Civil War Surgery

By Pvt. Hugh R Martyr, 20th Maine

The War broke out during a transition period in medical knowledge. Anaesthesia had been used since the 1840's and thus allowed operations to be performed that hitherto would have been impossible. However there was no knowledge or understanding about the spread of infection until the 1870's. Thus, able to carry out major surgery, medical staff unwittingly caused serious problems with infection.

By far, the most common of wounds to be dealt with, were caused by gunshot. The Minié Ball made a hideous wound, often changing shape as it entered the body and dragging in dirty clothing; upon hitting bone it caused shattering which in turn increased the severity of the damage. Approximately 71 per cent of gunshot wounds were on arms, legs, hands or feet.
There was a difference of opinion amongst Union surgeons about the need to amputate damaged limbs or attempt to repair and try to save them, however, for the staff at the field hospitals time was short. If in doubt the limb was removed. Abdominal wounds were far more serious and the percentage of soldiers surviving them was far less than those losing a limb; bowel and stomach wounds being the most serious.

One of the problems for the wounded was that the transportation from the primary care station to a general hospital was crude and unsanitary; if the wound had not been infected on the battlefield it was almost certainly contaminated en route in ambulance, train or boat. The transportation personnel were more interested in speed of delivery than the comfort of the soldiers in their care.

The officers in charge of advance field hospitals confined the treatment of the wounded to stopping haemorrhage and to bandaging. Tourniquets or compresses were applied, liquor in the form of whiskey or brandy given to counteract shock, and the patient was usually given an opium pill or a dose of morphine. Bandaging of wounds became less common as the war progressed as it was found that they became soiled and contaminated and were causing problems as they were cut away. Splints to be used on fractured limbs were usually cobbled together using fence rails or board, ambulances were furnished with "Smith's Anterior" a suspended splint in ambulances but many staff did not know how to use it correctly. One contribution to medical science was the Hodgen Splint, invented in 1863 by Surgeon J Hodgen. This was a splint that provided room for examination, prevented contraction and allowed drainage of the wounds without disturbing the break. The basic design is still in use today.

The wounded were brought to the field hospital and laid out on straw; the less serious cases would be dealt with by a "dressing surgeon" who together with a medical orderly would operate a triage system passing over the mortally wounded and getting the most needy to the operating table. Pressure of the work load and the primitive conditions of the field units often meant that recommended procedures often were by-passed. It was thought that it was important to operate before infection could set in, but to avoid work whilst the patient was in deep shock. However, there was not the luxury of time available to the surgeons, the operating table had hardly been swilled down after one case before the next was brought in.

The management of the cases after surgery was relatively simple and consisted of rest, the relief of pain by opiates, doses of liquor or quinine to "support the system" and the application of cold compresses to keep down inflammation.

These quick operations broke all the rules of modern asepsis, cleanliness was almost impossible and the field stations soon became a gruesome spectacle as the surgeons worked through the hundreds of cases brought to them. From a Spotsylvania hospital a surgeon wrote home to his wife that he had been steadily operating for four days and that his feet were badly swollen. "It does not seem as though I could take a knife in my hand today. Yet there are a hundred more cases waiting for me. The poor fellows beg for the chance to have an arm or leg taken off. It is a scene of horror as I ever saw."

Pain relief came in the form of opiates; in the state of shock and under the influence of the anaesthetic the pain of the initial surgery was mitigated. It was as shock subsided and infections took hold that the misery of pain was suffered. The poor handling and rough transportation did not help in any way to ease the wounded soldiers plight. Opium was administered in tablet form and often morphine was rubbed into the wound. The hypodermic syringe became more common in the later years of the war and morphine was then injected.

The problem of infection was never really solved; surgeons had little understanding of the healing process and thought that the pus-producing infections were the normal process of tissue repair. When wounds healed without this action as it is now expected to do so, it was thought unusual. Thus large amounts of fatalities occurred due to Septicaemia, Pyaemia and the now unknown "hospital gangrene". The doctors at the time expected this as they were common in the civilian hospitals at the time.

Surgeons reports and letters tell a dreadfully gruesome account of the work that they had to do, the lack of water, the untrained orderlies and the work load are all mentioned time and time again.

I would be wrong to dismiss the efforts of the doctors and medical staff as being poor, throughout the whole of the war huge resources and improvements were made. The medical budget of 1864 exceeded the total amount of money spent on the pre-war army. Medical knowledge was on the verge of major breakthroughs and I consider the numbers of wounded that survived horrific injuries that would even now cause major concern, a testament to the efforts of the Medical Staff and the Sanitary Commission.

From: acws.co.uk

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