"The Smell of Ether, the Odor of Blood"
Popular but generally incorrect images of Civil War medicine involve surgery-amputations without anesthesia, piles of arms and legs, the surgeon as a butcher. By modern standards, wartime surgery was limited. Despite the lack of both surgical experience and sanitary conditions, the survival rate among those who underwent the knife was better than in previous wars. Amputation was not the only surgical recourse available. Surgeons also extracted bullets, operated on fractured skulls, reconstructed damaged facial structures, and removed sections of broken bones.
As bullets hit their victims, shattered bone and shredded flesh became the calling cards of the minie ball. Most of the surgeons who had come from civilian practices had little or no experience in dealing with such wounds. They quickly became aware of the surgical options: remove the limb, remove the fractured portions of bone, or clean the wound and apply a dressing. Union surgeons documented nearly 250,000 wounds from bullets, shrapnel, and other missiles. Fewer than 1,000 cases of wounds from sabers and bayonets were reported.
Sickles' exploits extended beyond the Civil War. He was the first defendant to successfully use the temporary insanity defense in the United States. In 1859, Sickles was found not guilty of the murder of his wife's lover, Philip Barton Key, the son of the composer of the national anthem. Sickles had shot Key in Lafayette Square in Washington in a jealous rage after learning of the affair. Sickles served as a secret agent for President Lincoln and was appointed Ambassador to Spain by President Grant.
Anesthesia was an important surgical advance introduced a few decades before the Civil War. Ether or chloroform was applied to a cloth cone that was placed over the mouth and nose of the patient. The patient became stuporous in a matter of minutes. This state lasted for more than enough time to perform an amputation, which took about 6 minutes to complete. Union surgeons used anesthesia in more than 80,000 operations.
Since anesthesia was available, Civil War surgeons attempted new operative procedures to contend with some of the severe wounds they encountered. One such procedure, reconstructive surgery of the face, involved suturing together the soft tissues of the eyelids, nose, and mouth. Sometimes extensive rebuilding of the underlying bone with splints and surgical fixtures was required. Surgeons performed more than 30 of these operations.
Burgan's condition made him a candidate for reconstructive surgery. Dr. Gurdon Buck of City Hospital in New York performed a series of operations to rebuild Burgan's face. Dental and facial fixtures were crafted to fill in the missing bone and support the skin. Burgan's case was the first involving total facial reconstructive surgery. He went on to live a normal life, with minimal visual and physical reminders of the damage.
Although fortunate to be unconscious during surgery, soldiers who underwent the knife often received a nasty visitor a few days later-infection. Any open wound almost always became infected. The unwashed hands of the surgeon, the non-sterile surgical instruments used on a succession of men, and the dirty sponges used on an entire ward of wounded soldiers all introduced infectious bacteria into wounds. These infections often resulted in gangrene and death.
Surgeons frequently treated arm and leg wounds by amputating. The grisly wounds caused by bullets and schrapnel were often contaminated by clothing and other debris. Cleaning such a wound was time-consuming and often ineffective. However, amputation made a complex wound simple. Surgical manuals taught that an amputation should be performed within the first two days following injury. The death rate from these so-called primary amputations was lower than the rate for amputations performed after the wound became infected. Union surgeons performed nearly 30,000 amputations.
Patients undergoing amputation were first anesthetized. A tourniquet was applied above the site of the proposed amputation. The skin and muscle were then cut with amputation knives several inches above the fracture site. The muscles were pulled up to expose the bone. An amputation saw was used to cut through the bone. Once the cut was completed, large arteries were pulled out from the stump tissue with a tenaculum and tied off to prevent bleeding. The skin muscle was then released and the tissue sutured. Two types of amputation were commonly used. A circular amputation involved cutting straight through the skin to the bone and resulted in a stump that was circular in appearance. A flap amputation required the tissue to be cut leaving two flaps of skin that were used to create a stump. Fingers and other small bones were amputated using the smaller metacarpal saw.
Prosthetic limbs were designed and built to help amputees regain some of their former capabilities. Some of these devices were custom-made while others were mass-produced.
Surgeons treated some shoulder wounds with a technique known as excision, also termed exsection or resection. The fractured bone was removed, the tissues sutured, and the limb left to heal. Excision gave the patient limited use of the arm and usually full use of the hand. Prosthetic braces worn over the shoulder allowed nearly normal function of the limb for some patients.
Conservative treatment was employed in the cases of flesh wounds or minor bone fractures. The wound was cleaned of bone fragments, clothing, and other debris and dressed with bandages. Local anesthetic was often applied. Conservation left the limb intact, but the use of unsterilized instruments, unwashed hands, and dirty bandages often introduced infection.
Head wounds were not always fatal. A soldier's prognosis was best when bone splinters were removed and the wound was left to heal. In more severe wounds, trephination was used. Trephination involved drilling a circular hole into the skull to relieve pressure from bleeding or to remove fragments of bone pressing on the brain. Trephinations were fatal in over half of the 220 operations performed by Union surgeons.
To perform a trephination, the patient was first anesthetized. The tissue surrounding the trephination site was then pulled back and the trephine placed on the site. The trephine was turned in a circular motion to slowly cut through the bone. Care was taken not to cut the tissue surrounding the brain. An instrument called an elevator was used to raise sections of fractured bone away from the brain. A Heye's saw was used to remove protruding bone fragments.
Chest and abdominal wounds were nearly always fatal. Treatment of abdominal wounds often involved pushing in protruding organs and suturing the wound. Food was withheld because fecal material leaking from the intestines caused contamination. Opium was often administered to halt the action of the digestive system. Abdominal wounds were fatal in almost 90 percent of the cases reported by Union surgeons. Chest wounds were cleaned and the wound was sutured.