Alright folks. Well I want to welcome you here to Gettysburg National Military Park. My name is Dan Welch. I'm a park ranger here at Gettysburg and you all have successfully found your way to our 3 o'clock program today entitled "Care of the Wounded" Now as I was mentioning, if you do have any questions during the program today, that's what I'm here for. I want to make sure each and every one of you has an opportunity asking any questions you may have. We just ask that you hold them til the end of the program. And we'll be able to stick around for as long as you'd like and chat about any questions you may have. Well todays program is going to focus in on caring for the wounded. Soldiers that have been injured in combat. Although we will spend a brief time today also examining how we're going to deal with some of these soldiers, Union and Confederate that become ill or sick along the way, pick up some of the diseases that these men will experience from 1861-1865. Well particularly, we're going to focus in on how the wounded were treated here at Gettysburg. On July 1st, 2nd, and 3rd 1863, the Battle of Gettysburg would wage on the fields around you. And then after 3 days of fighting, 160,000 Americans, 95,000 Union soldiers, 75,000 Confederate Soldiers have participated in Armed conflict. At the end of that 72 hours, 51,000 Americans have become causalities of the battle. Men that had been killed in action. Men that had been wounded on those fields of combat. Others listed as missing or captured. And the focus of our program today, caring for those wounded. Over 27,000 Americans, Union and Confederate alike, Americans all, are in need of some sort of medical treatment following this battle. Now before we begin to discuss the care of the wounded, following the battle of Gettysburg, we need to take some time to catch us up with what is the state of medicine. in the 1860s, leading up to the American Civil War? What is the state of medical training? What kind of education would you receive if you went into the field of medicine? And ultimately, more specifically to warfare, what is the state of battlefield medicine? If you were a soldier fighting in this war, in 1861 at it's outbreak, what would you experience then that may have changed along the way by 1863? So with that, let's take a little step back further in time, before the Battle of Gettysburg, before the American Civil War, and begin to examine the state of medicine itself. Now obviously, as you can imagine, back in the 1800s and 1700s, medicine is nothing like it is today. You weren't required to have any insurance cards of HMO plans to be able to be seen by a doctor. during this time period in our history. Your doctor would be a local doctor, serving a community at large hopefully has had some sort of medical training and I do say hopefully, we'll get to that. part in just a moment about their level of education. Well by and large, from the late medieval times into the 1700s, and the beginning of the 1800s, medicine is based on whats known as Brownism Theory. Brownism Theory in it's most simplest form is whatever ales you, may be a cause of having too much of one type of fluid, they call them humors, or not having enough type of fluid or humors in your body. So for example, let's say that you may have a fever. And your doctor would come and diagnose this fever with it's chills and it's aches and it's pains, as you having too much of one particular humor, one particular fluid in your body is causing those symptoms. So how are we best going to deal with this? Well you have too much of that bad fluid, so we need to take it out of you. We're going to do all kinds of wonderful things. We may use some cupping, which where through a suction of a glass jar, container, on your body, we're going to suck the blood through the pores out of your body, We may do some blood letting, where we take some lancets and slice you and let you bleed freely. Perhaps you suffer from headaches, constant migraines. Well obviously something is wrong with the levels of fluids in your head. So we're gonna drill into your head. We're gonna relieve some of those fluids out of there to help you with that symptom and problem as well. And so the state of medicine in the 1500s, the 1600s, is Jamestown and settled in Virginia in the early 1600's into the 1700s and early 1800s is not as advanced as we think it is today. But it's gonna come a long way by the time of the American Civil War Across the 1800s, we'll see a lot of developments in Europe that will eventually make its way here to the United States. One of the big advancements in medicine in the 19th Century is the invention of the microscope. And no longer is it these levels of fluids or humors that are causing your problems. We are able to look at things we cannot see with the naked eye. We begin to determine that, oh, these little creatures that move under the microscope may be causing our ailments may be causing those illnesses and diseases. With the invention of the microscope, comes the idea of germ theory, that we are able to pass germs from one another. We're able to pass bacteria from one another, pick germs and bacteria up off of surfaces and animals and all sorts of different things. And that could cause some of our ailments, some of our illnesses and diseases. Flash forward about another 15 years or so, over in Europe as well, we get another advancement to the field of medicine. Along the lines of germ theory, there's a doctor in 1860 that is putting together a correlation between washing your hands and how healthy people are. Imagine that. Washing your hands after going to the bathroom. Washing your hands before prepare food. Washing your hands after you handle raw chicken. Washing your hands after you clean up garbage or something to that effect. By washing your hands, you are going to be less likely to become ill, seriously ill, and require some sort of treatment. So we are seeing a number of medical advancements across the 19th century in civilian doctors practices. But what the 19th century is not going to have a lot of advancements in is in battlefield medicine. And that's what we're going to be talking about in just a moment. Well what about the education? What kind of education and training are medical staff, medical professionals receiving across the 1800s itself? It's not nearly as long as it is today. I'm sure many of you probably watching some of those medical reality shows. You may know a nurse practitioner, doctor, back home in your local community. These folks go to school for a very long time. They have numbers of years in college and then they have a residency and then they work alongside, like an internship, an apprenticeship. So they have a lot of training before they're ever allowed to treat patients by themselves. Now so much the case in the 1800s. There were a number of medical schools in this country across the 1800s. Your average length of study at this time to become a doctor, just 2 years. Just 2 years folks, and during that 2 years, although you would rely on some medical books of the era, a lot of what you are going to learn is going to be coming from your professors. Your professors would come in, you would listen to a very long lecture, you may jot down a few notes that later that afternoon or evening you would work to learn from that lecture, memorize some of that lecture, commit to memory some of that lecture. You would go to class the next day and you would have your professor ask you some questions about the previous days lecture and he would ask questions about it, something you didn't understand, okay, let's go through it very quickly and move on. This is what you're gonna do for 2 years. You may have an opportunity during your time at medical school to have a look at the human body through use of a cadaver a body that's been donated for science and research. But not every medical school across the United States at this time is going to have access to that type of material to research and learn from. So this is the state of medicine in the civilian life as the American Civil War is going to come to pass in 1861. And suffice it to say, our country, these two armies that are going to develop as the war begins, the Union armies and the Confederate armies are wholly unprepared for what warfare will wrought on a battlefield. In 1860, just one year before the American Civil War begins folks, the entire United States Military, from Maine to California, is just 10,000 men strong. These soldiers are spread out on very far remote outposts. Some of these men will never encounter any real heavy campaigning or fighting will Native Americans and other wars that we're participating in during this time period. Out of that 10,000 soldiers stretching from Maine to California, 130 of them are medically trained officers in the United States Army. 130 doctors. for 10,000 soldiers stretched from Maine to California. If you're one of those soldiers that has been assigned to a remote outpost, in the west, maybe Mexico territory, Arizona territory, you may serve your entire duration in the United States Army without ever seeing a medically trained officer as part of the United States Army. So when the American Civil War breaks out in 1861, a war that many politicians, many citizens, many men who joined the Army feel it is only going to be 60-90 days, one big battle, it will be over, the medical situation in both armies is very bleak. A number of those 130 doctors in 1860 will ultimately end up joining the Confederate Army. And so we have a shortage immediately in the Union Army here in the Eastern theater of the war, amongst medically trained in the federal Army itself. 60-90 days, this war is over. We can get by with one big battle with the staff that we have while on hand. In addition to that, although we don't have a whole lot of surgeons for these men and for these Armies that are being created, we don't have a whole lot of stock in medical supplies. Bandages, anesthesia, operating kits, everything you could imagine that a doctor or surgeon would need today and then back then as well. So that's again, not a big problem, right? One big battle, 60-90 days this thing is over, we can get by with what we have on hand. What they will quickly realize, is however, that that is not the case. And both armies will very quickly, as well as their governments very quickly come to the conclusion that we need more medically trained men in the armies we need more medical supplies, and we need to adjust some of the ways in which we go about treating those that are sick, and treating those that will be wounded on the field of battle itself. Today we are going to focus on some of those advancements that will take place in the Union Army and I don't just say we're going to just do the Union Army because I happen to be a native Ohioan, and that Ohio would stick with the Union Army, or that we're in Pennsylvania, we're going to talk particularly about the advancements in the Union Army because one person, one man, who many of you will never have heard of, is going to make great advancements in the field of battlefield medicine that will not only impact those soldiers that become ill and sick, during the Gettysburg campaign but also that will help insure the survival of many wounded soldiers here at Gettysburg as well. Unfortunately, there is no real Confederate counterpart to the man that we are going to talk about next. And his name is Jonathan Letterman. Jonathan Letterman is going to be brought to the Union Army in 1862, in the summer of 1862, and he has been hired for this job to help treat and get the Union Army back on its feet. Because the medical situation in the Union Army at this point is very dire. Over the first year of the American Civil War from 1861 to 1862, if we had mentioned, there's a lack of trained medical staff, a lack of medical supplies and by the late spring, early summer of 1862, think about this for a second, 33%, 1/3 of the Union Army here in the Eastern theatre, or known as the Army of the Potomac, are in hospitals. The men are too sick, too ill to fight. Letterman has been hired to remedy that. In addition to that, after these large battles of 1861- 1862, men that have been wounded in combat, they are not being treated effectively, they are not being treated quickly, we are seeing not a great survival rate among those that have been brought to those hospitals. Letterman has been hired as well to work on that. He has a whole host of ideas that will revolutionize battlefield medicine during the American Civil War, and how all of you experience the medical field today. We will move to that in just a moment. So what are some of the things then that Jonathan Letterman is going to do that's so revolutionary when he first takes this position, as medical director of the Union Army, the Army of the Potomac, here in the Eastern Theatre. One of the biggest threats, to soldiers both North and South, during the American Civil War, not cannonballs, not bullets. They're not bayonets or sabers. One of the biggest threats to the Union and Confederate soldiers during the American Civil War is illness and disease. Would it surprise you to learn today folks that the number one killer in the American Civil War is something that we treat today with Pepto-Bismol or Imodium? The number one killer during the American Civil War folks is diarrhea. Take diarrhea and move it up the next level til you're unable to make it stop, mix it with some blood, now you have dysentery. And that is going to be just as deadly. Something that we fix today with Imodium and Pepto-Bismol, will kill 300,000 Union soldiers in 4 years in the American Civil War, It is an astonishing, astonishing number. So illness and disease is going to be some of the greatest challenges for men of the Union and Confederate Army. And Jonathan Letterman, the new director of the Union Armies, Armies of the Potomac is going to go about to change that and combat some of these illness and diseases. that are so negatively and so adversely affecting the men in the Union Army. The ones that are in the hospital in the summer of 1862, 33%. He thinks that a lot of these illnesses and diseases that are crippling the Army come from a lack of poor sanitation and hygiene. Poor sanitation and hygiene. I want you to completely dispel this notion of a Civil War Armies, perfectly aligned, shoulder to shoulder, beautiful ornamented uniforms, sabers, and shoulder scales and shoulder bores and things of that nature. I want you to think of these armies in terms of their sanitation as big, giant conglomerations of college aged male bachelors. Think about that for a second. You are able to smell these armies before they get near you, okay? Their sanitation is not that great. First and foremost, these men are washing their clothes, their uniform, their underwear once every 4 to 5 months. They are taking a bath once every 4 to 5 months. Think about everything that they're doing on a day to day basis. That's gonna work up a sweat, soak those undergarments. That's gonna soak that uniform. And they're gonna get up and repeat it the next day. They're not cleaning their uniforms. They're not bathing their bodies and they're not washing their uniform. It's poor sanitation. Again, getting back to that college age male bachelor description. These men when they would form their camps, several hundred men, several thousand men, in a large open field. If they were poking around the fire, maybe done with their meal instead of taking to some central garbage collection to throw away the leftovers or some of the garbage produced by cooking, they're just gonna throw it on the ground next to them and leave it there. and imagine 3, 4, 5 ,8 thousand men in one camp, just throwing their garbage at their feet and moving on. In addition to that, these men are not going to use the designated bathroom. And we have these men in camp. At the very far end of the camp, we're gonna dig a long ditch in the ground, known as a latrine. When they dig this ditch, they're gonna scoop down. They're going to shovel the dirt from the hole into the front It's gonna be a little seat if you have to do that sort of business at the bathroom. If not, you stand on top of the ground and go into the hole as well. These men will, by and large, in 1861, 1862, before Letterman comes to play. If they're in their tent, sleeping at night, they gotta get up and go to the bathroom, they just go right outside the tent. They're not gonna walk to the very edge of the camp to use the bathroom. They're just going right next to the tent. In addition to that, these men are very confused with how water and streams and creeks work as well. Those that are bathing, those that are washing, those that are grabbing their drinks, their water to cook from, their water to drink from, are grabbing it from downstream while upstream, men are using the bathroom in the same water source. Another issue that is making these men sick in the Army. So the sanitation is not great. Well then when Jonathan Letterman comes on board, as medical director for the Army of the Potomac and he is immediately gonna set out a number of orders and protocols in order to increase the overall level of sanitation, which will therefore increase the overall health of the Armies. So if we can get these men to the battlefield, and hopefully have an advantage of both men and means. One of the first things he's going to order is that garbage we talked about, leftover from the food. All that garbage needs to be emptied into a central location and at the end of each day in camp, we're gonna burn that garbage. Bathrooms, another situation. You're not going outside your tent or the closest tree. It is mandatory you're gonna use the latrine. At the end of each day, 6-8 inches of dirt must be thrown on that latrine. When it gets full, we're gonna build a new one. We're also going to be very particular about the difference between upstream and downstream. What we are doing in that drinking water, what we're doing in that cooking water beyond just bathing and using it for the bathroom and then downstream trying to cook with that same water. We're going to be very very particular about educating our soldiers to know the difference and how to establish a camp around a shared water source. Letterman is also going to make a suggestion. He never makes an official order, but he's gonna make a suggestion for the men to get their beards trimmed down very very short and keep their hair very short as well. Some of the problems that Letterman is eliminating through these orders when it comes to sanitation has to do with how illnesses and diseases are being spread. Think about that garbage pile. Think about that latrine sitting open. Think about all of that human waste. Flies, mosquitoes, insects coming to camp. Feeding on that garbage, feeding on that human waste and then coming biting you. We're starting to see a lot of men become ill and sick. So just by taking charge and cleaning up camp and having these men bathe and wash their clothes, we're eliminating many of the illnesses and diseases that are gonna be caused from an insect bite. Particularly when we talk about cleaning clothes, we talk about washing, we talk about keeping our hair short we're gonna ensure that we decrease body lice. Body lice is a huge problem in the Union and Confederate Armies. So much so that soldiers are creating games in which to utilize the lice from their own body. We're putting a skillet or pan over the fire, we're pulling the lice off, we're gonna take wagers and bets My lice can last in this heated pan longer than yours. My lice can jump higher than yours. Mine can call across the pan faster than yours. We're coming up with all sorts of games for body lice. So Letterman is really gonna target sanitation. Increase the overall efficiency and health of the Army itself. After he accomplishes this, the next thing he is going to do, which is going to tie into the rest of our program today is how are we caring for the wounded on the battlefield. And again, we're gonna spend time talking about Letterman, not because this is a Union slanted program but because we really lack Confederate counterpart, and that is gonna make so revolutionary changes to medicine that we still feel today. One of the first things Letterman is to look at how soldiers who are wounded in combat are removed from the battlefield. If you were a soldier on the battlefield and you were wounded, there was one of two ways you were getting off the battlefield. The first way is you are getting yourself off the battlefield. Imagine going through this experience of combat, being horrifically wounded, and now trying to figure out how am I gonna get off the battlefield, where's the hospital? The second option you have, is that the federal government in 1861 and 1862 help get wounded off the battlefield would hire what is essentially modern day cab drivers today. These guys were known as hacks and they would own a wagon and they would own a carriage. And if you were visiting a town such as Washington D.C., you could hire them and they would take you for a stop around the city. Well the federal government is hiring these private contractors to go to the battlefield with their carriage, go to the battlefield with their wagon, wait for the battle to be over, then go out on the field, pick up the wounded and take them to the hospital. When these private citizens, these contractors got out to a potential sight of a battle, and cannon balls start flying through the air, bullets start whistling through the air, these guys aren't sticking around. They're grabbing their carriage and wagon and they're going back to the Nation's capital. To heck with the wounded. They can get themselves off the battlefield. I'm not risking my life. I'm not getting paid enough for this. Look at the horror that combat really is, the war really is. Letterman's gonna set about changing all of that in the summer of 1862. He's going to establish a professional ambulance corps. And some of the things that he does with this ambulance corps will affect you today. One of the first things he wants to do is to standardize ambulances that are being used in the Union Army. Before Letterman comes on board, I want you to think about this for a second. If we saw today 3 Civil War ambulances lined up, you could go to the first ambulance and it would be full of bandages. Stocked to the gills with bandages, with room to carry wounded soldiers. You could go to the second ambulance parked in the middle, full of scalpels. All the scalpels in the world that you could possibly imagine. And you could go to the third ambulance and maybe it's loaded with anesthesia, chloroform, or ether. Perhaps you're a wounded soldier that is in need of a bandage, but you're placed in the ambulance with the anesthesia. That does no good to you. Letterman is going to standardize ambulances in the Union Army. Each ambulance has the same number of different things in it that could possibly be needed by one wounded soldiers being transported. It doesn't matter if you are from Virginia today, or if you are from Georgia or you live out in California, It doesn't matter what owned ambulance company you may need to use in a time of an emergency, but in 2015, every ambulance across the country has the same stuff in it. It may be a different make or model of type of ambulance, but they all have the same stuff in it. And that is an invention that Letterman has come to codify together in the summer of 1862. We're also going to train the men that will be driving the ambulances, which are not obviously going to be driven by motor power, but physical, real horse power. We're gonna train these men to be professional ambulance drivers. If you have a very severely wounded patient, who is bleeding profusely, probably taking the rockiest, bumpy road is not going to help them, particularly if the wound clots on its own. We don't want to break that clot open and have the wounded soldier bleed to death before he even gets to the hospital. So we're gonna train these men in which how to drive the ambulances, how to know where to look for the hospitals and different aid stations along the way. We're gonna train the men that are riding with those ambulances to get the wounded off the field, stretcher bearers. In 1861,1862, in the Early American Civil War, this is the part where the musicians and the drummer boys come into play. When battle happens, they put down their instruments, they go out on the field, they get the wounded and help them, put them on stretchers and get them off the field. They are not trained. These men in 1861, 1862, and I should say young boys, not men, they would go across the battlefield, they'd come pick up a wounded soldier here, take them all the way back to the hospital. When they came back, they would come over here to this side of the battlefield. They would pick up a guy put him on the stretcher and take him all the way back to the rear. One at a time. No systematic, organized fashion. Depending on the various decree of your wounded or where you were located, you could be left behind. You could be in serious need of medical attention and be the last to be taken. You could be someone who just needs a few stiches and be the first to be taken. We're gonna train these stretcher bearers on how to place these men on the stretchers. How to get them into the ambulances, how to care for them, if they are in need of some sort of care between the field and the nearest aid station or hospital. So Letterman is going to standardize the ambulance corps. He's going to standardize the ambulance men that are working it and standardize what's actually on the ambulances. Letterman is also going to codify a number of different protocols that have been developed across the country as well as in Europe and I'm gonna share with you the personal story today that is really gonna implement what Letterman is gonna pull together. Really highlight what Letterman is gonna together, see if you can guess what Letterman is so instrumental in developing. I grew up in a part of Ohio from a very urban area and I don't remember exactly what age I was maybe 8 or 9, had the flu, very bad for a couple days, high fever, all the wonderful symptoms that come along with the flu. My parents thought, you know what, he's pretty sick, pretty dehydrated, we should take him to the emergency room, it was on a weekend, Take him to the emergency room, have the doctor check him out, see if he needs any fluids, anything that we can do to help make him better. And so I can remember going to the emergency room and sitting in the waiting room, like many of you if you ever have gone to the emergency room, you sit there for a very long time and I had to hold the official emergency room bucket cause I had the flu, sitting there for what seemed hours, and all of a sudden, the emergency rooms burst open. And they're wheeling this guy in with a knife sticking in his leg. He got to go right back. I'd been sitting there holding the bucket with the flu for the last couple hours and this guy just cut in line. What I just experienced as a child, was one of the things that Letterman helped codify. And it's known as triage. Letterman's gonna pull together a different series of different protocols and practices happening in this country and Europe as well, put them together into a system of triage. Those that are less severely wounded on the battlefield, can wait for treatment, they're gonna last to receive it. Those who need some sort of life-saving procedure that will not live if they wait, are going to be treated first. Those that we cannot help, they'll be treated all the way at the end. And Letterman is going to establish this series and system of triage. He's gonna train those ambulance drivers and those stretcher bearers in this system as well. So when the battle was over and we were beginning to take the wounded back to the hospital, these ambulances that will arrive on the field, those stretcher bearers, they are going to examine these men very quickly on the field, if they have not been able to get themselves to an aid station or a hospital. They're gonna place these men into a category, according to the severity of their wound. That category will then dictate which level of care they need. Closest to the battlefield itself, we have aid stations. Maybe an outdoot aid station, maybe something under a tent of this size, but that would be if somebody needs a bandage, somebody needs some stiches, maybe you broke. You fell down, broke an arm or broke a leg, something that is not too serious. We're gonna put you in that middle category. You can wait a while. The next category is going to be those that need some sort of life-saving operation and they need it very quickly. You're gonna be the first priority. You're gonna be put on the stretcher, bypass that aid station closest to the battlefield, and we're gonna take you to a much more situated hospital further from the line where they could deal with that wound. And last but not least, if you have been wounded in some area of the body, such as the trunk of the body. from the waist to the neck. Doctors at the time could do very little for you, we're gonna put you at the very end of picking you up off the battlefield. By the time you get to the hospital, you'll be taken to the one a little further in the rear because of the seriousness of your wound We'll give you something to deal with the pain but we're gonna suggest you find somebody to write a letter home for you. Cuz this is going to be the last day or the last couple days of your life. There's nothing that these doctors can do for you. So Letterman is going to institute this practice of triage to diagnose these men, get them to the appropriate levels of care and get them treated very very quickly. And by the time that Letterman instituted all these changes in the late summer of 1862, the Union Armies, Army of the Potomac here in the Eastern Theatre, will participate in several battles. Battle of Antietam, September of 1862. Battle of Fredericksburg, December of 1862, Battle of Chancellorsville, May of 1863 Letterman's system is able to be put into place and he's able to make adjustments to it. And really codify all these different things that he has adjusted to the way of medical affairs in these armies, ultimately save more lives. So by the time of Gettysburg in July of 1863, Letterman's system has been in place for almost a year. And it is working very very well. On June 28th, just 3 days before the Battle of Gettysburg, the Union Army will receive a new commander. His name will be General George Gordon Meade. The Union Army is very far behind the Confederate Army and General Meade has several priorities of who should be on the road. Soldiers, ammunition, and we need food on the road. The medical department, all these things that Letterman instituted, they can wait. We'll send them to the very back of the Union Army. When this battle breaks out on July 1st, 1863, and over the next 24-48 hours, these medical personnel that have experienced this new system invented by Letterman are gonna be at a disadvantage. They will do quite well here at Gettysburg. After the Battle of Gettysburg is over then, what is some of the wounds that these doctors are going to be faced with treating? Things that they haven't even seen since 1861, 1862, we'll continue to see for 2 more years of war. Well let's look at some of the implements that will be causing such devastation and destruction to the human body, and then at the very end of the program today, we're going to need a volunteer to assist in treating one these types of wounds. Let's go ahead and begin by examining one of the least common wounds during the American Civil War itself and that is going to come from one of these bayonet or saber. Now if you've seen a Civil War movie, you've seen a Civil War documentary on television, it's a lot of drama to have thousands of men in this movie, this documentary, all with their bayonets on charge all across the field, and fight just with their bayonets. The bayonet and saber is the least least cause of wounds during the American Civil War. I want you to think about this for a second. It was estimated that every soldier that served in the American Civil War was wounded 3 to 4 times each year. 3 million Americans would serve in either Army during the American Civil War. If we take that higher number, 4 wounds, per soldier, per year, that would be 12 million wounds for each year of the American Civil War.\ 4 years of war, gives us about 48 million wounds in all. Out of those 48 million wounds, less than 1% come from a bayonet or a saber combined. Now despite not having a significant amount of occurrences, documented occurrences of these being used in combat and having wounds that will need to be treated by these, although there are examples, this is a very devastating wound. One of the things that you may notice about the bayonet is it's overall shape. The shape of it would appear to be a triangle. Now if you cut yourself with a sharp knife today, and you needed stiches, that cut is, for the most part, a straight line. All we have to do is pull that skin back together again. What I want you to imagine in the shape of a triangle, your palm, How are you going to pull that together symmetrically? You're not. You are not gonna be able to pull together, to stich up a wound from one of these. The wound that a bayonet will cause to the human body is very very devastating and it will be one of the reasons why following the American Civil War we are going to see the bayoney change from this triangular shape type weapon to something we think of more like a knife today. And we are going to see that very prophetically across the 20th Century. So some soldiers maybe coming to the hospital in need of treatment from a bayonet, or saber wound. Another type of wound that soldiers may experience on the field of battle will cum from artillery. There's all sorts of artillery shells, types of artillery ammunition used during the American Civil War We have the solid cannon balls that will bound and skip across the ground. We also have exploding cannonballs, types of ammunition. Those exploding rounds will produce something that looks like this. This is a piece of Civil War shrapnel from an exploding ammunition round of artillery. Think of a hollow cannonball, filled with black powder on a fuse. When that fuse runs out, that cannonball explodes. And it explodes into about 5 or 6 chunks about the size of what you see here Again, known as shrapnel. Shrapnel is going to actually be a person. This type of exploding round of ammunition for artillery for cannons is named after it's inventor, Henry Shrapnel. So we're gonna see soldiers coming to the hospital with sounds from artillery fire. But perhaps the most common wounds that are bringing men from the battlefield to the hospital are going to be caused from one of these. Bullets. This is one of the most common types of bullets used the American Civil War. A 58 caliber, mini ball, we've Americanized it a little bit. We call them mini balls, but it's actually pronounced monet, after its inventor, Claude Monet. What is so deadly about these projectiles is two fold. Number one, the material it's made out of. It's made out of lead. Lead is a soft metal. It's very malleable. The second thing that makes this so deadly, is how fast it is fired out of the weapons of the arrow. This is moving very very slowly through the air. And when it strikes something hard, such as the human body, these bullets this shape, this conoil shape, is going to flatten out and it will cause all sorts of damage. Let me show you a little comparison as to what this is going to look like before and after it strikes something hard. This is the before right here. This is the after it strikes something hard. Now these bullets, these mini balls, because of the speed at which they're traveling, because of the material they're made out of, they cause untold destruction to the human body. Particularly when it strikes something hard, such as a bone. When it strikes the bone, itself, it's gonna shatter the bone on impact. Think about your bone breaking down to dozens of little pieces about the size of toothpicks. In addition to shattering that bone on impact, it's also going to shiver the bone. Meaning, that it is going to crack the bone from either direction from impact site. The best thing that doctors can do during the American Civil War with this type of wound is to amputate the limb. To find out where that shivering ends, where that cracking bone ends, go up about 4 to 6 inches, and to amputate the limb. Now you would think that today, in 2015, with all of our advance medical technology in the last 150 years, we could do something much better than Civil War surgeons could do back then. But if for whatever reason, August 2nd in 2015, you were shot with one of these mini balls, and it broke, shattered one of your limbs, we would put you in an ambulance, we'll send you to Gettysburg hospital, just two blocks down the road. And we're gonna keep you comfortable. We will fly in the best surgeon in the world to come and take a look at your wound. The best thing they can do for you today in August of 2015, is to amputate. There's no sort of medical advancement that can repair the damage that these things do to bones in the human body. Now I don't want you to walk away from the program today that the options these Civil War doctors and surgeons had with these wounds. There's this perception that the Civil War surgeons, doctors, they're butchers. They're just out there amputating away every guy that comes in and has got a broken pinkie toe and they amputate his whole foot up. These men are able to grow with their profession from 1861, 1862, by the time you get here in 1863. They're able to diagnose what exactly they can or cannot do to treat this wound effectively. And this is the part of the program where we are going to need a volunteer for you to be able to understand those decsions that they have to make on the operating table from one of those wounds. So do we have a volunteer today? Alright, yes young man. Why don't you come down? What's your name? Jacob. Have a seat up here Jacob. You can just hop on up. It'll hold you. Alright. Jacob has been fighting here at the Battle of Gettysburg. Jacob today is going to represent one of 27,000 Union and Confederate soldiers that have become wounded as part of the Battle of Gettysburg itself. Jacob is making is way by stretcher and ambulance to a hospital in the rear of the Union lines. And Jacob has arrived with an injury to his lower left leg. I'm gonna have you swing your feet up here Jacob. Have you scootch down here a little bit. There you go. Now I want you to lay down. Plentry of room. Perfect. Alright. So once Jacob arrives, he may have a little wait at the hospital. Hospitals are gonna be staffed 7,8,10,12 surgeons there. For each surgeon on an average is gonna be working about 20-22 hours each day following the battle. Treating anywhere from 70-100 patients a day. So we've got a long line of patients behind us and Jacob may have to wait a little bit. Before he is brought to the table for examination. And then a determination of what to do. For our story today, Private Jacob in the Union Army has been wounded by one of those mini balls in the lower left leg and it has impacted his shin and we need to determine what is best for Private Jacob. One of the first things that I need to do once he is placed on the table itself is to control the bleeding. Before I examine the wound, before I make a decision as to what is going to be best, for our patient today. Civil War surgeons, doctors, medical personnel, have tourniquets. During the American Civil War, we are going to use one of those tourniquets to stop the flow or slow the flow of blood all together. During the American Civil War, all different types of makers of tourniquets. We have a very simple tourniquet here today. And we're gonna go up a number of inches above to stop the bleeding. Lift your left leg up Jacob, alright. Go ahead and lower that down. We're gonna stop or slow down the flow of blood. What this is going to allow for me to do is to again examine the wound and then be able to make a determination as to what exactly we need to do. Now, another myth that is going to be applied to Civil War surgeons medical staff is that these men are operating on soldiers while they're awake. And that is simply not the case. We have anesthesia during the American Civil War. This is going to be the next step for Private Jacob today. Two types of anesthesia that will be commonly used in the American Civil War, eather, and chloroform. Now how many of you have had wisdom teeth removal surgery? Okay, alright. So you know how that goes. I'm not gonna ask you to raise your hand if you've ever had any of those -oscopies. But whether you've had one of those -oscopies or your had your wisdom teeth out, you have received a level of anesthesia known as twilight. Your put into a very light sedated sleep. You don't remember having your wisdom teeth out. You don't remember the -oscopie scoping that you had done. But you are not 100% knocked out. Your brain is still very much awake. And when that procedure begins, your brain is going to kick in, a part of your nervous system that we call your flight or fight reactions. Your brains saying "hey! This hurts. Let's get away. Why are they doing this? How can we stop this?" So it is very common when we put the patients in the American Civil War under anesthesia in this level of twilight, that when we begin to examine the wound, or begin to operate on the wound, a patients arms may start moving up and down. Go ahead Private Jacob. Keep doing that. Could you imagine the next guy waiting in line for the operating table seeing that guy do that? You're thinking oh my gosh, this surgeon is operating on this guy while he's awake! And slowly, but surely, over time, that myth is gonna begin to grow. And that is simply not the case. His body's fight or flight reactions taking charge despite that level of anesthesia that he's in. He's asleep. He's asleep. So we are going to place several drops of chloroform or eather on an eather comb. Think of like a funnel that you use for car oil. Its got a piece of coral sponge in it. We're gonna hold that above his face for several seconds, have him take deep breaths, and very quickly he'll go into that twilight. And now as the surgeon, with several of my medical assistants, my staff with me, we can start the actual examination of the wound. We have some options for examining the wound. We may start with one of these. This is known as a bullet probe. You can see it has a bulbous tip on it. That bullet probe is coated in a porcelain coating and once we insert it into the wound, that porcelain coating hits something metal, you'll hear that little ping, or that ding noise. That tells me where that piece of metal is and it will help me to find it to get it out. However, using this equipment it takes a little while. It's slowing me down. I got a long line of wounded patients behind me. So instead, I'm going to prefer to use something that is much faster. Much more medically advance. Are you ready to see this tool? This piece of medical technology? I take my finger and I'm gonna insert it into the wound, looking for any sort of debris that's been carried onto the wound. Looking for what the wound has been caused by. A bullet, in our story today, and if it can be removed. If I can find the bullet, pretty readily, I'm going to grab a tool developed for such a case a pair of bullet forceps. We'll insert that bullet forceps into the wound, and grab ahold of that mini ball, that artillery shell fragment. Whatever the case may be. And go ahead and pull that out., If we can't seem to find the projectile, that's okay. It'll come out when we continue on with the operation. After examining the wounds, for Private Jacob, I have determined that the best thing for him today is to receive an amputation below the knee. We are now going to begin in participate interactively, if you will, with this operation. So one of the things that we need to do next is to grab a scalpel. We've got all sorts of scalpels that you could chose from, depending on where on the human body that the wound is located and where we are going to be performing the amputation itself. Scalpels are very, very sharp. Its not going to take a whole lot as we begin to cut in through the skin and the muscle. We'll stitch you back together at the end, it's okay. Alright so we're going to go ahead and we are going to cut through the skin and muscle itself. And then we are going to need to push that skin and muscle up to expose the broken part of the bone and help determine where there is good bone that is left. Generally again, we're doing this operation several inches above the site of the wound. Once we have utilized the scalpel, we have exposed the bone, itself, you can imagine at this point, all of the bleeding that is going on, and you can imagine all of the sort of foreign bodies that would be in there i.e. that shrapnel, the bullet would have had to have gone through his uniform so we've got bits of wool in there. Bits of his underwear in there. If he was anything else, maybe the bullet traveled through a soldiers next to him his knapsack or his canteen, so we've got all kinds of stuff in there that we're gonna have to deal with once we have exposed it. But to ensure that Private Jacob does not bleed out, as we continue to deal with those things today, we need to tie off all those veins and arteries that we have opened by using that scalpel. So we are gonna take our suture, and some silk thread, and we are going to begin to tie off each one of those veins and arteries to control the bleeding further. We're gonna leave a good portion of silk thread, a little excess thread on the very end and we'll see why at the end of the program and at the end of the surgery today. Before we tie off that last vein or artery, however, we are going to make sure that Private Jacob wakes up feeling really well. So I'm going to reach in and I'm going to grab out of my medical kit here some powdered morphine. And we're gonna sprinkle that on to that last vein or artery before I tie it up. We have introduced that pain killed into the blood, the circulatory system, it'll go to the heart, the heart will continue to pump, and spread that morphine, that opium, through the body itself. So when Private Jacob wakes up, he will already have a pain killer on board. I have to be very very measured with how much I use. Just this much too much and I will have created an opium addict. Following his surgery. And it's something we often do not talk about during Civil War studies, soldiers that are going to be addicted to opiates after the American Civil War from a surgery, from an operation in itself. So we've got that last vein or artery tied up. We have the bone exposed. I need to remove any of those foreign bodies that I discussed, so I'm going to breathe the wound itself. I'll get a pair of tweezers. Kind like ladies, kind of like tweezers that you have in your beauty bag, you makeup kit. We're gonna go ahead and remove as much as though bone shards, as much as the uniform parts, as much of the stuff that we can find, we're gonna get it out of the wound itself. Once I've debriefed the wound, I'm ready for the next phase of the operation today. And perhaps the coup de grace for many of you coming on this program that of the capital saw, or the bone saw. Again, Civil War surgeons get that myth of being butchers. They are not here hacking on this poor soldiers leg all day. It is a very quick process. One, two, three. 3 cuts and the leg has been completely severed. The limb will be placed in a bucket near the operating table and maybe handed to an assistant. Either way, once that bucket fills, once the pile in the area fills we'll move it out a little bit further away from the operating theatre and the surgeries for patients will continue. One of the last things we need to do now, once the limb has been removed, is to close up. We're gonna push down that muscle that we pushed aside, or push down that skin that we're beginning to form a stump. Before we close up, however, we need to file down the bone itself. I have used a serrated blade to cut that bone off. If I leave that bone sharp and jagged, it will be very discomforting to the survivor It will rub and cut and irritate the muscle and the tendons and the ligaments that are in there. And it could even leave to further injury. Case in point, Confederate General Richard Stotter Yule. Richard Stotter Yule in August of 1862 was fighting during the second battle of Manassas. He couldn't see the fighting or what his men were doing through the smoke. So he got on his hands and knees to look under the smoke, and to check on the progress of the fight. While on his knees, a Union bullet crashed through his knee cap traveled the entire length of his leg. Broke his leg. Surgeons on the battlefield would amputate his leg and he would recover for the next 4 months. On Christmas Day, the capital of the Confederacy, December 25th, 1862, Richard Stotter Yule is out on crutches. Enjoying the holiday. One of those crutches hits a patch of ice. Richard Stotter Yule slips and falls. When he falls, that bone cuts through the newly healed stump. And it will require a secondary amputation and further healing. The Battle of Gettysburg and the campaign of Gettysburg will be his first time back to the Army since August of 1862. Very important that we smooth and shape down that bone for the stump that we are now going to create. So we've taken care of that. And now we're gonna begin to close. We're gonna sow up that stump, again, with our silk thread and our sutures. And before we close the wound up all together, we're gonna leave a small hole for drainage. Civil War doctors and Civil War surgeons love to see puss. Puss is a good sign that the patient is healing, recovering from that wound. So we're gonna leave just a small little opening at the bottom, the base of that stump, and you may remember all that extra silk thread that we have when we tied off those veins and arteries? We're gonna pull all those silk and threads through that small hole that we've left open. We'll bandage the wound itself and we'll move Private Jacob to a place of comfort where he'll wake up feeling no pain from the powdered morphine. Want you to go ahead and sit up Jake. Over the next several days, his bandage is going to be changed repeatedly We are again looking for signs of puss. We don't want that puss to stink, however, if it's got a really nasty smelling muenster cheese flavor to it, that is not good news at all, gangrene is setting in. We're gonna have to perform another operation, another amputation to help him out with that. But after 2 to 3 days of recovery, being placed on a strict diet of liquids: broths, water, coffees, teas, things of that nature. We're going to bring Private Jake back before the surgeon for a check up. To see how he is doing and this where the surgeon begins to talk to Private Jake about his home life. Where are you from? He's from Florida. He's joined the Union Army folks. You're from Florida. Tell me a little bit about Florida. Well it's really sunny. And while I'm engaging him in conversation, I have examined the wound and I have grabbed on to those silk threads. And while he is deep in conversation, telling me where he's from, if he's received any letters from home, did you receive any letters from home? He's gonna say yes he did, and I'm gonna pull on those threads. And if those threads slip off all the veins and arteries, very easily, come out that hole, I know that the wound has healed. Or is healing I should rather say. However, if I give those things a yank and they don't budge, you say.... OW! Ow! Really loud. That tells me that there is some sort of irritation. Some sort of swelling, inflammation, and that I am going to have to schedule Jake to come back to see me later today where I'm going to perform a secondary amputation. And I'll go up a little higher, to take off a little more and we'll repeat the process again. Now it took us today about 15 minutes to talk through the length of an amputation, at best. A really good Civil War surgeon, 6-7 minutes would be able to preform the operation that we just discussed. Again, dispelling some of those myths that the Civil War surgeons are butchers. They're just hacking away at limbs, an amputation in the case of this type of wound is the best course of treatment. Private Jake being brought from the battlefield triage, very quickly, receiving treatmen, that amputation very quickly has an 80% chance of survival from this wound and the operation. If the wound was to be kept, if for whatever reason the doctor decided not to amputate, if he tried to preform what is known as a resection, where we pull out all of the damaged bone and we shorten the limb, but he gets to keep the limb, it's not functional, but it's there for appearance, he only has a 30% chance of survival if we keep the limb. So this was the best course of treatment for Private Jake today. Let's give Jake a round of applause today. You may return back to your family and recover from your wound. Well folks, over the last hour today, we have explored the state of medicine in our country in Civilian life in the 19th century the level of education that these doctors and surgeons received and ultimately, developments that occur between 1861 and the Battle here at Gettysburg, to 1863 and beyond the battlefield medicine. If you have any questions from the program, please stick around and I'd love to talk to you about them. If you would to see any of the tools utilized by a Civil War doctor or surgeon, please feel free to stick around. Well we hope to see you next time here at Gettysburg National Military Park. Take care folks.
