The Civil War spurred developments in medical techniques and instrumentation,
particularly for surgical procedures. Cone-shaped minié bullets (minié balls)
made of soft lead caused great damage to tissues and bones and the resulting
wounds usually became infected. Surgeons used probes of different sorts to try
to remove bullets and clean out wounds, but if these efforts were unsuccessful
or if the wound was severe, more extensive surgery would be required.
Often, the only way to save a soldier’s life was amputation, cutting off the
damaged limb. Another technique, used more often later in the war, was excision
or resection. This removed only the injured section of the arm or leg, leaving a
shortened, less functional limb.
Soldiers did not have to “bite the bullet,” as Civil War surgeons used anesthetic
for virtually all amputations and for many other procedures as well. Still,
amputation was a grisly procedure. Assistants were needed to administer the
anesthetic (chloroform or ether, usually dropped on a cloth held over the mouth
and nose), to keep the main artery closed, and to hold the limb being cut.
Though unconscious, patients would still move about, so they needed to be
restrained. In field hospitals, amputations were performed in the open air
rather than in the dark tents. Some soldiers witnessing these public, bloody
scenes became prejudiced against surgeons, labeling them as butchers.
Medical kits included a wide range of cutting tools: knives, scalpels, bistouries
(long, narrow knives for minor incisions), curettes for scraping and cleaning,
and double-bladed lancets for making punctures. Tools used for amputations
included tourniquets, scalpels, knives, bone saws, chain saws, sutures and
bandages.
There were two main approaches to amputation procedures: the circular method and
the flap method. In the first, the skin and tissue were rolled up, then pulled
down and sewn closed after the limb was cut off. In the second, two long flaps
of skin and tissue were cut, then folded over and sewn to form a stump.
Infections after surgery, such as the condition called “hospital gangrene,” were
very common, often causing the death of patients.
If the soldier survived, he could benefit from improved prosthetics. Braces of
different sorts, articulated artificial legs and artificial arms outfitted with
hooks and other tools were all developed to aid amputees. Amputations became
rather common during the Civil War; in fact, Philadelphia’s South Street
Hospital earned the nickname “Stump Hospital” due to the volume of amputee war
veterans served there.
By this time, physicians had largely abandoned the so-called “heroic” methods of
medical treatment, such as the blood-letting once thought to relieve
inflammation. Wartime conditions called for a different sort of heroism: the
courage to experiment, sometimes radically. New techniques emerged such as
tracheostomies, arterial ligation, neurosurgery, and even plastic surgery to
repair damaged faces. In an era before X-rays, doctors had difficulty assessing
damage to the inside of the body. Serious wounds to the chest and abdomen were
nearly impossible to treat and usually resulted in death. Civil War surgeons,
however, had some success in repairing damaged lungs and bowels.
Thermometers were rarely used for medical purposes at the time, since they were
cumbersome and body temperature was not usually studied apart from other
symptoms. Hypodermic syringes for injections were also uncommon, as most
medicine was taken orally. Nevertheless, doctors often used the most advanced
technology of their day, even in the field—stethoscopes for listening to hearts
and lungs, microscopes for examining blood and tissues and cameras for taking
photographs of patients and wounds. Many of these tools were designed and made
in Philadelphia, which was a major manufacturing center for precision
instruments of all types.