Subject: Civil War Doctors
Date: Sun, 08 June 1997 02:42:07 GMT
From: fsineath@aol.com (Fsineath) Frederick Sineath
Organization: soc.history.war.us-civil-war
Newsgroups: soc.history.war.us-civil-war

Part 1: Appointments, Examining Boards
    Many of the early war "Surgeons", were political appointments from their respective states (both sides) as were many other staff officers. The term "surgeon" is mainly a military term in reference to a doctor in the service, in fact many of these early surgeons had little to no experience with the knife. There were many able bodied surgeons that come from these ranks, but many not so good as well. When the fighting started these "surgeons" proved their worth, or their worthlessness.
    It is true that in that time there was no licensing board or standards for being or practicing as a doctor. Many before that time studied on their own and if one wanted to practice as a doctor, they hung a sign up and they did. Some later became very prominent individuals in the medical community, most of them didn't.
    There were "proper" medical schools in the north and south, for one to study and obtain the parchment for the wall, but it wasn't a requirement in society in that era.
    When these political appointed "surgeons" first went into battle, both sides soon discovered they had a big problem. This was the main reasons for the establishment of the Army Medical Examination Boards, for those that wanted to become a military Surgeon, they had to prove their knowledge and skill.
    But even this wasn't without faults. Many of those that served on these "Boards" were appointed. Old grudges, ego's and sour grapes from the past unfortunately laid pray to many able surgeons as well. Those that were already in the service had to go before the boards as well as those new coming in. This weeded out many of the incompetent ones, but lost a few good ones too.
    One surgeon that came before the boards, recognized one of the examiners as an old class mate of his from medical school, one that had flunked out of medical school !!, There appears to be no set standard that the boards used to prove who was and wasn't competent. The main part of the examination was an oral battery of questions from the examiners, to which the candidate had to answer the diagnosis and "proper" treatment, to a long series of cases and questions. Another surgeon failed the first time, for which he was puzzled about, he thought his answers were very proper and correct. Before his second interview he learned that what answers that were sought, were what the doctors present preferred, not any known "standard". Medical profession was in a great change during the war, with many advances (despite many modern, and incorrect thoughts on the subject) New items and trains of thought on the treatment of various injuries and ailments were constantly coming about, but rarely "one" set treatment that was standard amongst all, so conflicts of what was proper treatment, occurred. it depended a great deal on personnel preference. Many of these doctors experimented constantly with new ideas and treatments, especially amongst the younger ones.
    Some of these "examiners" were older doctors that were still doing things the "old way", the only way they knew. So many candidates had to study the persons on the board and what they liked and did, rather then what the candidate has learned or knew. The same doctor that had failed the first time, went back and passed on the second round, two of the examining doctors had very different treatments for the same injury question, he learned what they were, and gave both as treatments....and he passed.
    Both sides during the war published "manuals" of surgery, and medical treatments, for their respective medical officers to reference, to attempt in the main part to establish a standardization amongst them. Collection of surgical and medical case studies from those in the field, were done on both sides, and statistics were used to examine the various treatments and figure out which was best as well as collect information on many new techniques that were starting to be used, and go with it, and resulted in many changes in treatments through the course of the war which will be discussed in another chapter.

Part 2: Medical Schools
    In the east, two of the best of the formal medical schools were the University of Pennsylvania and Jefferson Medical College, which also trained many a Doctor that later became Confederate Surgeons (Yes there were many other good schools I know, these were "amongst" the most prominent during the era).
    As also a medical historian as well, one of the common questions I get asked is how long did it take or what it took to become a "proper" doctor in those days.
    For most of the medical schools in the east, from the 1850's till the beginning of the war; two or three years was standard, three years being most common. When the war started, most of these schools shortened the term to two years. There were many attempts to expand it back to three years, but to no avail. No school wanted to be the one to extend it and risk losing their students to another college that still had two years.
    An interesting note that the second year in most colleges was actually a repeat of the first year, with some additional that allowed more time for study, apprenticeship, and anatomy studies. I wont go into the entire catalog of study for the medical schools, but mainly it was chemistry, anatomy, physiology, and apothecary, as well as learning Latin and maybe some Greek. Much of the medical and apothecary terms and measurements were in Latin. Much of it was independent study, as well as in groups. The student "purchased" lecture tickets, as if one was going to see a theater production, to sit in and listen to various professors discuss the various subjects. With examinations at the end of the terms.
    Anatomy was a difficult and hard sought after study. Few of the schools could find and keep enough cadavers on hand to study. Social climate with death and the departed prevented much extensive hands on study. Students were always seeking a way to become proficient in their work, and with acute shortages of bodies to study they even sometimes extended to immoral and improper means. During John Browns raid on Harper's Ferry, several students from a known medical institution came down to see what all the excitement was about and assist with their medical knowledge if needed. and strange enough several of the ones that were killed, their bodies disappeared, only to learn that the bodies had made their way back to the school on the anatomy table. On at least another occasion, a fellow student in the anatomy room, recognized the "specimen" on the table as a recently departed neighbor of his whom he attended the burial of the day before. Now before everyone gets in a tizzy of horror, these historical examples were extremely rare, and not the normal or proper thing to do.
    Many of the Northern Medical Schools continued to thrive during the war. In the Southern states not quite as well. At the beginning of the war the South had 13 Medical Schools, within its borders. Once the war started all of them closed because most of their students had left school to go off to war. One institution was reopened at the request and assistance of the Confederate Government because they knew they would need the potential surgeons that would come from it. This facility was the newly incorporated Medical College of Virginia in Richmond (Formerly known as the Humped-Sydney Medical School, prior to 1860) This facility continued throughout the war. One interesting note on this facility is at the end of the war it survived the Richmond fire, and the buildings were looted and plundered by many of the newly arrived Federal soldiers, and some of the record books were taken away, and some of the medical equipment was destroyed and oddly enough the soldiers, by Federal authorities, were forced to return the taken equipment and paid for the damaged medical gear.

Part 3: "Anesthesia"
    Anesthesia: Unlike what is portrayed in "Hollywood" and in much "modern" conception of what surgery was like during the war, anesthesia was in common and widespread use during the war. The two primary agents were Ether and Chloroform. Ether was in longer use by the time of the war, and used by most early on. Ether had many side affects, and when Chloroform became into common use, many Federal surgeons preferred it because it seemed to work better and had less of the side effects that Ether had. Several unexplained deaths occurred and was blamed on the Chloroform so its use was discouraged, but still used to some degree throughout the war. some surgeons even mixed ether and chloroform together. Confederate Surgeons didn't seem to experience the same problems and used Chloroform freely.
    There are so many embellished stories and Hollywood movies of soldiers "biting the bullet", or screaming in pain during an operation. Many have told me they have uncovered bullets with teeth marks on it, so it "had" to be used during a surgical procedure. Well I've dug up many of these bullets as well, a close examination will reveal that about 80 percent of them aren't human teeth, but those of mice, squirrel's or other animals, which for some reason love to chew on the soft lead from a dropped cartridge and the others, well bored soldiers will be bored soldiers, even chewing on a bullet, I've also found many "dice" and checker and chess pieces fashioned from bullets, even one that was carved to resemble a penis.
    Not saying that the anesthesia supplies were "always" available, usually ran out and the medical supply wagons were stuck in the mud somewhere. There were times were whiskey or similar items were used instead. But these are exceptions to the rule, not the rule itself.
    One must remember when reading diary accounts, and memoirs, that its human nature to write about the extreme or unusual, not normally the basic boring everyday routine stuff, so accounts of these types about the medical observations, were usually the extreme, that's why they wrote about it, if things were calm and orderly when they passed a field hospital, would they still write about it, or how many accounts have been written to this, not many from those in the ranks.

Part 4: "Surgery"
    This is one of the most discussed and reference items of the medical profession during the war. The primary surgical operation performed by field medical officers by far was amputations. (Of those that lived long enough to leave the field.)
    The civil war brought about a new kind of surgical nightmare for the surgeon, that few of the medical officers prior to the war had known. The advancements in weapons and projectile ballistics was the main cause, and also its what placed Amputations at the head of the list as well.
    About 80 percent (depending on the publication you use) of wounds received at the field hospitals were those in the extremities (arms/legs) Most of those stuck in the head or body didn't live off the field.
    Prior to the war, the primary infantry weapon was mainly a 69 caliber smooth bore musket firing a single round lead projectile or "Ball", or even the favored combination of "Buck & Ball", which was one lead ball with three smaller "Buckshot" in the same cartridge. These weapons were normally short ranged in accuracy, and a rather slow moving projectile. Much of the damage done to the body from one of these was by the weight of the ball itself rather than the speed of it. Most of the tissue damage done by one of these was limited to the actual area that was struck. When these same projectiles struck a bone, it may bruise it or if sufficient force remained, crack or break it, but as long as the vital arteries remained intact, the limb could usually be saved.
    With the advancement of "rifled" muskets, and the invention of the "Minnie" ball, surgery took a different turn. These weapons could fire further, with greater accuracy, and higher projectile speeds, with still a large bullet. Which once used to be a local damaged area, became large bullet tracks (path) through the body, and a much greater extent of damage and bleeding. When one of these struck a bone, it no longer was cracked or broken, but smashed into a hundred pieces sometimes, and much greater vascular damage as well. It didn't leave much left with which to work.
    The modern marvels of Artery Grafting, Hoffman Pins to repair shattered bones, skin grafting, fluid/blood replacement therapy, Aseptic/Sterile techniques, these items were many many years down the road of medical discovery, these guys didn't have these advances to work with, so what did they have and why?
    Today we call it the "golden hour", when a serious traumatic injury occurs, the victims chances of survival after that first hour after the injury, to a medical facility greatly decreases as time after that continues.
    Such knowledge was known back then too, but in a slightly different way. They knew that the longer the time from when a wound was received and medical/surgical intervention was performed, the greater the mortality from the same wound. The main reason such operations were "rushed" at a forward location. As a basic statistical example: three soldiers with identical wounds and same treatments:, one was brought straight in, less than an hour since being wounded and amputation was performed, he would have about an 80 percent chance of survival. Second one was brought in eight hours later, he is weaker now, and loss of more blood, (statistically average) this guy would have about a 50-60 percent chance to survive. Third was lost in the woods and brought in the late the next morning, he would have chances of about 30 percent.
    The medical officers and many of the soldiers themselves knew the odds. Many accounts of soldiers at the hospital trying and yelling to be next in line for the surgical table, they knew time was the enemy now. Many surgeons became proficient and quick with the knife, and most amputations only took a few minutes to complete, to the horror and misconception of many observers.
    Many accounts of soldiers observing piles of arms and legs by the surgical tents, this is why. None of the medical officers liked to have to remove a soldiers arm or leg, but it was done to attempt to save his life, or what he had left of it. from what surgical knowledge was known at the time. Many attempts and experiments were done as the war raged on to find an alternative to amputation, to try to save the limb, most of these failed. One that was done to an extent later in the war was known as "resection".
    Resection was performed when the bone of an extremity was beyond repair or splinting, but the arteries and vessels remained intact, and normally done on an arm. Instead of amputation, the damaged bone was cut out and removed, but the remainder of the limb left intact. They no longer had "mobility" of the limb because of the missing bone, they would have to wear a split or brace device for the rest of their lives, but they still had the limb, with some limited use. Resections were becoming more and more common late in the war, and one of the few alternatives that was successful to some extent.