"The Surgeon's Role"
Modern medicine, as we know it, began in war. As war modernized so too did medical care. The American Civil War was the first modern war. Rapid communication, rapid transport of troops, rapid firing weapons, all combined brought mass injury to thousands of people.
When the war began the military and civilian medical personal were completely unprepared for what the war brought them. The military at the beginning of the war had 30 surgeons and 83 assistant surgeons. 3 of the surgeons and 21 assistant surgeons resigned to follow the South. Hundreds of civilian doctors enlisted on both sides helped to fill the void of medical personnel. These "grafted" doctors had to be taught the ways of the military.
The civil war was fought before the current idea of medical schools. There were schools. Schools that were established, consisted of one or two years of lectures. A student going for 2 years would sit in on the same lectures the 2nd year as they had the first year. There was another way to become a "doctor", apprenticeship, on the job training. A person wanting to become a doctor would work with another doctor until the mentor felt the student had learned all that could be taught and then sent the apprentice out to start their own practice. By 1860 there were over 100 medical schools and the majority of the doctors had some formal education. None of the experience or formal education prepared the doctors of the 1850's for what was to besiege them in the Civil War.
The civil war was "on the job training" for everyone who worked in the medical field. There was no experience with the numbers or types of casualties the war brought. Of nearly 3 million soldiers 618,000 would die. Around 400,000 died from disease. 218,0 00 died in battle or from wounds received during battle. Of the 618,000 the north lost 359,528 and the south lost 258,000.
The knowledge of Antisepsis was just beginning to be explored, in Europe, not in the U.S. The lack of knowledge about infectious causes of illness, resulted in the absence of basic hygienic and sanitatary principles. Doctors seldom washed instruments let alone their hands between patients. Patients were housed in over crowded quarters, food and water was often contaminated by fecal material from the men and animals. With the crowded conditions infectious diseases were rampant.
The background is now set
A surgeon, this is what the military called them, because the most often used method and the fastest way, to help the greatest number of wounded was to perform surgery. The most often used surgery was amputation.
The work of the surgeon was gory, often brutal. Large numbers of wounded were first treated on the field of battle or at aid stations, set up on the edge of the battle field, and then transported to field hospitals for surgery. Getting the wounded soldier to the surgeon was often times slow. Surgeons many times would go out on to the battle ground during the battle and either work on the wounded right on the ground or bring them back to the field hospital and work on them there. The Civil War was the beginning of the ambulance. The beginning of triage, the selection of which wounded get treated first. The ambulance and triage are still in use today. In the aid station or field hospital only the wounded that required the surgeon would see a surgeon. Minor injuries were treated by either the assistant surgeons or by stewards.
The tools of these surgeons varied from unit to unit. The surgeons were often required to bring with them their own surgical kits. These kits had the following basic tools:
Above left is a "Capital set" and right is a "chain saw" used as an amputation saw along with a folding scalpel.
Scalpels, scalpel guides, amputation knives (used to prepare soft tissue prior to amputation) various amputation saws, tourniquets, and the ever-necessary bullet probes, and extractors. These are the most often used "tools".
Surgery was carried out in the open air, often in full view of anyone nearby as well as in the wounded soldier's own tent. Flies, insects of all kinds were drawn to the discarded body parts, and blood. Flies are credited with helping save lives of some wounded men. Their larva would eat the decay from wounds reducing the incidence of gangrene.
Once on the surgical table a wounded soldier would be restrained by stewards or others as necessary. At times anesthetics were available in the form of chloroform, or ether for surgery. Morphine, opium pills, and Laudanum were used for the control of pain. These anesthetics were in short supply through out the war and therefore not always available.
Chloroform or ether was dripped from a bottle or can on to a cloth mask held close to the patient's face. Ether was a volatile liquid and would burn the patient if it came into contact with the skin. The fumes would cause the medical staff to become sick or sleepy as they worked unless the area was well ventilated thus the reason for open-air surgeries.
Morphine was given oral, rubbed into wounds and was just beginning to be injected. Opium pills, the best pain control at the time was given the same as Morphine. Laudanum was a form of opium that was taken orally. All of the pain medicines were addictive, though addictions were not thought of at the time.
The wound, a leg wound as example, would have any clothing removed above and below the site of wound. If the bone were not broken then the wound would be probed to see if the bullet or shrapnel was still in the body. If an object was located and could be reached with the extractors it would be quickly removed the then the hole would be sewn closed. An assistant surgeon would most commonly perform this simple procedure. For more difficult object removals then the surgeon would cut a path into the object. Once the object was removed the surgeon would move to another patient and an assistant surgeon would repair the wound. Any bleeding during the surgery would be soaked up with rags and sponges. These same rags and sponges would then be used on the next patient along with the same scalpels, probes, and extractors.
Because of the way surgeons worked it is no wonder that nicknames such as "saw bones" came about. It was a very dirty, gruesome business that the men and women undertook to aid the soldiers.
Civilian organizations were not to be ignored nor left behind. There were different organizations that came into being because of the obvious lack of the military to cope with the vast need of military medical care.
The US Sanitation Commission:
The US Sanitation Commission was a Civilian organization that raised funds, through donations, gifts and fundraisers such as bazaars. The USSC focused on an area of need that the army did not have funds or time to be concerned about. These funds were then used to buy food, medical supplies, personal sup plies, blankets, books, etc. The Sanitation Commission then formed their own supply trains to distribute the goods to the soldiers.
There were similar types of organizations for the Confederate army as well. Both the USSC and their Confederate counter parts were started by family members of soldiers who took action to help in the welfare of all the soldiers. From making clothing items in sewing parties to making medical necessities such as bandages, wives, mothers, daughters and sweethearts came together to support their men.
Women have been a major contributor to every war, if not the inspiration for the war, then definitely as the mothers of those who fought. The American Civil War was somewhat of a change for the role of women in war, indeed a start in the change of the role of the woman in society. At the beginning of the war women were excluded from most roles outside the home and health care was not an exception. Where today we see the medical field dominated by women at the outset of the Civil War there were few if any women involved. The great number of wounded and sick compelled many women to offer their assistance by volunteering as nurses. As volunteers they cleaned and dressed wounds. Cared for the sick as they did in the home. Extension of their home duties, were deemed unladylike out side the home.
Some individual women proved themselves to be an over powering force. Clara Barton as an example did not belong to any of the organizations yet by the wars end was recognized even by President Lincoln and given special tasks to assist in the location of missing soldiers.
Surgeons in the Confederate States Army were regulated much the same as their Federal counter parts. There were surgeons, assistant surgeons, medical stewards, and various other personnel that were needed to operate a large "mobile" hospital.
Wounded men would be collected both during the fighting and after the fighting and taken to field units or aid stations. These men would be treated and the patients that were considered well enough would be transported to a near by city where "hospitals" had been set up in suitable and commonly unsuitable buildings. These wounded men would be crowed together in unclean, unventilated conditions, which helped to spread the diseases, and infections that were rampant in the hospitals.
Soldiers that had to be operated on before they could be moved were taken to a tent or some near by farm building that had been conscripted by the surgeon. Here the wounded man would receive his operation. As stated before the most common form of operation was the amputation.
An operation would require the assistance of 2 to 4 assistants to the surgeon. One assistant would administer the atheistic, when it was available. One or two others would hold or tie the patient down and also be there to pass tools needed by the surgeon to him. Yet another assistant would hold the limb that was being removed.
The surgeon would quickly cut through the soft tissue that surrounds the bones and create a complete access to the bone. This was done by use of an amputation knife. In doing so he would prepare the skin into a flap that could quickly be sewn back over the end of the limb where the bond had been removed. Next came the bone saw. There were many different sizes and types depending on which bone was to be cut. Even a chain saw was used. These chain saws were effective and popular with the surgeons because they were more versatile and could be used in almost any amputation. It was fast and gruesome. An amputation, because of the lack on anesthesia and the number of wounded men to be seen, would often take just seconds. Once the amputation was performed an assistant surgeon would close the wound over while the surgeon moved to the next patient.
Bullet wounds that were found to not effect the bones were probed with a long thin wire instrument. The probe would be passed into the wound and if the bullet located, it would be heard and felt by taping on it. The location would be noted as well as the depth and angle the probe had entered the wound. The surgeon would then either operate to remove the bullet or would close the wound and send the patient to the larger better-equipped hospital. Infections such as gangrene would kill a majority of these patients within 2 to 3 weeks after their initial wounding. Were these infections from the bullets or shell fragments or from the tools used by the surgeons?
On top of the care of the wounded after a battle, surgeons were responsible for the care of the sick. Diseases such as Typhoid, Typhus, small pox and even childhood diseases became major problems for the medical staff. These diseases, especially, hurt the South. The southern army was populated with rural men. These men had lived a semi-isolated life. Childhood diseases, that we take for granted, were not common in the rural areas of the south. In adults these diseases can be deadly. Unsanitary conditions were the most common source of these diseases. From the start of the war, doctors had to fight an uphill battle with the "line" officers. The regular officers felt the doctors should be a "rubber stamp" to sign off on what the regular officer wanted. When the doctors began advising the officers on routine sanitary precautions (there was some knowledge i.e. building latrines away from and down stream of the camp) they were ignored. Once the advice of these doctors began to sink in the numbers of sick soldiers began to drop.
Denny, Robert E. Civil War Medicine, Care & Comfort of the Wounded New York, Sterling Publishing Co., Inc.
Schaadt, Mark J. Civil War Medicine, An Illustrated History Quincy Illinois, Cedarwood Publishing
Rutkow, Ira M. Surgery An Illustrated History St. Louis, Missouri; Mosby - Year Book Inc.
Dammann, Gordon Pictorial Encyclopedia of Civil War Medical Instruments & Equipment Vol. I, II, and III Missoula, Montana Pictorial Histories Publishing Company
Gillett, Mary C. The Army Medical Department 1818 to 1865 Center of Military History, U.S. Army
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