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More men died on the battlefield in the Civil War than in all previous American wars combined. Part of the reason for these horrific casualty statistics is that the Civil War was the first war fought by Americans in which guns and cannon had rifled barrels which significantly increased the range at which a soldier could accurately hit a target. Despite this, the Union Army continued to send large forces of infantry against entrenched opponents.

When an entrenched opponent had smoothbore muskets, this tactic could work because of their inaccuracy which allowed the advancing infantry a good chance of reaching the enemyís trenches, and then engaging in hand-to-hand combat. But the pinpoint accuracy of the new rifled muskets changed all that. These allowed the defending forces to thin the ranks of the advancing infantry at a long range, killing and wounding many before they could reach the entrenchments. The failure of both the Union and Confederate commanders to realize this, combined with advances in artillery, produced the horrific number of casualties during the Civil War.

To make matters worse, medical knowledge in general and that of the wartime surgeons was extremely low. For one thing, doctors didnít understand infection and did little to prevent it. Antiseptics had yet to be used and doctors made no attempt to maintain sterility during surgery. They didnít have any antibiotics, so minor wounds could easily become infected, and therefore fatal.

Any soldier fighting in the Civil War and injured was at the mercy of poorly equipped surgeons. Surgeons generally let those with serious injuries in the torso die. But those shot in the arm or leg, had only one optionóamputation.

The tide of wounded seemed never-ending to the overworked surgeons who could afford to only spend a few minutes with each patient. For this reason, many chose amputation as the treatment of choice and became proficient at it. Often, they completed an amputation in ten minutes. The shear volume produced stacks of amputated limbs up to five feet high. Adding the lack of hygiene to this quick in and out work ethic, itís truly amazing that as many as 75 percent of the amputees did recover.

Todayís surgeons enjoy modern, sterilized operating rooms filled with all sorts of high-tech, specialized equipment and bright, efficient halogen lighting. The Civil War surgeon often had only a lantern, held over the patient, for lighting. Farms, school houses, homes, and churches became makeshift operating rooms while doors and kitchen tables often acted as operating tables.

Much of the time they used chloroform, applied to a cloth and held over the soldier's nose and mouth until the man was unconscious. But when that wasnít available, they made their patients drink whiskey to numb the pain. There was a lack of water, basic supplies, drugs, and most of allótime. The Battle of Gettysburg alone resulted in over 50,000 casualties in three days of savage fighting. No wonder many historians call this battlefield surgery butchery.

Most Civil War surgeons did the best job they could under the circumstances. And at least those in the Union Army worked with finely wrought instruments, contracted for by the War Department. Basically, the Union surgeon's kit consisted of two surgical saws, a curved probe, retractor, cutting pliers, clamps, brush, and trepanning instruments carried in a plush-lined wooden chest. Surgeons frequently practiced trepanning with an instrument called a trephine which drilled a circular hole into the skull to relieve pressure on the brain tissue in the case of a compression fracture of the skull or to remove a blood clot on the brain.

Confederate surgeons usually had to improvise. If they had a complete surgery kit, made for that purpose, fine, but many of them didnít. They used common household tools instead, not bothering to clean or sterilize them in any way. Pen knives became their scalpels, the bark of a tree, a tourniquet, and the juice of the green persimmon, a styptic. They even used common tableware to save a life in a pinch.

Medical antiques, and in particular surgical or amputation sets, are collectibles frequently associated with guns and war. As a result, it's not unusual to find antique medical instruments on a table at a gum show. Today, itís easier to find surgical sets on sites like eBay. However, collectors should do their homework before accepting any claims that a particular Civil War surgeon used a set of instruments. Surgery kits used by civilian surgeons at the time show little difference to those used by the military. Unfortunately, much of what people claim to be from the Civil War is of questionable provenance.

When trying to validate a surgical kit, the first thing to look at are the types of handles on the cutting instruments. Prior to 1870, surgeons usually just wiped the knife handle or saw blade on their apron to remove the blood. Before and during the Civil War, cutting instruments came with non-metallic handles made of ebonized wood, gutta percha (a form of latex from a Malaysian tree), ivory, horn, or wood. After 1870, with the widespread use of sterilization techniques, these porous materials couldnít stand up to chemical and heat treatments. So the makers of surgical instruments began to use metal to make their instrument handles.

Civil War surgery sets, made or used during the war, came in three typesóU.S. Army Medical Department, U.S. Army Hospital Department, and civilian. Military sets almost always had double sliding latches and no keys while civilian sets had a central key and no latches.

Military sets also had manufacturers marks. The major producers of these surgical sets were in Philadelphia and New York, at least those contracted by the Union Army. Dietrich W. Kolbe of Philadelphia, a maker of deluxe surgery sets, and George Tiemann Co. of New York, the leader in manufacturing high quality surgical instruments in the 19th century, were two of the major producers. Brass plates on the top of the case and engraving on the various instruments read U.S.A. Hosp. Dept., U.S. Medical Department, or some variation. However, surgeons on either side could have used any surgical set that existed in the United States prior to or during the Civil War.

The only authentic Civil War surgical instrument set is one marked and designed for military issue. Sets used by the Confederacy came from Northern American, English or European civilian makers. There are no sets marked as being issued by the Confederacy since it purchased sets wherever it could.

Values of surgical sets are largely determined by sizeóa larger set commands a higher price than a smaller setóas well as condition, rarity, completeness, provenance, and the desirability of the maker. Replacement parts or parts that don't exactly fit the custom slots in a surgical kit case will lower its value. Collectors should view a set with parts marked by various makers as suspicious.

A multilevel major surgery set, including a bullet forceps, staves for male urinary treatment, and extensive bone and amputation instruments, today sells for $5,000 to $6,000 at auction.

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