amputation were bullet wounds from a minnie ball, fractured bones, and broken blood vessels. However, surgeons were often hesitant about conducting an amputation due to the many unfair criticisms from families and soldiers about unnecessary operations. To avoid such denunciation, doctors attempted a new method of surgery; excision. This was when a surgeon would only remove the part of the limb with the shattered bone or broken blood vessel. However, this method resulted in a higher death rate than amputation, and an inability for the patient to use an artificial limb, so excision was rarely practiced. Contrary to the popular myth, anesthetics were often used in amputations, resulting in the soldier feeling nothing at all during the operation. The procedure for operation was generally the same for both Confederates and Northerners; the anesthetic was administered to the patient as the doctor used a sponge or cloth to wipe the wound. Once the patient was unconscious, the damaged limb was cut through to the bone using a scapel. A bonesaw was then taken and used to sever through the bone, then a doctor would discard the amputated limb. Flaps of skin and muscle were sewn over the cut bone, and threads of horsehair, cotton or silk were used to tie off the arteries to prevent further blood loss. Even after a soldier survived battle and amputation, he had another threat coming his way: infection.

Infection
Infection was a common ailment to soldiers during the war. It was caused by almost everything in a soldier's day-to-day life: lack of needed amputation, surgeries gone wrong, broken bones, unsanitary surgical equipment, or if they were shot by a minie ball, which often had dirt and germs on it. Types of infections include bone or marrow infections, caused by broken bones that were outside of the skin, or in multiple pieces. Additionally, after an operation, a soldier faced the constant fear of surgical fevers. Pyemia was one of the most dangerous infections, and was a spreading blood poisoning with a mortality rate of ninety percent. Tetanus was another intimidating threat, with a mortality rate of eighty-seven percent. Osteomyelitis was bone inflammation, usually the result of shattered bones or bones exposed to oxygen. Lastly, there was Hospital Gangrene; a black spot on the wound, which was caused by an obstruction of blood flow, that would quickly spread. These infections were occasionally deadly, but most merely resulted in fever, continuous pain, bowel difficulties, and loss of muscle tissue. However, pus was also released from the wound, and would indicate the severity of the infection. If the pus was thick and creamy, it was called "laudable" and showed that the infection was unlikely to spread far. However, if the pus was thin and bloody, it was called "malignant" and was likely to spread and poison the patient's blood stream. While infection was common during the war, it was not the surgeon's fault; they were aware of the correlation between cleanliness and less infection, they simply had no way or knowledge of how to keep their equipment clean.

Surgeons
While soldiers and commanders are the most praised contributors to the Civil War, surgeons played their part for their country and their home. The Union army had 11,000 physicians during the war, though only 500 of them had ever had earlier experience doing surgery. The Confederates were even worse off; they had a scanty 3,000 physicians, with only twenty-seven having surgery experience before they enlisted. An American surgeon's education was informal and crude at best. Medical school in the United States only lasted two years, sometimes even less, while their European rivals had formal medical schools that lasted six years. Since the bigger colleges in America refused to teach medicine or science, the few medical students that went to college were undereducated. Furthermore, the surgeons in the army had a bad reputation; they were often accused of performing unnecessary amputations on soldiers. The surgeons were also often called butchers, due to the popular myth that they were incompetent and always resorted to amputation. While there are more effective ways than amputation to treat those wounds today, a Civil War surgeon could not be expected to have any knowledge of it. Accusing them of not using other effective cures on the wounded is like accusing Lincoln of not arming his soldiers with bazookas instead of rifles. However, the surgeons made the best of the resources provided for them, including anesthetics.

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Anesthetics
Since anesthetics were introduced in 1846, they were effectively in use all during the Civil War. The only record of a significant number of operations without anesthetics was in 1862 during the Battle of Iuka, Mississippi where 254 soldiers were operated on without painkillers. However, more than 80,000 surgeries with anesthesia were recorded during the war, and that number is thought to be an underestimate. The types of available anesthetics were morphine, opium, ether, and chloroform. Morphine was only given to the soldiers fatally wounded, to make them comfortable while they awaited death. Ether and chloroform were soaked into a cloth and held over a patient's mouth for them to breath in. It was only used for painful war wounds and amputations, and would knock the patient out and give them a sense of excitement. This side effect would often cause soldiers to cry out while they were being amputated on, though they could feel nothing, and lent to the popular myth that amputations occurred without anesthetics. While painkillers were never a huge problem during the Civil War, places to treat and operate on wounded soldiers were difficult to come by, and lacking in sanitation.

(Field) Hospitals
Before the Civil War, United States Hospitals were not a big deal to citizens and were run by community leaders instead of doctors. Since large colleges rarely taught science or medicine, there were few doctors to fill the hospitals anyway. However, by the end of the war, the North was able to create 204 hospitals with a capacity for 137,000 patients; the South made 150 hospitals, many improvised from homes and barns, and the largest military hospital ever in Richmond with a capacity of 8,000. The wounded were transported via Saterlee, or United States Regulation litters, made up of two pieces of canvas supported by two poles. Since there were no official ambulances until 1862, crowded two-wheel carts or four-wheel wagons were used to transport the wounded at the beginning of the war. Furthermore, field hospitals were only large fields with scattered tents. The wounded were left on the ground until a doctor was available to treat them, resulting in almost no organization in the treatment of injured.

**Bibliography**


 * Information:**
 * Adams, Gary. __The Truth About Civil War Surgery__. 2004. HistoryNet. 28 April, 2010. .
 * Behling, Ruth A., and Roder, Richard J. "Medicine in the Civil War era." In Waugh, Joan, and Gary B. Nash, eds. //Encyclopedia of American History: Civil War and Reconstruction, 1856 to 1869//, vol. 5. New York: Facts On File, Inc., 2003. //American History Online//. Facts On File, Inc. Online. 4 April, 2010. .
 * __Civil War Medicine__. 2008. Sonofthesouth.net. 28 April, 2010. .
 * <span style="font-family: Arial,Helvetica,sans-serif;">Goellnitz, Jenny. __Civil War Battlefield Surgery__. 2010. eHistory. 28 April, 2010. <http://ehistory.osu.edu/uscw/features/medicine/cwsurgeon/amputations.cfm>.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Greiner, James M. and Coryell, Janet L. and Smither, James R. __A Surgeon's Civil War__.
 * <span style="font-family: Arial,Helvetica,sans-serif;">__Medical Care, Battle Wounds, and Disease__. 24 Nov. 2006. 28 April, 2010. <http://www.civilwarhome.com/civilwarmedicine.htm>.


 * Images:**
 * Moritz, Frederic A. __Scouting the Civil War with Cell Phones__. 2008. 5 May, 2010. <http://www.worldlymind.org/cellofony.htm>.
 * Peck, Alex. __Medical Antiques Archives__. 2010. 5 May, 2010. <http://antiquescientifica.com/archive3.htm>.


 * Video:**
 * __Civil War Medicine - Episode 1__. 9 April, 2008. YouTube. 5 May, 2010. <http://www.youtube.com/watch?v=HZMjIW3lJHQ>.