The Mystery of the Glow-in-the-Dark Civil War Soldiers

By Lauren Davis, 4-7-12

The American Civil War Battle of Shiloh left 16,000 soldiers dead and 3,000 soldiers wounded, and some of those wounded soldiers are part of an odd mystery. Some of the soldiers had eerily glowing wounds, which healed more quickly than the non-glowing wounds. So what strange battlefield science was at work?

It took two days and nights for the medics to reach all of the wounded soldiers in Shiloh, and some of the soldiers noticed that their wounds glowed in the darkness. Because the glowing wounds healed more quickly and cleanly, the mysterious force was termed "Angel's Glow."

It wasn't until 2001 that this 1862 mystery was finally solved. Seventeen-year-old Bill Martin was visiting Shiloh with his family, where he heard about the strange glow. His mother, microbiologist at the USDA Agricultural Research Service, had studied luminescent bacteria, and Martin wondered if similar bacteria might have been at work. With his friend Jon Curtis, Martin researched Photorhabdus luminescens, a type of bacteria that lives in the guts of parasitic nematodes. When nematodes vomit up the glowing bacteria, P. luminescens kills the other microbes living in the nematoad's host.

Normally, P. luminescens couldn't live in the human body since it dies at human body temperature. But Martin and Curtis, studying the historical records and the conditions in Shiloh, realized that the nighttime temperatures were low enough for the soldiers to develop hypothermia, allowing the bacteria to thrive in their bodies, kill off competing bacteria, and perhaps save the lives of their human hosts.

For solving this decades old mystery, Curtis and Martin won first place in the 2001 Intel International Science and Engineering Fair.

From: io9.gizmodo.com

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Glowing Civil War Flesh Wounds

By Adrian, 4-4-16

When Civil War soldiers were injured at the Battle of Shiloh, their wounds emitted something they called Angel's Glow. If only they'd known the truth.

AN ILLUMINATING BATTLE

During the Civil War, the Battle of Shiloh produced more than 23,000 casualties and was the bloodiest battle in American history at the time.

On April 6, 1862, Confederate soldiers surprised Union soldiers camped near the Tennessee River. The Confederacy made a strong showing that first day, but Union reinforcements arrived the following day and ended the battle.

The fact that the South nearly won this decisive fight wasn’t what was so illuminating about the battle. Following the fight, the surviving soldiers were stuck waiting for medics to arrive, sitting in the rain and mud for two days straight. As night fell on the wounded survivors, they noticed something creepy: their wounds were glowing.

ANGEL’S GLOW

Ignoring the fact that glowing might not be the most tactically intelligent situation for war, the fact is that the human body shouldn’t glow. And as if a gaping flesh wound isn’t scary enough, imagine looking down at your bullet wound and seeing a light blue glow coming from it.

At a time when a small cut could get infected and kill you, I doubt glowing battle wounds would have been a welcome sight. But as the soldiers ended up in field hospitals, they started to notice that the ones afflicted by the glowing had a better survival rate than the ones who didn’t.

As a result, the strange phenomena came to be known as “Angel’s Glow.”

THE BRIGHT LIGHT OF TRUTH

While the soldiers might have thought it was the healing touch of angels causing their wounds to glow, the truth isn’t as comforting.

Nematodes, or roundworms, are a typically parasitic worm. There are thought to be a million different kinds of nematodes, but the ones in question fed on insects found in the dirt and mud in the area.

These nematodes hunt for insect larvae in the mud, burrow into their bodies, and then regurgitate a bacteria into the larvae which kills the host from the inside out. This bacteria is called Photorhabdus luminescens, and it’s bioluminescent and glows a soft blue.

The soldiers had nematodes living in their wounds vomiting up a kind of bacteria! The idea of having roundworms in your gunshot wound is gross, but the ability to see the bacteria they’re vomiting is a new kind of creepy.

Luckily for the soldiers, the P. luminescens were working to devour the germs and bacteria that otherwise would have lead to an infection. So having worms might not be a bad thing.. But just for the record, if I’m ever injured on a battlefield, I’d much rather a round of antibiotics to this alternative.

Image: Nematodes

From: ripleys.com

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Captain Minié’s Deadly Invention at Inkerman

By Victor Kamenir, 1-22-16

The force multiplier that allowed the outnumbered British to stand up to the overwhelming numbers of Russian attackers at Inkerman was the Minié bullet (not ball). The Russian soldiers, still armed with smooth-bore muskets, faced the daunting task of advancing into the muzzles of British Minié bullet-firing Enfield rifled muskets. The rapid-firing, deadly accurate British musketry literally mowed down the Russian ranks.

Since the Napoleonic Wars, European infantry had faced the dilemma of choosing between slow-firing but accurate rifles and faster firing but less accurate muskets. The ball fired by a smooth-bore musket did not have a tight fit, and upon leaving the musket’s muzzle it often went astray. On the other hand, the grooves inside the rifle barrel tightly gripped and spun the bullet, giving it range and accuracy.

In 1849 a French armory captain, Claude-Etienne Minié, an inspector of musketry at the military academy at Vincennes, found the solution to merge the two. The Minié bullet, made out of soft lead, was not really a ball, but rather a cylindrical bullet. Being smaller than the diameter of the barrel, the Minié bullet could be easily dropped inside the barrel. Shaped like a cone with a cavity in its base, the Minié bullet had three angular grooves on its body. When the powder charge exploded against the cavity in its base, the bullet would expand the grooves and create a tight fit in the rifled barrel. The cavity in the bullet’s base also helped to a degree in cleaning out the barrel of the black-powder fouling.

Before the advent of rifles, the artillery was the primary arm used to strike an enemy at a distance. The numbers of rifle-armed specialists were too few to seriously alter the makeup of the battlefield. But when regular infantry units became armed with rifled muskets firing Minié bullets, the artillery suddenly found itself within the range of hostile infantrymen. At the Battle of Inkerman, Russian artillerymen suffered greatly from British infantry fire.

The invention of the Minié bullet also changed the way infantry was employed in battle. The dense infantry columns of Napoleonic times were replaced with troops fighting in lose line formations and volley fire gave way to fire-at-will. To their dismay, the large Russian columns were decimated by British rifle fire during the Battles of Alma and Inkerman. Similar weapons were also used with devastating effect during the American Civil War a decade later.

Minié bullets significantly helped in removing cavalry as a decisive force on the battlefield, as well. During Napoleonic times, the infantry had to form a bayonet-bristling square to protect itself from cavalry. Now, the infantry was able to bring fire on the advancing cavalry at much longer distances and with much greater accuracy. The advent of the Minié bullet thus signified a turning point in military technology, marking the end of massed formations and the beginning of more decentralized operations by smaller units.

From: warfarehistorynetwork.com

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The Glowing Wounds of the Battle of Shiloh

By Rebecca Beatrice Brooks, 4-2-12

The Battle of Shiloh was a major Civil War battle that occurred on April 6 and 7 of 1862 in Hardin County, Tennessee.

The battle occurred when 40,000 Confederate soldiers led by General Albert Sidney Johnston clashed with a line of Union soldiers occupying ground near Pittsburg Landing on the Tennessee River.

The Confederates drove the Union troops from their camps and slowly surrounded, captured, killed or wounded most of them. The following day, a large number of Union reinforcements arrived and completely overwhelmed the weakened Confederate troops, forcing them to flee the battlefield.

After the battle took place, over 16,000 wounded soldiers lay in the rain and cold mud for over two days as overwhelmed doctors and nurses struggled to locate and treat the soldiers.

Some of these wounded soldiers later reported that as they lay on the ground awaiting help, their wounds started to glow in the dark, according to the book The Aftermath of Battle: The Burial of the Civil War Dead:

“Many soldiers were forced to lie in the mud and muck for two days while waiting for the medics to get to them. When the sun went down, an eerie blue-green glow began to be seen in several areas of the darkened Tennessee battlefield. Strangely, the wounds of some of the stranded soldiers were emitting this glow. No one had any idea what this phenomenon might portend, but the doctors and nurses noticed that those whose wounds had glowed brightly in the dark had a significantly higher survival rate than those whose wounds were not illuminated. Additionally, the wounds healed at a faster rate, and more cleanly. Because of the seemingly magical properties, the coloration became known as ‘Angel’s Glow.'”

At the time, the reason for the glow was a mystery but doctors did note that the wounds that glowed healed faster than those that didn’t. The mystery remained unsolved until 2001, when two teenagers finally uncovered the source of the glow.

After the two teens, Billy Martin and John Curtis from Maryland, conducted a variety of scientific experiments, they discovered that the wounded soldiers became hypothermic as they lay in the mud.

This lower body temperature allowed for the growth of a bioluminescent bacterium called Photorhabadus luminescens, which inhibits pathogens, to develop in the wound.

This bacterium not only caused the wounds to glow but also prevented them from became gangrenous, which saved the lives and limbs of many soldiers.

Although it was common for wounded soldiers to lay on the battlefield for days after the battle’s end, glowing wounds were not a widespread phenomenon of the Civil War.

The glowing wounds of the Battle of Shiloh are mostly due to the wet, cold and muddy conditions of that April battle as well as the fact that this glowing bacterium is known to attach itself to a certain type of flatworm, called planaria, which is commonly found in the Shiloh area.

Since worms only come to the surface when it is wet, there was an abundance of the worms moving throughout the mud during and after the rainy battle.

The discovery won Martin and Curtis the top prize at the Siemens International Science Fair Competition. Curtis later went on to pursue a career in science and Martin pursued a degree in American history, specializing in the American Civil War.

Image: Chromolithograph of the Battle of Shiloh, circa 1888

From: civilwarsaga.com

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Effects of the Minie Ball on Civil War Combat

by Mike Rinehart

During the Civil War the generals of both sides used old battlefield tactics which called for the men to march in tight formations (shoulder to shoulder) and attack the enemy across open ground.  This made the attacker an easy target for the defender.  These tactics worked great during the Revolutionary War when rifles were only effective under 100 yards.  The Civil War changed that.

The French army officer Claude-Etienne Minié invented the bullet that would bear his name in 1849. The Minié bullet, a cylindrical bullet with a hollow base that expanded when fired, proved lethally accurate over relatively long distances, and was soon used to devastating effect by the British army against Russian forces during the Crimean War. After the outbreak of the American Civil War in 1861, both Union and Confederate soldiers used the "minnie" bullet (as they called it) in their muzzle-loading rifles.

This bullet had a devastating effect on troops.  When it hit a soldier it often shattered or splintered bones in the process.  Here is the actual bone of a Civil War soldier that was struck by a Minie Ball. Notice how the bullet penetrated the bone rendering the bone useless and unhealable.

Since the bone could not recover, if a bone was stuck in the way above, a surgeon had no choice but to remove the wounded limp be it a arm or a leg.  If the limb was not removed the patient would automatically suffer a infection and die anyway.

The KEY thing to understand is the weapons of the Civil War were way ahead of the tactics (battle strategies) that the generals used.  Look at the sketch below.  This was the usually attack formation that both sides used.  The plan is for these men to march (walk) across a open field to an enemy waiting for them on the other side of a field.  This formation worked fine in the American Revolution or even in the Mexican War when armies used smoothbore muskets which were ineffective at any target over 100 yards away.  The Minie Ball gave the advantage to the defenders because by adding the accuracy and range this formation will soon be eaten alive by enemy fire.  This led to many of the high casualties of Civil War battles.

Here is a actual photograph of some Civil War surgeons posing how an amputation would take place.  Usually more people would be utilized to hold the patient down while the limb (a leg in the photo) would be SAWED off.  This process was dangerous and sometimes would kill the patient since in these days or primitive technology the surgeons would not clean their tools.  This would spread infections.  More soldiers would die of disease in the Civil War than via any other method. Some of them perished because of infections resulting from amputations.

Civil War medical kits looked like the following.  Notice the saw that today somebody would use to saw wood with.  Imagine that cutting into your bone!!  Yes I know it is a dreadful thought!

Hopefully you see now that war isn't all glory like it is portrayed in movies and in video games.  War means death, mutilation and suffering.

From: rossfordschools.org

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History of Wound Care: The Wound Care Nurse’s Journey Part 1: The Civil War

By Jaclyn Gaydos, 9-28-16

Editor’s Note: This is the first of a three-part series on the evolution of the wound care nurse. This series will continue as part of our History of Wound Care column in future issues of Today’s Wound Clinic. This article was not subject to editorial board review prior to publication.

“From the stump of the arm, the amputated hand,
I undo the clotted lint, remove the slough, wash off the matter and blood,  
Back on his pillow the soldier bends with curv’d neck and side-falling head,        
His eyes are closed, his face is pale, he dares not look on the bloody stump,        
And has not yet look’d on it.”
— Walt Whitman, The Wound Dresser (1896)

The 1800s were a time of development in the United States. Innovations included the steamboat (1807), Erie Canal (1821), sewing machine (1833), telegraph (1844), passenger elevator (1851), oil well (1859), and many others.1 While medical advancements also were made during this time, it wasn’t until the Civil War (1861-64) that rapid changes actually began to impact healthcare in America. Although the war’s well-documented bloodshed took away many lives in both the Union and Confederate armies — a level of violence that also divided a country that had established its independence only about 90 years prior to the onset of the war — a few notable outcomes related to the improvement of this country’s overall healthcare were also a direct result of the war’s carnage. From more efficient methods of trauma care and surgical procedures, the wide use of hypodermic needles, and the development of surgical educational programs, there’s evidence of the war’s positive impacts, even if they are a direct result of an historical event that led to utter devastation.2,3 One of the most notable impacts from a wound care perspective was the recognition the field of nursing earned as an important component of healthcare practice.2 While accounts vary, it’s generally understood that more than 20,000 male and female nurses served among both Union and Confederate armies. Consequently, the increasing need for nurses helped female volunteers enter the profession at such a pace that it forever changed society’s perception of women.4 This article will discuss the impact of nursing on American society, gender roles, and healthcare beginning with the Civil War.

The Great Divide

At the time leading up to the war, the definition of a “nurse” was quite different from the contemporary meaning known today. The role of the nurse was not only to serve as a healthcare/medical attendant, but also to take on the responsibilities of cook, laundress, maid, and matron.2,5 Also preceding the Civil War, a sharp gender divide existed. From this gap, women were not permitted to occupy positions in healthcare (ie, only men were employed as nurses until the outbreak of the war in 1861).2,6 Male nurses outnumbered females 5:1 during the war, which is a common misconception in American medical history.2,6,7

When women began volunteering during the war, male hospital attendants sometimes wore a piece of white cloth on their left sleeve to indicate their position.7 After 1862, they were required to wear “privates” uniforms that included a green half-chevron on the left arm.8 One of the largest reasons women were introduced as nurses was due to their penchant for cleanliness. According to Robert Slawson, MD, “Cleaning wasn't something men liked to do, so the hospitals were a mess.”2

Florence Nightingale’s program of nursing strictly enforced cleanliness and sanitation. The most important duty the female nurses had early on was to clean the hospitals.2,9 Other important responsibilities of the female nurse included instituting good air flow, seeing to dietary plans for the wounded, changing wounded soldiers’ clothing, and reading and writing letters for soldiers as they convalesced or lay dying.2  

These women felt they knew how to care for “their boys” better than the male healthcare personnel, which also helped to break down the gender gap. Prior to the war, most medical care was performed in the home, which largely meant women were taking on these roles for their families. Whenever they learned of the sick, wounded, and dying among those in hospitals, many women decided to volunteer at the hospitals because they were accustomed to treating their family members.2

Additionally, some of the volunteers were “ladies” first — and brought along what they considered to be proper attire — and some felt they were the only ones who knew how to perform certain daily tasks, so there was conflict between the nurses and the physicians.2 Still, despite the increasing number of women serving as nurses, most were restricted to the hospitals and were not permitted to tend to the wounded on the battlefields.7

Yet, while these white female civilians were praised for their eagerness to help the sick and injured, as well as for their patriotism during the war, African Americans who served as nurses were overlooked for their contributions. More common within Confederate forces, African Americans served as nurses in convalescent homes and government hospitals.10 These volunteers were doing the same work as their white counterparts; however, earning the label of “volunteer nurse” was differentiated based on social class. African Americans, in most cases, were referred to as “laundry help.”2 In fact, five African American nurses actually served on the first U.S. Navy hospital ship, the USS Red Rover: Alice Kennedy, Sarah Kinno, Ellen Campbell, Betsy Young, and Ann Bradford Stokes.10 These women attended to roughly 3,000 of the wounded and worked under the direction of the Sisters of the Holy Cross. Stokes was the first African American woman to serve onboard a U.S. military vessel and among the first to serve as a nurse in the Navy. She was also the first woman in the U.S. to receive a pension for her military service.10

Civil War Nursing Leadership

With a large influx of female volunteers, the federal government appointed Dorothea Dix as superintendent of female nurses in 1861 to manage, organize, and staff Union hospitals and establish firm criteria for contract nurses.11 Dix’s criteria discouraged single women from acceptance, and volunteers were required to be at least 30 years of age, matronly in appearance, dress in either black or brown garments, sober and self-sacrificing, able to pay their own way, and apply with two reference letters.2,11 If accepted, these nurses would receive 40 cents per day, plus ration. Through Dix’s approval, more than 3,200 nurses served.11 Aside from the appointment of Dix in the Union army, Catholic nuns also held a leading role. At the war’s onset, the only trained nurses were Catholic nuns.2,11 There were 28 already-established Catholic hospitals before the war began, and some nuns were trained and educated as nurses in these facilities.11 Nuns served as nurses for both Union and Confederate forces and came from the Sisters of Charity, the Sisters of St. Joseph, the Sisters of Mercy (first women to go with Nightingale during the Crimean War in 185412), and the Sisters of the Holy Cross.13 These women were previously teachers; and while some lacked previous hospital experience, the surgeons approved of them because of their sense of discipline. The wounded soldiers also liked having them around, but referred to all nuns as “Sisters of Charity.”13

Tackling Wound Care

Female nurses were not included in tending to wounds as the war’s commencement, but by 1863 that had changed dramatically. With only 100 physicians in the U.S. Army and Navy in 1861, the country was not prepared for the carnage that would swamp the U.S. Army Medical Department.14

After the First Battle of Bull Run, also known as the Battle of First Manassas (the name used by Confederate forces), soldiers walked 27 miles to the hospital or, if they were unable to walk, remained wounded on the battlefield for days before they were either picked up by their troops (or the enemy) or died. Due to this circumstance, Dr. Jonathan Letterman, who’s credited as the originator of modern methods for medical organization in armies or battlefield medical management, developed the first ambulatory system to transport wounded soldiers to hospitals more quickly.11,14

By the war’s end, the U.S. Army had expanded this service to a national level through the use of ambulatory trains and ships, as well as general hospitals with the capabilities of treating patients near their hometowns.14 The “Letterman Ambulance Plan” allowed for wounded soldiers to be treated more efficiently in comparison to the old system, but another factor involved in wound care during the war was the U.S. Sanitary Commission (USSC). With cleanliness being such an important factor in the female nurse’s duties and a topic Nightingale firmly enforced,2,9 subsequent work by President Abraham Lincoln included approval of the USSC in 1861 as a commission that worked with the U.S. Department of War and the Medical Bureau. The USSC provided medical and sanitary assistance to the Union forces and civilians during the war.15

Because this group was concerned with camp and hospital inspections; collecting statistics; and preparing reports on sanitary practice, preparation of food, and quality of supplies, soldiers’ wounds were cared for in a more holistic manner rather than simply treating the wound. Essentially, this represents the birth of “public health” services.15 In doing so, Confederate hospitals were more sanitary than Union facilities. Since the Confederacy did not have the funds for more supplies, nurses would boil tools, bandages, and linens to reuse on other soldiers.2 This also occurred with suture materials for surgeries.

Other agents used in the treatment of wounds during the war included honey, chloroform or ether, ointments or grease, morphine powder, different suture materials, and the hypodermic needle.2 Used for centuries, honey acted as a remarkable resource for healing wounds, so providers would apply it to the wound along with a dressing.2 The lack of chloroform use during the war is a long-held misconception. In fact, it was readily available to physicians. For instances in which it was not available, ether was used.2,16 Regardless, some form of anesthesia was utilized in 95% of operations, with the majority being chloroform or ether.17 To best relieve pain, physicians and nurses would apply morphine powder directly to the wound. This method proved to be the quickest and most efficient method for relieving a soldier’s pain from various wounds.2

With different types of agents in mind, dressing materials and methods during the Civil War are similar and different to today’s practice all at once. Medical personnel used moist dressings on wounds during the war, partly out of necessity.2 When performing amputations, the physicians couldn’t use primary closure because of infection risks, so they inserted drains that allowed fluids and pus to leave the wound through a tube. 2,17 Since wounds remained partially open, physicians used moist dressings to cover the wounded area.2

Another wet-dressing method was to utilize lint or cotton. Lint was used in a compressive dressing; it was folded and pressed into or onto the wound and a bandage was placed over the lint. This method helped control bleeding. Aside from its wet use, lint was also used as a sponge.18 Likewise, another interesting evolution in wound care advancement was the use of maggots. Dr. John Forney Zacharias is arguably the first physician to intentionally expose his patients’ wounds to larvae, whereby wounded Confederate soldiers were more likely to heal faster.19 twc_0916_gaydos_figure2

Summary

While the materials and methods used during the war may differ from today’s wound care practice, similarities are clearly evident from the advances during the Civil War. Many developments related to the progression of the wound care nurse occurred during the American Civil War, as nurses began to gain momentum and, in some cases, began to directly impact the practice of healthcare.

Although at the beginning of the war female nurses were also defined as cooks, laundresses and aides as compared to their male counterparts and physicians, by 1865 women had shown the importance of their roles in professional nursing and their ability to perform at a high level in the male-dominated field of healthcare.

Jaclyn Gaydos is assistant editor at HMP Communications.

References

1. Technology Timeline: 1752-1990. PBS.org website. Accessed at: http://www.pbs.org/wgbh/amex/telephone/timeline/timeline_text.html. Accessed July 6, 2016.

2. Gaydos J. Oral Interview. Robert Slawson, MD. Frederick, MD: National Library of Civil War Medicine. 13 Aug 2016.

3. Civil War Medicine: An Overview or Medicine. The Ohio State University website. Accessed at:  https://ehistory.osu.edu/exhibitions/cwsurgeon/cwsurgeon/introduction. Accessed August 16, 2016.

4. Whelan JC. American Nursing: An Introduction to the Past. University of Pennsylvania School of Nursing website. Accessed at: http://www.nursing.upenn.edu/nhhc/Pages/AmericanNursingIntroduction.aspx. Accessed June 9, 2016.

5. Women in the Civil War. History.com website. Accessed at: http://www.history.com/topics/american-civil-war/women-in-the-civil-war. Accessed June 15, 2016.

6. Campbell WT. Who gets your vote for the father of nursing? American Nurse Today. 2011; 6(4). Accessed at: https://www.americannursetoday.com/who-gets-your-vote-for-the-father-of-nursing/. Accessed July 10, 2016.

 7. Brown J. The Civil War Nurses. Cow Hampshire website. Accessed at: http://www.cowhampshireblog.com/2011/02/21/the-civil-war-nurses/. 21 Feb 2011. Accessed June 15, 2016.

8. Katcher P. American Civil War Armies (3): Specialist Troops. Men-at-Arms. Oxford, UK: Osprey Publishing; 2013.

9. Nightingale F. Notes on Nursing: What is it, and what it is not. New York, NY: D. Appleton and Company; 1860. Accessed at: http://digital.library.upenn.edu/women/nightingale/nursing/nursing.html.

10. MacLean M. Black Civil War Nurses: African American Nurses in the Civil War. Civil War Women website. Accessed at: http://civilwarwomenblog.com/black-civil-war-nurses/. Accessed June 18, 2016.

11. Early years: the Civil War. History and Collections, George Mason University website. Accessed at: http://chnm.gmu.edu/courses/rr/s01/cw/students/leeann/historyandcollections/history/lrnmreearlycivil.html. Accessed June 17, 2016.

12. Kelly MP. Hospital nuns: the Sisters of Mercy in the Civil War. Civil War Rx website. Accessed at: http://civilwarrx.blogspot.com/2014/02/hospital-nuns-sisters-of-mercy-in-civil.html. Accessed August 15, 2016.

13. Caring for the men: the history of Civil War medicine. Civil War Medicine webpage. Accessed at: http://www.civilwarhome.com/medicinehistory.html. Accessed August 16, 2016.

14. Manring MM, Hawk A, Calhoun JH, Andersen RC. Treatment of war wounds: a historical review. Clin Orthop Relat Res. 2009;467(8):2168-91.

15. United States Sanitary Commission records 1861-1872. The New York Public Library Archives & Manuscripts. Accessed at: http://archives.nypl.org/mss/3101. Accessed: August 18, 2016.

16. Dixon I. Civil War medicine: modern medicine’s Civil War legacy. Civil War Trust website. Accessed at: http://www.civilwar.org/education/history/civil-war-medicine/civil-war-medicine.html?referrer=https://www.google.com/. Accessed July 7, 2016.

17. National Museum of Civil War Medicine. Frederick, MD. 13 Aug 2016.

18. Mescher V. Lint and charpie: it’s not your dryer lint. Ragged Soldier website. Accessed at: http://www.raggedsoldier.com/lint.pdf. Accessed July 7, 2016.

19. Gaydos J. Maggots: an extraordinary natural phenomenon. History of Wound Care. Today’s Wound Clinic. 2016;10(4):29-31.

From: todayswoundclinic.com

Image: Civil War gunshot wounds

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Treatment of Head Injuries in the American Civil War

Howard H. Kaufman, M.D., Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia

Abstract
At the time of the American Civil War (1861–1865), a great deal was known about closed head injury and gunshot wounds to the head. Compression was differentiated from concussion, but localization of lesions was not precise. Ether and especially chloroform were used to provide anesthesia. Failure to understand how to prevent infection discouraged physicians from aggressive surgery. Manuals written to educate inexperienced doctors at the onset of the war provide an overview of the advice given by senior surgeons.

The Union experiences in the treatment of head injury in the Civil War were discussed in the three surgical volumes of The Medical and Surgical History of the War of the Rebellion. Wounds were divided into incised and puncture wounds, blunt injuries, and gunshot wounds, which were analyzed separately. Because the patients were not stratified by severity of injury and because there was no neuroimaging, it is difficult to understand the clinical problems and the effectiveness of surgery. Almost immediately after the war, increased knowledge about cerebral localization and the development of antisepsis (and then asepsis) permitted the development of modern neurosurgery.

From: thejns.org

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Treatment of War Wounds: A Historical Review (Excerpt)

M. M. Manring, PhD, Alan Hawk, Jason H. Calhoun, MD, FACS, and Romney C. Andersen, MD

Abstract
The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. We review the most important trends in US and Western military trauma management over two centuries, including the shift from primary to delayed closure in wound management, refinement of amputation techniques, advances in evacuation philosophy and technology, the development of antiseptic practices, and the use of antibiotics. We also discuss how the lessons of history are reflected in contemporary US practices in Iraq and Afghanistan.

Introduction
The need for surgical care of survivors of accidents or animal attacks is part of the story of civilization, as is the story of medical care of those wounded in that other peculiarly human endeavor, warfare. During the past 250 years, and particularly during the 20th century, developments in military trauma care for musculoskeletal injuries have greatly influenced civilian emergency medicine. The history of military trauma care must be understood in terms of the wounding power of weapons causing the injury and how the surgeon understood the healing process. Improvements in weapons technology forced surgeons to rethink their interventions in their effort to tip the odds of survival in favor of their patient.

Our purpose is to review the evolution of military trauma care during the past two and a half centuries in major conflicts in the West. The major areas of emphasis are medical evacuation and organization; wounds and wound management; surgical technique and technology, with a particular focus on amputation; infection and antibiotics; and blood transfusion.

Medical Evacuation and Organization
Perhaps the most basic problem facing physicians during wartime historically has been whether (and how) to transport the wounded to care or transport the caregivers to the wounded. A secondary problem historically has been how best to organize the delivery of care as modern nations began to dispatch vast armies and navies to fight across vast distances.

For example, Pikoulis et al. reviewed the wounds depicted in The Iliad and determined the arrow wounds such as the one suffered by Menelaus carried a mortality rate of 42%, slingshot wounds 67%, spear wounds 80%, and sword wounds 100%. These high mortality rates suggest surgeons were unable to get to wounded soldiers during the melee, treating only the higher class or those who survived after the battle had concluded. These Greek surgeons, whether they realized it or not, faced the same issues as all future practitioners engaged in wound care: wound management, The Golden Hour (the principle that a victim’s chances of survival are greatest if he receives resuscitation within the first hour after a severe injury), and infection control.

During the American Revolution (1775–1783), the Continental Congress authorized one surgeon to serve in each regiment. Few of the regimental surgeons, mostly trained through the apprenticeship system as there were only two medical schools in the United States (King’s College [now Columbia University] in New York, NY, and the University of Pennsylvania in Philadelphia, PA), had any experience treating trauma. The organization was minimal, and regimental surgeons tended to work for their unit instead of seeing themselves as part of the Hospital Department, which was rendered ineffective by bureaucratic infighting.

The outstanding military surgeon of the Napoleonic Wars (1792–1815), Baron Dominique-Jean Larrey (1766–1842), generally is regarded as the originator of modern military trauma care and what would become known as triage. He placed surgical teams near the front lines to shorten the time elapsed after injury and instituted specially designed horse-drawn “flying ambulances” in which the wounded rode with an early version of emergency medical technicians. Care was prioritized to provide first for the most badly wounded, without regard to the patient’s chances of survival or the need to restore less gravely wounded soldiers to the front lines quickly. After Larrey’s system was used during the Battle of Metz (1793), he was ordered to organize medical care for the entire French Army. Rapid access to care and immediate amputation reduced morbidity and mortality.

The Crimean War (1854–1855) underscored the importance of methods used by Larrey decades earlier, particularly the importance of organized evacuation and surgical care close to the front line. The war revealed a stark contrast between the battlefield care provided by the French, with their expert organization and system of light ambulances, and the poorly organized British Medical Services. Outrage over the poor treatment offered to the British wounded led the War Office to send a young nurse, Florence Nightingale (1820–1910), and a staff of 38 volunteers to the British barracks in Istanbul, Turkey, where Nightingale’s first act was to thoroughly scrub the hospital, provide clean bedding, improve ventilation and sewage disposal, and reorganize everyday sanitary procedures. She was an early theorist of sanitation and the design of hospital buildings. Although her efforts created intense resentment in the army bureaucracy, she was one of the founders of the modern nursing profession. She broke the monopoly of health care as the sole providence of the physician, which led to the development of the healthcare team in modern medical practice.

Nikolai Pirogoff (1810–1881), who served in the Imperial Russian Army, brought skilled nurses into military hospitals and worked to modernize Russian medical equipment. He is the namesake for a conservative technique of foot amputation.

At the onset of the American Civil War (1861–1865), the US Army and Navy combined had about 100 physicians, many with no experience with battlefield trauma, almost 30 of whom resigned to join the Confederacy. The structure of the Medical Department was decentralized with no clear chain of command and control of supplies. The US Army Quartermaster’s Corps, whose primary duties were supplying and provisioning troops, were responsible for direct battlefield evacuation. The Regimental Band served as litter bearers. The first Battle of Manassas (July 21, 1861) was a rout for the federal forces and the soldiers fled back to Washington. Ultimately, 2708 men were killed or wounded and the Medical Department could not handle the load. Regimental surgeons, because they worked for their unit only, were either swamped with casualties or idle. Regimental band members and civilian ambulance drivers hired by the quartermaster’s corps fled from the battle. Most of the wounded had to walk the 27-mile distance from the battlefield to Washington to reach the hospitals in the rear. Those who could not walk remained on the battlefield for several days until they were picked up by ambulances, captured by Confederate forces, or died.

The Union Army quickly reorganized its Medical Department in 1862 after prodding by a Sanitary Commission created by President Lincoln. Jonathan Letterman (1824–1872) reorganized the medical care in the Army of the Potomac. Wounded soldiers were removed from the battlefield by litter bearer, the predecessor to the medic or corpsman. Regimental Surgeons were responsible for dressing wounds and patients were evacuated in ambulances driven by Medical Corps noncommissioned officers to a division level field hospital for surgical treatment. By the end of the war, the Medical Department expanded this system by creating a national network of hospital trains, hospital ships, and general hospitals that could treat the patient near his hometown if he so desired. The main advance in American medicine during the Civil War was the creation of an effective military medical corps with medical evacuation, hospitals, and surgical specialists. Health care was beginning to become a system. Still missing was a formalized approach to care that recognized the severity of injuries. The poet Walt Whitman, who worked at several Union hospitals in Washington, DC, noted, “The men, whatever their condition, lie there, and patiently wait until their turn comes to be taken up”. Whitman’s poem “The Wound Dresser” (1865) poignantly illustrates the state of care at the time.

From: ncbi.nlm.nih.gov

Image: Civil War Gunshot Wound Of Private Cyrus Straus Of Illinois

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George Townsend Describes the Wounded on the Peninsula

From: civilwarhome.com

[George Alfred Townsend was only twenty when he began to report the Civil War for the New York Herald, but he quickly established himself as one of the most brilliant of all the many war correspondents.   There are few more graphic accounts of wounds, disease and death than those from his gifted pen.]

It was evening, as I hitched my horse to a stake near-by, and pressed Up to the receptacle for the unfortunates. Sentries enclosed the pen, walking to-and-fro with loaded muskets; a throng of officers and soldiers had assembled to gratify their curiosity; and new detachments of captives came in hourly, encircled by sabremen, the Southerners being disarmed and on foot.

The scene within the area was ludicrously moving. It reminded me of the witch-scene in Macbeth, or pictures of brigands or Bohemian gypsies at rendezvous, not less than five hundred men, in motley, ragged costumes, with long hair, and lean, wild, haggard faces, were gathered in groups or in pairs, around some fagot fires. In the growing darkness their expressions were imperfectly visible; but I could see that most of them were weary, and hungry, and all were depressed and ashamed. Some were wrapped in blankets of ragcarpet, and others wore shoes of rough, untanned hide. Others were without either shoes or jackets, and their heads were bound with red handkerchiefs. Some appeared in red shirts; some in stiff beaver hats; some were attired in shreds and patches of cloths and a few wore the soiled garments of citizen gentlemen; but the mass adhered to homespun suits of gray, or "butternut," and the coarse blue kersey common to slaves. In places I caught glimpses of red Zouave breeches and leggings; blue Federal caps, Federal buttons, or Federal blouses; these were the spoils of anterior battles, and had been stripped from the slain. Most of the captives were of the appearances denominated "scraggy" or "knotty." They were brown, brawny, and wiry, and their countenances were intense, fierce, and animal. They came from North Carolina, the poorest and least enterprising Southern State, and ignorance, with its attendant virtues, were the common facial manifestations. Some lay on the bare ground, fast asleep; others chatted nervously as if doubtful of their future treatment; a few were boisterous, and anxious to beg tobacco or coffee from idle Federals; the rest-and they comprehended the, greater number-were silent, sullen, and vindictive. They met curiosity with scorn, and spite with imprecations.

A child-not more than four years of age, I think-sat sleeping in a corner upon an older comrades's lap. A gray-bearded pard was staunching a gash the tail of his coat. A fine-looking young fellow sat with face in his hands, as if his heart were far off, and he wished to shut out this bitter scene. In a corner, lying morosely apart, were a Major, three Captains, and three Lieutenants,-young athletic fellows, dressed in rich gray cassimere, trimmed with black, and wearing soft black hats adorned with black ostrich-feathers. Their spurs were strapped upon elegantly fitting boots, and they looked as far above the needy, seedy privates, as lords above their vassals....

I rode across the fields to the Hogan, Curtis, and Gaines mansions; for sonic of the wounded had meantime been deposited in each of them. All the cow-houses, wagon-sheds, hay-barracks, hen-coops, Negro cabins, and barns were turned into hospitals. The floors were littered with "corn-shucks" and fodder; and the maimcd, gashed, and dying lay confusedly together. A few, slightly wounded, stood at windows, relating incidents of the battle; but at the doors sentries stood with crossed muskets, to keep out idlers and gossips. The mention of my vocation was an "open scsame," and I went unrestrained, into all the largest hospitals. In the first of these an amputation was being performed, and at the door lay a little heap of human fingers, feet, legs, and arms. I shall not soon forget the bare-armed surgeons, with bloody instruments, that leaned over the rigid and insensible figure, while the comrades of the subject looked horrifiedly at the scene.

The grating of the murderous saw drove me into the open air, but in the second hospital which I visited, a wounded man had just expired, and I encountered his body at the threshold. Within, the sickening smell of mortality was almost insupportable, but by degrees I became accustomed to it. The lanterns hanging around the room streamed fitfully upon the red eyes, and half-naked figures. All were looking up, and saying, in pleading monotone: "Is that you, doctor?" Men with their arms in slings went restlessly up and down, smarting with fever. Those who were wounded in the lower extremities, body, or head, lay upon their backs, tossing even in sleep. They listened peevishly to the wind whistling through the chinks of the barn. They followed one with their rolling eyes. They turned away from the lantern, for It seemed to sear them. Soldiers sat by the severely wounded, laving their sores with water. In many wounds the balls still remained, and the discolored flesh was swollen unnaturally. There were some who had been shot in the bowels, and now and then they were frightfully convulsed, breaking into shrieks and shouts. Some of them iterated a single word, as, "doctor," or "help," or "God," or "oh! " commencing with a loud spasmodic cry, and continuing the same word till it died away in cadence. The act of calling seemed to lull the pain. Many were unconscious and lethargic, moving their finger, and lips mechanically, but never more to open their eyes upon the light; they were already going through the valley and the shadow.

I think, still, with a shudder. of the faces of those who were told mercifully that they could not live. The unutterable agony; the plea for somebody on whom to call; the longing eyes that poured out prayers; the looking on mortal as if its resources were infinite; the fearful looking to the immortal as if it were so far off, so implacable, that the dying appeal would be in vain; the open lips, through which one could almost look at the quaking heart below; the ghastliness of brow and tangled hair; the closing pangs; the awful quietus. I thought of Parrhasius, in the poem, as I looked at these things:-

"Gods!
Could I but paint a dying groan-"

And how the keen eye of West would have turned from the reeking cockpit of the Victory, or the tomb of the Dead Man Restored, to this old barn, peopled with horrors. I rambled in and out, learning to look at death, studying the manifestations of pain,-quivering and sickening at times, but plying my avocation, and jotting the names for my column of mortalities....

Ambulances, it may be said, incidentally, are either two-wheeled or four-wheeled. Two-wheeled ambulances are commonly called "hop, step, and jumps." They are so constructed that the forepart is either very high or very low, and may be both at intervals. The wounded occupants may be compelled to ride for hours in these carriages, with their heels elevated above their heads, and may finally be shaken out, or have their bones broken by the terrible jolting. The four-wheeled ambulances are built in shelves, or compartments, but the wounded are in danger of being smothered in them.

It was in one of these latter that I rode, sitting with the driver. We had four horses, but were thrice "swamped" on the road, and had to take out the wounded men once, till we could start the wheels. Two of these men were wounded in the face, one of them having his nose completely severed, and the other having a fragment of his jaw knocked out. A third had received a ball among the thews and muscles behind his knee, and his whole body appeared to be paralyzed. Two were wounded in the shoulders, and the sixth was shot in the breast, and was believed to be injured inwardly, as he spat blood, and suffered almost the pain of death.

The ride with these men, over twenty miles of hilly, woody country, was like one of Dante's excursions into the Shades. In the awful stillness of the dark pines, their screams frightened the hooting owls, and the whirring insects in the leaves and tree-tops quieted their songs. They heard the gurgle of the rills, and called aloud for water to quench their insatiate thirst. One of them sang a shrill, fierce, fiendish ballad, in an interval of relief, but plunged, at a sudden relapse, in prayers and curses. We heard them groaning to themselves, as we sat in front, and one man, it seemed, was quite out of his mind. These were the outward manifestations; but what chords trembled land smarted within, we could only guess. What regrets for good resolves unfulfilled, and remorse for years misspent, made hideous these sore and panting hearts? The moonlight pierced through the thick foliage of the wood, and streamed into our faces, like invitations to a better life. But the crippled and bleeding could not see or feel it,-buried in the shelves of the ambulance.

Townsend, "Campaigns of a Non-Combatant"

Source: "The Blue and The Gray" by Henry Steele Commager. His source was Townsend, Campaigns of a Non-Combatant

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Myths About Wounds

From: wiroots.org

Everyone thinks about the Hollywood version of the Civil War surgeon doing
amputations of limbs after battle, with profuse bleeding and the soldier in
horrible pain.

The truth is, the surgeons treated many more wounds caused by horses (they kick
and step on people), campfire and gunpowder burns and metal shards from musket
percussion caps that ended up embedded in people.

Hollywood movies suggest a few swallows of whiskey or a bullet to bite on were
all that was offered to help the soldier through their treatment which often
meant amputation of a limb. The military almost universally used ether as general
anaesthetic in its field hospitals, which was instrumental in proving to other
surgeons that ether was a safe and effective surgical anaesthetic. Ether continued
to be widely used in surgery well into the 20th century.

Modern Civil War medical re-enactors associated with the National Museum of Civil
War Medicine near the Antietam National Battlefield, have fired a Minie ball, a
type of muzzleloading rifle bullet into ballistic gel to prove a Minie ball could
travel through as many as four human bodies — possibly infecting each with germs
from the animal fat that lubricated the projectiles.

Many more soldiers died from disease during and following the Civil War than from
wounds sustained on the battlefield. The idea of cleanliness and infection control
were just beginning to be considered and many doubted the importance of handwashing,
cleaning instruments and disinfectants to help prevent post-surgical infection. For
example, tetanus bacteria thrive in soil and when introduced in deep wounds, can be
deadly. (Tetanus vaccinations were not widely available until WWII--National Network
for Immunization Information, Jan 2007)

Antietam National Battlefield is where nearly 23,000 casualties occurred September 17,
1862, including an estimated 3,700 killed, 17,300 wounded and 1,800 captured or missing.
It is known as the bloodiest day in U.S. military history.

Sources: Rita, Oconto County Coordinator, WiGenWeb  and Joan Benner, Adams and Marquette County WiGenWeb Coordinator

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The Wounded Lion of the Union

By Sarah Handley-Cousins, 7-5-13

At this year’s sesquicentennial of the battle of Gettysburg, thousands of visitors will wander the battlefields, contemplating the terrible and magnificent events of those three days. Many will make their way to one of the most compelling spots on the battlefield, the rocky tor called Little Round Top, where they will ponder, discuss, and probably argue about the deeds of one of the battle’s most famous participants, Col. Joshua Lawrence Chamberlain of the 20th Maine.

On July 2, 1863, Chamberlain, who had been a professor at Bowdoin College in Brunswick, Me., before the war, cemented his place in history by playing a crucial role in the defense of Little Round Top, protecting the Union line’s vulnerable left flank. After being prominently featured in Michael Shaara’s book “The Killer Angels” and its film adaptation, “Gettysburg,” Chamberlain is one of the most popular figures of the Civil War era. Visitors to Gettysburg this July won’t be able to make it down the street without seeing Chamberlain’s face on signs, T-shirts and key chains.

For most of those visitors, Chamberlain’s story begins and ends with his actions at Gettysburg. In reality, it was far more complicated – and much less glorious. Almost a year after his defense of Little Round Top, Chamberlain stood before his men near Petersburg, Va. As he lifted his sword to motion for a leftward oblique, a Minié ball smashed into his side. The lead bullet traveled through his right hip to the left, crushing his bones and cutting into his bladder and urethra on its way. Blood pooled around his feet. Chamberlain knew the wound was likely to be mortal but feared that falling in front of his men might derail their momentum, so he held himself up on his saber until he weakened and fell. He lay bleeding into the Virginia soil for almost an hour, thinking of his mother as the life drained out of him. When he finally arrived at the field hospital, Chamberlain asked the surgeons to leave him and see to the soldiers first. Then he laid back to wait for the end.

But the end never came. The surgeons ignored his requests and instead worked with tenacity on his extensive wounds, toiling through the night until they could give the colonel a slight chance of recovery. For weeks it appeared he wouldn’t survive, but somehow, miraculously, he was back at the front of his brigade within a few months.

During the course of the war, Chamberlain was wounded six times and fell gravely ill twice. He returned to command quickly each time, though still weak and in pain. Chamberlain’s perseverance garnered respect among his comrades, who nicknamed him “the Lion of the Union.” By the end of the war, he was a major general and a bona fide war hero. He translated that popularity into four years as the governor of Maine, followed by 12 years as the president of Bowdoin. Even in his old age, Chamberlain was adored among Civil War veterans, speaking often at commemorations and encampments. Today, almost 100 years after his death, Chamberlain is still so well known around the state that his name and likeness appear on bottles of Maine pale ale.

Yet, in all this attention, little consideration has been paid to Chamberlain’s wounds and subsequent disability. When they are discussed, it’s often as proof of his valor – his scars have become a kind of physical manifestation of his gallantry in battle. Yet, as historians of disability Peter Logue and Max Blanck caution, we must be careful not to “assume that veterans always understood their own disabilities as prestige symbols.” For Chamberlain, his wound was more like an old enemy than a badge of courage. The man on so many a tourist’s keychain lived the majority of his life with pain, incontinence and infection.

The wound quietly tortured Chamberlain for almost 50 years. Because of the damage to his urethra, Chamberlain often required the use of a catheter, which created a fistula at the base of his penis. The hole never healed. It leaked constantly and left him susceptible to chronic bladder and testicular infections that caused him, he said, “unspeakable agony.” A surgery in 1883 attempted to close the fistula. Chamberlain barely survived, and his symptoms – including the fistula – soon returned. Over the next 30 years, infection plagued Chamberlain’s self-described “weak spot,” rendering him bedridden. When he died in 1914, it was of an infection of the old wound.

Despite his ambition and firm work ethic, Chamberlain’s body repeatedly failed him, though he often tried to ignore his pains. When his father-in-law visited his camp in 1865, he noted that the general was “pretty miserable but constantly working.”

In the spring of 1883, Chamberlain’s health took a turn for the worse. He had been postponing surgery to maintain his demanding schedule, traveling for speaking engagements and continuing his duties as president of Bowdoin. Chamberlain’s physician, J. H. Warren of Boston, finally insisted that he have the surgery immediately. The doctor believed that the delay of treatment, coupled with Chamberlain’s intense work schedule, had left his health in a precarious state. The general had little choice but to resign his long-held post at the college in the face of a long and arduous recovery away from Brunswick. The family’s finances suffered as a consequence.

At nearly 60 years old, Chamberlain tried his hand at various new ventures – real estate investor, art school president, railroad executive – but was successful at none. His pension allotments, though high compared to the average payment, weren’t enough to cover his medical costs and provide for his family. In 1893, after another health crisis, he applied for an increase in his pension, supported by affidavits from Army comrades – most notably the former general Fitz John Porter – who attested that Chamberlain was an “almost helpless invalid.” The increase was denied. An attempt at a private pension bill in 1906 also failed.

By the turn of the century, Chamberlain was facing penury. Many friends, including Ellis Spear, who fought with him that day in Gettysburg, undertook a letter campaign asking that Chamberlain be given a patronage position in the port of Portland, Me. President William McKinley gave him the post of surveyor of the port, a position the old general held until his death.

Chamberlain’s case is only one example of the struggles of hundreds of thousands of disabled Civil War veterans. The pain and difficulty of wartime wounds and illnesses did not simply resolve with the surrender at Appomattox, and although prosthetics manufacturers made much of their ability to “fix” disabled soldiers, the majority of veterans suffered wounds, like Chamberlain’s, that no artificial limb could repair.

These old soldiers often struggled to make a living, support their families and function in Gilded Age society, and although many received pensions, they were often insufficient for those who could not work to supplement the payments. Moreover, by the 1880s, pensioners found themselves at the center of the public criticism of perceived fraud and waste in the pension system. Chamberlain was fortunate to receive the post in Portland, but many other, less-well-connected veterans were unable to do so. Instead, they filled soldier’s homes, poorhouses, prisons and asylums.

Almost 20 years after the ball slammed through him, Chamberlain searched out the spot where he fell on the field at Petersburg. Bullets still littered the ground. As he gathered a few, Chamberlain asked “what it was all for, & what would come of it.” Undoubtedly many other disabled veterans wondered just the same thing.

Follow Disunion at twitter.com/NYTcivilwar or join us on Facebook.

Sources: The Medical and Surgical History of the War of the Rebellion; Alice Rains Trulock, “In the Hands of Providence: Joshua L. Chamberlain & The American Civil War”; John J. Pullen, “Joshua L. Chamberlain: A Hero’s Life and Legacy”; William J. Harmon and Charles K. McAllister, “The Lion of Union: The Pelvic Wound of Joshua Lawrence Chamberlain”; Max Blanck and Peter Logue, “Race, Ethnicity and Disability: Veterans and Benefits in Post-Civil War America”; James Marten, “Sing Not War: The Lives of Union and Confederate Veterans in Gilded Age America”; Joshua Lawrence Chamberlain pension file, National Archives; George Adams diary, First Parish Church, Brunswick, Me.; J.L. Chamberlain Collection, Bowdoin College Library.

Sarah Handley-Cousins is a graduate student in history at the University of Buffalo.

Image: Joshua Lawrence Chamberlain

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"I am sorry to tell that some of our brave boys has got killed"

Letter: M.W. Parris to Jane Parris, July 3, 1862.

July the 3 1862 peters burg, va dear wife I one time mor take my pen in hand to let you now that I am well at this time hoping thes lines may find you well and doing well the last leter I received was dated June the 7 it give mee great Sattis faction to hear from you that you was well though I am sorry to tel that Som of our brave boys has got kild and Severl wounded in the great battle at richmond which Commenct last wensday and is Still fiting yet we have not got a correct information of all the file neither Can I tel all ded and wonded but I will [deleted] tel what I have larnd a bout it giled long and John B. queen was Seen fall in the first of the fite that is all that we now of though thar was a great many missing [Eith ?] kild of or lost now I will give the names of what was wonded Joseph moody got to fingers shot off William Cogdal wonded in the neck leander hall in the lage harris hooper in the thy or lage [deleted] Samuel Parker Slitly wonded in the finger though hot his Sholder out of place and from what he Ses a bout the redgment it is but all up parker left them yesterday morning and ses that the redgment looks a bout as big as as four or five Companys our Cournel got five or six holes Shot threw his Cote and one Cut his face major frances badly wonded in the Sholder w william beard badly wonded threw the hips
Capt Coalman his head shot off with a ball that is all I have heard of the 16 redgment our men has whipt them evry fite and has drove them Severl miles and has taken a Site of prisners with som six Jennerls and has kild Scors of them I under Stand that all of our men is bured but the is laying in piles and not bered a tall I think that we will the victry but dearly bought Severl of our men got ther gun Shot in too in thier hands the the boys has lost ther blankets in the fite tha have bin gon a about eight days frm Camp I Cant tel when tha will Com back and one of our men did in the hospitel da befor yesterday david wilson and severl is in the hospitel yet A W parris is with the rest in the fite I hant heard any thing a bout him parker did not now hoo all was mising this is all I Can find out a bout the fite I was left to gard Camp James is not well he has bin punity Severl weaks I hant any thing Elce to write at this time mor then I want to See you verry bad but I Cant tel when I will be blest with that blesing it wont be long tel my time will be out a gin but I Cant tel whether I will gt git to Com or not I hant heard any thing sed a bout that times is two hot her now I am a frade for mee to git off I will rite a gin in a few days so nothing mor may the lord bles you and thake Care of you is my prays and has bin ever sence I left you
M W Parris to Jane Parris

From: learnnc.org

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The Civil War: Medicine, Wounds and Diseases

From: gwood.us/history

The Civil War. Many nations and countries had one. But there was a lot more riding on the American Civil War than just political disagreement. Brave men fought each other for what they believed was right; there were many reasons to choose sides. There were just as many reasons to die for that side. In fact, approximately one out of every four Civil War soldiers died during the conflict.

The Civil War is ranked number one in total number of deaths in any war fought by our nation. There were more deaths in this war alone than in World War I, World War II, the Vietnam War and the Korean War combined. These wars are in the top five total number of deaths, and combined
they are still less than the Civil War. And even with all this death, a soldier was far more likely to die from an illness, such as typhoid fever, than he was from getting shot.

There were nearly 625,000 deaths in the war and 388,580 (well over half) of them were due to this lurking predator. In the final count, disease was the unrivaled contributor of Civil War deaths.
So why were over half the deaths in America’s bloodiest clash due to disease?

Well, at that point in time medical progress was just nearing the end of “the medical Middle Ages.” There was little understanding of the cause of diseases, how to cure them or prevent them. Medical training for doctors, surgeons or physicians was barely adequate, and even medical school graduates had very little experience. Two years of book-learning and a few weeks of training was all that was required to become a doctor. There was also a huge hygiene issue. Many diseases could have been taken care of by doing something as easy as taking showers, clearing the waste away from camp or isolating the sick. Regulations that had been in practice since before George Washington’s time were needlessly ignored.

The top three killing diseases of the war were dysentery, typhoid fever and pneumonia. These diseases often started off as something simple and easily treated, like a cold, but grew into something fatal, like pneumonia. Other diseases were caused by poor diet and exposure to the elements, also something that was being ignored and could have saved lives.

Nevertheless the brave doctors and surgeons of the time did the best they could with what they had. Primarily on the Confederate side, whenever medicine was unavailable they would use nature’s “substitutes,” using American hemlock for opium, dogwood for chamomile, wild jalap for ipecac, hops for laudanum and even dandelion for calomel!

Amputation was also a huge source for disease and infection. And with the sanitary conditions at that time, or lack thereof, fighting infections proved to be a very difficult task. Surgeons rarely cleaned their instruments, because they didn’t have time or didn’t think it important. Diseases and infections were then quickly spread from patient to patient. Despite this, 75% of the amputation patients survived. And believe it or not, these surgeries actually saved more lives than they didn’t.

Surprisingly, almost all of the gruesome stories of going through an amputation without anesthetic
aren’t true. The biting down on a bullet to ease the pain was, more often than not, a myth.

Chloroform and ether had already been in use for years before the war. The surgeons would generally use chloroform before-hand, so the sounds of screaming usually came from soldiers that were watching or the soldiers that were just informed that they were going to lose a limb.

Chloroform was preferred over ether because it worked faster and didn’t explode. It was from amputations that surgeons got the nickname “butchers”. This isn’t at all shocking when you consider that three out of four surgeries on the battlefield were amputations.

So what about afterwards? What happened when all these wounded soldiers came home? As a matter of fact many of them didn’t. There were so many deaths and so much destruction that many of the soldiers that did return had no home to return to. The entire nation was in debt, and some states had to spend a part of what little money they had just on prosthetic limbs. So even if the soldiers, now veterans, had a home to come to, many of them couldn’t enjoy it. They weren’t of much use on the farm or business with an arm or leg missing. That is, if the farm or business wasn’t destroyed from the warfare. Also many of them had chronic illnesses. For some poor soldiers, the diarrhea or fever that they caught at camp during the war haunted them for the rest of their lives. Some of them even came home as opium or morphine addicts from what was supposed to help, but now hindered. The veterans that were fortunate enough to survive the bullets, diseases, infections and amputations now came home to devastation, destruction and emotional turmoil.

However, there is at least one bright light in this cloud of gloom. Even though it took the Civil War to make a change, America’s medical field was finally progressing. Doctors and surgeons now knew the best ways to treat a patient, the right amount of chloroform for an amputation, and the most important, the necessity for cleanliness. During the war many surgeons realized that infection and disease were caused by the unsanitary conditions of the average battle camp. Although they still didn’t think it as important as other things, both sides benefited from this new information.

“Throughout the war, both the South and the North struggled to improve the level of medical care given to their men. In many ways, their efforts assisted in the birth of modern medicine in the United States. More complete records on medical and surgical activities were kept than ever before, doctors became more adept at surgery and at the use of anesthesia, and perhaps most importantly, a greater understanding of the relationship between cleanliness, diet and disease was gained not only by the medical establishment but by the public at large.”

Even though there were so many obstacles to overcome during and after the war, at least there
was medical progression, possibly one of the greatest achievements of the Great American Civil War.

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Trauma and Surgery: "The Smell of Ether, the Odor of Blood"

From: medicalmuseum.mil

Popular but generally incorrect images of Civil War medicine involve surgery-amputations without anesthesia, piles of arms and legs, the surgeon as a butcher. By modern standards, wartime surgery was limited. Despite the lack of both surgical experience and sanitary conditions, the survival rate among those who underwent the knife was better than in previous wars. Amputation was not the only surgical recourse available. Surgeons also extracted bullets, operated on fractured skulls, reconstructed damaged facial structures, and removed sections of broken bones.

As bullets hit their victims, shattered bone and shredded flesh became the calling cards of the minie ball. Most of the surgeons who had come from civilian practices had little or no experience in dealing with such wounds. They quickly became aware of the surgical options: remove the limb, remove the fractured portions of bone, or clean the wound and apply a dressing. Union surgeons documented nearly 250,000 wounds from bullets, shrapnel, and other missiles. Fewer than 1,000 cases of wounds from sabers and bayonets were reported.

THE CASE OF MAJOR GENERAL DANIEL E. SICKLES
Major General Daniel E. Sickles, Union Third Army Corps commander, was struck by a cannonball during the battle of Gettysburg. Sickles was on horseback when the 12-pound ball severely fractured his lower right leg. Sickles quieted his horse, dismounted, and was taken to a shelter where Surgeon Thomas Sims amputated the leg just above the knee. Shortly after the operation, the Army Medical Museum received Sickles' leg in a small box bearing a visiting card with the message "With the compliments of Major General D.E.S." The amputation healed rapidly and by September of 1863 Sickles returned to military service. For many years on the anniversary of the amputation, Sickles visited his leg at the museum.

Sickles' exploits extended beyond the Civil War. He was the first defendant to successfully use the temporary insanity defense in the United States. In 1859, Sickles was found not guilty of the murder of his wife's lover, Philip Barton Key, the son of the composer of the national anthem. Sickles had shot Key in Lafayette Square in Washington in a jealous rage after learning of the affair. Sickles served as a secret agent for President Lincoln and was appointed Ambassador to Spain by President Grant.

ANESTHESIA
Anesthesia was an important surgical advance introduced a few decades before the Civil War. Ether or chloroform was applied to a cloth cone that was placed over the mouth and nose of the patient. The patient became stuporous in a matter of minutes. This state lasted for more than enough time to perform an amputation, which took about 6 minutes to complete. Union surgeons used anesthesia in more than 80,000 operations.

Since anesthesia was available, Civil War surgeons attempted new operative procedures to contend with some of the severe wounds they encountered. One such procedure, reconstructive surgery of the face, involved suturing together the soft tissues of the eyelids, nose, and mouth. Sometimes extensive rebuilding of the underlying bone with splints and surgical fixtures was required. Surgeons performed more than 30 of these operations.

THE CASE OF PRIVATE CARLETON BURGAN
Private Carleton Burgan, B Company, Purnell's Maryland Legion, age 20, was admitted to the general hospital in Frederick, Md., on Aug. 4, 1862, with pneumonia. He was given calomel, a strong mercurial drug. On Aug. 6, doctors discovered that the calomel had caused an ulcer on Burgan's tongue. The ulcer soon spread to his cheek and the roof of his mouth. The ulcer became gangrenous. The gangrene disappeared on Aug. 27, but it had destroyed Burgan's upper mouth, palate, right cheek and right eye. The bone of his right cheek was removed to halt any further spread of the gangrene.

Burgan's condition made him a candidate for reconstructive surgery. Dr. Gurdon Buck of City Hospital in New York performed a series of operations to rebuild Burgan's face. Dental and facial fixtures were crafted to fill in the missing bone and support the skin. Burgan's case was the first involving total facial reconstructive surgery. He went on to live a normal life, with minimal visual and physical reminders of the damage.

INFECTION
Although fortunate to be unconscious during surgery, soldiers who underwent the knife often received a nasty visitor a few days later-infection. Any open wound almost always became infected. The unwashed hands of the surgeon, the non-sterile surgical instruments used on a succession of men, and the dirty sponges used on an entire ward of wounded soldiers all introduced infectious bacteria into wounds. These infections often resulted in gangrene and death.

CASE OF PRIVATE JULIUS FABRY
Private Julius Fabry, K Company, 4th U.S. Artillery, age 38, was shot in the left knee at the battle of Deep Bottom, Virginia, on Aug.16, 1864. His leg was amputated just above the knee on the following day. The thigh bone became infected and Fabry's pain was treated with morphine for the next 6 years. Pus drained regularly from the infected bone. In 1870, the infected bone was remove at the hip joint. In 1878, Fabry reported no trouble with the stump, but he was unwilling to use an artificial limb. Fabry died in 1894.

AMPUTATION
Surgeons frequently treated arm and leg wounds by amputating. The grisly wounds caused by bullets and schrapnel were often contaminated by clothing and other debris. Cleaning such a wound was time-consuming and often ineffective. However, amputation made a complex wound simple. Surgical manuals taught that an amputation should be performed within the first two days following injury. The death rate from these so-called primary amputations was lower than the rate for amputations performed after the wound became infected. Union surgeons performed nearly 30,000 amputations.

Patients undergoing amputation were first anesthetized. A tourniquet was applied above the site of the proposed amputation. The skin and muscle were then cut with amputation knives several inches above the fracture site. The muscles were pulled up to expose the bone. An amputation saw was used to cut through the bone. Once the cut was completed, large arteries were pulled out from the stump tissue with a tenaculum and tied off to prevent bleeding. The skin muscle was then released and the tissue sutured. Two types of amputation were commonly used. A circular amputation involved cutting straight through the skin to the bone and resulted in a stump that was circular in appearance. A flap amputation required the tissue to be cut leaving two flaps of skin that were used to create a stump. Fingers and other small bones were amputated using the smaller metacarpal saw.

Prosthetic limbs were designed and built to help amputees regain some of their former capabilities. Some of these devices were custom-made while others were mass-produced.

THE CASE OF PRIVATE COLUMBUS RUSH
Private Columbus Rush, Company C, 21st Georgia, age 22, was wounded during the assault on Fort Stedman, Virginia, on March 25, 1865 by a shell fragment that fractured both the right leg below the knee and the left kneecap. Both limbs were amputated above the knees on the same day. He recovered quickly and was discharged from Lincoln Hospital in Washington on Aug. 2, 1865. In 1866, while being treated at St. Luke's Hospital in New York City, he was outfitted with artificial limbs.

EXCISION
Surgeons treated some shoulder wounds with a technique known as excision, also termed exsection or resection. Post-operative photograph of  Kegerreis. The fractured bone was removed, the tissues sutured, and the limb left to heal. Excision gave the patient limited use of the arm and usually full use of the hand. Prosthetic braces worn over the shoulder allowed nearly normal function of the limb for some patients.

THE CASE OF PRIVATE J.P. KEGERREIS
Private J.P. Kegerreis, Company B, 2nd Pennsylvania Heavy Artillery, was wounded at Petersburg, Va. on June 17, 1864 by a minie ball. The ball entered his neck, punctured his windpipe, and passed through his right shoulder joint and out his back. Keggereis was tagged for amputation at the field hospital but tore off the tag and crawled among the less seriously wounded. Three days later, while at City Point Hospital, his wound was treated and found filled with maggots. His neck wound healed in a month, but his shoulder wound was infected. In the winter of 1865, the infected bone was removed by excision. The wound healed slowly, and he was discharged in May of 1866. In December of 1867, a surgeon removed a large piece of bone from the joint and the bones of the arm later fused on a semi-flexed position. He was able to lift 135 pounds with his injured arm.

CONSERVATION
Conservative treatment was employed in the cases of flesh wounds or minor bone fractures. The wound was cleaned of bone fragments, clothing, and other debris and dressed with bandages. Local anesthetic was often applied. Conservation left the limb intact, but the use of unsterilized instruments, unwashed hands, and dirty bandages often introduced infection.

THE CASE OF CORPORAL G.W. STONE
Corporal G.W. Stone, Company A, 12th Massachusetts was wounded at Fredericksburg, Va. on Dec. 13, 1862, when a conoidal ball penetrated his right eye and lodged behind his left eye. His only exterior symptoms were a small wound to the lid of his right eye and the slight protuberance of his left eye. His left eye continued to function normally. Corporal Stone complained only of a slight headache. The wound to his right eye healed well, and within in three weeks, he was allowed to walk about the city with a hospital pass. Suddenly on Feb. 6, 1863, he developed chills. Fever and delirium followed. He died at midnight on Feb. 15, 1863.

THE CASE OF PRIVATE JOHN TUCKER
Private John Tucker, 17th Maine, age 20, was wounded by a shell explosion at the battle of Chancellorsville, Va. on May 3, 1863. The shell removed a large portion of the skin and muscle of the buttocks and lower back. Applications of wet lint doused with disinfectant lotion were used to treat the wound. Several days later he contracted tetanus and was treated with olive oil applied to cotton batting and with doses of morphine. He survived the tetanus. By 1870, part of the wound remained an open ulcer that drained a thick pus. The doctor recommended the new technique of skin grafting to heal the wound but it is unknown if Tucker underwent the operation.

HEAD WOUNDS
Head wounds were not always fatal. A soldier's prognosis was best when bone splinters were removed and the wound was left to heal. In more severe wounds, trephination was used. Trephination involved drilling a circular hole into the skull to relieve pressure from bleeding or to remove fragments of bone pressing on the brain. Trephinations were fatal in over half of the 220 operations performed by Union surgeons.

To perform a trephination, the patient was first anesthetized. The tissue surrounding the trephination site was then pulled back and the trephine placed on the site. The trephine was turned in a circular motion to slowly cut through the bone. Care was taken not to cut the tissue surrounding the brain. An instrument called an elevator was used to raise sections of fractured bone away from the brain. A Heye's saw was used to remove protruding bone fragments.

THE CASE OF PRIVATE J. LUMAN
Private J. Luman of Company A, 122nd Ohio Volunteers was wounded at the battle of Mine Run, Va. on Nov. 27, 1863, when a minie ball passed through his skull. He was treated in the field hospital for several days before being evacuated to the 3rd division hospital in Alexandria. By Dec. 8, Private Luman was comatose, and Surgeon E. Bentley applied a trephine and removed the splinters of bones associated with the wound. He condition failed to improve and he died five days later.

THE CASE OF CORPORAL G.H. SWIFT
Corporal G.H. Swift, Company C, 18th Massachusetts, was injured at the battle of Chancellorsville, Va. on May 3, 1863, when a musket ball fractured the top of his skull. Surgeons attempted to trephine the wound but halted the procedure upon discovering that the inner surface of the skull was not fractured. Corporal Swift died on May 17.

CHEST AND ABDOMINAL WOUNDS
The thread through Barnum's abdomen is visible in this photograph Chest and abdominal wounds were nearly always fatal. Treatment of abdominal wounds often involved pushing in protruding organs and suturing the wound. Food was withheld because fecal material leaking from the intestines caused contamination. Opium was often administered to halt the action of the digestive system. Abdominal wounds were fatal in almost 90 percent of the cases reported by Union surgeons. Chest wounds were cleaned and the wound was sutured.

THE CASE OF MAJOR GENERAL HENRY BARNUM
Major General Henry A. Barnum of the 12th New York was injured at Malvern Hill, Va. on July 1, 1862, by a musket ball that passed through his left lower abdomen. The ball penetrated his intestines and hip bone. The wound was considered fatal and he was left in a field hospital. A few days later he was captured and taken 18 miles to Libby Prison. Fifteen days later he was transported 17 miles and exchanged. In October, the wound was opened and several bone fragments were removed. He was promoted to Colonel in January of 1863 and sent back to the field. A year later, Barnum visited a private physician who pushed a probe through the wound causing a large abscess to drain. In order to keep the wound draining, the physician threaded a probe with a strip of oakum and passed it through the wound. Barnum wore a thread through the wound his entire life. He was promoted to Brigadier General and was also injured in battles at Kenesaw Mountain and Peachtree Creek, Ga.. Barnum died of pneumonia at the age of 65 still wearing a thread through the wound.

Image 1: Shell wound of the wrist, circa 1863, by William Schultze, a medical illustrator on staff at the Army Medical Museum.

Image 2: Confederate surgeon Julian Chisolm developed this anesthesia inhaler. His design allowed the administration of chloroform through the nostrils, reducing the amount of anesthesia needed to induce unconsciousness.

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Military Medicine at Wilson's Creek, Missouri

From: nps.gov

While certainly not as glamorous as other aspects of Wilson's Creek and the Civil War in general, field medical practices give us a sense of the horrors inflicted on the common soldier during the war, as well as an understanding of the period medical techniques, procedures and equipment used by surgeons operating with the armies. Medical science at the time treated wounds and sickness with the best knowledge of the day. Most surgeons took great care to insure the well being and survival of their patients. We should not be too quick to judge them based on modern medical practices, just as we would not expect future historians to pass judgement on the techniques of healthcare professionals today.

Who was a Surgeon?

Surgeons could either be commissioned officers of the U.S. or C.S. Army or volunteer officers in state service. Contract Surgeons were civilian doctors hired by the army, yet held no commissions and wore no uniforms or insignia of rank. In 1861 there was no military review board for volunteer or contract surgeons. Appointments were often based on nepotism, personal friendships and political patronage, with professional qualifications not the primary consideration. Most surgeons received their training by the apprentice system, training with an older, more experienced doctor, and thus learning out-of-date medical techniques. Younger doctors attended medical schools, but this caused many an old soldier to hold the opinion that they were only in the field to get more practice, not to save lives. In wartime, quality control standards were frequently ignored, so some doctors were outright "quacks" with forged credentials. Many surgeons returned to private pratice after the war, but some were addicted to pain-killers like opium, laudanum and alcohol like their patients.

Sickness & Disease

Of the approximately 618,000 fatalities of the Civil War, some 2/3 (approximately 414,000) were the result of disease. Typhoid, dysentery or diarrhea, malaria, measles, sexually-transmitted diseases, pnuemonia and other ailments killed more soldiers, North and South, then musket, cannon or saber. Many of these ailments were due to the living conditions of the soldiers, their dietary habits and poor hygiene. Although some attempts were made to treat diseases with home remedies, surgeons also used large doses of opium, quinine, turpentine, carbonate of soda, powdered rhubarb and calomel (a mercury compound). Surgeons did not understand the concept of sterilizing their instruments and hands before an operation, and would literally spread germs from patient to patient, only stopping to wipe instruments on a dirty shirt, apron or coat, or dipping them in a bloody and stagnant bucket of water.

Medical Aspects of Wilson's Creek

Both Federal and Southern wounded were treated at a makeshift field hospital established at the John Ray house. After the house was fired on by Union artillery from Bloody Hill, Southern surgeons placed a yellow flag on the porch to indicate its use as a hospital and protect it from fire from both sides. Besides the Ray House, impromptu field hospitals were set up all over the battle field, at other private homes and in the open, by both Union and Confederate surgeons. Dr. Samuel Melcher and other Federal surgeons stayed behind to care for their patients, and worked beside their Confederate counterparts. After the Southerners occupied Springfield on August 11, they cared for not only their own wounded but those Union soldiers too badly injured to be taken on the retreat to Rolla. The courthouse, churches, schools and private homes in Springfield were used as makeshift hospitals in the weeks and months following the battle, with many of the town's citizens acting as nurses and attendants. One surgeon, Dr. William Cantrell of the 1st Arkansas Mounted Rifles, wrote on August 17 "Springfield is a vast hospital."

Gunshot Wounds

Along with amputations, the treatment of gunshot wounds was one of the most common medical procedures of the war. The bullet, if located, was extracted or removed from the wound, the blood vessels sutured and the wound packed with medicinal lint (scraped from bed spreads by patriotic ladies at home) and bandaged. The introduction of the Minie Ball, a conical projectile, greatly increased the severity of gunshot wounds during the Civil War. Round musket balls used in smoothbore weapons tended to bounce off or bruise tissue, with less damage below the surface. The large, low-velocity, high-impact Minie Ball would bore and "keyhole" through the tissue, leaving a large gaping wound, shattering bone and bringing in foreign objects like grass, dirt, and pieces of clothing that would greatly increase the chance of blood poisoning or septicemia.

Amputations

The most common surgical procedure of the Civil War was amputation, but only when the severity of the wound made it necessary to preserve life. Amputations were necessary when any one of three conditions prevailed: massive tissue or muscle loss, severe trauma to joints and bones, and vascular damage. A primary amputation, done within 24 hours after receiving the wound, significantly reduced infection and septicemia. Contemporary medical knowledge recognized that amputation was the best hope for a soldier's survival. Surgeons also preferred to save as much of the limb as possible, to provide the patient with a more functional arm or leg in later life. Statistics also reveal that the farther away the wound was from the trunk or torso of the body, the greater the patient's chance for survival.

An Amputation step-by-step

The wounded soldier would be brought to the operating table, which was in some cases nothing more than a door on two saw horses, a table or even church pews -- anything that would support the weight of a man and was available to the surgeon in the field. The wound would require examination to determine severity. If amputation was deemed necessary due to any of the reasons mentioned above, the surgeon would proceed. The next step was to use a general anesthetic to put the patient to sleep. Chloroform and ether were the two anesthetics available to surgeons during the war. In fact, contrary to popular belief, anesthesia had been widely used by American physicians since the 1840s. As soon as the patient was unconscious, tourniquets or the hands of a competent assistant would be used to stop the flow of blood to the surgical site. The skin would be incised or cut with an amputating knife, then retracted or pulled back, and the muscle would be incised. The bone would be exposed and a surgical or capital saw used to sever the limb from the body. The surgeon would then ligate, or tie off the major blood vessels with surgical silk thread, using an instrument called a tenaculum to grasp the arteries. Ligatures were often left dangling from the stump to allow for their removal later. (This later removal could lead to secondary hemorrhaging, as surgeons were unable to quickly stop the flow of blood when the ligatures were pulled). After the major bleeding was stopped, gnawing forceps and a bone file would be used to smooth the rough edges of the stump of the bone and aid in the healing process. The wound was then closed with curved needles and silk thread. The average amputation could be finished in 10-15 minutes, partly due to the fact that the surgeon had to treat many patients and had to work as quickly as he could. After the operation, the patient would then be removed from the table for post-operative care. Several different painkillers were available, including morphine and opium. Pulverized opium could be rubbed directly into the wound, or mixed with whisky to make laudanum.

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