Today, I am launching what I hope will be a short series of blogs to discuss the progress made in medical knowledge from 19th century state of the art to present day surgical practice.
I suppose I should begin with an acknowledgement that 19th surgery was not only the last choice available to save a life, but in fact it was more common to die from this “art” than to live. So, as would be expected, it was chosen and the surgery performed when the patient was most ill and most likely would die anyway. And while surgery performed in a hospital setting might produce a better statistic of outcome, when done on a battlefield or in a battlefield hospital tent, results could be catastrophic. Thus, my tale is one of woe as compared to our present day situation, when the probability of death from or during surgery is very low.
In this blog I will concentrate on the conditions of war during the Civil War and explain what a surgeon knew as well as what was unknown at that time. Much of medical knowledge came down through the ages from ancient times and the Renaissance. Some even emerged during the 17th century, but it did not alter the basic understanding of the human body and how it worked.
Equally important was a lack of knowledge concerning infection, germs, and sepsis which was, by today’s standards, unbelievably filthy in every aspect of surgical practice, especially on the battlefield where the “niceties” of the surgical arena were unavailable. It is safe to say that speed was probably the single most important factor in a wounded soldier living to see another day: speed in stopping the bleeding, speed in carrying him to a field hospital, speed in removal of the injured extremity, if required and speed removing him to a general hospital in a nearby city. Those lingering on the battlefield for hours were unquestionably more likely to die than those picked up soon after injury. But the raging battle often made immediate rescue impossible and many injured simply died where they fell.