Doctors performed amputations for most limb injuries including broken bones, fractures, and gunshot wounds. Although anesthetics such as chloroform and ether were discovered in 1846, techniques were not perfected until the Civil War. Unable to control the effects of anesthesia and wary of its use, surgeons treated most patients without sedation or pain relief in the 1840s.
Surgery, especially for wounds acquired from battle, required the skills of the physicians, but patients who survived the knife sometimes died for a lack of proper sanitation. It was not until after the Civil War that an understanding of the importance of sterilization would come. The soldier who suffered a wound or required surgery was much to be pitied. Even as late as the Civil War in the nation's capitol, the worst conditions existed:
…Large mahogany boxes held the instruments; and the heavy center table was covered with a freshly wiped rubber cloth. But asepsis was not understood. The surgeon rolled up his sleeves, gave his knife a last flick on the sole of his boot, and the operation began. His exploring hands wore no gloves. The probe carried the infection deep into the torn tissues. If one of the sponges, employed to mop out the wound, happened to drop onto the floor, it was squeezed in water and used at once; and, in any case, only a cursory washing had cleansed it of the blood and pus of the last operation.
In threading the needle for the stitches, it was customary to point the silk by wetting it with saliva and rolling it with the fingers. Cold water was the sovereign dressing; bad wounds were repeatedly drenched to relieve the burning pain. Sometimes the wound was covered with wax; or ointments were applied on lint which bad been scraped from cotton cloth by the patriotic but unsterile hands of women and children. Poultices of flaxseed meal or moistened bread were valued for promoting an abundant flow of pus, for all wounds were expected to suppurate.
Blood poisoning, tetanus, secondary hemorrhage and gangrene were familiar visitors in the finest of the shining, whitewashed new pavilions of which Washington was so proud, and helped to fill the pine coffins which went jouncing in the dead carts to the cemetery.
Reveille in Washington 1860-65
Few early hospitals had operating rooms. Surgery was performed on a mess table wherever convenient. Attendants left to administer brandy or stimulants to the sick sometimes drank the liquor themselves to the neglect of the patient.
Amputation was common, especially if there were a compound fracture involved, if the bullet had entered a joint, or if there was uncontrolled bleeding and crushing of arteries and nerves. Two methods of amputation included circular amputation where cuts were made straight through the limb and flap amputation which involved diagonal cuts in the limb so that there would be a flap of skin left behind to fold over the stump.
The following tools are found in our surgeon's operating kit.