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GETTY IMAGES
by Chip Rowe
As it turns out, the bloodiest war in American history was also one of the most influential in battlefield medicine. Civil War surgeons learned fast, and many of their MacGyver-like solutions have had a lasting impact. Here are some of the advances and the people behind them.
1. Life-Saving Amputation
The General Who Visited His Leg
The old battlefield technique of trying to save limbs with doses of TLC (aided by wound-cleaning rats and maggots) quickly fell out of favor during the Civil War, even for top officers. The sheer number of injured was too high, and war surgeons quickly discovered that the best way to stave deadly infections was simply to lop off the area—quickly.
Among those saved by the saw was Daniel E. Sickles, the eccentric commander of the 3rd Army Corps. In 1863, at the Battle of Gettysburg, the major general’s right leg was shattered by a Confederate shell. Within the hour, the leg was amputated just above the knee. His procedure, publicized in the military press, paved the way for many more. Since the new Army Medical Museum in Washington, D.C., had requested battle-field donations, Sickles sent the limb to them in a box labeled “With the compliments of Major General D.E.S.” Sickles visited his leg yearly on the anniversary of its emancipation.
Amputation saved more lives than any other wartime medical procedure by instantly turning complex injuries into simple ones. Battlefield surgeons eventually took no more than six minutes to get each moaning man on the table, apply a handkerchief soaked in chloroform or ether, and make the deep cut. Union surgeons became the most skilled limb hackers in history. Even in deplorable conditions, they lost only about 25 percent of their patients—compared to a 75 percent mortality rate among similarly injured civilians at the time. The techniques invented by wartime surgeons—including cutting as far from the heart as possible and never slicing through joints—became the standard.
As for the nutty-sounding behavior of the leg-visiting commander, Sickles can be justifiably accused. In 1859, while serving in Congress, he shot and killed U.S. Attorney Philip Barton Key, the son of Francis Scott Key, for sleeping with Sickles’s wife. Charged with murder, Sickles became the first person in the United States to be found not guilty by reason of temporary insanity.
2. The Anesthesia Inhaler
A Knockout Breakthrough
In 1863, Stonewall Jackson’s surgeon recommended the removal of his left arm, which had been badly damaged by friendly fire. When a chloroform-soaked cloth was placed over his nose, the Confederate general, in great pain, muttered, “What an infinite blessing,” before going limp.
But such blessings were in short supply. The Confederate Army had a tough time securing enough anesthesia because of the Northern blockade. The standard method of soaking a handkerchief with chloroform wasted the liquid as it evaporated. Dr. Julian John Chisolm solved the dilemma by inventing a 2.5-inch inhaler, the first of its type. Chloroform was dripped through a perforated circle on the side onto a sponge in the interior; as the patient inhaled through tubes, the vapors mixed with air. This new method required only one-eighth of an ounce of chloroform, compared to the old 2-ounce dose. So while Union surgeons knocked out their patients 80,000 times during the war, rebels treated nearly as many with a fraction of the supplies.
3. Closing Chest Wounds
The Cub Doctor Who Kept Lungs From Collapsing
In the early part of the war, Benjamin Howard, a lowly young assistant surgeon, was shuttled to the sidelines with medical grunt work: changing bandages, suturing wounds, and grabbing grub for the docs. But when the other surgeons decided there was no point in treating chest wounds, Howard experimented with a new life-saving procedure.
At the onset of the war, a sucking chest wound was almost certainly a death sentence. Among French soldiers shot in the chest during the Crimean War (1853–1856), only 8 percent survived. The problem, as Howard came to realize, wasn’t the wound itself, but the sucking. The negative pressure in the thorax was created by the opening in the chest cavity. The effect often caused the lungs to collapse, leading to suffocation.
The cub doctor found that if he closed the wound with metal sutures, followed by alternating layers of lint or linen bandages and a few drops of collodion (a syrupy solution that forms an adhesive film when it dries), he could create an airtight seal. Survival rates quadrupled, and Howard’s innovation soon became standard treatment.
4. Facial Reconstruction
The Plastic Surgery Revolution
Carleton Burgan of Maryland was in terrible shape. The 20-year-old private had survived pneumonia, but the mercury pills he took as a treatment led to gangrene, which quickly spread from his mouth to his eye and led to the removal of his
