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Moments in Surgical History |

A Civil War Miracle

Ira M. Rutkow, MD, MPH, DrPH
Arch Surg. 2000;135(5):608. doi:10.1001/archsurg.135.5.608.
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WOUNDS OF THE thoracic cavity and mediastinum proved a formidable surgical problem during the Civil War. With surgeons having no technical know-how regarding operative intervention, penetrating injuries were fatal in 65% of cases. Treatment usually involved little more than the attempted removal of foreign bodies by a surgeon's unwashed and filth encrusted fingers and placement of a simple lint dressing topped with a broad chest bandage intended to maintain the chest immobile. Difficulty with respiration, secondary to either flail chest or pneumothorax, was not easily resolved and it was usually a pragmatic matter of the patient either improving on his own or dying. Suprisingly, pneumonia was an infrequent complication of penetrating chest trauma and in this preantibiotic era there were remarkably few cases of erysipelas or tetanus. The overwhelming surgical complication was empyema, which was treated by the insertion of drainage tubes.

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This drawing of Pvt Charles P. Betts was completed by Edward Stauch at the Potomac Creek Hospital 1 week after the private's injury. Published in The Medical and Surgical History of the War of the Rebellion, 1861-1865 (Vol II. Washington, DC: Government Printing Office: I:486), so faithful was the likeness of the patient, as well as the features of the wound, that 3 years later, surgeon S. A. Holman, medical director of the Sixth Corps, in unexpectedly viewing the illustration exclaimed, "I know that man; that's Betts."

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