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The Civil War was a seminal event in American history as combatants decided whether or not the United States would ultimately become a great nation. Civil War physicians were also faced with important choices and options in that they had been presented with two of the greatest discoveries in the history of medicine. Anesthesia and the importance of asepsis were known in the mid 19th century though many surgeons decided to practice neither.

Anesthesia

The first public demonstration of surgery under anesthesia took place on October 16, 1846, at the Massachusetts General Hospital amphitheater by Dr. John Collins Warren with anesthesia provided by Dr. William Morton (1). Despite their discovery 20 years earlier, ether and chloroform were not always available on the battlefield and some surgeons actually considered anesthesia an impediment to healing and avoided its use (2)

Germs - Enemy of both the Blue and Gray

Joseph Lister's contribution to aseptic technique came late in the 19th century, though there had been ample evidence to implicate microorganisms in the transmission of disease much earlier. Edward Jenner discovered the prevention of smallpox by vaccination in 1798 (3), and Simmelweiss' established the etiology of puerperal (postpartum) fever as a contagious disease in 1861. Nevertheless, infectious diseases caused the greatest mortality in the Civil War and of the 618,000 deaths (360,000 Union and 258,000 Confederate), 2/3 died of infectious diseases such as typhus, pneumonia, infectious diarrhea, typhoid, and tetanus. Surgery under oil lamps  was performed without gloves and instruments were wiped off on aprons between cases. Sick rooms often contained "fumigators" containing herbs and sometimes even formaldehyde to clean the air (4) with glass fly catchers quite common (5). The finding of "laudable pus" 2 to 3 days after surgery was considered a favorable finding in the minds of many surgeons at the front.

A Cure by Amputation

Battles were often fast and furious. The mini ball became a deadly weapon since it flattened on impact (6) causing great damage, so that surgeons who were faced with untreatable infections and unrepairable wounds discovered that a quick amputation was the most effective way to save lives. In fact, æ of all operations in the Civil War were amputations (7,8), and those soldiers who survived generated a market for medical prostheses (9-13) since plastic surgery was only in its infancy (14).

1) "First Operation Under Ether" (1881-1884), by Robert C. Hinckley

This minor surgery was conducted on October 16th, 1846 at the Massachusetts General Hospital Amphitheater by Dr. John Collins Warren, with anesthesia provided by Dr. William Morton. This was a landmark discovery in medicine that gave surgeons time to proceed with more invasive surgery, though many years passed before most surgeons were accepting.

2) Bite Bullet

This is a chewed bullet that was found outside the window of a farmhouse that was used as a hospital during the battle of Cross Keys, VA. on June, 8th, 1862, involving Generals Grant and Fremont. There is always some uncertainty about the authenticity of these artifacts since animals liked to chew these bullets, though the provenance of this one is helpful.

3) Vaccination Set

Ironically, asepsis was obviously not of much concern to the makers of this beautiful cased ivory vaccination set by Weiss. Though millions of lives have been saved by Dr. Jenner's discovery, many physicians fought vaccination well into the 20th century.

4,5) Fumigator and Fly Catcher

This is a large sick room brass fumigator made by J. Foot and Son (London), while the fly catcher is 10" tall and attracts flies with the sweet liquid placed inside.

6) Bullets and Bullet Probes

At the top right of the picture, you can see unfired bullets as compared to the misshapen projectile at the upper left that had been fired and would have caused a great deal of damage after entering the body. Below the bullets is a nelaton probe, invented by the French surgeon August Nelaton (1807-1873) and designed to find the bullet for extraction. Without x-rays, physicians had difficulty differentiating between bullet and bone, so the porcelain tipped nelaton probe was inserted into the wound and spun against a hard surface. The gray lead would put a mark on the white tip if the probe had found a bullet while the tip would remain white if touching bone. Removal could be by either the forceps shown, or by a bullet screw inserted into the projectile.

7-8) Private Jessie Jones

Private Jones was injured in 1862 in Baton Rouge. The wound remained unhealed for seven years until his leg required amputation, as pictured in this CDV that was taken at the Medical Museum in Washington, DC upon his visit there following the war. A trip to the museum in Washington today is always interesting since Civil War artifacts are usually on display.

9-13) Prostheses

Prosthetic devices of some sort were always available to those injured in war. An artificial nose Is here shown in "Armamentarium Chirurgiae" (1693), by Ioannis Sculteti, and another by A. Aubry in "Catalogue Illustre des Instruments de Chirurgie", (1900). One eye is built into eyeglasses to cover orbital trauma, while a finely crafted glass eye is stored in its own box when not in use. Also shown is a very delicate feminine prosthetic hand.

14) Early Plastic Surgery

This early technique of plastic surgery is beautifully illustrated in Bourgery's "Traite Complet de L'Anatomie de L'Homme", which was produced in the immediate post Civil War period. This level of care, however, was not available to most combatants.

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1) First Anasthesia

2) Bite Bullet

3) Vaccination Set
 

4) Fumigator
 

6) Bullet Probes

7) CDV, Amputation

13) Prosthetic Hand

14) Plastic Surgery