May 17, 2019 in Medicine

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For the U.S. Residents, the Civil War became the cornerstone of the nation’s history, and certainly the most important war for the entire period of the United States. During those battles, the doctors learned how to do anesthesia correctly, cure the shot lungs, which were considered before as the death sentence, carry out complex plastic surgery, and amputate quickly and qualitatively. All these medical inventions helped not only to save lives of the majority of wounded in that way, and in the subsequent American and non-American wars, but also to become the medical standard, which is underlying or applied in an original form in modern medicine.


At the beginning of the Civil War, the care about wounded was chaotic; therefore, the criticism of surgeons was competent. Employees of all divisions of the regular army expected short war, in which the professionals only had to participate, and tried to conform to the rules accepted for the pre-war army numbering 15 thousand people disseminated through small posts along the border. However, the Civil War involved the larger voluntary forces participating in huge battles followed by the enormous number of victims. Thus, the pre-war system failed. Hospitals with improvised forms of transportation of wounded were organized at regimental level. The wounded soldiers did not receive any medical care for some days. Surgeons worked separately, without any help or supervision.

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While the soldiers in their letters and newspaper articles described the plight of affairs, the new medical director, Dr. Jonathan Letterman, worked over the improvement of medical care. He achieved remarkable success, but these improvements were largely unnoticed by the public. Therefore, public criticism continued to put pressure on surgeons and interfered with them to make the right decisions, which sometimes could cost lives of soldiers.

However, eventually under the incessant press of criticism, the situation in the health service continued to improve. Evacuation and transportation of wounded, the organization and management of hospitals were adjusted. The percentage of wounded who died after being admitted to hospitals dramatically reduced.

Infections threatened the life of every wounded soldier of the Civil War, and the resulting pus produced a stench that characterized the hospitals of that period. When expiring pus was thick and greasy, probably, due to staphylococcus infection, it was called “benign,” because people believed that it was caused by a local infection which would hardly spread further. When pus was fluid and bloody due to Streptococcus infection, it was referred to as malignant because the infection was likely to spread more and could inevitably fall in blood. Medical records from the Civil War show that severe infections, now called streptococcal, were quite common. One of the most killing streptococcal infections during the war was known as "hospital gangrene."

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When a broken bone protrudes from the skin, as it occurred with injury from a broken artillery projectile, such fracture was called "compound fracture." If the bone has been broken into smaller parts, it was called a "fragmented fracture." Bullets and artillery shells commonly broke bones in pieces. Compound and fragmented fractures almost always caused inflammation of bone and bone marrow (osteomyelitis). The infection could enter the bloodstream and cause death, but even if this did not happen, the wounded usually had persistent severe pain with fever, suppuration, and the weakening of the muscles. The lives of soldiers could be saved with amputation, and stump cured with a prosthetic leg was better than the painful and virtually useless limb, from which constantly pus expired.

Antiseptic and aseptic began to spread in the decades after the war and later, during the Second World War, when penicillin was invented, the prospects for patients with osteomyelitis have improved significantly. However, in the mid-1800s the microbes were still unknown. The Civil War surgeons had to work without the knowledge of the nature of infection and without drugs to cure it. The critique for this lack of knowledge was pointlessly.

The Civil War surgeons were constantly reassessing their abilities on amputation and procedures. The military medical societies were formed, and on their meetings only issues concerning amputation were usually discussed. The main alternative to surgical amputation was the removal of the inflamed bone in the hope that the new bone would be formed, and the defect would disappear. The procedure, called a resection, allowed avoiding amputation, but as a result, the limb shortened, and a gap in the bone of the hand or feet occurred. Hand could still retain functionality, but on the artificial foot soldiers often went and stood better than on the leg with the removed bone. Another problem of the resection operation was large duration of amputation that increased risk of death from anesthesia; after resection mortality was generally higher than after the amputation of the same site. As soon as the war expanded, resection was carried out less frequently.

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Unfortunately, there is a myth that during the Civil War operations were done without anesthesia. Contrary to this popular myth, most surgeons did not work with patients without anesthetics. During the Civil War, ether, chloroform, or a mixture of these two substances were under the control of the surgeon’s assistant, who put a piece of clean cloth on the face of the patient, and while the patient was breathing deeply, dropped the anesthetizing medication on that fabric. When the medication started working, there occurred the first signs of loss of consciousness followed by the overexcitement of the patient. Due to safety reasons, the introduction of drugs soon came to an end, and this may explain the surprisingly low number of deaths .

The Civil War surgeons immediately started to work, trying to finish the operation before the stop of the drug action. Although the overexcited patient did not realize what was happening and did not feel any pain, during the operation, he could rush, moan, or scream. For the surgeon to continue the operation, his assistants kept the patient still. Operations, whenever possible, were carried out in the open air in order to take full advantage of daylight, which was brighter than the light of a candle or kerosene lamp.

However, during the Northern blockade, the Confederate Army had a difficult situation with anesthesia. Habitual soaking a handkerchief with chloroform meant extra expense of valuable anesthetic caused by its evaporation. Dr. Julian John Chisolm solved this problem and invented the 6.3-inch inhaler which was the first in its class. A drop of chloroform was dropped on the grid circle, then it was absorbed by the cotton plug located in the inhaler, and the patient breathed vapors through two tubes through both nostrils. In addition, this method allowed more economical spending of anesthetic and warned the inhalation of vapors by medical staff. Using this inhaler reduced the chloroform dose to 1/8 ounce, whereas before 2 ounces of chloroform had to be spent for one patient.

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In addition, during the Civil War a new kind of medical practice was invented and mastered: osteopathy. According to this practice, disease occur mainly due to loss of structural integrity of the body, which can be recovered and brought into a state of harmony or balance by means of specific manipulations. Those manipulations supposedly allow the body to heal itself. Osteopathic manipulation is used for diagnosis, treatment, and prevention of various diseases. The author of osteopathy was Andrew Taylor Still, the surgeon of the Union army during the Civil War. This type of medicine that is used until now was created by Still as an alternative to traditional methods of treatment that have proved powerless in the spinal meningitis that claimed the lives of Still’s three children. Dr. Steele came to a conclusion that many diseases recede after specific manipulations were carried out over a spine of a patient, and the body is experiencing a certain shake-up.

In the battlefield, soldiers often did not keep hygiene and did not care of their teeth. In addition, not many soldiers had toothbrushes, and their diet was defective. Besides, stomatology operations were more expensive, than common operations; therefore, they were accessible not to each soldier. However, despite the above-listed factors, the existence of teeth at soldiers was an important criterion. If the soldier had no six uppers and lower front teeth, he was turned down because these teeth were necessary for loading cartridges of some types of weapon. As a rule, dentists had hospital steward’s rank, but sometimes they could be the full surgeons. The significant contribution to the treatment of fractures of a jaw was made by the dentist Dr. James B. Bean. He used interdental splints, which were made of the vulcanized rubber and had a cup-shaped form. His interdental tires made a big success for that time.

During the Civil War, about two thousand women served as nurses-volunteers. Avoiding habitual household chores, nurses on own experience tested awful tendencies of the Civil War. They dealt with amputated limbs, diseases, spoiled bodies, dead persons. However, they rendered the unvalued help to patients and the wounded soldiers, and also medicine in whole during the Civil War. Thus, the role of women as mediators between patients and doctors considerably increased during the Civil War.

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Moreover, doctors began the modern neuralgia, having developed the new methods of treatment of the nerve injuries. Due to the fact, that most surgeons did not know that they had to wash their hands before starting the operations, a great amount of their patients died from the blood poisoning. Another reason for massive mortality among soldiers was their infection with diarrhea, dysentery, and other infectious diseases due to a lack of knowledge about elementary hygiene rules. The first transportation of wounded from the battlefields was performed using hand litters and two or four-wheeled wagons.

During the Civil War, a great variety of medical tools were invented. Surgeons used large single-edged amputation knives to cut through muscle and skin during the circular amputations. The amputation saw with the steel blade was used to cut through bones after skin and muscles were cut. The Civil War dentists applied the tooth keys for pulling teeth. Patients with amputated limbs used wooden crutch holders with the woolen armrests. For amputation of victims’ smaller bones, such as toes, fingers, hand, rib etc., the surgeons used the metacarpal saws.

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During the Civil War, the North and the South fought for improvement of medical care for their men. Thus, all improvements of medicine of those times became a basis of emergence of the modern medicine in the USA and worldwide. Complete records concerning surgical and medical research remained since the Civil War. Surgeons achieved big success in practice of anesthesia use, and the most important, deeper comprehension of interrelation between the diet, hygiene, and diseases. The doctors extended this knowledge not only within medical institutions but also in society. Participation of nurses in the treatment of sick and wounded soldiers, and also their influence on the interrelation between patients and doctors became one more important achievement.

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