by Jesse Lawson RN, BSN, LMT
During the time of the Civil War, doctors in the battle field were referred to a “surgeons”. They carried a small wooden case approximately the size of a modern board game box. The wooden box contained simple hand tools, known as instruments, used primarily for amputations and removal of shrapnel. The tools were a variety of single and double-sided knives, a small brush to wipe away the dust from sawing through bone, a saw, forceps use to remove objects from the patient, and a metal probe to locate bullets and bones fragments within the flesh of the injured. Some finer cases included additional tools; woven cloth tourniquets, spacers, or chisels, for example. The tools were manufactured with quality metals and were often seized by opposing forces.
Frequently, wounded soldiers were treated in the open-air, under trees, just off of the battle field. Working on the ground or in a small tent with little or no anesthesia at their
disposal, surgeons would have moments to assess an injury. They would use the small metal rod, known as a probe, to poke around inside of a wound to locate a bullet and assess the extent of injury to bone. If available, a tourniquet was tightly secured above the wound to decrease blood flow to the area before the knives were used to remove the flesh from the bone. Contrary to what is frequently found in movies, saws did not get employed until the live bone was scraped clean of flesh. After sawing through the bone, the flesh was seared closed with a hot metal plate (cauterized) or simply bandaged with strips of cloth, or both.
The tools used today have not changed much. We still use scalpels and chisels; they’re cleaner, of course, but essentially the same. We probe wounds now to find bullets and fragments with x-rays and CAT scans. The saw is now motorized, but the method is the same: scrape off the flesh, and saw off the limb.
Often times, a family home near a train station would be taken over as a hospital. Wounded soldiers could be sent by train from the field to hospitals or a recovery area. Surgical tables could be created by removing the interior doors of the house and laying them across saw horses. Other than being indoors, the conditions and treatments were no different, except, nurses might be present.
Nursing, as we know it, was in its infancy during the Civil War and was previously dominated by men. It was believed that woman simply could not tolerate the horrors. Increasing numbers of wounded and sick increased the demand for care-givers, and women came to the rescue. No official nursing schools existed. Women volunteered and worked long hours in these hospitals cleaning, feeding, changing bandages, and providing comfort. Nursing legends Dorothea Dix and Clara Barton (founder of the Red Cross) made history with their nation-wide efforts to recognize and organize women in nursing. Louisa May Alcott, another nursing legend, recorded her experiences as a Civil War nurse. While she was not alone, very few did.
The theory of germs was also in its infancy and more people died from post-surgical infection than from wounds inflicted on the battle field. Instruments were not cleaned, bandages were not sterile, and hands were not washed. Many surgeons and nurses simply did not know, or chose not to believe the new theory.
To the modern eye, the state of medical care during the Civil War may appear primitive or grotesque. In many ways it was, but this was a time that saw the dawn big change in medicine. Nursing became a science, women found a voice and presence on a national stage that was previously withheld from them, the Red Cross was founded, cleaning and sterilization began to be the norm. These changes became the foundation of modern medicine and much of what is used today.
Jesse Lawson RN, BSN, LMT is a Registered Nurse in a hospital emergency department, massage therapist, educator, and artist currently living in Alexandria.