CHILD LIFE May/June 2003, pp. 28-30 From CHILDREN'S DIGEST, copyright © 2003, by Children's Better Health Institute, Benjamin Franklin Literary & Medical Society, Inc., Indianapolis, IN. Used by permission. Civil War Surgeons By Leo Rosenhouse It was the late, hot summer of 1862, following the Second Battle of Bull Run. The North realized that the Civil War was going to be a long fight, with heavy casualties. Already, 17,000 valiant men in blue had been wounded, and a frantic call went out of Washington, D.C., for surgeons, bandages, and medicine. In a single day's fray, the War Office reported that 700 Union soldiers lay on the battlefield crying for aid. Only two ambulances and a handful of medics were there to assist them. It was worse in the Confederacy. Volunteers in Boston, responding to the call to aid the wounded and sick, made a house-to-house search. They seized sheets, curtains--even shirts--that could be torn into strips to serve as bandages. Practitioners left their offices to venture to the war front. Unfortunately, many of them were poorly trained in surgery. The North, working under the direction of Dr. Jonathan Letterman, built temporary first-aid stations, field hospitals, and--finally--permanent base hospitals. Upon completion, these facilities were immediately filled with the wounded. Records show that the Union Army had 2.9 million men; the Confederate Army had but 1.3 million. At the onset of war in 1861, only thirty-eight truly qualified surgeons were available to serve this large number of soldiers. Before the first major battle of the Civil War began, surgeons on both sides were kept busy with various minor duties. These included pulling teeth, lancing boils, treating skin rashes, and trying to combat diarrhea and other communicable diseases. Just a few days on the battlefield taught surgeons that the sooner they operated, the better the chance of survival for their patients. Delay meant death from blood loss, shock, or eventual infection. Most surgical procedures were performed after a retreat, when the wounded could be pulled from the battleground, loaded onto horse-drawn ambulances, and rushed to a surgical field station. Display of a green flag proclaimed that a surgeon was at work. The operating room was usually in the open, but sometimes it was in a tent, barn, or shed. The operating table was usually the tailgate of a wagon or a door placed across two barrels. It was frantic surgery for the most part. Surgeons would glance hastily at the wounded, rip away garments, then cut, saw, and sew. Most of the injuries and wounds were to arms, legs, hands, and feet; usually bullets caused them. In most cases, amputation was the only choice. The wounded soldier was removed from the field ambulance and given a strong drink of whiskey. While he awaited the operation, he was given a large dose of opium, if there was any. After the patient was placed on the table, the surgeon's assistant knocked him out. He did this by using a folded cloth that had been soaked with chloroform--the most widely used anesthetic during the Civil War. As soon as the patient was unconscious, the surgeon began the operation. He cut and sawed while one of his assistants chanted time, second by second. Surgeons had learned that the fast operation was the most successful one. Rapid surgery reduced the amount of shock, which itself often claimed lives despite the success of the operation. Surgeons in the Civil War often brought their own operating tools because there was a serious shortage of instruments. When a surgeon operated, he used just a few basic tools: some scalpels, probes, bullet extractors, and clamps for bleeding vessels, sewing needles, and catgut. It was a rule on the battlefield that a surgeon had to stand his post until the last wounded man had received attention. For many, this meant that they were operating around the clock. Often they went days or even longer without any food, rest, or sleep. Many dropped over right at the operating table and, after being revived, immediately went back to work. The incidence of blistered hands and swollen feet among surgeons was high. To assist the surgeon, dressers laid out an array of medications to treat wounds. The surgeon used carbolic acid, bichloride of mercury, alcohol, and bromine salt solutions. Most served as disinfectants. The carbolic acid was quite strong and was applied to amputated stumps to help burn and scar open tissue, which reduced bleeding and infection. The soldier with a lower abdominal wound was usually the unfortunate one. Unless the surgeon could quickly find the penetrating bullet and stop the blood flow from torn vessels, this patient was placed aside while the amputation of limbs went on. Surgeons had discovered that they lost most of their abdominal wound cases. They therefore gave priority to patients who needed an amputation--and whose chances of survival were greater. Head wounds were also given a lower priority than arm and leg wounds. Civil War surgeons could do little for a man with a bullet inside his skull, because probing and removal of the bullet usually led to hemorrhage and death. The American Civil War opened a new era of surgery and led to a modernization of medicine. For instance, old and dangerous practices such as bloodletting were tossed aside. By the time the Civil War ended in 1865, there were an estimated 500,000 battle wounds among soldiers and sailors of the North and South. Most had had surgical attention. The skills of surgeons had been sharpened remarkably, and many of them discovered that they could save more lives using the experience they had gained during the war. These medical men were just as brave as the patients they treated. Several surgeons died from stray bullets or snipers, others from disease. They were heroes. No one could have asked any more from these dedicated Civil War surgeons.