Chapter XII: Wounds and Complications.

THE MEDICAL AND SURGICAL HISTORY OF THE WAR OF THE REBELLION.

Part III.

Volume II.

Prepared, under the direction of Joseph K. Barnes, Surgeon General United States Army.

By George A. Otis, Surgeon United States Army,

and D. L. Huntington, Surgeon United States Army.




Otis, George A. (George Alexander), 1830-1881.
Huntington, David Lowe, 1834-1899.

Contributors:

Mitchell, S. Weir (Silas Weir), 1829-1914.
Keen, William W. (William Williams), b. 1837
Morehouse, George R. (George Read), 1829-1905

Washington: Government Printing Office, 1883.

Description: xii., 986 pp., xxix., 44 plates, 507 figures, 30cm.

Second printing: same year, 1883.

Photographs: 1 composite woodburytype.

Subject: Civil War, 1861-1865, war medicine.

Photographer: William Bell.

Notes:

• The medical history vol.s were prepared by J. J. Woodward, Charles Smart and George A. Otis.
• The surgical history vol.s were prepared by George A. Otis and D. L. Huntington.
• Both Otis and Woodward died before the publication dates of the surgical volume Part III and the medical volume Part III.
• See also Playfair »».





Nearly every man who loses a limb carries about with him a constant or inconstant phantom of the missing member, a sensory ghost of that much of himself, and sometimes a most inconvenient presence, faintly felt at times, but ready to be called up to his perception by a blow, a touch, or a change of wind. — Mitchell, Memorial addresses and resolutions. Philadelphia, 1914 ; page 122.


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"The following two cases of a shot wound of the portio dura nerve, seventh pair, is copied from Mitchell, Morehouse, and Keen, pp. 47, 51:"

Case 1079 »»
Case 1080 »»

"An illustration of paralysis of the facial nerve with distortion of the face is given in Plate XXXVIII, opposite. The patient suffered from loss of sight in the left eye and of hearing in the left ear."




At the outbreak of the war between the states, the medical corp of the U. S. Army was a skeletal ministry left over from the last major conflict, the Mexican War. That war was fought in the territories by a predominantly volunteer army, but because of the popularity of the adventure, conscription increased the number of federal troops to 78,700. Of this number, 1,733 men were killed in action, 11,550 troops died from disease and another 4,152 were wounded and survived. By comparison, the Civil War would take the lives of over 600,000 men and wound another 412,175 survivors. At Bull Run the mechanical sledge of war pounded out stump and stubble acreage of the wounded, the many thousands of soldiers dying for want of expeditious triage and ambulance volant on the battlefield. By the end of 1861, the urgent need for medical talent to care for the Union soldiers was starkly apparent.

With his promotion to Surgeon General in 1862, William Hammond brought to that office ten years of command in organizing hospitals and sanitary stations for the U. S. Army. He also brought with him the political support of the United States Sanitary Commission, and an intimacy with foreign military hospitals acquired from a European sabbatical he took during the year leading up to the Crimean War. One of Hammond's many visionary directives was the appointment of his friend S. Weir Mitchell to head the 400 bed Turnerís Lane Army Hospital which he established in Philadelphia specifically to treat those soldiers whose wounds were complicated by nervous disease. For his part, Mitchell had the foresight to share the task with William W. Keen and George Morehouse and in 1864 the three neurologists published Circular No. 6: Reflex paralysis which first described the conversion disorders and shock which can sometimes result from even minor nerve damage. Also published in 1864 was the longer treatise, Gunshot Wounds and Other Injuries of Nerves which first described the condition of "causalgia" — Mitchell's term for chronic pain in the sympathetic nerves that are distal to the damaged nerve in a wound, a serious condition that can become systemic.

When the subject turns to nerve damage, there are numerous citations in MSHWR to the works of Mitchell, Morehouse, and Keen. In Chapter 12 which he titled, Wounds and Complications, George Otis considered Reflex Paralysis important enough to reprint the entire paper, and he writes:

"The important labors of Mitchell, Morehouse, and Keen in the vast field presented by the organization of a hospital for diseases and injuries of nerves cannot be seen to better advantage or be better appreciated than in their clinical observations upon the remote effects of nerve injuries."

With this quote Otis is crediting Mitchell's work on causalgia and tacitly acknowledging the fact that many of the amputations that took place in field hospitals during the war were often severe and unnecessary procedures for what may have been more benign injuries that were complicated by the often frightening symptoms of a reflex sympathetic dystrophy. These symptoms can include a chronic inflammation of the skin that can be easily mistaken for infection, especially to the inexperienced eyes of the many newly hatched doctors who were deployed in the battlefields of the Civil War. A vivid description of causalgia and several other nervous disorders including the first description of "phantom limb" can be found in a short story titled The Case of George Dedlow which Mitchell wrote and published anonymously in the Atlantic Monthly (Boston: Ticknor and Fields; July, 1866). The story tells the experiences of a Civil War assistant surgeon who himself becomes a quadruple amputee, and it can be argued that Dalton Trumbo was borrowing heavily from Mitchell when he wrote Johnny Got His Gun in 1939. There are no recorded cases of quadruple amputation during the Civil War. Of the 29,980 amputations that were recorded, only 172 are double amputations and given the high rate of mortality — close to 50 % for double amputations — it is improbable a quadruple amputee would survive.

Hammond's term as Surgeon General lasted only two years, cut short by a reactive temperament that made him a political target of his own painting, but fortunately Mitchell was allowed to continue his work in Philadelphia. From the time the two men became friends and co-authored one of the first studies of snake venom, their destinies twinned. Together they established the American Neurological Association in 1874 and after becoming monuments of American neurology, let the honors pass so as to become respected novelists.

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Mitchell, Morehouse, & Keen: Gunshot Wounds and Other Injuries of Nerves, Philadelphia: J. B. Lippincott & Co, 1864. Reprinted, San Francisco: Norman Publishing, 1989.

Mitchell, Morehouse, & Keen: Reflex Paralysis, the result of gunshot wounds, and other injuries of nerves, founded chiefly upon cases observed in the United States General Hospital, Christian Street, Philadelphia. Circular no. 6 of the Surgeon General's Office, Philadelphia: J. B. Lippincott & Co, 1864. Reprinted, New Haven: Historical Library, Yale Univ. School of Medicine, 1941.

Mitchell, S. Weir: Injuries of nerves and their consequences, Philadelphia: J. B. Lippincott & Co., 1872.




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