Articles from prior issues of The Advocate

November/December, 1995

DDS Medical Consultant Demonstrates Field Amputation
by Keith Odom, BRADE

AH, THE CIVIL WAR, DASHING men in blue and gray fighting heroic battles, singing stirring songs, and penning love lyrics for their sweethearts. Wouldn’t it be great to have lived then? Dr. David Brinkman has a one-word antidote for this type of thinking: MEDICINE. Wounded soldiers had few treatment options, none of them pleasant. Amputations were performed routinely; “bleeding” and leeching were standard procedures; anesthesia was still in its infancy. Many patients survived in spite of their treatment rather than because of it.

Paul Brinkman, for years a practicing surgeon, is now a medical consultant at the Maine DDS and a full time Civil War enthusiast. General session attendees on Friday, October 27, 1995 were transported to an earlier era by Dr.Brinkman’s dynamic presentation, which included a 30-SECOND AMPUTATION! But more on that later.

Doctors were scarce throughout the Civil War. Exact figures are not available for the Confederacy, but the Union never employed more than 13,000, and the Union is thought to have had the larger supply. The few available doctors had woefully inadequate training by today’s standards. Medical school lasted from six weeks to two years, though some doctors did only a brief apprenticeship. Others had no training whatsoever. Nurses as we know them did not exist at the beginning of the war, battlefield nursing functions being assumed by other soldiers or by military “misfits” who were incapable of fighting. Then a patent clerk from Washington, D.C. named Clara Barton went to the railway station after the Battle of Bull Run to visit the wounded. She was so appalled at the botched treatment they’d received that she bought a wagon and founded her own nursing corps. Dorothea Dix, another nursing pioneer, staffed her corps exclusively with women who were: 1)over age 30; and 2)”uglier than sin.” Hardly the angels of mercy the soldiers were dreaming of!

In the mid-nineteenth century, disease was believed to consist of disequilibriums in the “air,” the blood (too thin or thick), or the bowels (too loose or constipated). Contemporary medical textbooks did not include the term INFECTION. This is hardly surprising, considering the bacteria were too small to be seen under the most powerful microscopes in America in the 1860s. Of the more than 600,000 fatalities in the Civil War, two thirds were due to microbial diseases such as measles, mumps and chicken pox. These diseases went essentially untreated.

Infections were considered a type of INFLAMMATION. A “localized inflammation,” such as boil, would have been treated with leeches, which coincidentally had the property of disseminating heparin through the inflamed tissue, thus thinning the blood and reducing the swelling. A “generalized inflammation,” such as a fever, would have been treated with VENIPUNCTURE (bleeding). The loss of blood disposed of the symptoms of fever: the patient’s body temperature dropped and he became pale instead of flushed. Care had to be taken not to over bleed or the patient would die, the fate that had met George Washington 60 years earlier.

Diarrhea was the unglamourous cause of a large number of Civil War deaths. Codeine could stabilize the rapid dehydration, but unfortunately was highly addictive. Colchicine was needed as a laxative to counteract the codeine. Birch bark tea, a Mic Mac Indian remedy, was effective against fevers, though no one realized at the time that it contained the same active ingredient that would later be used in aspirin.

Gunshot wounds claimed many lives, not surprisingly. Soldiers shot in the head, chest, or abdomen were thought untreatable and generally left to die; soldiers shot in extremities generally underwent amputations to prevent the onset of gangrene. Approximately 50% of Civil War amputations resulted in death due to infection. The risk of gunshot wound complications was magnified by poor transportation to and from battlefields. There were no paved roads. A fallen soldier might try to crawl to a hospital, wait for an ambulance (of which there were few), or stay put and wait for a doctor. Ambulances were undesirable as they were little more than wooden carts pulled by civilians. They traveled along ad hoc roads made of logs laid perpendicular to the path called “corduroy roads.” More often than not, patients would get thrown from the wooden box at the rear of the cart, or would be so jounced by the ride that they felt worse off than when they got in. Ambulances were nicknamed “avalanches” as a result. Most soldiers preferred to lie where they fell, often waiting 24 to 48 hours to receive treatment.

Amputations were performed with brutal swiftness. Dr.Brinkman dramatically demonstrated the technique by performing an above-the-knee amputation of HIS OWN LEG - a mock amputation, of course. First, he tied a tourniquet above the site and “cranked it tight” with a tightening knob. Then he plunged a long, thin knife into the tissue of his thigh anterior to the femur and sliced perpendicularly upward. He did a similar plunge-and-slice with the tissue on the posterior side. Then he took a broad, flat blade and sawed through the bone itself. He quickly wrapped the stump in linens to stop the bleeding. Someone in the audience timed him at 35 seconds. “A good surgeon could do it in 30,” he said.

Anesthesia was available but was far from perfect. The most commonly used type on the Union side was chloroform, which had been developed in the 1840s by Samuel Guthrie, the same gentleman who developed percussion caps for miniballs (bullets). Chloroform was quite effective but could cause liver toxicity if administered improperly. Ether, developed by dentist William Morton in 1849, was a potent general anesthetic; but unfortunately it was also highly flammable, rendering it impractical for operations by lamplight. The Confederacy had only one anesthetic; “good Wild Turkey.” The patient was given a few shots of liquor, held down by several of his buddies, and given a bullet to bite to distract him from the pain of the operation. (Hence the expression “bite the bullet.”) Confederate hospitals were often built next to distilleries where patients were sent to work during their recovery period.

To crib from Hobbes, life during the Civil War was nasty, brutish, and short. Anyone who heard Dr. Brinkman’s presentation could hardly yearn for those days to return. Dr. Brinkman is an animated speaker who fills his discussion with jokes and anecdotes. Those who heard his lecture will certainly never forget it, and the Maine DDS is lucky to have him on staff.