Then & Now
Instruments & Techniques
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.
Information for this section was contributed by The College of Physicians of Philadelphia, in particular Jane E. Boyd, Ph.D., Wood Institute Research Associate, and Robert D. Hicks, Ph.D., Measey Chair for the History of Medicine and Director of the Mütter Museum & Historical Medical Library. For more information about The College of Physicians and the Mütter Museum, visit www.collphyphil.org.
Image: Surgery Kit, mid-1800s. Courtesy of the Mütter Museum of The College of Physicians of Philadelphia.
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Resources & Reference Material
- Civil War Military Surgery Kits & Sets: Collection of Dr. Michael Echols
- A Call to Arms (and Legs) in the Civil War and in the Iraq War: The Huffington Post