Surgical Tools and Medicines

 

Lets step out of the air conditioned sanitized doctors office of today and throw open the canvas flaps of a typical Civil War doctor’s tent. In most cases, a doctor of the time had little more than two years of informal training in the medical field. With no comprehension of microbiology, a severe lack of training, and a general dismissal of sanitation; diagnostics and treatment of the 1860s was little more than guesswork. This month we will take a look at the top ten frequently used tools and medicine of the Civil War surgeon.

 

1. Mercury – Calomel, a chalk and honey, sometimes with licorice, mixed with mercury, was arguably the most common metal based toxin used. Given orally to patients complaining of everything from a headache to syphilis, this concoction did little beyond adding to the misery of it  recipient. Often if a patient did not respond well to the original dosage, doctors administered more of the “blue powder.”  A few notable side effects of the drug, were dehydration, tooth loss, destruction of the jawbone, and grave digestive damage.  In 1863, William Hammond, then surgeon general of the Union army, demanded calomel be removed from active usage in the field; the general public subsequently dubbed him a quack, and he was removed from his post months later.

                  Mercury was often used in the construction of hats. Long term exposure to the mercury caused cerebral damage, inspiring the term “mad as a hatter.”

 

2. Alcoholic Beverages  Starting with whiskey, followed by brandy, wine, and other spirits, alcohol was viewed as a medicine for a wide range of illness. Sometimes given in large quantities, alcohol was of little benefit beyond temporarily quenching a thirst. As a depressant, alcohol reduced a patient’s perception of pain, making the drink appear to heal. Whiskey did have the attribute of making bitter powders more palatable, especially quinine, which required a daily dose to keep malaria at bay.

      `           By 1862, the Confederate Medical Department had its own distilleries.

3. Plants – with a high agricultural background amongst doctors on both sides of the conflict, the faith in indigenous remedies was high; roots, oils, herbs, and barks all played a key role in the medical pack of the civil war surgeon. The medicinal lists of doctors, especially in the south, sounds a little more like witch’s brew; juniper, dogwood, horsemint, ginseng, bloodwort, butterwort, snakeroot, wormseed, oils of cloves, peppermint, cinnamon, extracts of dandelion, rhubarb, and sarsaparilla. Doctors also relied upon opium, usually in a liquid form as laudanum, to treat extreme cases of pain, agitation, depression, and dysentery.  

                  In 1863 Confederate Dr. Francis Porcher released his Resources of Southern Fields and Forests, a work covering available natural medicines. It was six hundred pages long.

 

4. Bandages – Fine lint, gauze, adhesive plasters, and sometimes cloth rags were used for hospital bandages. There were reports of Union surgeons using corn husks to cover wounds. This is defiantly one area of the conflict where the South had an advantage. When their supply of material for bandages ran short, southern hospitals turned to raw cotton as a supplement.  No matter what the material, bandages were never sterile. Doctors even insisted that bandages be kept moist, providing ideal breeding ground for bacterial growth; add to that the spread of disease caused by the removal of a deceased man’s bandage, the washing of it, and reapplication on a living man, and the numbers of bacteria reached uncountable levels. Perhaps the best treatment of a wound was to leave it uncovered. Often times an open wound would have maggots feasting on the dead tissue keeping it cleaner than the bandaging techniques of the day.

                  To “decontaminate” wounds before bandaging, medics sometimes used carbolic acid, bromine, or turpentine.

 

5. Scalpel – Along with the standard straight knife, most surgeons had curved and blunted scalpels. These were used to maneuver around tendons and bones or to prevent puncturing near by organs and arteries. These knifes were more of a jack of all trades. Used to incise skin, cut bandages, scrape bone, slice muscle, and lance boils, a surgeons scalpel in the changing of patient’s received sometimes little more than a wipe on the blood stained apron he was wearing. As the war progressed, medical instruments in the south became extremely scarce. Surgeons relied on what they could find; pocket knifes, kitchen knifes, and small daggers replaced scalpels. Confederate surgeon general Samuel Preston Moore scoured the south for spare medical instruments. He managed to find a few from retired or deceased doctors, but the shortage was never resolved.

                  There are reports of a Union soldier in a Confederate prison who amputated his own gangrenous feet with just a pocketknife.

 

6. Suture Thread –  When running off to war, surgeons on both sides stocked up on silk thread and catgut. Both were well suited for sewing together cuts, holes and stumps. Over time, as supplies ran out, they relied on cotton thread. To aid in threading their needles, doctors  would moisten the thread with saliva and rub it between their unclean fingers. This contaminated material often lead to cases of severe infection.  Many cases of hastily sewn amputation stumps would burst open from poor suturing, necessitating an amputation higher up the limp.

                        When cotton sutures ran out, Confederate doctors were known to use horsehair.

 

7. Probes – To search for and remove shell fragments, bullets, bone and other foreign matter, surgeons used a wide variety of probes, tweezers, hooks and even their fingers. Like everything else in the medical field, these instruments were not sterile, leading to the spread of disease and bacteria from patient to patient. Often times as surgeons had to work fast and anesthetics were scarce, patients would have to be physically restrained by orderlies as the surgeon probed around for the cause of a wound.  Numerous reports show that often foreign bodies were not completely removed from a wound.

                  In April 1865, when examining Abraham Lincoln’s head wound immediately after the shooting, attending doctors probed the bullet hole with their fingers – a common practice.

 

8. Tourniquet - Every standard medical satchel included at least one strap for cutting off blood flow.  Typically there were used on three occasions. 1. At dressing stations to slow arterial bleeding on those awaiting transport to a surgeon. 2. on the operating table to allow stitching or surgery. 3. Applied to a limb after the artery disintegrated and burst from infection.  In the last case, mortality reached more than 60 percent, and tourniquets served on to prolong the inevitable.

                  Some doctors discouraged tourniquet use for fear of cutting off blood to healthy areas.

 

9. Bone Saw – There were an estimated sixty thousand partial or complete surgical removals of limbs during the war. In almost every case, a bone saw was vital. It’s stated that if an appendage can be amputated within 24 hours the body had an 80 percent survival rate. After forty eight hours the survival rate dropped to 40 percent. The two most common forms of amputation were circular and flap.  A circular amputation involved slicing the skin in a perpendicular manner just below where the bone was to be cut. The surgeon then cut away an inverted cone of muscles and tendons. An assistant pulled the flesh up along the bone and the doctor sawed his way through. A single flap amputation used a diagonal cut across the limb. After cutting the bone and closing blood vessels, the doctor pulled the flesh over the bone to create a cleaner more uniform closure than the circular method.  Even in a world full of disease and bacteria, civil war amputees had a three in four chance of survival.  Most of these men would have died within days of their injury had the limb not been removed. 

                        Of all field surgeries conducted, 75 percent were amputations.

 

10. Anesthetics -  Ether and chloroform were discovered in the 1840s. Chloroform was more widely used.  Patients were finally spared the pain of invasive surgery, and doctors could work on a stationary subject. The anesthetic was poured onto a cloth and held over a patient’s nose and mouth. As soon as the patient went limp, the surgeons went to work. In many cases as these chloroform masks were reused, the resulting dosage of anesthetic received by the patient proved fatal. There are reports of patients receiving treatment with no anesthetic. In many of these cases, the patient suffered lasting mental trauma and in a few cases cardiac arrest during the procedure.

                        Stonewall Jackson received chloroform for the removal of his left arm. On his deathbed, Jackson described being anesthetized as “the most delightful physical sensation I ever experienced”

 

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