Sunday, February 16, 2014

About Treating Wounds in the Civil War

By Peggy Deland

The American Civil War had a tremendous death toll--nearly 620,000 soldiers died as a direct result of the war. Most of these soldiers died as a result of illness, rather than injury. Those who died of their injuries usually succumbed to infection, made far worse by the lack of cleanliness in camps. Although the care given to wounded soldiers was primitive by today's standards, the loss of life would have been much higher without treatment.

The Civil War lasted four years, from April 1861 through April 1865. This was long before the discovery of antibiotics, and medicine remained focused on balancing the body's "humors." Most doctors trained as apprentices under experienced physicians rather than attend medical school. Formal education for doctors was woefully inadequate, consisting of only one year of lectures before the students were sent out into the world as physicians and surgeons.

Wounded soldiers underwent triage to determine the extent of their injuries and in what order they would be treated. Gunshot wounds to the extremities were treated first, by amputating the affected limb. Surgeons often worked through the night, performing an amputation every 10 minutes. If there was time, minor injuries were treated by removing any foreign objects, packing with lint, and wrapping the wound in a wet bandage. Wounds to the head, neck, chest and abdomen were treated last, if at all. There was little that Civil War physicians could do for these patients, so most were given pain medication and left to die.

Although movies about the Civil War often depict amputations being performed without anesthesia, this was almost never the case. Chloroform was the most common anesthetic used; a rag soaked in the drug was held over the soldier's nose and mouth until he was unconscious. Injected morphine was used when chloroform was unavailable, and in the rare case that neither drug was available, soldiers were given copious amounts of liquor prior to treatment.

Infection was a near-universal complication of wounds treated during the Civil War. No attempts were made to maintain cleanliness, let alone sterility, by physicians of the time. Instruments and hands were not washed between procedures, and filthy rags were used as bandages. The appearance of pus draining from the wound was believed to be part of the healing process and was considered a good sign. Surprisingly, an estimated 75 percent of soldiers who underwent amputation during the Civil War survived.

Due to the sheer number of amputations that were performed during the Civil War, techniques improved significantly. Early in the war, most amputations were performed using the circular technique, in which the cut was made straight through the limb and then the blood flow staunched. The flap technique, in which skin is left attached to be sewn over the end of the stump, gained in popularity; by the end of the war it had nearly replaced circular amputation. The flap technique is still used today, in the rare cases where modern physicians must amputate a limb.



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