Monday, January 18, 2016

On Surgery's Cutting Edge In Civil War

By Mary Belferman, Washington Post Staff Writer, June 13, 1996

Medical 'Turning Point' Is Focus of New Museum
The canvas on the wooden stretcher is ocher with age, soiled a deeper brown in places with the blood of Civil War soldiers. In the flowing script of the last century, a Union surgeon inked his name across it -- good supplies were hard to hold on to. Nearby are tidy leather kits with tools for field amputations, the foot-long saw and scalpels now shining with cleanliness.

More than 600,000 soldiers died in that war, from wounds and diseases and malnutrition and infection, despite the best efforts of doctors and nurses who knew nothing of germs. "The real war will never get in the books . . . the hospital part," wrote poet Walt Whitman, who nursed soldiers in Washington.

The National Museum of Civil War Medicine, opening Sunday in Frederick, will tell that part. "It's the story of care and healing, courage and devotion amidst the death and destruction . . . [and] major advances that changed medicine forever," museum director Burton Kummerow said.

The only museum in the country dedicated to the medical side of the conflict, it will house and exhibit more than 3,000 artifacts, including the only surviving surgeon's tent from the war. Doctors' saddlebags are packed with small bottles and packets that once held quinine and other potions. An ambulance that carried wounded men from the battlefield has the advantage of crude springs to ease the rough wagon ride; many didn't.

Much of the collection comes from museum Chairman Gordon Dammann, an Illinois dentist who has been amassing Civil War medical objects for more than 20 years. The museum was his idea. "There's never been anything like it done before," Dammann said, calling the 1861-65 war "a turning point in American medicine."

Anesthesia, introduced in the 1840s, had its first widespread use during the Civil War. War surgeons developed an inhaler for its use, an improvement over the soaked rag, to conserve supplies. Confederates developed the prototypes of mobile army surgical hospital (MASH) units as they fled before Gen. William Tecumseh Sherman's advance. Perhaps most importantly, ambulances and a system for evacuating the wounded from the battlefield and treating them were established for the first time. Nursing was elevated to a profession, with thousands of women working in hospitals for the first time.

Unfortunately, the war also occurred just a few years before Louis Pasteur discovered the role of germs in infection; doctors dug bullet fragments out with unwashed fingers and operated with bloody instruments for lack of clean water.

It was a time of change in war technology as well as medicine. Rifled gun barrels and pointed, conical bullets came into wide use by both sides early in the war, multiplying casualties. The old, round bullets fired from a smooth-bore musket bounced off bone and were accurate to less than a hundred yards. The new, pointed projectile spun through a rifled bore, the spin producing a bullet accurate to 300 yards.

The heavy, conical bullet tore into the skin, carrying dirt and clothing with it and smashing the bone, often not exiting because of its large caliber and low velocity. Amputation generally was the safest way to handle such a wound; those shot in the hip or wounded internally often didn't survive.

Civil War amputation brings to mind scenes of agonized soldiers slugging whiskey and biting bullets as their limbs were chopped off without anesthesia.

"Hollywood has done a great disservice with that image -- that's one of the myths we want to dispel with the museum," said museum Vice President F. Terry Hambrecht, a neurosurgeon who collects Civil War medical artifacts. "In the vast majority of cases, they had plenty of anesthesia. The tools are very similar to those used in medical field operations today. The capital saw is virtually identical; it's just stainless steel instead of nickel-plated steel, with different handles. And in most cases, their technique was good. They just didn't know about infection. They understood that with cleanliness you had fewer complications, but they didn't know why. Given the conditions and the knowledge they had, they did a good job."

Whiskey was given, but it was meant to help the soldier bear up.

"A wounded soldier was given alcohol as a stimulant, some morphine derivative as a painkiller and ether or chloroform as anesthesia," explained Adrian Wheat, a retired U.S. Army surgeon and a member of the museum board. "They weren't completely put to sleep -- they remembered surgery but didn't feel pain. Observers would have seen that they were awake -- that might be the origin of the rumor that people were operated on awake, without anesthesia."

Along with dispelling misconceptions, the museum hopes to tell the stories of medical heroes on both sides, including the women who became nurses against the disapproval of their families. Jonathan Letterman, medical director of the Union's Army of the Potomac, was "the father of battlefield medicine in the United States," Dammann said.

In the beginning of the war, wounded soldiers languished for days before they were retrieved. Sometimes their friends would stop fighting and carry them to the rear, knowing no one else would, recounts historian James M. McPherson in "Battle Cry of Freedom." Litter-bearers were musicians, other soldiers and anyone who could be spared. Letterman developed a system for evacuating the wounded, establishing ambulances and dedicated personnel for each regiment.

The wounded were treated in three stages: "There was a dressing station 60 to 70 yards from the front line," Dammann said, noting that 350 doctors on the Union side were killed in battle. "First aid was done here, tourniquets and splinting. From there, they went back into battle or to a field hospital, maybe in a barn or church three or four miles behind the lines. Here they had operating surgeons, where they did amputations. Wounds of head, chest and abdomen weren't treated; they were given painkillers and most died there. From here, they were evacuated, usually by train, to fixed hospitals." Letterman's system saved lives, but for every man killed in battle, two died of disease. Many perished from malnutrition, especially in the South.

The museum's official opening Sunday will mark its first phase, director Kummerow said. Tools, uniforms and other items will be on display, and several scenes will be set up using real artifacts and reproductions, including a camp scene and a field hospital. The museum already sponsors living history talks and walking tours.

However, much of the museum remains on hold. Dammann and others who intend to give or lend items are keeping the bulk of their collections until the museum's security and environmental and fire controls reach a higher standard. Recent thefts around the nation underscore the increasing value of Civil War artifacts.

For example, Dammann said, "an amputation kit I paid $600 for 25 years ago is now worth about $4,000." About $6 million is needed for the museum, some of it already raised. Kummerow hopes to redo the museum completely within a few years to bring it up to standard.

Then he also hopes to introduce other innovations, such as identity cards featuring real soldiers to help personalize the war for visitors. This is one idea he took from the Holocaust Museum, he said; another is "how to exhibit a subject that is, by nature, somewhat gruesome." Some of the more explicit exhibits, unsuitable for young audiences, will be separated and marked.

Kummerow has high hopes for the museum, which was several years in the planning. Former Maryland governor William Donald Schaefer, a hospital administrator in World War II, was an early supporter. "It's a great thing to support the past, and the Civil War is now a hot issue," Schaefer said. "I see it as a major tourist attraction, unique in the country, and tourism is a major economic boon for an area. Frederick is a good place for it."

Frederick was picked as the location for several reasons. During the war, Frederick witnessed three Confederate invasions, 38 skirmishes and two major battles. A hospital and supply center, the town opened its doors to 6,000 wounded after the battle of Antietam, and the building that houses the museum was used as an embalming station after the battle.

Frederick is also near other Civil War sites, including Gettysburg, Antietam and Washington; with the growing public interest in the war, founders hope the museum will draw 100,000 visitors annually. Frederick and Maryland chipped in with funds to launch the museum, and the city is leasing the building to the museum for $1 a year for the first five years. Entrance is free, with a donation suggested, but the city hopes the attraction will pull in tourist dollars for other businesses.

One of the stories the museum illustrates is that doctors treated all wounded, not just their own. "Give the wounded men every attention possible and make no distinction between Federals and Confederates," Gen. Ulysses S. Grant is quoted as saying.

At battle's end, "those in possession of the field left doctors behind, and they treated all the wounded," Kummerow said. A sculpture commissioned for the museum from a local artist illustrates this: a Union doctor bends over a fallen Confederate soldier.

As Letterman put it, "History teaches us that a wounded and prostrate foe is not then our enemy."



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