Medical Techniques of the Civil War

A few of the Regular Army medical officers had some experience in the Mexican War and Indian border incidents. Others had observed combat casualties or served as volunteers in the Crimea. City surgeons knew gunshot wounds from the police clientele, or gentleman duellists. But prompt diagnosis of the extent of injury, skillful surgery, the initiative and ingenuity to use poor instruments or ill-adapted apparatus, and the techniques of dressing in the prospect of long delays before bandages could be renewed—in all these skills the new Army medics were weak. Fortunately (for the less-severely wounded) the wellinformed military surgeons were often in positions where they could help instruct the volunteers, and the current works of medical literature were relied upon.
The most valuable instruction was a series of pocket manuals issued by the Sanitary Commission on the more important operations, camp and field diseases. Indeed, except for the Bull Run casualties and a few injuries from occasional skirmishes in Virginia in the opening days of the War, the Union doctors had little to do except examine recruits and enforce hygiene in camps. Meanwhile, the volunteer surgeons and assist-

Dramatic Kurz & Allison Iitno of battle of Kenesaw Mountain, June 27, 1864, between Sherman and Gen. Moody McCook on Union side and C.S. General Johnston seems corny but is realistic presentation of point-blank musketry duels engaged in by soldiers generally armed for first time in history of warfare with accurate rifles. Foolhardy tactic explains, but does not excuse, record bloodbaths of battles.

ant surgeons, approximately 4,000 of them throughout the War, studied the Sanitary Commission handbooks until they knew the fundamentals of battlefield repair. As the War wore on, back from battle rolled the ebbtide of broken bodies.
To the problems of repair and treatment after gunshot wounds, a whole new generation of sawbones gave their devoted, Herculean attention. Wounds received in battle were almost always attended with considerable —often dangerous or fatal—hemorrhage. Checking bleeding before it induced shock was of first importance. Adapted from the French service, some form of tourniquet was used: a tie, suspenders, an old rope. But risk of damage from gangrene by shutting off the flow too long caused Dr. Alexander B. Mott of the Sanitary Commission to devise a tourniquet of two strips of metal, strapped at the ends. This left the blood vessels at the sides, as of the leg, free to carry the load, since the pressure was exerted by a pad on one strip, and at a point opposite when the strips were drawn up.
“The use of powerful styptics,” states a contemporary account, “has been recommended by some surgeons, and soldiers were advised to carry a small bottle of some of these styptics with them; but the most eminent surgeons disapprove of their use in wounds of the limbs whenever the tourniquet can be substituted for them, as their use is almost invariably followed by extensive sloughing and ulceration, and they are often unsuccessful in checking the hemorrhage, forming only a huge clot, which, falling away after a short time, leaves the orifice larger and the hemorrhage more profuse than at first.”
In head wounds or places where a tourniquet could not be applied, the styptics, such as persulphate or perchloride of iron, or alum styptic, were useful. A piece of lint which in more glamorous though less sanitary accounts may have been the undergarments of some Southern belle, shredded into fibers, was saturated with the solution and laid over the bleeding. A larger fold of dry linen was put on top and moderate pressure applied for a short time to hold it in place. Uniform and moderate pressure with a roller bandage snugly applied was generally enough to close the smaller blood vessels and inhibit bleeding from the larger. “In the field hospitals there is so much difficulty in the proper application of roller bandages that they are seldom used, a piece of cloth or lint wetted in cool water being the usual application,” said the American Annual Cyclopedia for 1864.
More equipment than a roller bandage and torn handkerchief was needed for the increasingly devastating wounds caused by the Minie ball. So similar was the appearance of the Minie wound to that of an explosive ball, that the two were often lumped together in medical discussions of wounds as two phases of the same problem.
The round musket ball, even of large diameter—.69 or .70 calibers—was readily thrown from its course on striking bone, tendon, even firm muscle tissue. Velocity was low and in spite of mass, the inertia was less; therefore less easily deflected. The Minie ball at greater velocity had two points in its favor. As to mass, it was equal to that of a round ball considerably larger in diameter, or much greater than a round ball of equal diameter. It was also thrown at a higher average velocity and, due to the form of the bullet, the velocity was disproportionately higher at the target, than a round ball of the same caliber. The Minie in its passage drove straight on through muscle, tendon, and bone, leaving a jagged, ugly wound. The temporary cavity effect, though not so large in proportion as the pulping caused by a modern high velocity bullet, was yet far greater than the neat wound channel of a spent round ball.