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Civil War Surgery Manuals

The TJU Archives' copies of two rare surgical field manuals from the U.S. Civil War have been digitized and posted for public accerss in the Jefferson Digital Commons. The following titles are now publicly viewable as eBooks:

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Illustration from Confederate States Army medical manual (1863), Amputation, Plate 11. Illustration from Confederate States Army medical manual (1863), Resection, Plate 1.   

These two manuals of military field surgery represent medical instruction for army surgeons of the North and South during the U.S. Civil War. The earlier work was by world-famous Jefferson physician Samuel D. Gross. Dr. Gross (1805-1884) was a graduate of JMC (1828) and later Chair of Surgery at Jefferson. He is the subject of America's greatest painting, Thomas Eakins’ The Gross Clinic and in his time was called “the Emperor of American Surgery.” Written by Gross in a blistering nine days, publishers J.B. Lippincott rushed the portable volume to press in only two weeks. Gross wrote in his Autobiography that it was intended to be, “a kind of pocket companion for the young surgeons who were flocking into the army, and who for the most part were ill prepared… [The book] passed through two editions of two thousand copies each. This little book was far more profitable to me, in a commercial point of view, considering time and labor bestowed upon it, than any other of my productions. A translation of it in Japanese appeared at Tokio in 1874.” So successful was its reception that the following year (1862) it was “pirated” (reprinted without permission) by a Richmond Virginia publisher for use by the Confederate Army medical department.

In an attempt to provide its own Dixie-grown wisdom, the Confederate Army manual of 1863 was compiled by Southern contributors “unambitious of authorship.” One of these unnamed authors was Dr. J. Julian Chisolm, professor at the Medical College of South Carolina. Dr. Chisolm also invented the “Chisolm Inhaler,” a device designed to administer chloroform, which was used as a general anesthetic.

Contrary to legend, supplies of anesthesia (ether and chloroform) were plentiful throughout the Civil War. Morphia and similar painkillers were also available for post-operative care. A combination of modern ballistics specially designed to shatter bone and overwhelming numbers of injured ruled out reconstructive operations on the battlefield where quick amputations became the practical order. In an age before sepsis and germ theory was accepted, most soldiers survived surgery but many succumbed to infection and later died.

Numerous manuals, handbooks and “practical treatises” were published during the war with the intention of getting information into the hands of field surgeons, many of whom were medical cadets, that is, medical students who had limited or no surgical experience.

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   Brigadier Surgeon, John H. Brinton, M.D., U.S. Medical Corps.

In The Personal Memoirs of John H. Brinton (1914) Dr. Brinton, a Jefferson graduate of 1852, relates the following Civil War anecdote of an inexperienced surgeon:

[In Cairo, Missouri]…one of my surgeons [was] a member of one of the Illinois regiments. He was a very earnest man, but at that time very deficient in professional, or at all events, surgical training. In his hospital lay a patient whose leg, seriously injured, demanded amputation. The surgeon came to my office one afternoon, confessing that he had never done, and had never seen an amputation, and moreover had no idea how one should be done, and begged me, at the appointed time, to perform the operation for him. I explained to him that this would never do; his position in the regiment demanded that he himself should remove the limb. And then I explained to him how the amputation should be done, and made him go through the motions, promising him that I would help him through when the time came. On the following morning I did so, and he operated very well, and to the satisfaction of the lookers on. Somehow or other this amputation established his reputation. He at once took rank as an experienced surgeon; nor, better still, did his newborn confidence desert him, for at a battle…some months afterwards, I was informed…that a great surgeon was busy operating in …a little country house, to which many wounded men were being carried.

I found bloodstained footmarks on the crooked stairs, and in the second-story room stood my friend of Cairo memory; amputated arms and legs seemed almost to litter the floor; beneath the operating table was a pool of blood, the operator was smeared with it and the surroundings were ghastly beyond all limits of surgical propriety. “Ah, Doctor,” said the new-fledged surgeon, “I am getting on, just look at these,” pointing to his trophies on the floor with a royal gesture.

In spite of this gory war tale, Jeffersonian William Williams Keen, Jr. (JMC 1862) wrote in his Reminiscences (1905), "I have no hesitation in saying that far more lives were lost in refusal to amputate than by amputation."

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“Pilulae Opii” (Pills of Opium) and vial, “Prepared at the USA Medical Purveying Depot, Astoria, NY,” ca. 1860s. Franklin Zimmerman Collection.   

Keen and two more Jeffersonians helped move medicine into the modern age with a landmark neurological study. Serving as Federal Army physicians at Philadelphia’s Turner’s Lane Hospital, S. Weir Mitchell, George R. Morehouse (both JMC 1850) and fresh intern Dr. Keen were afforded the opportunity to study numerous cases of soldiers who sustained nerve damage. Turner's Lane (at 22nd and Oxford Streets) was a specialty hospital and thus became the America's first neurological research center. This trio of Jeffersonians coauthored Gunshot Wounds and Other Injuries of Nerves in 1864. Gunshot Wounds rapidly became the authoritative scientific work on injuries to the nervous system; it included original descriptions of phantom limb, ascending neuritis, and causalgia (the “burning pain.”) Mitchell would become “the Father of American Neurology” and years later Keen was summoned to secretly operate upon President Cleveland.

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   Philadelphia Orthopaedic Hospital, ca. 1900.

Mitchell and Keen later continued their work at the offspring institution of Turner’s Lane -- The Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases. Incorporated in 1867 it became one of the first American hospitals to focus on orthopaedic treatment and surgery. One of its founders, Dr Samuel D. Gross, hosted the initial planning meeting in his offices at the southeast corner of 11th and Walnut Streets.

Dr. Brinton served as personal physician to General U.S. Grant and would become the first curator of the Army Medical Museum with the aim to improve battlefield medicine. The Surgeon General instructed Brinton to collect "specimens of morbid anatomy . . . together with projectiles and foreign bodies removed" for study at the new museum. Museum staff employed early photography to document the amputations and other procedures of wounded soldiers. First located in the notorious Ford's Theater in Washington, D.C. (site of Lincoln’s murder), the museum shared rooms with the Surgeon General’s Library (later renamed the National Library of Medicine).

Because of the significant roles Jefferson alumni and faculty played during the Civil War, Jefferson Medical College was known as “the West Point of medicine.”

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