continued from Sun. 5/9
B. The Civil War 1861-65: "The Civil War proved to be the single greates influence in the development of American surgery after the founding of the nation." (Rutkow 447)
1.Huge number of casualties; antiseptic techniques were unknown and many died of infection rather than the initial wound.
2. 90% of the wounds suffered in the civil war were from bullets, making it the first war in which the rifle was the primary cause of death.
3. the sheer number of casualties necessitated the development of a system for managing them, which included battlefield aid stations, field hospitals and general hospitals.
a. the aid station: usually located in close proximity to the battle, it was the first stop for the wounded soldier.
1. staffed by a regimental surgeon whose primary concern was controlling bleeding, bandaging wounds and administering opiates or liquor for pain and shock.
2. Over the course of the war a horse drawn ambulance service was developed for transporting wounded soldiers from the aid station to the field hospital.
b. the field hospital: usually located within two miles of the battlefield, it was often a barn, church, or home that was commandeered for the purpose.
1. the field hospital was often easy to recognize by the piles of amputated limbs left in plain sight.
2. the operating table was usually a wooden slab, or a door, or planks placed over barrells.
3. Instruments and surgeon's hands were rarely cleaned.
4. The injured soldier was evaluated; an attempt to remove foreign matter from the wound was made and damaged tissue was cut away. A soldier with a head or abdominal wound had less than a 10% chance of survival; they were given whatever opiates were available until they died.
5. Treatable wounds were dealt with as quickly as possible, amputation being quite common. Fast surgical action helped given the unsanitary conditions.
c. The General Hospital: located in large urban areas, the General Hospital was the final stop for injured soldiers. They were a vast improvement after the aid station and the field hospital.
1. wounded were often transported via trains, marked as hospital trains. The journey was often long and painful.
2. Hospitals were designed in a pavilion style. They were large and well ventilated. "The success of these large, airy institutions was evident: federal hospitals cared for more than a million men during the war, and less than 10% of them died." (Rutkow, 442)
4. anesthesia was still a relatively new, and controversial, medical development at the beginning of the civil war, but it's use became commonplace for both North and South. Chloroform was the agent of choice in the field hospital because it was fast-acting and inflammable.
5. Hemorrahging and infection of wounds were the major complications. Hospital gangrene was a problem and often attributed to miasma.
6. The civil war served to introduce numerous physicians to surgical principles. Untrained doctors underwent a trial by fire, receiving their surgical training on the spot and learning as they went. But the sheer number of wounded and operations broadened their knowledge and furthered American surgical practice.
7. The Medical and Surgical History of the War of the Rebellion (six volumes published between 1870-88) was received in Europe as the first substantial academic accomplishment of American medicine.
