Wednesday, August 5, 2015

Military Medicine at Wilson's Creek, Missouri


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received their training by the apprentice system, training with an older, more experienced doctor, and thus learning out-of-date medical techniques.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.

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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