Military Faces of Neurosurgery – Silver Lining in the Black Cloud of the Civil War: Improved Medical Education

schGuest post from Michael Schulder, MD, FAANS
Residency Program Director
Professor and Vice Chairman, Department of Neurosurgery Director, Brain Tumor Center Hofstra
North Shore LIJ School of Medicine North Shore University Hospital
Lake Success, NY

This year marks the 150th anniversary of the end of the American Civil War. While neurosurgery was not yet a specialty during the war, there were advances in medicine which ultimately had significant impact on the emergence of the specialty starting shortly after the surrender at Appomattox. To honor this, and in conjunction with this important anniversary, we highlight the American Civil War in this Military Faces of Neurosurgery feature.

The American Civil War (1861-1865) arguably was the first modern war, a dubious distinction indeed. This conflict was the first to:

  • Rely on mechanized transport, via railroads, that moved troops and equipment in unprecedented numbers and speed;
  • Employ electronic communications, using the recently invented telegraph;
  • Use rapid firing weapons (the Gatling gun), that facilitated mass slaughter;
  • Utilize aerial reconnaissance, using hot air balloons; and
  • Introduce steam powered, armored ships (most famously the Monitor and Merrimac).

For military medicine, the Civil War was a transitional and transformative event. Notable firsts include:

  • Chloroform anesthesia;
  • Rapid transport of patients; and
  • Thorough record keeping that included photographic documentation.

civil war 2But there was no anti- or asepsis, and, of course, no antibiotics. Amputation of shattered limbs was by far the most common treatment rendered to injured soldiers during the war. It was carried out on a mass scale under conditions that seem horrific to us — and were in fact perceived as such at the time. Twice as many soldiers died of infections compared to battlefield injuries. Doctors, including surgeons, were poorly educated and trained, often learning their techniques from books only. This was a time when medicine, and certainly surgery, was more of a trade and not a scientifically based profession as we prefer to think of it now.

Once the carnage ended, American society recognized the need for improved medical education, and thus the changes that led to our current well-organized, standardized, and excellent (yes, let’s not forget that) system for training doctors. Our 19th century forebears also recognized that cleaning hands and instruments led to decreased infections and deaths, paving the way for the coming era of sterile surgical conditions.  S. Weir Mitchell used information from treating soldiers to greatly increase understanding of nerve injuries and related pain, defining the concept of “causalgia.”

Improved medical education was the faint silver lining in the black cloud of the Civil War. It made us smarter and opened the doors to our modern medical era.

Editor’s Note: Today, Nov. 19, 2015, marks the anniversary of the Gettysburg address.

civil war

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