Sawbones

Becoming a medical reenactor was one of my dreams. A bucket-list item truthfully, and something for which I had studied for over a decade-and-a-half. So, when the opportunity arose to be a medical reenactor of the War Between the States, I couldn’t believe my ears, nor contain the excitement!

Starting with my first reenactment on the field, I portrayed a medic. Now, two years later, I alternate between medic and assistant surgeon. Since I have treated numerous reenactors for real ailments and emergencies, the boys call me “Doc.”

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There are many things that go into being a medical reenactor. One doesn’t only have to understand the military side of reenacting, the orders on the field, chain of command, the role of infantry, and safety on the field, but also every type of wound they would have incurred and how to treat them. Hours upon hours of research go into every aspect of our portrayal. We have to know every wound, how they would have examined it and determined treatment, what type of treatment they would have given, what tools and supplies they would have used, and whether they would have even had them! These details will change depending on which battle is being portrayed and what year it was, whether or not it was a multi-day or massive casualty battle or not, whether supply trains had been captured, or the blockade had affected supplies, and even which side of the war one is portraying. That means that one has to have an understanding of each battle, the troop movements, the capture of supply lines, and how they managed.

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Explaining that his leg is shattered and we are going to have to take it off, just before I put him under chloroform.

For instance, the Confederate medical corps used Chloroform or Ether whenever they had it, and they had lower mortality rates with its use than the Union army did (None by the end of the war). On the other hand, the Union medical corps was still having occasional casualties from anesthesia complications at the end of the war. They also would not use anesthesia for an amputation on a wound over 24 hours old. They thought the complications from the anesthesia along with the wound would be more than the patient could overcome, but did not account for the shock they would incur, which would subsequently kill many.

What did they do when they ran out of chloroform, such as at the battle of Sharpsburg, or when a Union soldier had received the wound more than 24 hours prior to facing the surgeon? That is the few instances where they would have to call in strong men to hold them to the table. Thankfully, they did have access to medical whiskey (if that had not also been taken in a raid, or drunk by the staff or trouble-making soldiers, as in a few cases), and at times morphine. Morphine had just come on the scene about this time and was being put to use. It came in liquid or powder form, and was applied topically to the wound for local pain relief, or might have a small amount placed in the mouth, or injected into the arm. The problem was that dosing was not yet understood, nor its addictive qualities, and after the war America began seeing its first cases of Morphine addicts and DTs when it was no longer available to them.

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Photo Credit: Kenny Stancil

At the beginning of the war, there was no procedure known as excision, but by the end of the war, there was an entire chapter on the procedure in the medical textbooks!

The procedure known as excision came about because of the physician’s desire to send as many boys home whole or functional as possible. If you read the records, you will see that they did not enjoy carving on boys and taking off limb after limb until they were stacked as high as the windows, or even rooftops, but for many it was the only way to save their life. If the bone was shattered beyond repair, if the blood vessels were severed, or nerve function destroyed then the limb had to come off. To leave it would mean the patient contracting gangrene and pyeamia (blood poisoning), and certain death. But for those whose bones were damaged, but blood flow and nerve function remained intact, could there be another option? The doctors found there was. They would send the patients back to the general hospitals and after they had recovered from the initial shock of the bullet wound(s) – the average soldier came in shot 3-4 times – then they would take them into surgery. During surgery, they would remove the damage section of bone, make sure all splinters or fragments were removed, and ensure that blood flow and nerve function remained intact. Then they would put the two ends of bone together and put the patient in a type of splint which would keep the limb aligned and the bone pieces together. The patient would then have to remain on strict bed rest for 6 weeks with absolutely no pressure on the limb. The idea was that if the bones would grow back together, then the soldier would retain use of his body. It worked! In fact, it worked on such a great scale that it changed the cobbler industry! Cobblers started making shoes with elevated soles so that patients who had undergone excision on their legs could once again walk as a normal man!

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Example of Excision. Picture taken while in Gettysburg, PA.

Amputations were literally a life-saving procedure. Most people think of them as barbaric, but most of the time, it was the only way to save their life or to save as many men as possible. When a soldier was shot with a .58 caliber to .69 caliber Minié ball or round ball, it could literally shatter the bone or joint. It could cause breaks for inches up the bone, or worse yet, the bullet could have lost momentum or ricocheted off another object before impacting the soldier. That impact with another object could cause the bullet to start spinning end-over-end and when it struck the soldier it would continue its momentum, causing spiraling breaks up the bone. If any of these were the case, the limb would have to be removed or the soldier would die a painful death.

The average amputation took only 12 minutes. TWELVE minutes! They had to be fast for multiple reasons. One, if the patient stayed under anesthesia for more than about 15 minutes it would kill them. Another was getting the limb off and homeostasis restored. They also had to be fast because the boy in front of them wasn’t the only one wounded and bleeding to death. By quickly and efficiently treating each one, they could get to more wounded in a shorter amount of time, and thus save more lives.

These doctors, in many cases, were innovators and world changers. Now, you did have the quacks and those without formal medical training treating some wounded (a standard for army medical doctors came into place during the war, but early war was terrible), but there were also those who changed the face of medicine. Many of the things that we take for granted in medicine today can literally be traced back to the War Between the States. These would include such things as washing wounds with cool water instead of warm. This, unknown to them, caused an environment that was unfriendly to bacteria, of which they still did not know or understand. Another is cutting out infectious areas with boarders of good tissue in order to keep it from spreading. We take this for granted today in cancer treatments and severe diseases, but it was more of a novel idea during the war. Sealing wounds came onto the forefront during the war, causing quite an argument through the Confederate medical corps, but they would eventually prove that by hermetically sealing wounds the rate of infection went down significantly. Today we do this with things like sealed dressings, wound vacs, and more.

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Example of a surgeon’s medical case

Prior to, and during the war, abdominal and chest surgery was considered certain death. To go into the chest cavity, the patient would surely hemorrhage or get an infection and die. Yet, the doctors would work on the chest superficially and take out broken pieces of ribs, or tie off surface vessels if the patient had been shot in the chest. They would cover the wound and wait and see if the lung would seal off itself and re-inflate, or if the patient would die. Abdominal surgery was viewed the same way. Most patients shot in the belly, or those who had doctors attempting to go into the belly, would die of peritonitis. Yet, all this would change with the nearly fatal wound of Joshua Laurence Chamberlain at the beginning of the Petersburg campaign. They could not let the hero of Little Round Top die, and so the first successful abdominal reconstructive surgery took place on American soil! (Those details are for another article). Now we take it for granted that surgeons can go and do surgery on whatever organ or body system is need. But that was not an option prior to these brave and innovative surgeons.

I could go on and on about the discoveries and innovations alone for well over an hour (I actually do when I’m lecturing!), but I will not bore you with them in this article. Suffice it to say that these old, barbaric “Sawbones” were hard-working men trying to keep as many men alive and together as they possibly could. Considering the carnage they were seeing, the lack of supplies, and the overwhelming number of wounded, not to mention the diseases and malnourishment which took out 2/3 of those who died, these men achieved more than one would imagine under other circumstances.

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Photo credit: Kathryn Holland. Field Hospital, Hurricane Shoals 2017

When we portray these men, when we stage a field hospital and do surgery on our men, what do we do? We attempt to think of each of these details. We strive hard to make sure that each component from our assessment, to tools, to treatment methods are to the standard of what these men had and did. We choose our cases specifically out of the medical records or journals of the doctors and nurses who treated the wounded. So, if you ever come to one of our events and see my co-surgeon Joel and myself treating the wounded, know that we have done our research and you are getting a little taste of the horror and help that these brave men endured. We hope you will join us soon!

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