.

Civil War Hospital Ship

The U.S.S. Red Rover, a captured Confederate vessel, was refitted as a hospital ship.

Evolution of Civil War Nursing

The evolution of the nursing profession in America was accelerated by the Civil War.

The Practice of Surgery

Amputations were the most common surgery performed during the Civil War.

Army Medical Museum and Library

Surgeon-General William Hammond established The Army Medical Museum in 1862. It was the first federal medical research facility.

Civil War Amputation Kit

Many Civil War surgical instruments had handles of bone, wood or ivory. They were never sterilized.

Tuesday, April 30, 2013

Civil War Wheelchairs

The wheelchair has helped people to move more freely for centuries. The oldest known example is depicted in carved stone on a 6th century Chinese sarcophagus.
The 1700’s produced the first wheelchair of a similar design to those used today. A long-lived model known as the “Bath Chair” was offered in 1783 by inventor John Dawson of Bath, England. The chair had two large front wheels and one small rear one. The Bath Chair outsold all others through the early 1800’s.
The Civil War is the first recorded instance of wheelchair use in America. The Bath Chair design continued to be popular until 1867 when inventors began to improve upon the somewhat uncomfortable device, adding hollow rubber wheels and “push rims” for self-propelling the chair.
IMAGE: Civil War era wheelchair of oak and caning

Confederate Hospital Trains

By Alfred Jay Bollet, M.D.

The Confederate Medical Department also used trains whenever possible, although the Southern railroad lines were much less developed than those in the North. They did not build special ambulance cars for their trains; the dearth of rolling stock and manufacturing facilities precluded it. Boxcars on trains brought supplies to the troops and returned carrying wounded and sick soldiers, usually with some straw thrown on the floor, water, food, and when possible, some nursing and medical personnel to accompany them.

The railroads were most useful to the Confederates in Virginia, where good service existed from Manassas Junction south to Gordonsville, and then on to Richmond. There was good east-west service from Richmond across the mountains to the Shenandoah Valley. From Staunton, in the Valley, there was service to Tennessee at Knoxville and then on to Chattanooga, but that segment was often cut and service was irregular. After the battles fought in northern Virginia, such as First and Second Manassas, the wounded were transported quickly by rail to Gordonsville and then to hospitals in Richmond or Charlottesville.

After Antietam and Gettysburg, wounded were taken by ambulance to Winchester and then down the Valley Turnpike (which had a macadam surface) to Staunton; once there, they could be sent south to Lynchburg or east to Charlottesville, Gordonsville, and Richmond, Depot hospitals, known as "receiving and forwarding hospitals", were set up at key points, such as Gordonsville and Staunton, to provide care en route and to serve as distribution centers.

Excerpted from: Civil War Medicine: Challenges and Triumphs by Alfred Jay Bollet, M.D.

IMAGE: From Confederate States $50 bill

See more about Civil War hospital trains at www.CivilWarRx.com.

Northern Hospital Trains

By Alfred Jay Bollet, M.D.

Before the war, no thought had been given to using trains as ambulances. However, during the war, both sides relied on the recently developed railroad system to move men and material, including their sick and wounded soldiers, whenever possible.

Later in the war, hospital cars were specifically designed for use in ambulance trains. The Sanitary Commission's official history describes these improvements:

"A very slight description of these hospital cards will give some idea of the increased comfort provided for the patients conveyed in them. The ordinary field and hospital litter or stretcher was used in loading, unloading, and carrying the patients. These simple litter-beds, with pillows, mattresses, and comforts attached, were then ingeniously and securely swung, in tiers three high, and end to end upon light stanchions, and there suspended by stout tugs of India rubber, which gave sufficient elasticity to obviate all jar to the bed and its patient.

"Thirty of these beds were thus swung along the side of each Hospital car. A number of invalid chairs and a broad couch filled the remainder of the available space. A pantry furnished with medicines, utensils, beverages, and substantial food, ready for serving to the patients hot or cold, made up the sum of creature comforts, while nurses, abundantly provided with towels, socks, blankets, sponges, etc., kept every man clear and warm, however long the trip of stormy the weather. All the usual appliances and skill of a well-regulated Hospital were at hand."

In addition to the hospital cars, these trains included cars for cooking and dining and for use as sleeping quarters for medical staff assigned to accompany the wounded. The trains were clearly identified by a bight red smokestack, engine, and tender and by the markings "U.S. HOSPITAL TRAIN" in enormous red letters, and they carried three red lanterns at night. There is no record that enemy forces ever molested any hospital train.

Excerpted from: Civil War Medicine: Challenges and Triumphs by Alfred Jay Bollet, M.D.

Monday, April 29, 2013

Hannah Ropes, Civil War Nurse

From the American Association for the History of Nursing, Inc.

Hannah Anderson was born in New Gloucester, Maine to a family of early New England settlers. She married educator William H. Ropes at the age of twenty five; they lived in Waltham, Massachusetts and had four children, two of which lived to adulthood.

When her husband abandoned her she was left to raise her children and Hannah bloomed in a new found self reliance. When her son was eighteen in 1855, he became a homesteader in the Kansas Territory. Increasingly interested in the abolitionist movement and the westward expansion, she and her daughter also moved to Kansas. But the political turmoil over the slavery issue caused Hannah's return to Massachusetts.

During this period she was increasingly politically active and well connected. She wrote a novel, Cranston House and also published Six Months in Kansas. Like other women of the time, she was called upon to nurse sick friends. A nephew had sent her a copy of Florence Nightingale's newly published Notes on Nursing and Hannah Ropes must have been deeply influenced by Nightingale's writing.

When her son Edward served in the Civil War, she volunteered to serve as a nurse. She was assigned as head matron of the Union Hotel Hospital in Washington D.C., where she worked with Louisa May Alcott. She actively decried the appalling conditions - both the lack of sanitation and the indifference and even cruel treatment of the soldiers - and was pro-active in making change. For Hannah Ropes and other women "nurses" this meant butting heads with the military and physicians who resented the presence of women in the makeshift hospitals.

She contracted typhoid pneumonia at that hospital and died at the age of 54. She had kept a diary which was only recently published. Between her diary and correspondence, a different perspective of the Civil War and the emergence of nursing has been gained. Thus while Hannah Ropes was barely known during her own lifetime, her significant work is available for study and admiration today.

Stethoscopes and the Civil War

By Dr. A. Jay Bollet

The evidence that army physicians during the Civil War knew how to use a stethoscope can be found in numerous reports in the Medical and Surgical History of the War of the Rebellion. They are brief summaries, but with enough detail to know that physicians were skilled at physical examination.
 

Some examples:
"Case 4, Regimental Register, 28th Mass. April 11, 1863...dullness over left nipple; crepitant râles distinct...14th: rubbing sound heard over upper part of left thorax, râles below and dulness overall...17th...no rubbing sound, dullness less marked...26th...Sent to general hospital to-day."
"Case 9, from Third Division Hospital, Alexandria, VA: "Diminished resonance over right side anteriorly with subcrepitant ronchus [sic] below...""Case 10, Ladies' Home Hospital, New York City:...dullness posterior over the upper portion of the lower lobe of the left lung with feeble respiratory murmur and moist bronchial râles..
 
The stethoscope is needed to hear rales and rhonchi, and to detect a 'feeble respiratory murmur'. Notably, the findings were used to determine the specific location of the pathology in the lung and it is described in many of these case reports. In fatal cases the findings on physical examination were verified by the autopsy findings. Today physicians would rarely try to define the anatomic location of lung pathology without first seeing a chest x-ray. In other cases, the description of the examination of the heart mentions murmurs and friction rubs, which are heard only with the stethoscope. Note also in the cases listed above that the use of the stethoscope and other techniques of the physical examination which originated in Europe was widespread among the military units; it is documented in regimental and divisional field hospitals, as well as general hospitals.
 
The regimental surgeons in the field thus were skilled in the use of the stethoscope, not only specialists in the cities. Ladies' Home Hospital was a general hospital of 263 beds (according to the Surgeon General's annual report of 1862) and would be expected to have specialists in New York City functioning as contract physicians. It was on Lexington Avenue at the corner of 51st Street; initially all soldiers from the NYC area who needed trusses were sent there. This hospital was sometimes called the "Soldier's Home."The use of percussion, another component of the technique of physical examination, is documented by the descriptions of dullness and diminished resonance in these case reports. A statement attributed to General Robert E. Lee when he had the first of several illnesses during the war, describes what it felt like to be examined by percussion. His physicians, he said, were "tapping me all over like an old steam-boiler before condemning it." 

Excerpted from: The Society of Civil War Surgeons

"Soldier's Heart"

Heart Disease in Civil War Soldiers

By Alfred Jay Bollet, M.D.

Heart symptoms often accompany anxiety, but the physical stresses of a soldier's life can also reveal underlying heart abnormalities. Given the limited diagnostic tools available (no electrocardiograms or radiographs) during the Civil War, the true cause of many soldiers' cardiac ailments baffled their physicians.

Dr. Jacob DaCosta, who also worked at Turner's Lane Hospital in Philadelphia, is credited with the first description of "soldier's heart" or "stress heart", a form of what i today considered psychogenic heart disease." Of the 300 cases DaCosta studied, most men had episodes of palpitation and shortness of breath, and some developed evidence of cardiac hypertrophy but not dilatation. DaCosta considered the findings a "functional disorder" and attributed then to "cardiac muscular exhaustion" Other physicians agreed, noting that the excitement of battle and "double quick" marching caused the syndrome of irritable heart.

During the war, 10,516 white and 100 black soldiers were discharged due to heart disease. Discharges due to valvular disease or "soldier's heart" were not separated out, but available records show that physicians did recognize various types of cardiac pathology. Valvular heart disease was diagnosed in 3,574 whites and 325 blacks; most undoubtedly resulted from rheumatic fever. Civil War physicians clearly were skilled at using a stethoscope to detect this form of heart disease.

Excerpted From: Civil War Medicine: Challenges and Triumphs by Alfred Jay Bollet, M.D.

IMAGE: Civil War era monaural stethoscope

Friday, April 26, 2013

Insanity and The 'Secret Vice' (Masturbation)

By Wm. M. Awl, Superintendent of the Ohio Lunatic Asylum

This degrading practice is quite a frequent cause of mental imbecility and insanity, and vary few recover either their bodily health or serenity of mind. Upon this subject we have reason to believe our annual reports in the past three or four years by those who appeared to be entirely ignorant of the injurious effects of this habit, until their attention was arrested by reading our remarks. The interest of parents and the guardians of youth has also in some degree been awakened to the fearful influence of this secret indulgence, upon both physical and mental health.

FROM: "Recovery From Insanity Produced by Different Causes", 1844, "The Boston Medical and Surgical Journal", Vol. XXIX, No. 26.

IMAGE: Tennessee Asylum for the Insane

Civil War Hospitals

In the 1800s, most people received medical treatment at home. There were few hospitals in the United States, and most of them cared for the very poor or the insane. The numbers and scale of military hospitals during the Civil War, however, changed this situation. Today, hospitals are an accepted feature of everyday life.
 
New systems developed rapidly to cope with the thousands of battle casualties. Triage sorted the wounded by the severity of their injuries and the treatment needed. Near the battlefield, tents often served as temporary field hospitals. Existing buildings were also used, but these were often dark, dirty and stuffy, lacking the space and ventilation of tents.
 
In previous wars, wounded soldiers had sometimes remained on the battlefield for days before being rescued. During the Civil War, however, special ambulance corps moved patients to field hospitals, helping to ensure that they received care sooner. Men who needed more extensive treatment or longer recuperation could then be transported by train to general hospitals in major cities. Some steamboats were even converted into floating hospitals.
 
The city of Philadelphia played a large role in treatment of the wounded. In addition to being a center for medical education, it was located at the intersection of several train lines. There were 24 military hospitals, plus branches, in the city at one time or another, in addition to the 22 small civilian hospitals that also treated troops. By the end of the war, Philadelphia hospitals had cared for about 157,000 soldiers and sailors. There were only four military hospitals elsewhere in the state: in Chester, south of Philadelphia; in York, south of Harrisburg; at White Hall in Montour County, near Williamsport; and in Pittsburgh. Because of racial discrimination, African American soldiers often received inferior medical treatment on the field and in hospitals, with few doctors and nurses willing to care for them.
 
Some Philadelphia military hospitals reused older buildings. For instance, Haddington Hospital at 65th and Vine Streets, with 200 beds, was housed in the old Vine Street Tavern. Most city hospitals had fewer than 500 beds, but two of the largest military hospitals in the country were located in Philadelphia. West Philadelphia or Satterlee General Hospital, with more than 3,000 beds, was built where Clark Park now stands. Mower General Hospital was located on the Reading Railroad line in Chestnut Hill. Designed by John McArthur, the architect of Philadelphia City Hall, it could accommodate 4,000 patients. These new hospitals were constructed using the “pavilion system.” They featured long, narrow wards, built quickly out of wood and arranged in a grid or a radiating pattern. Since bad air was thought to spread infection, the wards had large windows and extensive ventilation systems.
 
Hospitals required many workers: surgeons, nurses, administrators and clerical staff, cooks, laundresses and a host of others. At the start of the war, most nurses were male, since women were not supposed to take care of men who did not belong to their families. Gradually, however, white female nurses (including Catholic nuns) became more common, either as paid workers or as volunteers. Though African American women often served as hospital cooks or laundresses in the North, a small number were also hired as nurses. Organizations run by volunteers, such as the U.S. Sanitary Commission and the U.S. Christian Commission, contributed greatly to patient care, donating money, supplies and labor. Women throughout Pennsylvania were active in these groups and in many other volunteer organizations. The Sanitary Fairs of 1864 raised large sums of money for the Sanitary Commission’s work, with Pittsburgh’s fair bringing in $300,000 and Philadelphia’s earning over $1 million.
 
Philadelphia also hosted specialty hospitals, most notably the Turner’s Lane Hospital run by prominent physician Dr. S. Weir Mitchell. Here, Weir Mitchell and his colleagues studied nerve disorders and injuries, such as paralysis, spasms, and epilepsy (considered a nervous disease at the time). Detailed case histories were essential to such research and to medical care in general. Such record-keeping helped with follow-up care and rehabilitation, in hospitals and on the home front.
 
Information for this section was contributed by The College of Physicians of Philadelphia, in particular Jane E. Boyd, Ph.D., Wood Institute Research Associate, and Robert D. Hicks, Ph.D., Measey Chair for the History of Medicine and Director of the Mütter Museum & Historical Medical Library. For more information about The College of Physicians and the Mütter Museum, visit www.collphyphil.org.
 
Image: Mower U. S. A. General Hospital, Chestnut Hill, Philadelphia.  
 

Epilepsy

By Wm. M. Awl, Superintendent of the Ohio Lunatic Asylum

Of all the forms of insanity the epileptic is certainly the most hopeless and severe. They are a highly excitable, troublesome and dangerous class of mad folks, and very few have been known to recover, either in this or any other institution within our knowledge. In some hospitals we believe they are excluded altogether, on account of their impulsive violence and the very unpleasant effects of their paroxysms upon other patients. We look upon the epileptic with great compassion. Many of them exhibit the best traits of human nature during their lucid intervals, but at other times they are perfectly uncontrollable, disregarding alike both friends and foes, and we know of no class more dangerous to go at large.

Excerpted from: "Recovery From Insanity Produced by Different Causes", 1844, The Boston Medical and Surgical Journal, Vol. XXIX, No, 26

IMAGE: The First Ohio Lunatic Asylum

Abraham Lincoln's Little Blue Pills

Abraham Lincoln reached over and picked a man up by the coat collar at the back of the neck and shook him "until his teeth chattered." He became so angry "his voice thrilled and his whole frame shook." Lincoln only stopped when someone, "fearing that he would shake Ficklin's head off," broke his grip. A new study suggests that mercury poisoning may explain Lincoln's bizarre behaviour.
Lincoln during this 1858 Lincoln-Douglas debate is a far cry from our vision of Lincoln at the Lincoln Memorial, sitting patient and thoughtful with the weight of the nation on his shoulders. A study published in the Summer 2001, issue of Perspectives in Biology and Medicine reformulates a common anti-depressive medication of the nineteenth century and shows that it would have delivered a daily dose of mercury exceeding the current Environmental Protection Agency safety standard by nearly 9000 times.
"We wondered how a man could be described as having the patience of a saint in his fifties when only a few years earlier he was subject to outbursts of rage and bizarre behaviour," said Norbert Hirschhorn, M.D., retired public health physician, medical historian and lead author of the study.
"Mercury poisoning certainly could explain Lincoln's known neurological symptoms: insomnia, tremor and the rage attacks," said Robert G. Feldman, M.D., professor of neurology, pharmacology, and environmental health at the Boston University Schools of Medicine and Public Health, an expert on heavy metal poisoning and co-author of the paper. "But what is even more important, because the behavioural effects of mercury poisoning may be reversible, it also explains the composure for which he was famous during his tenure as president."
Lincoln was known to have taken "blue mass," a pill containing mercury, apparently to treat his persistent "melancholia," (then known also as hypochondriasis.) In 1861, a few months after the inauguration, however, perceptively noting that blue mass made him "cross," Lincoln stopped taking the medication.
"We wanted to determine how toxic the mercury in the blue mass pills was likely to be," said Ian A Greaves, M.D., associate professor of environment and occupational health and associate dean at the University of Minnesota School of Public Health, co-author. "We used a nineteenth century recipe to recreate blue mass. The ingredients included, besides mercury, liquorice root, rose-water, honey and sugar and dead rose petals. It was compounded with an old-fashioned mortar and pestle and rolled to size on a 19th century pill tile. But, in accord with 20th century safety standards, we wore surgical gowns, gloves, masks and caps and worked with modern ventilation equipment."
Caution was well advised. The method of compounding the blue mass pill, dispersing the mercury into fine particles and increasing its surface area, was meant to assure its absorption into the body and did. The vapour released by the two pills in the stomach would have been 40 times the safe limit set by the U.S. National Institute for Occupational Health. The solid element of mercury absorbed from two pills would have been 750micrograms. The EPA indicates that only up to 21micrograms of any form of mercury per day may safely be ingested. Someone who ate the common dose of two to three little pills per day would have seriously risked poisoning.
"The wartime Lincoln is remembered for his self-control in the face of provocation, his composure in the face of adversity," said Hirschhorn. "If Lincoln hadn't recognized that the little blue pill he took made him 'cross,' and stopped the medication, his steady hand at the helm through the Civil War might have been considerably less steady."
From: sciencedaily.com

Wednesday, April 24, 2013

Major Letterman Designs an Ambulance Corps

 
By late 1861, the need for a coordinated ambulance system became apparent to the military, the medical community and the civilian press.
 
Union Major Jonathan Letterman, Medical Director of the Army of the Potomac, instituted a plan. Letterman's design was a model of organization for medical support. The elements of his concept are still used in times of war.
 
Letterman's plan called for transporting the wounded to the hospital in dedicated vehicles, dropping them off with their bedding, picking up new supplies at the hospital and returning to the front.
 
The ambulances of a division would move together with specified personnel to collect the wounded from the field, bring them to dressing stations, then to the field hospital. The plan was implemented in August of 1862 with regulations for the organization of the ambulance corps and the management of ambulance trains.

The Need for an Ambulance Corps

One of the greatest challenges presented by the huge war was the transport of its wounded. The military had no formal ambulance corps.
 
Men, usually those considered unfit for battle service, were randomly appointed to drive ambulances and carry litters. The wounded who survived these emergency efforts were transported to army hospitals in nearby cities or towns, frequently by two-wheeled carts or four-wheeled wagons.
 
The crude vehicles that served as ambulances often caused additional injuries secondary to the battle wounds. Unpaved roads jostled the injured troops on their way to the field hospital. If a soldier survived his initial wound, he no doubt prayed he would survive the subsequent transport.

President Lincoln's "Blue Pills"

During the Civil War, the commonly used medication "blue mass", a clay-like compound of mercury and chalk, could lead to serious disfigurement and death.
 
Calomel, or "mercurous chloride" was the foundation for many Civil War treatments including blue mass and "blue pills".
President Lincoln used Blue Mass pills to treat his chronic constipation. The daily recommended dose of these pills contained more than 9,000 times the amount of mercury considered safe by today's standards. 
Calomel was dispensed to those with diarrhea, dysentery and typhoid fever, and many patients suffered from mercury poisoning. Writer Louisa May Alcott, who served as a Union nurse, almost died from mercury toxicity after being treated for typhoid. 

Did President Lincoln Have Marfan Sydrome?

From Mary Kugler, R.N.,

President Abraham Lincoln's health has been a topic of debate among scholars and physicians. In addition to known illnesses such as smallpox and constipation, at times it has been argued that he also suffered from depression and cancer. The fascination continues: the U.S. National Museum of Health and Medicine held a Symposium on President Lincoln's Health on April 18-19, 2009.
One of the more enduring theories about President Lincoln's health arose in the early 1960s. A physician published a paper in 1964 in the Journal of the American Medical Association which stated that President Abraham Lincoln had Marfan syndrome, a connective tissue disorder. The diagnosis was based on physical observations of Lincoln:
  • the fact that he was much taller than most men of his day
  • had long limbs
  • had an abnormally-shaped chest (sunken in)
  • had loose (lax) joints (based on written descriptions)
Since then, other physicians have disputed a diagnosis of Marfan syndrome for Lincoln. Some have argued that President Lincoln's hands did not have long, thin fingers, a common finding in people with the syndrome.
 
At a scientific workshop held in October 2001 in Cairo, Egypt, the scientists gathered there felt that there was not enough scientific evidence available to definitely diagnose President Lincoln with the disorder.
Marfan syndrome is an inherited disorder of connective tissue, although about one-quarter of all cases occur without any family history of the syndrome. It affects both men and women of all ethnic background. About 1 in 5,000 people have Marfan syndrome.

The Pain of Gunshot Wounds

Confederate surgeon Dr. Julian Chisholm described the sensation of a gunshot wound:
 
"The pain which accompanies the reception of gunshot injuries is often so trivial, that the attention of the wounded is only called to the fact by blood streaming down his legs. The majority liken the striking of a ball to a smart blow with a supple walking-cane, whilst with a few the pain is very severe, and simulates the feeling which would be produced by running a red-hot wire through the flesh. McLeod mentions the case of an officer who had both of his legs carried away, and who only became aware of the injury which he had received when he attempted to rise.
 
"It appears that every gunshot wound is accompanied by a certain amount of shock, or a partial paralysis of sensation, which is nature's preparation, permitting a thorough examination, with little or no pain. The unusual quiet of a hospital the night following a battle has been repeatedly noticed, and is accounted for by this nervous shock. When this condition passes off, then reaction brings with it much suffering."
 
At the Battle of Shiloh, Tennessee in 1862, Confederate General Albert Sidney Johnson was struck behind the knee by a minie ball. The General may not have realized he'd been wounded until he collapsed and slid off his horse. He bled to death within fifteen minutes.
 
PHOTO: Bone fractures from a Civil War gunshot wound.

Joseph Janvier Woodward, M.D.

Joseph Janvier Woodward received his M.D. from the University of Pennsylvania in 1853. He had an intense interest in photographic research on microscopic images. Many of his photomicrographs were later published in the "Medical-Surgical History of the War of the Rebellion".
 
At the outbreak of the Civil War he offered his services to the government. He served first as an assistant surgeon with the Army of the Potomac, although he spent most of his career in the Surgeon-General's office.
 
Woodward was put in charge of the Army Medical Museum in Washington. He supervised the collecting of the material that would be presented for publication and the education of new generations of physicians. He became famous around the world for his publications in the fields of microscopy and photomicography, and in 1881, was elected President of the American Medical Association. His devotion to the Museum was legendary.

Tuesday, April 23, 2013

Nashville Female Academy Hospital (Federal Hospital No. 14)

By Aloysius F. Plaisance and Leo F. Schelver, III

The Nashville Female Academy Hospital on Church Street was situated on a six-acre plot of land and was fairly well enclosed by a fence to keep out possible curiosity seekers. Some portions of the fence had been destroyed but this did not affect the grounds which included a lawn with several large shade trees. Porticos, corridors, and covered pavements furnished ample accommodations for exercise in all kinds of weather.

The Nashville Female Academy Hospital had 350 iron cots, well furnished with bedding and 191 patients. There were five surgeons in attendance at this hospital; Major Frederick Seymour was Surgeon-in-Charge. The yardmaster, steward, clerks and apothecary took care of all the other details. The nursing and care of the patients was superintended by ten Catholic Sisters of Charity from Cincinnati. Besides the Sisters, there were twenty-six male nurses, two white male servants, sixteen colored female servants, and twenty-six colored males.

Excerpted from: "Federal Military Hospitals in Nashville, May and June, 1863", The Journal of Civil War Medicine Vol. 12, No, 4.

IMAGE: Sketched by A.E. Matthews, member of the 31st Ohio Infantry. Besides being used as a hospital (No. 14), it was also used by the Provost Marshal and as a shelter for refugees.

The Dynamics of 'Taking a Hit'

By John Nevins

When a large, heavy bullet (like the Civil War era minié ball) hits the head, spine or lower skeletal structures, human beings quite obviously crumple to the ground. However, when shot in other locations in the torso or even limbs, people quite often lose leg function and fall to the ground immediately (within a couple of seconds). When this occurs, they may be unconscious, conscious, or initially unconscious--returning to consciousness in a few seconds.
 

The Permanent Crush Cavity (PCC) is the area or amount of tissue actually touched, crushed or pulped by the bullet. The severing of blood vessels and rupture of hollow viscera (major organs such as the liver, pancreas, etc.) induces neural shock and loss of motor control from damage to the nervous system. The PCC is enhanced when the bullet strikes bone, splintering it and sending these fragments through the body as secondary missiles. The PCC has a direct impact on the vestibulospinal tract causing collapse. This is the primary wound and incapacitation predictor where heavy, slow moving projectiles are concerned.

No doubt about it, a minié ball is a big, hard-hitting slug Nevertheless, being hit by one produces no more push than say a ten-pound weight being dropped about two inches. The impact will not push you backwards unless you were already off balance.

You might spin around to some degree if hit in the shoulder where bone and muscle is being struck and most of the bullet's energy (force) is being expended in you, rather than passing on out the other side. Yet most, if not all of that "spin" would likely be a reactionary move by you to the blunt force trauma you are receiving rather than the bullet actually causing you to spin.

Excerpted from: "The Dynamics of Taking a Hit" reprinted from The Civil War Courier in
The Journal of Civil War Medicine, Vol. 7, No. 2

Learn more about Civil War wounds at www.CivilWarRx.com.

The Pelvic Wound of Union Major Joshua Lawrence Chamberlain

By William J. Harmon, M.D. and Charles K. McAllister, M.D.

Major General Joshua Lawrence Chamberlain is a true American hero. His medical history and war wounds provide a rare snapshot of Civil War era medicine. In particular the most devastating injury was a rifle shot through the pelvis rupturing the bladder and urethra.

The prognosis was grim. Civil War surgeons were adept at removing limbs for extremity wounds but "gut wound" soldiers were left to die. Word of the injury reached his brother Tom who was still in the 20th Maine regiment. Tom recruited Drs. A.O.Shaw and M.W.Townsend, and through the night they searched field hospitals until they found his brother.

The surgeons embarked on an unprecedented open wound exploration in the field hospital with Chamberlain receiving morphine and chloroform sedation, Halfway through the operation the pain became sheet torture and the surgeons laid down the instruments, thinking that the agony had gone on long enough.

However, the patient himself encouraged them to continue and they did, reconnecting severed urinary organs and removing the minie ball that had done so much damage. Hope for recovery was nonexistent as shortly after finishing, the exhausted surgeons noted urine exiting the lower wound.

Miraculously, Chamberlain began to recover and by the end of July the surgeons started to admit that the danger of death was passing and recovery was certain. Ironically he would ultimately die of this wound but not until he was 85 years old.

Joshua Lawrence Chamberlain survived smallpox, heat stroke, malaria, typhoid and tuberculosis. His horse was shot from under him 5 times and 6 times he was hit with rebel lead causing his obituary to be sent to the New York papers on 2 occasions. The most devastating injury was the pelvic wound, the complications of which he endured for almost 50 years. Despite this medical history, he engaged in innumerable skirmishes and 24 battles, capturing 2,700 prisoners and 8 battle flags. He won the Congressional Medal of Honor for his effort at Gettysburg and was subsequently promoted to Major General. This former theology professor is not only among the most remarkable soldiers ever to serve, but also one of America's greatest heroes.

Excerpted from: "The Lion of the Union: The Pelvic Wound of Joshua Lawrence Chamberlain", The Journal of Civil War Medicine, Vol..6, No. 2

The Autopsy of John Wilkes Booth

By Allen D. Spiegel, Ph.D., M.P.H. and Merrill S. Spiegel, J.D.

During April 1863, Dr. John Frederick May, a prominent physician in the District of Columbia, surgically removed a fibroid tumor from the back of John Wilkes Booth's neck and treated him for a short time. An identifiable large, ugly scar resulted when the wound inadvertently tore open and healed by granulation. Shortly after President Lincoln's assassin was killed on April 26, 1865, a formal inquest was held to identify the body. May was summoned to examine the remains and made a positive identification based upon the recognition of the scar made by his scalpel.

At 2:00 PM on April 27, 1865, [Surgeon General Joseph K.] Barnes and Assistant Surgeon General Dr. Joseph Janvier Woodward conducted a postmortem examination of the body. A letter to Secretary of War Edwin M. Stanton reported their autopsy findings:

"Left leg had a fracture of the fibula 3 inches above the ankle joint . . cause of death was a gun-shot wound in the neck--the ball entering just behind the sterno-cleido muscle--2-1/2 inches above the clavicle--passing through the bony bridge of fourth and fifth cervical vertebrae--severing the spinal cord and passing out through the body of the sterno-ceido of right side--3 inches above the clavicle. Paralysis of the entire body was immediate, and all the horrors of consciousness of suffering and death must have been present to the assassin during the two hours he lingered."

Excerpted from: "J. Wilkes Booth as a Patient, as a Corpse to be Identified and Diagnosed as a Monomaniac", The Journal of Civil War Medicine, Vol. 5, No. 3

Onan's Revenge: Death From Masturbation

By Thomas P. Lowry, MD

In the 1800s, as America became less of a collection of religious colonies and more of a secular nation, a new prophet arose, who redefined masturbation as a medical problem, rather than a purely religious issue. Sylvester Graham, inventor of the graham cracker, published his magnum opus, Lectures to Young Men, in 1834. In this tome, Graham warned that the solitary vice would lead to physical decay, insanity, and death.

In the Civil War era, before any real understanding of physiology and infectious diseases, the medical profession relied on authority and tradition, in the absence of real knowledge. In dozens of court-martials, regimental surgeons testified that the defendant was not in his right mind because of masturbation. Almost everyone accepted this connection between masturbation and insanity. A notable exception was--Mark Twain. In his magisterial essay, On the Science of Onanism, he ascribed to Julius Caesar these immortal words: "To the lonely it is company. To the forsaken, it is a friend. To the aged and to the impotent is is a benefactor. They that are penniless are yet rich, in that they still have this majestic diversion." Twain's turns of phrase are, of course, skeptical and light-hearted, but in this he was nearly alone.

The intrepid researcher, Edward S. Milligan, has called to my attention the records of St. Elizabeth's Hospital at Washington, DC, which was for decades the nation's only Federal psychiatric institution. In the six years before the Civil War, twelve men were admitted to the hospital with a mental disorder "caused by masturbation". Their average age was twenty-five. During the war itself, thirty-eight men were admitted with conditions attributed to masturbation. In the decade following the war, fifty-five men were admitted as insane secondary to masturbation. Thus from 1855 to 1875 a total of 108 psychiatric patients at St. Elizabeth's had their mental illness attributed to The Solitary Vice.

Excerpted from: "Onan's Revenge: Death From Masturbation", published in The Journal of Civil War Medicine, Vol. 11, No, 2.

Charlottesville General Hospital

By Barbara Maling, R.N., M.S.N., A.C.N.P.

Overwhelmed with patients, hospitals transferred many debilitated soldiers from Richmond to other cities. The nearby university town of Charlottesville, with its medical school, became a major medical center to which patient over-flow could be sent throughout the war.

Several hospital were created in Charlottesville to handle incoming wounded, The largest was the Charlottesville General Hospital. It was actually an amalgamation of rented buildings throughout Charlottesville. In the fist month of its existence, the hospital admitted 2608 patients. Pressed for space the University of Virginia's facilities were also used for the troops. On 8 June 1862 Socrates Maupin, Chairman of the Faculty, noted in his diary:

". . . about 300 soldiers wounded in the battle of the 8th near Port Republic arrived at the University on the evening of the 9th June and were placed in the chapel, Public Hall and Moot Court room. On the 14th, the number of the sick and wounded at the University had increased to 600 and on the 24th, to about 1400. They were provided for in Dawson Row, East and West Ranges of dormitories and in tents in the Gymnasium field and elsewhere."

The military hospitals in Charlottesville were similar to Confederate hospitals throughout the South in that little preparation had been made for the nursing care of mass casualties. The South believed the war would be short and the soldiers assigned to serve as hospital personnel, plus the slaves, should provide whatever nursing care that was needed. Southern women quickly recognized that more nurses were needed, and they became involved in caring for the soldiers.

Excerpted from: "Women Providing Nursing Care in Charlottesville During The American Civil War, 1861-1865"

Visit more Civil War hospitals at www.CivilWarRx.com.

Horsehair as a Substitute for Wire (in sutures)

By Thomas Smith, Esq., Demonstrator of Anatomy St. Bartholomew's Hospital, and Assistant Surgeon to the Hospital for Sick Children

As a material for attaching the margins of the skin, and mucous membrane after circumcision, or other operations for phimosis, I have found horsehair most useful, having employed it both in children and adults. . . In the removal, the advantage of horsehair sutures over the wire is considerable, since, unlike wire, which after remaining a few days in a wound, stiffens into a metallic ring, horsehair, when cut just aside the knot, either retaining its original elasticity, springs open, or if it has been long soaked in the wound secretions, it becomes soft and pliable. I would recommend this suture for wounds of the eyelid and other parts of the face, and to the loose integuments of the scrotum and penis; since to all these parts I have either applied the suture myself with good effect, or I have seen it used by others at my suggestion.

For the purpose of suture, long white tail hairs are the best. Before being used they should be soaked for a minute or two in water, or they may be drawn once or twice through the moistened finger-ends. The suture may be fastened off in a double knot, but if the hair is stiff, a third knot if often required. It may be removed in the ordinary manner, seizing the knot with the forceps, and dividing the suture just aside of it. It is scarcely necessary to remark, that horsehair, as a suture, is not suitable for wounds where there is much tension between the edges.

Excerpted from an article appearing in the March 1866 issue of The Richmond Medical Journal, Vol. 1, No. 3, from where it had been reprinted from an issue of The Lancet.

PHOTO: Pocket surgical kit carried by surgeons during the Civil War

Thursday, April 18, 2013

Civil War Medicine Bottles

Excerpted from "Collectors Weekly"
 
Most bottles made in the United States before the 1850s, when the snap case tool virtually replaced the pontil rod (also called the punte or punty), have a pontil mark on their bases. The mark is formed when a bottle is transferred from the blowpipe to the pontil rod, which, unlike the blowpipe, is solid. Known as empontilling, this transfer allows the glassblower to form and finish the bottle’s mouth or bore. Though no longer used in glass manufacturing, this technique is still used in art glass today.
 
Antique medicinal bottles from between 1810 and the Civil War tend to have pontiled  bases; applied, rolled, flared, or sheared finishes; usually true two-piece key-and-hinge molds; predominantly rectangular, round, and square shapes; and crude glassmaking imperfections like whittle marks, bubbles, uneven tone, or an orange-peel surface. The first American-made bottle on record featuring proprietary embossing is a Dr. Robertson’s Family Medicine container from 1809.

Typhoid Fever

By Alfred Jay Bollet, M.D.
 
Feared and often fatal, typhoid fever was one of the most terrible epidemic diseases in the 1800s. Typhoid is an intestinal infection that is spread by ingesting food or water contaminated with the bacteria called "Salmonella typhi". Such contamination was usually widespread in army camps, and caused huge epidemics. During the Civil War, there were 75,418 cases in white Union soldiers and 27,,058 (36%) of then died. Black troops encountered the disease at a comparable rate, and the Confederate records that exist indicate a similar experience.

The disease was at its peak during the first full year of the war (July 1, 1861, to June 30, 1862). During that period, 5.9% of Union soldiers (based on the army's mean strength that year) were diagnosed with typhoid fever; 2% of the entire army died from it.
The next year, when there was still active recruitment, 4.9% of the men reportedly had typhoid fever and 1.7% died.

In subsequent years, the incidence of typhoid fever averaged about 1.5% of the army's mean strength, and less than 1% died. There are no exact statistics on the incidence of disease in Confederate troops during this period, but anecdotal reports from physicians and commanders suggest a similar experience.

Patients with severe typhoid experience fever and severe generalized malaise as the bacteria spreads through the body. These patients usually develop transient red skin lesions called "rose spots" and have diminished mental function. Paralysis of wall muscles in the bowel can lead to intestinal dilation, distending the abdomen; nineteenth-century physicians described this phenomenon as "adynamia". Diarrhea or constipation may occur, and performation of the intestine can lead to death. Typhoid can also cause bronchitis, leading to pneumonia.

There were no effective treatments for typhoid. Physicians attempted to treat the symptoms using analgesics and quinine (as an antipyretic), and tried to find a palatable, appropriate diet for sufferers. Occasionally, these measures did some good. However, some physicians prescribed calomel for typhoid fever, causing mercury poisoning in many of the patients.
  
Excerpted from: "Civil War Medicine: Challenges and Triumphs" by Alfred Jay Bollet, M.D.
PHOTO: President Lincoln's son, Willie, who died of typhoid fever at age 11.

Women Volunteers

By Barbara Maling, R.N., M.S.N., A.C.N.P.

. . . Many women volunteers were devoted caretakers and their contributions were significant. Many Civil War histories refer to women visiting hospitals but do not classify them as nursing staff. These women performed limited nursing activities such as feeding soldiers too weak to feed themselves, writing letters for soldiers, and preparing food.

. . . Many brave women during the Civil War, including those in Charlottesville, defied initial objections against "refined ladies" taking care of strangrs and nursing in military hospitals. They braved the frowns of those around them to volunteer their nursing services despite risk of disease and physical harm to themselves. . . In doing this they overcsme prejudices of many who initially opposed their presence among the wounded and ill.

(Excerpted from: "Women Providing Nursing Care in Charlottesville during The American Civil War, 1861-1865") "The Journal of Civil War Medicine, Vol. 12, No. 4

Dr. Alpheus William Tucker

African American Acting Assistant Surgeon

By Reg Pitts

Alpheus William Tucker was born in Detroit sometime in 1844 or the next year; he grew up in Toledo, Ohio and attended Oberlin from 1861 to 1863 (with Charles Burleigh Purvis) before enrolling in the Iowa School of Medicine, from where he graduated, class of 1865.

After moving to Washington, D.C., he married Martha Ellen Wood on January 26, 1867; they had a daughter, Sarah Estella, born 1869 (graduated from Miner Normal School [now University of DC] class of 1889). According to the city directories, Dr Tucker practiced medicine in Washington until 1878 when he returned to Detroit; he died there of a "cold" in January of 1880, according to the U.S. Census Mortality Schedule for Wayne County, Michigan.

His widow and orphan returned to Washington where Martha moved in with her parents (George W. and Mary E. Ferguson Wood; he was a messenger for the US Dept. of the Interior), and taught school in the DC school system. Her daughter followed in her footsteps, and the resided in the LeDroit Park section of Washington. Martha Wood died on March 14, 1921, aged seventy-two (her death cert said sixty-two).

Sources: census records through ancestry.com; city directories through ancestry.com; his middle name and the names of his inlaws from the listing for Martha's death cert at familysearch.com.

Dr. Moses Shaw Thomas, CSA

CONFEDERATE PHYSICIAN Dr. Moses Shaw Thomas (1830-1896)
By Robert Joseph Sonntag

Dr. Thomas was appointed as a Surgeon on Staff with 2nd Florida Infantry on October 16, 1861 and was paroled at Appomattox, VA on April 9, 1865. He was born in Baltimore, MD on January 3, 1830. After graduating a course of medical study at the University of Maryland at Baltimore, he practiced medicine in the Shenandoah Valley, VA for two years. In 1856 he came to Kansas and settled in Leavenworth.
 
When the war began, he left the position of surgeon at Fort Leavenworth, went to Richmond, VA and entered the Confederate Army as a surgeon in the Army of VA. He returned to Leavenworth at the end of the war and resumed the practice of medicine and surgery. He was married April 22, 1868 to Miss Alice A. Clark, daughter of Malcolm Clark.

Inserting Morphine Directly Into Wounds

by Alfred Jay Bollet, M.D.

Medical Director Henry Hewit reported on his order regarding the use of morphine in wounds during the Atlanta campaign:

"The insertion of morphine into wounds of the chest, attended by pain and dyspnoea, has been of the utmost advantage. I made the insertion of morphine into all painful wounds standing order of the medical department, and it has acted so admirably as to enlist every surgeon in favor of the practice. Its good effects are especially remarkable in painful wounds of the joints, abdomen, and chest. From one to three grains are inserted on the point of the finger. I desire especially to call the attention of the profession to this practice, which is simply a generalization of the well recognized application of morphine hypodermically."

Studies conducted in the early 1900s erroneously suggested that putting opium or morphine directly into a wound was useless, since the drugs worked only after reaching the brain. More recent studies, however, have demonstrated that there are opiate receptors in peripheral tissues which makes topical applications effective. In addition, some of the morphine applied to bleeding wounds probably enters the bloodstream and reaches the brain.

FROM: "Civil War Medicine: Challenges and Triumphs"

Tuesday, April 16, 2013

Dr. Martin Robison Delany

First African American to Receive a Commission as a Major in a Combat Unit

By Robert Slawson, M.D., F.A.C.R.

Martin Delany became interested in medicine later in life. After an apprenticeship, he applied for medical school without acceptance. After an apprenticeship as a dentist and subsequent practice, he applied again to a medical school.

This time, at age 38, he was accepted at Harvard Medical School. Because of student objections when a woman was admitted as well, he and two other African American men were allowed to attend for only that one year.He then opened a medical practice.

From age 19, Delany had been active in the abolitionist movement and he resumed this activity as well. After an abortive effort at colonization in Nicaragua, Delany organized an exploration of the Niger River.
By his return, the Civil War had begun and he campaigned to have African American troops used by the Union. When this was finally begun, Delany was very active in the recruitment of troops for both Massachusetts and Rhode Island.

Eventually Delany succeeded in obtaining a meeting with President Lincoln. This was followed by a meeting with Secretary of War Stanton, at Lincoln's request, and a Commission of Major of Infantry, United States Colored Troops in March 1865. At the end of the war, Dr. Delany was appointed a Sub-Assistant Commissioner of South Carolina and stayed there for several years.,

Dr. Delany was the first African American to receive a commission as Major in a combat unit. Although his commission was not in the Medical Service, he did practice as a physician on several occasions both before and after the war and must be included in any discussion of African American physicians of this period.

FROM: "The Journal of Civil War Medicine", Vol. 7, No, 2

Ann Bradford Stokes, African American Navy Nurse

By Robert Slawson
 

Ann Bradford, early African American navy nurse, was born a slave in Rutherford County, Tennessee, in 1830. Few other details of her early life are known.  She was not able to read or write and was taken aboard a Union ship as “contraband” (an escaped slave) in January 1863. The Emancipation Proclamation has just been issued freeing slaves in states that had left the Union including Tennessee.
 
In January 1863 she volunteered to serve as a nurse on the Union hospital ship, USS Red Rover.  At that time the United States Navy enlisted several young African American women into the Navy.  They were given the rank of “first class boy” and paid accordingly, but they were employed as nurses on the Red Rover.  She stayed on active duty until October 1864 when she became totally exhausted and resigned her position.

Shortly after leaving the Navy in 1864, Bradford married Gilbert Stokes, an African American man who had also been employed on the Red Rover.  They moved to Illinois where Gilbert Stokes died in 1866.  She remarried a man named George Bowman in 1867 and lived on a farm in Illinois.  In the 1880s she applied unsuccessfully for a pension based on her marriages to Stokes and Bowman.   Her pension application was made more complicated because of her inability to read or write. 

As her health grew worse, Stokes reapplied for a pension in 1890. She stated that she had “piles and heart disease.”   By this time she had learned to read and write and put forth her own arguments, emphasizing that she was basing her claim on her own military service, not a former husband.  This approach was unique and she was persistent.  The pension office asked the Navy to review her case and the Navy certified that she had actually served eighteen months as a “boy” in the United States Navy on the Red Rover and that she had a pensionable disability.  In 1890 Stokes was granted a pension of $12 a month which was the amount usually awarded to nurses at that time.

Stokes continued to live in Belknap, Illinois, with her husband, one child, and two step-children until her death in 1903.

Ann Bradford Stokes was remarkable in several ways.  She was one of the first women ever enlisted as active duty personnel in the United States Navy.  In addition, although some 15 African American women were enlisted in the Navy at that time, she is the only one who is known to have applied for a pension.  Most remarkable, she received a pension based on her own military service.

Clarissa Jones, Nurse for All

Clarissa Jones: Union or Confederate, Nurse Cared for All

By Janet D. Terrell

Civil War nurse Clarissa Jones of Philadelphia has captured the admiration of nurse historian Chris Foard, RN, MSN, physician liaison, Bayhealth Medical Center, Dover, Del. When war erupted, the 28-year-old Jones was principal of Rittenhouse Grammar School for Girls. She served as a volunteer nurse, using skills she gained caring for her ailing mother.

In 1863, just after the Battle of Gettysburg, she was stationed in a field hospital of the Second Division Union Army with 600 patients, 100 of whom were Confederate captives. Foard says Jones aided injured Union soldiers as well as dying Confederate soldiers in squalid conditions. At one point, she read the burial service for a dead Confederate officer because no chaplain was available. Battlefield hospitals were filthy, without antiseptics and sometimes without bandages. At times, Jones was the only female nurse.

According to Foard, Jones galvanized the Germantown community where she lived to send supplies to wounded soldiers. She wrote letters and returned to update townspeople on the war’s progress and the needs of hospitals for food and supplies. Jones kept her job as principal while she volunteered. According to Foard, she served at several hospitals and a hospital steamer ship, which meant leaving family and her job for longer periods.
“Clarissa’s impact assisted in paving the way for American nursing,” Foard said. “Today, nurses are on the forefront of lobbying for healthcare reform and committed to provide optimal services to patients in our communities.”

According to information from the Germantown Historical Society, Jones accompanied wagons loaded with supplies across nearly impassable roads to reach hospitals. A news report said she personally knew President Abraham Lincoln. Another article indicated she met the president during a White House reception.

In 1872, she married John Dye of Germantown. Her activism did not end as she served two terms as president of the National Association of Army Nurses of the Civil War and chaired a committee that sought pensions for volunteer Army nurses. The National Archives has a 1907 card Jones filed seeking a pension, but it wasn’t until years later that a bill was passed granting pensions to surviving nurses, Foard said.

The Johnstown, Pa., flood of 1888 claimed more than 2,000 lives. Jones responded by organizing the Women’s Permanent Emergency Association of Germantown to aid those in need. That group was active in the Spanish-American War and World War I, Foard said.

Her efforts to win pensions for volunteer nurses, as well as her care of wounded soldiers, made her a pioneer and forerunner of today’s nurses, he said.

Amputations in the Civil War

Under the Knife

By Terry L. Jones
On Aug. 28, 1862, Maj. Gen. Richard S. Ewell’s Confederate division was fighting desperately in the fields and pine thickets near Groveton, Va., during the Second Bull Run campaign. Heavy fire was coming from unidentified soldiers in a thicket 100 yards in front. To get a better look, Ewell knelt on his left knee to peer under the limbs. Suddenly a 500-grain (about 1.1 ounces) lead Minié ball skimmed the ground and struck him on the left kneecap. Some nearby Alabama soldiers lay down their muskets and hurried over to carry him from the field, but the fiery Ewell barked: “Put me down, and give them hell! I’m no better than any other wounded soldier, to stay on the field.”
The general lay on a pile of rocks while two badly wounded soldiers nearby cried out for help until stretcher bearers finally arrived on the scene. Despite their own painful wounds, the two men insisted Ewell be carried off first, but he instructed the litter bearers to take them away. Hours after being wounded, Ewell was finally placed on a stretcher and taken to the rear. Dr. Hunter McGuire, Gen. Thomas J. “Stonewall” Jackson’s medical director, amputated Ewell’s leg the next day.
Campbell Brown, Ewell’s aide and future stepson, witnessed the operation. McGuire and his assistants sedated Ewell with chloroform and used a scalpel to cut around his leg just above the knee. In his drug-induced fog, Ewell feverishly issued orders to troops, but he did not appear to feel any pain until McGuire applied the bone saw. According to Brown, the general then “stretched both arms upward & said: ‘Oh! My God!’”
McGuire opened up the amputated limb to show the officers in the room that the operation had been necessary. The bullet had “pierced the joint & followed the leg down for some inches,” Brown later wrote. “When the leg was opened, we found the knee-cap split half in two — the head of the tibia knocked into several pieces — & that the ball had followed the marrow of the bone for six inches breaking the bone itself into small splinters & finally had split into two pieces on a sharp edge of bone.” Brown and a slave wrapped the bloody limb in an oilcloth, and the slave “decently buried” it in the garden. Brown kept the two pieces of bullet as souvenirs for his mother, who was engaged to Ewell, although he never told the general he had done so.
Rank was no protection from such brutal operations, and General Ewell was just one of many high-ranking officers to face the surgeon’s knife. In fact, statistically speaking, a Confederate general was more likely to require medical treatment than a private. Almost one out of four died in the war, compared with 1 out of 10 Union generals. Of the 250 Confederate generals who were wounded, 24 underwent amputations. General Ewell was one of the lucky ones who survived and returned to duty many months later with an artificial leg.
Approximately two out of every three Civil War wounds treated by surgeons were to the extremities because few soldiers hit in the head, chest or stomach lived long enough to make it back to a field hospital. From a technical point of view, damaged limb bones presented the greatest challenge to surgeons. The war’s most common projectile, the large, oblong Minié ball, often tumbled when it hit the body and caused much more damage to bone than smoothbore musket balls. One Confederate surgeon observed, “The shattering, splintering, and splitting of a long bone by the impact of a minié or Enfield ball were, in many instances, both remarkable and frightful.” When bone was damaged, surgeons had to decide quickly on one of three possible treatments. If it was a simple fracture, a wooden or plaster splint was applied, but if the bone was shattered the surgeon performed either a resection or an amputation.
Resection involved cutting open the limb, sawing out the damaged bone, and then closing the incision. It was a time-consuming procedure and required considerable surgical skill, but some surgeons became quite proficient at it. After the Battle of Savage’s Station in 1862, one Union surgeon completed 26 resections of the shoulder and elbow in a single day. He was said to be able to eat and drink coffee at the operating table while pieces of bone, muscle and ligaments piled up around him.
Besides being a difficult procedure, resection also carried a high risk of profuse bleeding, infection and postoperative necrosis of the flesh. Successful resections, however, allowed the patient to keep his limb, although it was limp, useful merely to “fill a sleeve.” Because of the time required, resections were not always practical when there were large numbers of patients to treat, but they were used more frequently after surgeons learned that amputations had a much higher mortality rate.
The amputation process was fairly simple. After a circular cut was made completely around the limb, the bone was sawed through, and the blood vessels and arteries sewn shut. To prevent future pain, nerves were then pulled out as far as possible with forceps, cut and released to retract away from the end of the stump. Finally, clippers and a rasp were used to smooth the end of the exposed bone. Sometimes the raw and bloody stump was left untreated to heal gradually, and sometimes excess skin was pulled down and sewn over the wound. Speed was essential in all amputations to lessen blood loss and prevent shock. An amputation at the knee was expected to take just three minutes.
Civil War surgeons almost always had chloroform to anesthetize patients before an amputation. The chloroform was dripped onto a piece of cloth held over the patient’s face until he was unconscious. Although not an exact science, the procedure worked well, and few patients died from overdose. Opium pills, opium dust and injections were also available to control postoperative pain.
The mistaken belief that amputations were routinely performed without anesthetics can be partially attributed to the fact that chloroform did not put patients into a deep unconscious state. Bystanders who saw moaning, writhing patients being held down on the table assumed no anesthetic was being used. As in the case of General Ewell, patients often reacted to the scalpel and bone saw as if in pain, but they did not remember it afterward. After his left arm was amputated (Dr. McGuire also performed that operation), Stonewall Jackson mentioned that he had heard the most beautiful music while under the chloroform. Upon reflection, he said, “I believe it was the sawing of the bone.”
Because surgeons preferred to operate outdoors where lighting and ventilation were better, thousands of soldiers witnessed amputations firsthand. Passers-by and even wounded men waiting their turn watched as surgeons sawed off arms and legs and tossed them onto ever growing piles. The poet Walt Whitman witnessed such a scene when he visited Fredericksburg in search of his wounded brother. “One of the first things that met my eyes in camp,” he wrote, “was a heap of feet, arms, legs, etc., under a tree in front of a hospital.” Indeed, after the December 1862 Battle of Fredericksburg, Union surgeons performed almost 500 amputations.
Early in the war surgeons earned the nickname “Saw-bones” because they seemed eager to amputate. This eagerness stemmed not from overzealousness but from the knowledge that infections developed quickly in mangled flesh, and amputation was the most effective way to prevent it. Those limbs removed within 48 hours of injury were called primary amputations, and those removed after 48 hours were called secondary amputations. The mortality rate for primary amputations was about 25 percent; that for secondary amputations was twice as high, thanks to the fact that most secondary amputations were performed after gangrene or blood poisoning developed in the wound. Surgeons learned that amputating the limb after it became infected actually caused the infection to spread, and patients frequently died. Thus, the patient was much more likely to survive if a primary amputation was performed before infection set in.
PHOTO: Unidentified soldier, double amputee
FROM: The New York Times: The Opinion Pages

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