The primary form of Civil War surgery was the amputation. The common use of the minie ball, named after co-inventor Claude Etienne Minié in the American Civil War greatly increased catastrophic injuries. Made with soft expanding lead, when the mini ball struck flesh, bones and major organs the injuries were devastating.
A minie ball could be accurately fired from 1,000 yards and the basic line-formation tactics of the Civil War had not adapted to new weaponry. It could easily shatter bones and when faced with these types of injuries, Civil War doctors of this age often had no choice but to amputate.
This may seem archaic but due to the lack of time available to doctors to perform surgery, the high-risk of infection, and the catastrophic destructive power of these bullets, the decision to amputate was typically the right one.
The success rate for amputees was roughly 75% and these odds were good considering the awful nature of the injuries. Many injuries and death were caused by cannonballs, canister shot, shells and bayonets, but the majority of injuries were from bullets.
A woeful 1% of doctors in the Civil War had prior experience as surgeons. Doctors learned as they went and adapted quickly with practice and slowly gained practical experience. Early on there were many mistakes made, and men died from it. But as the war went on the doctors’ skills improved and the care provided increased.
A good surgeon could amputate a limb in under 10 minutes by using a bonesaw and other instruments. Chloroform was used when available to render the patient unconscious and morphine was utilized as a pain-reducer.
The bone was sawed clear through and the limb was disposed of often in a pile of other limbs form previous amputations. Next, the arteries were tied-off with silk, horsehair or cotton thread to stop blood flow to the area. Then the bone would be filed down smooth to prevent the sharp edge from protruding and causing future damage to the area operated on.
Finally, using a flap of skin that was left, it was folded over to create the stump with a hole for fluids to drain. Then the wound was bandaged and the solider was set aside to rest and recover. If infection or gangrene didn’t set in after 48 hours, the chances of survival were greatly improved. When “surgical fevers” did set in, the chance of survival was just over 10%.
Basically the closer the amputation was to the body, the less chance for survival. When a solider came in with a head, stomach or chest wound, they were typically put to the side as they were almost always fatal injuries beyond the help of Civil War medicine. This allowed the Civil War doctors to help the soldiers who had a chance to survive, rather than waste their time on those with a lesser chance.
The skill involved in Civil War surgery developed sharply over the course of the war and the efforts of the doctors really paid off for those lucky enough to survive the terrible injuries suffered on the field of battle.