Wounds and Injuries

Medical treatment of wounds and injuries during the nineteenth century was fairly primitive, and not substantially different than medical practices over the preceding few centuries. Doctors had little knowledge of bacteria, and therefore did not understand the importance of washing hands or sterilizing medical instruments when treating open wounds. Physicians learned that some substances seemed to aid recovery, such as iodine and bromine, but their properties were more mystery than scientifically understood. Additionally, antibiotics had not yet been discovered. As a result, even minor cuts could become infected and lead to severe disability or death. During the Civil War, more than 475,000 soldiers were wounded in battle. Thousands more suffered injuries in camp or on the march. Medical care for wounded and injured soldiers typically involved closing wounds and setting broken bones. After suturing or bandaging these injuries, physicians would carefully observe their patients and try to offer some medical support, but recovery most often depended upon the wounded man’s natural healing. Some medical practices had unintended consequences, both positive and negative. Horsehair proved to be a popular material for sutures, due to its length and strength. To improve its elasticity, Civil War doctors boiled the horsehair, thereby disinfecting it. Wounds stitched closed with boiled horsehair were less likely to grow infected from the sutures, although this benefit was not fully understood until after the war. On the other hand, physicians probing for bullets or foreign objects inside a wound often introduced more bacteria and generated worse infections than the patient may have experienced without the procedure. This practice continued well after the Civil War, and likely contributed to President James Garfield’s death in 1881, when doctors repeatedly used unsterilized fingers and instruments while searching for the assassin’s bullet lodged in his body. Doctors understood the danger of blood loss to wounded men, but devices such as the Petit Tourniquet—a French screw-tightened tourniquet designed in 1718—were typically found at a surgeon’s tent rather than with the soldiers along the front lines. Some physicians recommended supplying tourniquets among the soldiers, but others suggested much simpler practices, such as each soldier carrying a handkerchief or cloth strip and a six-inch long piece of wood in his pocket to function as a makeshift tourniquet. These life-saving practices were not mandated among Union and Confederate armies, though, and many wounded men died of blood loss before reaching medical help. The most iconic treatment of battlefield wounds during the Civil War was amputation. Most casualties during the war were caused by musket fire. The large caliber lead balls often shattered bones upon impact. Unable to splint or repair bones so damaged, physicians frequently chose to amputate the wounded person’s limb above the injury. Doctors typically sewed a flap of skin over the stump. Unfortunately, due to the high incidents of infection for reasons described above, amputated limbs often became infected. Gangrene was among the most dangerous conditions, which could lead to death. The only method of combatting gangrene was to perform another amputation further up the limb (if possible) and hope it healed properly. Confederate and Union physicians performed around 50,000 amputations during the Civil War. Contrary to some popular myths, anesthesia, such as chloroform and ether, was in use during the Civil War, and around 95% of wounded soldiers were afforded some comfort before amputation. Hundreds of thousands of soldiers returned home from the Civil War with scars or permanent disabilities from wartime wounds and injuries. The large number of amputees also led to new developments in prosthetics. Lessons learned from the war improved medical care a bit, as Union and Confederate doctors recorded their observations of wounds and treatments. Published reports provided a new wealth of information. However, only after scientists better understood microbes and accepted the Germ Theory in the late nineteenth and early twentieth century did medical practice substantially improve from the Civil War era practices. (Frank R. Freemon, <i>Gangrene and Glory: Medical Care during the American Civil War</i>, 41–50; Terry Reimer, “Wounds, Ammunition, and Amputation,” National Museum of Civil War Medicine; Paige Gibbons Backus, “Amputation and the Civil War,” American Battlefield Trust)

Medical treatment of wounds and injuries during the nineteenth century was fairly primitive, and not substantially different than medical practices over the preceding few centuries. Doctors had little knowledge of bacteria, and therefore did not understand the importance of washing hands or sterilizing medical instruments when treating open wounds. Physicians learned that some substances seemed to aid recovery, such as iodine and bromine, but their properties were more mystery than scientifically understood. Additionally, antibiotics had not yet been discovered. As a result, even minor cuts could become infected and lead to severe disability or death. During the Civil War, more than 475,000 soldiers were wounded in battle. Thousands more suffered injuries in camp or on the march. Medical care for wounded and injured soldiers typically involved closing wounds and setting broken bones. After suturing or bandaging these injuries, physicians would carefully observe their patients and try to offer some medical support, but recovery most often depended upon the wounded man’s natural healing. Some medical practices had unintended consequences, both positive and negative. Horsehair proved to be a popular material for sutures, due to its length and strength. To improve its elasticity, Civil War doctors boiled the horsehair, thereby disinfecting it. Wounds stitched closed with boiled horsehair were less likely to grow infected from the sutures, although this benefit was not fully understood until after the war. On the other hand, physicians probing for bullets or foreign objects inside a wound often introduced more bacteria and generated worse infections than the patient may have experienced without the procedure. This practice continued well after the Civil War, and likely contributed to President James Garfield’s death in 1881, when doctors repeatedly used unsterilized fingers and instruments while searching for the assassin’s bullet lodged in his body. Doctors understood the danger of blood loss to wounded men, but devices such as the Petit Tourniquet—a French screw-tightened tourniquet designed in 1718—were typically found at a surgeon’s tent rather than with the soldiers along the front lines. Some physicians recommended supplying tourniquets among the soldiers, but others suggested much simpler practices, such as each soldier carrying a handkerchief or cloth strip and a six-inch long piece of wood in his pocket to function as a makeshift tourniquet. These life-saving practices were not mandated among Union and Confederate armies, though, and many wounded men died of blood loss before reaching medical help. The most iconic treatment of battlefield wounds during the Civil War was amputation. Most casualties during the war were caused by musket fire. The large caliber lead balls often shattered bones upon impact. Unable to splint or repair bones so damaged, physicians frequently chose to amputate the wounded person’s limb above the injury. Doctors typically sewed a flap of skin over the stump. Unfortunately, due to the high incidents of infection for reasons described above, amputated limbs often became infected. Gangrene was among the most dangerous conditions, which could lead to death. The only method of combatting gangrene was to perform another amputation further up the limb (if possible) and hope it healed properly. Confederate and Union physicians performed around 50,000 amputations during the Civil War. Contrary to some popular myths, anesthesia, such as chloroform and ether, was in use during the Civil War, and around 95% of wounded soldiers were afforded some comfort before amputation. Hundreds of thousands of soldiers returned home from the Civil War with scars or permanent disabilities from wartime wounds and injuries. The large number of amputees also led to new developments in prosthetics. Lessons learned from the war improved medical care a bit, as Union and Confederate doctors recorded their observations of wounds and treatments. Published reports provided a new wealth of information. However, only after scientists better understood microbes and accepted the Germ Theory in the late nineteenth and early twentieth century did medical practice substantially improve from the Civil War era practices. (Frank R. Freemon, <i>Gangrene and Glory: Medical Care during the American Civil War</i>, 41-50; Terry Reimer, “Wounds, Ammunition, and Amputation,” National Museum of Civil War Medicine; Paige Gibbons Backus, “Amputation and the Civil War,” American Battlefield Trust)