Sunday, August 9, 2015

Shaping the Medical Practice through the Civil War and Future Generations

Written by Tim Talbott 8-13-13
By Julia Butz, Sunrise Elementary School, Rancho Cordova, CA, and Joseph Moneymaker, South Livingston Elementary, Smithland, KY

For some Civil War soldiers the surgical case of Confederate Doctor Orville Yager (catalog number 1999.43.15 in the Kentucky Historical Society digital objects collections) symbolized either “the angel of mercy” or “the angel of death” depending on one’s perspective.  During the Civil War, seventy-five percent of surgeries performed by doctors were amputations.  Taking into consideration both Union and Confederate, this totaled nearly 50,000 amputations.  The average time to complete an amputation was from ten to fifteen minutes.  One out of every four amputations did not survive the procedure, therefore some soldiers referred to their surgeons as “sawbones” or “butchers”.(source)

What would be found inside the case of a surgeon that would earn him such morbid nicknames?  Items used for amputation operations included: anesthetics, bone saw, tourniquet, probes, bandages, and suture needles and thread.  One of the most common anesthetics used in Civil War surgery was chloroform.  Chloroform was used to render the soldier-patient unconscious during an amputation or other surgical procedure.  Interestingly though, some soldiers refused the use of chloroform.(source)  Bone saws were hand saws used to amputate and cut through the bones during surgery.  Tourniquets served as a belt that went around the arm or leg to tighten and cut off the flow of blood for the amputation procedure.  Probes were used to dig out bullets from wounds the soldiers received in battle.  Bandages were made from cloth to help cover wounds and other injuries.  Suture thread included a needle and thread and was used to stitch cuts, wounds, and amputations.(source)

One soldier who witnessed an amputation described the horrific scene: “Tables about breast high had been erected upon which the screaming victims were having legs and arms cut off. The surgeons and their assistants, stripped to the waist and bespattered with blood, stood around, some holding the poor fellows while others, armed with long, bloody knives and saws, cut and sawed away with frightful rapidity, throwing the mangled limbs on a pile nearby as soon as removed.”(source)

Why was there such a high rate of death from surgery?  In order to answer this question it is important to understand some of the medical conditions surgeons operated under at the time of the Civil War.  Most surgeries were performed away from the battlefield in tents, and only one percent of the doctors in the Civil War had prior experience in the medical field.   Some doctors, especially early in the war, had to learn how to perform medical surgeries such as amputations as they went.  Many doctors had to learn how to perform amputations by reading the book “The Practice of Surgery”, by Samuel Cooper, with notes by Dr. Alexander H. Stephens or other such period works.  Naturally, battlefield conditions caused many mistakes.  Other factors such as the enormous number of wounded soldiers from battle and the conditions of the field hospital did not help.(source)

Surgeons worked throughout the day performing amputations inside these field hospitals. Field hospital structures varied.  Some were private homes, buildings, barns, and churches; others were warehouses and outbuildings.  Most of these structures provided the minimum required shelter and a nearby water source.   “Houses and barns, but chiefly the woods were used as hospitals and the wounded, necessarily endured much suffering,” wrote Dr. Jonathan Letterman, describing a field hospital that was used during the Civil War.

Often surgeons lacked enough medical supplies to attend and address the increased number of soldiers needing immediate medical attention due to the severity of their wounds.  One soldier stated:

 “In the operating tent, the amputation of a very bad looking leg was witnessed. The surgeons had been laboring since the battle to save the leg, but it was impossible. The patient, a delicate looking man, was put under the influence of chloroform, and the amputation was performed with great skill by a surgeon who appeared to be quite accustomed to the use of his instruments. After the arteries were tied, the amputator scraped the end and edge of the bone until they were quite smooth. While the scraping was going on, an attendant asked: ‘How do you feel, Thompson?’ ‘Awful!’ was the distinct and emphatic reply. This answer was returned, although the man was far more sensible of the effects of the chloroform than he was of the amputation.” (A Strange and Blighted Land, Gettysburg: The Aftermath of a Battle, by Gregory Coco, Thomas Publications, Gettysburg, 1995)

At the end of the day, stacks of amputated limbs were found reaching up to five or more feet high.  Thus, the increased number of soldiers needing immediate medical attention, along with the lack of water, meant that surgeons lacked the time to properly wash hands or instruments between procedures.  At most battle sites, wounded soldiers lacked the benefit of proper shelter or were left to suffer under the sun or other battlefield conditions until they were taken to a medical tent.  The lack of hygiene and a clean sterile environment increased the chance of infection and contagious diseases.

Not only did the American Civil War reunite a country and end slavery, it also significantly changed America’s medical practices.  Before the war, many of the physicians received minimal training.  Many of the older doctors only worked as apprentices and had no formal education. The younger doctors usually only had two years of formal training, generally with no laboratory experience.(source)  Despite these obstacles, medical practices improved dramatically in the areas of triage, cleanliness, and neurosurgery.

Jonathan Letterman, Medical Director for the Union Army drastically changed the way triage was performed on the field.  He created a well-organized system that treated the wounded on the battlefield, followed by rapid transportation to clinics and hospitals for the patient to be examined by a specialist.  Civil War soldiers who returned home expected this same type of care for any type of accident they might encounter, which thus led to the beginning of the modern ambulance system (and much the later 911 system) we benefit from today.(source)

Due to the urgency of tending to the wounded and the gathering of people from different towns and rural areas, much was learned about medical hygiene and the spread of disease.  Twice as many soldiers died from infectious disease than did soldiers from wounds acquired on the battlefield.(source)  Doctors on the battlefields soon discovered that clean instruments and hands led to fewer infections among the wounded.  At the time, it was thought that diseases were spread via “miasmas” or “bad airs”.(source)  The doctors soon discovered through trial and error that cleaning instruments greatly reduced death from infection.  A greater understanding of the relationship between diet, cleanliness, and disease was gained not only by the medical community, but by the public at large. (source)

Understanding pain and neurosurgery also made great advances during the Civil War.  Anesthesia became a specialty during the war because of the sheer numbers of wounded.  Ether and chloroform became the common anesthetics used.(source)  Confederate surgeon F. E. Daniel described the effects he discovered using chloroform while performing an amputation, “He rallies from the sleep of the merciful anesthetic.  He slept all through the ordeal . . . He felt nothing, knew nothing.”(source)  Doctors developed new ways to treat the dramatic increase in nerve injuries and chronic pain, which was the beginning of modern neurosurgery.(source)

The medical advances that were acquired during the Civil War may not have come for many more years without the necessity of war to improve basic health care.  The practices started during the war are practices that were the beginning of what we now have in modern medicine.  The lessons learned about expediency of care and the comfort of the patient was a slight silver lining in the black cloud of the American Civil War.



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