In 1862, U.S. Surgeon General William Hammond put out a call to medical field officers in the Union Army: Send any specimens of morbid anatomy that might be valuable to military medicine and surgery. It might seem like a strange request, but the medical profession was in the midst of change—from a system based on tradition to one based on evidence.
“When there’s a war, there are evolutionary changes, not necessarily revolutionary changes,” says Jeff Reznick, a historian at the National Library of Medicine in Bethesda, Maryland. Medicine in the United States did some significant evolving during the Civil War. Prior to the war, humoral theory—where an imbalance between the body’s “humours” caused illness—still formed the basis of medical practice. The idea of a germ wasn’t even on physicians’ radar. More than 12,000 physicians served during the Civil War on both sides. Together, they treated patients in the millions, and sometimes they had to get creative and veer off from the teachings of classical physicians.
“The real lasting impact was the change in mindset of both doctors and the people who they were treating,” says NLM historian Ken Koyle. Writing this week in the New England Journal of Medicine, Koyle and Reznick argue that the war instigated these lasting changes in mentality that forever altered the American medical profession:
Perhaps unsurprisingly, one of the most common surgeries conducted during the war was amputation. “The hallmark of a good surgeon was one who could remove a limb in less than three minutes,” says Koyle. “It was effective, but it was brutal.” Working in the field, surgeons learned two key techniques: Leave the wound open and clean it regularly until new skin formed, or close the wound with a flap of skin. The second option was more aesthetically pleasing but came with the potential for painful infection, because it sealed pathogens inside the body—though doctors might not have realized the cause at the time. Later on, when physicians became aware of the concept of germs, this served as the basis for modern closed amputation techniques.
The war also saw the emergence of distinct fields of surgery, with the development of plastic surgery in particular. New York surgeon Gurdon Buck famously photo-documented a series of facial reconstructive surgeries on a Union private named Carlton Burgan in 1862. Burgan had taken mercury pills to treat his pneumonia, but the pills had instigated a bout of gangrene that had taken out his right cheekbone. Buck used dental and facial implants to help Buck’s face regain its shape.