by Melody Amsel-Arieli
The Civil War, which left over 600,000 dead, was the bloodiest war in the history of the United States. Initially, surgeons tended the injured at the front, in fields, barns, tents, stables, and private homes. “Conditions were frightful,” wrote Dr. Nathaniel Alexander Morgan, a Confederate physician serving at a Battle of Chickamauga (1863) makeshift field hospital. Later, when hospitalization became more organized, medical personnel bandaged wounded who made it back to field hospitals, giving them whiskey to ease the shock and morphine or opium to ease the pain. Then they evacuated them to hospitals in nearby towns and cities.
Before the Civil War, when germ theory was still unknown, physicians commonly advocated traditional purging, cupping, and bloodletting to treat disease. Facing unprecedented numbers of the gravely injured in huge battles, however, forced them to devise innovative life-saving practices, techniques, and surgical procedures. In gaining emergency training and battlefield expertise, these physicians planted the seeds of modern medicine.
Through the mid-19th century, most medical manufacturers produced custom-ordered, individually crafted surgical instruments. Others filled custom orders with pieces imported from France or England. At the beginning of the War, many Union physicians brought existing surgical sets, comprised of custom instruments, with them to war. State Voluntary Militia Surgeons and part-time contract surgeons often arrived with their own as well. Most are unmarked or feature only personal identification. The U.S. Army Medical Department also issued custom surgery sets.
When American manufacturers began mass-producing medical instruments, the U.S. Army Hospital Department ordered thousands of sets for Union field surgeons from sources large and small. Hernstein, Tiemann, Kolbe, and Gemrig were among their major suppliers.
Most Union surgeons were general practitioners. So they were issued all-purpose surgical sets outfitted for an array of battlefield injuries. Along with amputation instruments, these typically included trephines, retractors, bullet extractors, razors, forceps, along with lancets, tourniquets, tweezers, bone gougers, hooks, probes, scalpels, surgical razors, suturing needles, and wedge-shaped Hey’s Saws, useful in skull surgery.
Experienced surgeons sometimes received specialized instruments. Urologic sets, for example, contained assorted brass tubes, gum catheters, syringes, knives, and dilators. Trephining sets contained hand-twisting saws that, much like apple corers, cut circular holes in skulls to treat fractures and compressions. These feature not only convenient T-shaped handles, but also central spikes to hold skulls in place.
Amputation Tools and Skills for Speed and Survival
Amputation sets routinely contained tourniquets, hooks to pull arteries from limb stumps, bone-grasping forceps, long, sharp Liston knives for slicing through muscle, surgical razors, perforated-edge, bone-cutting saws, and bone brushes, used to clear bone dust from amputation sites. Some also included finger saws, used for fingertip amputations.
Three out of four battlefield procedures were amputations. Senior surgeons, the only ones authorized to perform them, strove to leave limbs intact. Extremities that were badly infected or gangrened, however, could not be saved. Neither could those shattered by a new type of bullet, the slow-moving, soft lead, expanding Minié ball. According to A System of Surgery, (1879) by W. T. Helmuth , their effect was devastating.
…bones are ground almost to powder, muscles, ligaments, and tendons torn away, and the parts otherwise so mutilated, that loss of life, certainly of limb, is almost an inevitable consequence. None but those who have had occasion to witness the effects produced upon the body by these missiles … can have any idea of the horrible laceration that ensues. The wound is often from four to eight times as large as the diameter of the base of the ball, and the laceration so terrible that mortification [gangrene] almost inevitably results.
Despite tales to the contrary, most amputation patients were anesthetized, either by liquor, opium, morphine, hypnosis, or face-sponges soaked in chloroform. Though these operations did save lives, they were performed on simple, wooden planks or unhinged doors balanced on barrels, with surgical tools merely wiped clean. So many patients died later of infection.
Though many of the fallen were buried on site, others—concerned for their families back home—contracted embalmment in advance of possible death. Regular army surgeons, because they were familiar with chemical injections, performed these procedures in post-battle embalming tents. Tools of their trade included anatomical syringes, pipes of various widths, and post-mortem pumps that forced preservative fluid through the arteries of the deceased. This sideline was very lucrative, especially if surgeons teamed up with undertakers, who dealt with body preparation, removal, and transport.
As the War wore on, both the Union Surgeon General and the Confederate Army Medical Bureau requested that surgeons send them unusual specimens of amputated limbs and other findings for pathological study. Regimental surgeons prepared these with autopsy, post-mortem, or anatomical dissection surgical sets, outfitted expressly for this purpose. Typical ones contained needles and thread, Catlin knives, scalpels, forceps, scissors, chisels, intestine cutters, artery clamps, forceps, blowpipes, and chain-and-hooks.
Differentiating and Authenticating Civil War Medical Tools and Sets
Union Army surgical sets, whatever their purpose, usually feature ebony, horn, wood, or ivory-handled tools in ornate mahogany cases outfitted with plush interiors. Most feature sliding locks, brass corner-inlays and brass plates engraved with some variation of “Medical Department, U.S. Army,” or USA Hosp. Dept.” In addition, plates may reveal dates of production, as well as names of manufacturers. Since many were active before, during, and after the War, these details will help determine authenticity.
Although Union soldiers were held responsible for returning surgical sets to the U.S. Government after the War, they sometimes sold them—with identifying plates removed. In addition, many were destroyed, sold as surplus, or auctioned to distributors.
Surviving surgical sets may be incomplete or contain replacement instruments produced by a variety of manufacturers. Those with original pieces intact—authentic plates indicating names of actual surgeons, and whose provenance is supported by documentation like letters, government forms, photos, or citations—are very collectible. Complete, well-crafted, aesthetically appealing sets in prime condition with original, unique instruments made by a single, known manufacturer, traced to actual surgeons in specific Civil War battles, and backed by believable chains of ownership, are most desirable of all. They are also extremely rare.
Because the Confederate Army Medical Department did not issue official sets, its surgeons provided their own. Most were acquired from Southern blockade runners, or during pre-war studies in the North or at English medical schools. These were usually unmarked.
Similarly, if Confederate surgeons acquired Union surgical sets during or after the War, they often disfigured or removed their identifying plates.
Not all collectors seek complete sets. Scores concentrate on individual types of surgical instruments, say amputation knives or surgical saws, because they were produced in a variety of materials, shapes, and sizes. Many prefer pieces associated with specific bygone battle field procedures like trephines, bullet extractors, or stump hooks. Some favor instruments with ornate, gilded or carved handles, or pristine pieces sold as surplus. Others seek rusty or bloody ones.
Individual instruments and surgical sets are sometimes found in Civil War shows and flea markets. Auction houses, antique stores, and antique fairs, however, are usually more reliable sources. In any case, collectors should be wary of instruments with post-1880s metal handles, fake plate engravings, as well as pieced-together surgical sets repackaged for post-War, civilian use. These hodge-podges, assembled toward the end of the War and just afterwards, might, for instance, pair pre-war wooden cases and pre-war instruments, with wartime instruments.
“Lucky” finds are usually due less to luck than knowledge. Serious collectors are advised to frequent Civil War shows, endlessly ask questions, then explore Civil War history, mid-19th century surgical procedures, and related surgical instruments.
Enthusiasts may find Tiemann’s Catalogue of Surgical Instruments (1872), available at https://archive.org, of interest. Exploring Gemrig’s Surgical Instruments Illustrated Catalogue (1866), and “Civilian and Military Civil War: Medicine, Surgeon Education & Medical Textbooks,” a collection compiled at http://www.medicalantiques.com by Dr. Douglas Arbittier, MD, MBA, a longtime collector of medical and surgical antiques, may also prove worthwhile.
To collectors, placing Civil War surgical sets in context – even those without documentation – may bring them to life.
Melody Amsel-Arieli, an Israeli-American raised on a New Jersey farm, grew up amid cows, corn, and collectibles. In addition to writing countless magazine articles, she has also authored Between Galicia and Hungary: The Jews of Stropkov (Avotaynu) and Jewish Lives: Britain 1750-1950 (Pen & Sword).Visit her at amselbird.com.
Civil War Surgical Tools
Photos courtesy of: www.medicalantiques.com; www.skinnerinc.com; Heritage Auctions, HA.com; Dr. Nathaniel Alexander Morgan; Historical Medical College of Physicians of Philadelphia; National Archives and Records Administration